The final regulation divides goals into two sets. Providers, who include eligible professionals, hospitals, and critical access hospitals, must meet a core set of 15 objectives. They must also choose five items à la carte from a menu of 10 objectives.

The final rule represents a step back from a more demanding rule proposed in January which called for clinicians to meet 25 objectives and hospitals to meet 23 with no flexibility built in.

“We want providers to become meaningful users,” said David Blumenthal, national coordinator for health information technology at HHS. He called the goals ambitious, but achievable. “We want providers to be able to get on this escalator and stay on it.”

The changes allow providers to pick their own path toward full EHR implementation and meaningful use, Blumenthal said.

The final rule also lowered the bar on the use of e-prescribing. The proposed rule called for 75 percent of prescriptions to be done via e-prescribing; the new rule calls for around 40 percent.

HHS relaxed the goals in response to the 2,000 comments submitted on the rule proposed in January. Some complained that the proposed rule was too “all-or-nothing” and that it was too inflexible or too demanding. There were concerns about the pace and scope of the rule.

To be considered meaningful users, providers will have to meet certain targets related to EHR use. Some examples of required core measures include:

* Implement one clinical decision support rule
* More than 30 percent of patients with at least one medication in their medication list have at least one medication ordered through CPOE
* More than 50 percent of patients who request an electronic copy of their health information receive a copy within 3 business days

The menu of other measures includes these targets:

* Generate at least one listing of patients with a specific condition
* More than 10 percent of patients are given patient-specific education resources
* Medication reconciliation is performed for more than 50 percent of transitions of care

The goal of the announced rule is “to push the entire healthcare system forward while giving doctors and healthcare systems the flexibility to find their way, HHS Secretary Kathleen Sebelius said during a press conference. The regulation spells out how hospitals and clinicians must use EHRs to be considered meaningful users in 2011 and 2012, thereby qualifying for incentive payments.

The final rule will apply for the first two years, 2011-12. The rule likely will be modified for later phases, Blumenthal noted. For example, ideally, a health information exchange would make it possible for health information to follow patients as they move across systems and states. Right now, the capacity for such an exchange doesn’t exist yet. Later versions of meaningful use will demand more related to information exchange capabilities than the first version, Blumenthal said.

Some $27 billion in incentive payments will become available over 10 years, starting in 2011. Clinicians will be eligible for up to $44,000 through Medicare and $63,750 (through Medicaid).

Source   :    http://www.fiercehealthcare.com/story/hhs-relaxes-ehr-meaningful-use-rule-encourage-adoption/2010-07-13

The Certification Commission for Health Information Technology (CCHIT), Chicago, Ill. and the Drummond Group Inc. (DGI), Austin, Texas, were named today by the Office of the National Coordinator for Health Information Technology (ONC) as the first technology review bodies that have been authorized to test and certify electronic health record (EHR) systems for compliance with the standards and certification criteria that were issued by the U.S. Department of Health and Human Services earlier this year.

Announcement of these ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) means that EHR vendors can now begin to have their products certified as meeting criteria to support meaningful use, a key step in the national initiative to encourage adoption and effective use of EHRs by America’s health care providers.

“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.” said David Blumenthal, M.D., national coordinator for Health Information Technology.  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.”

Applications for additional ONC-ATCBs are also under review.

Certification of EHRs is part of a broad initiative undertaken by Congress and President Obama under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009.  HITECH created new incentive payment programs to help health providers as they transition from paper-based medical records to EHRs.  Incentive payments totaling as much as $27 billion may be made under the program.  Individual physicians and other eligible professionals can receive up to $44,000 through Medicare and almost $64,000 through Medicaid.  Hospitals can receive millions.

To qualify for the incentive payments, providers must not only adopt, but also demonstrate meaningful use of, certified EHR systems.  The law envisions that defined meaningful use requirements will help ensure that the patient and provider benefits of EHRs are realized.  Initial meaningful use criteria were defined in a final rule issued by the Centers for Medicare & Medicaid Services (CMS) on July 28.

In addition to the CMS rule, ONC also issued standards and certification criteria for EHRs on July 28, aimed at ensuring that EHR systems will support the specific tasks required under meaningful use.  Also, through regulations issued on June 24, ONC created a system by which technology review organizations could also qualify as ONC- ATCBs that will certify EHR products as meeting the requirements necessary for meaningful use.

With the initial two ONC-ATCBs now named, EHR vendors can apply to them for certification of their products.  By purchasing certified products, providers will have assurance that the products will support achievement of the meaningful use objectives.

“Multiple steps are underway to carry out the intent of Congress in supporting rapid and effective adoption of EHRs throughout our health care system,” Dr. Blumenthal said.  “The naming of initial ONC-ATCBs is one important step.  Actual certification of multiple vendors’ systems by the ONC-ATCBs is an important next step.  CMS is also working to create an online system for providers to register and attest for the EHR incentive programs. The first incentive payments are targeted to be made in May 2011.  Meanwhile, ONC is also carrying out new programs of technical assistance and training, especially for smaller hospitals and physician practices.”

Dr. Blumenthal said the Health IT initiative “is on an aggressive schedule to meet the urgent targets set by Congress and the President toward realizing the quality and safety improvements that we can achieve through health information technology.”

To learn more about the ONC-ATCBs named today visit www.cchit.org  and www.drummondgroup.com.

For more information about the ONC certification programs visit http://healthit.hhs.gov/certification.

For more information about other HHS Recovery Act Health Information Technology funding and programs, visit http://www.hhs.gov/recovery/programs/index.html#Health.

This news is published on : http://www.hhs.gov/news/press/2010pres/08/20100830d.html

“The good news is that if you choose a hospital with the best type of fully functional electronic health records (EHR), you will probably have a shorter treatment time and a much shorter overall stay in the emergency room,” said Assistant Professor Michael Furukawa, who authored the study. “However, I also found that if your hospital has just a basic electronic medical records system, efficiency could actually be worse than at emergency rooms with no electronic medical records at all.”

Furukawa said he examined data from the 2006 National Hospital Ambulatory Medical Care Survey. The nationally representative survey included records from more than 30,000 patient visits to 364 hospitals nationwide.

The study examined three categories: hospital emergency rooms with little or no electronic medical records; those with only basic electronic medical records, which lack more advanced functions like online access to certain test results; and emergency rooms with the best, fully functional type of electronic medical records systems.

Furukawa found that hospital emergency rooms with the best electronic medical records had 13.1-percent shorter treatment times, 23.5-percent shorter stays in the ER for patients eventually admitted to the hospital, and 21.3-percent shorter stays in the ER for patients who were treated and discharged without being admitted.

The study also found that hospital emergency rooms with only basic electronic medical records had a 47.3-percent longer wait time for patients specifically dealing with urgent or semi-urgent medical issues.

“Surprisingly, basic electronic medical records were associated with longer wait times on average, especially for patients arriving at the ER with truly urgent medical needs,” says Furukawa, “Therefore, the sophistication of health IT systems is important. Some hospitals may just plan to do the minimum necessary to get federal funding, and that may have unintended, negative consequences.”

Furukawa said he believes efficiency may improve over time as hospital staffers and others become more familiar with the basic systems.

“Partial electronic medical records are not optimal,” he said. “Don’t expect to go halfway to achieve the same efficiency and benefits. As the government is announcing its standards for health IT, this should be kept in mind.”

Furukawa’s new study, “Electronic Medical Records and the Efficiency of Hospital Emergency Departments” was recently published by Medical Care Research and Review.

Source   :    http://www.healthcareitnews.com/news/er-wait-times-reduced-22-percent-advanced-ehrs

This is a complicated issue, and the advice will vary from physician to physician, given his or her specific circumstances. There are, however, a few common facts that need to be taken into consideration.

As one healthcare consultant noted, putting in an EHR system in the office doesn’t instantly deliver value. It’s – rightly – what you do with the system. And that will require time, likely years, to reap the benefits of improved clinical outcomes of patients and perhaps derive new sources of revenues (such as charging agencies to send out data, etc.). The question is whether the physician has the time to develop value or meaningful use out of the EHRs.

There will be immediate benefits, such as data retrieval automation, which can cut down on office staff time doing low-priority tasks. Intangible benefits may surface in the form of increased patient satisfaction when appointments can be scheduled via e-mail or test results received electronically without staff intervention and time.

Another benefit is the elimination of duplicative tests, but until the fee-for-service model is replaced, this particular benefit is lost revenue for physicians. Although the industry is beginning to embrace such models as bundled payments and payments tied in with medical homes, the timeline for when we are completely rid of fee for service is fuzzy at best. Will the physician retire before that happens? If retirement is less than five years away, I’d say it’s unlikely we’ll see payment reform.

Choosing the most cost-efficient system and a vendor that guarantees achieving meaningful use criteria may remove some of the discomfort and uncertainty over the major changes. Certainly physicians should reach out to their local regional extension centers (RECs) to help with implementation and workflow and office reengineering.

The healthcare consultant made a number of good points. It’s not the end of the world if the physician’s practice does not have an EHR since many larger organizations have their own and simply have that acquired practice implement the system that they use. That’s what happened to my physician’s office, although the acquisition occurred more than five years ago, which was at a time when EHRs weren’t a hot issue, as they are now.

At any rate, David Blumenthal, MD, said that in the near future adopting health IT will be part of the cost of doing business and part of the profession. Who knows when that will be? But when that time does arrive, it may just matter who is fully using EHRs and who is not.

Source   :   http://www.healthcareitnews.com/blog/should-physicians-nearing-retirement-deploy-ehrs

Use of “certified EHR technology” is a core requirement for providers who seek to qualify to receive incentive payments under the Medicare and Medicaid Electronic Health Record Incentive Programs provisions authorized in the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH was enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009. The Centers for Medicare & Medicaid Services will soon issue final regulations to implement the EHR incentive programs.

Certification is used to provide assurance and confidence that a product or service will work as expected and will include the capabilities for which it was purchased.  EHR technology certification does just that:  It assures health care providers that the EHR technology they adopt has been tested and includes the required capabilities they need in order to use the technology in a meaningful way to improve the quality of care provided to their patients.

On March 10, 2010, the U.S. Department of Health and Human Services (HHS) issued a notice of proposed rulemaking (NPRM) entitled Proposed Establishment of Certification Programs for Health Information Technology. The NPRM proposed the establishment of two certification programs for purposes of testing and certifying EHRs —one temporary and one permanent.  The temporary certification program final rule issued today will become effective upon publication in the Federal Register.  The final rule for the permanent certification program is expected to be published this fall.

“By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system,” said David Blumenthal, M.D., M.P.P., national coordinator for health information technology.  “We hope that all HIT stakeholders view this rule as the federal government’s commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs.”

This final rule is issued under the authority provided to the National Coordinator for Health Information Technology in section 3001(c)(5) of the Public Health Service Act (PHSA) as added by the HITECH Act.

Source  :  http://www.hhs.gov/news/press/2010pres/06/20100618d.html

Digitized records provide a timely, cost-effective way to share patient information. If physicians aren’t using them in their private practices, they lose those benefits, as do the hospitals they work with. Paper records continue to be shuffled, putting patients at risk for medical mistakes, ill-informed treatment decisions, and unnecessary tests because hospitals and doctors don’t have easy access to information about recent tests, health histories, and other important data.

There are looming financial implications as well. The Health Information Technology for Economic and Clinical Health Act, part of last year’s stimulus legislation, provides more than $20 billion in incentives to doctor practices, hospitals, and other healthcare organizations that show they’re making meaningful use of EHR. A first round of rules defining what constitutes meaningful use was released last month and includes some requirements that providers be able to electronically exchange patient data; later stages of rulemaking are likely to include more stringent requirements.

At risk are incentive payments of as much as $64,000 for a physician practice. For hospitals with fewer than 50 beds, incentives could run as high as $2.5 million, and for ones with 500 or more beds, as much as $5.2 million, according to the American Hospital Association. Penalties for non-compliance start in 2015, when physicians and hospitals that treat Medicare patients would see a reduction in fee reimbursements.

Source : http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml?articleID=226200092&queryText=EMR

Eugene Heslin, MD, lead physician at Bridge Street Medical Group in the New York Hudson Valley, is one such physician champion. There’s an interesting element about Heslin’s story. His six-physician practice has been using EHRs since 2006. In 2009, it joined 10 other practices totaling 237 primary care physicians across 51 sites in the Hudson Valley region in adopting the patient-centered medical home model. Here’s the thing: Health IT was used to support the PCMH’s approach to care, which required physician office redesign.

The PCMH model is all about coordination of care and communication among a patient’s multiple healthcare providers, which could include inpatient, PCP, specialist, skilled nursing facility, and home healthcare. Try getting all the visits and results updated in real time for each provider by paper. If you succeed, no doubt you’ve expended a lot of time and resources.

There will be other new models of care that will require a more efficient means of communication and sharing of information. Health IT will be the infrastructure that enables that sharing and communication.

Heslin said that the federal incentives can help drive critical mass among his colleagues and create widespread adoption at the community level. Many say that health information exchange is what will make EHRs valuable. Once there’s widespread adoption, connectivity is the next step. So it’s important to get to critical mass.

Heslin was spot on when he said that we need “to develop efficiencies and logic systems that allow us to rationalize care – to care for our patients using more intelligent tools, more efficiently – and not ration care. Meaningful use moves us in that direction.” At a time when demand will far outstrip demand, the industry needs to be more efficient – not at the expense of the patient. Any time you can deliver clinical decision support, a comprehensive view of the patient, just to name a few, you are indeed rationalizing care. Important difference.

The industry needs more advocates such as Heslin to speak concisely and eloquently of the value of EHRs.

Source  :  http://www.healthcareitnews.com/blog/physician-champions-speak-out

As more organizations adopt electronic health records, physicians will have greater access to patient information, allowing faster and more accurate diagnoses. Complete patient data helps ensure the best possible care.

Patients too will have access to their own information and will have the choice to share it with family members securely, over the Internet, to better coordinate care for themselves and their loved ones.

Digital medical records make it possible to improve quality of patient care in numerous ways. For example, doctors can make better clinical decisions with ready access  to full medical histories for their patients—including new patients, returning patients, or patients who see several different providers. Laboratory tests or x-rays downloaded and stored in the patient’s electronic health record make it easier to track results. Automatic alerts built into the systems direct attention to possible drug interactions or warning signs of serious health conditions. E-prescribing lets doctors send prescriptions electronically to the pharmacy, so medications can be ready and waiting for the patient.

And while electronic health records require an initial investment of time and money, clinicians who have implemented them have reported saving money in the long term. With the efficiencies that electronic health records promise, their widespread use has the potential to result in significant  cost savings across our health care system.

The future looks bright, but the vision can’t become reality without first laying a firm foundation.

Helping us in this endeavor are the providers, software developers, health care administrators, patients, and others on the frontlines of health care. We talked with them about their experiences and expectations of health IT. We heard their aspirations and their reservations.   Our commitment to ensure privacy and security of electronic health records and health information exchange will remain at the forefront of all our efforts.  We are confident that what we’ve learned from these ongoing conversations will lead to the development of a structure designed to support and improve health care in this country.

The final rules recently released are the blueprints for that structure. The standards and certification final rule, released on July 13, 2010, helps ensure that certified electronic health records will have the capabilities necessary to achieve our goals. And now, with the release of the final rule for the meaningful use of electronic health records, we have a plan for how those capabilities can lead to better health care.

These rules are not an end in and of themselves, but provide us with a plan for the future.

I recognize the challenges and obstacles before us. Fundamental changes are difficult to undertake but I saw the difference an EHR made in my practice and I can clearly see where meaningful use of health information technology can take us.

Now that we have the foundation in place and the blueprints in hand, I encourage you to continue  your electronic health record adoption and implementation efforts so we can transform our vision into reality.

Source : http://www.healthcareitnews.com/blog/advancing-future-health-care-electronic-health-records

COLUMBIA, MO – Researchers from the University of Missouri are developing an electronic health record system aimed at meeting the needs of a population of older adults that’s expected to almost double in the next 20 years.

According to the U.S. Administration on Aging, there will be about 72 million older adults living in the U.S. who will require care from a workforce that is already projected to be lacking.

Researchers from MU are currently working on a solution they say may help alleviate some of the burden. They’re developing an EHR system that encompasses standard health assessments and those obtained through new technologies. The goal, they say, is to increase efficiency and accuracy, improve patient outcomes and reduce costs for long-term care.

“As the use of emerging technologies increases along with the older population, maintaining complete and accurate patient information can be overwhelming,” said Marilyn Rantz, professor in the MU Sinclair School of Nursing. “A comprehensive system that encompasses all measures, old and new, is the key to enhance and efficient clinical decision making.”

The EHR is being tested at TigerPlace, an independent senior-living facility in Columbia, Mo. According to the researchers’ initial findings, use of the EHR system can enhance nursing care coordination and advance technology use and clinical research.

“New technologies to passively monitor older adults’ health are being developed and are increasingly commercially available,” Rantz said. “The challenge remains to integrate clinical information systems with passive monitoring data, especially in long-term care and home health settings, in order to improve clinical decision making and ensure patient records are complete.”

Effective EHR systems display data in ways that are meaningful and quickly assessable for clinicians, Rantz said. With access to comprehensive data, clinicians can make more informed clinical decisions, better perform risk assessments and provide risk-reducing interventions.

Source: http://www.healthcareitnews.com/news/ehr-developed-long-term-care-holds-promise

ANN ARBOR, MI – CHIME’S analysis of the government’s final rule on electronic health records certification concludes that certification criteria will change, necessitating the ongoing need to certify health IT products for the foreseeable future.

The Office of the National Coordinator (ONC) released the final rule for the temporary certification program on June 24.

The permanent certification program will replace the temporary program as soon as Dec. 31, 2011. However, the analysis by CHIME (College of Health Information Management Executives) indicates that certification criteria will continue to change.

“CHIME found that the recently released final rule suggests that electronic health records will need to be certified on an ongoing basis, and that meaningful use criteria are likely to evolve over time,” the organization said in a statement it released Thursday.

To receive stimulus funds, eligible hospitals and providers that implement electronic health records must demonstrate that they are using them to improve care delivery and clinical results. The plan originally proposed by the Centers for Medicare & Medicaid Services would require providers to give evidence that their systems are achieving certain standards to show they’re using EHRs in meaningful ways.

The original plan anticipated that the measures for demonstrating meaningful use would get tougher every two years over the three stages of the program. Providers can enter the program at any time over the next four years by meeting Stage 1 meaningful use criteria.

While the industry is uncertain about the final shape of the meaningful use objectives that CMS will choose, the temporary certification final rule suggests that Stage 1 criteria could become tougher over time.

“Regardless of the year and meaningful use stage at which an eligible professional or eligible hospital enters the Medicare or Medicaid EHR Incentive Program, the certified EHR technology that they would need to use would have to include the capabilities necessary to meet the most current certification criteria,” the temporary certification rule notes.

Source: http://www.healthcareitnews.com/news/chime-analysis-indicates-continuing-ehr-certification