By Andis Robeznieks / HITS staff writer

Policies on security breaches, open source code, and government subsidies of electronic health-record systems have been adopted by the American Medical Association’s House of Delegates.

The policies concern physicians’ responsibilities in case of computer security breaches and support of electronic health-record systems based on open-source code. Another policy calls for the removal of penalties that are scheduled to affect physicians who are not using electronic prescribing by 2015, and another says that the AMA wants government subsidies for the implementation and maintenance of EHR systems to be adjusted for inflation.

AMA policy now dictates that, in response to a security breach, physicians are to place the interest of patients above those of themselves, their practice or institution. On open-source, delegates approved a resolution calling for the AMA to support law and public policy that makes open source EHR systems that meet certification and “meaningful use” requirements available to physicians at nominal cost.

The Florida delegation had introduced a resolution that would declare federal EHR incentive programs to be “noncompliant with AMA principles” and essentially a pay-for-performance program. After hearing testimony on June 14, a committee drafted a substitute resolution that stated federal programs should be made compliant with AMA principles by removing penalties for nonadoption.

“Resolved, that our AMA support the concept of electronic prescribing, as well as the offering of financial and other incentives for its adoption,” read the new resolution that was approved by delegates, “but strongly discourage a funding structure that financially penalizes physicians that have not adopted such technology.”

Above article published on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090617/REG/306179993/1153&AssignSessionID=373357728181706

By Steven Kraus, DC, DIBCN, CCSP, FASA

This spring, I traveled extensively to Washington, D.C., for a variety of reasons, mainly to advocate on behalf of chiropractic physicians as our government initiates massive health care reform efforts.

I attended the HL-7 Conference, which is an invitation-only gathering of health care officials dedicated to setting the programming standards for health information exchanges (HIEs) and standards for required data for electronic health records (EHRs).

The conference, sponsored by the Agency for Healthcare Research and Quality, has historically been limited to hospital and allopathic audiences. This year’s group was expanded for the first time to include other health care experts, and I was the designee from the chiropractic profession. My goal and commitment to the profession remains clear: I want to ensure that the interests of chiropractic physicians are considered in any and all discussions related to policy-making for health care information technology. And in the case of HL-7, chiropractic participation is critical so the concerns of our profession with regard to the development of HIEs will be heard.

The catalyst for broadening this conference audience was presumably the economic stimulus package, formally known as the American Recovery and Reinvestment Act (ARRA) of 2009, which includes more than $19 billion to fund the introduction of electronic health records in every physician office in America. The section of the ARRA that deals specifically with this appropriation is the HITECH Act, which outlines the requirements for funding eligibility. To be qualified for incentive payments offered through the legislation, doctors must adopt qualified EHRs that have the functionality to communicate with HIEs, making the standards by which HIEs are governed extremely important and elevating the prominence of interfacing capabilities with other systems.

I’ll discuss more about the requirements for incentive payments later in this article, but the main reason I share my involvement with the creation of health care information technology standards is to demonstrate how the general health care industry is finally opening its arms to the chiropractic profession. We’ve been dancing on the periphery for years, but finally, we are gaining recognition as an essential component of health care delivery and actively participating in these important discussions regarding policy, standards and reform.

Reform = Collaboration + Technology

Speaking of reform, during that same visit to D.C., I also met with Sen. Tom Harkin’s staffers as well as government relations personnel from the American Chiropractic Association to discuss the evolving model of reform for our health care system. As I shared in a previous column, elements of several models are under consideration including the Medical Home Model, which relies heavily on collaboration among health care professionals in order to improve the quality of patient care. Harkin and several of his colleagues are outlining a comprehensive national health care reform plan we can expect to be introduced later this year.

The cornerstone of that plan will be collaboration, and the framework to support collaboration will be driven by technology. While many uncertainties still remain, these two elements are certain. And with collaboration at the forefront, Harkin and others understand that chiropractic physicians and other nonmedical providers are an integral element of national reform. The reform movement is committed to supporting true wellness, something doctors of chiropractic have been preaching for years.

Now it’s time for us to rise to the occasion and continue walking our talk, while we have people watching us and listening. The first step in walking the talk is adopting EHRs. Why? Because technology will create the path to collaboration by assisting case management through registries, database queries, instant access to information, alerts and reminders, and all the related tools the digital age provides us. We need technology to form the health care teams that will improve patient care for every American.

With the anticipated health care reform model so heavily reliant on technology, those who do not adopt an EHR will be left out of the health care framework. In fact, the government is emphasizing the critical role an EHR will play in successful reform so heavily that it is funding the digital transition in its entirety. In order to adapt to the new model of health care, we must adopt an EHR. Since the government will pay for our EHR (up to $44,000 for each physician), we’re simply being asked to fund the energy and effort to implement it. Seems like more than a fair deal to me.

How to Access Your $44,000 Incentive

As I mentioned earlier, the process to fund your EHR is structured through incentive payments to physicians who adopt such systems. Not all health care professionals will be eligible for incentive payments, but doctors of chiropractic are an approved group, as they are covered by the Social Security code defining physicians, which the ARRA is using as its definition.

Two major areas will be evaluated by our government when determining payment approvals. First, the EHR system must be qualified, and second, the system must be used meaningfully by the chiropractic physician. A qualified EHR system must have the capacity to handle patient demographics and clinical health information, and also must have clinic management capabilities, as outlined by the entity that certifies qualified EHR. Only a certified EHR system will be eligible. The certifying body has not yet been announced, but the industry anticipates that the Certification Commission for Healthcare Information Technology (CCHIT) will be the likely choice since it was approved in 2006 by the government’s Office of the National Coordinator of Health Care Information Technology and Medicare to manage such efforts.

The second requirement, “meaningful use,” is determined by three important measures: (1) connectivity to health information exchanges and other EHR systems so they can share information when authorized by the patient; (2) regular reporting of quality measures to the Centers for Medicare & Medicaid Services (CMS), including capturing outcome assessments and performance of pain assessments; and (3) e-prescribing capability. Because we don’t have prescribing privileges, it is unknown at this time whether this will remain a requirement for doctors of chiropractic. With regard to reporting requirements, the general structure of the plan suggests that reporting of quality measures will likely be managed by the PQRI (Physicians’ Quality Reporting Initiative), a standardized mechanism that already exists.

As much as $44,000 can be paid as an incentive to a doctor for investing in a qualified EHR system. And in clinics with multiple physicians, each physician can qualify for the incentives, as long as the aforementioned terms are met. And while we know that CMS will be involved, its specific role is still being evaluated with regard to reporting and eligibility requirements for doctors participating in the incentive program. For example, minimum billing thresholds such as an annual $25,000 in covered services to CMS are being considered in order to be eligible for the incentive payments. However, there is some discussion on consideration for proportionate payments if the threshold is not met. So, if you average 16 Medicare patient visits a week, you would likely qualify. I will follow-up on this issue in a future article once the policies and standards relating to the Department of Health and Human Services and Medicare have been formally released.

To access the full $44,000, which is paid through Medicare in stages (four annual installments starting in 2011), the EHR system has to be qualified and used in a meaningful way starting in 2010. To clarify the timing, it is necessary to explain PQRI’s influence on the process. PQRI, which is expected to oversee reporting requirements, currently requires reporting on at least 80 percent of patients. To accommodate this requirement, the EHR system would need to be in use for the majority of the year prior to the first incentive payment, assuming adherence to PQRI standards will be required. Hence, EHR implementation in 2010 is necessary in order to receive an $18,000 first payment in 2011 and maximize the incentives available.

For new users, implementation of an EHR system typically requires 90 days to six months. Given the expectation that meaningful use will be necessary for the better part of 2010 in order to get a 2011 incentive payment, the implementation process for chiropractic physicians should begin promptly in 2009. Those who had the vision to implement a qualified EHR and can demonstrate meaningful use are already eligible for the full incentive payments.

Penalties for Not Transitioning to EHR

The Evolving Health Care Landscape: Technology Front and Center Those who choose not to transition to an EHR system will be penalized beginning 2015 and continuing through 2018. These penalties will be assessed through a reduction in your Medicare claims reimbursement on services billed. To further motivate adoption, some states have already passed laws that mandate EHR use after 2014 in order to attain a license to practice or to renew a license, concurrent with the stimulus plan. With financial and legal ramifications in play, the incentives to adopt an EHR now are enormous.

The Reform Cube

Given the benefits the government is providing chiropractic physicians, it is a wonder that any of us are still waiting to implement EHR. If the financial incentives are not enough motivation, doctors of chiropractic must consider what role they will play in the health care reform cube. Our health care landscape will soon shift to a different model; consider a cube in which quality, cost, and delivery of care through collaboration and access exist at each point, while technology sits squarely in the middle. Technology improves quality by offering reminders, alerts and other assistive techniques; technology lowers costs by reducing duplication of services; and technology improves collaboration and access by providing a mechanism to share patient health information across all providers. All of this allows for a robust clinic management system.

As chiropractic physicians, we strive to improve quality, we seek to reduce costs, and we crave the opportunity to collaborate on the health care team, so the cube is the ideal home for us. When we adopt the proper technology, we gain not only substantial financial support, but also membership in the cube. And isn’t membership what we’ve been asking for from the health care community all these years? This membership is not for the sake of privilege, but for the sake of having other providers refer patients to receive the benefit of chiropractic care, achieve wellness, and experience cost-effective and efficacious care naturally. Accept the invitation now - it won’t be offered again.

Above article published on

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

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

By Jacob Goldstein

Remember that survey last year that found only 17% percent of U.S. doctors have electronic health records? Turns out, the figure’s even lower for hospitals.

In all, about 9% of hospitals have EHRs, according to a survey published in the New England Journal of Medicine. Only 1.5% of U.S. hospitals have adopted “comprehensive” EHRs — those with a complete set of bells and whistles, installed throughout the hospital. Another 7.6% have basic systems installed in at least part of the hospital.

For both docs and hospitals, the main barrier to adoption was the same: Cost. That augurs well for the great big pile of cash the feds will be handing out in a few years to encourage everybody to get with the EHR program.

The federal money should be worth about $6 million over several years for a midsized hospital, according to an expert cited by the WSJ. That will cover a decent chunk of the cost of getting an electronic records system, which runs about $10 million, the WSJ says. But the stimulus incentives should

The survey, funded by the feds and the Robert Wood Johnson Foundation, is brought to you by the same researchers who did the EHR docs survey. One of the authors — Harvard Prof. David Blumenthal — was recently named as the feds’ health IT chief.

Above article published on http://blogs.wsj.com/health/2009/03/26/docs-hospitals-skip-electronic-records-for-the-same-reason/

SCHAUMBURG., The Certification Commission for Healthcare Information Technology (CCHIT)), the federally recognized body for testing and certifying electronic health records (EHRs), has announced it will develop dermatology-specific functionality criteria beginning in 2009. The CCHIT’s decision was in part a response to an application from the American Academy of Dermatology with support from the American Society for Dermatologic Surgery, American Telemedicine Association, the Medical Dermatology Society, and the Society for Investigative Dermatology as well as overwhelming support from the dermatology community and other key stakeholders.

“Beginning in 2006, CCHIT has placed a ’seal of approval’ on physician office-based EHR products to indicate that the system has met rigorous functionality, interoperability and security criteria for primary care, child health, and cardiology. The American Academy of Dermatology is pleased that the unique needs of dermatologists — who use digital images and body mapping to track patient health — will be recognized,” said dermatologist C. William Hanke, MD, MPH, FAAD, president of the American Academy of Dermatology. “This will be a service to the health care community as it continues to transition to a system that relies on electronic health records and the smooth and secure interchange of data. Dermatologists are committed to helping create functional criteria and technical elements that also will help many different physician specialties.”

CCHIT will appoint a work group of volunteer providers, payers, health IT vendors and other stakeholders to define those functions that will best help dermatologists enhance patient care quality and safety, improve practice efficiency, participate in clinical research and maintain board certification. In addition to spurring EHR adoption by dermatologists, developing dermatology-specific certification criteria has the potential to facilitate EHR care coordination between and among dermatologists and non-dermatologist physicians in various practice settings. CCHIT is expected to launch the dermatology-specific EHR certification program in 2010.

EHR systems refer to individual patients’ medical records in a digital format. These systems aid with accessing clinical information that can enhance patient care by helping to prevent medical errors, improve quality and facilitate clinical research. EHRs have grown in popularity amongst all physicians including dermatologists. However, barriers such as affordability, reliability, and whether the product will communicate with other electronic systems have kept many physicians from fully embracing these systems.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential representative of all dermatologic associations. A sister organization to the Academy, the American Academy of Dermatology Association is the resource for government affairs, health policy and practice information for dermatologists, and plays a role in formulating socioeconomic policies that can enhance the quality of dermatologic care. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.

Many dermatology practices, are using OmniMD EMR to increase the efficiencies and reduce their costs