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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Pressure is on for meaningful use rebuild | Healthcare IT News

Pressure is on for meaningful use rebuild | Healthcare IT News | EHR and Health IT Consulting |

A coalition of healthcare associations today called on HHS Secretary to revamp the meaningful use program.

"Without changes to the MU program and a new emphasis for interoperable EHRs/EMRs systems and HIT infrastructure, we believe that the opportunity to leverage these technologies will not be realized," the organizations wrote.

The letter is signed by the American Academy of Family Physicians, American Medical Association, Medical Group Management Association, National Rural Health Association, Memorial Healthcare System, Mountain States Health Alliance, Premier healthcare alliance and Summa Health System.

The AMA also wrote a separate letter to CMS and ONC, pushing a similar agenda and offering a detailed "blueprint."

The coalition letter to Burwell references the recent final rule that provided some flexibility in cases where certified EHRs were not available.

"Unfortunately, the recently released final rule that provided relief for unavailable technology did not address or improve the challenges of interoperability and usability," the letter stated. "It also only limited its impact to 2014, despite the growing concern with future stages of the MU program. Our organizations remain concerned that without changes the forward trajectory of the MU program will be in jeopardy."

The coalition recommended the following:

• Streamline and focus the ONC certification requirements on interoperability, quality measure reporting and privacy/security. Removing a heavy handed set of certification mandates and allowing instead for a flexible and scalable standard based on open system architectural features like application program interfaces will promote the delivery of more innovative and usable solutions. This in turn will allow data to move more freely across the healthcare system, reducing data lock-in and promoting more usable systems;

• Foster collaboration among stakeholders to promote the development of new HIT that is focused on meeting clinical care needs;

• Remove restrictive MU policies that stifle HIT innovation;

• Recognize vendors and providers need adequate time to develop, implement and use newly deployed technology and systems before continuing on with subsequent stages of the MU program. Testing and achievement of specific performance benchmarks should occur before providers are held accountable for any new MU requirements.

Among the AMA recommendations in the letter it sent CMS and ONC were:

Adopting a more flexible approach for meeting meaningful use to allow more physicians to successfully participate;

•Better aligning quality measure requirements including reducing the reporting burden on physicians and helping relieve them from overlapping penalties;

• Ensuring quality measures and clinical decision support within the program are current to improve care for patients and ensure physicians are following the latest evidence; and

• Restructuring EHR certification to focus on key areas like interoperability.

"Physicians will always embrace technology that can help them provide better care for their patients and foster innovation, but improvements must be made to the meaningful use program in order for those goals to be achieved," said AMA President Robert M. Wah, MD, in a news release. "We can no longer just delay the program from taking full effect. We must make the necessary changes to ensure that the meaningful use program requirements are in fact meaningful and deliver – not hinder – the intended improvements in patient care and practice efficiencies."

The blueprint outlines several ways CMS and ONC could improve meaningful use immediately and in the future.

As part of its recommendations to improve the program, the AMA is asking the administration to make optional the objectives physicians are finding most challenging. These objectives include view, download and transmit, transitions of care and secure messaging.

In addition, the AMA recommends that CMS and ONC take the opportunity with Stage 3 to make the meaningful use program less primary care centric by expanding options within the health IT objectives to meet the needs of specialists and requiring physicians to meet no more than 10 requirements.

The letter also reiterates AMA concerns with Stages 1 and 2 of the program, and offers recommendations for addressing the programs.

"The whole point of the EHR incentive program was to build an interoperable health information technology infrastructure that would allow for the routine exchange of important medical information across settings and providers and put medical decision-making tools in the hands of physicians and patients, yet that vision is not being realized and the lack of interoperability is stifling quality improvement," said Wah. "While more than 78 percent of physicians are using an EHR, thousands have not participated in the meaningful use program or attested to Stage 2, in large part because of the program's all-or-nothing approach. Physicians should not be required to meet measures that are not improving patient care or use systems that are decreasing practice efficiencies. Levying penalties unnecessarily will hinder physicians' ability to purchase and use new technologies and will hurt their ability to participate in innovative payment and delivery models that could improve the quality of care."

The coalition seems to be in agreement. In its letter to Burwell, it wrote:

"In addition to HIT interoperability challenges, existing systems also lack usability, complicating physician and provider workflows, and diverting resources away from patient care. For instance, many of the physicians have vocalized concerns that these challenges and greater administrative burdens are creating significant dissatisfaction with EHR/EMR usability; yet, their vendors are limited from addressing these concerns as they focus on meeting increasingly complex certification requirements."

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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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HHS calls Stage 3 rule 'flexible, clearer framework' | Healthcare IT News

HHS calls Stage 3 rule 'flexible, clearer framework' | Healthcare IT News | EHR and Health IT Consulting |

It's more of a requisite first step than milestone, but the Department of Health and Human Services sent the proposed rule for meaningful use Stage 3 to the Office of Management and Budget.

There’s precious little detail in these submissions, but HHS foreshadowed the major problems it intends to address with this next, and perhaps final, stage of the federal EHR Incentive Program.

"Stage 3 will focus on improving health care outcomes and further advance interoperability," according to OMB’s website. "Stage 3 will also propose changes to the reporting period, timelines and structure of the program, including providing a single definition of meaningful use. These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements."

The Office of the National Coordinator for Health IT also submitted a rule to OMB proposing a new 2015 Edition Base EHR definition, as well as modifications to the ONC Health IT Certification Program, "to make it more broadly applicable to other types of health IT health care settings and programs," another OMB web page states.

ONC’s proposed rule would establish capabilities and criteria, and specify standards and implementation specifications that EHR makers must meet, to "at a minimum support the achievement of meaningful use" for customers including eligible hospitals and eligible providers looking to attest and receive incentives.

OMB ranks both proposed rules as “major” but the in the form’s legal deadline field the status is none.

Stage 3 is expected to begin in 2017.

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