SMARTDC Monthly Newsletter- A Timely Summary of Your IT News

Come experience a demonstration of SMARTMD's Complete EHR Certified Clinician Desktop v4.1, at the Florida Chiropractic Association's National Convention, August 26-28th, 2011 in Orlando – Booth 618

$400M in EHR incentives Delivered

WASHINGTON – The government has paid $400 million in meaningful use incentives to physicians and hospitals so far, a Centers for Medicare and Medicaid Services official told the Health IT Policy Committee Aug. 3.To date, about 77,000 providers have registered for the program aimed at promoting the adoption and use of electronic health records.

CMS has collected data about healthcare providers that have attested that meet Stage 1 meaningful use, offering a glimpse of the experience of early adopters of certified electronic health records. One of the findings showed that providers used required EHR functions with a higher percentage of patients than was called for in the requirements, according to CMS officials. Twenty-one states have launched their Medicaid EHR program, with Arizona , Connecticut , Rhode Island and West Virginia in the past month, according to CMS. Among preliminary data, 2,383 physicians and other eligible professionals had verified that they met meaningful use requirements under the Medicare program, with 137 attesting unsuccessfully. The analysis did not explain why those providers failed attestation, but the agency will drill down to find the reason behind the numbers, said Robert Tagalicod, the new director of CMS' Office of e-Health Standards and Services. However, 100 hospitals have attested and all have done so successfully.

CMS has paid Medicaid incentives to 3,500 physicians and hospitals for adoption, implementation and upgrades of certified EHR technology, and under the Medicare program, 1,000 physicians and hospitals. One particular statistic in CMS' data is promising. The number of physicians who received meaningful use incentive payments under Medicare increased significantly in July over June, from 329 physicians to 566, said Elizabeth Holland, CMS' director of health IT initiatives group. “We're hoping that that will be a continuing trend,” she said.

To receive payments of up to $18,000 in 2011, providers must not only attest that they can demonstrate meaningful use but meet the threshold of $24,000 for allowed charges in claims for covered services to Medicare beneficiaries during 2011. Also in the July report, CMS included for the first time the medical specialties associated with the eligible physicians and other professionals. The two top specialties are family practice and internal medicine.

Among other findings, providers on average met or exceeded the threshold performance or percentage of a provider's patients involved in a measure demonstrating an EHR's functionality, Tagalicod said. For example, providers had to use computerized physician order entry (CPOE) for at least one medication order entered for more than 30 percent of unique patients who have at least one medication on their medication list. On average, providers used it for 87 percent of the defined patient population, he said. The most popular menu or choice objectives for attesting providers were to incorporate lab results, conduct drug formulary checks and fulfill patient lists. The least popular were conducting medication reconciliation and summary of care record at transitions.

More Changes On The Way For The eRX Incentives

The Centers for Medicare and Medicaid Services soon expects to publish a final rule making changes to Medicare's Electronic Prescribing Incentive Program. CMS has sent the rule for review to the Office of Management and Budget, one of the last steps before publication in the Federal Register . In a proposed rule published on June 1, CMS said the changes are designed to better align the eRX Incentive program with the electronic health record meaningful use incentive program. The eRX Incentive program has its own quality measure to determine whether an eligible professional is using a "qualified" electronic prescribing system that performs four specific functions. The program does not require certification of the system. Under the proposed rule, EHRs that have received meaningful use certification would be deemed to qualify for the eRX Incentive program by expanding the definition of a qualified e-prescribing system. The proposed rule also called for additional opportunities to providers to get a "hardship exemption."

Survey: Meaningful Use Driving Physicians To Adopt E-Health Records

Federal meaningful use incentive payments continue to be a strong driver of physician adoption of electronic health records, according to a new survey by Sage Healthcare Division and Forrester Research.

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

For the survey, researchers polled U.S. physicians who use EHRs, as well as those in the market for EHR products.

The survey found that 64% of all physicians consider meaningful use one of the strongest drivers to implement EHRs.

Among physicians who use EHRs, the survey found that:

• 80% said they have reached their business goals of lowering costs and improving patient service;
  
• 74% said the technology has helped them improve staff efficiency;
  
• 64% said they measure the success of the technology through reporting and tracking health care outcomes;
  
• 56% said error reduction is the most tangible benefit of EHRs.
  
• Among physicians who do not use EHRs, the survey found that: 
  
• 74% said they would measure EHR success through increased revenue; and
  
• 32% said insufficient capital is the main barrier to EHR adoption.

CMS Gives Attestation Tips

More than 56,000 providers have registered for the Medicare or Medicaid electronic health records meaningful use programs through May 2011, officials from the Centers for Medicare and Medicaid Services noted during a recent Health Data Management Web seminar. Robert Anthony, Health Insurance Specialist in CMS' Office of E-Health Standards and Services, walked Web seminar attendees through the registration and attestation processes and answered questions. He advised registering long before being ready to attest for meaningful use to ensure any problems are resolved and attestation doesn't get delayed. "Registration in the program doesn't commit you to anything," Anthony said. Providers register for the Medicare or Medicaid programs on the same CMS Web site, but those attesting to Medicaid meaningful use will do so on a state-specific Web site.

Other tips from Anthony include:

• Get your EHR's meaningful use certification number (which is required) from the government's Certified HIT Product List Web site, not the vendor.
  
• On attestation pages, most measures have a data field for the numerator first followed by the denominator, but the boxes are reversed for clinical quality measures.
  
• Eligible providers can designate a third party, such as an office manager, to register and attest on their behalf.
  
• A provider that fails attestation need not wait for 90 days to re-attest, but can select a different 90-day reporting period-even if it varies by only a day or so from the previous period

Experts Discuss Issues on Use of EHR Data in Malpractice Situations

Experts say electronic health record data present new challenges for health care organizations because such information can be used as legal representation of patients' health conditions and treatments. Health IT stakeholders discussed concerns associated with the use of EHR data in legal settings this week at an American Health Information Management Association summit in Chicago .

Stacey Cischke, an attorney who teaches at Loyola University Chicago, said that an increasing number of courts are saying that metadata and "access to the inner workings of the EHR system" can be relevant and discoverable in judicial proceedings. Adam Greene, a partner in the law firm of Davis Wright Tremaine, said there are "all sorts of liability fears" that come with EHR use, including the concern that EHR access logs could be used in malpractice suits. HIPAA rules require those who handle EHR data to log access to information that is personally identifiable. Cischke added that physicians and nurses sometimes can be "overwhelmed" by time or economic constraints, which could lead to incomplete information in an EHR. However, unlike paper-based records, EHRs generally do not allow alterations after a physician signs off on the record of a patient visit. Cischke recommended that health care providers work to identify potential lawsuits and promote consistency in how they produce reports and react to legal action. She said internal and external counsel and staff should learn about how EHR systems work.