SMARTDC Monthly Newsletter- A Timely Summary of Your IT News

ONC Plans to Iron Out Standards for Next Stage of Meaningful Use

In the next four months, the Office of the National Coordinator for Health IT plans to work out certification and standards-related details that will help guide vendors under Stage 2 of the meaningful use program, Government Health IT reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Doug Fridsma, director of standards and interoperability at ONC, said much more work needs to be done on standards and technical descriptions to support actions such as health information exchange. He said the office's goal is to make it easier for vendors to effectively encode standard functions in EHRs to help health care providers meet Stage 2 criteria. According to Fridsma, ONC will "refresh and reload" certification criteria and technical descriptions to guide vendors. In addition, the agency plans to evaluate outcomes from its Standards and Interoperability Framework initiatives.

In May, ONC will evaluate existing standards for drug formulary checks and electronic prescribing. In June, ONC will look at a number of issues that include: How health care providers can create an electronic list of care team members; whether hospital portals or personal health records would be more feasible for sharing patient data; and value sets for advance directives.

AMA Sends CMS List With 'Most Burdensome' Federal Regulations

The American Medical Association recently sent CMS Administrator Donald Berwick a list of what it deems the "most burdensome" federal regulations -- some of which relate to health IT -- that physicians say could interfere with patient care, increase administrative costs and create additional paperwork, HealthLeaders Media reports.

According to AMA President Cecil Wilson, the list and its accompanying proposed solutions are the result of a survey of more than 2,000 physicians from various specialties (Commins, HealthLeaders Media , 4/14).

AMA said physicians are burdened by conflicting requirements within the electronic prescribing and meaningful use incentive payment programs (Goedert, Health Data Management , 4/13).

The e-prescribing program started paying out incentives in 2009 and will continue to do so through 2013. Medicare providers who do not e-prescribe would face penalties beginning in 2012 ( iHealthBeat , 3/18). Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments. The discrepancy between the programs could compel physicians to purchase a stand-alone e-prescribing system this year and then purchase a certified EHR system in 2012 to avoid an e-prescribing penalty, according to AMA. In addition, AMA said quality reporting measures under the Physician Quality Reporting System vary from those laid out under Stage 1 meaningful use requirements (Health Data Management , 4/13).

CMS Gives Attestation Insights

Attestation for Medicare's electronic health records meaningful use incentive program opened on April 18, and 150 providers successfully attested that day, says Travis Broome, special assistant to the consortium administrator at the Centers for Medicare and Medicaid Services. Those providers will get their checks in mid-May, he adds. "We're excited to see success right off the bat."

Broome walked attendees through the attestation screens. The process is rather self-explanatory but he gave pointers in some areas, particularly watching to see which meaningful use objectives can be based off data from all patient records and which objectives must use records only from certified EHRs or EHR modules. Kahn explained the Medicaid meaningful use incentive program, under which providers register then receive a Web site link to complete a questionnaire. Thirteen states currently are accepting Medicaid MU registration with others rolling out their programs during the course of the year. As of March 31, Medicaid meaningful use incentive payments totaled $64 million--$13 million to eligible professionals and $51 million to hospitals. Medicaid's meaningful use criteria during the first year of its program are considerably easier to achieve than the Medicare program.

Under Medicaid, providers have to demonstrate a legal or financial commitment to adopt certified EHRs. That means showing an EHR contract, purchase order or user agreement, not just attesting to a commitment, Kahn says. "Planning doesn't cut it, but the pendulum doesn't have to swing all the way to the other side." Hospitals are able to participate in both meaningful use programs--a hospital that successfully attests under the Medicare program is deemed to be a meaningful user under the Medicaid program.

Eligible professionals must have at least 30 percent of their patients covered under Medicaid to participate in that program; 20 percent for pediatricians. Eligible professionals cannot participate in the Medicare and Medicaid programs at the same time, but can switch one time to another program and switch back if desired. Other tidbits from Broome and Kahn, based on Web seminar attendee questions, include:

• Medicare in the first year will use cost reports on file to determine the size of a hospital's meaningful use payment. When the 2011 cost reports are available the payment will be reconciled and may be higher or the hospital may have to repay some money.
  
• An eligible professional can send electronic prescriptions from the EP's own user ID, or permit a designee to send the prescriptions from the designee's user ID for the prescription to count toward meeting the meaningful use criteria. Under the CPOE criteria, however, all orders must come from the eligible professional's user ID.
  
• A physician leaving a practice after having demonstrated meaningful use does not affect the attestation, as the departure wouldn't change the fact that the practice met the criteria during the reporting period.
  
• A provider can register for attestation with a certain tax ID number in the first year then change to a different number in subsequent years. The only limit is that the tax ID being used must be associated with the national provider identifier.

American Well pushes web-based telehealth to doctors

Making the leap beyond its largely payer audience thus far, telehealth vendor American Well just debuted its second-generation product, Online Care for Providers, aimed at physician practices.

The system provides a web-based, secure platform for physicians to talk with their patients in real time--by video, chat or phone--without having to invest in a dedicated line or special equipment, company officials say. The calls can take place at the physician's home or office, and be received anywhere, according to company statements.

Most of the visits thus far, delivered through American Well's insurance company clients, have been for non-acute conditions, according to Xconomy . Ultimately, though, the company hopes the service will evolve to include physician consults with specialists, and even private-pay concierge medicine.

Study Shows Benefits of Using Clinical Decision Reminders with EHRs

Electronic clinical decision support reminders can help physicians avoid ordering unnecessary treatments, according to a study published in the journal Pediatrics , Modern Healthcare reports.

Researchers at Stanford University School of Medicine and Lucile Packard Children's Hospital studied whether automated alerts built into the hospital's electronic health record system could aid physicians in complying with new red blood cell transfusion guidelines.

According to the study, the system alerted physicians ordering transfusions about the new guidelines whenever a patient did not meet appropriate criteria for the procedure. The reminders prevented 460 unnecessary transfusions and saved a total of $165,000 in one year, the researchers said.

David Cornfield - medical director of critical care at Lucile Packard Children's Hospital and a senior author of the study - said the study "demonstrated that having clinical decision support baked into the fiber of ordering practices can have a significant, durable impact on the delivery of clinical care" ( McKinney , Modern Healthcare , 4/18).