Electronic health records

Feds Release Revised EHR Rules – Flexible Enough?

Posted in Electronic health records, Electronic Medical Records on July 13th, 2010 by MMS – 1 Comment

photo by Geopilia, via flickrThe federal government today released its revised and final “meaningful use” regulations that define how physicians can qualify for Medicare or Medicare bonuses after installing electronic health records.

The rules don’t change the timeline for demonstrating the meaningful use of EHRs, but relax some of the standards that physicians and hospitals must achieve.

No doubt, the experts will have a hearty debate over whether the rules have been relaxed enough to address concerns that the draft rules were too difficult for doctors to meet, and not flexible enough.

(The MMS, the AMA and others have commented that the draft rules were a case of “too much, too soon.”)

In general, the feds have implemented a two-track strategy. There’s a core set of standards that must be met – 15 for physicians (and other “eligible providers”) and 14 for hospitals. Then there’s a separate set of 10 standards, of which physicians and hospitals must meet five to qualify.

At least some of standards are relaxed. For example, the draft rules said that physicians must order 75 percent of their prescriptions to qualify. Under the final rule, it’s 40 percent. Another example: The number rules relating to clinical decision support have been reduced from five to one. Physicians must meet standards for measuring six quality measure, and hospitals must meet 15, out of a total of 44.

Dr. David Blumenthal, who leads the government’s health IT program, said the feds received more than 2,000 comments on the draft rules, and took the comments seriously. He said, “We very much want well-intentioned providers to become meaningful users. [The goals] are ambitious but achievable.”

He added, “If you try, you can get there, and get the incentives.”

Blumenthal summarized the rules in an article published today by the New England Journal of Medicine.

The Journal also published a commentary by Dr. Regina Benjamin, the US Surgeon General. She wrote about how she implemented an EHR after her Gulf Coast practice in Alabama was afflicted by multiple disasters, including two hurricanes and a fire.

She wrote, “Whereas I had previously decided against installing an EHR system because I couldn’t afford one, I now realized I could not afford not to have one.”

The news conference was highlighted by the passionate – and heartbreaking – comments of Regina Holliday, the widow of a recently deceased cancer patient. She shared how her inability to promptly obtain her husband’s medical records during the course of his illness compounded the agony of their ordeal. Easily accessible health records, she said, would have made a world of difference.

Here’s  a recording of her brief remarks. The audio quality isn’t perfect because it’s recorded off a computer speaker, but it’s certainly good enough to understand her point. (Length – 4:02)

“Meaningful Use” Regulations to be Released Tuesday

Posted in Electronic health records, Electronic Medical Records on July 12th, 2010 by MMS – Comments Off on “Meaningful Use” Regulations to be Released Tuesday

photo by stevendepolo via flickr.com

The federal government’s long-awaited guidelines under which it will reimburse physicians for implementing electronic health record systems are scheduled to be released 10 a.m. Eastern Time Tuesday.

These rules, known as “meaningful use” rules, were issued in draft form earlier this year, and were promptly attacked by almost every entity in organized medicine. The AMA and the MMS, for example, commented that the implementing schedule was much too aggressive, and would be all but impossible for physicians to meet.

In other words: Too much too soon.

The key question is whether the rules were relaxed and, if so, by how much.

Feds Release Draft EHR Rules – Critics Attack

Posted in Electronic health records, Electronic Medical Records, meaningful use on January 4th, 2010 by MMS – 2 Comments

The federal government last week finally unveiled its proposed definition for the “meaningful use” of electronic health records. Almost immediately, there were critics.

Physicians and hospital systems have been waiting for these definitions for many months. Last winter, as part of the sweeping federal stimulus bill, Congress set aside $20 billion to subsidize physicians, hospitals and others who install electronic health records and demonstrate their “meaningful use.” For physicians, that subsidy could be more than $44,000 per person over a four-year period.

So the definitions released on Dec. 30 had been eager anticipated. But almost immediately after they were released, several key stakeholders protested.

The American Hospital Association said the eligibility requirements for physicians and hospitals are too restrictive, and would penalize many hospitals that have already implemented clinical IT systems.

The Medical Group Management Association said the proposal is “overly complex,” and would discourage EHR adoption.

The American Medical Association hasn’t announced its position yet, but in initial comments it echoed earlier worries  that the time frames for implementation might be too strict.

A privacy advocacy group, Patient Privacy Rights, attacked the rules on the grounds that they don’t give patients control over their personal health information.

The 692-page proposal unveiled last week came in two parts:

The rules are the first of three phases. Phase 1 takes effect in 2011. Phases 2 and 3 – not released last week – take effect in 2013 and 2015 respectively.

David Blumenthal, MD, who leads the federal government’s health IT strategy in Washington, warned that the next two phases will introduce even more stringent criteria, because that’s what Congress wanted.

The rules issued last week are not final. A 60-day comment period begins when the rules are officially published in mid January.

Blumenthal, writing in the New England Journal of Medicine, said the insights from physicians, hospitals and others “can improve this rule.”

Like the AMA, the MMS is studying the proposals and will send in our suggestions to improve the rules’ ability to promote the adoption of electronic health records.

AMA: Proposed “Meaningful Use” EHR Timetable is Too Aggressive

Posted in Electronic health records, Health IT on June 29th, 2009 by MMS – Comments Off on AMA: Proposed “Meaningful Use” EHR Timetable is Too Aggressive

The American Medical Association and 81 state and specialty medical societies told federal officials last week that proposed milestones for the physician installation of electronic health records is too aggressive because physicians “lack the necessary infrastructure, standards, and systems” to achieve the council’s proposed timetable.

The Massachusetts Medical Society was one of the state medical societies co-signing the letter.

The letter proposes a detailed alternate timetable that “is aimed at ensuring that the bar is not set too high or too low; one that is reasonable and ensures that all eligible physicians in all size practices and specialties are able to take advantage of the incentives specified” in the stimulus bill.

The letter states that the path to widespread use of EHRs should last several years. It also stated that specific check points should be met before moving from one implementation phase to the next. “This check point will help ensure not only physician readiness and the capacity of the system to meet these goals,” said the letter, “but will also help assure continued access to safe, quality care for patients.”

The federal stimulus bill signed into law earlier this year gives physicians up to $44,000 in Medicaid or Medicare incentives starting in 2012 if they can demonstrate a “meaningful use” of electronic health records. Physicians and hospitals have been awaiting the specific definition of “meaningful use” since then. The Health Information Technology Council, a new entity created by the stimulus bill, released its proposed timeline on June 16 and accepted comments through June 26.

The council will now review the comments and is expected to issue final standards by the end of the year.

AMA Federation letter

AMA Federation Proposed Timetable

“Health Affairs” Tackles Health IT and Spotlights the Mass. eHealth Collaborative

Posted in Electronic health records, Health IT on March 10th, 2009 by MMS – Comments Off on “Health Affairs” Tackles Health IT and Spotlights the Mass. eHealth Collaborative

The new edition of Health Affairs, published today, is called "Stimulating Health IT." It is devoted almost entirely to the challenge of implementing comprehensive health IT systems throughout the country.

It relies heavily on case studies of EHR pilot projects. In two articles of local interest, Massachusetts eHealth Collaborative Executive Director Micky Tripathi co-authors articles about the results of his nationally renowned program.

  • In one article, Tripathi and the director of the Primary Care Information project in New York City, describe how they led successful efforts in their respective communities to implement broad-scale EHR adoption. The approaches contrast in many ways, but they share four broad lessons.
  • The second article, written Tripathi and three associates at the eHealth Collaborative, outlines how they were able to persuade 90% of patients in their communities to voluntarily allow their personal health information to be added to the community's health information exchange, while being very upfront and forthcoming with the patients about the difficult issues of privacy and consent.

This entire issue of Health Affairs is worthy of careful reading. A subscription is needed to read the full text of most articles.

The Health IT Money: What’s Coming to Massachusetts?

Posted in Electronic health records, Health IT on March 9th, 2009 by MMS – Comments Off on The Health IT Money: What’s Coming to Massachusetts?

The Massachusetts Medical Society has published an overview of how the new federal health IT funds could affect the Massachusetts health care system over the next five years. The complete picture will take many months to develop, but we can pass along some preliminary details.

The funding will come in two pools:

  • A relatively small pool of loans and grants, directed mostly to states, colleges and state-designated agencies. It's believed that most of these loans and grants will be used to help develop regional health information exchanges, but other IT projects are eligible. A lot of this money will be available within the next year.
  • A much larger pool of Medicare bonuses paid directly to qualifying physicians and hospitals after they install EHRs , starting in 2011 for up to five years.

The full analysis is available here, along with links to supporting documentation and other background information.