WASHINGTON – After signing the healthcare reform bill into law on March 23, President Barack Obama traveled to Iowa and Maine to promote his vision, which includes the role of healthcare IT in saving lives and cutting cost.

Obama visited Iowa City, Iowa on March 25 and Portland, Maine on April 1.

At the Maine rally, Obama said passage of the healthcare reform law is a reminder that the country has the power to shape its own destiny.

“It has reminded us that we, as a people, do not shrink from a challenge,” he said. “We overcome it.”

Obama has had a history of supporting healthcare IT advancement, which includes a call for every American to have an electronic health record by 2014. The president requested $110 million in his budget this year, to strengthen healthcare IT policy coordination and research activities.

Last year, the administration backed more than $20 billion over 10 years to advance healthcare IT adoption in the American Recovery and Reinvestment Act (ARRA).

At the president’s rally in Portland, Maine Gov. John Baldacci touted healthcare IT as the means for improving quality of care, noting that Maine has been an early leader in the adoption of medical technology.

Information technology “plays a huge role” in medical reform, Baldacci told Healthcare IT News. “A huge role. It’s going to be through medical information technology that you’re going to enhance the ability of the providers to give quality care but also do it in a way that will reduce costs. It’s a critical element that needs to be part of this.”

David Howes, a physician and CEO of Portland, Maine-based Martin’s Point Health Care, said the reform law is “an enormous step forward.”

“The bill builds support for primary care and EHRs,” Howes said. “It contains flexibility and support for new models of care and Medicare quality and effectiveness measures. It is an enormous step forward for the American people and businesses.”

“I think it’s an opportunity for the president to help market the good parts of the bill,” said Gordon H. Smith, executive vice president of the Maine Medical Association, prior to the president’s visit. “I think it’s a battle for the hearts and minds of the public.”

Above article publish on http://www.healthcareitnews.com/news/obama-launches-national-campaign-sell-health-reform-health-it

There are hundreds and hundreds of Electronic Health Record software packages in the marketplace that claim to be capable of allowing you to establish meaningful use, but how do you know if those claims are true?  So far there has not been an impartial, independent way to determine the truthfulness of a vendor’s claims.

Earlier this month, the National Institute for Standards and Technology (NIST) rolled out the first part of its testing infrastructure, created in conjunction with the Department of Health and Human Services (HHS), vendors, implementers, standards organizations and certification bodies.  The American Recovery and Reinvestment Act of 2009 (ARRA) designated NIST as the agency responsible for determining if EHRs meet HHS standards for functionality, interoperability and technical benchmarks.

According to Bettijoyce Lide, NIST’s senior advisor, program coordinator for Health IT, speaking to Information Week Magazine, the goal is to establish a health IT infrastructure that provides a high level of security to American’s electronic medical records.  “New test methods, along with testing infrastructure, certification, security and usability help ensure that the health information of Americans is exchanged safely, securely, reliably, and only to appropriate sources,” she said.

NIST created the test procedures and infrastructure based on the Interim Final Requirements (IFR) published by HHS on January 13th of this year.   If those requirements change, NIST says it will change its test procedures accordingly. Plans call for tests to be rolled out in four waves.

Fifteen test drafts have been rolled out so far, each keyed to a specific requirement as spelled out in the IFR.  As an example, test criteria 170.302(b) relates to maintaining an up-to-date problem list, a key meaningful use requirement. The test will determine if the program will “enable a user to electronically record, modify, and retrieve a patient’s problem list for longitudinal care in accordance with (1),the standard specified in §170.205(a)(2)(i)(A), or, (2) at a minimum, the version of the standard specified in §170.205(a)(2)(i)(B).”

Other tests will evaluate a product’s ability to maintain allergy and medication lists, calculate body mass index (BMI) and track among history.  Additional tests will be rolled out over the coming weeks.

To keep stakeholders informed about the full extent of NIST’s activities in the health care certification arena, NIST has set up a special website with links to all of its major activities: infrastructure creation, test methods, conformance testing, and testing and support.   The overall program can be used by vendors to determine if their products will meet standards before it submits them for certification, and will be used by approved certification bodies to test those product offerings.

This NIST program puts into place one of the final pieces of the certification puzzle.  It will enable you to determine if a product which claims to be certified will actually perform the functions it says it can perform, because it has been tested and proven to meet the standards set forth by the HITECH Act and the definition of meaningful use.

Above article publish on http://blog.pchealthstop.com/?p=959

The Obama administration is implementing aggressive and expensive plans rooted in the president’s belief that EHRs are crucial to health care modernization and cost containment, says David Blumenthal, the Harvard information technology expert who serves as the United States government’s national coordinator for health information technology.

“It’s a very strong priority. The White House stays closely involved with our work,” Blumenthal said in an interview. “They’ve been extremely supportive.”

Key officials including the president’s chief of staff, budget chief and health secretary have displayed a “very tight alignment” regarding EHRs, Blumenthal notes. Congressional support is also strong, he says: “It’s remarkable how much they seem to get it.”

After promising to ensure that all Americans benefit from EHRs by 2014, Obama’s administration is now making a breathtaking financial investment.

Under legislation passed last year, the US government will invest as much as $27 billion in recently launched incentives aimed at encouraging physicians to abandon their paperwork and join the information age, estimates Blumenthal. Physicians can receive subsidies up to $44 000.

But the US government’s commitment doesn’t stop there: A further $2-billion is earmarked for coordinating the effort and ensuring success with key issues like the development and adoption of national standards for new electronic health record technologies.

Government leadership is showing results: crucial government-operated elements of the largely privately operated US health care system — such as the $47-billion Veterans Health Administration, which insures 23 million veterans and employs more than 239 000 staff at over 1400 sites — have almost completely implemented electronic health records, which are being made available to patients over the internet.

With the US now engaged in a crash program to put EHRs to work, some observers worry that the frenetic pace may be unrealistic and unsafe.

Dean Sittig, a medical informatics researcher at the University of Texas at Houston worries that even with huge investment in electronic records training programs, a lack of skilled labour poses risks as the technology is integrated into clinical setting.

Sittig also worries that many of the technologies are untested in clinical settings and may be far from fail-safe. “Many of these technologies are not mature,” Sittig warns.

Tom Leary, senior director for federal affairs at the Chicago-based Healthcare Information and Management Systems Society (HIMSS), says the escalation of federal investment from pre-Obama levels as low as $20 million to a total federal commitment now approaching $50 billion reflects the government’s belief that a national EHR system will create as many as 50 000 new jobs while propelling cost-saving efficiencies and health care improvements.

These benefits have been demonstrated at the VHA and within numerous privately operated systems such as Kaiser Permanente, which has invested at least $4 billion to implement EHRs within its system, which operates facilities delivering care to 8.7 million patients.

Leary notes that government expenditures are only part of the overall US investment in EHRs. According to data from HIMSS US hospitals will spend $1.9 billion in 2010 on information technology. Major health management organizations are investing billions more.

Leary says the next phase of the federal effort must address the need to ensure that patients achieve access to their records via the internet. “Putting EHRs in the hands of patients is the next step we’ve identified for the government.

Here again, federal leadership on this issue is providing instrumental, says Leary, who notes that the federal Office of Personnel Management, which manages health plans for millions of federal employees and retirees, is now legally required to ensure its health beneficiaries get access to EHRs.

For Canadian observers, the US approach is highly instructive — although in many respects, discomfiting.

Blumenthal’s Office of the National Coordinator of Health Information Technology is mandated to ensure that electronic health record products are not marketed without national certification — which Blumenthal says he views “as a kind of consumer protection.”

By contrast, Canada Health Infoway, which has received $2.1 billion from Ottawa since 2000 to coordinate and co-finance development of national EHR capabilities, has left certification in the hands of the provinces.

Last November, federal Auditor General Sheila Fraser warned that Infoway has applied an “inconsistent implementation of standards” that poses “a risk to national compatibility.”

Ten years after launching operations, Infoway has agreed to address this problem “on a go-forward basis, for new investment approvals.”

The US government’s approach to offering subsidies for physician implementation of EHRs offers another point of contrast.

While the US incentives are nationwide and accompanied by tough measures to ensure that physicians actually use the EHRs paid for with government subsidies, Ottawa has left physician implementation to the provinces and has not tracked implementation.

The federal auditor general signalled that this is unsatisfactory. “To ensure Parliament and Canadians have sufficient information about progress achieved, Infoway should report on the extent to which electronic health record systems have been adopted by health care professionals and are compliant with standards,” Fraser said in a report last November.

In response, Infoway has belatedly agreed to “endeavour to develop measures on the extent to which EHR systems have been adopted by health care providers.”

With two studies in press comparing Canadian and US approaches to EHRs, Robin Tamblyn with the McGill University Clinical and Health Informatics Research Group says US officials could learn from Canadian mistakes.

In many respects, Tamblyn believes, Canada’s approach to EHRs has overlooked patient needs.

While the US approach is strongly oriented to patient needs and a growing demand among patients for access to personal medical information, the Canadian approach “faces the barrier of being an old-fashioned system” in which decisions are seldom driven by patient involvement.

Bill Pascal, chief information officer for the CMA, also worries that EHR capability is being pursued using top-down approaches rather than patient-centred approaches, such as the push for patient utilization of EHRs underway in the US.

Above article publish on http://www.cmaj.ca/earlyreleases/23mar10-electronic-health-records-a-strong-priority-for-us-government.dtl

Health Level Seven has published the health IT industry’s first ANSI-approved standard for using EHR information in clinical research. The standard–known as Electronic Health Record Clinical Research Functional Profile and based on the HL7 EHR System Functional Model Release 1–is a roadmap for integrating data to support both patient care and clinical research processes, the Ann Arbor, Mich.-based standards organization says.

The standard is the result of two years of work by representatives of the pharmaceutical, biotechnology, health IT, clinical research IT and regulatory community in the U.S. and Europe. “This profile is an excellent demonstration of how important functional requirements for secondary data use, such as clinical research, can be integrated into the patient care work flow and documented in EHR systems,” says Donald Mon, vice president of practice leadership at the American Health Information Management Association and co-chair of the HL7 EHR Work Group.

HL7 says the standard is intended to complement the EHR-Clinical Research specification that the Health Information Technology Standards Panel is developing. It also will serve as a resource for the Clinical Research Work Group of the Certification Commission for Healthcare Information Technology, which is working to include clinical research criteria in CCHIT’s EHR certification program.

Above article published http://www.fierceemr.com/story/hl7-finalizes-standard-ehrs-clinical-research/2009-11-12

Healthcare providers will have the option to use electronic health record systems to report Medicare quality and electronic prescribing measures to CMS in some of its pay-for-performance programs next year, according to an announcement by the Centers for Medicare and Medicaid Services.

The revisions are designed “to promote adoption and use of electronic health records and to provide both eligible professionals and CMS with experience on EHR-based reporting,” CMS said in the Oct. 30 announcement.

They run parallel to efforts by the Office of the National Coordinator for Health IT to set up additional incentives for providers to measure and submit data measuring the quality of their treatments.

According to CMS, providers could use EHRs to submit information for the CMS’s Physician Quality Reporting Initiative (PQRI) program, which pays an incentive to eligible physicians and other healthcare professionals who report on specific quality measures for care for Medicare patients.

Providers also will be able to report e-prescribing usage through qualified EHR systems or registries, according to CMS. Currently, providers’ reports about e-prescribing are based on patient medical claims.

Under the fee schedule rule, providers for the first time will be able to count quality data submitted through electronic health record systems toward their eligibility for a PQRI incentive payment, CMS said.

Next year, those payments will be equal to 2 percent of their total estimated allowed charges for the reporting periods, CMS said. The final rule will appear in the Nov. 25 Federal Register.

The rule also streamlines reporting of e-prescribing and focuses on the actual use of e-prescribing by the provider. In 2010, providers will use one code for e-prescribing, but they “need to report this code at least 25 times during the reporting period to be considered a successful electronic prescriber,” CMS said.

The Medicare fee schedule puts into practice provisions of the Medicare Improvement for Patients and Providers Act of 2008, which established a program for incentive payments for e-prescribing over five years. In 2012, CMS will impose penalties on providers who are not “successful e-prescribers.”

Once CMS publishes the rule, it said it will accept comments on designated provisions of the final rule until Dec. 29. The policies become effective Jan. 1, 2010.

Above article published on http://www.govhealthit.com/newsitem.aspx?nid=72313

Interoperability

Blumenthal said his office is undertaking efforts to help different EHR systems connect and share data. He said, ‘We’re gonna be helping states to create interoperability capability, capabilities to link records, to link institutions.”

In addition, Blumenthal said federal officials are developing nationwide standards and certification criteria that will support EHR interoperability. He added that the standards discussions “will all be a very open and transparent process.”

Privacy and Security

Blumenthal also addressed concerns about whether EHR systems would compromise the privacy and security of personal health data.

He said regulations are in place to ensure that any health data used for research purposes are stripped of all individually identifiable information.

Blumenthal also said his office plans to work with President Obama’s new cybersecurity initiative to ensure that EHR systems have advanced encryption capabilities and other data protections.

Above article published on http://www.ihealthbeat.org/Articles/2009/10/16/Blumenthal-Officials-Working-To-Boost-EHR-Connectivity-Security.aspx

Dr. David Blumenthal, the national health IT coordinator, said yesterday his office will explain “in the coming weeks” how it will define a “certified” electronic health record,” which providers must purchase in order to qualify for new federal health IT incentive payments.

In an e-mail message, Blumenthal gave a preview of what further guidance providers should expect in coming months as his office works with the Centers for Medicare and Medicaid Services to finalize the set of requirements for “meaningful use.”

Under the health IT stimulus legislation, providers who are meaningful users of certified health IT will be eligible to receive increased Medicare and Medicaid payments.

“As efforts advance, we will turn our attention to other necessary supporting programs, some of which you will hear more about in the coming weeks, including defining what constitutes a ‘certified’ EHR, which is one of the requirements to qualify for Medicare and Medicaid incentives,” Blumenthal said.

Blumenthal said his office will also outline programs aimed at smoothing the transition process and identify steps that physicians and hospitals can take now to promote adoption of EHRs.

While awaiting the CMS rule, he urged providers to become “as familiar as possible” with the discussion of meaningful use criteria in the recommendations of the Health IT Policy and Standards committees, two panels advising Blumenthal.

The policy committee completed its second set of recommendations on meaningful use in July. “Be assured you will not be alone as you seek to adopt an EHR system,” Blumenthal wrote, citing grants for regional extension centers that would assist providers in establishing an EHR system.

The public will be able to comment on the definition, and CMS will consider those comments before the rule is finalized in early 2010. Any formal definition of meaningful use will include specific activities that health care providers need to perform to qualify for the incentives, he said.

Eligible physicians can receive up to $44,000 over five years under Medicare or $63,750 over six years under Medicaid for being meaningful users of certified EHRs.  Hospitals could receive up to four years of financial incentive payments under Medicare beginning in 2011, and up to six years of incentive payments under Medicaid beginning in October 2010.

Above article published on

http://www.govhealthit.com/newsitem.aspx?tid=10&nid=72159

In my coverage of the healthcare technology industry, I’ve noticed that many software and hardware vendors, clinicians, and even some analysts tend to use the terms EMR (electronic medical record) and EHR (electronic health record) interchangeably. However, according to the National Alliance for Health Information Technology (NAHIT), there is a distinct difference between the two.

The NAHIT defines EMR and EHR as follows:

EMR — The electronic record of health-related information of an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.

EHR — The aggregate electronic record of health-related information of an individual that is created and gathered cumulatively across more than one healthcare organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care.

In other words, an EMR is a somewhat siloed record of a single diagnosis or treatment, most likely used by a single practice or specialist. Meanwhile, an EHR is a more comprehensive record that is interoperable with and compiles information from multiple medical providers’ systems.

Don’t Judge A Software Package Based On Name Alone

Despite the NAHIT definitions, it’s obvious that the industry is still unclear on how to delineate EMRs from EHRs. For example, some software vendors brand their technologies as EHR platforms when, in reality, they don’t provide interoperability capabilities and would therefore be more accurately marketed as EMRs. At the same time, other vendors brand their products as EMR packages when they actually provide more comprehensive EHR frameworks. In fact, analysis of software packages currently on the market indicates that the latter is more likely to be the case, as most clinical records software vendors tend to brand their products as EMRs as opposed to EHRs. However, the term EHR does seem to be gaining popularity as it is the phrase used by President Obama in his healthcare stimulus talks and is the prominent terminology used in the American Recovery and Reinvestment Act of 2009 (ARRA).

Knowing that the terms used to brand clinical records software aren’t always accurate, you must dig deeper to ensure a software platform you’re assessing is equipped to meet the needs of your facility and your patients. Criteria to consider when evaluating EMR/EHR software include:

• Interoperability with current certification standards (CCHIT [Certification Commission for Health Information Technology], HL7 [Health Level 7])
• An ACID (Atomicity, Consistency, Isolation, Durability)-compliant relational database for data protection and the ability to recover fully from failure (not just restore from backup)
• Both thin and fat client support (i.e. remote control and direct control) to accommodate for the lower bandwidth of satellite offices
• Ease-of-use at the point of care
• A workflow that matches your practice and specialty

If you purchase a system that matches your requirements, it should provide a speedy ROI regardless of whether or not it is “technically” branded correctly.

Above article published on

http://www.ecmconnection.com/article.mvc/EMR-Or-EHR-Whats-In-A-Name-0001?VNETCOOKIE=NO

Successful electronic health record (EHR) adoption not only improves quality of care by making patient information easily accessible, it also provides valuable clinical decision support. In addition, organizations benefit from streamlined operations — enabling physicians to spend less time on charting and documentation, and more time engaging in face-to-face interactions with patients.

Despite these obvious advantages, however, many physicians are resistant to adopting EHR systems.

A number of factors account for this resistance. First and foremost, organizations are leery of the cost and disruption that can sometimes accompany the conversion from manual to automated processes. Second, a portion of older physicians — who often serve as the leaders in an organization — are typically less comfortable with new technologies than their younger counterparts. And finally, some physicians believe that taking the time to electronically document patient visits will negatively impact patient interaction because it means spending time in front of a computer screen rather than with the patient.

Kittitas Valley Community Health Information Network is an electronic information-sharing partnership linking 30 providers — about 90 percent of all primary care providers in the county — from seven locations. When we implemented our EHR system in 2007, we utilized several strategies that proved instrumental in overcoming anticipated obstacles and ensuring successful adoption:

1. Locate a physician champion. When identifying champions, we looked for those physicians who had a track record of adopting new technologies, were able to maintain positive attitudes despite occasional setbacks and, most importantly, were well-respected by their peers. These champions could clearly articulate the goals and enthusiastically promote the benefits of a fully functioning EHR system to other physicians — helping to encourage even initially skeptical providers to get onboard.
2. Set honest, realistic expectations for physicians and their staffs. The more complex and sophisticated an EHR system, the more challenges a practice might experience in the early stages of implementation. However, we found the potential productivity gains and cost savings ultimately outweighed any inconveniences. By ensuring that everyone understands that there will be a learning curve and that they will experience some growing pains on the front end, you can alleviate frustration and set a positive tone post-implementation.
3. Ask each location to designate a physician, nurse and administrative user to participate in several days of training with the EHR vendor. These “super users” were then available to help others navigate the EHR system, reducing the need for support while building staff camaraderie.
4. Prepare for the transition. In our case, each location went to an abbreviated schedule for two weeks — scaling back patient volume so that physicians and administrative staff would have adequate time to train on the new system. In hindsight, we would recommend that organizations allow a full month for staff to get comfortable and then gradually add back patient visits each week. For example, a practice might take four patient slots out of both the morning and afternoon schedules during the first week, three slots during the second week, two during the third week, and so on. Providing staff members with the opportunity to use the system while performing their daily routines enables them to learn at a comfortable pace.
5. Use a staged rollout. We did not do this during our initial implementation, but have used it several times with processes and changes adopted since. Within each location, two to three physicians, who were committed to the EHR system and willing to work through any stumbling blocks, were selected for initial implementation. Working with fewer physicians at the onset enabled the implementation staff to provide a strong support system, and helped ensure that any issues or concerns were resolved early in the deployment process. Once the first few physicians went live in each location, other providers were added two at a time. That way, each successive group of physicians could seek guidance from colleagues who were already using the system and could witness firsthand the successful utilization of an EHR system.

As an increasing number of health care organizations take advantage of the dollars offered by the American Recovery and Reinvestment Act to deploy EHR systems, it will become even more important to ensure timely and successful adoption of these systems. By setting realistic expectations among key stakeholders, identifying hurdles early and putting plans in place to proactively deal with any challenges that may occur, the likelihood of a smooth transition is significantly increased.

Above article published on

http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=202207&CP=2