EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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How Does ONC Plan to Expand Health Information Exchange?

How Does ONC Plan to Expand Health Information Exchange? | EHR and Health IT Consulting |

With the vast amounts of data collected in the healthcare industry, providers, vendors, and other stakeholders are putting more focus into developing health information exchange (HIE) and greater EHR interoperability. The Office of the National Coordinator for Health IT (ONC) released a report to Congress – Update on the Adoption of Health Information Technology and Related Efforts to Facilitate the Electronic Use and Exchange of Health Information – to offer policy guidance on the best ways for optimizing health IT systems and supporting HIEs.

Ever since the federal government passed the Health Information Technology for Economic and Clinical Health (HITECH) Act, the number of hospitals and physician practices adopting EHR systems has grown substantially. Currently, more than half of hospitals have at least a basic EHR system in place while, in 2013, 48 percent of physicians had EHRs at their practice.

Additionally, eligible professionals and eligible hospitals across the country are participating in the Medicare and Medicaid EHR Incentive Programs. While there has been significant progress in implementing health IT, there are still barriers that are halting widespread health information exchange across healthcare organizations and vendor products.

For example, if an individual from Maine takes a vacation in Florida and experiences a patient encounter, their primary care provider from Maine would likely not be informed nor would be able to access the patient’s emergency care data.

The report states that some of the common barriers to EHR adoption and thereby challenges for expanding health information exchange include the cost of purchasing a system, loss of productivity, training difficulties, the costs of annual maintenance, and obstacles related to finding an EHR system that supports practice needs. Nonetheless, in 2013, eight in ten physicians were using an EHR system or planning to adopt one, according to an ONC data brief.

ONC explains in its report that some of the reasons health information exchange is lacking is due to inconsistent structure, format, and even medical vocabulary used across different EHR systems and vendor products. ONC outlines key actions the Department of Health and Human Services (HHS) will need to take to improve nationwide EHR interoperability. These actions include:

  1. Creating new standards that are integral to the development of a connected healthcare system
  2. Requiring more staff in the health IT workforce to support the implementation of electronic records
  3. Improving the sharing of data among providers and public health agencies
  4. Collaborating, advising, and sharing studies with states, communities, and providers to stimulate IT solutions in the healthcare field
  5. Driving patient engagement with their health information

ONC hopes that Stage 2 Meaningful Use requirements will also catalyze a widespread data exchange network within the healthcare sector. By using these five strategies, HHS plans to further advance health information exchange and invest in health IT usability throughout the nation.

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CMS, ONC Must Address Hospitals' EHR Fraud Vulnerabilities

CMS, ONC Must Address Hospitals' EHR Fraud Vulnerabilities | EHR and Health IT Consulting |

CMS and the Office of the National Coordinator for Health IT need to develop a plan to implement protections against fraud vulnerabilities in electronic health records, according to an HHS Office of Inspector General report, Health Data Management reports.

Report Details        

The Compendium of Unimplemented Recommendations report outlines and prioritizes 25 unimplemented suggestions that OIG believes would benefit HHS in terms of:

  • Cost savings; and
  • Quality improvements.
Report Findings

According to the report, EHRs can make it easier to commit fraud, which "not only harms the defrauded programs, it also puts patients at risk." Therefore, the report stated, "HHS must do more to ensure that all hospitals' EHRs contain safeguards and that hospitals use them to protect against electronically enabled health care fraud".

The report found that while most hospitals have adopted EHR systems, they might not be using them to their full capabilities to protect against fraud.

For example, OIG found that only about 25% of hospitals had policies in place regarding the copy-paste feature of EHR systems (Health Data Management, 3/20). The report recommended that CMS create guidance for using the feature.

OIG said that it will not consider its recommendations implemented until auditors receive, review and approve a plan to detect and reduce fraud, which CMS in July 2014 said it would develop with the help of ONC.

Meanwhile, the report also recommended that CMS:

  • Improve the Medicare appeals process at the administrative law judge level by standardizing case files and making them electronic; and
  • Implement an automated system that will reconcile Medicare outlier payments.

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New Measures Under Stage 3 Meaningful Use Requirements

New Measures Under Stage 3 Meaningful Use Requirements | EHR and Health IT Consulting |

The Department of Health and Human Services (HHS), the Office of the National Coordinator for Health IT (ONC), and the Centers for Medicare & Medicaid Services (CMS) have prioritized that all eligible professionals will need to meet Stage 3 meaningful use requirements under the proposed rule by 2018. Along with this determination, providers will also be able to file hardship exemptions if meeting this goal is unsustainable for their practice.

The established payment reductions for not meeting meaningful use requirements haven’t been modified. Along with the announcement about the eight objectives under the Stage 3 Meaningful Use proposed rule, the federal agencies also disclosed the 2015 Edition Health IT Certification Criteria, according to the Journal of AHIMA.

While the Stage 2 Meaningful Use requirements called for ensuring 5 percent of patients used portals to view, download, and share health records, the Stage 3 Meaningful Use proposed rule asks providers to engage 25 percent of their patients in accessing this medical information.

This also includes having 25 percent of patients use secure messaging tools to speak with their physicians. The proposed rule recommends providers to use a third-party interface when collecting this data.

Many stakeholders are encouraging further revisions in one area of Stage 3 Meaningful Use requirements. The full calendar year EHR reporting period is posing undue burden on healthcare facilities and many are urging the inclusion of a 90-day EHR reporting period instead.

Recording patient demographics within the health record is also a key part of Stage 3 Meaningful Use regulations. Some of the data that eligible hospitals will need to record includes patients’ preferred language, race, ethnicity, gender, date of birth, preferred method of communication, sexual orientation, occupation, and disability status.

Another new measure under the Stage 3 proposed rule includes a recommended menu item that states eligible hospitals and providers will need to receive electronic patient-generated medical information through either questionnaires/surveys or secure messaging systems. Patient-generated data through mobile technologies will also count toward this requirement.

Another interesting objective within the proposed rule asks for hospitals to send electronic notifications to a patient’s care team – especially primary care providers – about any important healthcare occurrences. While many of the proposed measures may be challenging to achieve across the healthcare sector, the overall goals of the EHR Incentive Programs is to establish health information exchange and improve interoperability.

“ONC’s proposed rule will be an integral component in the shared nationwide effort to achieve an interoperable health system,” Karen DeSalvo, M.D., M.P.H, M.Sc., national coordinator for health IT, said in a public statement. “The certification criteria we have proposed in the 2015 Edition will help achieve that vision through provisions that consider the range of health IT users and uses across the care continuum, including those focused on interoperable standards, data portability, improved transparency, privacy and security capabilities, and increased oversight through ONC’s Health IT Certification Program.”

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