By Joseph Conn / HITS staff writer

The Certification Commission for Health Information Technology is adopting a two-tier system of testing and certifying IT systems.

In a conference call with vendors and developers of health IT systems Thursday, CCHIT Chairman Mark Leavitt announced the not-for-profit organization’s new testing program, as the group readies itself for the new realities of the healthcare IT market since passage of the American Recovery and Reinvestment Act of 2009.

One testing and certification program, dubbed Preliminary ARRA 2011 Certification, will specifically test for compliance with what is expected to be—at least initially—a fairly limited set of criteria that HHS and the CMS will use to determine eligibility by hospitals and office-based physicians for an estimated $34 billion in federal subsidy payments for the purchase of EHRs under the stimulus law.

The other, the so-called CCHIT Certified 2011 testing program, will use an elaborate set of about 300 criteria, primarily developed by the organization since its founding, that will closely resemble previous CCHIT testing and certification programs. The core CCHIT criteria will be tweaked to ensure systems that pass muster for its more advanced testing program also will meet ARRA requirements.

When it began testing IT systems in 2006, and on through 2008, CCHIT had offered just one, gold-standard set of criteria for each type of EHR system it tested—ambulatory EHRs or inpatient EHRs, for example.

But by April, CCHIT announced it would halt further testing to adapt its systems to accommodate the stimulus law criteria, development of which remains a work in progress. At the time of the announcement, Leavitt said the organization would keep its full-featured certification program, but would add two new testing and certification regimes scaled down to meet the minimum requirements of the stimulus law.

One new program would have tested IT systems by “module” against the new criteria under the recovery act, which requires providers to put “certified” EHR systems to “meaningful use” in order to qualify for federal subsidy payments. The proposed new modular approach was expected to appeal to some physician office practices and, more commonly, to hospitals, that want to piece together a comprehensive IT system from component parts produced by multiple IT vendors.

The other new CCHIT regime would have offered “on-site” testing and certification of EHR systems—again, against the less stringent stimulus law criteria with an eye toward qualifying for federal subsidies. This form of testing would have been conducted on systems installed at physician offices or hospitals. It was an approach targeted to appeal to providers who have developed their own EHRs or planned to assemble an EHR from noncertified sources, and to the open source development community, according to CCHIT.

According to Leavitt Thursday, CCHIT’s testing scheme will be modified again, but only somewhat. While site certification has been dropped as a certification scheme in and of itself, “site certification is still there,” Leavitt said. “In Preliminary ARRA Certification 2011, you can get a product or a site certified.”

Leavitt said it’s unclear whether providers adopting EHRs that have passed the test under the more rigorous CCHIT Certified 2011 program would want on-site certification, but if there is demand for the service, CCHIT will provide it.

Starting in June and running through its latest report in August, the HIT Policy Committee, which was created under the recovery act, has issued three sets of recommended definitions of meaningful use. Some of those recommendations have been controversial. To have market relevance, however, any program of certification of EHR systems that CCHIT develops must take those meaningful use standards into consideration to ensure that certified systems will enable providers to meet meaningful use standards and qualify for federal subsidies. The meaningful use standards, ultimately, will be developed by the CMS, which is tasked with running the bulk of the EHR subsidy program through Medicare and Medicaid.

In addition, CCHIT has to keep an eye on the Office of the National Coordinator for Health Information Technology at HHS, which, on behalf of the HHS secretary, will issue its own certification criteria for EHR systems, since, to qualify for subsidies under the stimulus law, providers also have to use “certified” EHR systems. Leavitt said CCHIT is forecasting ONC will issue its final rule on certification standards by Dec. 31 this year and that they probably will be the same or perhaps even less stringent than the recommendations the HIT Standards Committee made to ONC in August.

“We believe the final requirements will be the same as or less stringent that the current recommendations,” Leavitt said.

Both CCHIT testing and certification programs will open for vendor applications Oct. 7. Duration of certification is expected to run though Dec. 31, 2012, when certification criteria under the ARRA are expected to be ratcheted up, becoming both more numerous and more stringent.

Fees for certifying systems will vary with the certification scheme and the product, according to CCHIT Executive Director Alisa Ray. Under the CCHIT Certified 2011 program, the fee to a vendor to certify an EHR is $37,000 for either an ambulatory-care or an emergency department system, $49,000 for an inpatient system and $18,000 for an electronic prescribing system. Annual renewal costs are $9,000 for each, except e-prescribing, which is $7,000.

For Preliminary ARRA 2011 Certification, costs are pegged to the number of modules being tested, with fees set at $6,000 for one or two modules, $10,000 for three to five, $15,000 for six to 10, $24,000 for 11 to 20 and $33,000 for more than 20. Annual updates range from $1,000 to $5,000.

According to EHR vendor representative Justin Barnes, who listened in on Thursday’s CCHIT call, CCHIT probably has hit on the right strategy by launching its new testing and certification program this fall, based on an educated guess at what the government’s criteria might be, but before the final rules are published. Barnes is the chairman of the Electronic Health Record Association, and a vice president overseeing corporate development, marketing and government affairs for Greenway Medical Technologies, a Carrolton, Ga.-based EHR system developer.

“The detail that we have right now around meaningful use, you really can’t write a product to it,” Barnes said. “The interim final rule will come down at the end of this year. I think that will be a fairly close definition that we could follow. I think it will be plenty to work off of. The certification process, I believe, will be tweaked a little bit as well.”

Barnes said he hopes Leavitt is right when he predicts the ONC and the CMS will not vary too far from the current recommendations in writing the preliminary rules. He also said he hopes they don’t dally in unveiling their preliminary rules so everyone involved, both EHR vendors and users, have time enough to act.

“If there are any discrepancies, that could pose an interest to some people if you have to do heavy product development,” Barnes said. “It takes 12-plus months for the product cycle to add functionality on the ambulatory side and 18-plus months on the inpatient side. There is a word of caution here. That’s why we’ve urged ONC to move on this as fast as they can.”

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By Mary Mosquera

The Centers for Medicare and Medicaid Services (CMS) plans to test its ability to accept selected clinical quality data directly from hospital electronic health record systems as early as July 2010.

CMS said it would seek volunteer hospitals to report stroke, blood clot and emergency department measures of care via EHR systems as part of the Reporting Hospital Quality Data for Annual Payment Update program, which provides higher Medicare payments to hospitals that report quality measures to the agency.

The agency detailed the plans in the Aug. 27 Federal Register in announcing changes to its rule for the Reporting Hospital Quality Data for Annual Payments Update. The program, a provision of 2003’s Medicare prescription drug legislation, required hospitals by 2010 to report on 42 quality measures to receive additional incentive payments.

Reporting to CMS is generally paper-based or through a mix of manual and automated systems.

Participating hospitals and their vendors will have to be able to transmit clinical EHR data that adhere to interoperability standards, such as cross document sharing, cross community access, clinical data architecture and Health Level 7 version 3, CMS said.

CMS has encouraged hospitals to adopt EHRs that can report quality data directly to a CMS data repository. Ideally, the use of EHR systems would improve the quality of care by providing physicians with pertinent clinical data as they were treating patients.

“The testing of EHR submission is an important and necessary step to establish the ability of EHRs to report clinical quality measures and the capacity of CMS to receive such data,” the agency said in the published interim rule.

The reporting of selected quality measures is also a key provision of the stimulus law. The Health IT Policy Committee, led by Dr. David Blumenthal, the national coordinator for health IT, has recommended that quality reporting be a part of the criteria providers must meet to demonstrate meaningful use of electronic health record systems, CMS said.

The stimulus law authorized Medicare and Medicaid incentive payments to providers who prove they are meaningful users of health IT starting in 2011.

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By Pamela Lewis Dolan, AMNews staff.

When it comes to electronic health records, functionality has had its time in the spotlight. Now, the buzz term is usability. What’s the difference? Functionality is what a system does. Usability is how easily you and your staff can operate the system.

Usability is coming into the spotlight as vendors and consultants are learning that a lack of it has been a major reason many implementations have failed. The push is now on for practices (and vendors and consultants) to pay less attention to the bells and whistles and more to whether physicians and support staff can figure out how to make them work.

Determining what usability means to you will require a hard look at not only the system but also your practice — how it works now, how you want it to work, and how ready and able employees are to adapt to technology.

Ron McNamara, PhD, a certified usability analyst who runs the EMR Usability Group, a consulting firm, said that despite the seemingly relative nature of usability, there is some science to it. But at its most basic level, usability means everyone will be able to use the records system to electronically complete tasks in the same or less time as it takes on paper.

McNamara has developed a nine-point assessment that practices can use to help determine a system’s usability:

Dictation: A good system will accommodate doctors accustomed to dictating their notes as well as those who are comfortable typing.

Prescriptions: Sending a prescription electronically should be just as fast as writing it on paper.

Ability to receive faxes: Allowing faxes to be imported directly into the EHR should not negatively impact work flow.

Appointment/scheduling integration: With good integration staff will not have to toggle between two systems.

Scanning: Your system should allow documents to be scanned directly into a patient file.

Vital signs: Support staff should be able to enter vitals directly into the patient’s file at the time of care, with a touch screen, tablet or laptop in the exam room.

Interface design: Is it customizable to match each physician’s current work flow? Can information that is not needed on a regular basis be hidden? Can it be customized according to user (whether physician, nurse, physician assistant)? Is it intuitive and easy enough that a novice can learn to use it?

Office work flow: Is your vendor willing to define current work flow and match the system to it as closely as possible and/or help identify current work flow problems that can be fixed with technology?

Application performance: Does the system take a long time to load? Does it go from screen to screen quickly? Does it crash often? Hardware, as well as software, will be a factor.

Can your staff adapt?

The other important task is assessing your employees’ ability to learn a new system.

Jeffrey Linder, MD, MPH, director of the Brigham and Women’s Primary Care Practice-Based Research Network in Boston, said there is no test to assess an employee’s tech-savviness. So you mostly have to rely on self-reporting.

Allen Wenner, MD, a family physician in Columbia, S.C., said that when he interviews potential employees at his practice, he addresses their tech-savviness with two basic questions.

The first is, “What is your e-mail address?” It must be a personal address, not a current or former work e-mail. The second is, “What operating system do you use?” A response of “Windows” is not adequate. He wants to know what version.

“If a person doesn’t know the answer to those things,” he said, “then you can’t teach the level of technology that is necessary to operate an EMR in a live environment while you are seeing patients.” Dr. Wenner is also the co-founder of the High Performance Physician Institute, an EMR training organization.

But that’s not to say everyone should be able to program the next best thing to Microsoft Windows. A good EHR system will meet people where they are and allow them to learn as they go along, McNamara said.

Dr. Linder said that during the implementation projects in which he has participated, there was an effort to get diversity on the teams charged with picking a system. The strategy was to form a group with the widest spectrum in terms of age, self-reported tech-savviness and job requirements to test-drive potential systems.

Dr. Linder compared a good EHR to Microsoft Word. He said most anyone can figure out how to use the program, but most users don’t use 92% of what’s in it. Likewise, a good EHR system will be easy enough for novices to use, but offer more options for a “power user.”

The caveat is that if all of the EHR’s functionalities aren’t being used by the majority of people in the office, the practice is not realizing the system’s full potential. That’s where incentives come in, Dr. Linder said.

As payment moves from fee-for-service toward pay-for-performance, practices will have the time and motivation to learn and utilize more of the EHR’s functionalities, he said. Incentives built around the patient-centered medical home model, for example, will be practice wide, not physician-specific, which means every employee in the practice will have an incentive to learn — and take their own steps — to increase the system’s usability.

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The requirements for what health IT users need to do to meet the meaningful use dictates of the stimulus law are now clearer, with the focus apparently swinging to how the IT certification process will handle them.

Healthcare providers finally have some certainty about what they need to do to be meaningful users of health IT, said Dr. Bruce Taffel, chief medical officer of SharedHealth, an healthcare information exchange and application provider.

Dr. David Blumenthal, the national health IT coordinator, and the HIT Policy Committee, a public/private organization, approved July 16 a list of 28 health IT functions and corresponding quality and efficiency improvement measures for 2011 that become progressively more rigorous in 2013 and 2015.

The schedule is aggressive and the criteria will be difficult for some to achieve.

“The recommendations provide more clarity at this stage, although there’s still a lot more work to be done,” Taffel said today.

The goals for meaningful use are for providers to electronically capture data, report quality measures and use the data to track patients’ medical conditions. Under the American Recovery and Reinvestment Act, providers will be eligible for increased Medicare and Medicaid payments beginning in 2011 if they demonstrate meaningful use of their certified health IT. The payments end after 2015 when health IT should be broadly adopted.

“The committee shaped their recommendations on meaningful use and the progression to achieve that on the basis of what we can do today, what the current condition is and with a fairly reasonable explanation of how you begin phasing in much of this,” Taffel said.

The policy committee also made its first recommendations on the certification process of electronic health records. Currently, the Certification Commission for Health IT (CCHIT) is the sole certifying and testing organization. The HIT Policy Committee wants more competition.

Multiple groups will be needed to perform certifications because so many more providers will seek to have the service conform to the stimulus, said Paul Egerman, retired businessman and chair of the committee’s certification and adoption work group.

The certification process should also accommodate a scaled-down version of certification process for systems or applications that still allows providers to prove they are meaningful users with components of comprehensive electronic health records, EHRs from multiple sources or self-developed applications, he said.

“If comprehensive certification is important, say for vendor marketing, it’s a positive thing that should continue to exist,” Egerman said.

The committee agreed to focus certification on a minimal set of requirements for meaningful use, and not on features and functions. The national coordinator’s office would review CCHIT certification criteria for gaps in assuring meaningful use.

“We could have the meaningful use gap certification process decided by Labor Day,” Blumenthal said.

Those products that are currently CCHIT-certified will be certified for meaningful use under the Health and Human Services Department definition for 2011, “subject to completing a special meaningful use gap certification,” according to the work group’s transition plan.

The work group also urged that the certification process be used to improve progress on security, privacy and interoperability and provide a tighter link with standards.

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The plan will rely on federal grants and build on previous state efforts to expand health IT adoption in underserved rural areas.

By Pamela Lewis Dolan, AMNews staff.

Louisiana Gov. Bobby Jindal signed into law a bill that would create a loan program for physicians and hospitals hoping to buy an electronic health record system.

The Electronic Health Records Loan Program Act, signed July 9, gives the Louisiana Dept. of Health and Hospitals the authority to apply for $25 million in federal stimulus funds in order to administer loans for EHR purchases. The measure also included $5 million in matching funds from the state, a requirement under the American Recovery and Reinvestment Act. The state will learn later this year if it will get the federal grant.

“This is another step in updating and improving Louisiana’s health delivery system for all Louisianians,” Jindal said in a prepared statement.

The measure builds on legislation passed in 2007 that helped seven rural hospitals acquire EHRs. The law also established the Louisiana Rural Health Information Exchange. In 2008, additional funding allowed another seven rural hospitals to become connected.

To qualify for the loans, the purchased EHR system must be certified by the body eventually chosen by the U.S. Dept. of Health and Human Services for such approval. Loans could also apply to fully integrated telemedicine systems.

Acknowledging upfront costs are a barrier that the incentives wouldn’t help alleviate, many EHR vendors also launched financing options for physician practices as a result of the stimulus. General Electric Co., for example, is giving practices the options of deferring payments until incentives start being paid in 2011.

Jenny Smith, health information technology project manager for the Louisiana Health Care Quality Forum, which is the state-designated entity for distributing all grants coming out under the federal stimulus package, said details are still being worked out in terms of the loan agreements. Work groups consisting of several stakeholders in the state are currently working on structuring the loan program, she said.

“The goal is to maximize the amount of support we can give to providers in Louisiana who couldn’t otherwise purchase an electronic health record or upgrade their electronic health record to meet the meaningful-use criteria for the incentives,” Smith said.

Once the state has reached 100% compliance, Smith said, the fund would likely be used for support such as upgrading systems or training.

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One part of President Obama’s healthcare agenda that has been nudged out of the spotlight is the push to create a nationwide network of electronic health records (EHR) by 2014. McKnight’s will hold a webcast on this issue later this month.

Even though a deadline is in place, EHR faces significant challenges toward implementation. One of the main factors holding back EHR adoption is the sheer cost of the undertaking, according to CNNMoney.com. Depending on the size of the facility, an EHR system can cost tens of millions of dollars to implement, and take years to get off the ground. One Kentucky hospital system will require $80 million and three years to fully implement an effective EHR system, CNN reported. Convincing physicians to change their long-held practices can be a challenge as well, according to the report. Smaller rural facilities face other challenges, including lack of training and resistance to change. The long-term care industry has long been considered ahead of the curve in EHR adoption practices.

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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.

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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.

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http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53922

Electronic Health Records Emerging as Important Care, Research Tool

With the American Recovery and Reinvestment Act set to spur their development and implementation, electronic health records (EHRs) are getting a lot of attention.

The widespread adoption of EHRs, however, involves “huge challenges,” acknowledged Dr. David Blumenthal, the National Coordinator for Health Information Technology. As a recent study he led documented, less than 2 percent of U.S. hospitals have a comprehensive EHR system in place. Cost, the study found, was the biggest obstacle to adoption.

Despite some of the problems reported to date with EHRs, evidence is emerging that they can improve the quality and efficiency of medical care. For example, the relatively new EHR system at the University of Arkansas for Medical Sciences (UAMS) has made many aspects of delivering care “so much better,” said Dr. Laura Hutchins, director of Hematology/Oncology at the UAMS Winthrop P. Rockefeller Cancer Institute. While the system is not perfect, she continued, “I don’t know of anybody here who wants to go back to a paper record. In addition to saving money, she explained, the system has generally made patient visits more efficient—for example, streamlining the search for information that can influence diagnosis or treatment.

Whereas the UAMS system is still in its early days, the EHR system at the University of Pittsburgh Medical Center (UPMC) dates back to 1991. The center recently completed the first phase of an “interoperability initiative” intended to eventually provide staff at 20 hospitals and more than 400 physician offices and outpatient sites access to what Dr. Daniel Martich, UPMC’s chief medical information officer, calls a “full-fidelity” EHR system, an integrated network of patient records with data on everything from admissions to allergies to recent imaging studies. While access to a number of EHR-related tools, such as electronic prescribing, still varies, he explained, the goal is a widely accessible EHR system that “provides a unified view of what’s going on with the patient.”

Importantly, EHR systems are beginning to demonstrate their utility in research. At UPMC, for example, they have conducted studies showing that, with the addition of clinical prompts, the EHR system reduced the risk of patients receiving an overdose of acetaminophen and improved by fivefold the number of patients notified by their primary care physicians that they may be candidates for clinical trials. Dr. Hutchins and colleagues at UAMS, meanwhile, used their EHR system to evaluate vitamin D levels in women with metastatic breast cancer who received bisphosphonates to treat bone pain and osteoporosis, finding that vitamin D supplements were being underprescribed, which can affect patient outcomes.

The success of EHRs, Dr. Martich believes, will be measured by the extent to which they can be effectively integrated into clinical care and research systems. “The real issue [with EHRs] isn’t a technological one,” he said. “The question is: How do they function within the workflow of a health care system?”

Above article published on http://www.cancer.gov/ncicancerbulletin/050509/page6