In a letter addressed to David Blumenthal, National Coordinator for Health Information Technology, the HIT Policy Committee (HITPC) members developed several recommendations to communicate to the Centers for Medicare & Medicaid Services (CMS) in response to its Notice of Proposed Rule Making (NPRM) regarding CMS’s incentive program for the meaningful use (MU) of electronic health records (EHRs). Here is the condensed version. Bottom line, the MU definition is still a moving target.
RECOMMENDATION 1: REINSTATE HITPC RECOMMENDATION TO INCLUDE PROGRESS NOTE DOCUMENTATION FOR STAGE 1 MU DEFINITION FOR EPs.DRAFT 2
Recommendation 1.0: Include “Document a progress note for each encounter” for Stage 1EP MU definition.
Recommendation 1.1: Signal clinical documentation as a required MU criterion in Stage 2 for hospitals.
RECOMMENDATION 2: REMOVE CORE MEASURES FROM STAGE 1.
RECOMMENDATION 3: REINSTATE HITPC RECOMMENDATION TO STRATIFY QUALITY REPORTS BY DISPARITY VARIABLES.
Recommendation 3.0: Providers should produce quality reports stratified by race, ethnicity, gender, primary language, and insurance type.
RECOMMENDATION 4: PROVIDERS SHOULD MAINTAIN UP-TO-DATE LISTS OF PROBLEMS, MEDICATIONS, AND ALLERGIES
Recommendation 4.0: EPs and hospitals should report the percentage of patients with up-to-date problem lists, medication lists, and medication allergy lists
In order to support quality of care and care coordination, key patient summary information (e.g., active problem lists, active medication lists, medication allergy lists) must be maintained in the electronic health record.
RECOMMENDATION 5: REINSTATE HITPC RECOMMENDATION TO INCLUDE RECORDING OF ADVANCE DIRECTIVES FOR STAGE 1 MU DEFINITION FOR EPs AND HOSPITALS.
Recommendation 5.0: EPs and hospitals should record whether the patient has an advance directive as part of the Stage 1 MU criteria.
RECOMMENDATION 6: REINSTATE BUT AMEND HITPC RECOMMENDATION TO INCLUDE PATIENT-SPECIFIC EDUCATION RESOURCES FOR STAGE 1 MU DEFINITION FOR EPs AND HOSPITALS.
Recommendation 6.1: EPs and hospitals should report on the percentage of patients for whom they use the EHR to suggest patient-specific education resources.
RECOMMENDATION 7: REINSTATE HITPC RECOMMENDATION TO INCLUDE MEASURES OF EFFICIENCY FOR STAGE 1 MU DEFINITION FOR EPs AND HOSPITALS.
The committee had recommended two high impact efficiency measures dealing with use of generic medications and coding of indications for high-cost imaging services. Recommendation 7.0: All EPs should report to CMS the percentage of all medication, entered into the EHR as a generic formulation, when generic options exist in the relevant drug class.
Recommendation 7.1: CMS should explicitly require that at least one of the five clinical decision support rules address efficient diagnostic test ordering.
The NPRM states that EPs and hospitals need to: “implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering.” In order to highlight an important area of health care system efficiency, the committee recommends that the wording should be amended to: “implement five clinical decision support rules relevant to specialty or high clinical priority, at least one of which should be aimed at improving the efficiency of diagnostic testing or the ordering of appropriate treatment.”
RECOMMENDATION 8: CMS SHOULD CREATE A GLIDEPATH FOR STAGE 2 AND STAGE 3 MU EXPECTATIONS
Recommendation 8.0: CMS should advance its timetable for the release of future MU NPRMs in order to allow adequate ramp-up time for vendors and providers.
To the extent possible, CMS should consider publishing the Stage 2 MU NPRM well before its anticipated December 2011 timeframe because vendors need more time to develop the appropriate functionality and providers need more time to integrate it into the clinical workflow.
RECOMMENDATION 9: CPOE SHOULD BE DONE BY THE AUTHORIZING PROVIDER.
Recommendation 9.0: The numerator for the CPOE measure should define a qualifying CPOE order as one that is directly entered by the authorizing provider for the order
RECOMMENDATION 10: AMEND PREVENTIVE/FOLLOW-UP REMINDERS CRITERION TO APPLY TO A BROADER POPULATION AND ALLOW FOR PROVIDER DISCRETION FOR WHERE TO FOCUS REMINDER EFFORT.
RECOMMENDATION 11: CLARIFY “TRANSITIONS OF CARE” and “RELEVANT ENCOUNTER”
RECOMMENDATION 12: ALLOW SOME FLEXIBILITY IN MEETING MEANINGFUL USE CRITERIA
Recommendation 12.0: Eligible professionals and hospitals should be given the flexibility to defer up to 6 meaningful-use criteria as described in the table below, but must meet all mandatory objectives.
Wednesday, February 17, 2010
Wednesday, December 16, 2009
Companies Find Opportunities Even In Recession
Darrell Rigby has a really hard job. He advises CEOs on what to do during a downturn as part of his work at the Boston consulting firm Bain & Co. He tells them to think of their companies as race cars careening around a track, where recessions are the curves.
Rigby says it's hard for companies to pass each other during good times on the straightaway. The big companies stay in front on power alone.
"But on a curve, curves are driven by strategic finesse and so even a company that has less power — if it is skillfully maneuvered in curves — can pass much larger, stronger competitors," Rigby says.
The U.S has just been through its worst recession in decades. More than 100 banks have failed and countless businesses have gone under. But there's a growing body of research that suggests some companies actually do well in recessions. That's because recessions create opportunities that don't tend to occur when the economy is humming along. Inevitably, some companies are able to take advantage of these opportunities.
Story
Monday, December 14, 2009
NCG Medical, Perfect Care EHR Achieves ARRA 2011 Certification From CCHIT
NCG Medical, Perfect Care EHR Achieves Preliminary ARRA 2011 Certification From CCHIT
ORLANDO, Fla., Dec. 11 /PRNewswire/ -- NCG Medical announces that their Electronic Health Record, Perfect Care EHR® has been inspected by the Certification Commission for Health Information Technology (CCHIT®) and is Preliminary ARRA 2011 certified, meeting proposed Federal standards supporting the proposed 2011-2012 Meaningful Use Objectives for Eligible Providers under the American Recovery and Reinvestment Act of 2009 (ARRA).
Press Release
ORLANDO, Fla., Dec. 11 /PRNewswire/ -- NCG Medical announces that their Electronic Health Record, Perfect Care EHR® has been inspected by the Certification Commission for Health Information Technology (CCHIT®) and is Preliminary ARRA 2011 certified, meeting proposed Federal standards supporting the proposed 2011-2012 Meaningful Use Objectives for Eligible Providers under the American Recovery and Reinvestment Act of 2009 (ARRA).
Press Release
Wednesday, September 2, 2009
New HHS office to manage ARRA healthcare funds
The U.S. Department of Health and Human Services has opened a new office dedicated to making sure healthcare funding coming out of ARRA gets into healthcare providers' hands.
The Office of Recovery Act Coordination will aim to ensure "timely, organized and transparent distribution of an estimated $137 billion" in funds managed by HHS, according to a press release. Those funds include $19 billion designated for healthcare IT, $2 billion of which will go to the Office of the National Coordinator for Health IT for various initiatives.
Dennis Williams, a 20-year veteran of HHS, will head the office and serve as HHS' deputy assistant secretary for recovery act coordination.
Rest of Story
The Office of Recovery Act Coordination will aim to ensure "timely, organized and transparent distribution of an estimated $137 billion" in funds managed by HHS, according to a press release. Those funds include $19 billion designated for healthcare IT, $2 billion of which will go to the Office of the National Coordinator for Health IT for various initiatives.
Dennis Williams, a 20-year veteran of HHS, will head the office and serve as HHS' deputy assistant secretary for recovery act coordination.
Rest of Story
Thursday, August 13, 2009
Friday, July 10, 2009
Bing -vs- Google
I have been using the new Micosoft Bing search engine for about two weeks now and I have to say that it is a fine competitor to Google. David Pogue from the New York Times wrote a much better comparison than I ever could:Bing/Google Comparison. In the article he references a site where you can query both search engines at the same time. I have been using it for the past week and it provides you a quick way to compare results.
Dual Search:
Bing -vs- Google
Dual Search:
Bing -vs- Google
Monday, June 29, 2009
Thursday, June 25, 2009
Medicare Payment Incentive Schedule for Eligible Providers
The schedule above was created based on the information provided by the Centers for Medicare and Medicaid Services fact sheet, and illustrates how CMS plans on distributing ARRA funds for EHR implementation.
CMS Fact Sheet
Wednesday, June 17, 2009
HHS "Meaningful Use" Matrix
The Health and Human Services department has published their working document to define "meaningful use" of EHR usage. The matrix is available after the jump.
Meaningful Use Matrix
Meaningful Use Matrix
Monday, June 8, 2009
Tuesday, June 2, 2009
Bing!
Bing Search Engine by Microsoft - Ahead of schedule appears to be the theme of this beautiful, bright 1st of June. Microsoft’s anticipated new search engine Bing was originally scheduled to launch on Wednesday, but it was available Monday. Though it will take more than a couple of hours to decipher just how much of a “Google killer” it is, it does offer some new features that set it apart. When searching travel destinations, for instance, you’ll be provided with real time pricing and availability to make booking fast and seamless. Similarly, online shoppers and those looking for health-related and local information are provided with more customized tools.
Not wasting any time, searchers have been busy shutting off the “safe search” and searching terms like “porn”. Because what good is a new search engine if it can’t help you weed through the limitless spanker stash that is the Internet? You won’t have to go to far, either; click on Bing’s image search and you’ll be treated to some pictures of phallic-shaped rock formations that are part of Bing’s inexplicable desert and hot air balloon theme (a little too loud if you ask me, I’d opt for Google’s no-frills home page any day).
So far, reviews have been mixed with some really taking to the new search engine and others stating that there’s nothing so compelling as to make them leave their default search engine. In my limited use, I found the results were largely similar to those I get with Google. For the time, I’m in category 2. Take some time to try it out for yourself and decide: will Bing be the revolution needed to lift Microsoft out of its downward spiral or will it be just another substandard MS product that sits in the shadow of something better?
Via PC Magazine
Friday, May 29, 2009
An Interesting Perspective on EHR Funding
Lyle Berkowitz is not an electronic health-record systems basher; far from it.
Nor is he opposed to the federal government subsidizing hospitals and physician offices, although he says the proposed maximum payments of $44,000 for most office-based physicians like himself in the American Recovery and Reinvestment Act of 2009 won’t cover the true cost of installing an EHR.
No, what gets Berkowitz going is the poor quality of the user interface of the current crop of EHR systems on the market.
Story
Nor is he opposed to the federal government subsidizing hospitals and physician offices, although he says the proposed maximum payments of $44,000 for most office-based physicians like himself in the American Recovery and Reinvestment Act of 2009 won’t cover the true cost of installing an EHR.
No, what gets Berkowitz going is the poor quality of the user interface of the current crop of EHR systems on the market.
Story
Thursday, May 21, 2009
Plan Outlines Medicare/Medicaid Incentives
The Department of Health and Human Services has released the outlines of the program to offer Medicare and Medicaid incentive payments for meaningful use of electronic health records systems.
The payments are authorized under the economic stimulus law. Medicare incentives to eligible hospitals will start in October 2010, HHS has clarified. Medicare incentives to physicians, as well as Medicaid incentives to physicians and hospitals, will start in January 2011.
By the end of 2009, HHS expects to:
* coordinate with the Office of the National Coordinator for Health Information Technology to develop related policies for the incentive programs, such as the definition of meaningful use;
* develop proposed rules to allow public input to the incentive program policies;
* plan systems and other requirements to support the incentive programs; and
* plan a national outreach program.
By the end of 2010, HHS expects to:
* conduct outreach to eligible professionals and providers and to state Medicaid agencies;
* develop systems to support the payment of incentives;
* develop final rules to establish policies to pay incentives; and
* develop systems to monitor and evaluate incentive payments.
The Centers for Medicare and Medicaid Services has been appropriated $145 million a year for FY 2009 through 2015, and $65 million for 2016, for administration of the incentive programs.
Text of the plan is available at: Report
The payments are authorized under the economic stimulus law. Medicare incentives to eligible hospitals will start in October 2010, HHS has clarified. Medicare incentives to physicians, as well as Medicaid incentives to physicians and hospitals, will start in January 2011.
By the end of 2009, HHS expects to:
* coordinate with the Office of the National Coordinator for Health Information Technology to develop related policies for the incentive programs, such as the definition of meaningful use;
* develop proposed rules to allow public input to the incentive program policies;
* plan systems and other requirements to support the incentive programs; and
* plan a national outreach program.
By the end of 2010, HHS expects to:
* conduct outreach to eligible professionals and providers and to state Medicaid agencies;
* develop systems to support the payment of incentives;
* develop final rules to establish policies to pay incentives; and
* develop systems to monitor and evaluate incentive payments.
The Centers for Medicare and Medicaid Services has been appropriated $145 million a year for FY 2009 through 2015, and $65 million for 2016, for administration of the incentive programs.
Text of the plan is available at: Report
Tuesday, May 5, 2009
Search Trends for EHR and EMR
In the last five months the amount of search traffic on Google has almost doubled for the terms EHR and EMR. The increased interest in the technology shows that the issue is registering with the public, and could lead to down-up pressure from patients for adoption of the technology.
Friday, May 1, 2009
iDocs?
Being a healthcare IT software development shop, my company is in constant contact with physicians’ offices, by default we end up being IT staff to our physician partners. We are always asked for opinions on technology trends, and the subject of cell phone technology comes up quite frequently. Due to my obsessive need to email at all hours, I am a Blackberry user, but I am a big fan of the iPhone, and almost always recommend it to physicians. There just is no other portable device that can match the resouces that the iPhone has for doctors. Here is a just a brief list of some of the medical applications already out for the iPhone with more on the way
List
And here is a related BusinessWeek article regarding the iPhone in healthcare:
Article
Thursday, April 30, 2009
Twitter Quitters
It seems like the past month Twitter has seen an explosion in coverage. Everyone from Oprah to ESPN's Pardon The Interruption is incoorporating it into their offerings. However Nielsen is reporting that there may be some problems with Twitter's business; at 40% retention rate after the first month, Twitter has a significantly higher dropout rate for users than other major networking sites.
Story
Story
Wednesday, April 29, 2009
HIMSS' Proposed Definition of EHR Meaningful Use
This morning HIMSS published its definitions of meaningful use of certified EHR technologies. Some excepts from the document:
Background
The American Recovery & Reinvestment Act of 2009 (ARRA) calls for up to five years of Medicare incentive payments to physicians who meet the requirements of meaningful users of certified electronic health record (EHR) technology. To be eligible for the payments, physicians must use the technology in a meaningful manner, which includes e-prescribing; exchanging electronic health information to improve the quality of care; having the capacity to provide clinical decision support (CDS) to support practitioner order entry and, submitting clinical quality measures – and other measures – as selected by the Secretary of Health & Human Services (HHS). Further, physicians must meet the definition within a specified time frame, which as described in ARRA, must be made increasingly stringent over time by the Secretary.
HIMSS’ Definition of Meaningful Users of EHR Technologies
HIMSS recognizes that defining a meaningful user is a complex endeavor. In order for the nation to benefit from the spirit and intent of ARRA, and for physicians to have a reasonable chance of achieving the definition, HIMSS asserts that the requirements must be introduced – and made increasingly stringent – in incremental stages. In the final stage, which must commence in FY15, HIMSS believes the mature definition of “meaningful user of certified EHR technology” includes at least four attributes:
1. Utilization of an EHR certified by the Certification Commission for Healthcare Information Technology (CCHIT);
2. Demonstrated ability to electronically exchange standardized patient summary data with clinical and administrative stakeholders;
3. Demonstrated practice of electronic prescribing; and,
4. Demonstrated reporting of quality and patient safety data.
In addition HIMMS made the following recommendations to HHS
Recommendation #1 Adopt CCHIT as the certifying body for EHRs
Recommendation #2 To achieve the incremental maturation, milestones be achieved in phases of not less than two years each, commencing in 2011.
Recommendation #3 HHS coordinate with Healthcare Information Technology Standards Panel (HITSP) and Integrating the Healthcare Enterprise (IHE)to create new harmonized dtandards and implementation guides
Recommendation #4 Reconcile the gap between “Certified EHR Technologies”, “Open Source”, and “Best of Breed” models
For the full text of the definitions and proposed timelines click on link:
HIMSS' Meaningful Use of EHR
Tuesday, April 28, 2009
A Primer on EMR/EHR and Health IT Industry
With all of the attention that the EHR industry has received lately, and I am holding a lot more "intro sessions" with friends, colleagues and investors summarizing the terms and issues associated with health IT. Attached is a good primer for anyone interested: Story
Monday, April 27, 2009
Hearing on "Meaningful Use" for EHR Slated
The National Committee on Vital and Health Statistics will hold a public meeting April 28 and 29 in Washington to discuss a definition for “meaningful use” of electronic health records under the economic stimulus program.
The two-day meeting of the NCVHC executive subcommittee will feature 10 panel discussions with a variety of speakers. Kicking things off will be David Blumenthal M.D., national coordinator for health information technology. The conference, which also will be broadcast live on the Internet, will include one brief time slot each day for “public comments.”
Under the American Recovery and Reinvestment Act, hospitals and clinics can get incentive payments from Medicare and Medicaid if they meet yet-to-be-defined qualifications for making “meaningful use” of electronic health records.
Link to the agenda and link to hear live: Agenda and Audio
The two-day meeting of the NCVHC executive subcommittee will feature 10 panel discussions with a variety of speakers. Kicking things off will be David Blumenthal M.D., national coordinator for health information technology. The conference, which also will be broadcast live on the Internet, will include one brief time slot each day for “public comments.”
Under the American Recovery and Reinvestment Act, hospitals and clinics can get incentive payments from Medicare and Medicaid if they meet yet-to-be-defined qualifications for making “meaningful use” of electronic health records.
Link to the agenda and link to hear live: Agenda and Audio
Friday, April 24, 2009
Mainstream Media Starts to Follow EHR Implementation Issues
I have noticed that most physicians our company comes in contact with are not even aware of the Electronic Health Records portion of the Recovery Act. Even when we educate them on how the reimbursements will be allocated physicians distrust that these monies will never actually be distributed. I anticipate as the mainstream media picks up on the story some of this will become more "real" for doctors. Below is a recent story from this week's BusinessWeek. They managed to get some comments from some of the more prominent CEO's in the industry.
Story
Story
Tuesday, April 21, 2009
Discussions on EHR Definitions
With the Recovery Act's reimbursement payment schedules pretty much established, there are still three questions that the indutry and physicians are waiting to be answered:
1) Who will certify EHR/EMRs. (Believed to to be CCHIT)
2) What will be the "meaningful use" threshold?
3) How will reimbusement payments be made?
Below is a link to some discussions of what items 1 & 2 may look like.
Story
1) Who will certify EHR/EMRs. (Believed to to be CCHIT)
2) What will be the "meaningful use" threshold?
3) How will reimbusement payments be made?
Below is a link to some discussions of what items 1 & 2 may look like.
Story
New Google Tool for Viewing Search Timelines
Google on Monday unveiled a new experimental product called Google News Timeline that displays news and related search results on an interactive timeline. It offers interesting possibilities for exploring stories, especially older ones, that are largely hidden in newspaper and magazine archives.Story
Wednesday, April 8, 2009
The Recovery Act and EHR Implementation
This is the best summary that I have found of how the The American Recovery and Reinvestment Act will affect EHR/EMR implementation. Story
Twittering for Revolution
Could it be that five years after the famous protests in Kiev's Maidan Square another technology - Twitter - will usher in another revolution in neighbouring Moldova?
Story
Monday, April 6, 2009
Health Care Industry Moves Slowly Onto the Internet
The health care industry, a well-known laggard in information technology, is where most of corporate America was a decade or more ago in adopting Internet-style computing. There are innovators, intriguing experiments and lots of interest, but the technology hasn’t yet gone mainstream
Story
Story
Wednesday, February 18, 2009
Facebook Backs Down
Facebook backed down late Tuesday on policy changes that tens of thousands of users complained would grant the social-networking site the ability to control their information forever, even after they cancel their accounts.
“Based on this feedback, we have decided to return to our previous terms of use while we resolve the issues that people have raised,” Facebook's founder, Mark Zuckerberg, wrote on The Facebook Blog.
http://www.msnbc.msn.com/id/29239948/
“Based on this feedback, we have decided to return to our previous terms of use while we resolve the issues that people have raised,” Facebook's founder, Mark Zuckerberg, wrote on The Facebook Blog.
http://www.msnbc.msn.com/id/29239948/
Monday, February 16, 2009
Facebook Owns All of Your Content!
The Consumerist has noticed a seemingly slight but very important (and disturbing) change in Facebook’s terms of service, regarding user-generated content.
In short, all of the content you’ve ever uploaded on Facebook can be used, modified or even sublicensed by Facebook in every possible way - even if you quit the service.
http://mashable.com/2009/02/16/facebook-tos-privacy/
In short, all of the content you’ve ever uploaded on Facebook can be used, modified or even sublicensed by Facebook in every possible way - even if you quit the service.
http://mashable.com/2009/02/16/facebook-tos-privacy/
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