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/

Healthcare iPad Deployment To Approach 70% In 2011

Results from a survey of nearly 950 Healthcare Information and Management Systems Society (HIMSS) members indicates that iPad deployments are accelerating in large part due to the mobile device’s compelling point-of-care applications and uses.

Conducted October 26 during an online webinar cosponsored by HIMSS and BoxTone, a mobile service management (MSM) company, the survey’s results were released earlier this month.

Data showed that nearly 70% of the attendees were from hospitals or healthcare organizations with more than 1,500 employees, and 15% of attendees were executive-level staff or physicians.

More than 25% of the HIMSS respondents plan to deploy the iPad and other iOS devices immediately and nearly 70% plan to deploy the devices within the next year.

One-third of respondents identified point-of-care applications — including lab order visualization and results, clinical decision support, and medical image viewing applications — as top priorities, while 18% identified general administration, including billing, coding, and claims applications, as top priorities.

Nearly 75% identified secure configuration and deployment as the number one iPad IT management challenge, and 53% identified mobile application deployment as a key issue.

Lynne Dunbrack, analyst with IDC Health Insights, said security will remain a top concern for healthcare CIOs, especially if clinicians bring in their own devices to access the hospital’s healthcare information systems, such as electronic medical records (EMRs) and computerized physician order entry (CPOE) systems.

“As more patient information is moved into EMRs and made accessible both inside and outside the organization via a range of devices, including mobile devices and tablets, the risk of a privacy breach rises. Organized deployment and virtualized clients will help to mitigate this concern,” Dunbrack said.

Dunbrack also noted that the iPad, which has a sleek design, an intuitive user interface, and a large screen (relative to a smartphone), is becoming increasingly popular among clinicians. As the iPad gains traction among healthcare providers, EMR vendors will develop bidirectional integration between their EMR applications and clinicians’ mobile point-of-care devices such as smartphones and tablets.

Vendors are also developing EMR applications specifically for the iPad, Dunbrack observed. One example is St. Louis-based ClearPractice, a company that develops Web-based ambulatory EMR and revenue cycle management applications. ClearPractice recently launched Nimble, a comprehensive EMR application designed and developed specifically for the iPad.

Alan Snyder, BoxTone’s CEO, said in a statement that the iPad is redefining how organizations leverage mobile technology in the enterprise and the healthcare community is leading this paradigm shift.

“As these devices are used more frequently at the point of care, IT must ensure both data security and privacy, as well as superior remote connectivity,” Snyder said.

Source : http://www.emrspecialists.com/2010/12/healthcare-ipad-deployment-to-approach-70-in-2011/

Making Meaningful Use Meaningful for Patients and Health Care Providers

HHS recently released a package of regulations clarifying the definition of achieving “meaningful use” of electronic health record systems. Eligible providers and hospitals must meet the meaningful use criteria to qualify for government incentives and bonus payments for the adoption of EHR systems. The regulations signify a milestone accomplishment in moving forward our nation’s commitment to the universal adoption of EHRs.

Each day, the American health care system conducts more transactions than the New York Stock Exchange, most of them on paper and at risk of human error. The Institute of Medicine estimates there are between 44,000 and 98,000 deaths attributed to medical errors each year, and while not all errors can be precluded by the adoption of EHRs, there is no question that standardized, interoperable systems will move us in the direction of improved quality and efficiency and reduced errors and waste.

We expect to experience bumps along the way. The core criteria for meaningful use cover several domains, and stakeholders provided a great deal of feedback to HHS after the proposed rule was issued. While changes were made, there remain some issues that may not directly be addressed by HHS but have widespread implications. I offer several for discussion below and request feedback from iHealthBeat readers.

1. EHRs and health care professionals ineligible for government incentives: In its current form, the monetary incentives provided by the federal government (which could total $44,000 under Medicare and $63,750 under Medicaid for eligible providers) are not broadly applied to the entire spectrum of care providers. For example, while physician assistants and nurse practitioners are eligible for the Medicaid EHR incentive program, they are not eligible for the Medicare EHR incentive program. In parts of our nation, particularly in rural and isolated areas, nurse practitioners and physician assistants provide independent and critical care to Medicare patients. While they always work closely with physicians, they may be located hundreds of miles away.
2. Meaningful use ehr, bending the cost curve and quality of care: The widespread adoption of EHRs is expected to significantly improve the quality of clinical care; however, without concerted effort and commitment, the opportunity for bending the cost curve and improving quality of care could go unrealized. Most health systems have already made and will continue to make large investments in interoperable EHR systems, spending tens of millions of dollars on systems that will push them farther along the meaningful use spectrum. This does not, however, inevitably translate to an immediate return on investment; moreover, it may not be enough to change the quality paradigm of an institution. For example, the Veterans Health Administration has an EHR system that goes above and beyond the meaningful use criteria, but recent studies have shown that the VHA’s quality of care is variable across the country. This demonstrates that even the most sophisticated and robust EHR is not alone a panacea.
3. Implications for patient-centered care: There is no question that wiring the country is a step in the right direction, but will patients notice? And if so, will they like what they see? Many patients (including my own) express concern that their doctors spend more time typing on the computer than talking to them. In an age when we are embracing patient-centered care, where can health IT fit in the patient-doctor relationship? What functions of health IT do patients care most about? Potentially the following:
   

• The ability to schedule appointments with clinicians online during or after official office hours;
• A mechanism to receive relevant health advice or recommendations online; and
• An integrated and meaningful capacity for discharge instructions after a hospitalization. (Given the emphasis on discharge instructions and clinic visits in the core set of criteria, the next step is a patient-centered approach to ensuring that a clinic visit in the outpatient setting related to a hospital discharge is also “bundled” together with the original hospital visit, creating a more integrated picture of a particular patient’s care continuum.)
  

Health reform has brought many changes to the health sector, most of which have been long overdue. With 58.5% of practices still using only pen and paper, we need to take advantage of this wave of change, push our comfort limits, and think about how best to augment, complement and modify the existing criteria to rekindle and reinvigorate the very reason we all went into health professions — to deliver the best care for our patients to the best of our ability.

Source : http://www.myemrstimulus.com/hhs-panel-seeks-public-input-on-2013-quality-measures/

Officials Preparing Adjustments to Meaningful Use Final Rule

CMS soon will release modifications for certain provisions in the final rule for Stage 1 of the meaningful use ehr incentive program, Government Health IT reports.

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

Tony Trenkle — director of the Office of e-Health Standards and Services at CMS — said the adjustments to the meaningful use criteria currently are undergoing a federal clearance process, which is the final step before publication. Trenkle spoke on Wednesday during a Health IT Policy Committee meeting.

Trenkle added that CMS also will release guidance for health care providers on how to meet quality measures in the incentive program.

Discussion of Stages 2, 3

During the meeting, the Policy Committee also considered what incentive requirements to include in the next stages of the meaningful use program.

Committee members discussed whether Stage 2 meaningful use requirements — which are expected to go into effect in 2013 — should be incrementally built on requirements from Stage 1, or if there should be a set of larger steps framed around measuring and improving patient outcomes.

Paul Tang — chair of the meaningful use work group and chief medical information officer at the Palo Alto Medical Foundation — said the committee would prefer to establish the Stage 3 goals for 2015 first and then backtrack to form Stage 2 requirements.

Committee member Latanya Sweeney — director of the data privacy lab at Carnegie Mellon University — said future meaningful use criteria should incorporate privacy regulations (Mosquera, Government Health IT, 10/20).

National Coordinator for Health IT David Blumenthal said that the rollout of Stage 1 of the meaningful use criteria “was very rushed” (Conn, Modern Healthcare, 10/21). He added that the next stages should focus on infrastructure and interoperability.

Time Frame

Tang said that the meaningful use work group aims to have draft requirements for Stages 2 and 3 by Nov. 19, adding that it will revise the draft after taking comments from the full Policy Committee.

He said final recommendations could be submitted to the Office of the National Coordinator for Health IT by the third quarter of 2011, while CMS could release a notice of proposed rulemaking on the next stages by the fourth quarter of next year (Manos, Healthcare IT News, 10/21).

Source : http://www.myemrstimulus.com/officials-preparing-adjustments-to-meaningful-use-final-rule/