A resource for sharing information and ideas intended to assist New Jersey (and non-NJ) physicians and their practices with using Health Information Technology (HIT) tools to achieve Ambulatory Care Excellence. Included are: adopting Electronic Health Records (EHRs), connecting to Health Information Exchanges (HIEs), achieving Meaningful Use (MU) for Eligible Professionals, and other relevant topics.
The June 28, 2011 Healthcare IT News article, "Mostashari to providers: MU is not about 'hoop jumping'", reports on the speech given by Farzad Mostashari, MD, the National Coordinator for Health IT, at the National Health IT and Delivery System Transformation Summit in Washington, DC. Dr. Mostashari made an "eloquent and persuasive case for how meaningful use is not just an arbitrary set of requirements the government is asking of providers in exchange for incentives". He said: “Look at meaningful use not as a distraction or a bureaucratic list of hoops to jump through. Meaningful use is the best-we-could-make-it roadmap to prepare for delivery of higher quality care and mitigating some of the costs toward getting there,” he said. “If it’s a distraction we need to change it and I want to hear from you personally.” Dr. Mostashari explained how “the sum total of meaningful use” is to provide what is needed to make sure fewer people die prematurely for things that could have been prevented.
The HITECH Act established programs under Medicare and Medicaid to provide incentive payments for the “meaningful use” of certified EHR technology. The Medicare and Medicaid EHR Incentive Programs provide incentive payments to Eligible Professionals (EPs) as they demonstrate adoption, implementation, upgrading or meaningful use of certified EHR technology. The programs began in 2011. These incentive programs are designed to support providers in this period of health IT transition and instill the use of EHRs in meaningful ways to help the United States to improve the quality, safety and efficiency of patient health care.
For more detailed information on EHR Incentives & Certification see the following on the HealthIT.gov web site:
If you have not already started, now is the time for you to begin your journey of becoming a meaningful user of EHRs. If you have already started on this all-important journey, persistence and patience will be your biggest allies for achieving success.
“Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy and save lives.”
- President Obama, Address to Joint Session of Congress, February 2009
As promised by the President, the American Recovery and Reinvestment Act of 2009 included under which, according to current estimates, as much as $27 billion over ten years will be expended to support adoption of electronic health records (EHRs). This is the first substantial commitment of federal resources to support adoption and help providers identify the key functions that will support improved care delivery.
Under the Health Information Technology for Economic and Clinical Health Act (HITECH), federal incentive payments will be available to doctors and hospitals when they adopt EHRs and demonstrate use in ways that can improve quality, safety and effectiveness of care. Eligible professionals can receive as much as $44,000 over a five-year period through Medicare. For Medicaid, eligible professionals can receive as much as $63,750 over six years. Medicaid providers can receive their first year’s incentive payment for adopting, implementing and upgrading certified EHR technology but must demonstrate meaningful use in subsequent years in order to qualify for additional payments.
Since enactment of HITECH in February 2009, the Office of the National Coordinator for Health Information Technology (ONC), the Centers for Medicare & Medicaid Services (CMS) and other HHS agencies laid the groundwork for the massive national investment in EHRs:
Created Regional Extension Centers (RECs) to support providers in adopting EHRs
Developed workforce training programs
Identified “Beacon Communities” that lead the way in adoption and use of EHRs
Developed capabilities for information exchange, including building toward a Nationwide Health Information Network
Improved privacy and security provisions of federal law, to bolster protection for electronic records
Created a process to certify EHR technology, so providers can be assured that the EHR technology they acquire will perform as needed
Identified standards for certification of products, tied to “meaningful use” of EHRs
Identified the “meaningful use” objectives that providers must demonstrate to qualify for incentive payments.
Supported State Medicaid Agencies in the planning and development of their Medicaid EHR Incentive programs with 90/10 matching funds.
Electronic Health Records improve care by enabling functions that paper records cannot deliver:
EHRs can make a patient’s health information available when and where it is needed – it is not locked away in one office or another.
EHRs can bring a patient’s total health information together in one place, and always be current – clinicians need not worry about not knowing the drugs or treatments prescribed by another provider, so care is better coordinated.
EHRs can support better follow-up information for patients – for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided; and reminders for other follow-up care can be sent easily or even automatically to the patient.
EHRs can improve patient and provider convenience – patients can have their prescriptions ordered and ready even before they leave the provider’s office, and insurance claims can be filed immediately from the provider’s office.
EHRs can link information with patient computers to point to additional resources – patients can be more informed and involved as EHRs are used to help identify additional web resources.
EHRs don’t just “contain” or transmit information, they also compute with it – for example, a qualified EHR will not merely contain a record of a patient’s medications or allergies, it will also automatically check for problems whenever a new medication is prescribed and alert the clinician to potential conflicts.
EHRs can improve safety through their capacity to bring all of a patient’s information together and automatically identify potential safety issues -- providing “decision support” capability to assist clinicians.
EHRs can deliver more information in more directions, while reducing “paperwork” time for providers –for example, EHRs can be programmed for easy or automatic delivery of information that needs to be shared with public health agencies or quality measurement, saving clinician time.
EHRs can improve privacy and security – with proper training and effective policies, electronic records can be more secure than paper.
EHRs can reduce costs through reduced paperwork, improved safety, reduced duplication of testing, and most of all improved health through the delivery of more effective health care.
Why “meaningful use” requirements?
EHRs do not achieve these benefits merely by transferring information from paper form into digital form. EHRs can only deliver their benefits when the information and the EHR are standardized and “structured” in uniform ways, just as ATMs depend on uniformly structured data. Therefore, the “meaningful use” approach requires identification of standards for EHR systems. These are contained in the ONC Standards and Certification regulation announced on July 13, 2010.
Similarly, EHRs cannot achieve their full potential if providers don’t use the functions that deliver the most benefit – for example, exchanging information, and entering orders through the computer so that the “decision support” functions and other automated processes are activated. Therefore, the “meaningful use” approach requires that providers meet specified objectives in the use of EHRs, in order to qualify for the incentive payments. For example: basic information needs to be entered into the qualified EHR so that it exists in the “structured” format; information exchange needs to begin; security checks need to be routinely made; and medical orders need to be made using Computerized Provider Order Entry (CPOE). These requirements begin at lower levels in the first stage of meaningful use, and are expected to be phased in over five years. Some requirements are “core” needs, but providers are also given some choice in meeting additional criteria from a “menu set.”
Identification of the “meaningful use” goals and standards is the keystone to successful national adoption of EHRs. The announcement of final “meaningful use” regulations on July 13, 2010, marks the launch of the Nation’s push for EHR adoption and use.
The American Recovery and Reinvestment Act (ARRA) of 2009, the economic stimulus package, was signed into law by President Barack Obama on February 17, 2009. The Health Information Technology for Economic and Clinical Health (HITECH) Act, which is an integral part of ARRA 2009, promotes the adoption and meaningful use of Health Information Technology (HIT).
The Office of the National Coordinator for Health Information Technology (ONC) spearheads the federal government's HIT efforts and is a resource to the entire health system to support the adoption of HIT and the promotion of nationwide Health Information Exchange (HIE) to improve health care. ONC reports into the Office of the Secretary for the U.S. Department of Health and Human Services (HHS). The position of National Coordinator was created in 2004, through an Executive Order, and legislatively mandated in the HITECH Act of 2009.
The HITECH Act authorizes a HIT Extension Program. This program consists of a national HIT Research Center (HITRC) and HIT Regional Extension Centers (RECs). The HITRC will gather information on effective practices and help the RECs work with one another and with relevant stakeholders to identify and share best practices in EHR adoption, meaningful use, and provider support. The RECs will support and serve health care providers to help them quickly become adept and meaningful users of electronic health records (EHRs). RECs are designed to make sure that primary care clinicians get the help they need to use EHRs.
ONC has funded 62 RECs (pronounced R-E-Cs) to help more than 100,000 primary care providers meaningfully use EHRs. Eligible Providers who adopt and meaningfully use EHRs may receive incentive payments through the Medicare and Medicaid EHR Incentive Programs. Providers do not have to become technology experts to achieve meaningful use of EHRs; RECs will provide them with on-the-ground assistance. REC services include:
Outreach and education
EHR support (e.g., working with vendors, helping choose a certified EHR system)
Technical assistance in implementing health IT and using it in a meaningful way to improve care.
RECs represent a range of organizations that serve local communities throughout the country. The RECs’ focus is to provide on-the-ground assistance for:
Individual and small practices, including primary care providers, physicians, physician assistants, and nurse practitioners
Medical practices lacking resources to implement and maintain EHRs
Those who provide primary care services in public and critical access hospitals, community health centers, and other settings that mostly serve those who lack adequate coverage or medical care
If you need assistance and/or some guidance for implementing an EHR, qualifying for Meaningful Use, and/or connecting to an HIE, you should consider contacting the REC that serves your local community. Click the following links to locate the REC in your local community:
The Electronic Health Record (EHR) is a tool and Health Information Exchanges (HIE) are services which can be effectively combined and used in a meaningful way to assist physcians and their practices to achieve ambulatory care excellence. The EHR Journey involves a lot of hard work on the part of every member of a physician practice and requires buy-in by everyone. Technology plays an important role in the EHR Journey, but this journey is mainly involved with creating a cultural shift in the way a practice operates. This cultural shift is the enabler in the practice for reaching its goals of delivering the highest quality patient care.
To start the EHR Journey, the following brief documents should be read and digested:
The small physician practices (1-10 physicians) face the bigger challenges for EHR implementation since they typically have fewer resources at their disposal than the larger practices. The following documents will help the small practices gain an understanding what needs to be done to succeed in their EHR Journey:
For starters, there are a set of "General Interest Links" and "News & Magazine Links" in the right-hand column. It is difficult to know where to start with this blog since the anticipated audience will most likely range from novice to expert. So, your feedback is most appreciated to let me know the EHR/HIE topics that are relevant to your situation and the specific information that is of interest to you. I look forward to adding value and making a difference in these very exciting times of Electronic Health Record (EHR) adoption and implementation in the hope that we will eventually achieve Ambulatory Care Excellence throughout the United States.
One must look at the EHR as a foundational tool that will provide some benefit at the outset. The more the EHR is used, the more useful it will become. The greatest benefits will be realized when physicians can gain access to patient information from all points of care and share the successes and learning experiences of treatment. All of this needs to be accomplished in a most secure and private environment. The great concern for security and privacy was rampant when the financial services industry initially transformed from a paper to an online environment. Today, we rarely give this any thought since we have become comfortable with the protection of our personal financial information. Our hope is that we will soon be as comfortable with the security and privacy of our personal health information as we are of our personal financial information.
I look forward to your feedback and to helping in this exciting and very worthwhile EHR/HIE journey! Let us all do our parts in making today and every day a great day!!