Electronic health records

CMS, AMA Announce Help with ICD-10 for Physicians

Posted in Electronic health records, Health IT, Health Policy on July 6th, 2015 by MMS Communications – Be the first to comment

With the October 1 deadline for the implementation of ICD-10 looming, The Centers for Medicare & Medicaid Services road 1 icd(CMS) and the American Medical Association (AMA) today jointly announced some good news – and relief – for physicians.

The two organizations have reached agreement on important elements of a “grace period” for the implementation of version 10 of the new International Classification of Diseases that includes some 68,000 codes. The medical codes, used for diagnosis and billing, have not been updated in more than 35 years.

Among the major steps announced by CMS and the AMA:

• For a one-year period beginning October 1, Medicare claims will not be denied or audited solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes.
• To avoid potential problems with mid-year coding changes in CMS quality programs for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores. CMS will continue to monitor implementation and adjust the duration if needed.
• CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
• CMS will also establish an ICD-10 communications and coordination center, to identify and resolve issues arising from the transition.
• CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

The organizations also said they will reach out to providers across the county, with webinars, on-site training, and educational articles to help them learn about the new codes and prepare for the transition. The free help from CMS also includes the Road to 10, The Small Physician Practice’s Route to ICD-10, a website aimed specifically at smaller physician practices to help them with the transition.

Today’s CMS/AMA joint announcement may be read here. More information on ICD-10 is available at this CMS site and from this post by AMA President Steven J. Stack, M.D., which contains links to additional information and resources.

Interoperability is New Focus for Health IT

Posted in Electronic health records, Electronic Medical Records, meaningful use on February 13th, 2015 by Erica Noonan – Comments Off on Interoperability is New Focus for Health IT

By Leon Barzin

MMS Director of Health Information Technologykeyboard 1

Barriers to interoperability continue to be main challenges to moving the nation’s health care system beyond simply making electronic silos of information from paper ones, according to experts at the recent annual meeting of the eHealth Initiative.

The recent Meaningful Use Program started with three goals for the identified stages: Stage 1: data capture and sharing; Stage 2: advance clinical processes; and Stage 3: improve outcomes.

Stage 1 of Meaningful Use, as painful as it has been to some independent practices, is generally considered quite successful in fostering electronic data capture.  It has moved the use of electronic medical records from single digits in the pre-Meaningful Use period to an estimated 70 percent nationwide today.

Unfortunately, it appears that both Stages 1 and 2 have largely failed in the primary objective of “sharing,” moving health data security to the right place at the right time – especially among dissimilar systems.

In January 2015, the U.S. Department of Health and Human Services released the document, A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure.

If improved interoperability can be achieved via this federal roadmap, such a system would support more efficient and effective healthcare and lead to a continuously improving health system that empowers individuals, customizes treatment, and accelerates cure of disease.

On the heels of the release of the government’s document, the eHealth Initiative held its yearly meeting last week, bringing together physicians, administrators and other national experts to focus on how this plan could be implemented in real clinical environments.

Several consensus items among attendees were clear:

  • EHR vendors and providers can no longer ignore interoperability.
  • New secure interoperability software is on the near horizon and mobile devices will be the focus.
  • Patients will soon be included as active partners in their healthcare and possess some or all of their records on their smartphones.
  • Wearable sensor devices like Fitbit will become more clinically connected and able to provide useful clinical information.
  • Early pilots in telemedicine are moving toward standard operation, especially chronic disease management, benefiting from advances in sharing technology.

Although there seems to be little impetus for additional “checkbox” Meaningful Use requirements, it appears efforts will shift throughout the industry, within provider communities, and at CMS to push forward with interoperability improvements.

Board of Registration in Medicine Gives Final Approval to EHR Proficiency Regulations; New Rules Effective Jan. 2

Posted in Electronic health records, Electronic Medical Records, Uncategorized on December 17th, 2014 by Erica Noonan – 1 Comment

 

The Board of Registration in Medicine today gave its final approval to new regulations, strongly supported by the MMS, interpreting that law in a way that allows physicians many options in how they demonstrate proficiency in the use of electronic medical records.

The new regulations will go into effect January 2, 2015, but all physicians renewing their licenses before March 31, 2015 will receive a one-time waiver from the requirements.

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In addition, physicians with renewal dates up to 60 days after March 31 could submit a renewal application prior to March 31, and be within the window for an automatic waiver.

The regulations establish multiple ways in which physicians would be in compliance with the requirement. There are also a broad set of exemptions for certain license categories, where electronic health record use is intrinsic or not relevant.   Read full details of  state’s new EHR proficiency requirement and exemptions here.

Today’s action successfully culminates a two-year effort to work with the Board to interpret the state legislature’s 2012 law connecting federal Meaningful Use and a Massachusetts medical license in a way that did not disenfranchise thousands of physicians.

“The Massachusetts Medical Society believes that electronic health records have enormous potential for patient care, and the Society’s extensive policy on EMRs declares support for them and a desire to work toward improving them,” said MMS President Richard Pieters, MD.  We are grateful that the Board of Registration in Medicine has taken a reasonable approach on this issue, exhibiting utmost concerns for patient safety and access to care.”

 

–Erica Noonan

The President’s Podium: Common Sense on EHRs

Posted in Board of Medicine, Electronic health records, Electronic Medical Records, Health IT, meaningful use on September 26th, 2014 by MMS Communications – 1 Comment

By Richard Pieters, M.D., President, Massachusetts Medical Society

In its landmark 2001 report,  Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine recognized the “enormous potential” of technology to improve health care.  Indeed, of all the changes sweeping throughout healthcare in recent years, perhaps the most revolutionary has been health information technology (HIT).

One area of explosive growth within HIT has been electronic health records (EHRs). The U.S. Department of Health and Human Services noted in May of 2013 that the use of EHRs by doctors and hospitals more than doubled from the previous year, with Massachusetts one of the heaviest adopters.  Statistics from the Office of the National Coordinator for Health IT show that 71 percent of physicians and 80 percent of hospitals in the Commonwealth have adopted EHRs.

Yet, 14 years after the IOM’s report, after billions of dollars spent in federal incentives, and despite skyrocketing adoption, physician acceptance of EHRs appears at best, a mixed bag, at worst, a struggle. Recent efforts are instructive.

In its 2014 Survey of America’s Physicians released this month, The Physicians Foundation found that nearly half of respondents (45.8%) felt that EHRs “detracted from efficiency” and slightly more (47.1%) thought it “detracted from patient interaction.”  More than half (50.5%) believe EHRs “pose a risk to patient privacy.”

Separately, on September 16, the American Medical Association called for an overhaul of EHR systems. “Today’s current EHR products,” said AMA President-Elect Steven J. Sack, M.D., “are immature, costly, and are not well designed to improve clinical care…. The usability of EHRs is a significant driver of physician professional dissatisfaction and a challenge to practice sustainability.” AMA then outlined eight priorities for improving EHR usability to benefit caregivers and patients.

Frustration and dissatisfaction with electronic health records among physicians had surfaced well before the AMA pronouncement, and complaints about EHRs have been increasing as well. The inability of different systems to communicate easily with one another – the “interoperability” issue – remains a drawback.  Perhaps most unsettling, however, is the reality that hazards and risks remain, as the promise of widespread and reproducible gains in patient safety has yet to be fulfilled.

Here in Massachusetts, electronic health records have captured physicians’ attention for quite another reason.  Chapter 224, a law passed in August 2012 that outlined phase two of health care reform for the Commonwealth, included a provision that required physicians to demonstrate “meaningful use” proficiency (which only applies to Medicare and Medicaid) with EHRs as a condition of licensure.  That mandate is to become effective on January 1 of next year.  Without proper interpretation, the law as written could have had severe unintended consequences by disenfranchising over half of the state’s licensed physicians.

Now here’s the good news: The Board of Registration in Medicine has proposed regulations that include a broad set of exemptions for certain license categories.  The Board’s proposal also establishes multiple ways in which physicians could comply with the requirement.

The Board has posted its draft regulations and is accepting comments on them through Friday, October 3 at 5 p.m. MMS offered testimony in strong support of the proposals at the public hearing on Monday, September 29, and I encourage members to add their comments as well. Comments may be submitted via email to Eileen.Prebensen@state.ma.us All comments become public records and will be posted to the state’s website.

MMS has advocated on this issue since the law was passed two years ago, raising the specter of severe disruptions in physician practice and patient access to care.  We are now near a resolution that is advantageous to both physicians and patients.

The Board’s proposal, which addresses all of our major concerns, represents a reasonable, prudent approach to complying with the law, easing physician concerns, and maintaining access to care for patients.

While physician frustration with EHRs is high, it is important to distinguish between problems of technology and problems of policy.  Technological issues are likely to be worked out over time, if only by continued physician persistence and outcry for solutions, as demonstrated by the AMA.

Policy issues, as shown by the Board of Registration in Medicine’s common sense approach to fulfilling the requirements of Chapter 224, are more readily capable of resolution.

MMS, like the IOM, believes that electronic health records do indeed have “enormous potential” for patient care. Our extensive policy on EHRs declares support for them and a desire to work toward improving them, to capture “an opportunity for dramatic benefits to patients in clinical care, research, and the delivery of health care.”

Reaching that potential, however, will require the strong voice of physicians. Whether the issue is one of technology or policy, our local experience has shown how important it is that physicians participate in the conversation.  I urge you once again to review the draft regulations and send in your comments.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine. 

Recapping a Busy Year: MMS Health Care Advocacy in 2014

Posted in Annual Meeting 2014, Electronic health records, Health Reform, meaningful use, Medical Marijuana, Medicare, Payment Reform on May 15th, 2014 by MMS – Comments Off on Recapping a Busy Year: MMS Health Care Advocacy in 2014

Ronald W. Dunlap, MD, president of the Massachusetts Medical Society, kicked off the Society’s 2014 Annual Meeting with a review of five significant advocacy issues from the 2013-14 year:

  • Medicare payment
  • ICD-10 deadlines
  • Regulatory overreach
  • State regulations on EHRs
  • Medical Marijuana

 

EHR Next Chapter: A “Tool” in the MD’s Medical Arsenal

Posted in Electronic health records, Electronic Medical Records, Health IT on May 5th, 2014 by Erica Noonan – 2 Comments

data 2By Debra Beaulieu-Volk

Some of the Commonwealth’s premier experts in health information technology and electronic health records gathered recently at MMS headquarters to take part in the day-long continuing education event, Electronic Health Records Next Chapter: Best Practices, Checklists, and Guidelines.

“The EHR revolution is not new,” said Jeff Loughlin, project director of the Massachusetts eHealth Collaborative, while opening the morning session about EHR best practices and pitfalls. “Along the way, we have seen a lot of failures, primarily because a lot of expectations were put on the EHR to solve the problems of the medical practice,” he said, “rather than using the EHR as one other tool in your arsenal to improve work flow and provide better care.”

To help attendees make the most of this tool, physicians representing small, medium, and large practices weighed in on lessons learned from their EHR experience to date:

Don’t Fear Switching

Today, many physicians are deeply worried that the EHRs they adopted a decade ago no longer suit their needs, said Eugenia Marcus, MD, FAAP, pediatrician and chair of MMS Committee on Information Technology. She can relate, having learned and implemented three different EHR systems since beginning her quest for the paperless office in 1996. “Switching is not that hard,” she said. “Every word of the record does not need to carry over.”

During Marcus’ transitions, staff were responsible for making sure critical information, such as demographics and medication lists, was transferred immediately. But high school students to copy over the rest of the material over a long time period.

Use EHR to Improve Patient Satisfaction

EHRs do far more than simply house patient records, noted Hugh Taylor, MD, a family physician at an 11-doctor practice with three sites throughout the North Shore. In fact, out of the 17 functions Taylor listed that his EHR performed, the last four had little to do with practicing medicine.

“The EHR does many things that don’t affect the clinician so directly but are extremely important to how the office runs,” he said. Examples of these functions included scheduling, confirming insurance coverage, coding and billing, and tracking patient flow. That last item pulls double duty in Taylor’s offices, he said, by helping the practice inform patients when doctors are running behind and of how long they may have to wait. This data is also used to help the practice strive to improve its Press Ganey patient satisfaction scores, he said.

MDs Need Not Do All Documenting

Larry Garber, MD, and his team at Reliant Medical Group, where he serves as Medical Director of Informatics, pulled together a list of which individuals should do the documenting in the medical record, in order of preference, to promote optimal efficiency. “It doesn’t have to be just one person; it can be a combination of people,” he said.

The top choice of documenter, however, isn’t a person at all, but the computer itself. “Whenever possible, reuse data that you’ve already got,” he said. “Let the computer do as much work as it can.” (As a caveat to the pitfalls of copying and pasting, Garber noted that it’s a practice policy that physicians are responsible to review and update any information in notes they create.)

Next, Garber recommended letting patients populate some of their own data. Even triage nurses speaking with patients on the phone can contribute to the record, placing them in the third spot of preference. “What a great place to take history without tying up an exam room,” he said.

Rounding out the list of preferred documenters were medical assistants, doctors assisted by speech recognition, doctors assisted by transcriptionists, doctors typing, and scribes typing. When it comes to accuracy, Garber noted that physicians who use a combination of typing and speech recognition tend to produce the highest-quality notes.

More information about the event and links to faculty presentations are available online.

Free white paper for MMS members: “MMS Guide to Health Information Technology”

EHR Conference Speaker Emphasizes Importance of Protecting Patients’ Information

Posted in Electronic health records, Electronic Medical Records, Health IT, HIPAA on May 2nd, 2014 by MMS – Comments Off on EHR Conference Speaker Emphasizes Importance of Protecting Patients’ Information

By Vicki Ritterband

Ali Pabrai

Ali Pabrai

Encryption. Encryption. Encryption.

Those are the “three” most important activities doctors should do to protect the security of their patients’ electronic protected health information (ePHI), says cybersecurity expert Ali Pabrai, a  presenter at MMS’s recent conference, Electronic Health Records Next Chapter: Best Practices, Checklists and Guidelines.

Encryption is the conversion of data into a form that cannot be understood unless the reader has a key or password to unscramble the information. All sorts of electronic transmissions should be encrypted—including texts and emails—no matter what the device, said Pabrai. If data is encrypted, even if you have a security breach, it is protected.

“Unfortunately, application vendors in the healthcare industry have been lethargic about embedding encryption capabilities,” said Pabrai. “That makes it difficult for a practice or a healthcare organization to implement encryption.”

As more and health information moves between the cloud and mobile devices, organizations will increasingly need to focus their security efforts on those two areas, according to Pabrai. Healthcare data fetches a high price on the black market because it is so rich in identity information.

Cyber security attacks to all types of businesses are occurring at a breathtaking pace: the average organization experiences 1,400 attacks per week and of those attacks, approximately two accomplish their purpose, said Pabrai.  HIPAA fines for information security breaches can run into the hundreds of thousands and even millions of dollars. “Physician practices are more vulnerable to HIPAA fines than ever before,” said Pabrai. Often, organizations don’t know their systems have been broken into until months after the thieves have left the premises.

So what’s a practice to do? Here are the seven steps Pabrai suggests physicians take to ensure that their patients’ electronic protected health information (ePHI) is secure and complies with HIPAA regulations:

  • Assign someone in your practice to be the security or compliance officer. Make sure they have access to the appropriate resources to do their job.
  • Conduct risk analyses regularly, ideally on an annual basis.
  • Develop a security strategy and policies and document them. If HHS’s Office for Civil Rights investigates a security breach, the first thing they will ask is to look at your policies, said Pabrai.
  • Remediate when necessary: address any deficiencies in your protection strategy
  • Secure third parties: make sure your business associates are protecting your patients’ ePHI to the same degree you are.
  • Train your staff so they comply with your cyber security rules and regulations.
  • Evaluate your performance.

For an overview of what’s required from healthcare providers to comply with various aspects of the HIPAA Privacy and Security rules, the U.S. Department of Health & Services offers six free, CME-eligible online educational programs.

More information about the event and links to faculty presentations are available online.

Free white paper for MMS members: “MMS Guide to Health Information Technology”

House Approves Critically Needed Changes to Physician EHR Requirement

Posted in Electronic health records, Electronic Medical Records, Mass. Legislature on February 13th, 2014 by MMS – 10 Comments

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UPDATED: March 20, 2014

Read an update about this issue here.

The Massachusetts House this week approved changes in state law that would disconnect medical licensure from a physician’s use of electronic health records. The issue has been a major focus of the MMS’ advocacy efforts this year.

Under current law, effective Jan. 2015, physicians who wish to renew their license must demonstrate that they utilize EHRs that are at the level of the federal government’s meaningful use program.

MMS President Ronald W. Dunlap, MD, has met several times this year with legislative leaders, and cautioned that if the requirement is enforced, more than 10,000 physicians could lose their license, most of whom cannot, under law, qualify for Meaningful Use incentives. The resulting impact on the health care system would be devastating.

The House language would instead require practicing physicians to demonstrate that they use “digitized patient-specific clinical information.” Practicing physicians who don’t use digitized health records would be given the opportunity to demonstrate that they know how to use such records, by a method to be determined by the Board of Registration in Medicine.

Following a recent meeting between MMS President Ronald W. Dunlap and House Ways and Means Chairman Brian Dempsey (D-Haverhill), the House approved the language Wednesday by a very wide margin.

Unfortunately, the Senate’s supplemental budget bill did contain not such language, so the matter now heads to conference committee, where Chairman Dempsey has indicated will be a strong advocate for the substitute language.

We’d like to extend a big thank you to Chairman Dempsey and the House of Representatives for their actions this week.

Feds Extend Meaningful Use Attestation Deadline By One Month

Posted in Electronic health records, Electronic Medical Records on February 10th, 2014 by MMS – Comments Off on Feds Extend Meaningful Use Attestation Deadline By One Month

data 2The Centers for Medicare and Medicaid Services announced last week that it is extending the deadline for attesting to meaningful use for the 2013 reporting year by one month, to March 31, 2014, at 11:59 p.m. ET. The previous deadline was Feb. 28.

The criteria must still have been met by Dec. 31, 2013, the end of the reporting period for incentive payments.

The extension does not apply to the Medicaid portion of the EHR inventive payment program.

The President’s Podium: Mass. Medicine, After Cost Control

Posted in Board of Medicine, Electronic health records, Electronic Medical Records, Global Payments, Health IT, Health Policy, Health Reform, Regulation, Uncategorized on December 9th, 2013 by MMS Communications – 1 Comment

By Ronald Dunlap, M.D., President, Massachusetts Medical Society  

Massachusetts entered its second phase of reform with the 2012 passage of DSC_0003 Dunlap 4x6 color 300 ppi_editedChapter 224, cost control legislation officially titled “An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency and Innovation.”

While the first phase, Chapter 54 passed in 2006, was indeed landmark legislation and served as the model for the Affordable Care Act, Chapter 224 alters the state’s health care industry perhaps like no other law.

The changes this law brings are vast, from payment reform to giving the Attorney General new powers in the health care marketplace. Although 224 does include some benefits for physicians (medical malpractice reform for one), other provisions pose significant challenges, particularly for physicians in small practices. Here are two that raise concern.

Health Information Technology (HIT) One of the biggest challenges presented by Chapter 224 is its embrace of health information technology. Physicians will be required – as a condition of licensure – to demonstrate proficiency in all aspects of health information technology by January 1, 2015.

While MMS supports HIT and recognizes its intent to improve patient care, this provision of the law could severely disrupt medical care. Because the statutory language creating the requirement is tied to Federal standards of “meaningful use” (which in turn is tied to participation in Medicare and Medicaid), it raises concerns that strict interpretation of this provision would lead to denial of license renewals for some 26,000 physicians.  Our state has a high certification rate for meaningful use, with more than 14,000 physicians having met stage 1 requirements, but nearly 40,000 physicians have a Massachusetts license, and most are not included in the population targeted for meaningful use certification.

Additionally, the costs of establishing HIT can be huge. The outlay for such items as implementation, maintenance, software and hardware upgrades, conversion to Federal ICD-10 codes, training, and data conversion could approach well over half a million dollars for some practices while not including the “opportunity loss of income” from decreased productivity.  While the law allows for assistance to providers for HIT, the level of help is unknown, and the financial burden can be crippling to small practices.

The law further requires all providers to implement fully interoperable electronic health records that connect to the statewide health information exchange by January 1, 2017 (a goal not in sight) and imposes penalties for noncompliance. These technologies are not only critical for physicians to practice medicine, but also to participate in quality measurement programs.  The specter of this kind of commitment to HIT, however, with its financial outlay, is certain to make physicians pause and think, especially those close to retirement.

MMS has had lengthy discussions with the Board of Registration in Medicine (responsible for implementing the HIT requirement) and has testified in support of legislation to delay this requirement and provide relief to physicians. Our voice has been heard, and we are hopeful such relief will be forthcoming.

Data Collection and Reporting Chapter 224 is equally enthusiastic about data collection and reporting.  It creates a “provider organization registration program,” requiring organizations to provide detailed information about their operations: costs, financial performance, utilization, total medical expenses, and patient referral practices, among other information.  This data is hard to extract from many EMR systems.

This information will be collected by the Center for Health Information and Analysis (CHIA), a new independent state agency created by 224 that takes over most of the responsibilities of the Division of Health Care Finance and Policy, which was abolished by the law. Physician groups are now required – for the first time – to submit such data. The law contains language focusing on the reporting on risk-bearing groups while exempting smaller groups, but the applicability of this language has not been fully tested yet, so it isn’t clear how reporting requirements will be enforced and upon whom.

On a promising note, CHIA Executive Director Aron Boros told our House of Delegates at the Interim Meeting on December 6 that CHIA’s goal is to gather “reliable and meaningful” information through an “engaged transparent operation.”  He believes his agency must be “transparent, open, and collaborative” to build credibility.

The law also stipulates that by January 1, providers must disclose to patients within two working days of their request, how much a proposed procedure or service costs and what the health plan offers as payment.

I am not optimistic that physicians will be prepared within a month’s time to inform patients about specific or estimated costs for all procedures. We are encouraging legislators and the Health Policy Commission to implement the law incrementally, by considering the most expensive procedures first.

HIT and data collection/reporting requirements are but two areas that Chapter 224 dramatically changes. These changes, coupled with constant concerns over Medicare reimbursements as well as added requirements such as those imposed by ICD-10 codes, continue to strain physician practices.

What policymakers and regulators must keep in mind is that, even in a highly sophisticated medical environment like Massachusetts, no less than 64 percent of our physicians are in practices with fewer than 25 physicians. Policies and regulations that burden these practices and reduce their viability will not only affect the quality of care but will also reduce health care access for Massachusetts residents.

The President’s Podium appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine. For a section by section analysis of Chapter 224, click here.