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September 09, 2009
Experts say success hinges on the outcomes of these decisions
By Alice Lipowicz Former President George W. Bush urged doctors and hospitals to go digital on their own, with a few booster shots of federal help. Consequently, progress was slow. But the pace of change has been increasing since President Barack Obama has made health IT a priority and Congress put some real money on the table. Under the economic stimulus law passed earlier this year, as much as $45 billion will be distributed to health care providers who buy and use approved electronic health record systems.
The road ahead is still bumpy for EHRs, but experts say success hinges on the outcomes of five major decisions.
1. Strong standards or wiggle room? Officials at the Health and Human Services Department have the daunting task of creating a framework for certifying EHR systems that are capable of collecting and sharing patient data in ways that satisfy the broader goals of the stimulus law. A critical question is whether HHS can strike the right balance between strong rules and flexibility.
“There is always a trade-off between innovation and any kind of a certification process,” said Wes Rishel, a vice president and distinguished analyst at Gartner’s health care provider research practice.
2. Broaden the meaning of “meaningful use?” In the stimulus law, Congress said only doctors and hospitals that show meaningful use of EHRs can receive incentive payments. That language was meant to prevent the buying of systems that sit idle or are not used as intended. Key decisions for HHS are how broadly and stringently to apply the meaningful-use framework to meet major goals, such as cost savings, improved care and better public health.
3. Take baby steps or giant leaps forward? To help HHS meet its fast-approaching deadlines, an advisory committee urged the agency to immediately set up a temporary program that would allow an existing organization to certify vendors’ EHR systems until more permanent arrangements could be made.
Dr. Carol Diamond, managing director of the Markle Foundation’s Health Program, said HHS should allow the same sort of flexibility for providers to meet EHR-use goals. Some are already using EHRs, but others lag far behind, she added. “We still live in the real world,” she said. “You cannot get up to speed all at once.”
4. Let the states lead the way on data exchange? The ultimate goal of health information technology is the automatic sharing of patient data. The reasoning goes that if providers exchange patient data with government agencies and one another, analysts can identify trends and send the results back to doctors and hospitals to help them provide better care and reduce costs.
For now, a little sugar is making the medicine go down easier — such as the $564 million in state grants for health information exchanges that HHS announced in August. But the agency still has a key decision to make on the federal government’s role in creating that data network.
“You have to either grow the state exchanges that will be connected or try to seed from the top,” said Deven McGraw, director of the Center for Democracy and Technology’s Health Privacy Project.
5. Wait for broader health reforms or forge ahead? Dr. David Blumenthal, HHS’s national coordinator for health IT, said he hopes to strike a balance between incentives and penalties for EHR use. The rules must foster competitiveness, innovation, privacy and security, among other often-conflicting goals. But decisions are also looming about how hard HHS should push for health IT in advance of more comprehensive reforms that will affect health care access and payments.
“If we do not do the work on payment reforms, we will not really reap all the value of health IT,” McGraw said.
Above article published on http://fcw.com/Articles/2009/09/07/FEDLIST-5-steps-to-EHR-success.aspx?Page=1
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/
August 21, 2009
Filed Under (EHR, Electronic Health Records) by admin
By David Blumenthal, National Coordinator for Health Information Technology
A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
In my role as National Coordinator for Health IT, I have the privilege to be part of a transformative change in health care that will help to extend the benefits of health information technology (HIT) to all Americans. With the passage earlier this year of the Health Information Technology for Economic and Clinical Health (HITECH) Act, we have the tools to begin a major transformation in American health care made possible through the creation of a secure, interoperable nationwide health information network.
Of course, this system is not an end in itself. Rather, it will enable countless other improvements in the quality and efficiency of health care that will make Americans healthier and their economy stronger.
My personal belief in this transformation is not based on theory or conjecture. As a primary care physician for over 30 years, I spent the first twenty shuffling papers in search of missing studies and frequently hoping, during middle-of-the-night emergencies, that I knew enough about patients’ medical histories to make good decisions. All that changed when I began to have access to patients’ electronic medical records. It made me a much better doctor. I would never go back, and neither would the vast majority of American physicians who have made the leap into the electronic age.
In fact, it would be hard for any health professional today to escape the conclusion that the antiquated, paper-dominated system we now have in place isn’t working well for patients, creates added costs and inefficiencies, and isn’t sustainable. As we look at our nation’s annual health care expenditures of approximately $2.5 trillion, there are many ways our current system fails both patients and providers. It is clear that change is necessary.
But how and why is nationwide electronic health information exchange so critical to achieving such change? Most importantly, because it provides the best opportunity for each patient to receive optimal care. The technology will make patients’ complete medical information securely and reliably available to health care providers where and when it is needed – when clinician and patient are together facing medical decisions that can make a lasting difference.
Better, faster, more reliable and efficient care also ultimately reduces system-wide costs by delivering results that help to avoid expensive or prolonged hospitalization from delayed or ineffective treatment, avert costly and sometimes fatal adverse events and unnecessary procedures, and can help to eliminate the onset of disease by better informed management of each patient’s health.
The goal of assuring an electronic health record for every American is daunting. We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration.
We also recognize that we cannot achieve the benefits of a nationwide health information system unless we can assure all Americans that their personal health information will remain private and secure when this system exists. Putting into place safeguards for the privacy and security of this information, when it is in electronic form, will be an ongoing priority that influences and guides all of our efforts.
In the days, weeks, and months ahead, we will be rolling out a number of pivotal initiatives called for under the HITECH Act. I urge you to join and support us as we lay the foundation for every American to benefit from an electronic health record, as part of a modernized, interconnected, and vastly improved system of care delivery. We at ONC will be making every effort to keep you updated and fully engaged in all the steps of this national journey.
Above article published on
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 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/ |
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