Posts Tagged ‘Health Information Technology’

HIT and EHR Workflows – Comments Requested

Tuesday, June 30th, 2009

Workflow.AHRQ Seeking Comments – The Agency for Healthcare Research and Quality (AHRQ) is seeking information from small- and medium-sized healthcare practices on tools for analyzing and redesigning workflows before or after an HIT implementation.

AHRQ is assessing existing research and evidence in the area of the impacts of health IT on workflow, its linkage to clinician adoption, and its links to the safety, quality, efficiency, and effectiveness of care delivery.”

Comments and Deadline – Comments should be submitted on or before August 24. Electronic responses should be addressed to WorkflowRFI@ahrq.hhs.gov.

To read the full notice published in the Federal Register and visit the project’s website, go to AHRQ’s National Resource Center for Health Information Technology.

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Loans for EHR Systems

Monday, June 29th, 2009

LoansU.S. Representative Kathy Dahlkemper (D-Pa.) has introduced a bill that would create the “Small Business Health Information Technology Financing Act,” designed to provide financing to solo doc’s and small physician practice groups for their acquisition of an EHR system. The text of the current draft of the bill appears below.

In addition to the reimbursements already available under the American Reinvestment and Recovery Act (ARRA) to physicians and hospitals, if this bill becomes law, physicians and small practice groups will have an attractive means of funding their ERH system investment on the front end. “Buy now and get reimbursed later” might not work for many smaller healthcare providers who lack the cash for their initial investement, and so this financing option could produce greater EHR adoption rates among smaller healthcare shops.

A BILL
To amend the Small Business Act to provide loan guarantees for the acquisition of health information technology by eligible professionals in solo and small group practices, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ` Small Business Health Information Technology Financing Act’.

SEC. 2. AMENDMENT OF SMALL BUSINESS ACT.

The Small Business Act is amended by redesignating section 44 as section 45 and by inserting the following new section after section 43:

`SEC. 44. LOAN GUARANTEES FOR HEALTH INFORMATION TECHNOLOGY.

`(a) Definitions- As used in this section:

`(1) The term `health information technology’ means computer hardware, software, and related technology that supports the meaningful EHR use requirements set forth in section 1848(o)(2)(A) of the Social Security Act (42 U.S.C. 1395w-4(o)(2)(A)) and is purchased by an eligible professional to aid in the provision of health care in a health care setting, including, but not limited to, electronic medical records, and that provides for–

`(A) enhancement of continuity of care for patients through electronic storage, transmission, and exchange of relevant personal health data and information, such that this information is accessible at the times and places where clinical decisions will be or are likely to be made;

`(B) enhancement of communication between patients and health care providers;

`(C) improvement of quality measurement by eligible professionals enabling them to collect, store, measure, and report on the processes and outcomes of individual and population performance and quality of care;

`(D) improvement of evidence-based decision support; or

`(E) enhancement of consumer and patient empowerment.

Such term shall not include information technology whose sole use is financial management, maintenance of inventory of basic supplies, or appointment scheduling.

`(2) The term `eligible professional’ means any of the following:

`(A) A physician (as defined in section 1861(r) of the Social Security Act (42 U.S.C. 1395x(r))

`(B) A practitioner described in section 1842(b)(18)(C) of that Act.

`(C) A physical or occupational therapist or a qualified speech-language pathologist.

`(D) A qualified audiologist (as defined in section 1861(ll)(3)(B)) of that Act.

`(3) The term `qualified eligible professional’ means an eligible professional whose office can be classified as a small business concern by the Administrator Small Business Administration for purposes of this Act under size standards established under section 3 of this Act.

`(b) Loan Guarantees for Qualified Eligible Professionals-

`(1) IN GENERAL- Subject to paragraph (2), the Administrator may guarantee up to 90 percent of the amount of a loan made to a qualified eligible professional to be used for the acquisition of health information technology for use in such eligible professional’s medical practice and for the costs associated with the installation of such technology. Except as otherwise provided in this section, the terms and conditions that apply to loans made under section 7(a) of the Small Business Act shall apply to loan guarantees made under this section.

`(2) LIMITATIONS ON GUARANTEE AMOUNTS- The maximum amount of loan principal guaranteed under this subsection may not exceed–

`(A) $350,000 with respect to any single qualified eligible professional, and

`(B) $2,000,000 with respect to a singled group of affiliated qualified eligible professionals.

`(c) Fees- (1) The Administrator may impose a guarantee fee on the borrower for the purpose of reducing the cost (as defined in section 502(5) of the Federal Credit Reform Act of 1990) of the guarantee to zero in an amount not to exceed 2 percent of the total guaranteed portion of any loan guaranteed under this section. The Administrator may also impose annual servicing fees on lenders not to exceed 0.5 percent of the outstanding balance of the guarantees on lenders’ books.

`(2) No service fees, processing fees, origination fees, application fees, points, brokerage fees, bonus points, or other fees may be charged to a loan applicant or recipient by a lender in the case of a loan guaranteed under this section.

`(d) Deferral Period- Loans guaranteed under this section shall carry a deferral period of not less than 1 year and not more than 3 years. The Administrator shall have the authority to subsidize interest during the deferral period.

`(e) Effective Date- No loan may be guaranteed under this section until the meaningful EHR use requirements have been determined by the Secretary of Health and Human Services.

`(f) Sunset- No loan may be guaranteed under this section after 5 years after meaningful EHR use requirements have been determined by the Secretary of Health and Human Services.

`(g) Authorization of Appropriations- There are authorized to be appropriated for the cost (as defined in section 502(5) of the Federal Credit Reform Act of 1990) of guaranteeing $10,000,000,000 in loans under this section. The Administrator shall determine such program cost separately and distinctly from other programs operated by the Administrator.’.

HIT/EHR Canada – Lessons for the United States

Friday, March 6th, 2009

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.

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Federal EHR Incentives – Required Certification

Wednesday, February 25th, 2009

January 5 UPDATE – Definition of “Meaningful Use”

ONCHIT has released “Meaningful Use” regulations that will impact EMR certification and providers’ qualification for ARRA EMR incentives. Learn more here.

July 17 UPDATE – Multiple EHR Certification Groups

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”.

July 16 UPDATE – 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:

    Allow patients to access their health records in a timely manner;

    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.

July 13 UPDATE – Definition of “Meaningful Use”

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.

    CCHIT comments
    The Markle Foundation comments
    The American Hospital Association (AHA) letter
    College of Health Information Management Executives letter
    The American Medical Association (AMA) letter and comments
    Healthcare Information Mangement Systems Society (HIMSS) comments
    eHealth Initiative comments

June 23 UPDATE – Definition of “Meaningful Use” – Standards and Certification Criteria

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.

June 16 UPDATE – Definition of “Meaningful Use”

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.

April 16 UPDATE – Definition of “Meaningful Use”

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.

April 8 UPDATE – HIT Standards Committee and HIT Policy Committee

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.

March 19 UPDATE – HIT Standards Committee and HIT Policy Committee

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.

March 12 UPDATE – Continuing Role for CCHIT?

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.

March 11 UPDATE – Serve on Standards or Policy Committee

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.

March 8 UPDATE – National Institute of Standards and Technology (NIST) – Role in Developing HIT and EHR Standards

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.

Feb. 26 UPDATE – “Billions for health records rest on NIST standards”

Great article from NextGov here.

Feb. 25 Original Post: Federal EHR Incentives – Required Certification

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.

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Incentives In Stimulus Could Benefit Software Vendors Less

Thursday, February 5th, 2009

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.

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House Passes Economic Stimulus Bill – Over $20 Billion For HIT

Thursday, January 29th, 2009

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.

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