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Meaningful Use Payouts Hit $19 Billion

The pace of meaningful use payouts has stayed strong of late, with CMS disclosing that it has disbursed more than $19 billion in EMR usage incentives. While hospitals have been particularly prone to stay on the meaningful use train, eligible providers are collecting their payouts too, according to Healthcare IT News.

According to CMS data, there were 440,998 registered providers participating in the federal EMR incentive program as of the end of 2013, who have to date received 19.2 billion in incentives.

About 88 percent of all eligible hospitals have been given EMR incentive payment so far, according to CMS officials.  Also, about 60 percent of Medicare eligible providers are meaningful users of EMRs, the agency reports.

And the meaningful use programs for Medicare and Medicaid are both active, with more than 340,000 eligible providers having received an incentive payments to their program. Medicaid eligible providers are distinctly less likely to be involved in the meaningful use program; only 20 percent of Medicaid EP’s are meaningful users.

What the Healthcare IT News article doesn’t discuss, but ought to, is that there is considerable evidence that many doctors are not willing to push beyond Stage 1 of meaningful use. Stats suggest that these doctors have little financial incentive to move ahead with Stage 2, and can’t afford the time or money to push through the MU 2 obstacles.

In other words, before CMS runs a victory lap, it might do well to see what’s happening with the doctors walking away from the program.

February 12, 2014 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 @annezieger on Twitter.

McKesson, Meditech Chosen As EHR Test Systems for Meaningful Use

Here’s an interesting situation which is just popped up on my radar screen.  CMS and the ONC have chosen the first two vendors to serve as designated test EHR systems, and they’ve gone with McKesson and Meditech.

These test vendors are there to help eligible providers meet the requirements of Meaningful Use Stage 2.  To meet MU Stage 2 requirements, providers must successfully conduct at least one exchange test with a CMS-designated test EMR. (The providers can also meet the requirements by performing one electronic exchange of a summary of care document with a recipient using a different EMR technology.)

What intrigued me about this is that CMS and ONC are starting out with only two vendors for use as test EMR providers.  Given the diversity in the marketplace, you’d think that CMS would want to have fuller stock of vendors lined up before it went forward announcing its plans.

If I were an eligible provider going this route, I’d want to have the choice of a wider range test EMRs. Given how little real interoperability there is between EMRs, I’d like to know that I had a fallback position if my original tests didn’t work out.  After all, nothing I’ve read here suggests that EPs won’t have a chance to try again if the initial testing doesn’t go through, and if I were a provider, it’d be good to know that I could take the shot with other test EMRs. But I could be wrong, and that could have an effect on whether vendors see this as a win.

Let’s see if other substantial EMR vendors take up the ONC’s call to serve as test EMR participants.  It will be interesting to see whether vendors see participation as a credibility-raiser or a chance to get pantsed publicly if interoperating with their systems is a pain.

January 23, 2014 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 @annezieger on Twitter.

Should Doctors Say Goodbye To Meaningful Use?

Of late there’s been a lot of concern about doctors exiting the Meaningful Use program, with many saying the financial reward was simply not worth the trouble. This trend, of course, has the medical world abuzz with discussion as to what will happen if doctors drop Meaningful Use like a stone.

Meanwhile, a few months ago, an EMR vendor brought the discussion more heat when it announced that it would no longer be Meaningful Use certified. ComChart Medical Software said, in a letter to the EMR community, “unfortunately, will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as its requirements are technically extremely difficult to implement.”

If I were running a medical practice, and my vendor took away from me the choice of complying with Meaningful Use or not, I might be angry, but I might breathe a sigh of relief.  After all, complying with Stage 2 will be a major accomplishment for virtually any practice, and if my vendor takes the choice of complying or not complying with Meaningful Use out of my hands, I won’t have people breathing down my neck saying I’m not a team player.

But even if my vendor continues to support a certified EMR for now and into the future, it’s still worth wondering whether it’s worth the trouble for doctors, half of whom are in smallish practices that don’t have much of an IT budget.  After all, if my practice has completed Stage 1 I’ve already realized most of the financial benefits the program offers, notes Modern Healthcare.

So what do you think readers? Do the next stages of Meaningful Use pay off in other ways that make the struggle for compliance worth the trouble?

January 7, 2014 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 @annezieger on Twitter.

EMR Mandate Delay, Patient Focused EMR, and Guaranteed EHR Benefit


This article makes some interesting points about the challenge of EMR. However, I don’t think there’s any shot that the EHR train is going to slow down. At the best there might be a delay in meaningful use stage 2. Although, that could be unlikely as well. P.S. There is no EMR Mandate.


Not true. It takes GREAT EMR design to do that. The regulations are just brutal and don’t focus on the patient.


It’s always beautiful for me to find someone tweeting a blog post I created 4 years earlier. The content is still quite good. Reminds me that I need to finish my EHR Benefits series.

October 27, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Healthcare Standards – Opportunities and Challenges Remain for SNOMED CT, RxNorm and LOINC

The following is a guest blog post by Brian Levy, MD, Senior Vice President and Chief Medical Officer for Health Language.
Levy Low Res

Health IT standards and interoperability go hand-in-hand. Going forward, the success of the industry’s movement towards greater health information exchange (HIE) will hinge on the successful uptake and adoption of standards that will ensure reliable communication between disparate systems.

Progress is being made in this area through both messaging and coding standards introduced as part of Meaningful Use (MU). Specifically, MU coding standards that draw on such industry-respected clinical vocabularies as RxNorm, SNOMED CT® and LOINC® have the potential to drive more accurate, detailed sharing of patient information to promote better decision-making and patient outcomes.

Effectively deploying and adopting these standards is a huge undertaking with responsibilities falling to both vendors and providers going forward. To survive in future of healthcare, EMR vendors will have to evolve to support current and future industry standards. Providers will also have to grow their knowledge base and become more aware of how standards impact care delivery—instead of simply relying on vendors to pick up the slack.

The ability to “normalize” data to support all of these standards will be critical to advancing interoperability and communication between healthcare providers. With so many federal health IT initiatives competing for resources, the integration and use of terminology management solutions will become an important element to any data normalization strategy.

As providers assess their current needs and vendors move towards more enhanced offerings to align with new standards, the combined effort should produce significant progress towards improved information sharing. In the meantime, many challenges and opportunities exist along the roadmap to full implementation and adoption.

Vendor Readiness

While the EMR vendor market hit $20 billion in 2012, recent surveys suggest that many will not have staying power for Stage 3 MU. And one of the primary reasons, according to a 2013 Black Book Market Research report, is lack of focus on usability. An earlier report also pointed to 2013 as the “year of the great EHR switch,” pointing to provider frustrations that their current EMRs do not address the complex connectivity and sophisticated interface requirements of the evolving regulatory landscape.

Stage 1 MU created an artificial opportunity for many vendors to enter the market through government incentive grants. Because most initial EMR systems were not designed with Stage 2 requirements for HIE standards in mind, many vendors may find that they are not in a position to fund the infrastructure advancements needed to support future interoperability.

For instance, many EMRs support ICD-9 or free text for the development of problem lists. Under Stage 2 MU, problem lists must now be built electronically using SNOMED CT, requiring EMR vendors to develop and put out new releases to support the conversion. In tandem with this requirement, EMRs will also have to be designed to support RxNorm and LOINC.

It’s a time of upheaval and financial investment in the EHR industry, and when the dust settles, healthcare providers will have designated the winners. The end-result will ultimately include those players that can support the long-term goals of industry interoperability movements.

Minimizing Workflow Impacts

In existence since 1965, the SNOMED CT code set has a long track record of success and international respect. A comprehensive hierarchical system that includes mappings to other industry terminology standards, the code set enables computers to understand medical language and act on it by organizing concepts into multiple levels of granularity.

Few would dispute the potential of SNOMED CT to enhance accuracy and address the detail needed to promote enhanced documentation practices, but the expansive nature of the code set is still not exhaustive. Searching and finding the SNOMED concepts to include in Problem lists often requires further expansion of synonyms and colloquial expressions commonly used in clinical practice.  In addition, an accurate SNOMED code may not equate to a billable ICD-10 code, potentially requiring clinicians to conduct multiple searches if EMR workflow is not carefully planned.

The challenge for healthcare organizations is two-fold when it comes to the complicated SNOMED CT conversion process. First, the conversion represents one more complex IT project that healthcare organizations must undertake  amid so many other competing initiatives. Second, the success of implementations will be diminished if clinician workflows are negatively impacted. With EMR documentation practices already requiring more time from a clinician’s day, the situation will only be exacerbated if multiple code searches are required to ensure regulatory compliance for MU and ICD-10.

Terminology conversion tools that leverage provider-friendly language can be a great asset to easing the burden by providing maps between ICD-9 or ICD-10 and SNOMED CT problems. Physicians search for the terms they are accustomed to using in the paper record, and terminology tools convert the terms to the best SNOMED CT and ICD-10 codes behind the scenes.

For example, a clinician may add fracture of femur to a problem list, but ICD-10 requires documentation of whether the fracture was open or closed, the laterality of the fracture and whether the fracture was healing. Provider-friendly terminology tools provide prompts for the additional elements needed and guide clinicians to the most appropriate choices without the need for multiple searches.

Improving Mapping Strategies Internally and Externally

Industry crosswalks and maps exist to help ease the transition to new standards like SNOMED CT, RxNorm and LOINC. While these tools provide a good starting point in most cases, there is simply not a gold standard map that will work for every case.

Consider RxNorm, a naming system that supports semantic interoperability between drug terminologies and pharmacy knowledge base systems. Working in tandem with SNOMED CT to improve accurate capture of patient information from external systems, RxNorm codes are now required as part of the CCD (Continuity of Care Document) and HL7 messages for capture of medication information.

While designing EHRs with the capability to send and receive RxNorm codes is the first step, healthcare providers will still require a method of converting codes from RxNorm to internal medicine systems and drug information and interactions databases like Medi-Span, First Databank, Micromedex and Multum. Another challenge to standardizing medication information is the use of free text. Many healthcare providers receive drug information that is not coded at all, requiring a specific, customized mapping.

LOINC, a universal standard for identifying medical laboratory observations, is particularly challenging in this arena. Because the industry is home to hundreds of local lab systems and thousands of local lab codes, creating a single industry mapping solution is nearly impossible. The process often requires that sophisticated algorithms be built by performing an analysis of individual lab tests that are conducted in a particular hospital.

By leveraging the expertise and sophistication of a terminology management solution, healthcare providers can more easily automate and customize mapping of patient data to standardized terminologies. Otherwise, IT departments must expend valuable staff time to build complex mapping systems to address the myriad of needs associated with an influx of new standards.

Conclusion

The healthcare industry has identified use of a common medical language as a key foundational component to advancing information sharing capabilities. By designating such standards as SNOMED CT, RxNorm and LOINC as MU requirements going forward, the industry is taking a progressive step forward to ensuring clinicians have more efficient access to better patient information.

It’s a critical step in the right direction, but the road to success is complex. Healthcare organizations that draw on the expertise of terminology management solutions will be able to achieve the end-goals of this movement much quicker and with fewer headaches than those trying to implement these complex standards on their own.

October 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

MGMA Raises Meaningful Use Stage 2 Concerns

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.

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 @annezieger on Twitter.

Meaningful Use Dropout Rate At 17 Percent

In theory, once a provider achieves Meaningful Use and picks up their first check, one might think that they’re on board and ready to power through the program. Well, think again.

According to a piece published in HIT Consultant, 17 percent of providers who got an $18,000 EMR check in 2011 didn’t get the second $12,000 incentive payout in 2012.  The stats come from a recently published analysis of the federal April EMR attestation data crunched by Wells Fargo.

What that means, in real terms, is that 17 percent of providers were able to demonstrate MU for the 90 days required in 2011 but couldn’t keep things up for the full year required for to get the second check, notes Evan Steele, CEO of EMR firm SRSsoft, who authored the article.

You’d think that providers could have demonstrated a year’s compliance, given that after 90 days they already had the needed workflows in place to support those requirements, but for nearly 20 percent of providers, it seems that simply wasn’t the case, Steele says. And this is very bad news, he suggests:

A 17% loss rate in any business is wholly unacceptable, and this failure does not portend well for the future of the EHR Incentive Program. If $12,000 proved to be insufficient motivation for physicians with meaningful use experience to meet the relatively low requirements of Stage 1 on an ongoing basis, it would be foolish to expect physicians to muster the wherewithal to meet the increasingly demanding requirements of Stage 2. The incentive for a year’s performance at that point will be a mere $4,000.

Thinking that perhaps the 17 percent dropoff trend will correct itself as time passes?  Probably not. As Steele points out, another survey recently found that 14 percent of physicians who attested to Stage 1 already say that they don’t intent to attest to Stage 2.

As Steele sees it, this is evidence that we need to simplify Meaningful Use rather than making it increasingly complex, while focusing on interoperability across the entire healthcare system.  In his view, if we don’t “the entire program will go down the drain.”

I don’t know if these numbers are evidence that Meaningful Use is on the skids, but a 17 percent dropoff is certainly troubling. Clearly something must be done to reach out to providers who’ve climbed off the train.

July 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 @annezieger on Twitter.

CHIME Seeks Year-Long Meaningful Use Stage 2 Extension

Recently, six senators wrote a letter to HHS Secretary Kathleen Sebelius criticizing the Meaningful  Use program.  The letter, which came with a white paper listing their concerns about federal health IT policy, questioned whether the $35 billion allocated to Meaningful Use was being spent effectively, especially given the fact that provider interoperability is still minimal.

This week, the College of Healthcare Information Management Executives (CHIME) sent a letter to the six senators responding to their concerns, one which largely defends Meaningful Use though advocating for a one year extension of Stage 2.

In the letter, CHIME leaders concede that that there is some reason to be concerned with the current state of interoperability. However, they note, “we strongly believe that EHR incentive payments under the policy of Meaningful Use have been essential in moving the nation’s healthcare system into the 21st Century.”  The incentive payments providers are receiving are critical to the business plans and interoperability solutions they’re developing, CHIME says.

And while we may not have interoperable EMRs in place just yet, the MU program has helped make progress in that direction, they say. “The work accomplished through Meaningful Use to reach consensus on transport, vocabulary and content standards is foundational to advancing interoperability and exchange,” the letter argues.

All that being said, it would be a good idea to extend Stage 2 of Meaningful Use for another year before moving ahead with Stage 3, CHIME contends:

A year extension of Stage 2 will give providers the opportunity to optimize their EHR technology and achieve the benefits of Stage 1 and Stage 2; it will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policymakers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules.

Personally, I hope that HHS agrees to CHIME’s request and moves Stage 2 up a year. After all, the existing timelines aren’t holy writ, and if changing the deadline allows providers and vendors to consolidate their gains significantly, it’s probably worth the wait.

John’s working on an interview with CHIME to discuss their letter. Watch for that over on Hospital EMR and EHR.

May 8, 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 @annezieger on Twitter.

EMR and EHR Whitepapers

For a while I’ve been considering how the Healthcare Scene network of blogs can provide an EMR, EHR and healthcare IT whitepaper service. Over the many years I’ve been blogging about EMR and EHR, I’ve seen a lot of really valuable whitepapers created by the various EHR vendors. The time required to create a whitepaper is lengthy and for someone looking for an in depth look at a subject, a whitepaper is a nice option.

With that in mind I recently launched a new EMR, EHR and Healthcare IT whitepaper portal. We’re just getting started with the healthcare whitepaper portal, but we’ll be growing the content that’s available there over time. We’ll also be including a nice sidebar widget for those interested in the latest whitepapers we have to offer and we’ll embed a list of whitepapers in the email subscription as well.

We already have a number of great whitepapers available. For example, athenahealth created this whitepaper on Making the Switch: Replacing Your EHR for More Money and More Control. We’ve often talked about EMR switching becoming a very popular and important topic. This whitepaper helps a practice considering the EMR switch to go through an analysis of why to switch EMR or not.

Another whitepaper by NextGen is called The tips and tools to help you on the path to MU (Meaningful Use) and beyond. Considering less than 50% of providers have attested to meaningful use, this could be useful to many. It contains a lot of great resource links and some tips on how to approach meaningful use. If you’re looking at meaningful use stage 2, check out this one from AdvancedMD called Achieving Stage 2 Meaningful Use in Private Practice.

Those are just a few examples. You can find many more of them on this EMR and EHR whitepaper library page. I look forward to adding a lot more interesting whitepapers in the future. Hopefully you’ll find the content valuable.

April 23, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Will 2013 Be The Year Of EMR/Device Convergence? Nope.

Increasingly, healthcare organizations are introducing wireless medical devices which can hook up to EMRs.  And this makes a lot of sense, given that data from, say, infusion pumps offers a critical part of a patient’s overall picture and can boost safety as well.  On the other  hand, equipment and integration costs have held back hospitals from widespread convergence.

Given these opposing forces, it it looks like we’re poised at a point where adoption of wireless, EMR-connectible devices could gather momentum or stall out and drag into 2014 or beyond. But don’t get your hopes up for 2013. Here’s some trends that are likely to drag down the progress of medical device connectivity for the coming year:

* Device interoperability not required for Stage 2:  According to one blogger, William Hyman of Medical Connectivity, Stage 2 of Meaningful Use doesn’t directly doesn’t require providers to connect most traditional devices to the EMR. (Imaging and lab systems are exceptions, he notes.)  Well, if Stage 2 doesn’t require smart devices, must less connected ones, it’s hard to imgine CIOs making this a priority.

FCC initiatives to benefit wireless medical device use aren’t mature yet:  The FCC is taking several steps to encourage the use of connected medical devices. These include promoting the use of medical body area networks (MBANs), for which it has reserved spectrum, as well as making frequencies available for medical micropower networks. The agency is also working on making it easier to experimentally license spectrum for wireless health test beds for wireless medical devices.  These initiatives are just getting rolling, however.

Medical devicemakers face big EMR challenges:  As Medical Connectivity’s Tim Gee notes, creating device software that will smoothly pump data into an EMR is actually a pretty big challenge.  Devicemakers will need to export data in digital form, work with a central server aggregating data from your medical devices and translate you device data into HL7 for the EMR. Device vendors face big development expenses if they hope to get this right, he notes.

Will the wireless medical device become a standard part of hospital gear? I’d say it’s only a matter of time. But this year, progress is likely to be slow.

December 31, 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 @annezieger on Twitter.