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July 31, 2009
By Chris Hobson, MD Health IT industry news followers have probably noticed industry confusion and inconsistencies regarding terminology about what to call patient information that is collected and shared electronically.
In fact, analysts, vendors, journalists and practitioners all are guilty of using the terms electronic medical record (EMR) and electronic health record (EHR) interchangeably as if they are one and the same. In fact, these are two different terms that address two different sets of business needs with different — although overlapping — sets of features and capabilities. The distinction is more than minor semantics, and it’s crucial for health IT decision-makers to understand the difference.
Electronic record
To many, an electronic record is considered to be any clinical record that isn’t paper-based or hanging on a clipboard. The problem is, this doesn’t describe how the data will be used, gathered or shared. Will the electronic record be used only within the confines of a single office or practitioner, or within a single regional health system? Alternatively, will the data be shared across a wide range of different providers, such as specialists’ offices, labs, insurance providers and government agencies? For the sake of clarity and accurate understanding, it is important to distinguish between electronic records that can be shared widely and those that are designed to reside within a single organization.
When discussing digitized medical records, depending on the software vendor, geographic region, country or even the personal preferences of the presenter, the two terms — EMR and EHR — are being used interchangeably. Unfortunately, that distinction has been lost in the flood of material appearing in the literature.
According to the Healthcare Information and Management Systems Society (HIMSS), an EMR is a component of an electronic health record that is owned by the health care provider. The EMR is a set of applications and workflow tools that digitizes the creation, collection, storage and management of patient information within the confines of a single organization. An EMR system may touch clinical data repositories, lab applications and patient information management systems, among others — but all within the reach of a single organization.
EHRs, on the other hand, comprise as far as is possible, a complete and unified view of all the patient’s clinical assessments and care records drawn from across a wide region corresponding to all the providers who are seeing the patient — the totality of his/her personal data, state of health and delivered care. HIMSS defines EHR as a longitudinal electronic record of patient health information produced by encounters in one or more care settings.
An EHR consists of data provided from organizations throughout the service delivery chain — laboratories, providers, pharmacists, insurance payment records — as well as all of the patient’s personal data such as date of birth, address, weight, provider visits, and so on. These records can be shared easily across separate health care providers, labs, government agencies and insurance companies, made available whenever and wherever the patient is seen
Improved workflow
While both EMRs and EHRs provide some similar benefits — cost savings through improved workflow and paper reduction, improved delivery of care accuracy — EMRs provide those benefits only within a single organization. EHRs, because they are shared across the irrelevant geographic or otherwise defined region, increase the efficiency of patient care and improve patient outcomes, disseminate information rapidly between care providers, help with research efforts, and cut costs throughout the entire system more promptly and reliably.
The industry may be confused about what exactly is the difference between an EMR and an EHR, but there should be no confusion about the type of solution an organization needs. The benefits associated with sharing patient information with partners, suppliers and insurance companies can only be achieved through an EHR. In the years ahead, solutions that survive this rapidly changing market must be capable of sharing electronic patient information effectively both within an organization, between facilities and across regions. Health care organizations need to ensure that they are laying the groundwork today to make that future collaboration possible.
Dr. Hobson is chief medical officer at Orion Health. Above article published on http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=203986&CP=2
July 31, 2009
By Joseph Conn There may soon be one more incentive for hospitals and physician offices to buy and install electronic health-record systems on or before 2011. The added push could come from the prospect of increasingly higher thresholds of initial federal eligibility requirements for EHR subsidies under the American Recovery and Reinvestment Act of 2009, according to discussions at today’s meeting of the Health Information Technology Policy Committee.
A work group of that committee delivered its first draft of recommended definitions of “meaningful use” of EHRs, a standard that providers must meet to qualify for subsidy payments estimated at $34 billion to be handed out by Medicare and Medicaid. The work group recommended instituting a series of increasingly complex meaningful-use requirements between 2011, the first “payment year” of the subsidy program, and 2015, the final year payments will be made before financial penalties for not adopting begin.
During those discussions, Anthony Trenkle, director of the CMS’ office of e-Health Standards and Services, said the requirements will not be “tiered” based on when the provider adopts an EHR after 2011. Instead, whatever meaningful use standards are applicable for the year the provider applies for an EHR subsidy are the standards that provider must meet, regardless of whether it is the provider’s first year of EHR implementation.
A 10-day public comment period opens today on the work group’s initial recommendations. Trenkle said the CMS hopes to have a final definition of “meaningful use” to put out for a 60-day comment period later this year, with final rulemaking not expected until early next year. Above article published on http://www.modernhealthcare.com/article/20090616/REG/306169965/-1
July 29, 2009
On Tuesday, the Health IT Standards Committee approved quality measures and standards for how health care providers can demonstrate “meaningful use” of electronic health records by 2011, Government Health IT reports.
Under the federal economic stimulus package, hospitals and physicians who demonstrate meaningful use of EHRs will qualify for Medicaid and Medicare incentive payments.
The standards panel endorsed a matrix of 27 quality measures and 12 standards that build on each other to improve patient outcomes. The standards call for health care providers to use health IT tools for transmitting:
The committee said health providers who have not yet adopted EHR technology could use certain unstructured data for 2011, provided that they work to eventually meet structured data standards.
John Halamka, co-chair of the Standards Committee, said the panel attempted to provide “comfort levels” to encourage physician compliance with the standards and quality measures. He said future criteria will require health care providers to meet stricter standards.
The standards panel also suggested that meaningful use criteria require health care providers to fully comply with HIPAA privacy and security rules by 2011 (Government Health IT, 7/22). Above article published on http://www.ihealthbeat.org/Articles/2009/7/23/
July 24, 2009
Filed Under (EHR) by admin
The Health IT Policy Committee’s recent revised recommendations on “meaningful use” of electronic health records could be too daunting for health care providers to adopt by 2011, according to health IT experts, Medical Economics reports.
John Moore, managing partner of Chilmark Research, said, “The bar has been set too high, and the recommendations put forth will be virtually impossible to implement within the aggressive time schedule” of the federal economic stimulus package.
Under the stimulus package, hospitals and physicians who demonstrate meaningful use of EHRs will qualify for Medicaid and Medicare incentive payments.
Moore suggested that officials should pay more attention to processes and workflows when issuing final rules on meaningful use (Lewis, Medical Economics, 7/24).
John Haughom — senior vice president of clinical quality and patient safety at the PeaceHealth hospital system in Washington state — also said certain providers could encounter difficulty in implementing EHR systems by the 2011 benchmark.
He said the current recommendations might “discourage organizations that aren’t as far along” in implementing EHR systems. He said rural hospitals, small group practices and solo practitioners could be in that group.
To address these challenges, Haughom called for the Policy Committee to scale back the meaningful use objectives in three categories:
Hospitals and physicians both are pleased that the Policy Committee’s recent recommendations allow health care providers to meet the meaningful use criteria on a shifted timeline depending on when they begin implementation, according to HealthLeaders Media.
Haughom said further flexibility and revisions to the meaningful use recommendations could help spur health IT adoption and ensure the success of the federal stimulus package (Vaughan, HealthLeaders Media, 7/21. Above article published on http://www.ihealthbeat.org/Articles/2009/7/22/Experts-
July 22, 2009
Filed Under (EHR, Health IT Policy) by admin
When the government’s Health IT Policy Committee met a couple of weeks ago, some committee members suggested that a workgroup’s preliminary definition of “meaningful use” of electronic health records had gone too far. Now the official comments are in, and it’s clear that most of the healthcare industry agrees that the requirements in the workgroup’s first draft are overly aggressive. It will interesting to see what the committee comes up with when it reconvenes on July 16.
The “meaningful use” definition is of vital importance to the industry, because physicians and hospitals will have to show that they are using EHRs meaningfully in order to qualify for billions of dollars in government financial incentives. The committee wants to use its power to define the requirements to achieve certain policy objectives. But healthcare providers are concerned that they will be asked to do too much too soon. If the criteria to qualify for incentives in 2011, the first year of the reward program, are too stiff, not many providers will receive the maximum amount of government incentives.
In a letter to the Office of the National Coordinator For Health IT, Mark Leavitt, MD, and Alisa Ray, respectively chair and executive director of the Certification Commission for Health IT, succinctly summed up the problem:
“The lag between a decision to invest in EHR technology and its full, meaningful use in a provider organization is 1 to 2 years at best, and more typically, 3 to 5 years. For this reason, we believe most of the measures proposed for 2011 would be difficult to achieve by providers who have not already begun EHR implementations. Given current adoption levels, the incentives would only be available to a small percentage of providers, potentially provoking disillusionment and frustration with the ARRA incentive program.”
An AMA-led group of 81 medical specialty societies and state medical associations expressed a similar concern, noting that the committee’s timeline “is too aggressive, given that we continue to lack the necessary infrastructure, standards and systems.”
On the hospital side, both the AHA and the Federation of American Hospitals (FAH) opposed the timetable. The AHA noted that according to a recent study, only 1.5 percent of hospitals have a comprehensive EHR and 8-12 percent have a basic system. Consequently, the AHA said, the workgroup’s schedule for EHR implementation is “not achievable in the time frames proposed.” The FAH pointed out that computerized physician order entry (CPOE), which would also be required at an early point, is being used in only a tiny fraction of hospitals today.
Similar points were made by associations of health IT professionals. Bill Bria, MD, the president of the Association of Medical Directors of Information Systems (AMDIS), noted that it takes considerable time and effort to get physicians to use CPOE, even after it’s installed.
All of this noise is not about healthcare providers digging in their heels and refusing to play along with President Obama’s health IT initiative. Rather, it is a frank admission that implementing this technology will be a gargantuan undertaking that will require tremendous amounts of time and money. As AMDIS put it, there must be a “crawl-walk-jog-run” progression to EHR adoption. “These cycles cannot be skipped or condensed … without risking failure to ‘go the distance’ in the marathon that is HIT-powered healthcare transformation,” the association said. Above article published on http://industry.bnet.com/healthcare/1000879/industry-pushes-back-on-ehr-meaningful-use-definition
July 20, 2009
Gordon Gillerman — chief of the standards division of the National Institute of Standards and Technology — said officials might push for an accreditation organization to oversee the Certification Commission for Healthcare IT, Modern Healthcare reports.
Gillerman delivered a presentation for the Health IT Policy Committee’s certification and adoption work group.
He said an organization such as the American National Standards Institute could serve as a watchdog for CCHIT.
Gillerman added that he does not foresee NIST becoming involved in accrediting certification groups. Rather, he said, NIST could help the Office of the National Coordinator for Health IT develop an appropriate accreditation process (Conn, Modern Healthcare, 7/14).
CCHIT as Sole Certifier
In related news, the Electronic Health Record Association on Monday sent a comment letter to the Health IT Policy Committee’s certification and adoption work group urging officials to designate CCHIT as the single certifying body for electronic health records.
The EHR association is part of the Healthcare Information and Management Systems Society, which co-founded CCHIT.
The EHR group said it “supports CCHIT as the single certifying entity to avoid duplication of effort, unnecessary expense and confusion in the market.”
The association added that CCHIT certification should ensure that a health IT system “is a qualified, comprehensive EHR and is capable of enabling providers to achieve ‘meaningful use’ requirements” (Goedert, Health Data Management, 7/14).
Other Recommendations
The EHR Association’s comment letter also offered recommendations for developing criteria on the meaningful use of EHRs.
The association called for 2011 EHR objectives to:
Differentiate between inpatient and ambulatory care criteria; Emphasize existing software and standards; and Focus on adoption and use of comprehensive systems. The group also recommended linking computerized physician order entry systems to electronic medication administration records and data on chronic diseases.
The Health IT Policy Committee is scheduled to release its second draft definition of meaningful use during a meeting on Thursday (Merrill, Healthcare IT News, 7/14). Above article published on
July 20, 2009
By Ken Terry The Health IT Policy Committee, which advises the U.S. Department of Health and Human Services, has adopted the revised recommendations of its workgroup on the “meaningful use” of electronic health records. Physicians will have to show meaningful use to qualify for government financial incentives that are scheduled to start flowing in 2011.
The revised definition is apparently more lenient to physicians than the one presented to the committee about a month ago. Among the requirements for 2011:
Physicians will be expected to participate in the National Health Information Network by 2015, and will have to give patients access to personal health records to qualify for incentives in 2013. The PHR deadline is two years earlier than the one that was originally proposed.
Another big change from the earlier version is that physicians who apply for government subsidies for the first time after 2011 will only have to meet the 2011 criteria for meaningful use in the year when they apply. That will make it much easier for physicians who are just learning how to use their EHRs.
The government will use the recommendations in shaping its requirements for EHR incentives. HHS is expected to publish a final rule by the end of the year.
On another front, the HIT Policy Committee is also considering how EHRs should be certified for functionality. Earlier this week, it heard testimony concerning whether the Certification Commission for Health Information Technology (CCHIT) should continue to the be sole body that certifies EHRs. This is an important question, since only “qualified” EHRs—which many have interpreted as “certified”—will be eligible for government subsidies.
The committee members listened to hospital executives and others complain about the lack of interoperability among EHRs from different vendors. CCHIT chair Mark Leavitt, MD, noted that CCHIT is requiring that certified products be able to import and export the Continuity of Care Document (CCD), which includes key medical data. But he added, “There are not standardized HIEs [health information exchanges] and almost none of them is using the standardized format that the government approved.”
Meanwhile, in a letter to the HIT Policy Committee’s certification/adoption workgroup, an important organization of health IT professionals said that the CCHIT approach to certification should not continue. The American Medical Informatics Association stated, “We believe that highly prescriptive and detailed, one-size-fits-all requirements will ultimately be counterproductive.”
CCHIT has drawn a great deal of fire of late, mainly from those who fear that continuing to raise the bar on certification criteria will cull down the health IT business to a handful of vendors that can bear the expense of continuing software development and certification fees. But I would ask CCHIT’s critics a question that paraphrases Voltaire: If CCHIT did not exist, would it not have to be invented? How are EHRs going to meet the rising requirements for “meaningful use” unless someone sets standards that apply to all? Above article published on http://industry.bnet.com/healthcare/1000927/round-2-of-meaningful-use-lets-up-a-bit-on-physicians/
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
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
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
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