Patient-Centered Medical Home Requires an EMR System

Patient-centered medical homes have become all the rage in the healthcare industry these days. The big push is coming from payers who want to cut costs and provider organizations who want primary care physicians to have a bigger say in the care of their patients. No matter who is driving the financial and clinical model, the train isn’t leaving the station, so to speak, without health IT to power it.

At a primary-care practice in St. Louis, Mo., both patients and their families are seeing firsthand how an electronic medical record (EMR) system documents patient treatment and applies clinical decision support and analytics to tailor a patient’s treatment plan.

PCMHs are not all the same, and the Des Peres Internal Medicine office further personalizes treatment by having a nurse practitioner and social worker as part of the PCMH team. One of the Des Peres Internal Medicine physicians said that one of the goals of the PCMH is to increase patient access to care. That could mean access to the social worker via telephone. It also gives patients the extra channel of communicating or completing tasks such as making an appointment, filling a prescription or entering patient vitals via a patient portal.

One of the best benefits of an EMR in a PCMH is the streamlining of care delivery, which includes the elimination of duplicative tests. Most patients in a PCMH likely have multiple chronic conditions that a care team must manage. If patients see multiple specialists on their own, who is coordinating the care? Even if the coordination is done through a primary-care physician, without an EMR to aggregate data and document what happens in every specialist office, the amount of administrative and clinical paperwork would be overwhelming.

Another benefit is empowering patients, which can often translate into taking better care of themselves, especially when they have their up-to-date patient information available to them via the patient portal and clinical decision support and analytics to support their entire care team.

Source : http://www.emrspecialists.com/2011/02/patient-centered-medical-home-requires-an-emr-system/

CMS Clarifies Hospital Patient Requirements Under Meaningful Use

Last week, CMS revised an online frequently asked questions site regarding provisions in the meaningful use ehr program that affect patient-reporting requirements for hospitals, AHA News reports.

Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

According to the revised FAQ site, eligible hospitals and critical access hospitals have two choices concerning the type of patients to consider for Stage 1 rules of meaningful use ehr:

• The “Observation Services method” includes patients who are admitted directly to an inpatient setting, patients who arrive in an emergency department and then are taken to an inpatient department, and patients who receive treatment in an ED and are given observation care.
• The “All ED Visits method” includes patients who receive care in and are discharged from an ED.
  

The FAQ section was revised based on feedback from hospitals that earlier guidance was not clear about which observation services can be counted.

The revision recognizes that some hospitals are prioritizing EHR adoption in their EDs, while others are concentrating on deployments in inpatient departments, according to AHA News (AHA News, 12/2).

Source : http://www.myemrstimulus.com/cms-clarifies-hospital-patient-requirements-under-meaningful-use/

EMR Spending Expected to Double in 4 years

Government incentives for using electronic medical records will result in spending on systems doubling by 2015, according to a report by IDC Health Insights. However, the study notes that much of that growth will come closer to end of that projected period, because vendors are having trouble keeping up with the orders.

Total EMR spending, which is expected to grow from $1.9 billion in 2009 to $3.8 billion by 2015, is about twice the growth rate analysts are seeing over the health information technology market and the general IT market, said Judy Hanover, research director of provider IT strategies for the Framingham, Mass.-based market research company and co-author of the report.

The report notes that a separate IDC survey in August 2010 found that 44% of health care organizations plan to accelerate or aggressively accelerate their plans to deploy EMRs because of financial incentives in the 2009 economic stimulus package. The stimulus provided incentives of up to $44,000 under Medicare and nearly $64,000 under Medicaid for meaningful use of an EMR.

But this rapid deployment is causing a vendor backlog that has resulted in unanticipated delays of up to six months for some practices and hospitals. Hanover said this has been a bigger issue for inpatient system deployments, but analysts are starting to see it on the ambulatory side as well.

The authors of the report predicted that the largest chunk of EMR investments will come in 2015. Not only is the backlog expected to cause delays, but some physicians will put off purchasing until it gets closer to 2015, when incentives turn to penalties.

The forecast shows clinics and physician practices will spend $335 million on EMRs in 2011 and $490 million in 2015. Ambulatory EMR spending overall was $633 million in 2009 and is expected to reach $1.4 billion in 2015.

Making an early decision on an EMR will help ensure that staff members are available for its installation, Hanover said. Practices might want to consider looking at third-party vendors if their primary vendors are experiencing a backlog, she said. Many third parties can provide installation and training services with the help of the vendor, she said.

After 2015, vendors are expected to enter a “maintenance cycle” in which revenue will come mostly from replacement systems or upgrades. Not only could the government require EMRs to perform more functions than they do today to qualify for incentives, health system reform may have an impact.

“We do expect to see, as health care reform goes into effect, a massive consolidation in the provider community in terms of acquisitions and reductions in the total number of providers,” Hanover said. “And that will drive some replacements and upgrading and reinvestment in EMRs.”

Source : http://www.emrspecialists.com/2011/02/emr-spending-expected-to-double-in-4-years/

Medicare EMR Incentive Program Begins Registration

Washington — Starting Jan. 3, eligible physicians and hospitals will be able to register for the Medicare electronic medical record incentive program, a prerequisite for obtaining billions in available federal bonuses, the Centers for Medicare & Medicaid Services announced Dec. 22, 2010.

Also starting Jan. 3, registration for the Medicaid EMR incentive program will launch for Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee and Texas. In February, registration will open in California, Missouri and North Dakota. The remaining states probably will launch their Medicaid EMR incentive program sign-ups in the spring and summer, CMS said.

Officials with CMS and the National Coordinator for Health Information Technology said they hope for broad registration by doctors and hospitals. To prepare for the process, health professionals are encouraged to visit the CMS website (www.cms.gov/ehrincentiveprograms/).

“With the start of registration, these landmark programs get under way, and patients, providers and the nation can begin to enjoy the benefits of widespread adoption of electronic health records,” said CMS Administrator Donald M. Berwick, MD.

David Blumenthal, MD, the national health IT coordinator, said, “It’s time to get connected.”

He added that his office and CMS have numerous resources to help physicians and hospitals enroll in the program. They include a website that lists more than 130 certified EMR systems (onc-chpl.force.com/ehrcert/).

Another site lists the 62 regional extension centers that can assist physicians in obtaining the bonuses (healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__rec_program/1495/).

Physicians who want to participate must register in either the Medicare or Medicaid EMR incentive programs. Participants must choose only one program — they cannot receive payments from both. However, after receiving a bonus for a given year, they may change their program selection once before 2015.

In 2010, CMS finalized standards that doctors and hospitals must meet to demonstrate meaningful use of their EMR systems. Physicians can receive as much as $44,000 over a five-year period through Medicare, and up to $63,750 over six years through Medicaid.

CMS on Dec. 22, 2010, announced several additional key 2011 dates for the EMR physician incentive program:

• January — Some state agencies begin issuing Medicaid EMR incentive payments.
• April — Participants begin to attest eligibility for Medicare bonuses.
• May — CMS begins issuing Medicare bonuses.
• Oct. 3 — Physicians have a final chance to begin their 90-day reporting period to demonstrate meaningful use in 2011.
• Dec. 31 — 2011 bonus payment year ends for eligible professionals.
  

Source : http://www.emrspecialists.com/2011/01/medicare-emr-incentive-program-begins-registration/

AMA Meeting: Physician Input Welcomed On Meaningful Use, CMS Official Says

San Diego — With stage 1 regulations for meaningful use released and discussion begun on stage 2, a federal official speaking at the AMA Interim Meeting called for more feedback to ensure these regulations will be workable for physicians.

“We need to work together and make sure that meaningful use ehr is defined and carried out appropriately,” said Betsy L. Thompson, MD, DrPh, chief medical officer for the Centers for Medicare & Medicaid Services’ Region IX office in San Francisco. She spoke during an educational session at the meeting. Based on a show of hands when she asked the crowd about EMR use, about half of the participants had an EMR in their offices, and the remainder were considering getting one.

Stage 1 rules are intended to increase adoption of health information technology, stage 2 rules are meant to change the process of care, and stage 3 rules are for improving outcomes. “Right now our emphasis is for practices to adopt and start to use these systems,” Dr. Thompson said. “At stage 2, we expect processes of care to change so that we can truly improve outcomes and population health by stage 3.”

Achieving meaningful use at the three stages qualifies physicians for financial incentives for using electronic medical records. They were part of the 2009 economic stimulus package. While finalizing meaningful use standards for stage 1, CMS received more than 2,000 comments, including those from the AMA and other medical associations.

“We had to read and respond to each, and the comments improved the rule substantially,” Dr. Thompson said.

This led to stage 1 rules being issued with more flexibility for physicians and deferral of some early requirements, but the AMA continues to request improvements.

“These are challenging times. … It is worth the effort to be able to collect data and collaborate with each other for the betterment of the patient, but we have reasons to be concerned and worried about what the future holds,” said AMA Trustee Steven J. Stack, MD.

Stage 2 of meaningful use is scheduled to begin in 2012.

Source : http://www.myemrstimulus.com/ama-meeting-physician-input-welcomed-on-meaningful-use-cms-official-says/

Hospitals Integrating Their Medical Devices and EMRs

A third of hospitals have integration between medical devices and electronic medical records, allowing data recorded on the devices to be uploaded automatically into EMR, according to a survey released Dec. 1 by HIMSS Analytics.

Most hospitals that have linked devices and EMRs said they believe it saves staff time by eliminating manual documentation.

HIMSS Analytics, part of the Chicago-based Healthcare Information and Management Systems Society, surveyed 825 U.S. hospitals on their use of medical device utilization. It found the devices most likely to be interfaced are intelligent medical device hubs (networked diagnostic equipment that provide data streams) and physiological monitors.

Recording and charting vital signs is one of the core measurements of stage 1 meaningful use. The Centers for Medicare & Medicaid Services meaningful use incentives offer hospitals a base payment of $2 million each from Medicare and Medicaid. Although the stage 1 meaningful use criteria do not require the charting to be done automatically, many believe integration between medical devices and EMRs will be required later.

“The transfer of data directly from a medical device to the EMR can reduce potential medical errors and improve patient care, because no manual transfer of data takes place,” said John Daniels, vice president of health care organizational services for HIMSS. “Such data integration also improves workflow by saving time for clinical staff, a valuable benefit when looking at nursing shortages in health care.”

The report notes that hospitals are not yet conducting return-on-investment studies on the integration of the monitoring devices to EMRs. But some hospitals have reported that integration has saved time. St. John’s Medical Center in Jackson, Wyo., reports that integration of vital sign monitors to its EMRs has yielded a 60% time savings, because staff do not have to enter the data manually.

The report said a critical factor hospitals face is determining how to connect an intelligent medical device to an EMR.

For those that integrate some devices to an EMR, about half use a wired local area network to provide the connectivity. Only 8% rely solely on wireless LAN connections for the integration.

The report says hospitals will place more importance on integrating medical devices to EMRs when more is known about the stage 2 and stage 3 meaningful use requirements. The Office of the National Coordinator for Health Information Technology is working on stage 2 criteria.

Source : http://www.emrspecialists.com/2011/01/hospitals-integrating-their-medical-devices-and-emrs/

Terrific Head Start To Meaningful Use

CHICAGO – Hospitals across the country are on track to meet 2011 meaningful use criteria set by the federal government, according to new data from HIMSS Analytics. Nearly a quarter of the participating hospitals reported they could achieve 10 or more of the 14 required meaningful use core requirements today.

HIMSS Analytics, a subsidiary of the Healthcare Information and Management Systems Society (HIMSS), introduced Monday the first of what executives promised would be quarterly analysis of hospitals’ progress toward achieving meaningful use.

The 687 hospitals that responded to the HIMSS Analytics survey have the ability to meet some of both core and menu requirements for Stage 1 of meaningful use ehr. The final rules designate a “core” group of 14 requirements that must be met, plus an additional “menu” of 10 procedures from which providers must select five.

“It’s good to see that so many hospitals are in position to meet the criteria” said John P. Hoyt, executive vice president, HIMSS. “We’ve got a terrific head start.”

The key findings of the survey showed:

• Nearly one quarter (22 percent) of participating hospitals have the capability to achieve 10 or more of the required core measures in the meaningful use Stage 1 requirements.
• Some 34 percent of respondents have the capability to achieve between five and nine of the core measures for meaningful use.
• Just over 40 percent (40.47 percent) of the market indicated they have the capability to meet five or more of the menu items for meaningful use.

“Our data indicate that hospitals have the capability now to meet some of the requirements for meaningful use, which is significant in the lead up to the Medicare and Medicaid EHR Incentive Programs because they indicate that healthcare organizations continue to move toward implementation of health IT,” said Hoyt.

Michelle Glenn, senior director, product management at HIMSS Analytics, said the results of the survey are statistically significant at a 99 percent confidence level and a 5 percent margin of error.

Each quarter, beginning January 2011, HIMSS Analytics will release updated data and analysis on meaningful use compliance for healthcare organizations.

HIMSS Analytics, known for its annual analysis of health IT implementations at more than 5,000 U.S., non-federal hospitals, added questions on meaningful use to its annual survey of U.S. hospitals before the final rules were announced. Thus, the data reports on 12 of the 14 core and eight of the 10 menu requirements, since not all of the final requirements were initially included in the questions.

Source : http://www.myemrstimulus.com/terrific-head-start-to-meaningful-use/