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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

There’s a lot of interesting speculation going on right now around what HHS is going to do in regards to meaningful use. There’s no doubt that a lot of the feedback given to HHS on meaningful use surrounded the idea that it was too much and had too many objectives. The question remains, what will HHS do with this feedback?

A number of people have suggested that the meaningful use objectives will be relaxed. In this company is past healthcare IT czar, David Brailer. The interesting part of this chorus is that it includes a large number of providers that say it’s going to be relaxed. Then, they follow up that statement with something like, “If it’s not relaxed, then doctors won’t show meaningful use and will not worry about the EMR stimulus money.” Basically, it will become a failed government initiative if the meaningful use bar is too high.

Other people are suggesting that meaningful use is going to stay the same. Carol Flagg of HITECH Answers quotes the following from David Blumenthal as indication that meaningful use will not substantially change:

“Introducing change in health care is never easy. Historically, adopting our most fundamental medical technologies, from the stethoscope to the x-ray, were met with significant doubt and opposition. So it comes as no surprise that in the face of change as transformational as the adoption of health IT – even though it carries the promise of vastly improving the nation’s health care – some hospitals and providers push back….The question health care providers are facing today is whether we are pushing too hard, too fast to make this important change. I respectfully submit, no. In turn, I ask, ‘Can we make these changes expeditiously enough?… Every provider, every patient throughout our nation will benefit from the goals envisioned by the HITECH Act. Yes, this will be a challenge. While large hospital networks and smaller providers may be stretched to meet national health IT goals, it is not beyond their capacity for growth.”

Little by little I’m leaning this direction. I’m not sure exactly why, but I’m getting the feeling that HHS either can’t or won’t change the meaningful use criteria. It’s basically going to be similar to what we have now with maybe one or two items of note.

What do you think? What will happen with the MU final rule?

I’m preparing for my time at the HIMSS conference. I can tell that the conference is going to be incredibly busy. Plus, I don’t want to over schedule my time since I want to make sure I spend plenty of time discovering new things and smaller companies that are doing really interesting things. Specially related to EMR is best, but even the technologies that make EMR better are great too.

Well, I got an email from HIMSS about one of the keynote speakers. When I looked at the subject line I read “Blumenthal HIMSS Address Should Prove Meaningless.” At first I didn’t realize the email was from HIMSS. I then came to the email again and realized that I’d misread it. The email actually said, “Blumenthal HIMSS Address Should Prove Meanignful.”

Well, I couldn’t help the irony of the misread. Blumenthal has a chance on a pretty large stage to make some important statements. I am interested to hear what he says. I have a philosophy to listen to smart people when they talk. That’s why I loved the chance to hear Marc Probst (HIT Policy Committee and CIO of IHC) and that’s why I plan to listen to Blumenthal. In many respects, Blumenthal holds the keys to billions of dollars in EMR stimulus money. Let’s hope he will provide something meaningful, but I’m not holding my breathe.

As a side note, I’ll be covering my time at HIMSS on this site and on EMR and HIPAA. I’m also hosting a couple meetups at HIMSS which I’ll be announcing tomorrow or the next day.

I just found this really nice interview by InformationWeek with David Blumenthal, Health IT Czar. Here are a few snippets of what David Blumenthal said with my own commentary in italics.

Congress set very ambitious goals for the HITECH legislation. The concept of meaningful use is novel, and a very powerful and important concept. The process of defining meaningful use has gone through many months, through many public hearings.

I think David Blumenthal realizes that meaningful use is going to be a major problem for many doctors offices. I think we’re going to hear him blaming Congress for the “ambitious” HITECH legislation which has his hands tied. It probably does, but it’s too bad he can’t just say it that way if it is the case.

The Office of National Coordinator is still committed to developing the Nationwide Health Information Network. Many of our federal colleagues and quite a number of larger healthcare organizations are on the verge of using NHIN as it was originally conceived and configured for their own purposes, and we’re continuing to invest in it.

At its last meeting the HIT Policy Committee adopted recommendations that they have not yet formally transmitted to me to encourage the development of a more flexible, adaptable, less complicated method of health information exchange than the Nationwide Health Information Network. And that’s something that we’ll be studying.

I think this is a good move. This national network in its current state just doesn’t seem like it’s going to have much affect on small doctors offices, which last I checked make up a large part of our healthcare system. I think in politics they call this move taking it to the people.

InformationWeek: Once you get clinicians using e-medical records, who pays to maintain the exchange infrastructure?

Blumenthal: It’s a short-term issue. Long term it’s going to become an expectation on the part of the clinician and patient that information is going to be exchanged. And I think it will become a cost of doing business in the healthcare sector just as physicians and nurses consider it a cost of doing business to buy stethoscopes and run an office.

Doctors will hate to hear this quote. Although, they shouldn’t be too upset. In reality, they’ll be passing this cost on to the consumers. Now how we get to the point Blumenthal talks about is beyond me. That’s a huge gap to cross.

InformationWeek: Will the Certification Commission for Heath IT–CCHIT– remain the organization doing these certifications, or will there be others?

Blumenthal: We’ll have to see what the regulation actually is and see where CCHIT fits in. CCHIT is clearly going to have the option to participate in certification going forward, but I can’t tell you what role exactly it will play.

Translation: I don’t care about CCHIT. If they want to participate great, but I’m playing no favorites here.

Goverment Health IT summarized some of the discussion that happened today at the HIT policy committee meeting which focused on the challenge of applying meaningful use across all of the various specialty groups in healthcare. Here’s some excerpts from the article:

The Health IT Policy Committee today confronted the problem of how to craft a manageable set of requirements for the “meaningful use” of health IT across an industry where specialties and new practice variations are common – and where one policy may not fit all.

…

Those measures were geared for what is normally a patient’s first encounter with the health system: the primary care physician. But many specialists – who do not treat a wide range of diseases and conditions – may not be able to comply with all the current 2011 [meaningful use] requirements.

“Not all objectives and measures are appropriate for all eligible professionals,” said Paul Tang, vice chairman of the Committee and chief medical information officer at Palo Alto Foundation.

As a result, the committee must decide which of the 25 meaningful use measures should apply to specialists so they still can qualify for 2011 incentive payments – and which requirements to delay introducing til 2013 and 2015.

“I don’t think it was understood that we weren’t intending to have all the measures apply to all specialists,” said Dr. David Blumenthal, the national health IT coordinator.

Unfortunately, I think this discussion has just begun and is going to get more complicated as we go. I know of a number of cases where the MU requirements just don’t make sense to a specialist. However, the challenge will be to have a set of requirements that aren’t so complex that it takes a specialist to be able to understand how the meaningful use requirements apply across the spectrum of doctors in healthcare.

What are your thoughts on how they should apply meaningful use effectively?

There’s been a lot of talk around the blogosphere about the new EHR certification pathways proposed by CCHIT. However, Neil Versel is reporting on his blog that there’s a rumor that ONC is planning a July meeting with several people that are considering starting up an EHR certification program.

Makes complete sense to me. David Blumenthal does seem open to the idea of not having CCHIT be the sole certification body. Certainly he’ll feel some big time pressure from the various big EHR vendors out there, but I’m hopeful that David Blumenthal will be able to do well and keep at least some competition in the EHR certification process.

Everyone in the healthcare IT world is sitting and waiting to know the fate of the words “certified EHR” and “meaningful use.” Yes, only a few billion dollars of EHR stimulus money are riding on those 2 terms.

Well, after the Health IT Policy Committee came out with their initial set of recommendations, it was reported that David Blumenthal, National Coordinator for Health IT, said “lively discussion (on the criteria) and considerable input on meaningful use, we decided to send the work group back to work on another set.”

Looks like the new date for more guidance from the Health IT policy committee will be their July 16th meeting.