Archive for the ‘Meaningful Use’ Category

The Office of the National Coordinator (ONC) for Health IT announced two organizations as an Authorized Testing and Certification Body (ONC-ATCB). The two organizations are the:

1. Certification Commission for Health IT (CCHIT). Read the CCHIT press announcement.
   
2. Drummond Group (DGI). Read the DGI press announcement.

According to David Blumenthal, M.D., national coordinator for Health Information Technology:

“Less than two months following the issuance of final meaningful use rules, we have approved our initial ONC-ATCB certifiers.  EHR vendors can begin immediately to get their products certified. This is a crucial step because it ensures that certified EHR products will be available to support the achievement of the required meaningful use objectives, that these products will be aligned with one another on key standards, and that doctors and hospitals can invest with confidence in these certified systems.”

Additional information on the ONC certification programs is available on the HHS Health IT site.

This is another step forward in putting the parameters and processes in place which are being driven by HITECH and the standard of Meaningful Use. HITECH is driving the adoption of EHR systems, offering physicians up to $44,000 in Medicare incentives and almost $64,000 in incentives through Medicaid. Hospitals are eligible to receive millions of dollars as well. In addition to implementing certified EHR systems, providers must meet staged Meaningful Use benchmarks to gain the full incentive amount.

On Tuesday, the New England Journal of Medicine published a testimony by the Surgeon General of the U.S. Public Health Service, Regina Benjamin, M.D., M.B.A., advocating for the use of electronic health records (EMRs) reflecting on the recently released meaningful use criteria.

In addition to the article’s applicability to the HITECH news in the healthcare industry, the article was particularly profound given the events that the southern Louisiana area has experienced in the last decade.

Take a minute to read through our Surgeon General’s experience with EHRs and healthcare integration.

Finding My Way to Electronic Health Records

Social media, and twitter in particular, provides the unique opportunity to tune into the voices of leaders across the world for commentary on global events, trends and issues.

Each of the following twitter feeds are the voices of key individuals and organizations involved in the healthcare policy transformation, significant current events and the exciting debates defining the future of the healthcare industry. As social media leaders, they make up the foundation for the health IT information network on the Web and are shaping the future of health IT for all of those involved. Follow what these leaders are saying and join in on their conversations:

1. @HIMSS – HIMSS (or Healthcare Information and Management Systems Society) is a non-profit membership organization dedicated on “providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare.” @HIMSS currently has over 5,000 followers.
2. @HL7 – HL7 International (or Health Level 7) is an international not-for-profit organization, “ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services.”
3. @HITECHActHelp – The HITECH Act and Meaningful Use guidelines have stirred up a significant amount of news recently, and most likely will continue to do so as the policies are implemented and enforced. @HITECHActHelp provides regular updates on this Act and how it affects those involved within the health IT industry.
4. @Histalk and @IngaHIStalk – HISTALK is an anonymous social media user who provides insight and opinion on current events in the industry. HISTALK, and his assistant Inga, regularly interview leaders in the industry, sponsor guest bloggers and tweet about current events. Although a self-proclaimed “cynic,” HIStalk provides a valuable perspective for those interested in HIT.
5. @kevinmd – Kevin Pho, M.D. holds an acclaimed social media presence within the healthcare community and has been recognized for his “punchy, prolific” healthcare insights by multiple major media outlets including The Wall Street Journal and The New York Times. @kevinmd provides daily commentary chronicling America’s healthcare system from a providers’ perspective.
6. @ahier – Brian Ahier is an active HIS thought leader in the healthcare community and currently has approximately 4,500 followers on twitter. He provides insights on health IT, healthcare reform and HITECH in addition to other broad technological advancements.
7. @SIIM_Tweets – SIIM (or The Society for Imaging Informatics in Medicine) is an organization dedicated to advancing the health IT industry through education and research. They are widely recognized within the healthcare IT and radiology industry for their SIIM Annual Meeting held each summer.
8. @ehrandhit – This twitter feed stems from the blog EMR and HIPAA that is dedicated to providing aggregated EMR, HER and HIT related content. @ehrandhit is recognized for providing information on health IT integration, HITECH and Meaningful Use.
9. @motorcycle_guy – Keith W. Boone is a thought leader on healthcare standards. He is the author of the Healthcare Standards blog that frequently reflects on current events in healthcare IT. Common topic threads are ARRA, CCD, HITECH, HL7 and healthcare integration.
10. @MedicalQuack – Barbara Duck, a healthcare IT consultant from Orange County, is a leading voice in the healthcare IT social media community. She is the author of one of the most popular health IT blogs online, The Medical Quack, and currently has over 3,000 followers on twitter.

Feel free to follow us on twitter @healthstandards for updates on HL7 standards and other health IT information, and Corepoint Health @corepointhealth for more information on interface engines and healthcare integration.

Who do you follow on twitter for news on healthcare IT?

Questions regarding the certification process of EMR technology, as well as the relevance of previous certification procedures, were key topics this week within the healthcare IT industry. Additionally, the impact of Meaningful Use and what it will mean for the EMR certification process was of importance.

A few interesting articles shared among users online explain the impact of recent legislative events and the overall implications of HITECH for patients and providers alike.

• Software Advice: The Medical Blog by Chris Thorman: EMR Ratings: How Relevant Is CCHIT Certification In the HITECH Era? This blog post discusses CCHIT’s role in certifying EMR software products. Recent legislative actions regarding the HITECH Act will be the catalyst for change in the certification process of EMRs, and niches within the market will be redefined.

• HealthImaging.com article: ONC issues final rule for EHR certification program. This article highlights breaking news from this week that involved the Office of the National Coordinator for Health IT (ONC). The ONC issued a “final rule to establish a temporary certification program for HER technology.”

• Health IT Buzz by David Blumenthal, MD: Adoption of Health IT. This blog post by the national coordinator for health information technology responds to several questions regarding the state of health IT and the positive impact of Meaningful Use.

The above information is helpful to follow as progress continues with the HITECH implementation.

This Monday and Tuesday, the 2nd Annual Healthcare New Media Marketing Conference will take place in Chicago, Illinois to discuss the impact of social media on the healthcare industry. Shahid Shah, author of the popular blog “The Healthcare IT Guy” and last year’s keynote speaker at the conference, will begin the conference with a “State of the Industry” address. You can find an abstract of that address on his blog here.

It will be interesting to observe the impact of new media in the coming years, not only on the healthcare industry as a whole, but on the progress of healthcare integration and health IT as HITECH and Meaningful Use incentives are implemented.

In March 2010, HHS released the health IT certification program NPRM or Notice of Proposed Rule Making. Visit the HHS site to learn more about the NPRM for certification. The certification program is a result of HITECH and Meaningful Use. As part of the NPRM process, several organizations have released comments about the proposed rules for certifying health IT. Three to take note of include:

1. Health Level Seven (HL7) International – PDF statement
2. American Health Information Management Association (AHIMA) – PDF statement
3. Markle Connecting for Health - PDF statement

Each statement offers interesting perspectives. One of the differences between these three is on what to certify. While AHIMA and HL7 urge incorporating more into the certification program, primarily Personal Health Records (PHR) and Health Information Exchanges (HIE), Markle is hesitant to put it all under a certification program. Their perspective:

“Regardless of the technology in question, the approach to certification should be limited to the minimum needed to enable providers to meet the Meaningful Use objectives, interoperability and existing privacy and security requirements. The cost of expanding the certification program should be carefully weighed against the benefits. However, HHS should allow PHRs or HIEs that wish to be qualified as EHR modules for purposes of helping providers and hospitals achieve Meaningful Use. We consider PHRs and HIEs separately below.”

From my perspective, two key points from their statement:

• Keep certification focused on what is needed for providers to meet Meaningful Use and associated requirements
• There is a cost to expanding the program – be careful

Good advice. There is enough to be done, so stay focused on what is necessary to meet Meaningful Use. There are many programs being launched already as part of HITECH, so be careful to not over-extend and over-program (see point 1).

Connecting for Health does a good job with their comments on the proposed certification program. It is worth reading in detail their recommendations on four key areas of the proposed health IT certification program:

1. HHS should create clear, standard language about the purpose and goals of its certification program, and its limitations in addressing important public policy questions raised by the adoption and use of health IT.
2. HHS should clarify the rules by which EHR modules may be exempt from testing against all privacy and security certification criteria.
3. Except for the specific circumstances in which such services are being used to help health care providers and hospitals qualify for Meaningful Use incentives under ARRA, HHS should limit the scope of extending the current certification program to other forms of health IT such as electronic personal health records (PHRs) or health information exchanges (HIEs).
4. HHS should clarify the type and scope of modifications that would require a 65 product to be recertified.

If you have the time to review only one of the three organization’s comments, read Markle’s Connecting for Health’s statement. It is more meaningful and insightful.

There are two interesting articles worth a quick read on the subjects of health care reform and health IT reform. As a refresher, health care reform passed earlier this year after intense debates and interesting legislative tactics. Health IT Reform passed as part of the Stimulus bill over a year ago and is known as HITECH.

First, the health care reform related article is entitled Cash for Doctors. The article highlights Dr. Brian Forrest’s practice in North Carolina, Access Healthcare. What is unique about his approach is that he accepts no insurance, and he has a published price list for the services he offers. Patients can see exactly what the service or test will cost. Dr. Forrest has negotiated lab test costs directly with labs, which are lower than what the insurance company has in place. All is paid by the patients immediately, no waiting for insurance processing, etc.

Consideration point: Health care reform has turned into a complex maze which will be costly and still has an enormous amount of unknowns. Dr. Forrest’s approach is simple, straightforward, with no hidden costs or agendas. Maybe there should have been more time during the legislative process to explore ways to simplify health care.

Second, in a Dallas Morning News article entitled Hospitals Criticized over Offers to Earn or Save Money by Sharing Electronic Patient Data, it highlights the concern over patient data privacy. Although there are significant penalties and other restrictions now in place, there are concerns on whether too much patient information would be transferred to various physicians and clinicians. Additionally, unidentified patient data is being sold to drug companies as another way for health care providers to make money. This raises concerns as well. This article outlines some of the practices and unease as we enter a highly electronic patient information era.

Consideration point: Maybe the model is somewhat backwards. All patient information should be sent electronically to a Personal Health Record, and the individual decides who gets what information. Additionally, if they want to sell their data to drug companies, let the individuals make that decision. This places more responsibility on the patient in the flow and privacy of their own data.

Two interesting articles on health care reform and health IT reform… It is worth spending a few minutes reading both to consider impacts and unique ways to accomplish improved healthcare delivery objectives.

In a recent poll, we asked for primary sources used to stay current on HITECH & Meaningful Use. The results were fairly resounding for HIMSS, not the HHS / ONC website, that garnered the most votes with 31%. Read below for the complete results.

Question: What are your primary sources to keeping updated on HITECH & Meaningful Use news and insights?

• HIMSS – 31%
• HHS / ONC website – 23%
• Healthcare IT News – 15%
• iHealthBeat – 15%
• Health Management Technology – 8%
• Various healthcare blogs – 8%

If there is a poll topic you think would be appropriate or interesting, please send it to info@HL7Standards.com.

We have posted various responses to the Meaningful Use NPRM. Response highlights include:

• U.S. Senators: Meaningful Use Proposed Rules Unite Partisan Senators
• Various Healthcare Trade Groups: Meaningful Use & Healthcare Standards – Expressed Concerns on Proposed Rules

While most of the comments have been calling for a relaxation of the benchmarks in Stage 1 (see above), a group of consumer and employer organizations have sent a letter to the U.S. Department of Health and Human Services and Centers for Medicare & Medicaid Services urging Stage 1 requirements remain with the currently defined strength (as outlined in the preliminary rule).

The bottom line of the letter: You are on the right track; don’t slow the Meaningful Use requirements down.

The letter can be read in its entirety here. The participants in the letter are a unique mix from Walmart to AARP to the National Retail Foundation to the National Council of Jewish Women…

Two key quotes from the letter:

“A final rule that does not lay a clear path in the first year toward tangible improvements in quality and lay the foundation for the systemic changes necessary for reform could waste taxpayer dollars and not launch us on the needed course for the future.”

“The meaningful use incentive program is just that – an incentive program. It is not a mandate, and it does not constitute regulation of the health care industry. Providers who want to implement HIT on a different timeline and with their own resources can do so.”

The points are valid. If we really want to move health IT forward, then the foundation needs to be aggressive and strong. The program is not mandatory; there is a choice of when health care providers can begin, if at all. Essentially, the proposed rules are well-balanced and flexible.

Within the Meaningful Use NPRM, the letter highlights five essential elements which will “mostly likely” improve health outcomes and reduce costs:

1. Collecting and reporting on care quality metrics are good; it is only way to improve care.
2. Requiring patient electronic access to their information will lead to people taking better care of themselves.
3. Computerized physician order entry – CPOE – is a critical capability to enable collecting quality measures and implementing clinical decision support.
4. Including patient progress notes in the electronic records is a key enabler of patient safety.
5. Added privacy and security requirements in health IT will increase patient trust in the systems.

With all the calls for slowing the Stage 1 requirements, it is refreshing to read a different perspective.

We posted a debate which poses the question:  Is the driver of achieving HITECH’s objectives health IT or health IT users?

HITECH is centered on implementing health IT to improve patient care and reducing costs. The approach may be a “Field of Dreams” one – build IT and they will us IT. There are many examples of good technology driving people to be active users of it, and it then becomes a way of life (e.g., ATMs, Apple products). Will health IT be the same, or will users (physicians and clinicians) ultimately decide the fate of HITECH’s success?

This group is saying:  Keep the benchmarks strong, so that healthcare technology shift our healthcare system into the modern age; it is the only way to gain quality improvements and affordability.

Health Level Seven (HL7) International sent a letter to the Office of the National Coordinator (ONC) for Health Information Technology regarding the proposed rule on the certification programs for health information technology. The two primary comments are as follows:

• HL7 has produced the Electronic Health Record  System Functional Model (EHR-S FM), which was done at the urging of CMS and HHS and has been used by CCHIT in past certification criteria. “HL7 strongly recommends that ONC continue to include functional requirements as part of the certification program.”
• HL7 recommends that other systems other than EHRs be certified. HL7 has developed the PHR System Functional Model (PHR-S FM) which can be used as part of the certification process, just as the EHR-S FM is. HL7 goes on to recommend that EHR systems across the spectrum of care be certified as well, and HL7 has profiles for “…Emergency Department, Long Term and Post Acute Care, Behavioral Health, and Child Health…”

Read the complete HL7 Letter on the proposed certification programs (PDF).

A few other comments on the proposed certification programs have been submitted. American Health Information Management Association (AHIMA ) and the Medical Group Management Association (MGMA) have submitted letters to the ONC. iHealthBeat has an article – Groups Comment on Proposed Certification Rule for EHR Systems - which highlights the key points of their comments. Both of these organizations comment on already certified EHRs:  “allow CCHIT-certified products to remain certified until temporary certification entities are operational and able to re-certify the products” (AHIMA position) and “recognize EHR products certified by CCHIT in 2008 or later as meeting the requirements of stage 1 of the EHR incentive program” (MGMA position).

So, a quick summary of comments emerging on the proposed EHR certification programs – one coming from a healthcare standards organization and the others coming from healthcare trade associations. There is a definite difference in comment approach between the two types of organizations, and there will likely be more comments coming from others.

One thing is certain about HITECH / Meaningful Use today – it has created opportunity for many, many organizations to comment on its various components.