Meaningful Use – What you need to know at every stage from HIMSS
From GE Healthcare comes this video showing the current roll out of Meaningful Use Stage 1 criteria as well as Stage 2 and Stage 3 projections.
Few Medical Devices Connect with EMR Systems
December 8, 2010 By 2 Comments
According to a white paper from HIMSS Analytics, fewer than a third of US hospitals report having active interfaces between medical devices and their EMR systems, according to FierceEMR blog. And the situation with individual medical practices can’t be much better. Although this might not sound like a big deal to most, the inability to interface medical devices with your EMR system can jeopardize satisfying Meaningful Use criteria and their potential financial incentives. Do you have any critical medical equipment that does not connect with your EMR system? If so, what do you plan to do about it?
11 Steps to Maximize Your EHR Incentive Payments
November 10, 2010 By 2 Comments
In a post on Becker’s Hospital Review, Jaimie Oh presents a list of 11 best practices for maximizing healthcare IT incentive payments. And although the audience is specifically administrators of hospitals, if you are a physician or medical practice administrator there is still much you can take home from the following recommendations:
- Figure out what incentives you are eligible for – are you going for Medicare alone or Medicaid as well?
- Understand the core objectives and the five menu set objectives you need to meet Stage 1 Criteria
- Implement EMR in a way that maximizes efficiency
- Mix learning and adoption methods – different staff need different levels of training
- Form an EMR [steering] committee – this is one of my faves
- Elect an IT medical director – or a Physician ‘champion’
- Meet with your vendor regularly to ensure the EMR is working optimally
- Consider the vendor’s implementation recommendations – although you’re less likely to get this as a medical practice
- Reach out to established organizations such as CHIME or HIMSS for resources and education
- Strategize your approach to meaningful use going forward
- Wait another year to apply, if need be – actually, since the new rules give you 2011 as a ‘grace’ year, it makes more sense to wait until 2012 to make sure your ducks are all in a row
More Money Spent on IT Security
November 8, 2010 By 3 Comments
According to the 2010 HIMSS Security Survey, with responses from 272 healthcare IT and security professionals, hospitals and medical practices are spending more on information technology (IT) security but still spend less on average than companies in other industries. The results of the third annual survey were reported on CMIO.net and included other interesting facts:
- Hospitals are more likely to have a formally-titled IT security officer compared to the typical medical practice, which often outsource this entirely
- Two-thirds of respondents have a formal plan for investigating security breaches
- Hospitals say they are more likely to adopt future security technologies than their medical practice counterparts
- One-third of respondents reported at least one known case of medical identity theft
The Meaning of Meaningful Use of EMR
October 27, 2009 By 7 Comments
If you talk to anyone who is involved in the electronic medical records (EMR) industry, one of the biggest points of discussion is what is known as “Meaningful Use of EMR.” 
What started as a well-intentioned (by some) effort to establish standards for EMR software systems has morphed into political jockeying by corporations, consumer watchdogs, and others.
The US Dept of Health and Human Services (HHS) outlined these criteria for Meaningful Use of EMR:
1) Improve quality, safety, efficiency, and reduce health disparities
2) Engage patients and families
3) Improve care coordination
4) Improve population and public health
5) Ensure adequate privacy and security protections for personal health information
And although each of these has defined goals followed by specific objectives and measures for the years 2011, 2013, and 2015, these still sound a bit ambiguous. Many industry experts, however, expect these to be more fine-tuned as the dates approach, but medical practices will have to stay informed to keep ahead of the curve.
Financial Incentives
As part of the ARRA (American Recovery and Reinvestment Act of 2009), financial incentives will be given to those physicians whose practices demonstrate “meaningful use” beginning January, 2011.
The incentive payment, according to CMS, is equal to 75% of Medicare-allowable charges for covered services in a given year, and maxes out as follows:
- Year 1 – $15,000
- Year 2 – $12,000
- Year 3 – $8,000
- Year 4 – $4,000
- Year 5 – $2,000
For those practices who are early adopters of the technology and hit the threshold for meaningful use in 2011 or 2012, the first year payment would be $18,000. Note that this only applies to Medicare; there are additional incentives for healthcare providers who have a certain threshold of Medicaid patients and/or who practice in a rural area. The threshold for office-based pediatricians is lower, and so they would be more likely to qualify for those additional funds.
[table courtesy of SoftwareAdvice.com]
Even considering the fact that EMR implementation may cost anywhere from $10,000 to $50,000 per provider, these incentives would certainly make that investment more palatable.
Those practices that procrastinate, however, will be penalized with cuts in Medicare and Medicaid payments:
- 2015 – 1%
- 2016 – 2%
- 2017 – 3%
- 2020 – 5% (maximum reduction)
So, how do you know if you qualify? According to the health IT blog NetDoc, to be a “meaningful EHR user”, a physician must satisfy three criteria:
- Must use “certified EHR [EMR] technology”
- Must demonstrate that the certified EHR technology is connected in such a way that it provides for the electronic exchange of health information to improve the quality of health care, such as promoting the coordination of care (using HL7 or XML standards)
- Must submit information on clinical quality measures specified by HHS (such as PQRI)
Some physicians have told me that because there isn’t a final definition of what is considered “certified EHR technology” they are just going to wait. Big mistake. Most health care IT experts working on and advising on this issue feel fairly strongly that the Office of the National Coordinator for Health Information Technology (ONCHIT) will set CCHIT (Certification Commission for Health Information Technology) criteria as the standard for EMR certification.
CCHIT is a non-profit organization funded by various corporations and groups such as the American College of Physicians and the American Academy of Family Physicians, and was recognized by the US Dept of Health and Human Services (HHS) as a certifying body in 2006.
Some critics, however, charge that CCHIT is a shill for the Healthcare Information and Management Systems Society (HIMSS), the healthcare industry’s membership organization focused on healthcare IT. Although made up of both corporate and individual members, these critics feel that their goal is to corner the market for certain major EMR players. Nevertheless, unless or until there is an alternative, most EMR vendors are using CCHIT certification as the benchmark.
In addition to the EMR certification criteria, the ONCHIT is expected to adopt an initial set of standards and implementation specifications by the end of the year 2009.
Timeline
So, is too late to implement EMR in your practice and still qualify for the financial incentives? Well, that depends on the size of your practice, type of specialty, and how motivated your doctors and staff are to go paperless. Just don’t expect to run down to Office Depot, buy an EMR program and launch it the next day (although there is talk about WalMart getting into the EMR business, but we’ll leave that story for another day…)
According to MBA HealthGroup, these are some reasonable time frames to expect for EMR Implementation:
- Stage 1 – up to 6 months – researching vendors, getting buy-in, setting up an EMR committee, checking out demos, and making a final decision on the EMR system
- Stage 2 – up to 5 months – time it will take to actually ‘go live’. In the meantime, adapting workflow to EMR system you chose, ordering hardware, and standardizing processes
- Stage 3 – between 6 and 12 months – amount of time it will likely take to achieve “meaningful use”, which includes ePrescribing, documenting electronically, and ability to report certain items (which are still being determined)
[timeline courtesy of MBA HealthBlog]
Smaller groups and solo doctors may be able to purchase a more basic, “out-of-the-box” EMR system and more quickly adapt their workflow to the system, rather than vice versa in the case of larger medical practices. But, the one thing you can count on with EMR implementation is that you can’t count on anything – that is why some sort of timeline is important [see EMR Implementation Rollout].
What this boils down to is that those practices that have already started implementing EMR will have a good shot at getting those higher financial incentives. On the other hand, physicians who have been wishing that the whole idea of EMR was just a fleeting fad may not only miss out on these incentives but may also face cuts in their reimbursement.
Questions? Comments? Post them below
Legal Issues of the Electronic Medical Record
July 19, 2009 By 4 Comments
When medical practices change over from paper to electronic medical records (EMR), 
steps must be taken to ensure that the records remain legally sound. The change to electronic medical records brings up some issues with compliance, privacy, and security. Below you will find some important considerations to make when switching your practice over to EMR.
When writing an exam on a piece of paper and signing it, you create a legal document. You are most likely familiar with the problems that can result from changes to medical records, and the importance of good documentation. The Healthcare Information and Management Systems Society (HIMSS) asserts that electronic medical records must be stored legally. Otherwise, these records can be challenged as hearsay and deemed invalid.
This is important, because when electronic medical records do not meet the legal requirements, a payor can sometimes deny a claim. Also, you could create the risk of an adverse outcome in litigation. In addition to being sure your electronic records aren’t altered, you must also be able to demonstrate the procedures which are used to ensure this.
How, then, can you make sure your electronic records can’t be altered? The ideal system lets users make updates and correct errors while keeping the record’s legal integrity intact. Ask yourself the following questions:
* Does the system keep a record of who is accessing and writing to the record? You wouldn’t want your name appearing as the author of another user’s entry.
* Does it contain a security protocol which is strict but not too time-consuming? Features could include an automatic time-out after a period of inactivity, and periodic changes to the alphanumeric passwords.
* Does the system prevent access to certain critical features? For example, an employee working the front desk shouldn’t be able to edit a patient’s clinical findings.
* Does it use a secure ‘lock-out’ feature? Perhaps you want the doctors to be able to make changes at the end of the day, but after a certain amount of time has passed the record should lock. This sort of feature helps protect you by preventing unauthorized changes.
* Does the system write time stamps on all entries, to show an audit trail? For example, the system could write an unalterable draft of each event and entry.
By paying attention to these important considerations, you’ll be on your way to ensuring your electronic medical records system is legal and defensible.
