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April 26, 2010
Between 75-85 percent of physicians with EHRs are already using functions that meet some of the proposed criteria for demonstrating meaningful use, according to analysis from Seth O. Hogan, survey director, and Stephanie M. Kissam, health services research associate, at RTI International in Chicago.
The authors of the survey, published in the April edition of Health Affairs, said their analysis contributes new information about the rates at which primary care physicians, medical specialists and surgical specialists who had a basic EHR system used specific functions before the passage of the stimulus law, compared to the level of expected meaningful use of EHRs set forth in the proposed federal regulations.
“Among physicians who had key functions available to them, 75-85 percent reported using functions in the patient record category. These functions included organizing patient information such as sex and date of birth, lists of medications taken by the patient, problem lists or the current diagnoses of patients and clinical notes,” wrote the authors.
A stratified random sample of 5,000 U.S. office-based physicians was drawn from the American Medical Association’s Physicians Masterfile where, after 516 were determined as ineligible, 2,758 of the 4,484 eligible physicians completed the surveys during a data collection period from August 2007 to February 2008, yielding a 62 percent response rate.
The authors sorted completed interviews by whether physicians reported having a basic EHR system, meaning that it offers practitioners, at minimum, the following functions: the ability to record patient demographics, including name, address and sex, inclusion of patient problem lists, clinical notes, patient medication lists, and orders for prescriptions and electronic viewing of laboratory and imaging results. “Applying these criteria resulted in a sample of 485 physicians eligible for analysis,” the authors noted.
Fewer than one in five physicians reported having at least a basic EHR system, the survey found. Of those who did, primary care physicians were the most likely to report having a basic EHR system (19.4 percent). Medical specialists were the next group most likely to have a basic EHR system (17.1 percent) followed by surgeons (16.7 percent). “Availability of additional EHR functions, beyond those defined in a basic system, varied across all physician groups,” the authors wrote.
The use of these basic functions did not differ significantly by broad medical specialty yet the authors reported these data to provide baselines for tracking changes by specialty groups over time.
According to the survey, 79 percent of 306 responding physicians whose EHR systems had warnings for drug-to-drug interactions used this function. For information exchange functions, the authors also reported on the use of sending prescriptions electronically (79 percent of 265 respondents whose records had this function) and submitting laboratory orders electronically (used by 64 percent of 256 respondents whose records had this function).
“Public health reporting functions were less commonly used among the small number of physicians who had those functions available to them,” the authors wrote. In addition, only 27.6 percent of the 128 responding physicians said they could provide at least 10 percent of unique patients with timely electronic access to their health information, the authors found.
“To qualify for new federal funds intended to promote the widespread adoption and use of EHRs, U.S. physician practices must meet the government’s meaningful use benchmarks,” concluded the authors. “Tracking the use of EHRs across different types of providers will be a critical component in evaluating how their use affects healthcare costs, quality and safety and overall population health measures.” Above article publish on http://www.healthimaging.com/index.php?option=com_articles&view=article&id=21577:healthaffairs-about-80-of-emr-users-meet-some-meaningful-use-criteria
September 07, 2009
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.
Above article published on http://www.govhealthit.com/newsitem.aspx?nid=72031
September 04, 2009
If the state’s governor gets his way, Kentucky will soon be home to a statewide electronic health records system. To foster that goal, State Gov. Steve Beshear (D) has created the Governor’s Office of Electronic Health Information.
The state is creating the office to make sure it gets its share of the Obama administration’s stimulus funding package for EHRs, which goes to states who adopt them by 2014.
To get those funds, states are required to create a department that oversees its EMR project. These state offices serve as single points-of-contact for federal and state agencies helping to get the EMR ball rolling. In this case, the office will also work with the state’s three regional health information organizations, healthcare providers, consumers, insurers and the whole kit and kaboodle involved in sharing health data.
It will be interesting to see if any of this comes to fruition. Despite some big talk, RHIOs aren’t going great guns, and getting a state’s worth of EMRs in place by 2014 sounds a tad optimistic at best. But hey, press releases wouldn’t exist if people weren’t optimistic!
Above article published on
September 01, 2009
By Ken Terry While the debate over “meaningful use” of electronic health records rages on, it has been easy to forget the other half of the requirement for getting government health IT subsidies: Physicians and hospitals must use “qualified” EHRs.
Since the passage of the HITECH Act, part of last spring’s stimulus package, there has been speculation that a qualified EHR would have to be certified by the Certification Commission for Health Information Technology (CCHIT), which so far has been the only game in town. But the Health IT Advisory Committee, which advises the Department of Health and Human Services on information technology matters, has decided that there should be multiple certification bodies. All of them would have to certify EHRs under criteria developed by HHS.
According to the work group that made the recommendations approved by the whole committee, CCHIT’s criteria for certification are too detailed and the organization is too close to the industry to be the only certifying entity. Other observers have pointed out that CCHIT is very close to the Healthcare Information and Management Systems Society (HIMSS), a trade association for health IT professionals that include many software vendors among its members. In addition, Mark Leavitt, MD, chair of CCHIT, used to be a HIMSS executive and, before that, led an EHR company. However, there is no evidence that CCHIT’s ties with HIMSS have influenced its approach to certification, which has been implemented by workgroups that include a wide range of industry professionals.
In any case, CCHIT plans to certify EHRs under the criteria that will be established by HHS. Meanwhile, the advisory committee has asked CCHIT to submit a proposal for developing a “Preliminary HHS Certification” process that would allow it to provide preliminary certification to EHR vendors so that providers can begin purchasing qualified products, perhaps as early as October. In addition, the committee approved a plan to grandfather in vendors that have 2008 CCHIT certification, with the proviso that they upgrade their products later.
In a signifier of what this debate is really about, the committee has approved the certification of “open-source” EHRs, which contain non-proprietary code that is available to anyone who wants to use it. The best-known example in the healthcare arena is the VA system’s Vista EHR, which has been available to software developers for a number of years. In addition, the comment about CCHIT’s criteria being too detailed suggests that the committee wants to use looser criteria under which less advanced (and less expensive) EHRs could qualify for government aid.
I applaud this decision on a couple of grounds: First, continuing to tighten criteria for “qualified” EHRs would help a dozen or so vendors consolidate their hold on the market as providers sought EHRs that could garner government aid. Second, physicians don’t need all of the bells and whistles in current EHRs to improve health care. Relaxing the criteria in certain respects would help the development of nontraditional community EHRs, including those linked to disease registries, that might serve the purpose better. But as HHS develops its criteria, it should bear in mind that the EHRs that are qualified for government subsidies must also help doctors demonstrate meaningful use.
Above article published on http://industry.bnet.com/healthcare/10001008/hhs-will-choose-criteria-for-ehr-certification/
September 01, 2009
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.
Above article published on
August 26, 2009
The Certification Commission for Health Information Technology is moving forward with plans to launch a new, less comprehensive electronic health records software certification program in light of the federal economic stimulus package.
In October, the commission plans to launch a more limited, modular inspection program for EHR software, focusing only on compliance with standards required for “meaningful use” of EHRs under the American Recovery and Reinvestment Act.
Rather than wait for the federal government’s final rule defining “meaningful use” of EHRs next spring, CCHIT is moving forward with its new certification efforts based on preliminary definition recommendations from federal HIT advisory committees, says Mark Leavitt, M.D., the commission’s chair. That’s because providers will have limited time to select and implement EHRs by 2011 to qualify for maximum Medicare and Medicaid incentive payments under ARRA.
CCHIT also will continue to update and enhance its existing, more comprehensive, EHR certification system for ambulatory, inpatient and emergency department settings, Leavitt said.
The Chicago-based commission will hold an online “town hall” meeting at noon September 3, when electronic health records vendors can learn about and discuss the two CCHIT certification efforts.
The commission’s action comes after the federal HIT Policy Committee’s certification/adoption workgroup recently recommended that multiple organizations offer “HHS Certification” testing of EHRs for the incentive program. The workgroup, in making its recommendation, said that CCHIT’s existing, comprehensive certification of EHRs should not be a requirement for incentive payments. Instead, software should be certified solely for achieving the minimum set of criteria to meet ARRA’s “meaningful use” standard, according to the workgroup.
But federal regulators have yet to make a final decision on a certification approach, much less designate whether CCHIT, or other organizations, will be the government’s recognized certification bodies.
Above article published on http://www.healthdatamanagement.com/news/CCHIT-38877-1.html
August 21, 2009
Filed Under (EHR, Electronic Health Records) by admin
Health care providers and health IT vendors should consider legal issues as they begin to transition to electronic health record systems, experts said at the American Health Information Management Association’s third annual Legal EHR Summit, Modern Healthcare reports.
Health Record Ownership
EHR technologies have started to alter discussions on health record ownership, experts said.
In the past, health care providers generally had exclusive ownership of a patient’s paper medical record. However, state and federal regulations are beginning to grant patients greater rights to access and modify their health records.
George Schroeder, director of risk management and medical network services at Cedars-Sinai Health System, said legal constructs for EHR ownership are similar to a trustee model. He explained that health care providers can function as trustees because they act on behalf of themselves and their patients. He said, “You have to have a balance between competing rights and competing responsibilities.”
Legally Defensible EHRs
Experts at the conference also noted that most EHR systems on the market cannot produce a legally defensible health record because they do not track when people access and modify the records.
Linda Kloss, AHIMA CEO, said many vendors have not focused on developing legally defensible EHR systems. In addition, health care providers have not created a demand for such functionality.
Kloss said the annual summit aims to counter vendor inattention to the importance of legal EHRs. She added that AHIMA will pressure policymakers to include auditing requirements in certification criteria for EHRs (Conn, Modern Healthcare, 8/18).
HIPAA Enforcement
Kirk Nahra, an attorney in Washington, D.C., said the federal economic stimulus package imposes stricter enforcement guidelines for the HIPAA privacy and security rules.
Nahra said the stimulus package sets penalties of $25,000 to $1.5 million for violations of patient data restrictions. The stimulus package also grants state attorneys general the authority to enforce HIPAA rules.
Nahra noted that the stimulus law also requires software vendors and other health care business partners to alert consumers about security breaches. He said he expects health care providers to revise vendor contracts to reflect the new provisions (Anderson, Health Data Management, 8/18).
Above article published on
August 21, 2009
Critics have complained that the Certification Commission for Health Information Technology is too closely aligned with large EMR vendors. By Marianne Kolbasuk McGee
The Certification Commission for Health Information Technology, which has been the group providing a seal of approval for electronic medical record products since 2006, will continue to be the certification body for health IT systems at least until December when the U.S. government finalizes its definition of “meaningful use” of e-health products.
After the meaningful use definition is finalized, multiple organizations will be allowed to perform testing and certification of products for meeting the evolving criteria and standards of U.S. and Health and Human Services health IT certification rules. Vendors would need certification from only one certification body.
The continuation of CCHIT as a certification body was among the recommendations endorsed by the HIT Policy Committee certification and adoption workgroup during a meeting on August 14.
The HIT Policy Committee is an advisory board to the Office of Coordinator of National Health IT, which is guiding the U.S. Dept. of Health and Human Services on filling in the details of the $20 billion federal stimulus HIT legislation signed into law in February.
The non-profit CCHIT organization was founded in 2004 and began certifying products in 2006 during the Bush administration’s push for most Americans to have e-health records by 2014.
To date, CCHIT has certified more than 200 e-health products. However, with the passage of the American Recovery and Reinvestment Act ’s health IT legislation earlier this year, the future role of CCHIT was uncertain.
According to provisions in ARRA, in order for healthcare providers to be eligible for federal stimulus rewards starting in 2011, they must use “qualified” health IT products in “meaningful” ways. The details of qualified and certified–as well as “meaningful use” are still being hammered out. However, the HIT Policy Committee meeting last week helped clarify some of those ongoing questions, including the role of CCHIT at least in the short term.
Over the last few months, critics of CCHIT have complained to the HIT Policy Committee that CCHIT is too closely aligned with large EMR vendors selling comprehensive, feature-rich products, making it difficult or impossible, as well as expensive, for smaller vendors, open source developers and in-house development teams, who provide modular products with fewer bells and whistles, to get CCHIT certification.
CCHIT announced recently it will offer additional paths of certification for open source and modular products, such as e-prescribing, as well as in-house developed or assembled e-health systems.
In documents distributed at its Aug. 14 meeting, the HIT Policy Committee said that moving forward, the proposed definition of HHS Certification “means that the system is able to able to achieve the minimum government requirements for the security, privacy and interoperability, and that the system is able to produce the ‘meaningful use’ results the government expects.”
The HIT Policy Committee added that “HHS Certification is not intended to be viewed as a ’seal of approval’ or an indication of the benefits of one system over another.” Other recommendation by the HIT Policy Committee:
Above article published on
August 07, 2009
By Jean DerGurahian / HITS staff writer
Providers looking to make decisions about technology will find the revised “meaningful use” definition helpful, but the implementation timeline might still be challenging, professionals say.
The federal Health Information Technology Policy Committee approved updated recommendations from its meaningful use work group during a conference. The revised definition for the meaningful use of electronic health records includes changes to computer physician order-entry criteria and speeds up the schedule for granting real-time access to patient information through personal health records. The 2011 measures are being established with a focus on data capture and sharing, according to the work group’s recommendations.
Overall, the revisions “have some nice granularity to them,” said Brian Jacobs, a critical-care physician and chief medical information officer of 230-bed Children’s National Medical Center, Washington. As the medical center finishes components of its EHR, the revised measures will serve as guidelines for what it needs to focus on, he said. The medical center is already available for the full, first-year IT adoption incentive payment under the American Recovery and Reinvestment Act of 2009 because it meets the 2011 criteria now.
The American Hospital Association said that it is reviewing the revisions and the deadline for meeting criteria. “We remain concerned that many hospitals that haven’t already adopted health IT systems may find the proposed timelines unachievable,” said Don May, AHA vice president for policy, in a written statement Above article published on http://www.modernhealthcare.com/article/20090717/REG/307179990/1153
August 07, 2009
Filed Under (EHR) by admin
In a recent interview with American Medical News, National Coordinator for Health IT David Blumenthal discussed timetables for electronic health record adoption and the generation gap between older and younger users of the technology.
EHR Timetables
Blumenthal said federal officials are promoting EHR adoption in an effort to meet President Obama’s goal of providing all U.S. residents with an EHR by 2014.
He added that the Office of the National Coordinator for Health IT also is working under the time frame of the federal economic stimulus law, which imposes penalties on health care providers who do not adopt health IT tools by 2015.
Blumenthal acknowledged that many physicians have concerns about the pace of the EHR adoption timelines. He said ONC is “very aware that we need to find a balance between our long-term goals of using electronic health records to improve practice and the practical realities of everyday medicine.”
Blumenthal said his office will continue to solicit and consider stakeholder feedback on EHR timetables and other issues.
Health IT Generation Gap
In addition, Blumenthal spoke about generational differences in technology use among health care providers. He said many younger physicians are comfortable with EHRs and expect to use IT systems that connect them with colleagues and comprehensive medical data. However, he said older physicians might have less experience with the technology” Above article published on |
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