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Interview with ICSA Labs About EHR Certification

Posted on January 31, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

After hearing the news about CCHIT shutting down it’s EHR certification business, I thought it would be interesting to interview ICSA Labs, the EHR Certification body that CCHIT recommended to its users. The following is an interview with George Japak, Managing Director at ICSA Labs.

Is there a backlog of EHR vendors that want to schedule test dates with ICSA labs?  

A: There is no backlog. Since ICSA Labs received its ONC authorization, it has been our intent to grow our healthcare programs and offer the best testing and certification program in the industry. Over time we have ramped up our testing team and we have a deep pool of very experienced testers on staff. We have been getting a steady stream of news customers and inquiries and expect the CCHIT announcement will accelerate the pace.  At this point we have the capacity to test applicants as they are prepared to do so.

Is ICSA Labs able to support the onslaught of EHR companies that will come over from CCHIT?  Will that cause any delays on getting EHRs certified?

A: ICSA Labs at this point does not anticipate any delays. The ONC program was designed so that vendors and product developers would have a choice when it came to testing and certification. We were not the first lab to be authorized, but we knew that given the opportunity we would be able to deliver a program where customers would experience high satisfaction.

In my post, I suggested that the economics of EHR certification aren’t all that great.  Especially if you have a legacy cost structure like CCHIT.  Is the secret to ICSA’s success having a broader certification business beyond just EHR?

A: ICSA Labs has been in business since 1989, we have a number of accreditations to support an array of certification and testing programs, such as the IHE USA Certification program which just kicked off its second year at the 2014 IHE North American Connectathon. Our business is diverse and we leverage our capabilities across our business. We are used to doing business in competitive markets, so it has always been important for our programs and cost structure to emphasize efficiency and effectiveness and those benefits are passed onto our customers. Our testing and certification programs have always been competitively priced and efficient yet rigorous and done superior quality.

How much more complex is 2014 EHR certification compared with 2011 from an ONC-ACB perspective? 

A: As any recently certified company can attest to, the 2014 Edition criteria are significantly more complicated than the 2011 Edition. There are more test tools to maintain; more test data sets to review; frequent revisions and updates to the criteria and additional types of attestation to review. The time to complete testing has close to doubled and there are more requirements as they pertain to surveillance. After the 2011 Edition criteria, ICSA Labs asked for ONC to raise the bar, and they did. For ICSA Labs the added complexity was not unexpected.

The timelines for meaningful use stage 2 are starting to get squeezed.  Will the majority of EHR vendors be 2014 certified and ready in time?

A: There will always be stragglers, but I believe a majority of EHR vendors will be 2014 certified and ready in time for Meaningful Use 2. There has been an uptick in the vendors getting certified over the last few months. Providers and hospitals however are a different story, and they may feel the squeeze in terms of the timeline to purchase, implement and begin meaningfully using their EHR system. ONC extended the Stage 2 timeline to relieve some of that pressure.

I’ve heard that in some cases the ONC-CPHL has been slow at putting up newly certified EHRs.  Have you seen this?  Do you have a bunch of 2014 certified EHR vendors that haven’t been listed on ONC-CPHL yet?

A: The ONC-CHPL is generally responsive to our concerns and we work with them as they continue to refine new features like links to the public test results summary.

Bill Would Allow Mental Health Providers To Get MU Incentives

Posted on November 25, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Right now, mental health providers aren’t eligible to get Meaningful Use incentive payments — but a new bill would make that possible.  U.S. Senator Rob Portman, a Republican from Ohio, has filed legislation that would add mental health providers to HITECH, making them eligible for payments if they meet Meaningful Use standards, according to a story in Healthcare IT News.

The bill, the Behavioral Health Information Technology Coordination Act, is intended to “fix an oversight in the system,” said Portman in a press statement announcing its filing. “”[By] making IT the bedrock to fully integrated care, my bill will enhance care and treatment for the mentally ill and put them on a path to lead healthy and productive lives.”

The announcement drew praise from a mental health trade organization in Portman’s home state. The CEO of the Ohio Council of Behavioral & Family Health Services Providers, Hubert Wirtz. “Adequate investment in healthcare information technology is critical to enabling mental health and addiction providers to implement systems that help them improve care coordination, provide quality care, measure outcomes and enable continuity of care between primary care, mental health and addiction services,” reports HIN.

However, it seems that Portman’s bill may not reach a vote, as it now sits in a congressional committee, the HIN story notes.

Regardless, though, Portman’s proposal is a good one. Good mental health outcomes, which the right EMR can enhance, can do much to address the health of a population, empowering consumers to take better care of their physical health.  What’s more, encouraging behavioral health providers to have a mental health EMR in place can share their findings smoothly with care managers (ideally PCPs) who can do their part to provide integrated care. All told, this seems like an idea whose time has come.

Non-Profit Achieves Meaningful Use For In-House EMR

Posted on October 23, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Most organizations hoping to achieve Meaningful Use milestones buy their way in, by acquiring certified technology from an established EMR vendor. However, there are still some organizations that are working to create in-house technology that meets Meaningful Use standards.

One such organization, the Massachusetts eHealth Collaborative (MAeHC), recently achieved a nice win by meeting all three Meaningful Use Stage 2 requirements for its in-house-built EMR module, according to a report in Information Week. To meet certification criteria, modular EMRs must use the Quality Reporting Document Architecture Type 1 document to capture and input the data electronically.

MAeHC, a not-for-profit health IT organization, has created a modular EMR for clinical quality measurements (CQM) reporting, which the CCHIT certified to support Meaningful Use Stage 2, IW reports. The MAeHC product, which is hosted in the cloud, integrates with stand-alone EMRs and can span across multiple EMR platforms.

Getting certified was partly a matter of interpreting the criteria for Stage 2, which include capture and export, import and calculate and electronic submission, MAeHC execs told IW.

From the get-go, for example, the first criterion was problematic, as “capture and export” require EMRs to electronically record data and export it using established standards. MAeHC’s EMR has no user interface to manually key in data.

But the group’s leaders were determined to meet all three criteria, and they managed to get all of their issues sorted out. The MAeHC system is now certified for eligible providers and should be certified for eligible hospitals within the next few weeks, according to IW.

Looking at the challenges faced by those that blaze their own EMR trail, it’s interesting to note that two years ago, Beth Israel Deaconess Medical Center became the first hospital to have its entire home-brewed EMR certified as “complete” by the CCHIT. Considering the resources required, and the tough problems a group like MAeHC faced just to create one module, I’m not surprised that most of its hospital brethren have gone with packaged solutions instead.

MGMA Raises Meaningful Use Stage 2 Concerns

Posted on August 26, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Becoming another of several groups asking for Meaningful Use changes, the head of the Medical Group Management Association has written a letter to HHS outlining several concerns the group has with Meaningful Use Stage 2.

In the letter, which was addressed to HHS Secretary Kathleen Sebelius, MGMA President and CEO Susan Turney raised several issues regarding the ability of her members to step up to Stage 2. She argued that physicians have a “diminished opportunity” to achieve Stage 2 compliance, and that as a result it would be unfair to impose Medicare reimbursement sanctions on her members. Turney argues that HHS should institute an “indefinite moratorium” on practices that have successfully nailed Stage 1 Meaningful Use requirements.

Why should HHS give practices a break?  The reason, she says, is that vendors are proving slow to produce Stage 2-certified products, leaving medical practices in the lurch. At the time of writing, Turney said, there were only 75 products and 21 complete EMRs certified for Stage 2 criteria, a small fraction of the more than 2,200 products and nearly 1,400 complete EMRs certified under 2011 criteria for ambulatory eligible professionals.

With vendors largely not ready yet to help practices through Stage 2, practices are likely to have little time to work on software upgrades or expect timely vendor support, she notes. And worse, EPs who invested big in Stage 1-certified EMRs might need to “rip and replace” them for a new one certified to meet Stage 2 if they want to avoid Medicare reimbursement cutback deadline.

On top of all of this, she notes, many practices are having to wait in line for Stage 2 upgrades of their EMR product behind practices adopting  an EMR for the first time. The wait is lengthened, meanwhile, by vendors’ attempts to cope with ICD-10 support, whose Oct. 1, 2014 deadline falls right in the middle of preparations for Meaningful Use Stage 2.

Turney makes a lot of sense in her comments. The vendor market clearly isn’t going to be able to keep up with ICD-10, MU upgrades and new installation within the same time period. I don’t know if an indefinite moratorium on Medicare penalties is the right policy response, but it should certainly be given some thought.

After all, punishing doctors who drop out of Meaningful Use due to factors beyond their control isn’t going to help anyone, either.

HHS Releases Health IT Safety Plan

Posted on July 3, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

HHS has released a plan designed to strengthen health IT-related patient safety efforts, offering “specific and tangible” advice for stakeholders across the healthcare industry spectrum as to how they can participate.

The Health IT Patient Safety Action and Surveillance Plan builds on an earlier effort by the Institute of Medicine which examined how to make health IT-assisted care safer.  This Plan breaks down further how key health system players such as patients, providers, technology companies and healthcare safety oversight bodies can take appropriate steps to improve health IT safety.

The Plan also spells out the steps HHS believes it should take to make sure knowledge of best practices in health IT are leveraged to make a difference.  The following offers a few examples of what the agency expects to do:

Use Meaningful Use and the National Quality Strategy to advance health IT safety:  HHS plans to use knowledge of health IT safety risks and trends, and focus that knowledge on clinical areas where there’s already safety issues (such as surgical site infections). ONC, for its part, is going to establish a public-private mechanism for developing health IT-related patient safety measures and targets. And HHS also plans to incorporate these improvement priorities into the Meaningful Use program.

Incorporate safety into certification criteria for health IT products:  ONC expects to update its certification criteria for health IT products — including EMRs — to address safety concerns.  ONC  has already incorporated safety principles for software and design principles in its 2014 final rule, but just two such requirements  Expect more to come.

Support R&D of testing, user tools, and best practices related to health IT safety:   HHS and its federal partners are supporting R&D of evidence-based tools and interventions for health IT developers, implementers, clinical staff and PSOs.  This year, ONC will begin disseminating a new class of health IT safety tools designed to help health IT implementers and users assess patient safety and leverage the latest applied knowledge of health IT safety.

*  Incorporate health IT safety into education and training for healthcare pros:  Through its Workforce Development Program, ONC awarded grants to universities and community colleges to develop health IT programs. This effort will continue, but will add up-to-the-minute information on health IT-related safety to the schools’ programs.

*  Investigate and take corrective action addressing serious adverse events or hazards involving health IT:  HHS plans to work with private sector organizations which have the capacity to address such events or hazards, including The Joint Commission.

This is a meaty report, and I’ve barely skimmed the surface of what it has to say. I recommend you review it yourself. But if you’re looking for a quick takeaway, just know that HHS is entering a new era with its focus on health IT safety, and if the agency gets half of what it plans done, there are likely to be some serious ripple effects.

Hospital Mergers Complicate EMR Transition

Posted on June 14, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Getting an EMR up and running in a hospital or health system is complicated enough. But managing EMR implementations in the midst of hospital mergers is even more difficult.

Like it or not, though, hospital CIOs are increasingly facing the likelihood that they’ll be facing a merger in the midst of their EMR rollout, notes a new piece in the Wall Street Journal. With reimbursements from both Medicare and private insurers falling, hospitals’ margins are growing perilously thin, and the pace of hospital mergers is likely to increase, according to a March report by Moody’s.

Right now, for example, two of New York’s biggest hospital chains — NYU Langone Medical Center and Continuum Health Partners — have agreed to discuss a possible merger. Continuum CIO Mark Moroses is in the process of moving his chain of hospitals to its GE Centricity EMR, in a move which will allow the chain to collect $20 million to $30 million in Meaningful Use incentives.

If the merger between Langone and Continuum goes through, Moroses will have to stitch together dozens of billing,  procurement and patient care systems over the next few years, the WSJ notes. But more than that, the hospital chains will have to synchronize their clinical information management, a formidable job which, as Moroses says, leaves no room for error.

It’s not just systems integration that merging systems will face, however. As the WSJ piece notes, when North Shore-Long Island Jewish Health System took over Lenox Hill Hospital in 2010, the systems’s CMIO Michael Oppenheim had to bring Lenox Hill’s data to a new version of its Allscripts EMR.  The system used currently by Lenox Hill is an old one which isn’t certified for Meaningful Use.

Ultimately, hospitals’ urge to merge makes sense on a lot of levels. Given their tremendous capital costs (including EMR spending) it only makes sense to achieve economies of scale.  Unfortunately, the commonsense desire to save money and be more efficient is going to subject HIT leaders to an even rougher ride then they might have expected.

Meaningful Use Attestations With Faked Vendor Info?

Posted on April 17, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

When providers attest to Meaningful Use Stage 1 compliance, they have to identify the vendor whose EMR they used. But what if a large number of providers were faking this step in an effort to get incentive money that they don’t deserve?  That would be a lot of fraud, no?

Well, according to one vendor CEO, this could be happening on a large scale. Mike Jenkins, CEO of cloud-based vendor BuildYourEMR.com, reports that after going over CMS data on Meaningful Use, he found that a whopping 74 percent of providers who attested to using his company’s technology were not his customers.

Jenkins points out that if fraud were actually this common, a full $5.4 billion of the $7.6 billion paid out to providers would have been paid out in error. He admits that there could be something wrong with the CMS data, or that providers selected his company’s product name by accident, but concedes that it’s possible attestation fraud is more common than we think.

I’m not telling you this to suggest that the Meaningful Use program is riddled with fraudulent activity.  I’m doubful, in fact, that even a fraction of providers would dare incur the wrath of Medicare by making such a traceable error, much less consciously try to rip the incentive program off.

This does suggest, however, that more healthcare IT people should take a look at the CMS data and go over it themselves, especially EMR vendors. While there may not be a hailstorm of fraud going on, something may be seriously amiss in how CMS collects data or how providers report on their attestation.  It’d definitely be good to get ahead of any pending troubles with CMS, for sure.

ONC Plan Focuses On Health IT Safety

Posted on January 2, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The ONC has decided that it’s time to move health IT safety up to the next level, proposing a plan that would standardize the way health IT safety incidents are reported and make it easier to report straight from an EMR. And brace yourselves, vendors: this could include changing the EMR certification process to include the ability to make such reports easily.

The agency’s Health IT Patient Safety Action and Surveillance Plan is designed to strengthen patient safety efforts, including patients, providers, technology companies and healthcare safety oversight bodies in the mix. The idea, not surprisingly, is to use health IT to make care safer.

The ONC’s key objectives include the following:

*  Making it easier for clinicians to report patient safety events and risks using EMRs

Right now, it’s not exactly easy for clinicians to create a safety event report when something goes wrong in their use of an EMR, and the data they do sometimes produce isn’t easy to work with or compile.  ONC is proposing using certification criteria to make sure that whenever possible, EMRs make it easy to report safety events using the Agency for Healthcare Research and Quality’s standardized Common Formats.

*  Getting health IT developers to support patient safety and safety reporting

Within 12 months, the ONC plans to create a code of conduct — working with professional groups and health IT developers — which will hold developers accountable for:

— Creating usable, safe designs for products and adverse event reporting
— Working with a Patient Safety Organization to report, aggregate and analyze health IT related safety events
—  Scrapping practices that discourage provider reporting of safety events, such as limits in nondisclosure clauses and intellectual property protections
—  Participating in efforts to compare user experiences across different EMR systems

There’s plenty more to consider in this report, but I’ll leave you with these details in the hope that you’ll read it yourself.  As you’ll see in the introduction, you have until February 4th to comment on ONC’s plans. I hope plenty of readers do — this is important stuff.

Pediatricians Find EMRs Lacking

Posted on December 10, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While there’s no lack of specialty EMRs out there, it seems that pediatricians feel undeserved anyway. In fact, a new study suggests that there are five functions pediatricians look for in EMRs which are seldom found in a single system.

Almost half of pediatricians have adopted EMRs (48.5 percent), and 61.7 percent of doctors in internal medicine/pediatrics, according to a report in American Medical News.  (The data was drawn from marketing research firm SK&A, which does ongoing surveys on EMR adoption and use at 250,000-odd practices nationwide.)

The study, which appears in this month’s issue of the journal  Pediatrics, reports on a random survey of 646 postresidency pediatricians done in 2009 before the MU incentive program began. At the time, only 3 percent were using an EMR that they considered fully-functional and supportive of their specialty.

The authors say that pediatricians need five key features in place to consider an EMR complete. These include tracking of well-child visits, support of growth chart analysis, immunization tracking, immunization forecasting and weight-based drug dosing. Unfortunately, Meaningful Use standards  are nowhere near addressing the entire bundle of functions, they note.

So, are there any solutions for pediatricians which have emerged since the study survey was done? Certainly, there are scads of EMRs out there being marketed as pediatric EMRs. However, at first glance at least, most of the market for pediatric EMR solutions seems to be general  purpose systems offering pediatrics-specific templates.

On the horizon, however, there may be a glimmer of hope. Apparently, the Agency for Healthcare Quality and Research has designed a model children’s EMR which includes a list of child-specific functions, and ONC anticipates including these features in future stages of the EMR certification criteria.

In the mean time, it looks like pediatricians face the need to either work with (arguably) inefficient systems or customize systems on their own. Neither possibility would sound good if you were a pediatrician, would it?

CMS Needs To Tighten Up Meaningful Use Procedures, OIG Says

Posted on December 4, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

It looks like members of Congress aren’t the only ones finding fault with how CMS handles Meaningful Use incentives. In fact, HHS’s Office of the Inspector General has concluded that CMS needs to do more to verify that providers have indeed met MU standards both before and after payments get made.

As the OIG notes in its new report, CMS estimates that it will pay out $6.6 billion in incentives between 2011 and 2016. As things stand, the payments will be based on data self-reported by professionals and hospitals. To get a sense of how well this method is working, the OIG reviewed CMS’s incentive program oversight for 2011, as well as analyzing the self-reported data and auditing the agency’s planning docs, regs and guidance for the  program.

What did the OIG find?  Researchers concluded that CMS faces obstacles to overseeing the EMR incentive program which could end up with its paying providers and hospitals that haven’t fully met Meaningful Use requirements.

More specifically, the OIG concluded that CMS hasn’t put strong prepayment safeguards in place, nor has it good mechanisms for auditing incentive disbursements postpayment.  Moreover, ONC requirements for EMR reports might be getting in the way of more accurate incentive payment processes, the report said.

The OIG’s recommendations include having CMS get and review supporting documentation from selected hospitals and professionals before it cuts Meaningful Use checks, a step CMS rejects as imposing too big a burden on providers and slowing the payment process too much.  (For the sake of providers that need timely checks, let’s hope it stays that way.) The OIG also recommended that CMS  issue specific examples of documentation that can be used to support MU compliance.

Meanwhile, the OIG would like to see ONC  change certification requirements for EMRs to make it more likely that they can produce reports for yes/no Meaningful Use measures where possible. It would also like ONC to improve the certification process for EMR technology to make sure EMRs generate accurate reports.

For the most part, the  OIG’s recommendations seem reasonable, if not capable of being done overnight.  But I’ve got to agree that auditing incentive payments before issuing them would throw a serious kink into the process. Let’s hope the OIG and CMS compromise on something reasonable here.