Sierra Systems (British Columbia) has issued a white paper comparing the national health care information technology initiatives of Canada and the United States. Worth a read.
You can view the white paper here.
ONCHIT has released “Meaningful Use” regulations that will impact EMR certification and providers’ qualification for ARRA EMR incentives. Learn more here.
The Health IT Policy Committee has suggested that multiple groups engage in the certification of EHR systems. Previously, the Certification Commission for Healthcare Information Technology (CCHIT), a private organization, had a monoploy on EHR system certification. The Health IT Policy Committee also recommended that officials examine gaps between existing CCHIT certification criteria and the emerging definition of “meaningful use”.
The Health IT Policy Committee approved a work group’s revised recommendations for defining “meaningful use” of electronic health records. Current elements of the definition of “meaningful use” include:
Develop capabilities to exchange health information where possible;
Implement at least one clinical decision support rule for a specialty or clinical priority;
Provide patients with electronic copies of discharge instructions and procedures;
Submit insurance claims electronically; and
Verify insurance eligibility electronically when possible.
Read more here.
The comments period for the first release of a working definition of “meaningful use” ended on June 26. Following are links to comments submitted by a number of organizations.
The HIT Standards Committee is meeting today to discuss the application of standards and certification criteria to the definition of “meaningful use” of health IT (EHR). No additional information is available at this time.
The HIT Policy Committee today offered some criteria that it feels should be part of the definition of “meaningful use”. You can view the Meaningful Use Workgroup’s June 16, 2009 update here.
A workgroup of the HIT Policy Committee has until June 16 to deliver its recommendations for a working definition of “meaningful use” of electronic health records. If the Committee approves the definition, it will be forwarded to ONCHIT for approval and adoption.
The HIT Standards Committee has received over 1,000 nominations, but as of today, no appointments have been made.
The HIT Policy Committee has made 13 of 20 appointments.
By law, the Office of the National Coordinator for Health Information Technology (ONCHIT) must announce appointments to the HIT Standards Committee and HIT Policy Committee on or before March 31, 2009. ONCHIT has not been forthcoming with news about its progress toward filling these committee posts.
During a webinar today, CCHIT Chair Mark Leavitt said he is confident that HHS will select CCHIT as the certification body identified in the stimulus law because HHS has recognized CCHIT since 2006. He thinks there is not enough time to develop a new certification group because IT systems need to be certified within the next year to qualify for stimulus package bonuses.
The Office of the National Coordinator for Health Information Technology is seeking nominations to the HIT Standards Committee and HIT Policy Committee, both created under the American Recovery and Reinvestment Act.
The deadline for letters of nomination for both committees is March 16. The e-mail address is HIT_FACA_nominations@hhs.gov. The postal address is Office of the National Coordinator, Department of Health and Human Services, 200 Independence Avenue NW, Washington, DC 20201, Attention: Judith Sparrow, Room 729D.
As part of the Economic Stimulus Package, the NIST will receive approximately $20 Billion to fund its development of HIT infrastructure structure and related standards, including those impacting Electronic Health Records (EHR). You can access the NIST’s Project Statement here.
Great article from NextGov here.
The American Recovery and Reinvestment Act of 2009 (Economic Stimulus Bill) provides financial incentives for physicians and other healthcare providers to adopt electronic health records (EHRs). Physicians, hospitals and health systems will be eligible for the incentives through implementation of their first EHR system or completion of an ongoing EHR project. However, in order to qualify for the incentive payments, a deployed EHR system must be “certified”.
The Certification Dilemma – The certification requirements necessary to qualify for the federal EHR incentives are not known yet and may not be defined until late 2009 (or later). As of today, the EHR certification provided by a nonprofit think tank, the Certification Commission for Healthcare Information Technology (CCHIT), is the closest relevant certification standard in effect. But don’t necessarily rely on that certification to be the one adopted by the federal government when it decides what EHR systems will qualify for the financial incentives.
Stay Informed – On a weekly basis I will be tracking certification standards as they are promulgated by the Office of the National Coordinator for Health Information Technology (ONCHIT), including notice of “comments periods” during which members of the public are invited to comment upon proposed regulations.
If you want to stay abreast of these certification developments, check back often for additional details, or subscribe to the RSS feed below to automatically receive updates.
Click here to learn more about EMR Match™.
Not Like the Others – If you have tried other EMR selection tools or evaluators, you may have been disappointed for any number of reasons: 1) you thought the tool was objective and unbiased, but you found later that it is sponsored by an EMR vendor or multi-vendor reseller; 2) the selection criteria were too few or too many; or 3) your search for an EMR vendor was not narrowed sufficiently or it was narrowed too much. Your inital disappointment may have led to outright frustration in the form of unsolicited calls from EMR vendor salespersons.
EMRmatch is different. VERY different! EMRmatch has no ties to EMR software or ASP vendors and does not accept any commission, referral or finder’s fee from any EMR vendor or reseller. EMRmatch is entirely objective and unbiased. Further, the classification criteria within EMRmatch range beyond those within the other available EMR selection tools, whose classification criteria are limited to the typical EMR functionality points. You want to know how a given EMR solution will fit into your particular technical environment, and whether the necessary application support is covered by your existing resources. EMRmatch helps you with this important element of your EMR buying decision.
Extended Evaluation – EMRmatch transitions seamlessly over to EMRselect, a sophisticated electronic procurement tool that lets you interface with the EMR vendors you choose. You do not have to contact any vendor until you are ready, and you can remain anonymous to vendors for as long as you choose. As you move closer to a buying decision, you can use EMRselect‘s electronic RFI and RFP features to streamline the final stages of your vendor selection process.
Integration Support – After you have purchased your new EMR system, you can use EMRconsult to identify competent independent consultants who can assist with your installation, configuration and implementation needs. In most cases you can buy these additional services from your software vendor or reseller. EMRconsult simply gives you more choices. More choices increase your odds of finding the best EMR implementation expert for your needs. And finding the right expert can result in better implementation results, within a shorter timeframe, and with reduced impementation expense.
View the February 20, 2009 UPDATE to this post here.
The Vote – The Senate voted 61-37 to approve an economic stimulus bill that’s expected to cost $838 billion through 2019, according to the latest estimate from the Congressional Budget Office.
Work That Remains – The Senate will have to work with the House to settle differences between the approved Senate version of the bill and the $820 billion House version. Hopefully, those differences will be resolved expeditiously. A finalized version of the bill will be presented to Obama for his signature.
Text of Senate Bill – You can view the text of the Senate bill here.
EHR Incentives – Good news! The EHR incentives under TITLE IV—HEALTH
INFORMATION TECHNOLOGY, Subtitle A—Medicare Program, remain intact.
Preservation and possible creation of HIT jobs also remains intact. I am very pleased with this outcome. If you are, too, shout out to others by commenting below.
If you do not see a comments window below, click on this post’s title. You DO NOT NEED TO REGISTER in order to comment.
View the February 20, 2009 UPDATE to this post here.
Despite a vote to occur within the Senate in less than 24 hours, the text of consolidated Senate revisions to HR1 is not yet available. However, this from the United States Senate website, updated February 9, 2009. Presumably, this is the most recent (current) version of the Senate amendment affecting incentives available to EHR adopters.
Senate Amendment 570 to HR1 (scroll down to S.A.570) still contains the following language, verbatim, from HR1 regarding incentives for provider adoption of EHR:
“(B) LIMITATIONS ON AMOUNTS OF INCENTIVE PAYMENTS.–
“(i) IN GENERAL.–In no case shall the amount of the incentive payment provided under this paragraph for an eligible professional for a payment year exceed the applicable amount specified under this subparagraph with respect to such eligible professional and such year.
“(ii) AMOUNT.–Subject to clauses (iii) through (v), the applicable amount specified in this subparagraph for an eligible professional is as follows:
“(I) For the first payment year for such professional, $15,000 (or, if the first payment year for such eligible professional is 2011 or 2012, $18,000).
“(II) For the second payment year for such professional, $12,000.
“(III) For the third payment year for such professional, $8,000.
“(IV) For the fourth payment year for such professional, $4,000.
“(V) For the fifth payment year for such professional, $2,000.
“(VI) For any succeeding payment year for such professional, $0.
So, despite the headlines depicting broad HIT spending cuts by the Senate, it appears this little chunk of spending will be carried forward into the compromise bill.
View the February 20, 2009 UPDATE to this post here.
UPDATE – See the February 9, 2009 UPDATE to this post here.
The current Senate version of HR1, the “American Recovery and Reinvestment Act of 2009″, increases the amount of incentives available for EHR adoption. (Section 4201)
Status Quo Plus More EHR Incentive Dollars For Rural Eligible Professionals
“Eligible professionals” (which does not include “hospital-based professionals”) who are “meaningful EHR users” can receive up to $41,000 in EHR incentives over five (5) years. This provision is identical to the HR1 provision. Adding a new twist, “rural eligible professionals” are eligible for an additional 25% over the amount available to non-rural eligible professionals.
You can view the text of the Senate version of HR1 here. The EHR incentive provisions begin at Page 648.
The Senate will vote on its version of HR1 as early as next Tuesday.
So far, so good, for HIT and EHR within the economic stimulus package.
View the February 20, 2009 UPDATE to this post here.
ASP EMR To Gain Preference? – According to Bloomberg News, the economic stimulus bill approved by the House last week favors health IT firms that operate on an application service provider model over software vendors.
ASP Less Expensive Up Front – The House’s $819 billion economic stimulus package includes $20+ billion for health IT. The bill would provide financial incentives to physicians over time, rather than upfront, lump sum payments. This means doc’s and hospitals will likely opt for a less-expensive ASP EMR solution, versus investing in a locally-installed software package that is relatively more expensive to buy. Or so Bloomberg’s logic goes.
I Don’t Necessarily Agree – On the surface Bloomberg’s logic seems sound, but let’s face it. There’s a lot more to an EMR buying decision than initial cost.
Internet Interruptions – If I’m a doc’, and I’m about to make the leap to managing my practice electronically, I’m certainly going to think about the reliability of the sytem I choose. What if my internet connection goes down, or the speed of my connection bogs down to a snail’s pace? Am I supposed to stop seeing and scheduling patients, and stop prescribing their med’s, until my connectivity is restored?
Security – With all of the state and federal onus placed on practitioners and healthcare facilities to protect and secure patient health information, is it wise to allow such information to vaporize into the web cloud? I would love to see the indemnification provisions contained in an ASP EMR license agreement and the ASP’s terms of service. If anyone has an example, please do forward it on.
Long-Term Value – The fee basis for many ASP EMR arrangements is tied to revenue. Is it better to make a somewhat larger investment upfront, depreciate it over several years, and own it outright? Or, better to make the smaller upfront investment and share revenue indefinitely? I think many EMR buyers will opt for ownership and control of their EMR system.
Initial Costs – Lastly, another flaw in the Bloomberg analysis is the fact that locally-installed EMR systems (software versus ASP) are just not that expensive. You license the software, maybe buy some additional hardware, and it’s off to the races. For a small office practice, initial cost estimates for an EMR system vary from $3,000 to over $40,000. Certainly, wise buyers will do just fine with investing at the smaller end of this range. In the current House bill, independent (not hospital-based) providers can receive up to $15,000 in 2009, and a lesser amount each year thereafter, during a total incentive period of five (5) years. In my mind, the current incentive figures are more than adequate to support purchase of a locally-installed EMR system.
View the February 20, 2009 UPDATE to this post here.
UPDATE – See the February 9, 2009 UPDATE to this post here.
As the Senate works on its version of the Economic Stimulus Bill, CongressDaily is reporting the following amendments to the House version of the bill.
Reduce HIT Spending – So far, a reduction of the amount of HIT spending and incentives has not been attacked in the Senate. Good news for those of us who work within and touch HIT.
Health Care Disparities – In an effort to eliminate healthcare disparites, this amendment would require that electronic health records collect information on race, ethnicity and gender.
Health Privacy Violations – Changes would allow state attorneys general to file class-action lawsuits against violators of federal health privacy laws, and prohibit states from hiring outside lawyers on a contingency basis to ensure that damages collected are returned to taxpayers.
Data Breach Notification – Changes are aimed at closing loopholes that would in many cases prevent consumers from knowing if their medical information has been improperly accessed.
Quality Initiatives – An amendment that would exempt quality initiatives, such as disease management and care coordination efforts, from a provision that requires the HHS secretary to issue new health care operations rules.
So, thus far, all good news in terms of maintaining substantial funding for HIT. This happens to be the objective that I care about most right now–a good chunk of HIT spending that is cemented into the final bill. We can worry about the peskier of details later, in my opinion.
View the February 20, 2009 UPDATE to this post here.
UPDATE – See the February 9, 2009 UPDATE to this post here.
The House version of the Stimulus Bill passed on January 28, 2009 and is worth some $819 Billion. The Senate will vote on its version of the bill next week, which is worth close to $900 Billion and includes an additional $3 Billion for HIT.
Funding That Will Become Available
The bill creates the “Health Information Technology for Economic and Clinical Health Act” or the “HITECH Act”. You can view the approved House version of the HITECH Act here (scroll down to Page 30).
Independent Professionals
Under the HITECH Act, “eligible professionals” (which does not include “hospital-based professionals”) who are “meaningful EHR users” can receive up to $41,000 over five (5) years. (Section 4311)
Hospital-Based Professionals
“Hospital-based professionals” are not excluded from incentive payments, but their eligibility and maximum incentives will be extablished through subsequent rulemaking. (Section 4311)
Hospitals
“Eligible hospitals” that are “meaningful EHR users” will receive a “base amount” ($2 Million) plus a “discharge amount” (based on annual Mecidare discharges), times a “transition factor” applied over five (5) years. The transition factor starts at unity (1) for the first year, and declines to zero (0) in the fifth year. (Section 4312)
Positive Effect
There will always be naysayers and detractors, but to me these are substantial sums, and they demonstrate the federal government’s commitment to HIT (though mixed with its commitment to economic stimulus). These monies will no doubt save many HIT jobs–not just within hospitals and clinics, but across HIT vendors and consultancies–and in the best of worlds, the dollars may be sufficient to create new HIT jobs over time.
NOTE: The figures above are based on my quick read of the House version of the HITECH Act, which has not yet been enacted. My interpretation of this version may not be accurate, and in all events, all of its provisions are subject to further revision and amendment prior to enactment.
