Walker Family Medicine adopts OmniMD EMR/ PMS solution

Tarrytown, NY- OmniMD, one of the leading healthcare information technology companies, which provides Electronic Medical Records (EMR), Practice Management (PMS) and other Healthcare IT products and services to the providers and clinics across the nation, has announced today that Walker Family Medicine (WFM) located in Willcox, Arizona has adopted the companys EMR and PMS solution in order to improve the quality at point of care.

WFM decided to implement an Electronic Medical Record (EMR) system from day one to access patient medical records, to improve the quality at point of care, to increase productivity and reduce medical errors. Besides the financial benefits, the major objective was to enhance the quality of care as well as the satisfaction of its patients.

"After comparing many EMRs, I determined that OmniMD was the best software for my new clinic. I run a high volume family practice clinic with two mid-level providers. OmniMD is used for scheduling, reminder calls, medical records, insurance and patient billing. OmniMD is a critical tool for my practice. It is a very good software, but I am also very pleased with the level of service OmniMD provides with their technical support team, Dr. Walker (Board Certified in Family Practice) says.

Dr. Walker is pleased with the performance of the OmniMD solution, which allows her to access and maintain entire patient medical records promptly. The system allows the clinic to customize templates as per their specialty, at the same time multiple providers can access a single chart at once. In case of a Specialty Provider, the system allows the sharing of charts among providers and staff across multiple locations. OmniMD Medical Billing System can electronically track claim status, payments and work flow of the billing team. OmniMD Patient Portal allows patients to register on-line, update and view their information, request an appointment, order an Rx refill and view lab reports.

About Walker Family Medicine
The Walker Family Medicine (WFM) team has worked together for over five years while serving the Willcox community. They are committed to providing patient-centered care in order to maintain their community's health. WFM provides routine healthcare for children, including immunizations. WFM also has associations with pediatric specialists. WFM provides routine women's healthcare. This care includes annual gynecological exams, family planning, pre -and post- menopausal counseling and treatment.

WFM has Urgent Care services. The clinic is available to care for patients basic urgent healthcare needs, such as simple lacerations, sprains, fracture diagnosis and care. They are associated with Charles Leighton Hospice and they provide referrals when appropriate. For more information, please visit www.walkerfamilymedicine.com

About OmniMD
OmniMD is a division of Integrated Systems Management, Inc. (ISM), a leader in software development, system integration, business and technology consulting for fortune 500 companies since 1989.

OmniMD integrated Electronic Health Records (EHR) and Practice Management (PMS) product and services, offers unparalleled reliability, ease-of-use, efficiency, and customizability. The solution is a HIPPA compliant, web-enabled and support device, which can range from tablet PCs, handhelds to desktop computers. The solution is SureScripts Certified, which also provides real-time alerts for drug-drug, drug allergy and other interactions based on a patients EMR. The solution captures complete documentation such as HPI, ROS and Physical Exams, Assessment & Plan to complete patient visits. The system follows HL7 standards for information sharing and integration across practices and hospitals. The solution is secured by Thawte, which uses 128bit encryption and digital certificates to ensure complete data security. OmniMD received a 5-star rating in the AC Group survey in 2006. For more information, please visit Medical Billing Services.

Government Provides Incentives to Encourage E-Prescriptions

Under the Medicare Improvements for Patients and Providers Act (MIPPA) providers who implement e-prescription programs are eligible for incentives. Offices are looking for medical software to help them implement this program and reap the rewards.

The E-Prescription Incentive Program

In 2003 the Medicare Modernization Act (MMA) included provisions for electronic prescriptions. Growing evidence that e-prescriptions reduce medication errors and protect patient safety, as well as physician liability, has motivated many medical offices to convert over but many doctors still depend on paper prescriptions.

This in part led to the creation of the 2009 Electronic Prescribing Incentive Program that rewards providers who use e-prescriptions for their Medicare Part B claims. In 2009 a qualified e-prescriber will be eligible for a 2% incentive payment. The hope is that most or even all providers will seek out medical software that supports e-prescription and adopt that system for growing numbers of patients. The goal is not only to improve public safety but to make Medicare filing more cost effective and save money.

Qualification for the Program

The requirements for participation in the program are quite simple. The medical software used must be able to do the following, quoted directly from the measure specifications:

- Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs) if available

- Select medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts

- Provide information related to lower cost, therapeutically appropriate alternatives (if any). (The availability of an e-prescribing system to receive tiered formulary information, if available, would meet this requirement for 2009)

- Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan (if available) More Read Electronic Prescription

Interoperable Electronic Prescribing In The United States: A Progress Report

Although the vast majority of U.S. physicians still handwrite prescriptions, adoption of electronic prescribing is slowly growing. Major barriers to adoption remain, including the inability to electronically submit prescriptions for controlled substances and confusion about standards for data exchange. Federal and state governments and private insurers are using payment and policy incentives to boost e-prescribing because they still believe in its promise for improving the quality and efficiency of health care. However, additional efforts and further investments are needed to reap the benefits of e-prescribing on a national scale.

ELECTRONIC PRESCRIBING BURST ONTO THE health policy scene in 2003 with passage of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). MMA created a prescription drug benefit for Medicare beneficiaries (Part D) and required that Part D plans support an “electronic prescription program,” should any of their providers and pharmacies voluntarily choose to prescribe using computer systems. MMA also called for the adoption and testing of specific technical standards for the data exchange transactions that Part D plans would use.

Medicare and other payers are particularly interested in fostering the use of e-prescribing because it could provide information at the point of care to improve the quality and safety of medication use while lowering medication costs.2 Health plans that have sponsored e-prescribing programs expect an initial return on investment (ROI) simply through increased generic drug use and formulary compliance. For example, the Health Alliance Plan of Michigan estimated a five-year ROI of more than $14 million, based on the 2005 and 2006 improvement in its generic use rate. A new study based on e-prescribing in Massachusetts found that physicians who adopted e-prescribing systems with the ability to check formulary status increased their prescribing of generics and other lower-cost options, resulting in a conservative estimate of savings for consumers and insurers of $845,000 per 100,000 patients per year. Such savings could be particularly important for Medicare, which spent $42.2 billion in 2007 for beneficiaries’ prescription drugs. Such savings also could become increasingly important for private insurers that are facing decreasing investment earnings and enrollment because of the recent economic crisis.

With the impetus from Medicare, e-prescribing has gained momentum. In many areas of the United States, payers, employers, pharmacies, technology partners, professional associations, state governments, legislators, and other stakeholders are working to spur its adoption through incentive payments; legislation; and funding for software, hardware, and connectivity fees.

Since 2006 we have seen a dramatic rise in volume for key transactions: prescription transmissions, eligibility checks, formulary and benefit information, medication history requests in ambulatory settings, and medication requests for patients in acute care settings (Exhibit 1). The numbers reflect both maturing of the market as well as expanding use by prescribers, which is still primarily occurring among early adopters. Read MOre Electronic Prescription

Healthcare Update: Obama Holds Town Hall Meeting In New Hampshire

President Obama held a town hall meeting in New Hampshire today, Tuesday, August 11, in an effort to calm fears over the Democrats’ legislative initiatives to reform healthcare in this country. The meeting was structured, and no visible emotional outbursts were seen as in other meetings with lawmakers across the country.

Obama answered questions posed by attendees, emphatically telling the audience that the current healthcare system solely benefits the insurance industry. With 46 million in the country without health insurance, he tried to reassure his audience that they would be able to keep their current coverage and doctor and that the government would not be “in charge”. Obama hammered on the fact that the government and insurance bureaucrats should not be meddling, that pre-existing conditions will be covered and that insurance companies would not be able to drop or deny coverage or water down coverage. Many of the questions on voter’s minds that were expected to be answered, especially with respect to employers and small businesses, were not addressed.

Numerous recent polls show support for healthcare reform is eroding, and the President’s numbers are dropping as well over fears that a government takeover of our healthcare system in the U.S. will lead to a Canadian style system with long waits for treatments and referrals.

The President’s message today was supposed to address people who already have insurance through their employers and highlight how his proposals would affect them. HAI monitored the town hall meeting and didn’t find the retool of the White House message to have answered those questions. Another town hall meeting with Obama is scheduled for Bozeman, Montana on Friday, and on Saturday, Obama will be in Grand Junction, Colorado.

Meanwhile, the White House has opened a Reality Check website with a viral tool aimed at online healthcare combat on everything from rationing to euthanasia. The website incorporates lessons learned from the Obama presidential campaign, and shows the White House is becoming more aggressive in dispelling what they call misinformation in the healthcare debates.

The August Congressional Recess is not even half over, and Democratic lawmakers are very much at risk of losing control of the public debate over healthcare reform, facing wary constituents and facing a barrage of accusations and criticism over their writing of the legislation prior to leaving Washington. Powerful groups on both sides of the debate are using the August recess to hammer home to lawmakers that there are very serious political consequences to the healthcare issue. Read More EMR Stimulus Package

Government Provides Incentives to Encourage E-Prescriptions

Under the Medicare Improvements for Patients and Providers Act (MIPPA) providers who implement e-prescription programs are eligible for incentives. Offices are looking for medical software to help them implement this program and reap the rewards.

The E-Prescription Incentive Program

In 2003 the Medicare Modernization Act (MMA) included provisions for electronic prescriptions. Growing evidence that e-prescriptions reduce medication errors and protect patient safety, as well as physician liability, has motivated many medical offices to convert over but many doctors still depend on paper prescriptions.

This in part led to the creation of the 2009 Electronic Prescribing Incentive Program that rewards providers who use e-prescriptions for their Medicare Part B claims. In 2009 a qualified e-prescriber will be eligible for a 2% incentive payment. The hope is that most or even all providers will seek out medical software that supports e-prescription and adopt that system for growing numbers of patients. The goal is not only to improve public safety but to make Medicare filing more cost effective and save money.

Qualification for the Program

The requirements for participation in the program are quite simple. The medical software used must be able to do the following, quoted directly from the measure specifications:

- Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs) if available

- Select medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts

- Provide information related to lower cost, therapeutically appropriate alternatives (if any). (The availability of an e-prescribing system to receive tiered formulary information, if available, would meet this requirement for 2009)

- Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan (if available)

In addition, at least 10% of a participating provider’s Medicare Part B services must be made up of specific procedure codes detailed in the measure. More information can be found at http://www.cms.hhs.gov/ERxIncentive/06_E-Prescribing_Measure.asp

What Software Is Required?

There are a number of medical software options available to providers. Many EMR systems include an option for e-prescriptions. The software used doesn’t have to be CCHIT certified which allows a number of inexpensive and free EMR systems to be considered. Read More Electronic Prescription

Healthcare providers see certainty on meaningful use

The requirements for what health IT users need to do to meet the meaningful use dictates of the stimulus law are now clearer, with the focus apparently swinging to how the IT certification process will handle them.

Healthcare providers finally have some certainty about what they need to do to be meaningful users of health IT, said Dr. Bruce Taffel, chief medical officer of SharedHealth, an healthcare information exchange and application provider.

Dr. David Blumenthal, the national health IT coordinator, and the HIT Policy Committee, a public/private organization, approved July 16 a list of 28 health IT functions and corresponding quality and efficiency improvement measures for 2011 that become progressively more rigorous in 2013 and 2015.

The schedule is aggressive and the criteria will be difficult for some to achieve.

“The recommendations provide more clarity at this stage, although there’s still a lot more work to be done,” Taffel said today.

The goals for meaningful use are for providers to electronically capture data, report quality measures and use the data to track patients’ medical conditions. Under the American Recovery and Reinvestment Act, providers will be eligible for increased Medicare and Medicaid payments beginning in 2011 if they demonstrate meaningful use of their certified health IT. The payments end after 2015 when health IT should be broadly adopted.

“The committee shaped their recommendations on meaningful use and the progression to achieve that on the basis of what we can do today, what the current condition is and with a fairly reasonable explanation of how you begin phasing in much of this,” Taffel said.

The policy committee also made its first recommendations on the certification process of electronic health records. Currently, the Certification Commission for Health IT (CCHIT) is the sole certifying and testing organization. The HIT Policy Committee wants more competition.

Multiple groups will be needed to perform certifications because so many more providers will seek to have the service conform to the stimulus, said Paul Egerman, retired businessman and chair of the committee’s certification and adoption work group. Read More EMR

Study places EHRs at core of saving cardiac patients? lives

An EHR program that cut cardiac deaths by 73 percent has also kept patients healthy two years later, according to a new study.

The Kaiser Permanente program in Denver linked coronary artery disease patients and teams of pharmacists, nurses, primary care doctors and cardiologists with an electronic health record to help keep the patients healthy two years after they left the program by keeping them in touch with their caregivers electronically, according to a randomized study.

The study, which was funded by the American College of Clinical Pharmacy, is published in The American Journal of Managed Care this month. It is the first randomized study to evaluate a follow-up system for patients discharged from a cardiovascular risk reduction service, researchers said.

The Clinical Pharmacy Cardiac Risk Service at Kaiser Permanente Colorado combines Kaiser Permanente’s HealthConnect EHR with patient outreach, education, lifestyle adjustments and medication management.

The two-year randomized trial of 421 patients found that patients discharged from the program kept their lipid and blood pressure levels at controlled, healthy levels by receiving electronic reminders.

“Because lack of adherence to medications and failure to maintain treatment goals are so high among heart disease patients, we wanted to find out what would happen to the patients after they were discharged from the program but remained in contact with the healthcare system through our electronic health record,” said the study’s lead author, Kari L. Olson, a clinical pharmacy specialist with Kaiser Permanente Colorado’s Cardiac Risk Reduction program. “The takeaway message here is that we can help support patients in maintaining treatment goals and medication adherence, which is often a challenge with most chronic conditions. Using technology and integrated systems already in place, we can help keep patients healthy for longer and deliver continuity of care in a cost-efficient manner.” Read More EMR

Do You Qualify for a $63,750 Medicaid EHR Bonus?

A new report estimates that as many as 45,000 office-based physicians who participate in Medicaid and use electronic health records, or EHRs, could collect as much as $63,750 paid out over a six-year period as part of the American Recovery and Reinvestment Act of 2009.

Notably, about 9,800 primary care physicians — defined by report authors as family physicians, internists and general practitioners — could qualify for the bonuses.

Boosting Health Information Technology in Medicaid: The Potential Effect of the American Recovery and Reinvestment was issued by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, an arm of George Washington University’s School of Public Health and Health Services in Washington.

The report provides insight into federal EHR funding efforts, according to Leighton Ku, Ph.D., M.P.H., professor of health policy at George Washington University and one of four report authors. He said the team wanted to research the little-explored Medicaid payout because it pays significantly more money than the $44,000 maximum provided by a similar Medicare program.

Ku noted that HHS’ bonus payment rules prevent “double dipping” from the Medicare and Medicaid programs. But “If you’re eligible for both (programs),” said Ku, “you’re probably better off taking the Medicaid money.”

HHS is anxious to expedite EHR implementation and is investing $49 billion in the two programs to help ensure that 40 percent of America’s physicians are up to speed with health information technology by 2012.

That goal may be difficult to attain. According to 2006 data from the National Ambulatory Medical Care Survey, only 15 percent of U.S. physicians have fully implemented EHRs; another 16 percent have begun the implementation process, and 69 percent do not use an EHR system.

Medicaid Bonus Criteria

To receive the Medicaid bonus, physicians must meet criteria beyond using a certified EHR. For example, to qualify for the full bonus, at least 30 percent of a physician’s patient panel must be enrolled in Medicaid.

Physicians who practice in federally qualified health centers or rural health clinics have less stringent criteria — they need only claim that 30 percent of their patients are “needy individuals.” As such, the patients must be covered by Medicaid, provided with free care or billed on a sliding-fee scale.

The authors point out that “after-the-fact debt forgiveness is not sufficient to classify a provider as one who serves ‘needy’ patient who are uncovered by Medicaid.” Read More EMR Stimulus Package

Docs see money faster with automation

HUDSON, IA – Full-practice automation seems to pay off for many small physician offices, but others who choose only select areas to convert are feeling the positive financial effects as well.

Kurt Kastendieck, MD, a family practitioner in Sante Fe, N.M., is in the process of automating his practice and finds his e-prescribing tool to be particularly useful.

“It works well,” he said. “Things like refill communications are automatically sent back. It saves an amazing amount of time.”

The e-prescribing program came with Kastendieck’s EHR, which he installed two years ago. He also bills through the system.

Larger pharmacies are better equipped for e-prescribing, but not many smaller pharmacies are, Kastendieck said. Some still take prescriptions by phone or fax.

The e-prescribing tool calculates and produces a 24-hour turnaround bill through the clearinghouse and on to the insurance company. Kastendieck said reimbursement now averages two weeks from a patient’s visit.

Automation, such as e-prescribing, helps improve a doctor’s quality of life, said Kastendieck. one doesn’t need a complete EHR, only Internet access.

Theresa Dickson, who manages her husband’s solo general surgery practice in Dennison, Texas, says electronic billing technology brings the money in quicker, even without an EHR.

“The few practices I know of out there that paper bill their claims simply budget the practice to allow for the 45 day delay in payment as opposed to 20-30 days that we experience,” she said.

Dickson said many IT companies say an EHR will save money because physicians will need less room to store charts. However, Dickson says the monthly fees for the use of an EHR often outweighs the cost of hard copy storage.

“I have seen monthly fees of $500 to $1,500 a month for one doctor,” she said. “We are not being reimbursed by our major carriers enough to offset that cost. In our particular community, real estate is relatively inexpensive, so for me personally it would cost me less to store charts.” Read More EMR

Electronic Health Records: The $20 Billion Prescription

WASHINGTON (ISNS) –The progress and problems in developing a national system of electronic medical records topped the agenda Thursday as the Obama Administration’s “best and brightest” from the world of science, medicine and technology gathered in Washington for the inaugural meeting of the President’s Council of Advisors on Science and Technology (PCAST).

David Blumenthal, the national coordinator for health information technology, said there was an “appalling lack of use of technology” in the U.S. medical record-keeping system. “Only 20 percent of physicians and 10 percent of hospitals have meaningful electronic records,” he told the 21-member panel. The transition from the paper-based medical record-keeping system to an electronic one is a priority in President Barack Obama’s push for health care reform, Blumenthal said, as a way to save money over the long run and improve the quality of health care.

In February, Obama signed the American Recovery and Reinvestment Act, which would put $20 billion toward what Blumenthal called a “completely revised, interoperable, integrated health information system.” The system, which is supposed to be functional by 2014, will actually be many different electronic records systems developed by private companies that meet a host of federal standards and requirements that are currently being developed.

“Paper records put us in a suboptimal position [to improve health care],” said Eric Lander, a co-chair of PCAST and the director of the Broad Institute, a medical genetics research program in Cambridge, Mass., run by both Harvard University and the Massachusetts Institute of Technology. An electronic records system, in addition to allowing a patient’s medical records to be shared among doctors, could allow medical researchers to “mine data and combine data” to do faster, more sophisticated medical studies, he said.

Blumenthal said the point of the system isn’t the technology itself, but how that technology is used. “There is very little about the health care system that doesn’t concern us or that we can’t affect in some way,” he said. “We are enabling information to be more accurate and available at the point of care.”

“Use” is one of three area of concern for the scientists and others developing the records system. The other areas focus on getting doctors and hospitals to adopt the electronic system, and, once they have it, how to use it to efficiently exchange information. Read More EMR Stimulus Package

Interoperable Electronic Prescribing In The United States: A Progress Report

Although the vast majority of U.S. physicians still handwrite prescriptions, adoption of electronic prescribing is slowly growing. Major barriers to adoption remain, including the inability to electronically submit prescriptions for controlled substances and confusion about standards for data exchange. Federal and state governments and private insurers are using payment and policy incentives to boost e-prescribing because they still believe in its promise for improving the quality and efficiency of health care. However, additional efforts and further investments are needed to reap the benefits of e-prescribing on a national scale.

ELECTRONIC PRESCRIBING BURST ONTO THE health policy scene in 2003 with passage of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). MMA created a prescription drug benefit for Medicare beneficiaries (Part D) and required that Part D plans support an “electronic prescription program,” should any of their providers and pharmacies voluntarily choose to prescribe using computer systems. MMA also called for the adoption and testing of specific technical standards for the data exchange transactions that Part D plans would use.

Medicare and other payers are particularly interested in fostering the use of e-prescribing because it could provide information at the point of care to improve the quality and safety of medication use while lowering medication costs.2 Health plans that have sponsored e-prescribing programs expect an initial return on investment (ROI) simply through increased generic drug use and formulary compliance. For example, the Health Alliance Plan of Michigan estimated a five-year ROI of more than $14 million, based on the 2005 and 2006 improvement in its generic use rate. A new study based on e-prescribing in Massachusetts found that physicians who adopted e-prescribing systems with the ability to check formulary status increased their prescribing of generics and other lower-cost options, resulting in a conservative estimate of savings for consumers and insurers of $845,000 per 100,000 patients per year. Such savings could be particularly important for Medicare, which spent $42.2 billion in 2007 for beneficiaries’ prescription drugs. Such savings also could become increasingly important for private insurers that are facing decreasing investment earnings and enrollment because of the recent economic crisis.

With the impetus from Medicare, e-prescribing has gained momentum. In many areas of the United States, payers, employers, pharmacies, technology partners, professional associations, state governments, legislators, and other stakeholders are working to spur its adoption through incentive payments; legislation; and funding for software, hardware, and connectivity fees.

Since 2006 we have seen a dramatic rise in volume for key transactions: prescription transmissions, eligibility checks, formulary and benefit information, medication history requests in ambulatory settings, and medication requests for patients in acute care settings (Exhibit 1). The numbers reflect both maturing of the market as well as expanding use by prescribers, which is still primarily occurring among early adopters. Read More Electronic Prescription

HHS Issues Privacy Guidance Promising to Rule by Reason

The Department of Health and Human Services (”HHS”) issued comprehensible, no surprises guidance under the final HIPAA privacy rule that went into effect on April 14, 2001. From the perspective of all but the health care provider community, the guidance was pretty much a nonevent; HHS addresses issues that are primarily of relevance to providers. If there is a message that resonates with all covered entities under the rule, it is that the sky is not falling and a rule of reason will be the Government’s compliance mantra. On the other hand, covered entities (and others affected by the rule) should not hold out hope that the rule will still change in any significant way. Any implementation activities delayed on that basis should now move forward.

The absence of any real policy change in the guidance was widely expected. When HHS reopened the comment period earlier this year, there was initial widespread speculation (fueled to some degree by the new administration) that the Bush administration would delay the rule’s effective date and go back to the drawing board on some of the more controversial issues. The issues thought likely to be revisited included preemption of state laws, “minimum necessary” use and disclosure, the need for business associate contracts, and oral versus electronic transmission of data. This speculation was short lived. Although HHS Secretary Tommy Thompson simultaneously allowed the rule to go effective on April 14 and promised soon to issue guidelines and/or modifications, the most knowledgeable observers doubted he would support any modification without following the notice and comment requirements of the Administrative Procedure Act (”APA”). This collective wisdom was right. The July 6 guidance clarifies several controversial provisions and only portends modifications (that will be made in accordance with the APA) in at least four areas. These planned modifications are at the margin of the rule and will have no significant effects on implementation efforts.

Guideline Overview – Plenty for Providers but Only Snippets for the Rest of the Health Care Community

Much of the guidance addresses “common sense” interpretations of the privacy rule in the context of a debate that has, on occasion, focused on extreme views. Overall, there is little that is new. As anticipated, HHS does not address some of the more controversial provisions of the rule, such as a parent’s guaranteed access to a child’s health records and the perimeters of “minimum necessary,” both of which it now intends to address through rule modification. It is also silent on the preemption of state laws.

For health plans, the guidance is of much more limited relevance than for providers. But one key message should be heard by all covered entities, not just providers: the guidance stresses the reasonableness of compliance efforts by covered entities. In the minimum necessary discussion, for example, HHS states that covered entities have “substantial discretion” in implementing the minimum necessary standard and may rely on “standard protocols” for routine disclosures. Further, this standard “is intended to make covered entities evaluate their practices and enhance protections as needed to prevent unnecessary or inappropriate access to [protected health information]. It is intended to reflect and be consistent with, not override, professional judgments and standards.” Although the guidance focuses on “disclosure” versus “use” of protected health information, it implies that covered entities will be required to be reasonable in all their actions, not adhere to wooden absolutes. Thus, HHS is unlikely to nitpick a covered entity’s implementation of the rule or its day-to-day operation under the rule, where its actions are “reasonable” for a covered entity of its size and sophistication.

In terms of actual guidance for health plans, there are a few items of interest. First, the overlap between “treatment, payment and health care operations” (”TPO”) and “marketing,” is discussed with a clarification that certain marketing communications must receive an authorization (or at least an opt-out opportunity) even if they also fit within payment or health care operations. Thus, if an action constitutes both marketing and health care operations, the health plan must meet all HIPAA requirements concerning marketing communications.

Second, the guidance arguably “clarifies” that when a health plan must obtain protected health information from a provider to complete certain Coordination of Benefits (”COB”) or third-party payer transactions, the health plan must first receive the patient’s authorization. HHS explains that since “the provider’s disclosure is for the TPO purposes of the plan [and not the provider], it would not be covered by the provider’s consent” obtained from the same patient. Putting aside the question of how often this COB fact pattern actually arises, to many this clarification seems more like a misreading of the final rule. For example, some believe that the rule provides that if the consent given to the provider relates to TPO, it does not matter if it is for the purposes of the TPO of the provider or the TPO of the plan. However, the rule and preamble appear silent on this issue, leaving one to ask if HHS has inadvertently modified the rule. Clearly, the ramifications for other TPO issues are great. Read More Electronic Prescription

State Governments Join Push For Health IT

State governments around the country are working to facilitate, and in some cases, enhance, Washington’s stimulus-funded incentives for doctors and hospitals that adopt new health information technology. “A group of the nation’s governors and state officials has released a guide for state implementation of the Health Information Technology for Economic and Clinical Health Act,” the formal name for the portion of the stimulus bill, McKnight’s Long-Term Care News reports. A key recommendation is that state leaders create health information exchanges so providers can readily share information to improve coordination of care (8/7).

Meanwhile, members of the National Lieutenant Governors Association called for support of “advance interoperable health IT and its adoption among providers” in a resolution this week, Modern Healthcare reports. They call on states to adopt systems with the stamp of approval of the Certification Commission for Health Information Technology, a group affiliated with an e-health industry association (DerGurahian, 8/6). EMR Stimulus Package

Louisiana creates loan program for EHR purchases

Louisiana Gov. Bobby Jindal signed into law a bill that would create a loan program for physicians and hospitals hoping to buy an electronic health record system.

The Electronic Health Records Loan Program Act, signed July 9, gives the Louisiana Dept. of Health and Hospitals the authority to apply for $25 million in federal stimulus funds in order to administer loans for EHR purchases. The measure also included $5 million in matching funds from the state, a requirement under the American Recovery and Reinvestment Act. The state will learn later this year if it will get the federal grant.

“This is another step in updating and improving Louisiana’s health delivery system for all Louisianians,” Jindal said in a prepared statement.

The measure builds on legislation passed in 2007 that helped seven rural hospitals acquire EHRs. The law also established the Louisiana Rural Health Information Exchange. In 2008, additional funding allowed another seven rural hospitals to become connected.

To qualify for the loans, the purchased EHR system must be certified by the body eventually chosen by the U.S. Dept. of Health and Human Services for such approval. Loans could also apply to fully integrated telemedicine systems.

Acknowledging upfront costs are a barrier that the incentives wouldn’t help alleviate, many EHR vendors also launched financing options for physician practices as a result of the stimulus. General Electric Co., for example, is giving practices the options of deferring payments until incentives start being paid in 2011.

Jenny Smith, health information technology project manager for the Louisiana Health Care Quality Forum, which is the state-designated entity for distributing all grants coming out under the federal stimulus package, said details are still being worked out in terms of the loan agreements. Work groups consisting of several stakeholders in the state are currently working on structuring the loan program, she said. EMR

State Alliance for e-Health issues HIT exchange guidance

The State Alliance for e-Health issued new guidance on Tuesday for state health information exchanges.

The executive-level organization, composed of governors, state legislators, attorney generals and state commissioners, included information on how states can lead the way in using health IT as they begin instituting the federal Health Information Technology for Economic and Clinical Health (HITECH) Act.

The HITECH Act, enacted as part of the 2009 American Recovery and Reinvestment Act, expands the role of states in fostering health information exchange and adoption of electronic health records over the next five years.

“Governors understand that swift and thoughtful action is needed at the state level to plan and implement a national system of health information exchange,” said Tennessee Gov. Phil Bredesen, co-chairman of the alliance. “Widespread adoption and use of electronic health records provides a critical foundation for improving health outcomes and cost-effectiveness.”

The report recommends actions states should take now to qualify for the HITECH Act, including:

* Preparing or updating the state plan for HIE adoption;
* Engaging stakeholders;
* Establishing a state leadership office to manage the different phases of HIE implementation;
* Preparing state agencies to participate;
* Implementing privacy strategies and reforms;
* Determining the HIE business model;
* Creating a communications strategy; and
* Establishing opportunities for health IT training and education.
Read More EMR Stimulus Package

?Meaningful use? revisions receive mixed reviews

Providers looking to make decisions about technology will find the revised “meaningful use” definition helpful, but the implementation timeline might still be challenging, professionals say.

The federal Health Information Technology Policy Committee approved updated recommendations from its meaningful use work group during a conference. The revised definition for the meaningful use of electronic health records includes changes to computer physician order-entry criteria and speeds up the schedule for granting real-time access to patient information through personal health records. The 2011 measures are being established with a focus on data capture and sharing, according to the work group’s recommendations.

Overall, the revisions “have some nice granularity to them,” said Brian Jacobs, a critical-care physician and chief medical information officer of 230-bed Children’s National Medical Center, Washington. As the medical center finishes components of its EHR, the revised measures will serve as guidelines for what it needs to focus on, he said. The medical center is already available for the full, first-year IT adoption incentive payment under the American Recovery and Reinvestment Act of 2009 because it meets the 2011 criteria now. EMR

Electronic health records facing a tough sell to doctors

Dr. David Blumenthal, the Obama Administration’s national coordinator for health information technology, can recall the day he became a true believer in the potential of electronic health records. He was about to order a lung scan when the computer in his Boston hospital alerted him to a similar image already in the file. The patient was spared an unnecessary dose of radiation and the health care system was spared the cost of an unnecessary test.

Such experiences, he said, “suggest… how small victories… can lead us to be better physicians, higher quality physicians.” That thinking is informing his actions as head of the Office of the National Coordinator, which wants doctors to use electronic medical records as part of a broader effort to modernize the health care system.

Blumenthal’s office, along with two advisory panels, reported Thursday on their progress in developing the framework for the $33 billion health information technology initiative. The undertaking, which began with the February passage of the stimulus bill, has required that they define key terms, such as “meaningful use,” that will guide doctors as they adopt electronic health records. They are also setting the minimum requirements physicians will have to meet in order to receive financial incentives.

For Blumenthal, the most difficult challenge will be to convince doctors that participating is worth it. Even with assistance from the federal government, physicians will have to spend big money on the digital transition. And the return on their investment is murky. Blumenthal must show doctors how this program is good for them by identifying goals for improvements, and ultimately, savings in their practices. Read More EMR

Obama says he will reform US healthcare by end of year

US PRESIDENT Barack Obama has promised to overhaul the American healthcare system by the end of this year – without Republican support if necessary.

Speaking in Indiana after a town hall meeting to promote his economic policies, the president said he would prefer to sign a bipartisan healthcare Bill but it was not yet clear if negotiations with Republicans would prove fruitful.

“Sometime in September we’re going to have to make an assessment,” he told MSNBC. “I promise you, we will pass reform by the end of this year because the American people need it.”

Mr Obama told his audience in Elkhart, which experienced the sharpest unemployment rise in the US last year, that he would issue $2.4 billion in taxpayer grants to create electric cars and tens of thousands of jobs.

“For too long, we failed to invest in this kind of innovative work, even as countries like China and Japan were racing ahead,” he said.

“That’s why this announcement is so important – this represents the largest investment in this kind of technology in American history.”

Mr Obama identified energy, innovation, healthcare and education as the pillars of the new US economy he wants to build from the wreckage of the recession.

“Now, there are a lot of people out there who are looking to defend the status quo. There are those who want to seek political advantage. They want to oppose these efforts.

“Some of them caused the problems that we got now in the first place, and then suddenly they’re blaming other folks for it. They don’t want to be constructive. They don’t want to be constructive; they just want to get in the usual political fights back and forth,” he said to applause.

“But you and I know the truth. We know that even in the hardest times, against the toughest odds, we have never surrendered. We don’t give up. We don’t surrender our fates to chance. We have always endured. We have worked hard, and we have fought for our future.

“Our parents had to fight for their future; our grandparents had to fight for their future. That’s the tradition of America.

“This country wasn’t built just by griping and complaining. It was built by hard work and taking risks. And that’s what we have to do today.”

Republicans, who have opposed all Mr Obama’s key proposals, from the economic stimulus package to healthcare reform, see in the president’s declining popularity an opportunity to make gains in next year’s congressional elections. More Read EMR Stimulus Package

Spring Hill collects more on medical bills than county

The Spring Hill fire district has collected at least 90 percent of its medical billing nearly every year since 2003 - a double-digit improvement compared to the county’s fire and rescue services.

For the five annual billing cycles beginning September 2003 and ending September 2008, Spring Hill Fire Rescue collected 90 to 91 percent of its net charges for patients who were transported and-or treated.

On average, the district failed to collect less than $208,500 per year since September 2003, according to records obtained by Hernando Today.

“That’s not too bad. That’s actually a pretty good number,” said Rajeev Rajagopal, co-owner of Managed Outsource Solutions out of Tulsa, Okla. “Whenever you’re dealing with ambulance calls, you have a lot of patients who may not have enough money for medical bills. That definitely falls into play.”

A perfect score is impossible because sometimes the patients are deceased by the time the billing process is filed, said Spring Hill Fire Chief Mike Rampino.

“I’m very happy about it,” the chief said about the numbers from the past six years. “It’s something to be proud of. We’re doing the best we can with what we have, and I’m proud of what they do.”

Hernando County Fire Rescue’s numbers also are considered better than average. For the billing cycle from April 1, 2007, to March 31, 2008, the department collected 80 percent of what it charged. During the same period the following year, the county collected 74 percent, but that number is likely to increase as some patients complete their payment plans, said Hernando County Fire Chief Mike Nickerson.

“Our net collection rate of 75 to 80 percent is consistent with, or higher than, the regional average and is an improvement from the average 70 percent collection rate by our previous billing company, dating back to 2006 and prior,” Nickerson said. Read More Medical Billing Outsourcing

Electronic health records overlooked in healthcare debate

One part of President Obama’s healthcare agenda that has been nudged out of the spotlight is the push to create a nationwide network of electronic health records (EHR) by 2014. McKnight’s will hold a webcast on this issue later this month.

Even though a deadline is in place, EHR faces significant challenges toward implementation. One of the main factors holding back EHR adoption is the sheer cost of the undertaking, according to CNNMoney.com. Depending on the size of the facility, an EHR system can cost tens of millions of dollars to implement, and take years to get off the ground. One Kentucky hospital system will require $80 million and three years to fully implement an effective EHR system, CNN reported. Convincing physicians to change their long-held practices can be a challenge as well, according to the report. Smaller rural facilities face other challenges, including lack of training and resistance to change. The long-term care industry has long been considered ahead of the curve in EHR adoption practices. Read More EMR

Agencies Seek to Use Stimulus Funds to Find Cheaper Health Care

Federal health agencies, seeking to hand out stimulus funds to research the effectiveness of various medical treatments, said they will include projects that look in part at the cost of drugs and other treatments.

The approach — which was unveiled in a report to Congress this week by the Agency for Healthcare Research and Quality and the National Institutes of Health, both agencies under the Department of Health and Human Services — could provide more fodder to conservatives worried that the government might use the results of such studies to limit health care to consumers.

Administration officials have said they want to use stimulus funds to help doctors and patients choose more-effective treatments and ultimately, help rein in rising health-care costs. Democrats are considering including measures that would support such research as part of health-care legislation making its way through Congress.

The Agency for Healthcare Research and Quality, which has $300 million to spend on comparative research, mostly in the fiscal year starting Oct. 1, said it would increase funding to projects that focus on arthritis, cancer and 12 other conditions that are often costly to treat. Read More EMR Stimulus Package

Guidelines on EHR meaningful use moving forward

The recommendations, which will help determine who receives federal stimulus funding, have been revised from an initial draft.

By Chris Silva, AMNews

The Obama administration’s national health information technology coordinator has approved recommended definitions for what constitutes “meaningful use” of electronic health records, about a month after asking a key working group to revise its initial recommendations.

The green light from David Blumenthal, MD, means that the recommendations now will be sent to the Dept. of Health and Human Services, which by the end of the year must issue a rule with final definitions. Meaningful use is a key term that ultimately will determine which physicians and hospitals are eligible for billions in federal EHR money made available through the economic stimulus package approved earlier this year.

Recommendations from Dr. Blumenthal and the Health IT Policy Committee provide the first look at a policy framework for the development and adoption of a nationwide health information infrastructure. The committee said it received nearly 800 comments after unveiling a first draft of the recommendations June 16, though policy experts say few major changes were made since then.

“To say Dr. Blumenthal sent the working group back to the drawing board really is inaccurate,” said Erica Drazen. a managing partner in the health care group at Computer Sciences Corp., a technology firm in Waltham, Mass. “There weren’t really too many surprises or changes made from the initial draft. If anything, it’s slightly more aggressive.”

Drazen pointed out, for example, how the final recommendations specified that only 10% of all orders entered by an authorizing physician at a hospital must be made via computerized physician order entry. The initial draft did not provide an exact percentage. But the requirement for physician practices remains the same — they must use CPOE for all orders, according to the final version. Doctors also received several additional recommended standards to meet by 2011. Read More EMR

Obama?s talk with retirees highlights digital health records

President Barack Obama told participants in an AARP tele-town hall Tuesday that electronic health records will help put an end to the inefficiencies they have experienced in healthcare.

“We’re also working to computerize medical records, because right now too many folks wind up taking the same tests over and over and over again because their providers can’t access previous results,” he said at the session at AARP headquarters. “Or they have to relay their entire medical history – every medication they’ve taken, every surgery they’ve gotten – every time they see a new provider. Electronic medical records will help to put an end to all that.”

Obama met at AARP headquarters in the nation’s capital with AARP CEO A. Barry Rand, AARP President Jenny Chin Hansen, moderator and AARP radio host Mike Cuthbert and an audience of about 60 retirees. He took questions from the audience, as well as from telephone calls and e-mails.

In a statement, Rand posted on the AARP site earlier this month, he said: “All Americans should have affordable healthcare choices. But our current healthcare system costs too much, wastes too much, makes too many mistakes and gives us back too little value for our money.”

He spoke about ending billion-dollar subsidies to insurance companies for Medicare Advantage, using nurse practitioners for home healthcare follow-up visits after hospitalizations, proving incentives for physicians to work as a team, creating a healthcare exchange for affordable coverage, including a public option and paying for improvements with greater efficiencies.

In response to a question about negative ads that emphasize the cost of healthcare reform and the high cost of automating the system, Obama acknowledged the upfront costs and mentioned his recent visit to the Cleveland Clinic.

“In order for us to save money, in some cases, we’ve got to spend some money up front,” he said. “Let me give you some very specific examples. Healthcare IT: Healthcare is the only area where you still have to fill out five different forms – when you go into a bank you don’t have to do that. You’ve got an ATM. If you use your credit card, they’ll find you real quick and the billing is real easy – right? But if for some reason you want healthcare, you fill out pencil and paper – I guess they Xerox it – they give it to somebody else. Sometimes you see their files and it’s all stuffed with papers, and nurses can’t read the doctor’s handwriting.” Read More EMR Stimulus Package

Drug-monitoring law approved in Florida

Florida is among 11 states without electronic means to track the dispensing of controlled substances, but as of May, a new law was passed by the Florida General Assembly and has Kentucky lawmakers hoping the pill pipeline will cease.

During a sentencing hearing Wednesday in U.S. District Court in Ashland, Judge David L. Bunning told convicted drug dealers Roger Martin Jr., and Jason Clay Carter that he is hopeful the new law will curb Kentuckians appetite for prescription drugs.

“I have been advised the state of Florida is going to adopt rules that I hope will curtail the problem of drugs being piped from Florida to Kentucky,” Judge Bunning said. “This has become an epidemic, and we must get a handle on it before more lives are destroyed.”

The drug epidemic has mounted by the day as people from Rowan, Carter and Elliott counties travel in planes, buses and vans to Florida’s pill mill to visit doctors prescribing hundreds of pain pills for cash.

And although the prescriptions are obtained legally, traffickers carry the drugs back to the Bluegrass and sell them on the streets, causing numerous drug-related court cases, convictions – and even deaths blamed on overdoses. Read More Electronic Prescription

Medicare proposal would simplify PQRI

Medicare is proposing a rule that would simplify reporting requirements for the Electronic Prescribing Incentive Program and the Physician Quality Reporting Initiative and set the Medicare Physician Fee Schedule for calendar year 2010.

The proposal would also add more measures for physicians to report under the PQRI pay-for-performance program, allow data submission from an electronic health record system and create a process to ease quality measure reporting for group practices.

The Centers for Medicare and Medicaid Services has also revised the reimbursement system for some payments. For example, it proposes to stop paying for “consultation” codes typically billed by specialists at a higher rate than equivalent “evaluation and management” services. In addition, CMS is proposing to remove physician-administered drugs from the definition of “physician services,” an action the American Medical Association has been calling for since 2002. Read More Electronic Prescription

Obama Defends Stimulus, Health Care Efforts

President Obama plans to huddle with his Cabinet and top advisers on Friday and Saturday to review lessons learned from his first six months in office. There’s bound to be some gnashing of teeth over the pace of the health care overhaul, and also some satisfaction over signs the economy is staggering back.

But based on his remarks at Wednesday’s town halls in Raleigh, N.C. and Bristol, Va., don’t expect a major recalibration of the administration’s message.

Obama continued to strenuously defend economic relief efforts launched in the aftermath of last fall’s financial crisis and lay some blame at the feet of former President George W. Bush. And he eagerly portrayed himself as a responsible steward of taxpayers’ money, to deflect persistent Republican charges that he’s incapable of controlling federal spending.

“I know that some critics in Washington think we’ve been slow to get these projects started,” Obama said in Raleigh, referring to work funded by the $787 billion economic stimulus package (PL 111-5). “They are saying we should have broken ground on all our highway projects on the first day. But everyone knows that’s impossible, especially because I wanted to be sure we did our homework and invested tax dollars only in those projects that actually created new jobs and jumpstarted our economy.”

Speaking in a state where the jobless rate is 11 percent, Obama said while there’s still much work left to be done to assure a complete recovery, “there is little debate that these steps, taken together, have helped stop our economic freefall.”

Obama also fired back at critics who blame him for running up the federal deficit, saying he inherited a $1.3 trillion shortfall. Without mentioning Bush by name, Obama said the staggering deficit was “a debt that is partially a result of two tax cuts that went primarily to the wealthiest few and a Medicare drug program, none of which was paid for.”

Finally, Obama continued to subtly recalibrate his health care message, casting the debate as one that revolves around curbing insurance companies’ less-savory business practices.

He outlined a series of consumer-protection measures aimed at preventing health plans from denying coverage to individuals who have preexisting medical conditions, dropping coverage for individuals who become seriously ill or charging unlimited out-of-pocket expenses. He also said the health overhaul would force the plans to pay for preventive care and routine checkups and remove arbitrary caps on the amount of coverage individuals can receive in a given year or in a lifetime. Read More EMR Stimulus Package

E-prescribing gains traction in Michigan

He gave up the paper pad four years ago and now only writes prescriptions for patients electronically.

While Dr. Richard Smith can’t specifically quantify the results, he knows without any doubt that e-prescribing has generated efficiencies in his medical practice.

“As you accept it in your practice, it’s a phenomenal tool,” said Smith, an obstetrician with the Henry Ford Medical Group and president of the Michigan State Medical Society. Smith, who’s been in practice for nearly 30 years, is among a growing number of physicians in Michigan and nationwide who now use e-prescribing, as health care rushes to catch up with other industries in the use of information technology. A June report shows Michigan is one of the leading states in e-prescribing rates, ranking third behind Rhode Island and Massachusetts. It moved up from fifth in 2007 and three spots from two years earlier.

In 2008, doctors in Michigan ordered 9.03 percent of all prescriptions electronically - 4.2 million new prescriptions and more than 603,000 refills - more than twice that of 2007 and more than quadruple the 2006 rate, according to Surescripts, a national provider of electronic access to health information that issues the annual Safe-Rx Awards to the top 10 states. The use of e-prescribing in other leading states has grown by similar rates since 2007. The rate in Massachusetts, for instance, grew to 20.5 percent in 2008 from 13.43 percent the year before and 8.80 percent in 2006.

Advocates of e-prescribing suspect Michigan’s 2009 rate is now in the mid-teens and say it will continue to rise rapidly. “We’re on a continuum right now,” Smith said. “We’ll see more and more.” At Grand Rapids-based health plan Priority Health, the e-prescribing rate by participating doctors was 14 percent as of May, up from just 3 percent at the end of 2008, pharmacy administrator Steve Marciniak said. Despite the strong growth in Michigan’s e-prescribing rate the past two years, Health Alliance Plan’s Denice Asbell says advocates need to maintain the push to go much further.

“Nine percent leaves a lot of room for growth and improvement,” said Asbell, project manager of purchasing initiatives at HAP, a unit of Henry Ford Health System. Read More Electronic Prescription

EHR adopters could face series of tighter standards

There may soon be one more incentive for hospitals and physician offices to buy and install electronic health-record systems on or before 2011. The added push could come from the prospect of increasingly higher thresholds of initial federal eligibility requirements for EHR subsidies under the American Recovery and Reinvestment Act of 2009, according to discussions at today’s meeting of the Health Information Technology Policy Committee.

A work group of that committee delivered its first draft of recommended definitions of “meaningful use” of EHRs, a standard that providers must meet to qualify for subsidy payments estimated at $34 billion to be handed out by Medicare and Medicaid. The work group recommended instituting a series of increasingly complex meaningful-use requirements between 2011, the first “payment year” of the subsidy program, and 2015, the final year payments will be made before financial penalties for not adopting begin.

During those discussions, Anthony Trenkle, director of the CMS’ office of e-Health Standards and Services, said the requirements will not be “tiered” based on when the provider adopts an EHR after 2011. Instead, whatever meaningful use standards are applicable for the year the provider applies for an EHR subsidy are the standards that provider must meet, regardless of whether it is the provider’s first year of EHR implementation. Read More EMR

Editorial: Prescription abuse

Florida’s medical examiners recently reported that prescription medicines caused more deaths in 2008 than illicit drugs. The medical examiners also reported sharp increases in deaths caused by prescription tranquilizers and painkillers, such as Oxycodone and hydrocodone.

The results of the year-end report weren’t surprising. Since the middle of last year, physicians, pharmacists and law enforcement officials have warned of a near-epidemic of deadly prescription medicine abuse. In 2005, the Medical Examiners Commission began reporting the drugs discovered in bodies subject to autopsies. The percentage of decedents with at least one drug in their bodies has increased each year; to 53 percent last year.

“The vast majority” (4,924) of the 8,556 drug-related deaths studied last year by the state’s medical examiners involved the presence of more than one drug, according to the 2008 report. The presence of at least one prescription drug caused the death of 2,184 people last year.

To put the scale of those numbers in perspective, consider: There were 2,983 deaths on Florida’s roads last year; 1,169 of those fatalities were alcohol-related. Prescription drugs caused more deaths than alcohol-related crashes in Florida.

Of particular concern: Death-related occurrences of both benzodiazepines and oxycodone were up by more than 20 percent in 2008 compared with 2007. The drugs that caused the most deaths in Florida: oxycodone (941), benzodiazepines (929), methadone (693), cocaine (648), alcohol (489), morphine (300), hydrocodone (270). Read More Electronic Prescription

Standards Panel Backs Quality Measures for ?Meaningful Use?

On Tuesday, the Health IT Standards Committee approved quality measures and standards for how health care providers can demonstrate “meaningful use” of electronic health records by 2011, Government Health IT reports.

Under the federal economic stimulus package, hospitals and physicians who demonstrate meaningful use of EHRs will qualify for Medicaid and Medicare incentive payments.

The standards panel endorsed a matrix of 27 quality measures and 12 standards that build on each other to improve patient outcomes. The standards call for health care providers to use health IT tools for transmitting:

* Continuity of care documents;
* Discharge summaries;
* Inpatient and outpatient prescriptions;
* Laboratory test results; and
* Other structured health data.

The committee said health providers who have not yet adopted EHR technology could use certain unstructured data for 2011, provided that they work to eventually meet structured data standards. Read More EMR

AMA Unveils Enhanced ePrescribing Learning Center to Provide Physicians Tools to Make Informed Decisions About Electronic Prescribing

Zero-In RX is a one-stop shop for electronic prescribing information and resources for physicians

Earlier this year the American Medical Association (AMA) launched a new online learning center to provide physicians with the information and tools they need to make informed decisions about electronic prescribing (ePrescribing). Today, the AMA unveils enhanced tools for ePrescribing and opens the site and all its resources to all physicians.

“A recent survey found about 30 percent of physician participants use an ePrescribing system in their practice. This is a sizable increase from the 13 percent who said the same at the end of last year,” said AMA Board Member Joseph M. Heyman, MD.

“With the current Medicare ePrescribing incentive and the promise of increased patient safety and practice efficiency, physician interest in adopting new technologies is increasing. We are glad to be able to offer physicians guidance on ePrescribing.”

The learning center includes a variety of tools and resources to help physicians, including calculators to estimate time savings and eligibility for incentive payments and planning tools to help determine practice readiness for and ease implementation of new technologies. Some of the new tools include: Read More Electronic Prescription

Obama Continues To Tout Health IT as a Key to Health Reform

As President Obama continued his push to reform the U.S. health care system, he highlighted the Cleveland Clinic as a model for how effective health IT systems can improve care and lower costs, Healthcare IT News reports.

Obama visited the Cleveland Clinic on Thursday and viewed a presentation on the center’s health IT initiatives.

Cleveland Clinic executives also spoke with the president about patient-centered health IT projects involving Microsoft HealthVault, Google Health and MyChart. MyChart currently connects 202,000 patients to an online portal for appointment scheduling, prescription management, preventive health reminders and test results.

C. Martin Harris, Cleveland Clinic’s CIO and a member of HHS’ Health IT Standards Committee, said the center “is developing health IT that gives patients the power to better manage their health care.”

Harris added that the Cleveland Clinic is “focused on helping lead the nation toward a comprehensive electronic medical records system that will reduce medical errors, improve quality and lower costs.”

During a town-hall meeting later that day, Obama said the Cleveland Clinic has “one of the best health IT systems in the country.” He said the center’s electronic health technology allows it to: More Read EMR Stimulus Package

Standards panel aligns interoperability specs with ARRA

The Healthcare Information Technology Standards Panel has approved new interoperability specifications for electronic health records, data exchange and architecture that align with the federal government’s stimulus package for healthcare IT.

“HITSP has transformed its existing work to be completely aligned with the American Recovery and Reinvestment Act of 2009 (ARRA),” said John Halamka, MD, chairman of the panel. “These approved specifications represent the culmination of some 90 days and 13,000 hours of volunteer effort to meet the requirements of this landmark piece of legislation.”

Approved by the panel at its July 8 meeting are:

* HITSP/IS107 – Electronic Health Record (EHR)-centric Interoperability Specification
* HITSP/TN904 – Exchange Architecture and Harmonization Framework Technical Note
* HITSP/TN903 – Data Architecture Technical Note
* HITSP/SC108-SC116 – Service Collaborations

On April 7, HITSP began to leverage its 13 Interoperability Specifications (IS) and 60 related constructs to consolidate all information exchanges that involve an electronic health record system. The work was organized around ARRA requirements, specifically for the HITECH section.

HITSP formed temporary “tiger” teams to map EHR-related information exchanges to ARRA requirements. These teams identified “capabilities” – specific, implementable business services that use existing HITSP constructs to define and specify interoperable information exchanges. For example, the Communicate Hospital Prescriptions Capability addresses the interoperability requirements needed to support electronic prescribing for inpatient prescription orders. Read More EMR

Obama losing favour with healthcare reform

United States President Barack Obama is battling slumping poll numbers as he tries to counter the growing criticisms of his economic and health policies.

Mr Obama has used a prime time media conference to defend his campaign to overhaul America’s health system, calling it vital to pulling the economy back from the brink.

It was his 10th news conference since taking office six months ago and the timing was critical.

The President held it during prime time in the US to guarantee a national television audience. And he did it in a bid to convince Americans and the Congress to back his ambitious health care reforms.

“This debate is not a game for these Americans and they can’t afford to wait any longer for reform. They’re counting on us to get this done. They’re looking to us for leadership and we can’t let them down,” he said.

With the US in a deep recession, unemployment rising and the deficit ballooning, healthcare reform is set to be Barack Obama’s biggest test yet.

Forty-seven million Americans do not have health insurance but the President’s far reaching plans to bring affordable health care to all Americans have left many worrying who will foot the bill.

The growing public unease with his approach is partly due to an onslaught from his Republican critics and some within his own Democratic Party remain sceptical.

But Barack Obama says the time is right for a health care overhaul.

“I’m the President of the United States so I’ve got a doctor following me every minute which is why I say this is not about me,” he said.

“I’ve got the best health care in the world. I’m trying to make sure that everybody has good health care, and they don’t right now. “ Read More EMR Stimulus Package

At this time, EMRs have not yet shown their value

EMR, DICOM, SNOMED, HIPAA, CCHIT — how many readers can explain in detail what each of these means to their practice? While to date only a few more than 10% of us have fully adopted electronic medical records, by 2015 we will all face significant penalties if we are not fully engaged in this next government mandate.

We at Minnesota Eye Consultants are still delaying implementation of electronic medical records (EMRs), partly because the costs are staggering, the technology available for ophthalmology is in evolution, and especially because of the horror stories we have heard from so many of our colleagues who have made the attempt to go electronic in the past. I am concerned that the penalties may be significantly greater than just the astronomical cost of implementation and the potential for reduced reimbursement for those who are noncompliant.

I am now old enough to have a few medical maladies of my own — hypertension for one, well managed on medical therapy, and a few sports injuries requiring joint surgery. Just this last week, I visited my internist who is part of a large multispecialty clinic that adopted EMRs 2 years ago. As I sat in the examination room, first the nurse and then the physician recited a long list of required questions while seated in front of a computer monitor, the whole time intent on the monitor and keyboard, without once looking up at me as they completed the history. Clearly, to me, this was a major disconnect in the way I have classically interacted with patients in our currently non-EMR clinic. Of course, there was an examination and a little laying on of hands with a few follow-up questions. Then another 5 minutes for me to look at the back of my physician as the data was entered and the treatment plan formulated.

On a positive note, a summary of the plan of therapy was immediately printed and handed to me, and the physician, one of the best internists in Minnesota, did turn and look me in the eye as he went over the plan and answered any questions. Having a good relationship with this committed physician, I asked him what he thought about EMRs. After a long sigh, which was in itself the answer to my question, he conceded that on the positive side, EMRs were a potentially powerful tool for large multi-specialty clinics such as his, where multiple providers at multiple locations participate in a single patient’s care. All caregivers at all locations have access to all the data immediately once it is entered. He admitted it was also a constructive tool for monitoring physician productivity and patterns of care, providing a powerful data set to those managing and regulating our practices. Read More EMR

Obama asks Americans to set aside health-care fears

WASHINGTON — facing possible defeat on his signature domestic policy priority, President Barack Obama appealed on Wednesday for Americans to put aside fears about health care reform and back sweeping changes that include the creation of a government-run medical insurance program.

During a prime time news conference in which he linked passage of health care legislation to the nation’s overall economic stability, Mr. Obama also claimed his administration’s controversial US$787-billion stimulus package and financial industry bailouts had all but rescued the American economy from collapse.

“As a result of the action we took in those first weeks (in office), we have been able to pull our economy back from the brink,” Mr. Obama said.

The president’s declaration of victory in the fight to save the economy came amid a wave of recent criticisms that the stimulus has done little to stem the tide of job losses. It’s expected the U.S. unemployment rate could rise above 10% later this year.

“We still have a long way to go,” Mr. Obama acknowledged. “I’ll be honest with you – new hiring is always one of the last things to bounce back after a recession.”

With Congress now wavering on White House demands to pass a US$1-trillion-plus health care bill before the fall, Mr. Obama warned a failure to overhaul the system now will lead to ballooning costs and force millions of more Americans to lose their coverage over the next decade.

“If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket,” Mr. Obama said. “If we do not act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction.”

Answering Republican opponents who this week predicted the health care issue would be his “Waterloo,” Mr. Obama made a defiant prediction: “We will do it this year.” Read More EMR Stimulus Package

Mass. bill would offer tax breaks for e-prescribing

A bill pending in Massachusetts has a goal of pushing more electronic prescribing in a state already tops in such activity.

The bill, introduced by Rep. Peter J. Koutoujian, would provide tax incentives to any corporation with licensed physicians that invests in e-prescribing technology. That would include physician practices.

Under the provisions of the bill, deductions would be allowed for the cost of the technology itself, any needed infrastructure and associated labor costs of installing the systems.

The state has been urging physicians to switch to electronic prescribing as a way of curbing rising health care costs associated with paper-based medical systems.

Sonya Khan, research analyst for Koutoujian’s office, said a hearing on the bill was held on July 8 before the revenue committee, which will send its recommendations back to the house later this year.

According to SureScripts, the e-prescribing health information exchange, Massachusetts ranked first for the percentage of prescriptions sent electronically in 2008 with 20.5%. The next highest was neighboring Rhode Island, at 17.3%.

A growing number of physicians are looking into adopting e-prescribing systems now that Medicare is providing incentives for using of the technology. Those incentives will turn to penalties in 2012. Read More Electronic Prescription

Surescripts merger 1 year old as ARRA pushes e-Rx

This month marks the one-year anniversary of the merger of the two largest electronic-prescribing exchanges, SureScripts and RxHub, creating a market-dominant, privately held, for-profit company just in time for the federal government to all but mandate that physicians e-prescribe.

So, how is the merger going? The answer depends on who’s talking.

“The question you may be asking is, has the merger yielded any benefits and we’re happy to say, it absolutely has,” said Harry Totonis, CEO of the merged company, now called Surescripts.

Totonis only recently joined Surescripts—in April—after serving as head of adviser services at MasterCard, and previously working 14 years as a consultant with Booz Allen Hamilton, which works extensively in healthcare as well as for the federal government in defense and national security and intelligence programs.

“E-prescribing volume has just skyrocketed and we’ve handled that without adding a lot of new people,” Totonis said. “We’re processing twice as many transactions with relatively the same number of people. The efficiency we get is benefiting everyone.”

Justin Barnes is a vice president of Carrollton, Ga.-based Greenway Medical Technologies. In that post, he oversees corporate development, strategy, marketing and government affairs for the electronic health-record system vendor. Barnes also serves as chairman of the Electronic Health Record Association, a trade group for EHR vendors that is an arm of the Healthcare Information and Management Systems Society.

Vendors, Barnes said, while not hostile to Surescripts having such predominance, are “not completely comfortable” with the situation, either.

“It’s kind of pushed on us,” Barnes said. “When you have no competition, they may not want to listen to people. Competition breeds excellence at the end of the day. It always has and always will.”

The merger, which seems natural now, pooled the resources of two competing companies whose rival sponsors that either are themselves or have members that are still battling for market share in prescription drug sales. Both SureScripts and RxHub were formed in the aftermath of the 2000 bursting of the dot-com bubble that wiped out scads of e-prescribing startup companies. Read More Electronic Prescription

Obama sticks by healthcare IT in prime time plea for reform

President Barack Obama says the nation can use healthcare IT to dig itself out of the ever-increasing burden of escalating healthcare costs.

In his fourth prime time TV press conference Wednesday night, Obama said he would like to see a bill pushed through as early as this summer, but he won’t sign a bill that puts the majority of the burden on the backs of the middle class.

As Capitol Hill debates the merits of proposed healthcare reforms, the president has been lobbying for change, making almost daily speeches to educate the American public on what his reform plan would hold.

Obama and the Democrats have said two-thirds of the cost of the proposed healthcare overhaul would come from eliminating wasteful or fraudulent spending of taxpayer dollars. The remaining third is up for debate, with Obama recommending limiting tax deductions for the wealthiest Americans to match deductions available to middle class Americans. He said he is not sure if Congress will follow his advice, and the House is currently considering taxing Americans who jointly earn more than $1 million a year.

Obama’s speech and his answers to questions about healthcare reform emphasized that change must come, and it will involve the use of healthcare IT to eliminate duplicate testing, prevent medical errors, help monitor chronic care, encourage preventive care and help doctors know what care is most effective. Without these changes, he said, the nation will maintain a status quo that will bankrupt more families.

“Currently, 14 million Americans lose their health insurance every day,” Obama said. “This is about Americans who don’t have healthcare, and this is about every American who has ever worried about losing healthcare.” Read More EMR

Obama seeks to blunt criticism, highlights potential benefits of reform

President Barack Obama moved to stem growing criticism of his blueprint to overhaul the U.S. healthcare system, warning a national audience not to “become consumed in the game of politics” and underscoring the potential benefits everyday individuals could reap under a wholly reformed system.

In a news briefing that focused almost entirely on healthcare, the president tried to put the focus on the personal rather than the political.

“My hope is, and I’m confident that, when people look at the cost of doing nothing, they’re going to say, ‘We can make this happen. We’ve made big changes before that resulted in a better life for the American people,’” Obama said.

Over the past three weeks, Obama’s push to fundamentally change how care is provided and paid for has come under attack from a bloc of fiscally conservative Democrats, stalwart Republicans and both right- and left-leaning interest groups.

Longtime policy shapers have begun to tie the president’s upstart reform efforts to one that failed spectacularly in the early 1990s. Such comparisons could prove to be as damaging as any legislative setback or missed deadline.

The president reiterated a pledge not to support any new taxes that would hit the middle class. His steadfast opposition to a tax on health benefits has rankled some lawmakers who had hopes of using such a levy to help defray the expected $1 trillion overhaul price tag.

“If I see a proposal that is primarily funded through taxing middle-class families, I’m going to be opposed to it,” he said. But, he added that he’s open to other tax proposals now being hashed out by congressional leaders. More Here EMR Stimulus Package

Obama sticks by healthcare IT in prime time plea for reform

President Barack Obama says the nation can use healthcare IT to dig itself out of the ever-increasing burden of escalating healthcare costs.

In his fourth prime time TV press conference Wednesday night, Obama said he would like to see a bill pushed through as early as this summer, but he won’t sign a bill that puts the majority of the burden on the backs of the middle class.

As Capitol Hill debates the merits of proposed healthcare reforms, the president has been lobbying for change, making almost daily speeches to educate the American public on what his reform plan would hold.

Obama and the Democrats have said two-thirds of the cost of the proposed healthcare overhaul would come from eliminating wasteful or fraudulent spending of taxpayer dollars. The remaining third is up for debate, with Obama recommending limiting tax deductions for the wealthiest Americans to match deductions available to middle class Americans. He said he is not sure if Congress will follow his advice, and the House is currently considering taxing Americans who jointly earn more than $1 million a year.

Obama’s speech and his answers to questions about healthcare reform emphasized that change must come, and it will involve the use of healthcare IT to eliminate duplicate testing, prevent medical errors, help monitor chronic care, encourage preventive care and help doctors know what care is most effective. Without these changes, he said, the nation will maintain a status quo that will bankrupt more families. Read More EMR Stimulus Package

Industry Pushes Back on EHR ?Meaningful Use? Definition

When the government’s Health IT Policy Committee met a couple of weeks ago, some committee members suggested that a workgroup’s preliminary definition of “meaningful use” of electronic health records had gone too far. Now the official comments are in, and it’s clear that most of the healthcare industry agrees that the requirements in the workgroup’s first draft are overly aggressive. It will interesting to see what the committee comes up with when it reconvenes on July 16.

The “meaningful use” definition is of vital importance to the industry, because physicians and hospitals will have to show that they are using EHRs meaningfully in order to qualify for billions of dollars in government financial incentives. The committee wants to use its power to define the requirements to achieve certain policy objectives. But healthcare providers are concerned that they will be asked to do too much too soon. If the criteria to qualify for incentives in 2011, the first year of the reward program, are too stiff, not many providers will receive the maximum amount of government incentives.

In a letter to the Office of the National Coordinator For Health IT, Mark Leavitt, MD, and Alisa Ray, respectively chair and executive director of the Certification Commission for Health IT, succinctly summed up the problem:

“The lag between a decision to invest in EHR technology and its full, meaningful use in a provider organization is 1 to 2 years at best, and more typically, 3 to 5 years. For this reason, we believe most of the measures proposed for 2011 would be difficult to achieve by providers who have not already begun EHR implementations. Given current adoption levels, the incentives would only be available to a small percentage of providers, potentially provoking disillusionment and frustration with the ARRA incentive program.”

An AMA-led group of 81 medical specialty societies and state medical associations expressed a similar concern, noting that the committee’s timeline “is too aggressive, given that we continue to lack the necessary infrastructure, standards and systems.” Read More EMR

Ohio doctors slow to sign on to system that allows electronic authorization of prescriptions

Ohio doctors seem reluctant to give up their prescription pads, according to findings by Surescripts, the largest national prescription network.

The state lags far behind the nation’s leaders when it comes to sending prescriptions electronically over the network, which covers all major chain pharmacies, such as CVS and Walgreens, as well as 10,000 independent pharmacies.

In 2008, Ohio doctors electronically routed just 4.67 percent of prescriptions, Surescripts reports. Massachusetts tops the list for the second consecutive year with 20 percent — more than four times Ohio’s rate.

Electronic prescriptions, colloquially known as e-prescriptions, allow doctors to monitor and control treatment more efficiently. By getting rid of paper prescriptions and illegible handwriting, e-prescribing also reduces the risk of medical errors.

With the click of a mouse, doctors are able to pull up information about the patient’s insurance coverage when prescribing treatment. Easy access to comprehensive patient information allows doctors to prescribe alternative generic drugs to bring down the cost of medication, said Surescripts spokesman Rob Cronin.

The number of prescriptions routed electronically nationwide grew from 29 million in 2007 to 68 million in 2008, and the number of e-prescribers jumped 12 percent.

“One thing that gets the most focus with e-prescriptions is patient safety,” Cronin said. “The doctor can use software that provides them with a complete view of the patient’s medical history.”

Although the national rate of e-prescription use hovers at about 10 percent, John Halamka, an expert on e-prescriptions and chief information officer at Harvard Medical School, expects to see “rapid increases in e-prescribing volumes” next year, as use of electronic prescriptions will likely be a requirement for receiving stimulus money.

Barriers to adopting e-prescribing technology at hospitals and doctor’s offices include initial and long-term costs and confusion about competing product offerings, Halamka said. The cost to implement e-prescribing can range from $1,000 to $10,000 per physician in the first year and $250 to $3,000 in subsequent years. Read More Electronic Prescription

Stimulus will provide $220 million for health care training

TOPEKA | U.S. Labor Secretary Hilda Solis said Tuesday that $220 million in federal stimulus funds will be disbursed to programs across the country to train workers in health care and other high-growth industries.

Tuesday was the first day that training programs could begin applying for the money through the Labor Department. Solis unveiled the plan during a tour of the Shawnee County Community Health Care Clinic in Topeka and the University of Kansas Medical Center in Kansas City, Kan., saying health care services would be one of the fastest-growing career fields over the next decade as the population ages.

“We know there’s a shortage,” Solis said after touring the clinic.

She devoted much of her remarks to health care and President Barack Obama’s desire to push a health care reform bill through Congress this summer. She said such training grants were part of the equation, helping to provide an adequate work force to meet demands in rural states and areas seeing high unemployment.

Solis said $25 million of the funds would be reserved for training in communities hurt by the recent restructuring of the auto industry.

The stimulus money will go to public entities and private nonprofit groups that train workers in health information technology, nursing, long-term care and allied health careers. Read More EMR Stimulus Package

Who really profits from digital medical records?

Dave Michaels reported from Washington, and Jason Roberson from Dallas.

An unprecedented effort to computerize the nation’s hospitals and physician offices could be the key to reducing crippling health care costs – or a giveaway to technology vendors whose sales will be subsidized by taxpayers.

Computerizing the paper-based world of medicine was a significant component of this year’s $787 billion stimulus package, which reserved $45 billion for hospitals and physicians to adopt electronic health records.

The Obama administration argues that electronic records will allow doctors to coordinate care for the sickest patients, eliminate errors such as adverse drug reactions and avoid duplicate lab and imaging tests. Medical errors alone cost the country $37.6 billion each year, according to the Institute of Medicine.

Despite years of technology development, most hospitals and physician offices, including those in North Texas, can’t electronically share information or even record patient data.

Data sharing confronts age-old assumptions that providers, not patients, own health records, which are valuable assets that can be used to obtain grants and market hospitals. It requires the government to decide what kinds of systems will improve care and how providers should use the systems to achieve that.

‘Meaningful use’

Congress dubbed that exercise “meaningful use,” and the government is taking most of this year to set the standards. The exercise is being closely watched by North Texas hospitals, vendors and consultants such as Plano-based Perot Systems and Addison-based MedHost Inc.

Some observers are concerned that the stimulus investment could be a bonanza for software vendors if the rules for “meaningful use” are too rigid and simply tied to buying software.

“Meaningful use is the whole shooting match,” said Richard Kneipper, a lawyer who co-founded Dallas health care information technology firm PHNS Inc. “The guts of the discussion will be how fast do you go?”

The first draft of “meaningful use,” produced by a federal advisory panel, resembled an approach advocated by the Healthcare Information and Management Systems Society. The government’s draft, however, was more aggressive. Read More EMR

Fate of healthcare up to Senate moderates

Could it be a reprise of the stimulus on healthcare?

There are certainly hints that moderate US senators of both parties could determine the fate of President Obama’s agenda yet again.

Obama is holding separate private meetings this morning to discuss healthcare overhaul with Senators Olympia Snowe, a Maine Republican, and Ben Nelson, a Nebraska Democrat. They are among the senators being targeted by new TV ads, launched by Obama’s grassroots organization, that say “it’s time” for healthcare reform.

Nelson and Snowe’s fellow moderate senator from Maine, Susan Collins, played a key role in negotiations to win Senate approval in February for the $787 billion economic recovery package championed by Obama. The stimulus bill passed the House without a single Republican vote, and the administration’s horse-trading focused on satisfying Nelson and Collins, who pushed for a smaller package.

After meeting with Obama, Snowe said the president repeated his wish for Congress to pass a bill before its August recess. “He’s determined to have that happen,” she said on MSNBC.

But Snowe said it’s more important to get bipartisan consensus in the Senate Finance Committee, especially on how to pay for the bill. Supporting a Senate vote in September, she also said she wants to give ample time for all senators and the public to review the bill.

“This deserves a thoughtful process,” she said.

Asked about Senate Finance Chairman Max Baucus saying today that Obama had hindered his efforts to reach a bipartisan deal by opposing a tax on some employer-provided health insurance benefits to help pay for the deal, Snowe said it would be helpful if Obama endorsed a financing approach.

The panel is “working mightily” to find “offsets” and other savings to reduce the cost of the bill. “It’s all part of building a consensus,” she said. Read More EMR Stimulus Package

Ohio doctors slow to sign on to e-prescriptions

Ohio doctors seem reluctant to give up their prescription pads, according to findings by Surescripts, the largest national prescription network.

The state lags far behind the nation’s leaders when it comes to sending prescriptions electronically over the network, which covers all major chain pharmacies, such as CVS and Walgreens, as well as 10,000 independent pharmacies.

In 2008, Ohio doctors electronically routed just 4.67 percent of prescriptions, Surescripts reports. Massachusetts tops the list for the second consecutive year with 20 percent — more than four times Ohio’s rate.

Electronic prescriptions, colloquially known as e-prescriptions, allow doctors to monitor and control treatment more efficiently. By getting rid of paper prescriptions and illegible handwriting, e-prescribing also reduces the risk of medical errors.

With the click of a mouse, doctors are able to pull up information about the patient’s insurance coverage when prescribing treatment. Easy access to comprehensive patient information allows doctors to prescribe alternative generic drugs to bring down the cost of medication, said Surescripts spokesman Rob Cronin.

The number of prescriptions routed electronically nationwide grew from 29 million in 2007 to 68 million in 2008, and the number of e-prescribers jumped 12 percent.

“One thing that gets the most focus with e-prescriptions is patient safety,” Cronin said. “The doctor can use software that provides them with a complete view of the patient’s medical history.”

Although the national rate of e-prescription use hovers at about 10 percent, John Halamka, an expert on e-prescriptions and chief information officer at Harvard Medical School, expects to see “rapid increases in e-prescribing volumes” next year, as use of electronic prescriptions will likely be a requirement for receiving stimulus money. Read More Electronic Prescription