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The State of the Meaningful Use

Posted on January 30, 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.

UPDATE:
If meaningful use were gone (ie. no more EHR incentive money or penalties requiring meaningful use), which parts of meaningful use would you remove from EHR immediately and which parts would you keep?
Responses:
*Michael Sherling, MD – Modernizing Medicine
*Shahid Shah – Influential Networks
*Joel Kanick – interfaceMD
*Michael Brozino – simplifyMD
*Dr. Michael Koriwchak
*Karen Knecht – Encore Health Resources

I recently wrote what’s been a really popular article on EMR and HIPAA called “Meaningful Use Program a Success…Depending on How You Measure Success.” I think we’re at an interesting point in the meaningful use program and it’s worth taking a step back and seeing where we’re at with meaningful use.

As I state in the other article, there’s no doubt that the EHR incentive money has moved the needle on EHR adoption. Those of us who believe that EHR holds lots of potential benefit to healthcare have to be happy about the amazing EHR adoption rate that has occurred thanks largely to $36 billion of EHR incentive money (we’ll save the question of whether we’ve gotten our money’s worth for another post).

While we could Monday Morning quarterback (appropriate football reference the week of the Super Bowl) the EHR incentive program and meaningful use, that won’t change the fact that it’s here and it’s not going anywhere. So, instead of asking whether we should have spent the money on EHR and whether we should have done meaningful use, I decided to take a deeper look at meaningful use and how we could improve the program. Which elements of meaningful use are really adding value and which parts of meaningful use should be removed? Or maybe it’s all great and we should just continue on the path we’re on.

I decided to use a simple approach to identify what’s good and what’s bad with meaningful use. I reached out to EHR vendors, doctors, practice managers, hospital executives, and other EHR experts and asked them a simple question. The answers to this question should provide a solid understanding of what’s meaningful in meaningful use and what’s not.

Here’s the question I asked:
If meaningful use were gone (ie. no more EHR incentive money or penalties requiring meaningful use), which parts of meaningful use would you remove from EHR immediately and which parts would you keep?

The concept is simple. If there wasn’t some outside influence (ie. government money) influencing the requirement to do meaningful use, which elements of MU actually provide value to the users of an EHR. Those that provide value will continue to be embraced by an EHR vendor and those that don’t will be removed. Plus, this is the reality of what’s going to happen once the EHR incentive money runs out, so let’s find this info out now.

I originally thought that this question would lead to a blog post with quotes from a variety of people offering their unique perspectives. However, every person who’s answered so far had so much to say on the topic, that each of their responses was worthy of a blog post of its own.

With that in mind, over the next couple of weeks, I’ll be posting all of the responses as separate posts across the network of Healthcare Scene blogs. I’ll link each of these blog posts at the bottom of this post as they are published.

Open Call for Participation
As I considered this, I realized that hundreds of other people might want to participate as well. As a health IT community I think we can make a real impact. So, I encourage everyone who reads this to publish their response to the question above.

If you have your own blog, publish it there and link back to this post so we can add your post to our list below. If you don’t have a blog, wish to remain anonymous, or would just rather have us publish it, we’re happy to publish it for you. Drop us a note on our contact us page and we can work out the details.

I believe this will become an incredible resource of information to better understand how to improve meaningful use. Once I’ve gathered a good number of responses, I’ll be reaching out to ONC and CMS to make sure they take in the body of contributed work as well. Hopefully this simple approach will be effective at gathering a response from more people than the convoluted rule making process was able to do.

Meaningful Use will go down as one of the most impactful things to hit healthcare IT and EHR in my lifetime. It behooves us to do what we can to make the most of meaningful use.

Love it or Hate it, Meaningful Use Stage 2 is Fast Approaching

Posted on February 15, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

Valentine’s Day may be behind us, but I still wonder how many providers would be willing to write love notes to their EHR vendors, especially with rumors swirling that CMS will release Meaningful Use Stage 2 requirements in the next few weeks. (John Moore at Chilmark Research is apparently taking bets via Twitter, if anyone’s interested in doing a bit of gambling in preparation for the big HIMSS event in Vegas next week. He predicts it will be the Friday after HIMSS. I think it might just make good fodder for Farzad Mostashari’s keynote next Thursday morning, as he has been vocal about delaying the start of Stage 2 until 2014.)

Whether they’re released during or after the show, I decided it would be a good idea to bone up on Stage 1 versus Stage 2, and how what may or may not be included in Stage 2 will lead providers to love (or hate) their systems all the more.

I fortunately came across a very well written and comprehensive (though not too long) report from CSC entitled “Moving Ahead with Stage 2 of Meaningful Use,” which provides a very clear-cut picture of the challenges providers found with Stage 1, and what they are likely to encounter as challenges in Stage 2. It’s a brief, informative read that I highly recommend folks take a look at before they head to HIMSS in just a few days.

My biggest take away from the report was that the providers surveyed had done very little in Stage 1 to engage patients and coordinate care, which is not surprising given that most were concentrating on getting their EHRs up and running in time to fully attest for Stage 1. Combine this with the fact that formal ACO rules weren’t released until late last year, and I can understand why engaging patients and coordinating care just wasn’t on the radar of most healthcare facilities.

But oh what a difference a few months can make! The CSC report notes “Stage 2 is coming soon and a full year of operational use of capabilities will be required (rather than three months for Stage 1). Waiting until the final rule is issued to start moving is simply not an option.

“Now is the time for organizations to work in earnest to build capabilities to engage patients, coordinate care and electronically report on quality.”

And finally, the report notes that:

Three essential areas where organizations need to start now are:

  1. Providing patients with access to their health information electronically through patient portals or directly from EHR systems.
  2. Electronic capture of physician notes, including diagnosis and treatment, plus rationale for excluding patients from treatment recommendations.
  3. Exchange of patient information at transitions in care.

I’d be interested to hear from our readers that have successfully attested for Stage 1 how they view these predictions for Stage 2. Are they manageable? Do they fit with your organization’s current strategy? Please share your thoughts in the comments below.

US EMR Market to Exceed $8 Billion in 2016

Posted on January 2, 2012 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.

In case you missed it, I’ve moved a lot of my discussion of the EMR and Health IT markets to my site: EMR Thoughts. I’ve done a lot of posts on that site that look at the EMR market, the health IT investments, the Health IT incubators (or accelerators if you prefer), and other movement in the EMR, EHR and Health IT markets. If you like that type of content, you should definitely subscribe to the EMR Thoughts email list.

Even though, I’ve moved a lot of my EMR market discussion to the other site, every once in a while I’ll drop in some EMR market stuff on here as well. In the article linked in my Costco EMR post, they discussed the size of the EMR market:

Millennium Research Group said in its November report, “U.S. Markets for Electronic Medical Records 2012,” that the U.S. market for EMRs will exceed $8 billion by 2016, with the fastest-growing segment occurring in the small-practice market. Web-based EMRs that don’t require an expensive information technology infrastructure are contributing to the growth, the report said, because they are an affordable option for small practices on tight budgets.

I always hate when they don’t split the EHR market into ambulatory EHR and hospital EHR. I also still haven’t figure out a good way to reconcile that the EMR market in the US will be $8 billion in 2016, but we’ll have spent a good portion of the $36 billion of EHR stimulus money by 2016. Those two numbers don’t jive very well.

I also find it interesting that the fastest-growing segment of the EMR market is the small-practices. I’m not sure I agree with this. I think the larger sales and hospital EHR sales are brisker than the small practice EMR market. Much of the small practice market is still “waiting and seeing.”

Pediatrics Face Unique Set of EMR Challenges

Posted on October 26, 2011 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

My recent blog about Sandhills Pediatrics and its successful implementation of an EMR prompted, fortunately, a very intriguing comment from Chip Hart, a Director of Sales and Marketing at Physicians’ Computer Company who also maintains the blog “Confessions of a Pediatric Practice Consultant: True Stories from the land of Pediatric Practice Management.” He wrote: “I’ll spare everyone the diatribe about how ARRA deals with pediatricians and how only about 1/2 of them qualify, as I write to make one quick statement.” There’s a story there, I thought to myself. So, being an avid observer of pediatric EMR news and views, I reached out to him to gauge his thoughts on where healthcare IT solutions fit in the world of pediatricians.

What sort of challenges are you seeing pediatric practices facing when it comes to implementing EMR systems?
“On one hand, most of the challenges they face are hardly unique to pediatrics: resistance to change, practice differences, the lack of time and resources to be trained and configured properly, poor support, etc.

“Specific to pediatrics, there are two major issues.  First, children are not simply small adults and EMRs, as a rule, are written for adult medicine. There are many pediatric-specific features and functionality that a pediatric practice needs that simply aren’t met by your large, generic system. Simply claiming “pediatric templates” isn’t enough.

“Second, although every specialty complains about the hit that EMRs take on their productivity, pediatricians are obviously in the worst shape. Their volume is the highest and their payment is the lowest. Just adding a minute to each encounter means an extra 30 minutes of charting a day … and I hear stories, daily, of practices adding another 1 to 2 hours! Pediatricians can’t afford to see 5-percent fewer patients. Radiologists can. And pediatricians really like to eat dinner with their families.

“One second-tier issue is that less than 50 percent of all pediatric practices don’t qualify for ARRA and the regional extension centers (RECs), as a rule, don’t understand the Medicaid rules well.  Thus, we have clients and potential clients calling us to ask how they can get money they’ll never get, or to tell us some crazy thing a REC person told them.”

Are there different sets of challenges for those that are private practices versus those that are hospital/healthcare system affiliated?
“Unquestionably – the big one being that hospital/health system pediatricians simply won’t have a choice or even a voice in the process. Yes, I’ve worked with some who appear to be at the table, but in the end … you get what they hand you. Right now, Epic is pushing everyone out but that pendulum will swing back.

Also, those employed physicians don’t have to consider the impact on their productivity in the same way. I’ve met too many peds offices whose docs didn’t take home checks for a few months after implementation – that’s not right.”

Why do you think practices like Sandhills “get it” in terms of moving forward with HIT implementations, and just being forward thinkers in general?
“If I could answer that question, I’d only be working with those practices! Every successful practice I know is successful in a different way for different reasons, but there is one common trait I see in many of them: They run their practices like the businesses they are. Keep the docs in the exam rooms, where they can generate revenue, and hire professionals to actually run the business. Just because it says “MD” after your name doesn’t mean you’re the best-qualified person to run your office. Would Dirk Nowitski or Lebron James make good coaches? I doubt it.

“In the case of Sandhills, they have some excellent, excellent staff who bring some non-healthcare experience to the table. Although I’ve seen it fail, having some management that comes from outside the healthcare system to ask and answer some tough questions pays off for a lot of practices.

“We’ve enjoyed working with them.  I should also add that they, like the other ‘heads up’ clients I know, realize that we’re on the same team. That helps tremendously.”

How long have you offered the PCC EMR? What sort of up tick in implementations have you seen since ARRA/HITECH came about?
“Our PM has had pediatric clinical features (immunization tracking, registry interfaces, well visit recall, etc.) for almost 30 years, but the official EMR itself was released about 2 years ago.

“When ARRA was first announced, we received a lot of calls, all along the lines of, “Where do I get my free money?”  It was very frustrating to explain that it would be state dependent (about a quarter of them still can’t get it) and half of our clients will never qualify due to the Medicaid requirements.

“Things are starting to settle down and get organized.  Still, we are busier right now than we have ever been. We are telling potential clients they might get installed in May or June. A nice problem to have, but it’s not fun to get some excited only to explain it will be 6 months, especially when it used to be 6 weeks!”

Are any of your pediatric clients thinking of becoming involved in ACOs?
“Thinking?  Yes.  They’re all being told how if they don’t get big, they’ll be out of business, which is utter BS. The rules, as we know them now, seem to make no sense whatsoever for pediatricians. I did see a compelling presentation by Colleen Kraft at the AAP NCE last week that very much supported the ACO-esque model she employs, but I think her situation is both unique and not potentially an ACO.

“With some issues – 5010, PCMH, etc. – we take a pro-active stance. With ACOs, I’m glad to let someone else jump first.”

How will your solutions enable your customers to integrate with ACOs or coordinated care programs?
“Far too soon to tell.  In general, I can say, “Hey, we have had really good reports that have tracked patient populations for years.”  Our clients use them all the time, as it’s both good medicine and good business.  As a practical tool, I’d put our patient recall program up against anyone’s – your front desk can crank out a list of kids who need flu shots or asthma followups in seconds – but we don’t know quite what the ACOs will need.

“One thing we’ve learned, though: when a small peds office puts its data in the hands of a large entity, it’s worth double-checking the results. For more than 20 years, I’ve helped our clients fight insurance companies (which an ACO emulates) and the insurance companies never have the data right. Ever. So if a private peds office can work with us and still be in an ACO, they’ll be able to confirm the accounting.

“Here’s my prediction: As ACOs grow, the practices who participate are going to regret losing control of their data. I’m really going out on a limb there, I know.

What do you think is the greatest challenge being faced by pediatrics when it comes to keeping up with healthcare IT?
“Not getting run over by the Juggernaut.  Everyone else’s demands are put ahead of the pediatricians and the peds usually get served what everyone else is eating.  And it rarely suits them.

“I also tell them all the time: ignore the Meaningful Use money. Completely. And ignore the “deal” that you can get from your local hospital/IPA/etc. Pick the EHR that suits you the most and go with that. All the discounts or federal checks in the world won’t make up for even a 5-percent hit in your productivity or having to spend an extra 10-20 hours a month on charting or IT work. If you do like the local deal, great!  But don’t feel like you have to leap in.”

So there you have it folks. I’d be interested to hear from a pediatrician or two who has gone through or is going through some sort of HIT implementation as a follow-up to these views. Feel free to get in touch with me via the comments section below.

Job Growth in Healthcare and the EHR Bubble

Posted on August 11, 2011 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.

It’s a crazy world that we’re living in today. The market is on a roller coaster. The riots in London. A lot of other crazy things happening. Not the least of which is the high unemployment in the US. Despite the challenging times, I’m not seeing as many of the same challenges in healthcare IT.

This was higlighted in some recent tweets I saw that talked about the job growth that’s happened in healthcare. That’s right, healthcare has actually had job growth. It’s quite amazing to consider, no?

Healthcare IT is especially interesting thanks to the $36 billion in EHR stimulus money. It’s a frother EMR and EHR market out there and I expect the froth is going to continue for another couple years. Is it fair to say that we’re in an EMR and healthcare IT bubble? I think so.

The question I’m starting to consider is what’s going to happen when the bubble pops? I’m not sure that we’re going to see one big pop in the EMR market. Maybe I’m wrong, but I think that we’re going to see a long protracted fall out of EMR and EHR companies. I guess this type of slow failing EMR companies is better than a major pop, but it still doesn’t sound good.

Well, at least it doesn’t sound good for those clinics who are using the EMR software from the EMR companies that fail. However, it’s going to present some interesting opportunities for EMR companies that can clean up the mess that’s left. Of course, most of us won’t know the details of the mess. We’ll just see flowery announcements about EMR companies selling off to larger EHR companies. However, those acquisitions will be a great customer acquisition buy for the EHR companies who have the cash and can transition users effectively to their EHR software.

How far off is this? I’d say at least 2 years. So, the next 2 years are going to be an interesting time for EHR vendors that are trying to position themselves for these types of acquisitions.

EHR Incentive Money Congressional Authorization versus Appropriation – Will EHR Incentive Money Disappear?

Posted on July 5, 2011 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.

I’ve been having a number of discussions online and through email with people about the future of the EHR incentive money. A number of people are quite concerned with the government funding for the EHR incentive money. You may remember that I posted about this before on multiple occasions and had some really interesting discussion.

Here’s a summary of some of the points that I’ve heard people making when it comes to the EHR incentive money being taken away:

1-There is a crucial difference between the two steps required for Congressional funding, a-authorization and b-appropriations. Congress can authorize, but cannot appropriate for 5 yrs. This applies to the EHR stimulus money. Thus the 5 year EHR payment has been authorized, but no EHR funds have been, nor can they be, appropriated for 5 years, right?

2-There is $18k this year for doctor Medicare EHR. But not the remaining $26k over 5 years has not been apropriated (same applies to hospitals funds).

3-The budget deficit and debt ceiling suggest Congress will be looking now and in the future for cutting every dime they can,
and thus the $20B or so for EHR could be part of the cut. Thus there may be reduced EHR funds, or none, appropriated by Congress after this year.

I still believe in my gut that the EHR incentive money is going to be safe and still around going forward. There’s little benefit to cutting a mere $20 billion from a program that is generally bi-partisan. Plus, no one in congress really knows the potential good or bad impacts of the HITECH act on EHR and healthcare IT. However, it’s really easy for them to quickly assume that more technology in healthcare is good and worth funding (whether the way they’re doing it is good or not…a subject for a different post).

It’s certainly not beyond the realm of possibilities that the government could make some sweeping cuts and the EHR incentive money is a casualty of those sweeping no holds bars type cuts. Point being that I don’t think there are any people in congress that are passionately for it or passionately against it. So, I think that means that it will likely either get carried forward on a whim or cast aside on a whim.

How’s that for a concrete answer? Are there points that I’m missing? Are we misunderstanding the HITECH funding process? Feel free to chime in with any knowledge you might have of the government process.

Haven’t Been Paid your EHR Incentive Money Yet? One Possible Reason Why

Posted on June 28, 2011 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.

The CMS FAQ site has a great question up that I have a feeling a number of doctors will be interested in knowing the answer to:
I am an eligible professional (EP) who has successfully attested for the Medicare Electronic Health Record (EHR) Incentive Program, so why haven’t I received my incentive payment yet?

Here’s their answer:

For EPs, incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year.

The Medicare EHR incentive payments to EPs are based on 75% of the estimated allowed charges for covered professional services furnished by the EP during the entire payment year. Therefore, to receive the maximum incentive payment of $18,000 for the first year of participation in 2011 or 2012, the EP must accumulate $24,000 in allowed charges. If the EP has not met the $24,000 threshold in allowed charges at the time of attestation, CMS will hold the incentive payment until l the EP meets the $24,000 threshold in order to maximize the amount of the EHR incentive payment the EP receives. If the EP still has not met the $24,000 threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March 2012 (allowing 60 days after the end of the 2011 calendar year for all pending claims to be processed).

Payments to Medicare EPs will be made to the taxpayer identification number (TIN) selected at the time of registration, through the same channels their claims payments are made. The form of payment (electronic funds transfer or check) will be the same as claims payments.

Bonus payments for EPs who practice predominantly in a geographic Health Professional Shortage Area (HPSA) will be made as separate lump-sum payments no later than 120 days after the end of the calendar year for which the EP was eligible for the bonus payment.

For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.

This is actually something that I’ve written about before (probably on EMR and HIPAA), but I have a feeling many people weren’t looking at the details to realize why they aren’t getting their incentive money. You have to wait until you have enough Medicare Allowable Charges before they’ll pay you. I think this is a smart plan I do find it interesting that there were some clinics that had enough allowable charges in 3 months to receive the full EHR incentive money right away. I’d love to see some stats on medicare allowable charges per provider. Would be interesting to see how this aspect of the EHR incentive program affects Medicare providers.

Either way, hopefully this information will help someone who is wondering where they EHR incentive money is. Thanks to @jimtate for tweeting the FAQ and reminding me of this part of the program.

Guest Post: The Meaningful Use Clock is Ticking

Posted on March 8, 2011 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.

John’s Note: Much of this post will be child’s play for those of you reading the blog that are steeped in meaningful use, the HITECH act, EHR Certification, and the EHR stimulus money. However, I thought this guest post was a nice intro to the EHR stimulus money for a doctor or practice manager which was starting to learn. I’m all about helping doctors, so here it is.

90 days of data collection. This is what is required for year one meaningful use. This means by October 1 you better be collecting data…and hopefully you didn’t just start on October 1…that would be playing with fire.

What really is the purpose of Meaningful Use? In the grand scheme of things, the CMS wants to make sure that a practice hasn’t bundled together a spreadsheet and word processor, call it an EHR, and then try to claim a big reimbursement. So, sure, it makes sense that the CMS would have some requirements for your EHR.

As is the situation anytime you try and get money from the government, the list of requirements is lengthy, the red tape is plentiful and the maze continues to get more complex.

So is the case when “proving” meaningful use. Hopefully you aren’t of the idea that buying a Meaningful Use certified EHR makes you a Meaningful User.

Having an EHR with that “certification” stamped on the box is not like an Easy Button.

Selecting that EHR is the first big hurdle you have to conquer…now you have to show you are a Meaningful User.

The items of proof are shown here in this CMS summary [PDF]. What you’ll see is there are 15 Core Objectives you must be able to report on.

That shiny new EHR should have all of these reports built right in. You better try pulling some of those reports to make sure there is some data in them.

So, those 15 mandatory Core Objectives are already selected for you. Next, there are five more you must select from a gallery of ten.

Which objectives should you choose? Wait for it…IT DEPENDS.

Such the non-answer answer.

It does depend on a number of items, but really which five would you choose?

The easiest to gather? DING DING!

Why not?

Why make this craziness any more difficult than it needs to be.

We’ll go over the Menu Set Objectives, and which ones are the easiest for you to pull, in a future article.

John Brewer is the founder of HIPAAaudit.com. He and his team help physicians run HIPAA Compliant practices in the simplest, most pain free way.

Screwed Up Meaningful Use (at least for specialists)

Posted on January 24, 2011 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.

I regularly get passionate emails from readers of EMR and EHR (and of course my other site EMR and HIPAA. I don’t always agree with the emails, but I almost always find them interesting. The following is one such email. It wasn’t intended to be published, so excuse the format. However, I find much of the comments about ONC’s approach to specialists spot on. The hard part is that I think ONC realizes this as well. The question is whether ONC in meaningful use stage 2 is going to do anything to address the specialist problem. I think this is a topic we need to voice to ONC.

The EMR’s basically started with certification requirements from CCHIT…ONC took that starting point…and moved to MU from it…without regard to specialty. Properly done, they should have started with MU by specialty…then figured out what the product certification requirements should be from there—for that specialty: Orthopedic guys see lots of patients (50-70 per day, and lose two days/week to surgery), mostly NEW patients with specific problems (broken bones or joint replacements)…no big longitudinal charts…and need to dictate complex notes; Dermatologists have lots of lab/biopsy tests, need to draw pictures and annotate them, not dictate; Pediatricians need growth charts and long medical histories and trends; Oncologists need detailed treatment histories, dosages, outcomes; Ophthalmologists need lots of technical data, measurements and interfaces to optic devices. Yet ONC made a set of rules that really only apply to Primary Care…which is where much of the CHRONIC conditions (and a large portion of the medical cost issues) are quarterbacked…and have the best chance of prevention.

Besides…all the data from specialists should flow back to the PriCare docs anyway…why try to keep it coordinated in both places? I think we have a long way to go to get all healthcare “communitized”…and powers that be need to recognize how different things are for various specialties…and define MU from each specialty’s point of view…and find out that the current certification standards are WAY overkill for most of them…unnecessary complexity and, thereby, cost….to do the irrelevant things to qualify for incentives. After five years, they will stop doing those things anyway, when incentives run out. Having a data pathway between in-patient and out-patient (ambulatory) is a great goal…that should come first..the ability to share data…even if via documents. That could be done today. Trying to devise interoperability standards for 400 EHR’s, a dozen or so major Hospital-based vendors…and registries, labs and other participants….that is a LONG way from being reality

Will be interesting to see how the “success stories” pan out this year starting in May for EP’s. Thank goodness ONC has made it almost impossibly easy for specialists in Stage I….they can opt out of almost everything required and get incentives the first 2 years($30k)…is that a good use of taxpayer money?

Great Chart Comparing Meaningful Use Stage 1 with Stage 2 and 3

Posted on January 21, 2011 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.

Today I came across this really great chart that compares the meaningful use stage 1 requirements with the proposed requirements for meaningful use stage 2 and 3. The comment period is still open for meaningful use stage 2 and 3 so make your voice heard.

Here’s the roadmap as described by John Halamka:
Jan, 12, 2011: release draft Meaningful Use criteria and request for comment
Feb-March, 2011: analyze comment submissions and revise Meaningful Use draft criteria
March, 2011: present revised draft Meaningful Use criteria to the HIT Policy Committee
2Q11: CMS report on initial Stage 1 Meaningful Use submissions
3Q11: Final HIT Policy Committee recommendations on Stage 2 Meaningful Use
4Q11: CMS Meaningful Use NPRM

See the comparison chart embedded below.