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We’re getting more and more meaningful use details each day. No one should say that there isn’t a lot of information out there about meaningful use. Yet, I’m guessing there are still a LOT of physicians who still know little about meaningful use. McKesson’s even created this YouTube video explaining the Meaningful Use Final Rule. I can think of a few million YouTube videos I’d rather watch, but if you prefer video to reading, this video does give a general overview of many of the meaningful use final rule details:

UPDATE: Check out another meaningful use video that is definitely more exciting than the previous video (albeit with a little less content). However, it’s under 3 minutes and has music to keep it light and interesting. Thanks for sharing it Michelle. Although, I do wish I could embed the video on here.

Today we got news of the new ONC-ATCB EHR certifying bodies: CCHIT and Drummond Group. However, this is really just the start of the EHR certifying bodies. ONC released that “Applications for additional ONC-ATCBs are also under review.”

One of those possible additional ONC-ATCB EHR certifying bodies is Weno Healthcare. This EMR Daily News guest blog post (Thanks Michelle for pointing it out) asserts that Weno Healthcare has submitted their application to be an ONC-ATCB EHR Certifying body. They also offer this interesting insight:

Until recently, only one body was promoted to do this testing and certification. Because of no competition, their prices were out of the ballpark for smaller technology companies who may have built the better and cheaper mouse trap for doctors and hospitals, but could not afford the fees for certification. The technology companies that certified their products earlier are not considered certified by the new rules today, so all technology vendors must go through an ONC-ATCB in order to be re-tested and certified, if they choose to do so.

If Weno is approved as an ONC-ATCB, more technology vendors can afford the testing and certification fees. Weno savings can be as much as $19,000 for complete EHRs. These savings will certainly provide physicians and hospitals with more cost effective certified technology options to choose from. Again, competition is a good thing because it brings prices down and quality up.

Comparing the Weno Healthcare EHR certification price above with the CCHIT and Drummond Group EHR Certification prices, it’s going to be really interesting. That puts the costs of EHR certification (not counting software development costs) at:
Weno Healthcare: $14,000-18,000
Drummond Group: $19,500
CCHIT: $33,000

Of course, this assumes that Weno Healthcare becomes an ONC-ATCB and that the prices don’t change. I won’t be surprised if they do change. Plus, there could be other EHR certifying bodies.

There are a TON of meaningful use resources for those physicians and clinics interested in showing meaningful use of an EMR in order to get the EMR stimulus money. Here’s one such resource that I thought gave a nice summary of what’s required. Here’s a small sample of the content they offer about meaningful use:

Core Set Measures

• Use CPOE (Computerized Physician Order Entry) to order medications for more than 30% of all unique patients with at least one medication in their medication list.
• Enable drug-drug and drug-allergy interaction check functionality on the EHR for the entire reporting period.*
• Maintain an up-to-date problem list of current diagnoses for 80% of all patients. If there are no problems, indicate no problems are known.
• Maintain an up-to-date list of active medications for 80% of all patients.
• Maintain an up-to-date problem list of medication allergies for 80% of all patients.
• Generate and transmit prescriptions electronically for 40% of prescriptions written by the provider.
• Record demographics for at least 50% of patients.*
• Record and chart changes in vital signs for at least 50% of patients.*
• Record smoking status for 50% of patients 13 and older.*
• Report ambulatory clinical quality measures to CMS.*
• Implement one clinical decision support rule relevant to the provider’s specialty.
• Provide at least 50% of patients with an electronic copy of their health information, upon request, within 3 business days.*
• Provide at least 50% of patients with clinical summaries of their office visit within 3 business days.*
• Perform at least one test of the certified EHR technology’s capacity to electronically exchange key clinical information.*
• For the EHR and its related IT network, conduct a security risk analysis and implement security updates as necessary; correct security deficiencies.*

Menu Set Measures

• Enable drug-formulary checking functionality and have access to a formulary for the EHR reporting period.*
• Incorporate clinical lab-test results into the EHR as structured data for at least 40% of all lab test results.*
• Generate at least one report listing patients with a specific condition.*
• Send reminders to 20% of all patients, 65 years or older, per patient preference for follow-up care.*
• Provide at least 10% of all unique patients timely access to health information within 4 business days of the information being available to the provider.*
• Provide patient-specific education resources to at least 10% of all unique patients.*
• Perform medication reconciliation at least 50% of the time for patients transitioned from another setting of care.
• Provide a summary care record for at least 50% of patients for patients being transitioned to another setting of care.
• Perform at least one test of the certified EHR’s capability to submit electronic data to immunization registries.*
• Perform at least one test of the certified EHR’s capability to submit syndromic surveillance data to public health agencies.*

*These functions may be performed by nursing, administrative or IT staff

It is expected that EHR vendors will provide the capability to generate much of the above mentioned information within their software and they will also assist physicians in conducting data exchange testing.

The Washington Times recently had an article by Tevi Troy and Dr. Jason D. Fodeman about the EMR Stimulus program which talks about how the program might be counterproductive to its goal. The final paragraphs are an interesting perspective:

Unfortunately, Congress and the administration have decided to prioritize “getting it done” over “getting it right.” Other than being able to bring those signs saying “Project funded by the American Recovery and Reinvestment Act” that pop up across the nation’s highways to our hospitals sooner, there does not appear to be much benefit from this approach.

It will take much more than bombarding hospitals with extra computers and complicated, expensive software for health information technology to attain its true promise. It will require the right computers with the right software with properly trained support staff and physicians who know how to use them. All this takes time to establish and time to work out the kinks.

Unfortunately, for whatever reason, the administration is unwilling to devote the time and would prefer to roll the dice and pick up the pieces later. The administration’s rush to establish an interoperable health information technology network may very well prove counterproductive. It easily could waste money, endanger patients and, possibly, do irreparable harm to the technology’s reputation.

I’ve been preaching some of these things for a while, but it’s interesting that the mainstream media is finally starting to pick up the story.

I’d only caution that we not confuse the EMR stimulus with EMR. EMR is no doubt the future of healthcare IT. It’s just important to consider if EMR stimulus is the right approach to getting people to use as the article says “the right computer with the right software.”

In another great comment from BobbyG (who works for a REC), he talks about the realization that states have the option to opt out of doing the Medicaid part of the EMR stimulus if they want. The following is the full explanation of the discovery and why they’d make such a decision. Plus, it highlights the challenge of understanding all the regulations around the HITECH act.

Here’s just one example of the difficulty you run across. Yesterday we were on a CMS conference call MU incentives presentation in which they said that states’ participation on the Medicaid side was “voluntary.”

We all went “WHAT?! How did we miss that?”

Sure enough: on the CMS website you see “The Medicaid EHR incentive program is voluntarily offered and administered by States and territories. States can start offering their program to eligible professionals (EPs) as early as 2011″

“voluntarily”, “can start”

Not “shall” or “must”.

Now, we knew from the IRF that (paraphrasing here) “there is no statutory basis for the manner via which states disburse incentive payments” but it somehow escaped us that states could simply opt out entirely.

I went back to the ARRA legislation itself (on the assumption that the FR cannot, beyond operational implementation mechanics, mandate additional requirements not in the legislation). Beginning on page 375 you see “Subtitle B—Medicaid Incentives SEC. 4201. MEDICAID PROVIDER HIT ADOPTION AND OPERATION PAYMENTS; IMPLEMENTATION FUNDING.”

You get to page 380 and then only see stuff about the administrative and reporting “requirements” for states getting the “FFP” money (Federal Financial Participation).

And that’s it.

I searched ARRA from beginning to end and found NO explicit wording that states’ Medicaid participation is “voluntary.” You just have to infer it from the Section 4201 language.

What is one potential adverse upshot? Your REC could be signing up a boatload of providers coming in on the Medicaid side, and if your state opts out, well you now have what’s known as “Reputation Risk” writ large (not to mention a torpedo below the waterline in your Ops plan and its milestone payments assumptions).

Why would a state opt out? Because they are only federally funded for 90% of their “reasonable” administrative expenses for the EHR incentive program. They have to find the other 10%. My state (NV) is currently wrestling with a three BILLION dollar budget gap. Similar relative woes exist elsewhere in statehouses (can you say KAHL-EE-FOR-NEEYA?).

You better know where your state stands before recruiting Medicaid providers if you’re a REC or a consultant or VAR, etc.

In MedCity News, John Halamka makes an effort to summarize as simply as possible the Quality Measures:

I’ve been asked to summarize the Quality Measures as simply as possible

a. The Core Measures for All Eligible Professionals, Medicare and Medicaid are in the Final Rule Table 7, page 287. The Measures are

• Hypertension: Blood Pressure Measurement
• Tobacco Use Assessment and Tobacco Cessation Intervention
• Adult Weight Screening and Follow-up

b. If the denominator for one or more of the Core Measures is zero, EPs will be required to report results for up to three Alternate Core Measures. The Alternate Core Measures for Eligible Professionals are in the Final Rule Table 7, page 287. The Measures are

• Weight Assessment and Counseling for Children and Adolescents
• Preventive Care and Screening: Influenza Immunization for Patients ? 50 Years Old
• Childhood Immunization Status

c. The Clinical Quality Measures for Submission by Medicare or Medicaid EPs for the 2011 and 2012 Payment Year (EPs must choose 3) are in the Final Rule Table 6, page 272 . Here’s a summary of the 44 quality measures that CMS posted last week.

d. The Clinical Quality Measures for Submission by Eligible Hospitals and Critical Access Hospitals for Payment Year 2011-2012 are in the Final Rule Table 10, page 303. The Measures are

• Emergency Department Throughput ’ admitted patients Median time from ED arrival to ED departure for admitted patients
• Emergency Department Throughput ’ admitted patients Admission decision time to ED departure time for admitted patients
• Ischemic stroke ’ Discharge on anti-thrombotics
• Ischemic stroke ’ Anticoagulation for A-fib/flutter
• Ischemic stroke ’ Thrombolytic therapy for patients arriving within 2 hours of symptom onset
• Ischemic or hemorrhagic stroke ’ Antithrombotic therapy by day 2
• Ischemic stroke ’ Discharge on statins
• Ischemic or hemorrhagic stroke ’ Stroke education
• Ischemic or hemorrhagic stroke ’ Rehabilitation assessment
• VTE prophylaxis within 24 hours of arrival
• Intensive Care Unit VTE prophylaxis
• Anticoagulation overlap therapy
• Platelet monitoring on unfractionated heparin
• VTE discharge instructions
• Incidence of potentially preventable VTE

Everything clear now?

The AMA has finally weighed in on the meaningful use final rule and it’s not a glowing recommendation for meaningful use and the changes that were made. Here’s a short summary from the Wall Street Journal healthcare blog.

Now, after “careful review,” the AMA is weighing in. In a memo [PDF] to its board of trustees, the group’s CEO, Michael Maves, says that while “the Administration did move on several points, the [AMA] believes that it will be challenging for many physicians to participate successfully in the program. This will be especially true for those physicians in solo or small group practices who have not previously utilized an EHR.” (That refers to an electronic health record — the Health Blog has traditionally used “electronic medical record.” Tomatoes, tomahtoes.)

The AMA had pressed for reducing the number of criteria physicians needed to meet in order to get the first round of incentives from the original mandated 25 to a choice of any five of those. The final requirements include a “core” group of 15 requirements; providers must choose an additional five from the remaining items. That “is still too high,” the group says.

In addition, the group says no currently available EMR does everything that docs will need to do to meet the requirement — though products should be available this fall — making it tough to ramp up before the beginning of the incentive program. Also included on the list of what the AMA calls “remaining challenges”: high threshold requirements for many of the requirements, a lack of focus on how usable the systems are and the absence of an appeals process for docs if they are declared ineligible for incentives.

An article by Government Health IT’s Mary Mosquera has some interesting data from ONC about the number of EHR certifying bodies there might be available to EHR vendors. Here’s the most relevant section:

So far, ONC has received six or seven completed applications out of the 30 it sent to organizations that have requested them since July 1, said Dr. David Blumenthal, the national health IT coordinator, at a meeting of the advisory Health IT Policy Committee.

ONC released in June its final rule for the temporary certification program, which lays out steps organizations must take to be authorized by ONC to both test and certify that EHRs can perform the functions required for meaningful use.

“We are optimistic that we will have a new landscape in the certification realm in which, instead of having a single certification body, there will be more opportunity, a broader pipeline for certification, hopefully more price competition and shorter waiting times to get certification,” Blumenthal said at the committee meeting July 21.

6-7 applications to certify EHR software and 24 more out there that could come in. That sure blows the initial projection of 5 EHR Certifying body applications out of the water. I’m not really sure the business model for these organization. The customer base is about 300 EMR companies. That’s a pretty small market for these organizations to share.

I imagine this is really bad news for those people at CCHIT too. Mostly because CCHIT’s only product is certifying EHR software. At least other organizations like the Drummond Group do a number of certifications. Who would have guessed that the ARRA EMR stimulus money that looked so promising for CCHIT could become the legislation that drives them to irrelevancy?

Today, I thought it would be interesting to list the meaningful use final rule comments that I know of and to invite my readers to tell me about other meaningful use final rule commentary that they know about. Just reply in the comments of this post or on the EMR and EHR contact us page and I’ll update this post with all the meaningful use final rule resources we can find.

Full Meaningful Use Final Rule, Press Conference Video and EMR and HIPAA MU Thoughts
Comparing the Preliminary Meaningful Use Rule to the Final Meaningful Use Rule Done by Inga from HISTalk and a great resource.
List of Meaningful Use Webinars – Done by EMR and HIPAA
Everything HITECH Analysis of Meaningful Use
Advice on Addressing Meaningful Use – Good advice from the Healthcare IT guy on not being in a hurry to address meaningful use.
Interview with David Blumenthal About Meaningful Use
Mr. HISTalk and John Glaser Reactions to MU (have to scroll down a bit to see the obligatory meaningful use section)
Meaningful Use and It’s Impact on Physician Productivity
HISTalk Initial Comments and Reactions to MU – Just read the comments on this one.
Summary of Meaningful Use Announcement and Rule
CMS Page on Meaningful Use
Meaningful Use Final Rules Are a Big Deal – Wm. T. Oravecz Take on Meaningful Use Final Rule on HITECH Answers
David Blumenthal’s Thoughts on Meaningful Use
John Halamka’s Summary of Meaningful Use Final Rule Changes
Halamka’s Presentation on the Meaningful Use Final Rule
Summary and Other Meaningful Use Documents – The Summary Chart that’s embedded on this is an interesting one. Too bad it’s partially cut off on my screen.
Summary of the 2 Reginas and Meaningful Use – Matthew Holt talks about the 2 Reginas that spoke about Meaningful Use of an EHR
Chilmark Research Quick Meaningful Use Analysis – An always insightful look at healthcare IT
The Fox Group’s Thoughts on Where to Go from Here

I’m sure that there are plenty more. If you know of some good ones, let me know and I’ll add them to the list.

This just came in. The wait is finally over. I guess I know what I’m doing tomorrow.

CMS AND ONC TO ISSUE FINAL RULES ON MEANINGFUL USE AND STANDARDS AND CERTIFICATION FOR ELECTRONIC HEALTH RECORDS INCENTIVE PROGRAM

WHAT: CMS and ONC will host a press briefing to announce the final rules on Meaningful Use and Standards and Certification under the HITECH Act’s Electronic Health Records (EHR) incentive program.

WHO: Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services
Donald Berwick, M.D, Center for Medicare & Medicaid Services, Administrator
David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology
Regina Benjamin, M.D., M.B.A, Surgeon General

Dial In: Call in: 800-857-6748
Verbal Passcode: HHS

To watch the webcast live visit www.hhs.gov/live