Key step in national initiative toward adoption of electronic health records

The Certification Commission for Health Information Technology (CCHIT), Chicago, Ill. and the Drummond Group Inc. (DGI), Austin, Texas, were named today by the Office of the National Coordinator for Health Information Technology (ONC) as the first technology review bodies that have been authorized to test and certify electronic health record (EHR) systems for compliance with the standards and certification criteria that were issued by the U.S. Department of Health and Human Services earlier this year.

Announcement of these ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) means that EHR vendors can now begin to have their products certified as meeting criteria to support meaningful use, a key step in the national initiative to encourage adoption and effective use of EHRs by America’s health care providers.

“Less than two months following the issuance of final meaningful use rules, we have approved our initial ONC-ATCB certifiers.  EHR vendors can begin immediately to get their products certified.” said David Blumenthal, M.D., national coordinator for Health Information Technology.  This is a crucial step because it ensures that certified EHR products will be available to support the achievement of the required meaningful use objectives, that these products will be aligned with one another on key standards, and that doctors and hospitals can invest with confidence in these certified systems.”

Applications for additional ONC-ATCBs are also under review.

Certification of EHRs is part of a broad initiative undertaken by Congress and President Obama under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009.  HITECH created new incentive payment programs to help health providers as they transition from paper-based medical records to EHRs.  Incentive payments totaling as much as $27 billion may be made under the program.  Individual physicians and other eligible professionals can receive up to $44,000 through Medicare and almost $64,000 through Medicaid.  Hospitals can receive millions.

To qualify for the incentive payments, providers must not only adopt, but also demonstrate meaningful use of, certified EHR systems.  The law envisions that defined meaningful use requirements will help ensure that the patient and provider benefits of EHRs are realized.  Initial meaningful use criteria were defined in a final rule issued by the Centers for Medicare & Medicaid Services (CMS) on July 28.

In addition to the CMS rule, ONC also issued standards and certification criteria for EHRs on July 28, aimed at ensuring that EHR systems will support the specific tasks required under meaningful use.  Also, through regulations issued on June 24, ONC created a system by which technology review organizations could also qualify as ONC- ATCBs that will certify EHR products as meeting the requirements necessary for meaningful use.

With the initial two ONC-ATCBs now named, EHR vendors can apply to them for certification of their products.  By purchasing certified products, providers will have assurance that the products will support achievement of the meaningful use objectives.

“Multiple steps are underway to carry out the intent of Congress in supporting rapid and effective adoption of EHRs throughout our health care system,” Dr. Blumenthal said.  “The naming of initial ONC-ATCBs is one important step.  Actual certification of multiple vendors’ systems by the ONC-ATCBs is an important next step.  CMS is also working to create an online system for providers to register and attest for the EHR incentive programs. The first incentive payments are targeted to be made in May 2011.  Meanwhile, ONC is also carrying out new programs of technical assistance and training, especially for smaller hospitals and physician practices.”

Dr. Blumenthal said the Health IT initiative “is on an aggressive schedule to meet the urgent targets set by Congress and the President toward realizing the quality and safety improvements that we can achieve through health information technology.”

To learn more about the ONC-ATCBs named today visit www.cchit.org  and www.drummondgroup.com.

For more information about the ONC certification programs visit http://healthit.hhs.gov/certification.

For more information about other HHS Recovery Act Health Information Technology funding and programs, visit http://www.hhs.gov/recovery/programs/index.html#Health.

This news is published on : http://www.hhs.gov/news/press/2010pres/08/20100830d.html

Electronic medical record (EMR) systems have the true potential to transform the practice of medicine in ways that will improve patient care. But physicians must be secure in knowing that they will have the necessary support when they make the leap into the paperless world.

Congress and the White House have recognized the need for that support by getting behind Medicare and Medicaid incentives for physicians who undertake the daunting and costly process of adopting EMR systems. A final rule issued in July outlines how doctors can become “meaningful users” and receive the bonuses needed to help offset such a major investment.

Fortunately, federal officials are listening to some physician concerns about the government setting the bar too high for doctors to clear. Based in large part on advice from the American Medical Association and others in organized medicine, the final meaningful use rule has some greater flexibility for physicians. For instance, it allows them to defer some EMR requirements in the first two years and makes others easier to fulfill.

But despite the improvements, the bonus requirements are still going to make adoption a tough sell for many practices, especially the smallest ones. Obtaining a Medicare or Medicaid bonus in 2011 or 2012 still will require physicians to meet 20 EMR objectives, each with its own measure to determine whether doctors are compliant. Miss just one of them, and a physician who has spent tens of thousands of dollars on an EMR system might lose out on as much as $18,000 in a Medicare bonus for the year.

The margin of error is not wide enough for physicians. A requirement for doctors to maintain up-to-date diagnosis lists on their EMRs, for instance, mandates that such lists cover more than eight out of every 10 patients — a tall order. And if the government determines that a practice did not qualify for a bonus, no appeals process exists for those physicians to argue that they made the grade.

Physicians also are dealing with a tight deadline for EMR adoption. Because the federal government’s meaningful use rule on EMR systems is so recent, not a single vendor so far has been able to offer a product that will meet the requirements.

Officials expect such products to start reaching the market this fall, but that doesn’t leave physicians much time to research, purchase, implement and test such systems before the incentive program launches in 2011. Getting on board with a paperless system involves much more than simply plugging in the box and booting it up.

And as for those dedicated physicians who are ahead of the curve on EMRs? Some of them might not find out until fall that their costly systems are not going to be deemed government-certified for meaningful use.

The AMA is calling on the federal government both to establish a bonus appeals process and to deem early adopters’ systems as certified if they meet the meaningful use requirements. Heeding that advice would help allay some physician concerns.

But with all the uncertainty in the air, too many physicians — especially those in smaller practices — might conclude that the risks of failure are not worth the potentially outside chance of reward when it comes to EMR adoption. That would serve only to widen the gulf between those who have entered the paperless world and those who are still struggling to do so.

That gap will have consequences. The EMR incentives are voluntary — but not for long. Unless Congress changes the plans, in a few years Medicare bonuses will be replaced by penalties for vulnerable physicians who have not been able to overcome the barriers to EMR adoption. Those cuts will be on top of any deep reductions that might be required under the broken Medicare sustainable growth rate payment formula.

Physicians are ready to be teammates with the federal government in the shift to a better way of handling patient records. But federal officials must realize that if they are too strict in setting the rules of the game, they risk shutting out too many valued players.

Source :  http://www.ama-assn.org/amednews/2010/08/16/edsa0816.htm

Investing in an electronic medical records system was not something many physicians late in their careers were probably thinking about a few years ago. But the introduction of incentive pay for adopting an EMR — and the penalties for not adopting — have older physicians wondering if such an investment is worthwhile.

Starting in 2011, physicians will have the opportunity to earn up to $44,000 over five years in Medicare incentives, or $64,000 in Medicaid incentives, for “meaningful use” of an EMR as defined by the federal government. But if a physician plans to stay in practice more than five years and does not adopt an EMR, he or she can expect Medicare reimbursement to start declining in 2015, leading to a 5% total cut by 2019.

Todd Sherman, lead partner of the Sherman Sobin Group, a Mount Laurel, N.J.-based financial consulting group that specializes in physician retirement planning, said meaningful use is a hot topic for those deciding whether to invest in technology this late in a career.

Sherman, who works mostly with physicians five to eight years away from retirement, believes the choices for physicians in one- or two-physician practices is especially hard. Not only must they consider shouldering an investment in a new system they might not use for long, they also must try to reflect on how that system might affect the sale of the practice.

Experts say many vendors would like doctors to believe an EMR would be a great selling point for potential buyers of a practice. In some cases, that’s true; in others, it could become a major expense with no return.

The answer depends on the true value of the EMR, said Joseph Mack, a health care consultant from Dana Point, Calif. Several factors play into that equation, including the cost of the investment, its financial return and the time it takes to arrive at that return. But don’t think the system alone will add value to your practice, Mack warned. The value comes from what is accomplished with the EMR.

An EMR can help reduce costs and improve care in many ways, including better documentation, improved efficiency and better care coordination. But a physician generally must invest money and time to reach a break-even point.

The system’s price is usually the biggest factor. However, some systems can be implemented with little capital investment, especially Web-based models that are hosted remotely and do not need a big infrastructure investment.

For most practices, there will probably still be periods of several-months of reduced patient volume while the practice adjusts to new workflows, which means practices also should plan on reduced revenue as staff members get up to speed with the new procedures, experts say.

“There’s a lot of manpower costs that are not articulated in vendor information, because they [the vendors] don’t have to deal with it,” Mack said.

It could take 18 months to several years before practices reach the break-even point. For a physician on a tight time schedule, underestimating break-even by as little as six months could throw a wrench in long-held retirement plans. Therefore, practices need to quantify benefits so they can be weighed against the costs, and a realistic time frame can be predicted, Mack said.

Exactly when break-even occurs could depend on the technical savvy of the practice staff, who will need to know how to operate the EMR, Mack said. It also could depend on choosing the right system.

Sherman said once a realistic expectation of break-even is set, physicians can determine their succession plans. Those less than three years away from retirement may have a hard time justifying the investment, Mack said. But those eight to 10 years away probably should find a way to make the investment, Sherman said. Not only could they earn incentive pay and avoid penalties, they also could provide a higher level of service in those last years of practice.

That higher level of service also can help build the practice’s profitability, which is especially important if the physician plans to sell, Mack said. Data collected from an EMR could help physicians earn other pay-for-performance bonuses in addition to those from meaningful use. If the EMR helps improve efficiencies, it could lead to a larger patient load and, at the very least, cleaner claims for better billing.

Everything that adds to the cash flow in a practice matters to a potential buyer, not how much was spent on technology, Mack said. But if you buy an ineffective EMR, it actually could increase your costs, thus reducing the value of your practice, he said.

If it doesn’t make financial sense to make the purchase, the lack of technology won’t necessarily hinder selling, Sherman said. Many small practices are being bought by larger groups that already have an EMR. They will want that same EMR installed at any practice they buy.

“I am a big proponent of an EMR, but doctors have to examine the cost benefit of it,” Mack said. “Unless the EMR helps increase their profitability … then it can’t really be said the EMR will increase the value of the practice when you sell it in one, two or three years.”

Source  :   http://www.ama-assn.org/amednews/2010/08/16/bica0816.htm

BOSTON – Radiologists’ use of an advanced search tool that aims at improving the way they retrieve and sort data from an electronic medical record has the potential to benefit many other departments, according to one of the authors of a new study.

The Queriable Patient Inference Dossier (QPID) search engine was initially developed in 2005 in response to the need for radiologists at Massachusetts General Hospital in Boston to quickly have access to information about their patients.

Michael Zalis, MD, lead author of the study, which was published in the August issue of the Journal of the American College of Radiology, says the system serves as an adjunct to the hospital’s EMR system.

“Even in its simplest implementation, the presence of an EMR system presents considerable challenges to the radiologist,” he explains. “For example, radiologists commonly encounter each patient with little prior familiarity with the patient’s clinical situation. As a result, the time and effort required to retrieve, review, and assimilate EMR data relevant for the case at hand becomes an important consideration for use of EMR in busy clinical practice.”

The QPID system currently serves 500 registered users at Massachusetts General Hospital and posts 7,000 to 10,000 thousand pages of medical record data daily, according to hospital officials.

“[QPID] It was developed separately from the EMR and operates in a read-only fashion in relation to it,” Zalis says. “Thus QPID is not a source of new EMR data, but serves as a method to extract useful patterns of EMR data from the separately curated clinical data repositories at our institution,”

He says this tool has the ability to extend the radiologist’s awareness of a patient’s clinical history and care record, which he says can lead to better value, quality, and safety of practice.

“The potential impact of advanced EMR search tools is by no means limited to radiology and in fact many departments in the hospital and outpatient clinic may benefit from these capabilities,” Zalis says. “In our own institution, with the QPID search system, we have catalyzed a growing base of enthusiastic users, many of whom have contributed their own insights and content to the system’s catalogue of search modules, each of which is potentially applicable at more than one site. The future for advanced search of the EMR looks to be exciting and full of potential.”

Source  :  http://www.healthcareitnews.com/news/emr-retrieval-tool-full-potential

COEUR D’ALENE, ID – Beginning this fall, North Idaho College (NIC) is offering a program to train students with a prior background in healthcare and/or information technology to construct and use electronic health records. NIC is funding the course though a $625,000 grant it was awarded for the purpose of training health IT professionals.

“This online program is ideally suited to Idaho residents currently employed in a healthcare setting who need education in the selection, implementation and project management phases of adopting an electronic medical records system,” said Sue Shibley, EMR program manager at NIC.

Hospitals now have more incentive to establish digital record systems in place of paper-based ones due to the American Recovery and Reinvestment act of 2009 – incentives which may affect every level of the industry. According to federal estimates, at least 51,000 health IT professionals will be required over the next five years to assist healthcare professionals.

NIC’s Electronic Medical Records (EMR) Adoption for Healthcare Practices curriculum is designed to provide students a practical toolkit for planning and establishing EMR systems. If students take 10 credits worth of classes, the program can be completed in a single semester.

Courses in the program include Introduction to Health Information Technology, Medical Terminology, Legal Issues in Healthcare, EMR System Planning and Selection and EMR System Deployment and Management. Graduates of the program will receive post-secondary certificates. The first 135 students to complete the program before mid-May 20111 will be eligible for tuition reimbursement.

Prospective students are encouraged submit an online application directly to the EMR program for evaluation.

Source  :  http://www.healthcareitnews.com/news/idaho-college-offers-emr-courses