EMR Vendor Executives on Meaningful Use and Certification Requirements – Part Five of a Series

We asked several vendors a series of six questions related the federal government’s recent announcement on the latest proposed meaningful use definitions and EHR certification criteria.

Practices are required to provide patients with electronic copies of their visit information. How will providers do that and how will patients use that information?

Allscripts – Glen Tullman, CEO

As the Interim Final Rule (IFR) and the Notice of Proposed Rule Making (NPRM) both describe, there are many ways for physician practices to provide patients with clinical summaries of their visit information in paper or electronic form.  Many of our clients have already selected the Allscripts Patient Portal as the best means of delivering this sort of secure health information to patients, whether it’s a visit summary, test results or an email message from their physician.   We expect that more healthcare organizations will turn to patient portals to satisfy this requirement.

Patients, for their part, are likely to use the information they obtain from a portal for self-education, which tends to improve compliance with their physicians’ prescribed therapy. We also hope patients will share the information they take away from physician visits with other providers they may see.  That is exactly the sort of information exchange that can improve the coordination of patient care across all settings, improving overall quality and lowering costs from such things as duplicative tests.

To that end, we suggest that HHS require providers to include patient portal functionality within the EHR they implement in order to meet Meaningful Use criteria.  Personal Health Record utilization is not  widespread at this point, but enabling physicians to be change agents in notifying patients of the availability of critical health information is an approach we strongly support and which we believe would quickly increase the number of PHR participants. We also suggest that HHS require all EHRs to include access to at least one Personal Health Record and one or more storage mediums, for example, Microsoft HealthVault or Google Health.

eClinical Works – Girish Kumar Navani, CEO and co-founder

There are currently tools available that will make that a possibility with little effort. As it stands now, providers using eClinicalWorks can have the visit summary automatically uploaded to the eClinicalWorks Patient Portal. Once there, all a patient needs is a username and password to obtain that information. Having an informed patient will increase the probability that key aspects of the visit will be remembered and followed-up on, if need be, while at the same time reducing calls into the office.

Eclipsys – Philip M. Pead, President and CEO

I believe this component of the criteria will increase the deployment of patient portals, although the easiest way to meet this requirement in Stage 1 would be a simple encrypted file copy of the information to a CD-ROM or USB-Memory device.

e-MDs – Michael Stearns, President and CEO

Our providers have this capability currently as they can export some or all of the information in an electronic format that can be provided to the patient in a number of formats, including a patient portal.  Patients and family members can make use of this information by sending it electronically or physically carrying it (e.g., on a USB key) and making it available to health care settings that do not have access to an interoperable EHR.

We believe this functionality will gain increasing importance as providers and patients become more involved in care coordination, in particular in the setting of chronic disease.

GE Healthcare – Vishal Wanchoo, President and CEO, GE Healthcare IT

The meaningful use criteria specify a wide range of electronic ways that this can be met, for example PHRs, patient portals, CDs, and “thumb drives.”  We expect providers will use methods that meet patient needs and are consistent with their technology.  Likewise, patients will use this information to meet their needs, such as reviewing information at home, giving it to another provider, or using a PHR.

InteGreat, a MED3OOO Company – Tom Skelton, President

This can be accomplished by a simple print of a patient’s health summary and completed note. In addition, this can be accomplished by having an integrated patient portal with your EHR. There is also mention that the format given to the patient must be “readable and understandable”.  We think some additional guidance here would be beneficial. Since certification under CCHIT 2008 and beyond requires support of the HL7 CCD, we expect that most EHR products will provide the visit information via a secure web portal that is populated via a CCD.  Some practices may prefer to provide the electronic copy on a CD or memory stick. We suspect that the format will still be the CCD so that the data can be viewed using a standard web browser. Either way, patients will use it to research their medical conditions on the internet and to bring their records with them when seeing a specialist.

McKesson – Dave Henriksen, SVP and GM, Physician Practice Solutions

The criteria states that the eligible provider must provide clinical summaries for patients for each office visit in paper or electronic form that includes – at a minimum – diagnostic test results, medication list, medication allergy list, procedures, problem list and immunizations. We offer a robust patient portal that provides patients with online access to that information, but which also makes this information available in other acceptable formats. We believe this approach aligns with the government’s ultimate goal — that patients have easy access to their most current health information so they can make informed care decisions and ultimately better manage their health. For McKesson, we believe that we are well-positioned with RelayHeath’s PHR and HIE capabilities to provide the needed interoperability services to our customers.

NextGen Healthcare – Scott Decker, President

Physicians have always had the capability to provide patients with copies of their automated record. We have been working with our clients to provide this information for several years, however the real challenge will be getting all physicians to meet this requirement, as many don’t do it today. There are also some privacy and security issues to be worked out before record sharing can be done as effectively as the authors of these regulations wish. We hope that patients will also use their personal health information to strengthen their commitment to better health by working more closely with their doctor.  Educating patients on the benefits that personal health records can have on their health will be key.

Sage – Lindy Benton, Chief Operating Officer

Our solution today is to enable the patient to access the clinical record on-demand and online though our practice portal. This enables consumers to use that information in whatever way they feel is appropriate. Patients can view or print the clinical summary from the portal, or merge the CCD into their PHR.

Alternately, the practice can provide an electronic copy on a memory stick or CD, however, this leads to the second part of this question—how will the patient use it? So the online portal seems to us the most beneficial way to share clinical information with the patient, in that it is secure, portable and immediately useful.

Ultimately, we are interested in putting the patient in a position to leverage emerging technologies. We are of the opinion that ubiquitous platforms will emerge, such as a healthcare-geared Facebook-type platform that patients will gravitate toward. In this case, it becomes a question of secure messaging and allowing the patient to consent and direct their record accordingly.

SRSsoft – Evan Steele, CEO

We don’t see this as a measure to save healthcare costs or provide improved care. This is a privacy/security/access issue; a convenience for patients who need to have access to the data in their records for some reason. I cannot envision the majority of patients requesting their medical records on a CD or a thumb drive, now or in the foreseeable future. Patients may need to request copies of their records, or portions of their records if they relocate, change providers, etc., but they typically want paper documents that they can read themselves and share as they see fit. Many providers have issues with this in that they must be much more careful and perhaps less candid about comments and notes they make in patient records if they know the patient is going to view them. Some comments could alarm them or be cause for other concerns if providers are just noting things to look out for in the future, for example.

You do not need a comprehensive, point-and-click EHR to make records available to patients. In fact, it is a lot easier to and faster to do this with a hybrid EMR. In addition, most physicians find the templated exam notes that are generated from a point-and-click EHR to be of little value—difficult to find information and lacking the detail, nuance, and precision that most specialists require.

News 1/19/10

From: Certifiably Confused “Re: EHR certification. A vendor is suggesting its product is ‘meaningful use certified,’ which will permit its physician clients to qualify for ARRA money. Is ‘meaningful use certified’ an official designation? And what does it mean?” I had to consult with Evan Steele of SRS, who has become a certification guru of sorts. No, I don’t believe that ‘meaningful use certified’ is an official term. More likely the vendor is suggesting his solution will meet the certification requirements under the new HHS-certification regulations. Evan believes that CCHIT will be one of the certification organizations but that full (comprehensive) CCHIT certification will not be necessary for an EHR to qualify under ARRA. Look for the ONC to release another proposed rule regarding the certification process and the authorization of certification organizations. In my opinion, the clarification can’t come soon enough.

Girish Kumar Navani of eClinicalWorks wins a 2010 Business Leader of the year award, presented by Worcester Business Journal. The newspaper includes an interesting profile on Navani, who won in the Big Business Leader category. Navani provides some history on the company, which is now in its 10th year. My favorite comment comes from the Micky Tripathi, CEO of the Massachusetts eHealth Collaborative. Tripathi calls Navani “an unbelievable salesman.” I love sales types, and I agree with the assessment.

If you are looking for an EMR to work with your iPhone, MobiHealthNews provides a list of 12 applications with iPhone capabilities. By this time next year, I bet we’ll have more EMRs with iPhone apps than without.

Allscripts CEO Glen Tullman is quoted as saying his company will hire another 250 people in coming months in sales, training and solutions management. Tullman also says the company’s workforce grew 10% last year, to about 2,500.

HIE provider Medicity announces a 91% increase in bookings in 2009 versus 2008 and a 35% increase in its five-year revenue backlog.

Advanced Foot and Ankle Specialists (FL) goes live with Aprima Medical Software for EHR and PM. Doctor’s Administrative Solutions provided the training and remote hosting services.

Two community health centers are partnering with Cisco, the HMO Molina Healthcare, and the state of California to establish a $10 million telehealth pilot project to provide health services to underserved communities. More than 15  sites will be connected over the next six months.

eClinicalWorks signs a big order with Summa Physicians (OH) to provide EMR for its 223 physicians. Summa Health Systems is already an eCW client, having contracted with eCW in 2006 to provide EMR and PM solutions for its community physicians.

Tomorrow’s question in part five our EMR Executive Series on Meaningful Use and Certification Requirements: Was there enough emphasis on clinical decision support and interoperability?

NoMoreClipboard announces a new patient portal that allows patients to create their own PHR and share clinical and financial information with their providers.

Technology is making “participatory medicine” an easier alternative for providers. Proponents of involving patients more into their own care process believe it can increase patient satisfaction, save time, reduce costs and improve care. Other benefits for physicians: reduced liability risks and possibly a new revenue stream for online consults. It’s all about getting doctors to use the tools, such as email, PHRs, patient portals, home monitoring devices, and social networking sites.

An Ohio woman tampers with her own medical records to make friends and co-workers believe she has breast cancer. She apparently used a computer to cut and paste her doctor’s signature from a legitimate medical record and then added it to a fake one that indicated she was being treated for cancer. Her concerned co-workers raised $7,000 to help offset medical bills, though she actually resisted the help. Eventually the doctor learned about the false documents and notified police. She’s now been charged with two counts of felony forgery. Her motive was unclear though her family says its not the first time she has faked a cancer diagnosis. By the way, I think I have tennis elbow in case anyone wants to send money my way.

E-mail Inga.

EMR Vendor Executives on Meaningful Use and Certification Requirements – Part Four of a Series

We asked several vendors a series of six questions related the federal government’s recent announcement on the latest proposed meaningful use definitions and EHR certification criteria.

Was there enough emphasis on clinical decision support and interoperability?

Allscripts – Glen Tullman, CEO

Yes and no.  While we’re grateful that HHS responded to our request that they push the industry forward with tougher requirements around Clinical Decision Support and interoperability, we would have preferred a much more aggressive approach on both fronts. If not for this year, then HHS should have made it clearer that in 2013 the bar will be substantially higher so we can begin to plan and develop necessary changes to our applications today.  The American taxpayer is investing billions of dollars in this program and they deserve much more rapid progress on Clinical Decision Support (which translates into improved quality) and interoperability (which leads to better quality and lower costs). For instance, HHS could require vendors to support more of the IHE profiles that the vendor community consistently demonstrates are valuable, tested methods of sharing health data in a standard way.

Allscripts has devoted considerable resources to interoperability over the years, as demonstrated by our repeated participation in the HIMSS interoperability showcase and other similar events. Through our leadership, we’ve helped to create an infrastructure of collaboration and connectivity, and we invite some of the other vendors who have not taken part in this effort to join us.

Concerning interoperability, there are a few things we would like to see adjusted in the final rules. We would like to see additional clarity around medication allergies, as well as a stricter approach to problem lists (by allowing only SNOMED CT and not ICD-9).  We expect that both of these limitations will be addressed by the time the 2013 certification requirements are released.  For the Stimulus incentives to have their intended effect, it’s critical to establish true interoperability of Electronic Health Records.

On Clinical Decision Support, we are excited to be part of initiatives that will push CDS and quality measures into the interoperability conversation. We have actively participated with the National Quality Forum, the National Committee for Quality Assurance, the American Medical Association, HL7 and the HIMSS EHR Association in the creation of a new HL7 standard for the expression of Quality Measures.  The new Health Quality Measures Format (HQMF) that these groups have jointly developed will make quality measures interoperable. Right now hundreds of EHR vendors are reading 90 quality measures and trying to extract the logic of those measures from pdf documents.  This is an enormous, clumsy and unnecessary effort. With the adoption of HQMF (which we hope will be part of the 2013 certification requirements) our Electronic Health Records will be able to “consume” quality measures automatically, enabling Clinical Decision Support without the “hand coding” that is so often required today. This will significantly enhance our ability to quickly respond to changes in clinical guidelines, and ensure that our clients receive the latest information to guide their delivery of the best possible patient care.

eClinical Works – Girish Kumar Navani, CEO and co-founder

There was not enough emphasis on clinical decision support or interoperability. Many are nervous because intuitive clinical decision support is difficult to develop; however, it serves as the basis for a good prevention-oriented EMR. We would have liked to see more focus in this area and raise the bar for clinical decision support as a requirement for EMR use.

Eclipsys – Philip M. Pead, President and CEO

We consider the threshold for Clinical Decision Support (CDS) is clearly a token gesture in Stage 1, and will require a much better definition of what does and does not qualify as CDS before this criteria can become measureable.

What’s important to note is that the landmark Institute of Medicine report, “To Err is Human” was published approximately 10 years ago, calling for expanded use of CPOE to reduce avoidable medical errors and deaths. We believe the passage of ARRA is an unprecedented opportunity to move forward the quality and safety of care for all of us. We agree a one size fits all solution for CPOE isn’t the right approach and we believe the initial ARRA definition timeline gave physicians and hospitals ample time to appropriately customize their adoption of clinical decision support tools. As healthcare leaders we know meaningful CPOE adoption is achievable and we don’t understand what would merit any delay in implementing a technology that prevents human errors and has been proven to reduce costs, injuries and deaths.

e-MDs – Michael Stearns, President and CEO

We have for many years viewed decision support as a key added value associated with HIT adoption. We currently offer warnings related to drug-drug interactions and allergy-checking, drug-disease contraindications and formulary support in our e-prescribing module. These features, in addition to the use of health reminders and the five clinical decision support rules relevant to the quality measures is in our opinion sufficient for Stage 1 meaningful use.  Regarding interoperability, in the future we would like to see a little more emphasis on data integrity in HIEs.  We fully support the need for information to be stored as machine processable structured data.  However, given current standards and methodologies, we have concerns over how this information can be safely shared in information systems without an independent validation process in place.

GE Healthcare – Vishal Wanchoo, President and CEO, GE Healthcare IT

There was strong emphasis on clinical decision support. It’s no secret that we have advocated for a robust level of interoperability as part of “meaningful use” and standards and certification. As a company and an industry, we have been focused on adopting harmonized interoperability standards in a logical stepwise progression.

Since we saw the initial meaningful use proposal, our concerns have remained centered on the underemphasis of standards, interoperability and health information exchange in the meaningful use criteria.  On initial review, we’ve noted the companion standards and certification criteria rules contain a scaled-back set of standards for interoperability and security.

InteGreat, a MED3OOO Company – Tom Skelton, President

We believe so. Decision support can take many forms, and most products today have some degree of this functionality included. The real question is how the physician interfaces with this functionality. Our clients have told us that numerous pop-ups flying in the physician’s face is not only annoying but can lead to a complete disregard to alerts that appear. Too many alerts can result in a critical alert being missed resulting in a patient care incident. If meaningful use includes a tracking of physician use of this functionality, we need to ensure that it is balanced so as not to make excessive use of a good thing. Given the lack of standardized coding for the majority of clinical elements, the hurdles for higher levels of decision support and/or interoperability are difficult to achieve. As such, the next step before requiring greater decision support or interoperability is a mandate for the use of a standardized nomenclature.

McKesson – Dave Henriksen, SVP and GM, Physician Practice Solutions

The decision support requirements increased significantly between the HIT Policy Committee’s summer recommendations and the December proposed and interim final rules. The original recommendation was to implement at least one decision support rule, but now the requirement calls for five rules. So that certainly is a much greater emphasis on decision support as “a critical aspect of improving quality, safety, and efficiency.” Some of the decision support requirements will be challenging for providers and vendors alike and need clarification.

From an interoperability perspective, we will recommend robust requirements. The sharing of clinical summaries (problems, allergies, meds, etc.) is still required for transitions of care as expected. However, the immunization registry and public health agency reporting requirements call for the ability to “perform at least one test” for connectivity. While this lowers the burden on providers/hospitals, vendors must enable their systems to comply whether it’s a single test or daily feeds. This means some health systems and physicians may believe that rudimentary point-to-point connections may be sufficient. However, in the long run a point-to-point method will be difficult to maintain and will not provide the robust network connectivity foundation required to achieve the larger national goals.

NextGen Healthcare – Scott Decker, President

The parameters set by the federal government are in line with what the President originally outlined, and a good start toward achieving the ultimate goals of ARRA. We view health information technology as the means to improvement in our healthcare delivery system, and not the end result. From that perspective, the meaningful use criteria establishes the right foundation for physicians not only to implement technology but then to use it for the delivery of better patient care through timely and accurate access to key health data on individual patients. With the detailed requirements included, the federal government is challenging doctors to create a healthcare delivery system that is more clinically efficient, financially responsible and patient-accessible than it is today.

Sage – Lindy Benton, Chief Operating Officer

These are really two separate questions, but in both cases, there’s a delicate balance between the end goal and where the market is today.

The intrepid new EHR user is looking to accomplish some basic goals that are meaningful to the physician. Though in many cases these goals overlap with certain meaningful use criteria, we are often looking at something more basic than clinical decision support. Once they have accomplished these goals, the question becomes: “OK, so what else can EHR do for me?” So, from that perspective, the requirement to implement a single rule is a good start and prevents clinical decision support from becoming a workflow distraction rather than an enhancement.

Similarly with interoperability, an incremental, proof-of-concept approach makes sense given that medical communities are typically fragmented and it is rarely the case that a comprehensive HIE exists. Sage has been at the forefront of what has come to be called interoperability, from early lab interfaces, to e-prescribing, to our present ability in Sage Intergy EHR to share a CCD with any entity capable of receiving and consuming it. We’re going to be right there with providers developing and taking advantage of opportunities for meaningful exchange

SRSsoft – Evan Steele, CEO

How much is “enough”? The government wants to achieve a return on the investment it believes it is making in healthcare IT. Having access to massive amounts of clinical data and having the ability to share that data across providers are seen as ways of doing this. But the industry is too far behind the automation curve in terms of infrastructure, networking, and repositories to take that big a step at the outset. By Stage 3, beginning in 2015, the hope is that many of those technologies will have been built out to make decision support and true interoperability viable. The question is: Will providers be willing to accept lower patient volumes and financial penalties to comply over the next 5 years?

For Stage 1, it was clear that CMS wanted to kick-start requirements for clinical decision support—the requirement was increased from implementing one decision rule to five. Not only do physicians have to implement each rule, but they also are required to track their compliance with each rule. How much time and effort will that take? No one can even guess yet. Again, more documentation and reporting will be required. And even if this is done successfully, there is no infrastructure in place to do anything with the data or provide evidence-based guidelines on it.

Interoperability is not within the control of physicians, and existing EHRs do not possess the capability to exchange data electronically, nor is the existing infrastructure of HIEs and registries consistent or sufficient across communities around the country. Interoperability is clearly slated for the future, and will not become even a remote possibility until at least Stage 3.

Important to note: Not one of the hundreds of stakeholders and bureaucrats who have shaped, debated and voted on these guidelines has done anything to vet the realities of EMR deployment up to this point. Specialists and other high-performance physicians have experienced it worst: the high failure rate (there are no cited landmark studies that conclude EMR improves healthcare, reduces risk or decreases costs while there are dozens of studies that conclude the opposite); the low adoption rate achieved up to this point; the unacceptable productivity impact on providers; and poorly designed products that force users to be data-entry clerks as much as physicians. Why is it that this initiative assumes it will suddenly work successfully? Who is concluding that? If this homework isn’t done, this whole program is fraud on the American people. Remember who brought us the $1,200 toilet seats and $800 hammers?

EMR Vendor Executives on Meaningful Use and Certification Requirements – Part Three of a Series

We asked several vendors a series of six questions related the federal government’s recent announcement on the latest proposed meaningful use definitions and EHR certification criteria.

What kinds of practices will be able to reach the 80% CPOE level?

Allscripts – Glen Tullman, CEO

Reaching the threshold of delivering 80% of orders electronically will be easier for physician practices that have had an Electronic Health Record in place for some, giving them time to adjust their previous workflow for orders. Data “get” – receiving information – is always easier at first than data “put,” such as sending orders electronically. In other words, shifting from verbal orders (“Marge, can you draw a lipid profile on Mr. Jones, please?”) to electronic order entry will require patience on the part of physicians, and proactive care on the part of the IT or administrative staff.

That said, as I noted in my response to question No. 2, this transition is not only possible but can be accomplished on a large scale and all at once, if the executive, IT and clinical leaders are all aligned and committed to making it happen — and if the practice has already established full clinical utilization of an EHR. It’s worth highlighting that this requirement is all the more reason for practices to adopt an Electronic Health Record sooner rather than later. The longer they delay, the longer it will take them to accomplish the necessary workflow adjustments, demonstrate meaningful use and qualify for ARRA incentives.

eClinical Works – Girish Kumar Navani, CEO and co-founder

We expect that our customers will be able to reach this level without much difficulty.

Eclipsys – Philip M. Pead, President and CEO

I would expect that any physician office, which has implemented a CCHIT Certified Ambulatory EHR will easily be able to achieve this criteria.

e-MDs – Michael Stearns, President and CEO

The ability to reach 80% CPOE is highly dependent on EHR capabilities, training and the ability to create orders easily and without restraint.  This is especially true for specialty practices, as the clinicians may need to incorporate unique orders and order sets during the implementation process.  However, the diversity of order types is lower in specialty practices vs. primary care.  In either case a well designed EHR supported by content that can be modified should enable the majority of ambulatory practices to meet this objective with relative ease.  In our experience adding value to the ordering process by presenting the clinician with decision support generated recommendations has tended to increase the use of CPOE.

GE Healthcare – Vishal Wanchoo, President and CEO, GE Healthcare IT

Those that have a high e-prescribing percentage should be better positioned, as well as those that have focused on using the CPOE functionality in the EHR. I don’t think, at this early stage, we can further generalize by practice size or location.

InteGreat, a MED3OOO Company – Tom Skelton, President

Primary care practices will have the easiest time complying with this requirement. Specialists routinely delegate a much higher percentage of this work to support personnel in the practice. This will be a profound paradigm shift for them. We also recognize that a private practice implementation model is a much different model than a mandated hospital or clinic model. Independent physicians with limited IT resources are going to require more assistance with implementation and a system that is intuitive to use to reach this goal.

McKesson – Dave Henriksen, SVP and GM, Physician Practice Solutions

Physician practices that have already adopted some level of clinical information technology will have an advantage over those that have not. For example, physicians that are already using e-prescribing and need to expand their use of the EHR to include order entry will achieve this requirement sooner.

NextGen Healthcare – Scott Decker, President

We do not think that practice compliance with any criteria will relate as much to a physician specialty as it will to the commitment the physician makes to provide care with health information technology (HIT) as their operating foundation. Part of the EHR selection process for any provider should be a practice workflow assessment with specific emphasis on the manual procedures that will have to be augmented because of the addition of automation. NextGen Healthcare provides several workflow assessment tools to enable a practice to identify these opportunities for procedural refinement.

With the introduction of an automated tool, appropriate changes can be made in the practices’ operations, which will help them comply with meaningful use criteria, regardless of specialty. At NextGen Healthcare, we have always been committed to helping our clients use HIT to practice at the highest level of patient care possible.

Sage – Lindy Benton, Chief Operating Officer

In our experience, those practices serious about tracking orders are most motivated to take on CPOE.  Successful e-prescribers should also find it relatively easy to transition to CPOE for other types of orders.

On the surface, the 80% threshold may look like a challenge, given existing workflows where orders are often handwritten on a script pad for patients and communicated verbally to staff, but we find that anything less than 100% compliance raises workflow issues, since you have different orders being handled in different ways.

So, on the one hand, we would be tempted to point to the benefits of CPOE and say that most practices will see the light and respond to the incentive.  At the same time, we’ve seen firsthand that CPOE is often easier for larger practices that already have a process for orders management (even if it’s paper based).

The fact that there is not a connectivity component associated with this requirement certainly removes a major obstacle, especially in the context of today’s medical communities where health exchange is seldom more than fragmented.

SRSsoft – Evan Steele, CEO

This will be a huge challenge for most providers. Many systems right now have significant issues with things such as the drug-to-drug interaction alerts. Many providers turn this function off because of frequent “false positives” that occur. Perhaps physicians in lower-volume practices, some primary-care practices and non-fee-for-service / salaried providers will be willing to spend the time it takes to customize and use CPOE. High-performance physicians, typically specialists, are far more sensitive to the effects of reduced productivity, and cannot afford the time required to customize and cope with the time-consuming data input for CPOE. The impact of such productivity issues have been totally ignored by the requirements, and won’t be discovered by many providers until it is too late.

Again, the government-sanctioned committees that have created the guidelines have acted in a way that shows almost a negligent disregard for the burdens that will be placed on providers in this process. When this initiative fails to really produce significant improvements in the healthcare system and runaway costs in the US, hopefully they will focus more on the real aspects that can have an impact.

News 1/14/10

From: Big Fan “Re: 100,000 readers. The reason you are about to hit 100,000 readers is because you are a great writer! And I am sure amazingly attractive with great shoes! And you’ve got the good stuff. That’s why 100,000 people have read HISTalkPractice!” As Mr. H can attest, I am pathetically insecure. However, these kind words are making me glow.

From: Money Squeeze “Re: Medicare versus Medicaid and ARRA. What’s your take on the major differences between the Medicare and Medicaid incentive plans?” Thanks to Allscripts who provided most of the above details. Bottom line is that the Medicaid incentive program provides more money for providers that qualify. And if you are a mid-level provider, Medicaid is the only plan to offers a chance to earn funds.

Here are a couple more FAQs on the latest EHR incentive guidelines:

Q: If an eligible professional (EP) meets the criteria for both the Medicare and Medicaid electronic health record (EHR) incentive programs, can they choose which program to participate in?

A:  Yes. EPs who meet the eligibility requirements for both the Medicare and Medicaid incentive programs must elect the program that they wish to participate in when they register. The current recommendations allow EPs to change their program selection one time during payment years 2012 through 2014.

Q: Who is responsible for demonstrating meaningful use of certified electronic health record (EHR) technology, the provider or the vendor?

A: To receive an EHR incentive payment, the provider (eligible hospital, critical access hospital or eligible professional) is responsible for demonstrating meaningful use of certified EHR technology under both the Medicare and Medicaid EHR incentive programs.

This last question puzzles me a bit. Why would a provider think it was up to the vendor to demonstrate meaningful use, unless the vendor perhaps misled them – ?

A New York Times article mentions an upcoming study that concludes that the Danish HIT system is the most efficient in the world, saving doctors 50 minutes per day and the country $120 million per year. They have advantages for that kind of adoption, however: high taxes, free medical care, and different attitudes toward privacy (one Dane official suggests that privacy concerns all but disappear once you are sick.)  Mr. H doesn’t like the model because it leaves little room for greedy capitalists.

Practice Fusion, a company already offering a free EHR, launches its free e-prescribing product.

Flagstaff Bone and Joint chooses the SRS hybrid EMR for its 13 providers.

The VA opens its first “tele-health” clinic in Colorado. The facility will primarily use videoconferencing technology to allow veterans to communicate with doctors in another regional outpatient clinic. The VA has plans to open another nine tele-health facilities across the country.

MEDENT teams up with Cardiac Science Corporation to provide users the ability to connect diagnostic monitoring devices with MEDENT’s EMR.

ITelagen partners with medical distributor Bell Medical Services to promote ITelagen’s EMR and medical billing services.

University Medical Center at Princeton partners with QuadraMed to provide e-MDs EHR to its affiliated physicians.

Kaiser fires an employee who took home an external drive without authorization. The drive, which contained medical information on 15,500 patients, was stolen from the employee’s car. Is it me or does it seem like every time we hear about stolen computers with medical information, the employees weren’t suppose to take the hardware from the office in the first place?

E-mail Inga.