Blumenthal: Patient Care, Not Tech, Will Drive Meaningful Use

National health IT coordinator Dr. David Blumenthal dropped a big hint about upcoming criteria for giving out e-health records grants. He advised healthcare IT managers to focus on “goals of care” rather than technology.

Blumenthal works for the U.S. Department of Health and Human Services, which is responsible for giving out grant money to reimburse healthcare providers for implementing electronic medical records. The U.S. American Recovery and Reinvestment Act of 2009 (ARRA), which set aside the money, specified that the funding will go to “meaningful use” of EMRs, but did not specify a definition for the phrase. HHS plans to release a preliminary definition of meaningful use next month. But Blumenthal dropped a hint at an address at the Medical Informatics Association’s annual symposium. He “gave attendees what they wanted to hear by reiterating his philosophy that technology simply is an enabler of quality improvement, not a panacea for healthcare,” according to FierceEMR.

“The meaningful use framework will be about the goals of care, not the technology,” Blumenthal said. While he didn’t elaborate on that statement, he did state the position of the Obama administration–one largely held by the informatics community, if not the broader healthcare industry–that the billions of dollars in federal subsidies aren’t simply meant to buy EMRs for providers. “It’s not the money that will turn out to be the most important,” Blumenthal said.

Instead, the net $19 billion investment is a way to demonstrate that EMRs should and will be accepted in the fairly near future as “symbolic of professionalism in medicine,” just as much as the stethoscope or examination table are today. “The idea that government should subsidize health IT will be as foreign an idea that the government should buy stethoscopes or exam tables for doctors,” Blumenthal explained.

“Information is really the lifeblood of medicine,” Blumenthal added. “Health information technology is its circulatory system.”

Final standards for meaningful use will be released in the spring, after a period of public comment on the first effort to be released by the end of the year, according to a ModernHealthcare.com write-up of Blumenthal’s address.

Blumenthal stressed that health IT must be focused on the goal of making the healthcare system work better for patients and providers.

“It’s not the technology that’s important, but its effect,” Blumenthal said. “That’s the purpose of the stimulus bill.”….

While Blumenthal declined to give a specific definition of meaningful use, he offered some hints. People working in health IT should think about EHRs “not as a technology project, but as a change-management project,” he said. Components of meaningful use include sociology, psychology, behavior change and the “mobilization of levers to change complex systems and improve their performance,” he added.

Through the stimulus law, Congress mandated that meaningful use become more focused over time, with yearly benchmarks. There has been a “lively discussion” in the Obama administration of that timetable in the proposed rulemaking of meaningful use, Blumenthal said.

Privacy and security will be essential, he said.

HHS plans to announce the first round of recipients of two major rounds of grants soon, Blumenthal said. The first, for $700 million, will establish up to 70 health IT regional extension centers nationwide to help healthcare providers become meaningful users of EHRs. The second program offers $560 million in grants to states to develop health information exchanges linking providers.

HHS also plans programs to increase the supply of trained health IT workers.

“The skills needed are not necessarily what our teenage children have,” Blumenthal said, which brought laughter from the crowd.

Specifically, the nation needs professionals who understand meaningful use and improved processes of care, the ability to redesign workplaces to integrate the new technology and to help providers use the technology to its full potential, he said.

“The training needed is well beyond the installation of information technology,” he said.

Blumenthal expressed great confidence that health IT can be a foundation for fundamental change in the healthcare system.

“I believe it will be a short time before EHRs are as common in medicine as the stethoscope, the cardiogram, the MRI and other core tools,” he said. “I think we’re already moving in that direction.”

Iowa gets $1.6 in ARRA funds for EHR planning

Iowa’s Medicaid program is the first to receive matching federal funds to plan for the implementation of an EHRs incentive program as established by the American Recovery and Reinvestment Act of 2009 (ARRA).

According to the Centers for Medicare & Medicaid Services (CMS), Iowa will receive $1.6 million in matching funds.

“While Iowa is the first state to receive approval of its plan for implementing the Recovery Act’s EHR incentive program, a number of other states have submitted plans as well,” said Cindy Mann, director of the Center for Medicaid and State Operations at CMS.

Iowa will, according to CMS, use the funds for planning activities such as conducting an analysis to determine the status of health IT in the state, including barriers to EHR implementation, eligibility for EHR incentive payments and the creation of a state Medicaid health information technology plan.

Electronic Health Record – Meaningful use rule ‘on target’ for end of year

The Centers for Medicare and Medicaid Services is still on target to publish by the end of the year a proposed rule on the meaningful use of electronic health records, despite growing fears from industry about the possible impact of the regulation.

Tony Trenkle, director of the Office of e-Health Standards and Services at CMS, said he had been spending a lot of time with health industry folks who have expressed “concerns and fears” about what will be in the regulation.

Those include how high the bar will be set for meeting meaningful use targets during the first year of implementation, and whether the industry will be able to meet them, he told a meeting today of National Committee on Vital and Health Statistics (NCVHS).

Other concerns include whether hospitals outpatient clinics would be eligible to receive separate payments, whether quality measures will disadvantage specialty health providers, and worries particularly by the states about whether CMS would be able to harmonize Medicare and Medicaid requirements.

Under the HITECH Act, a part of the American Recovery and Reinvestment Act, health care providers can receive payments from both the Medicare and Medicaid programs if they can demonstrate meaningful use of certified EHRs. Payments are due to begin in 2011.

One of the major outcomes of the Nov. 19-20 NCVHS meeting is expected be a letter setting out recommendations to the Secretary of the Health and Human Services for measures that can be applied to decide on just what meaningful use is.

They include commissioning a “fast track” study from the Institute of Medicine on a national strategy for quality measurement development, to begin a process to identify essential data elements, to require EHR vendors to use defined quality data elements, and to require that any certified EHR be able to add data elements that may be defined in the future.

Iowa to receive grant money for EHR implementation

Iowa has become the first state in the nation to have its Medicaid program chosen to receive funds from the American Recovery and Reinvestment Act of 2009 to assess implementation of electronic health records and personal health records.

Iowa’s Medicaid program will receive a grant of $1.16 million in federal matching funds through the CMS, which is awarding grants to states to assess EHR readiness and awareness among their Medicaid providers. The money will go toward activities to plan for the adoption of EHRs, including efforts to promote interoperability and “meaningful use” of the records and identifying barriers to adoption. The stimulus law provides 90% of the funds needed to administer the grants to providers, including auditing.

The grant funding will also go toward assessing expectations for PHR technology. Unlike EHRs, which are maintained by providers, PHRs are managed directly by the consumer.

“While Iowa is the first state to receive approval of its plan for implementing the recovery act’s EHR incentive program, a number of other states have submitted plans as well,” said Cindy Mann, director of the CMS’ Center for Medicaid and State Operations, in a news release.

Social Security budgets $24M to exchange health data with hospitals, HIEs

The Social Security Administration has set aside $24 million to expand a program under which it contracts with hospitals and health information exchanges willing to electronically share electronic health data on patients seeking disability benefits.

Each year, SSA makes more than 15 million patient-authorized requests for medical information from treating providers, but most of this exchange is paper based and as such is very inefficient, SSA officials say. They’re hoping the use of health IT will greatly improve the process.

SSA is looking for a provider willing to link to the agency via local HIEs and the Nationwide Health Information Network. Contracts for the project, proposals for which are due Sept. 18, will be funded through the stimulus law.

Using the NHIN, providers will get a standardized electronic request for medical records along with a patient’s authorization. Providers will then be able to automatically respond to SSA requests with a standardized Continuity of Care Document.

To be eligible for the project, providers must use a certified electronic health record app and be able to demonstrate the technical ability to create a sample Continuity of Care Document with de-identified EMR information.

E-prescribing 'could cut cost of human negligence'

Electronic prescribing systems that reduce the possibility of human error could cut clinical negligence claims by more than 70 per cent, according to US hospital chain Banner Health.

The company, which has worked with national IT programme supplier Cerner to evaluate the impact of its electronic prescribing system, said systems that reduced the possibility of human errors such as illegible handwriting or misrecorded doses had led to a 72 per cent reduction in the cost of clinical negligence claims at one of the group’s hospitals.

The National Patient Safety Agency has estimated that 9 per cent of patient safety incidents relate to medication errors, which together constitute some 20 per cent of all clinical negligence claims against the NHS.

In 2007-08, the NHS Litigation Authority paid out approximately £64m in damages for cases involving misprescribing.

Banner Health’s system director for care transformation Judy Van Norman told HSJ: “Some clinical leadership in the hospitals are interested and enthused about being involved but the resources at the individual hospital level to really lead the adoption of this is a frustration.”

Health IT execs meet to boost e-prescribing

Health and Human Services Department officials looked to spark the adoption of e-prescribing at a conference this week attended by some 1,400 health care professionals and industry representatives.

The meeting, held in Boston and sponsored by the Centers of Medicare and Medicaid Services, was put together in six weeks in preparation for the planned launch of the federal e-prescribing incentive program, set for January. Incentive payments for physicians who institute e-prescribing will initially be set at 2 percent.

We need to raise awareness in plenty of time to be ready for Jan. 1 said Kerry Weems, acting CMS administrator. We have a very short period of time to begin and end the education process.

The next milestone in the adoption push will come in November, when CMS plans to publish its final rule regarding incentive payments to providers. That rule will lay out definitive guidelines on what constitutes complete and successful e-prescribing, Weems explained. He said CMS continues to formulate that guidance and will use the conference to obtain feedback as it prepares the final rule.

Barry Straube, CMS chief medical officer, said the rule for qualifying for bonus payments is potentially reachable by many physicians’ offices.  He said the likelihood of qualifying is quite high for those offices obtaining an e-prescribing system.

HHS officials said they believe the bonus payments will provide the financial driver to accelerate adoption. There is a lot of money on the table here, said HHS Secretary Mike Leavitt.

Leavitt cited a $1 billion estimate as the dollar value of prescriptions that fall under the Medicare incentive.

Some physicians, however, remain skeptical of e-prescribing. Questioners during a conference session brought up the cost of adoption and the need for tort reform as issues affecting e-prescribing adoption.

Some anecdotal evidence, however, points to increased adoption.

Randy Boldyga, president and chief executive officer of RxNT, an e-prescribing vendor in Annapolis, Md., said 50 doctors implemented his company’s solution during one recent week, about double the usual number of installations. He said the Medicare incentives are playing a role in the increased activity.