Standards Panel Backs Quality Measures for ‘Meaningful Use’

On Tuesday, the Health IT Standards Committee approved quality measures and standards for how health care providers can demonstrate “meaningful use” of electronic health records by 2011, Government Health IT reports.

Under the federal economic stimulus package, hospitals and physicians who demonstrate meaningful use of EHRs will qualify for Medicaid and Medicare incentive payments.

The standards panel endorsed a matrix of 27 quality measures and 12 standards that build on each other to improve patient outcomes. The standards call for health care providers to use health IT tools for transmitting:

• Continuity of care documents;
• Discharge summaries;
• Inpatient and outpatient prescriptions;
• Laboratory test results; and
• Other structured health data.

The committee said health providers who have not yet adopted EHR technology could use certain unstructured data for 2011, provided that they work to eventually meet structured data standards.

John Halamka, co-chair of the Standards Committee, said the panel attempted to provide “comfort levels” to encourage physician compliance with the standards and quality measures. He said future criteria will require health care providers to meet stricter standards.

Stimulus Package Steps Up Health Data Privacy, Security

Health care providers are gearing up to meet the privacy and security provisions of the federal economic stimulus law, Healthcare Informatics reports.

Under the health IT provisions of the federal stimulus package, all entities that handle protected health information must comply with HIPAA privacy regulations. In addition, the stimulus law calls for health care providers to:

• Notify all affected patients within 60 days of a security breach;
• Report security breaches to the HHS secretary and prominent media outlets if the incident affects more than 500 individuals;
• Track all personal health information disclosures; and
• Upon patient request, provide an account of every disclosure for the previous three years.

Experts say health care facilities could face serious penalties if they fail to comply with the new security provisions of the federal stimulus package.

Lisa Gallagher, senior director of privacy and security for the Healthcare Information and Management Systems Society, said health care facilities have focused on the funding aspects of the stimulus law instead of the security provisions. She said health care executives “need to devote time to creating additional policies, procedures and processes for meeting these requirements.”

E-prescribing gains traction in Michigan

He gave up the paper pad four years ago and now only writes prescriptions for patients electronically.

While Dr. Richard Smith can’t specifically quantify the results, he knows without any doubt that e-prescribing has generated efficiencies in his medical practice.

“As you accept it in your practice, it’s a phenomenal tool,” said Smith, an obstetrician with the Henry Ford Medical Group and president of the Michigan State Medical Society. Smith, who’s been in practice for nearly 30 years, is among a growing number of physicians in Michigan and nationwide who now use e-prescribing, as health care rushes to catch up with other industries in the use of information technology. A June report shows Michigan is one of the leading states in e-prescribing rates, ranking third behind Rhode Island and Massachusetts. It moved up from fifth in 2007 and three spots from two years earlier.

In 2008, doctors in Michigan ordered 9.03 percent of all prescriptions electronically – 4.2 million new prescriptions and more than 603,000 refills – more than twice that of 2007 and more than quadruple the 2006 rate, according to Surescripts, a national provider of electronic access to health information that issues the annual Safe-Rx Awards to the top 10 states. The use of e-prescribing in other leading states has grown by similar rates since 2007. The rate in Massachusetts, for instance, grew to 20.5 percent in 2008 from 13.43 percent the year before and 8.80 percent in 2006.

Advocates of e-prescribing suspect Michigan’s 2009 rate is now in the mid-teens and say it will continue to rise rapidly. “We’re on a continuum right now,” Smith said. “We’ll see more and more.” At Grand Rapids-based health plan Priority Health, the e-prescribing rate by participating doctors was 14 percent as of May, up from just 3 percent at the end of 2008, pharmacy administrator Steve Marciniak said. Despite the strong growth in Michigan’s e-prescribing rate the past two years, Health Alliance Plan’s Denice Asbell says advocates need to maintain the push to go much further.

“Nine percent leaves a lot of room for growth and improvement,” said Asbell, project manager of purchasing initiatives at HAP, a unit of Henry Ford Health System.

A 20 percent e-prescribing rate is a “realistic goal” for 2009, Asbell said. “We’ve had a significant number of physicians come on board and start using the technology just since December,” she said. “Physicians are recognizing this is the way the world is going and they have to get on board. Patients are expecting it now.”

Helping to drive the rate higher is a 2 percent incentive payment for 2009 that doctors can receive from the federal Center for Medicare and Medicaid Services for e-prescribing when writing prescriptions for Medicaid and Medicare recipients.

In Michigan, Surescripts credits the February 2005 formation of the Southeast Michigan e-prescribing Initiative, or SEMI, with the growing adoption of e-prescribing technology by physicians. The group consists of representatives from Ford Motor Co., Chrysler and General Motors, Blue Cross Blue Shield of Michigan, Health Alliance Plan, the Henry Ford Medical Group, Medco Health Solutions and CVS Caremark Corp.

E-prescribing advocates cite its ability to improve the operating efficiency of physician practices and reduce potentially dangerous drug interactions in patients.

Since 2005, the use of e-prescribing in Southeast Michigan has generated a 24 percent reduction in the incidence of adverse drug reactions, according to SEMI.

Between 2005 and 2008, some 2.75 million prescriptions for patients were changed or canceled because the electronic network alerted participating doctors to a potential drug-to-drug adverse reaction, according to a SEMI analysis of 9.5 million prescriptions that were ordered electronically.

Doctors changed or canceled another 260,000 prescriptions because a drug allergy warning. A HAP survey of physicians found 77 percent agree that e-prescribing improves patient safety. Physicians also cited a reduction in staff time for handling prescription renewals, reduced pharmacy call backs and faster patient transactions at the pharmacy. The 500,000-member HAP estimates the collective administrative savings for Henry Ford Medical Group physicians at $560,000 annually. Another $540,00 a year is saved by reduced ER visits and hospital admissions resulting from prevented adverse reactions.

EHR adopters could face series of tighter standards

A work group of that committee delivered its first draft of recommended definitions of “meaningful use” of EHRs, a standard that providers must meet to qualify for subsidy payments estimated at $34 billion to be handed out by Medicare and Medicaid. The work group recommended instituting a series of increasingly complex meaningful-use requirements between 2011, the first “payment year” of the subsidy program, and 2015, the final year payments will be made before financial penalties for not adopting begin.

During those discussions, Anthony Trenkle, director of the CMS’ office of e-Health Standards and Services, said the requirements will not be “tiered” based on when the provider adopts an EHR after 2011. Instead, whatever meaningful use standards are applicable for the year the provider applies for an EHR subsidy are the standards that provider must meet, regardless of whether it is the provider’s first year of EHR implementation.

A 10-day public comment period opens today on the work group’s initial recommendations. Trenkle said the CMS hopes to have a final definition of “meaningful use” to put out for a 60-day comment period later this year, with final rulemaking not expected until early next year.

Electronic Records: EMR vs. EHR

Health IT industry news followers have probably noticed industry confusion and inconsistencies regarding terminology about what to call patient information that is collected and shared electronically.

In fact, analysts, vendors, journalists and practitioners all are guilty of using the terms electronic medical record (EMR) and electronic health record (EHR) interchangeably as if they are one and the same. In fact, these are two different terms that address two different sets of business needs with different — although overlapping — sets of features and capabilities. The distinction is more than minor semantics, and it’s crucial for health IT decision-makers to understand the difference.

Electronic record

To many, an electronic record is considered to be any clinical record that isn’t paper-based or hanging on a clipboard. The problem is, this doesn’t describe how the data will be used, gathered or shared. Will the electronic record be used only within the confines of a single office or practitioner, or within a single regional health system? Alternatively, will the data be shared across a wide range of different providers, such as specialists’ offices, labs, insurance providers and government agencies? For the sake of clarity and accurate understanding, it is important to distinguish between electronic records that can be shared widely and those that are designed to reside within a single organization.

When discussing digitized medical records, depending on the software vendor, geographic region, country or even the personal preferences of the presenter, the two terms — EMR and EHR — are being used interchangeably. Unfortunately, that distinction has been lost in the flood of material appearing in the literature.

According to the Healthcare Information and Management Systems Society (HIMSS), an EMR is a component of an electronic health record that is owned by the health care provider. The EMR is a set of applications and workflow tools that digitizes the creation, collection, storage and management of patient information within the confines of a single organization. An EMR system may touch clinical data repositories, lab applications and patient information management systems, among others — but all within the reach of a single organization.

EHRs, on the other hand, comprise as far as is possible, a complete and unified view of all the patient’s clinical assessments and care records drawn from across a wide region corresponding to all the providers who are seeing the patient — the totality of his/her personal data, state of health and delivered care. HIMSS defines EHR as a longitudinal electronic record of patient health information produced by encounters in one or more care settings.

An EHR consists of data provided from organizations throughout the service delivery chain — laboratories, providers, pharmacists, insurance payment records — as well as all of the patient’s personal data such as date of birth, address, weight, provider visits, and so on. These records can be shared easily across separate health care providers, labs, government agencies and insurance companies, made available whenever and wherever the patient is seen

Improved workflow

While both EMRs and EHRs provide some similar benefits — cost savings through improved workflow and paper reduction, improved delivery of care accuracy — EMRs provide those benefits only within a single organization. EHRs, because they are shared across the irrelevant geographic or otherwise defined region, increase the efficiency of patient care and improve patient outcomes, disseminate information rapidly between care providers, help with research efforts, and cut costs throughout the entire system more promptly and reliably.

The industry may be confused about what exactly is the difference between an EMR and an EHR, but there should be no confusion about the type of solution an organization needs. The benefits associated with sharing patient information with partners, suppliers and insurance companies can only be achieved through an EHR. In the years ahead, solutions that survive this rapidly changing market must be capable of sharing electronic patient information effectively both within an organization, between facilities and across regions. Health care organizations need to ensure that they are laying the groundwork today to make that future collaboration possible.

Obama budget reflects IT promise

Obama’s $3.4 trillion federal budget, released May 8, expanded the outline he presented to Congress at the end of February. It includes $879 billion for the Department of Health and Human Services, an estimated $63 billion increase over fiscal year 2009.

The Agency for Healthcare Research and Quality (AHRQ) is expected to receive $372 million to conduct research on comparative effectiveness, prevention and care management, value research, health information technology and patient safety. In addition, the AHRQ will use the funding to support research it conducts with other agencies.
The president’s budget for AHRQ will be in addition to the $1.1 billion allotted for comparative effectiveness research under the stimulus package.

Obama’s plan calls for $635 billion over 10 years as a “down payment” toward health reform. Health and Human Services Secretary Kathleen Sebelius called it “a smart investment.”

“No one should underestimate President Obama’s commitment to getting healthcare reform this year,” she said. “This budget sends a clear message that we can’t afford to wait any longer if we want to get healthcare costs under control and improve our fiscal outlook,” she added. The president has made it clear that he considers health IT as a major aspect of containing costs into the future.

David Blumenthal, MD, National Coordinator for Health Information Technology, said his office is “totally focused” on President Obama’s initiatives to establish healthcare IT. He called health IT “a critical pillar” in the plan to build more quality into American healthcare. Obama’s goal calls for every American to have electronic health records by 2014.

Though Obama clearly has much support, some are not sold. At a Senate Finance Committee hearing May 11, Ranking Member Chuck Grassley (R-Iowa) was skeptical about spending a lot on health reform, including health IT.

“It will be some time before this fairy dust turns to gold,” he said. Grassley did say that President Obama’s leadership would be “essential” in figuring out how to pay for health reform.

Electronic Prescribing Sees Significant Growth, Surescripts' Report Finds

Adoption of electronic prescribing has increased significantly since 2006, but further action must be taken to continue its growth, according to e-prescribing network Surescripts’ annual National Progress Report on E-Prescribing, Healthcare IT News reports.

Report Details, Findings

The report details the status of e-prescribing adoption and use in the U.S. from 2006 through 2008.

According to the report, more than 100,000 prescribers now are transmitting e-prescriptions (Merrill, Healthcare IT News, 4/22).

The report found that there were 74,000 active e-prescribers by the end of 2008, compared with 36,000 at the end of 2007 and 16,000 in 2006 (Surescripts release) (.pdf).

Meanwhile, the use of three critical e-prescribing components — electronic prescription benefit, history and routing — increased by 61% in the first quarter of 2009.

The report attributes the increase in e-prescribing to three factors:

• The attention e-prescribing received at the federal and state policy level;
• National programs that spur e-prescribing and offer practical tools to help the industry in adoption; and
• The adoption of e-prescribing by important groups, such as payers, subscribers and pharmacies.

Harry Totonis, president and CEO of Surescripts, said, “In the past two years, the U.S. has gone from 19,000 to 103,000 prescribers routing prescriptions electronically — punctuated by 39% sequential growth in prescriber adoption in the first quarter of this year.” He added that “while this growth shows clear evidence that the steps taken by policymakers, prescribers, payers, pharmacies and others are having a positive impact, swift and specific action is required for the U.S. to achieve mainstream adoption and use of e-prescribing.”

Surescripts’ Recommendations

Surescripts offered five recommendations to ensure the growth of e-prescribing use continues and to further realize cost reductions and improvements in safety and efficiency:

• Continue work with the U.S. Drug Enforcement Administration to pass regulations that permit controlled substances to be electronically prescribed in a way that is workable and scalable;
• Ensure the term “meaningful use” under the economic stimulus package requires the use of e-prescribing;
• Close gaps in e-prescribing participation among payers, state Medicaid programs and independent pharmacies;
• Promote awareness across the industry and encourage the use of e-prescribing, including prescription benefit, prescription history and prescription routing; and
• Provide education, financial incentives and implementation assistance to all prescribers, specifically focusing on the needs of small- and medium-sized practices (Healthcare IT News, 4/22).

Reports: Hospital Health IT Spending, EHR Market To Grow

For the report, titled “Essentials of the U.S. Hospital Market, 4th Edition,” HIMSS Analytics surveyed 5,100 hospitals.

The researchers projected that health IT would account for about 43% to 48% of total hospital capital budgets this year.

The projected figures are lower than 2007 levels, possibly as a result of the ongoing recession. However, the report predicts that health IT spending will increase over a longer time frame by a compounded annual rate of 7.5%.

The report identifies several factors that could account for the increase in health IT spending, including:

• Incentive payments for electronic health records outlined in the federal economic stimulus package;
• Increased clinical automation spending;
• New ICD-10-CM codes; and
• New 5010 standards for electronic claims.

Materials related to the report are available on HIMSS Analytics’ Web site (Anderson, Health Data Management, 6/4).

EHR Market Growth

In related news, a recent study by Kalorama Information suggests that the market for EHR applications and data transfer will increase from $575 million in 2008 to $1.6 billion by 2013, Healthcare IT Newsreports.

The report, titled “High-Tech Patient Monitoring Systems Markets,” predicts that the market will increase by 23.3% annually through 2013 as a result of increased EHR use in hospitals and physician offices.

The report also notes that EHRs are a key component of President Obama’s health care reform efforts because they have the potential to:

• Boost efficiency and accuracy;
• Cut health care costs;
• Improve patient outcomes and satisfaction;
• Provide greater physician freedom; and
• Reduce hospitalizations.

Stimulus money boosts health clinics serving poor

Homeless teenagers at a central Colorado shelter are feeling the effect of the government’s economic stimulus package. It’s the feeling of a dentist’s drill.

The 20 runaway youths living at the Urban Peak shelter had no regular dental care until this spring, when a $1.3 million stimulus grant to a community health center paid for a mobile dental and medical clinic to visit once a month. The residents now get medical and dental screenings, and cavities filled, right from their shelter’s parking lot.

“I knew my teeth needed to be fixed but I had no money,” says Michelle Daulton, 18, who has been living at the shelter for about four months and hadn’t seen a dentist since she was 13.

Now she’s had three chipped teeth repaired. “It was absolute and pure relief, I mean that,” she said.

From the Colorado homeless shelter to rural Pennsylvania clinics that can accept new patients, health centers that serve the poor are among the first places the federal stimulus package is being spent.

The stimulus law sets aside $2.5 billion for free and low-cost health clinics, and a big chunk of it – about $500 million – is already being spent. The White House has promised another burst of money this summer.

“This has really been a boost for us,” said Bob DeFelice, CEO of First Choice Community Health Care. “It’s allowed a level of stability in some very difficult times.” DeFelice’s group runs nine community health clinics around Albuquerque, N.M., and used a $703,000 grant to hire two physicians and four support staffers.

Health clinic executives say the money will allow them to keep their doors open as the rolls of uninsured patients grow. An estimated 64 million people use rural health clinics, a number that is expected to rise as people lose their jobs and health insurance.

“We’re seeing more and more people,” said Edward Michael, president of the Rural Health Corp. in Wilkes-Barre, Pa. The six-clinic group in northeastern Pennsylvania had no room for new patients until it received a $311,000 grant in April. Now, Michael says, his clinics can expand from seeing 18,000 patients last year to 19,000 this year.

“You know, we weren’t there back in the Depression, so we never experienced being back in the ’30s standing in line for food, standing in line for a doctor,” Michael said. “This money is really going to prevent a lot of long-term hardship.”

The health clinic grants are one-time boosts, not long term health care fixes. The stimulus won’t make up for a lack of doctors in poor and rural areas, a shortage the Association of American Medical Colleges says is growing and could reach 159,000 doctors by 2025.

“I look at the stimulus bill as one step to health care reform,” said Maggie Elehwany, vice president for government affairs and policy at the Washington-based National Rural Health Association. “It isn’t everything.”

While Congress considers a health care overhaul, clinic workers hope just to keep up with basic needs such as vaccinations and exams.

“I can’t imagine not having the stimulus money right now because we wouldn’t be able to do any of this,” said Nicole Noll, who drives the mobile health clinic to the teen homeless shelter and rural elementary schools.

The van was provided by Ronald McDonald House Charities. But stimulus money pays for Noll, the doctors and the dentists.

Far more than a brighter smile can be at stake in dentistry. In Maryland, a 12-year-old boy whose Medicaid coverage had lapsed, Deamonte Driver, died in 2007 after bacteria from the abscess of an aching tooth spread to his brain. An $80 tooth extraction might have saved his life.

“I’m so glad they did this,” Michelle Daulton said. “My parents were cheap. They never took me to the dentist. And when you don’t have any money, your teeth, you just leave ‘em alone. Not anymore.”

E-Health Records Planned Despite Stimulus Uncertainty

More than 50% of healthcare providers surveyed by IVANS do not believe the federal stimulus package will successfully encourage health IT adoption.

By Marianne Kolbasuk McGee InformationWeek

Although a majority of healthcare providers remain skeptical about how they’ll benefit by the federal government’s $20 billion stimulus program, many plan to forge ahead anyway, according to a report released this week.

About seven in 10 healthcare providers believe electronic medical records will have a positive impact on their businesses and patient care, but 80% say the lack of money is their biggest obstacle to deploying health IT systems, said the new report by IVANS, a supplier of EDI and network services to the insurance industry.

The nationwide, e-mailed survey of 508 healthcare providers — including hospitals, clinics, private medical practices, nursing homes, home healthcare organizations and medical billing companies — found that while nearly 40% plan to forge ahead with e-medical record deployments within the next 12 months, more than 50% of healthcare providers do not believe the federal stimulus package will successfully encourage health IT adoption.

Healthcare providers’ doubt appears to be rooted to several factor, most notably uncertainty about the specifics of the government’s eligibility requirements for receiving HIT-related rewards. Starting in 2011, the federal government is expected to begin awarding approximately $20 billion over the next five years, rewarding higher Medicare and Medicaid reimbursements to doctors and hospitals that demonstrate “meaningful use” of health IT.

However, the details of what will constitute “meaningful use” haven’t been worked out yet. The federal government is in the process of investigating and defining the scope of what “meaningful use” of health IT will qualify for the American Recovery and Reinvestment Act of 2009′s HITECH (Health Information Technology for Economic and Clinical Health) stimulus funding incentives. Just this week, a federal advisory panel — the HIT Policy Committee — unveiled some of its recommendations for the “meaningful use” definition.

“They’re on the right track,” said Clare DeNicola, IVANS CEO, of the HIT Policy Committee’s recommendation so far to the U.S. Dept. of Health and Human Services about the “meaningful use” definition. “It’s not about technology, it’s about the care — we can’t lose sight of that,” she said about the committee’s suggestions for how IT can be used for improving quality of patient care and public health.

Also fueling uncertainty among healthcare providers participating in the survey was this: Home healthcare providers and nursing homes were among the 508, healthcare providers polled. However, so far the HITECH federal stimulus legislations is vague on how those healthcare providers will participate in the new programs, despite the growing population of aging baby boomers who’ll likely increasingly require their services in coming years.

In fact, despite their skepticism and uncertainly about the government incentive programs, about four in 10 healthcare providers are planning to implement e-medical record systems over the next 12 months.

Many are already making investments in IT, including those that can help support e-medical record deployments, including wireless networks, business continuity technologies and connectivity to remote locations.

“Healthcare providers are wary but they are moving forward with technology innovations,” said DeNicola. “They’re not driven so much by the stimulus funds as they are in their belief that these technologies can help improve their businesses and patient care,” she said.