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July 03, 2009
Kyle Hardy, Community Editor CHICAGO – The Healthcare Information and Management Systems Society’s EHR Usability Task Force has released a white paper focusing on the level of usability in electronic medical records and their implementation at healthcare organizations.
“Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating” identifies usability of software in an EMR as “one of the major factors and possibly the most important factor hindering widespread adoption of EMRs.”
“Through our research, we found that usability as a requirement in the certification process could benefit product development for more usable EMR products and give users or decision-makers more confidence in selecting clinical EMR systems,” said Jeffery L. Belden, MD, associate professor of clinical medicine at the University of Missouri Health Care’s School of Medicine and chairman of the HIMSS EHR Usability Task Force.
Principles and methods are highlighted in the study as processes that offer benefits for organizations that certify technology. These procedures allow certifications organization “to test and rate products for usability.”
The study also looks at:
The HIMSS task force gives suggestions for rating the usability of an EMR through a five-step process, emphasizing that organizations start small with usability ratings, devise measurements and create a five-star rating system base on a standard. “With the American Recovery and Reinvestment Act as the catalyst for healthcare reform, this white paper provides an insightful review of usability for the EMR and its value in the certification process,” said Edna Boone, HIMSS’ senior director of healthcare information systems. “The task force will continue to study this important topic of usability and its benefits for successful EMR implementation.” Above article published on http://www.healthcareitnews.com/news/himss-white-paper-usability-critical-adoption-emrs Share your views and comments with OmniMD, a CCHIT & Surescripts® certified Electronic.
July 03, 2009
Filed Under (EMR, Electronic Medical Records) by admin
Chip Means, Web Editor CAMBRIDGE, MA – Economically healthy industries empower workers to make decisions, compensate based on productivity and use a lot of information technology. The healthcare industry doesn’t do any of this – yet.
Stimulus funds for IT could save the day and the economy, according to Harvard economics professor and Obama campaign advisor David Cutler, who spoke at the Tuesday afternoon session of the HIT Symposium at the Massachusetts Institute of Technology in Cambridge.
Every industry except healthcare has figured out how to become more efficient by replacing administrative work with information technology, he said. Nurses spend a third of their time documenting – a procedure Cutler said often involves printing digitized information and re-entering it into another IT system.
With the right IT systems and processes, he said, the business of healthcare could change to focus more on compensation and empowerment, making hospitals and practices more profitable.
Cutler said the promise of electronic medical records lies in three areas that can greatly improve the economic health of a hospital:
Simplified billing – The greatest potential for reducing administrative costs lies in eliminating the process of spending all day talking to insurers and drug companies. Electronic claims and e-prescribing can replace that process, he said. Decision support – “Meaningful use has almost certainly got to mean decision support in place to avoid mistakes,” Cutler said. “Mistakes alone cost us $100 billion a year.” Learning which treatments are effective – IT can provide organizational insight to demonstrate what is and isn’t working. Some physicians fear that if healthcare becomes too automated, the nation will have “cookie-cutter medicine,” said Cutler.
“What we know in every industry is that computerization is good for high-skilled people – it frees them up to use their expertise to do what they should be doing.” Doctors estimate 40 percent of their time is spent doing needless administrative work, he said. “If I cut your administrative task time in half, I’ve increased the time you have to see patients by 20 percent.”
Simply putting the systems in place isn’t enough. “Electronic medical records are the beginning, not the end,” said Cutler. “What has to happen is IT has to lead to a change in healthcare as big as it led to in other businesses. If it doesn’t, everything we do now will be a big failure.” Above article published on http://www.healthcareitnews.com/news/saving-healthcare-industry-emrs-are-beginning-not-end Share your views and comments with OmniMD, a CCHIT & Surescripts® certified Electronic.
July 02, 2009
By Joseph Conn Only 1.5% of nonfederal U.S. hospitals use a comprehensive electronic health record system, according to HHS-funded researchers in a report released by the New England Journal of Medicine and mirroring preliminary survey results released by the same researchers this past November.
Lead author Ashish Jha, an associate professor at the Harvard School of Public Health and a staff physician at staff physician at Veterans Affairs and Brigham and Women’s hospitals in Boston, said in a news conference that just 7.6% of hospitals had a “basic” EHR that included the capability to record and store physician and nursing notes. The survey found that 10.9% of hospitals had a basic system without those clinical note-keeping functions.
“Very few hospitals in America have a comprehensive electronic health record,” Jha said. In addition, Jha said, “We didn’t get into effective use of these technologies. And we don’t have information right now with the notion of sharing data with other providers. Just because they have these systems doesn’t mean they are sharing that information with other doctors or hospitals down the street.”
That said, not all was gloom and doom. For one thing, if data from the VA hospitals, which were gathered but excluded from the final survey totals, were added back in, the comprehensive EHR adoption numbers would nearly double to 2.9% and the national numbers for the basic adoption rates would be driven up as well.
“All VA hospitals now have adoption of comprehensive medical records,” said Jha, who is serving as VA advisor. “There are as many VA hospitals with comprehensive medical records as there are non-VA hospitals (with those systems) if you look at it numerically.”
Also, he said, “There is no suggestion here that 90% of hospitals don’t have a computer in the hospital,” Jha said. In fact, some component parts of an EHR are in widespread use. For example, the survey found that 75% of hospitals surveyed reported having electronic lab and radiology systems.
What hospitals don’t have is “a constellation of functionalities” that help doctors and nurses provide the best care possible, Jha said, but the relatively high levels of adoption of some components “suggests we have a good place to start.”
Information about the study was under embargo until Wednesday, but its authors and other healthcare luminaries were available to reporters via a telephone conference Tuesday. One of those was David Blumenthal, the physician founder of the Institute for Health Policy, who spoke briefly about the research report and an article he had written for the New England Journal of Medicine on the federal role for health IT promotion.
Last week, Blumenthal was named as President Barack Obama’s choice to be the national coordinator for health information technology. Blumenthal said he will take over the post in mid-May.
Speaking of the impact the American Recovery and Reinvestment Act of 2009 would have on healthcare information technology, Blumenthal said that for physicians, “This whole project was conceived by the Congress as a building block as a pillar of healthcare reform.”
“One of the key elements is to support behavior change,” he said. “IT is one important and ultimately critical way to do that. I think it would be wrong to see it as a technology that can be adopted on its own, but as a technology to support that.” The study and Blumenthal’s article are scheduled to appear Thursday in the journal’s online edition. Above article published on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID= Share your views and comments with OmniMD, a CCHIT & Surescripts® certified Electronic.
July 01, 2009
By Joseph Conn / HITS staff writer On balance, it would appear that members of the open-source healthcare software community are satisfied with the proposed changes in the way electronic health records systems will be tested and certified by the federally supported Certification Commission for Healthcare Information Technology. Earlier this month, CCHIT announced it was adding two new testing and certification regimes to meet what CCHIT Chairman Mark Leavitt called an anticipated “stampede” toward EHR adoption, triggered by an estimated $34 billion in Medicare and Medicaid subsidy payments under the American Recovery and Reinvestment Act of 2009. In both new schemes, CCHIT said it would test and certify that EHR systems effectively meet the “meaningful use” standards now under development by HHS instead of just CCHIT’s own long list of discrete EHR functions used exclusively in the three previous rounds of CCHIT testing up to this point. The stimulus law requires providers to not only use “certified” EHR systems, but also to use them in a “meaningful manner.” The CMS, which will oversee the official rulemaking process for HHS in determining “meaningful use,” is expected to have an initial set of standards ready for publication early next year. The changes to the certification process also seem to align with requests made of CCHIT by open-source advocates to make its testing and certification process more amenable to the peculiarities of open source development, according to four open-source mavens contacted for this story. “It was surprising to us,” said Fred Trotter, a programmer, blogger and co-founder of the Liberty Medical Software Foundation, Houston, a recently formed not-for-profit organization seeking to promote what Trotter describes as free and open-source software (FOSS) in the U.S. healthcare IT market. “I’m happy and everybody in the community is happy, too.” And in a recent e-mail to community members, Trotter said, “I am personally endorsing the new CCHIT certification programs for certification for ARRA funding.” That happy state of affairs reflects a sea change for Trotter, who as recently as March, in an e-mail to open-source community members, wrote: “The largest single threat to the future of FOSS in healthcare in the U.S. is the certification process mandated by the stimulus act,” adding that “CCHIT has had an anti-open source stance for years.” Open-source advocates indicated their focus would be on the two new testing regimes directly linked to the meaningful-use criteria. Trotter and others said the new programs will afford the open-source community, as well as vendors of proprietary software and end users, more flexibility. They also expressed satisfaction that CCHIT had addressed open-source issues as quickly as it has. One prominent wellspring of open-source clinical IT system software is the Veterans Affairs Department. Copies of the VA’s Veterans Health Information Systems and Technology Architecture, or VistA software system, often called FOIA VistA because of its availability under the Freedom of Information Act, are available to the public without charge. Technically, the VistA system is referred to as public domain software, although the bulk of the VistA code was developed by programmers operating within the VA in a fashion that was similar to the development model of open-source used to produce the popular Linux operating system and Apache Web server software, according to VistA cognoscenti. A VistA cousin, the Resource and Patient Management System, or RPMS, developed by the Indian Health Service, also available under FOIA, is starting to find some traction outside the IHS with public health clinics. Physician Edmund Billings is the chief medical officer and executive vice president of Medsphere Systems, Carlsbad, Calif., the developer of OpenVistA, a commercial version of the VistA clinical IT system used by the Veterans Affairs healthcare system. Medsphere also owns the intellectual property rights to the VueCentric graphical user interface of RPMS. Medsphere is “in the process” of seeking certification for its version of VistA and RPMS, he said. Billings also said he sees the changes at CCHIT as positive developments, but was holding back on a full endorsement. “I’m pleasantly surprised,” he said. “I think the way CCHIT handled this was graceful and thoughtful and responsive to the industry. It hit me that they were listening. It opened the door. We are happy with the modular option.” Still, he said, “I think the devil will be in the details.” Although Medsphere’s VistA derivative is not yet CCHIT-certified, according to Billings, “The go forward for Medsphere is to be a certified EHR technology as to the stimulus bill. Our clients are going to want to get paid for meaningful use and part of our service is to get them certified for meaningful use.” In addition, Billings said it makes sense, from the government’s point of view, to have a certification system linked to what the government is paying for, i.e., meaningful use. Mike Ginsburg is marketing manager for Document Storage Systems, Juno, Fla., developer of vxVistA, also a commercial VistA derivative. DSS received CCHIT certification for vxVistA in 2007. Ginsburg, too, said, “Generally, we were happy that CCHIT was paying attention to the open-source community,” but added that he, too, will withhold final judgment until the details of the program are made known. “We’ll see what the specifics are,” he said. “Whatever we have to do to allow our customers to be eligible for ARRA money, that’s what we’ll do.” Joseph Dal Molin is a Toronto-based IT consultant on the board of directors of WorldVistA, a not-for-profit organization that developed WorldVistA EHR VOE, an open-source variant of the VA’s system that also received CCHIT certification in 2007. Dal Molin is currently working in Amman, Jordan, as a consultant with Electronic Health Solutions, a not-for-profit corporation set up by the Jordanian health system, which is installing WorldVistA at a government-run hospital and outpatient clinic. Perot Systems was hired as the lead integrator on the pilot project. Cost, not complexity, was the biggest problem the WorldVistA community had with CCHIT under its initial testing and certification model, Dal Molin said. WorldVistA’s EHR was CCHIT-certified in April 2007 to the then-current 2006 criteria, a certification that’s good through April 2010. It cost the organization $38,000 for initial testing and around $4,800 per year to continue to use the CCHIT seal in WorldVistA advertising, Dal Molin said. That adds up to nearly $50,000 for the three-year life of the certification, a lot of money for a small, not-for-profit organization, Dal Molin said. “Having gone through the comprehensive model, I think it’s doable,” Dal Molin said. “For the open-source community, all they need to do is drop the costs, because you really are gambling. We felt we would be investing all of WorldVista’s savings and not being assured of getting anything back.” On the one hand, that comprehensive model might seem stringent, but on the other hand, Dal Molin argued against dumbing down the proposed new meaningful-use certification criteria too much. “We’re thankful that CCHIT is listening to making certification more accessible to others and so on, but ultimately, certification has to serve clinical improvement, not giving people and easy pass to going after ARRA money. That would be, ultimately, a mistake,” he said. While open-source software has captured only a tiny fraction of the healthcare IT market thus far, there is plenty of room for growth. Meanwhile, Congress, HHS, and a handful of commercial vendors and consultants are raising the open-source profile. This week, HHS is hosting a two-day conference in Washington, D.C., on its CONNECT project, an open-source software interface the government developed to link federal healthcare IT systems to the proposed National Health Information Network. Above article published on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090629 Share your views and comments with OmniMD, a CCHIT & Surescripts® certified Electronic.
June 30, 2009
FISMA is becoming a roadblock for electronic health record implementation, Government Health IT magazine reported this week. The Federal Information and Security Management Act (FISMA), passed by Congress in 2002 to better protect the federal government against cyber attacks, mandates information security standards for all federal agencies. This includes the flow of data between the Centers for Medicare and Medicaid (CMS) and their contractors—over 200 hundred of them, processing billions of Medicare claims. The new worry from CMS, according to Government Health IT, is that healthcare providers sharing EHR files will be required to meet FISMA standards, which include an annual security test and FISMA certification. A CMS spokesperson is quoted as saying that this would be more than “burdensome” for both CMS and health care providers and organizations. The conundrum is that information will be moving between the HIPPA world (the private sector) and the FISMA world (the government)—that latter of which is much more secure, from a protocol/standards perspective. Federal agencies are held to a higher standard than the private sector with respect to information security. For a long time, consumer groups have argued that HIPPA is a weak standard for patient information security. Yet, many worry that if FISMA is applied to the private sector, there will be a compliance crisis that will be costly to remedy. But why shouldn’t the transfer of health information be held to the highest security standards? Advocates of a middle ground argue “yes,” but not quite as stringent as FISMA. They standards should be more of a more of a “HIPPA-plus” or “FISMA-lite,” in the words of Vish Sankaran, a program director for the Federal Health Architecture project to connect health information entities. In other words, get health care providers better engaged in securing healthcare information but do not stunt the growth of the EHR movement by placing the bar too high. In the end, the Office of Management and Budget will dictate the debate through their determination of what falls under the FISMA umbrella. In August of 2008, OMB issued some guidance, stating that FISMA applies to groups that “possess or use Federal information—or which operate, use or have access to Federal information systems (whether automated or manual)—on behalf of a Federal agency.” OK, that could include a ton of organizations. Confusing? You bet. This is government language after, all. Much like statistics, just mold it to your current need. There is still debate over whether, for example, health information exchanges (HIEs) that “exchange” information but do not “access” federal information systems need to be FISMA compliant. In any event, there is a strong and important need to address information security in the field of healthcare. Will FISMA be the best vehicle for achieving information security with respect to patient information? That remains unresolved, but hopefully, the work to find a middle ground, coaxing the private sector into requiring more robust security standards, will be the outcome. Above article published on http://ohmygov.com/blogs/general_news/archive/2009/06/30/fisma-a-roadblock-for-ehrs.aspx Share your views and comments with OmniMD, a CCHIT & Surescripts® certified Electronic.
June 30, 2009
Filed Under (EHR, Electronic Medical Records) by admin
Maryland further strengthened the goals of the stimulus package or the American Reinvestment and Recovery Act (ARRA) this past week by passing legislation that required insurers to provide “monetary” incentives for physicians to adopt electronic health records (EHR). The bill, signed by Governor Martin O’Malley, is one of the first of its kind to give sharper teeth to the EHR movement. Insurers may choose from a variety of fiscal incentives including increased reimbursement and lump-sum payments, according to Health IT News. The effort is viewed as a double incentive to providers to join the digital transition that promises to increase health care system efficiency while reducing medical errors for patients. Maryland is not alone in its effort to promote the change from paper to portal; other states are reviewing similar measures that would jumpstart implementation. Included in the Maryland bill is a requirement for the state to bring a piloted health information exchange (HIE) live by October 1. The goal of the HIE, often comprised of business and community representatives, is to provide support to health care system stakeholders with the goal of increasing efficiency and quality. Wait, have we heard of an HIE before? Yes. For clarification purposes, regional health information organizations (RHIO) and HIEs are terms used interchangeably; the HIE is simply a new name for a RHIO—it has yet to be determined if it is also a newer and better RHIO. Lingo aside, HIE investment is up. Other states are looking to HIEs/RHIOs to play a prominent role in EHR adoption. New York, Texas, and Florida are all investing in these information exchanges. In New York, the Western New York Clinical Information Exchange, known as HealthElink, signed on 6 EHR software vendors to provide community pricing to its clients. In Texas, the legislature passed two pilot health information exchange programs that promote data transfer between local agencies. Florida, having received a $9+ million grant from the Federal Communication Commission (FCC), is exploring how to expand broadband access across nine rural hospitals to increase the speed and efficiency of health data transfer. Other states are vying to develop strategies for technology adoption that support EHR implementation as stimulus dollars dangle overhead. Now that EHRs are heavily banked by both federal and state government, HIEs and RHIOs may take a greater role in aiding communities in EHR adoption. These exchanges hope to serve as important providers of data warehousing as well as offering leadership for the development of criteria for data sharing and data quality. States view HIEs/RHIOs as vehicles for transporting dollars toward the development of technology infrastructure and they are moving as quickly as possible to get their take. Above article published on http://ohmygov.com/blogs/general_news/archive/2009/06/ Share your views and comments with OmniMD, a CCHIT & Surescripts® certified Electronic.
June 30, 2009
Filed Under (EHR, Electronic Medical Records) by admin
Show me the technology! That is the conclusion of a study from the Beth Israel Deaconess Medical Center (BIDMC) to be released in the Journal of General Internal Medicine (JGIM) in June. The study reveals that consumers who are defined as “internet-savvy” are ready to take a chance on electronic health records (EHR) despite warnings of potential privacy risks. The study, supported by the Robert Wood Johnson Foundation (RWJF), investigated whether or not patients were comfortable making the leap with their health care providers to the digital age through the adoption of EHRs. In the tech-savvy cities where they held focus groups, the answer was a resounding ‘yes.’ Not a terrible surprise given that they investigated consumers in Boston, Portland, Tampa and Denver—some of the more tech-educated spots in the country. However, investigators did attempt to include a diverse group of people, drawn from both urban and rural areas. Additionally, they included health professionals in their study to compare their perspectives about health technology relative to consumers. The findings should not come as a major surprise since an estimated 60 percent of households across all states have a home internet connection. Citizens are increasingly interested in managing their lives via computer—EHRs seems a natural progression in this evolution. Yet, the study findings echo a sense of surprise at the willingness of consumers to give up some of their privacy in order to obtain greater transparency with respect to their health information. In actuality, it may be more of a reflection of the distrust and frustration with the current patient-physician/health care provider relationship where one may deem transparency of much greater importance than whether or not someone uncovers that they have kidney stones… Above article published on http://ohmygov.com/blogs/general_news/archive/2009/05/ Share your views and comments with OmniMD, a CCHIT & Surescripts® certified Electronic.
June 30, 2009
Filed Under (EHR, Electronic Medical Records) by admin
HDM Breaking News, The federal government should extend the transition to a fully functional electronic health records system beyond 2015, according to the American Hospital Association. The AHA has sent a comment letter on the initial proposal of a workgroup of the HIT Policy Committee to define meaningful use of electronic health records to David Blumenthal, national coordinator for health information technology. “Our members believe that the functional abilities of the EHR that would result from implementation of the draft definition are correct, but that the proposed sequence for adoption is overly aggressive and unrealistic for most,” according to the AHA. “Increasing the requirements for being considered a meaningful user every two years should provide enough time for adoption, but only if the initial requirements are set at an achievable level. The AHA encourages the committee, ONC and the Centers for Medicare and Medicaid Services to develop a ‘meaningful use’ adoption timeline that begins with fewer functional requirements and extends the transition to a fully functional EHR beyond 2015.” Computerized physician order entry, for instance, should not be required until after 2015 or beyond, the AHA contended in the comment letter. “Most hospitals are not prepared to make such significant advancements under the proposed implementation timeline, so rushing to adopt could compromise patient safety and the success of this effort,” the letter states. “Our members, including those with significant previous HIT investments and CPOE, consider a 2011 CPOE requirement to be unrealistic.” The AHA calls for the definition of meaningful use in 2011 to focus on getting the majority of hospitals running with a basic EHR. Appropriate functions for 2011 should include clinical documentation of patient demographics, problem lists, medication lists, discharge summaries, and results viewing for lab reports, radiology reports and diagnostic tests, the AHA advises. The association, mirroring comments of the American Medical Association and some 80 other physician organizations in a separate comment letter, also noted that providers must work during the same time period to migrate to the HIPAA 5010 transaction sets and ICD-10 code sets. Above article published on http://www.healthdatamanagement.com/news/meaningful_use-38560-1.html Share your views and comments with OmniMD, a CCHIT & Surescripts® certified Electronic.
June 29, 2009
Filed Under (EHR) by admin
By Andis Robeznieks / HITS staff writer Policies on security breaches, open source code, and government subsidies of electronic health-record systems have been adopted by the American Medical Association’s House of Delegates. The policies concern physicians’ responsibilities in case of computer security breaches and support of electronic health-record systems based on open-source code. Another policy calls for the removal of penalties that are scheduled to affect physicians who are not using electronic prescribing by 2015, and another says that the AMA wants government subsidies for the implementation and maintenance of EHR systems to be adjusted for inflation. AMA policy now dictates that, in response to a security breach, physicians are to place the interest of patients above those of themselves, their practice or institution. On open-source, delegates approved a resolution calling for the AMA to support law and public policy that makes open source EHR systems that meet certification and “meaningful use” requirements available to physicians at nominal cost. The Florida delegation had introduced a resolution that would declare federal EHR incentive programs to be “noncompliant with AMA principles” and essentially a pay-for-performance program. After hearing testimony on June 14, a committee drafted a substitute resolution that stated federal programs should be made compliant with AMA principles by removing penalties for nonadoption. “Resolved, that our AMA support the concept of electronic prescribing, as well as the offering of financial and other incentives for its adoption,” read the new resolution that was approved by delegates, “but strongly discourage a funding structure that financially penalizes physicians that have not adopted such technology.” Above article published on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/ Share your views and comments with OmniMD, a CCHIT & Surescripts® certified Electronic
June 25, 2009
Filed Under (EHR) by admin
By Steven Kraus, DC, DIBCN, CCSP, FASA This spring, I traveled extensively to Washington, D.C., for a variety of reasons, mainly to advocate on behalf of chiropractic physicians as our government initiates massive health care reform efforts. I attended the HL-7 Conference, which is an invitation-only gathering of health care officials dedicated to setting the programming standards for health information exchanges (HIEs) and standards for required data for electronic health records (EHRs). The conference, sponsored by the Agency for Healthcare Research and Quality, has historically been limited to hospital and allopathic audiences. This year’s group was expanded for the first time to include other health care experts, and I was the designee from the chiropractic profession. My goal and commitment to the profession remains clear: I want to ensure that the interests of chiropractic physicians are considered in any and all discussions related to policy-making for health care information technology. And in the case of HL-7, chiropractic participation is critical so the concerns of our profession with regard to the development of HIEs will be heard. The catalyst for broadening this conference audience was presumably the economic stimulus package, formally known as the American Recovery and Reinvestment Act (ARRA) of 2009, which includes more than $19 billion to fund the introduction of electronic health records in every physician office in America. The section of the ARRA that deals specifically with this appropriation is the HITECH Act, which outlines the requirements for funding eligibility. To be qualified for incentive payments offered through the legislation, doctors must adopt qualified EHRs that have the functionality to communicate with HIEs, making the standards by which HIEs are governed extremely important and elevating the prominence of interfacing capabilities with other systems. I’ll discuss more about the requirements for incentive payments later in this article, but the main reason I share my involvement with the creation of health care information technology standards is to demonstrate how the general health care industry is finally opening its arms to the chiropractic profession. We’ve been dancing on the periphery for years, but finally, we are gaining recognition as an essential component of health care delivery and actively participating in these important discussions regarding policy, standards and reform. Reform = Collaboration + Technology Speaking of reform, during that same visit to D.C., I also met with Sen. Tom Harkin’s staffers as well as government relations personnel from the American Chiropractic Association to discuss the evolving model of reform for our health care system. As I shared in a previous column, elements of several models are under consideration including the Medical Home Model, which relies heavily on collaboration among health care professionals in order to improve the quality of patient care. Harkin and several of his colleagues are outlining a comprehensive national health care reform plan we can expect to be introduced later this year. The cornerstone of that plan will be collaboration, and the framework to support collaboration will be driven by technology. While many uncertainties still remain, these two elements are certain. And with collaboration at the forefront, Harkin and others understand that chiropractic physicians and other nonmedical providers are an integral element of national reform. The reform movement is committed to supporting true wellness, something doctors of chiropractic have been preaching for years. Now it’s time for us to rise to the occasion and continue walking our talk, while we have people watching us and listening. The first step in walking the talk is adopting EHRs. Why? Because technology will create the path to collaboration by assisting case management through registries, database queries, instant access to information, alerts and reminders, and all the related tools the digital age provides us. We need technology to form the health care teams that will improve patient care for every American. With the anticipated health care reform model so heavily reliant on technology, those who do not adopt an EHR will be left out of the health care framework. In fact, the government is emphasizing the critical role an EHR will play in successful reform so heavily that it is funding the digital transition in its entirety. In order to adapt to the new model of health care, we must adopt an EHR. Since the government will pay for our EHR (up to $44,000 for each physician), we’re simply being asked to fund the energy and effort to implement it. Seems like more than a fair deal to me. How to Access Your $44,000 Incentive As I mentioned earlier, the process to fund your EHR is structured through incentive payments to physicians who adopt such systems. Not all health care professionals will be eligible for incentive payments, but doctors of chiropractic are an approved group, as they are covered by the Social Security code defining physicians, which the ARRA is using as its definition. Two major areas will be evaluated by our government when determining payment approvals. First, the EHR system must be qualified, and second, the system must be used meaningfully by the chiropractic physician. A qualified EHR system must have the capacity to handle patient demographics and clinical health information, and also must have clinic management capabilities, as outlined by the entity that certifies qualified EHR. Only a certified EHR system will be eligible. The certifying body has not yet been announced, but the industry anticipates that the Certification Commission for Healthcare Information Technology (CCHIT) will be the likely choice since it was approved in 2006 by the government’s Office of the National Coordinator of Health Care Information Technology and Medicare to manage such efforts. The second requirement, “meaningful use,” is determined by three important measures: (1) connectivity to health information exchanges and other EHR systems so they can share information when authorized by the patient; (2) regular reporting of quality measures to the Centers for Medicare & Medicaid Services (CMS), including capturing outcome assessments and performance of pain assessments; and (3) e-prescribing capability. Because we don’t have prescribing privileges, it is unknown at this time whether this will remain a requirement for doctors of chiropractic. With regard to reporting requirements, the general structure of the plan suggests that reporting of quality measures will likely be managed by the PQRI (Physicians’ Quality Reporting Initiative), a standardized mechanism that already exists. As much as $44,000 can be paid as an incentive to a doctor for investing in a qualified EHR system. And in clinics with multiple physicians, each physician can qualify for the incentives, as long as the aforementioned terms are met. And while we know that CMS will be involved, its specific role is still being evaluated with regard to reporting and eligibility requirements for doctors participating in the incentive program. For example, minimum billing thresholds such as an annual $25,000 in covered services to CMS are being considered in order to be eligible for the incentive payments. However, there is some discussion on consideration for proportionate payments if the threshold is not met. So, if you average 16 Medicare patient visits a week, you would likely qualify. I will follow-up on this issue in a future article once the policies and standards relating to the Department of Health and Human Services and Medicare have been formally released. To access the full $44,000, which is paid through Medicare in stages (four annual installments starting in 2011), the EHR system has to be qualified and used in a meaningful way starting in 2010. To clarify the timing, it is necessary to explain PQRI’s influence on the process. PQRI, which is expected to oversee reporting requirements, currently requires reporting on at least 80 percent of patients. To accommodate this requirement, the EHR system would need to be in use for the majority of the year prior to the first incentive payment, assuming adherence to PQRI standards will be required. Hence, EHR implementation in 2010 is necessary in order to receive an $18,000 first payment in 2011 and maximize the incentives available. For new users, implementation of an EHR system typically requires 90 days to six months. Given the expectation that meaningful use will be necessary for the better part of 2010 in order to get a 2011 incentive payment, the implementation process for chiropractic physicians should begin promptly in 2009. Those who had the vision to implement a qualified EHR and can demonstrate meaningful use are already eligible for the full incentive payments. Penalties for Not Transitioning to EHR
The Evolving Health Care Landscape: Technology Front and Center Those who choose not to transition to an EHR system will be penalized beginning 2015 and continuing through 2018. These penalties will be assessed through a reduction in your Medicare claims reimbursement on services billed. To further motivate adoption, some states have already passed laws that mandate EHR use after 2014 in order to attain a license to practice or to renew a license, concurrent with the stimulus plan. With financial and legal ramifications in play, the incentives to adopt an EHR now are enormous. The Reform Cube Given the benefits the government is providing chiropractic physicians, it is a wonder that any of us are still waiting to implement EHR. If the financial incentives are not enough motivation, doctors of chiropractic must consider what role they will play in the health care reform cube. Our health care landscape will soon shift to a different model; consider a cube in which quality, cost, and delivery of care through collaboration and access exist at each point, while technology sits squarely in the middle. Technology improves quality by offering reminders, alerts and other assistive techniques; technology lowers costs by reducing duplication of services; and technology improves collaboration and access by providing a mechanism to share patient health information across all providers. All of this allows for a robust clinic management system.
As chiropractic physicians, we strive to improve quality, we seek to reduce costs, and we crave the opportunity to collaborate on the health care team, so the cube is the ideal home for us. When we adopt the proper technology, we gain not only substantial financial support, but also membership in the cube. And isn’t membership what we’ve been asking for from the health care community all these years? This membership is not for the sake of privilege, but for the sake of having other providers refer patients to receive the benefit of chiropractic care, achieve wellness, and experience cost-effective and efficacious care naturally. Accept the invitation now - it won’t be offered again. Above article published on http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53922 Share your views and comments with OmniMD, a CCHIT & Surescripts® certified Electronic Medical Records Solution Providers. |
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