Tag: Meaningful Use Stage 2

HIT Newser: A Setback for MyMedicalRecords

Jan 12, 2015• 2

By MICHELLE RONAN NOTEBOOM

There’s No Place Like Epic’s Home

Epic reveals plans for a fifth campus, which is slated to include half a million square feet of office space and pay homage to literary classics like “Charlie and the Chocolate Factory” and “The Wizard of Oz.”

A Setback for MyMedicalRecords

A US District Court rules against MyMedicalRecords in its patent case against Walgreens, Quest Diagnostics, and others. MyMedicalRecords, a company that many label a patent troll, contends its patents covered a method of providing online PHRs in a private, secure way. However, a judge ruled that “the concept of secure record access and management, in the context of personal health records or not, is an age-old idea,” and is therefore abstract.

Despite the setback, I doubt MyMedicalRecords will stop demanding organizations to pay up or risk facing a lawsuit. I predict they’ll make some tweaks to their business plan, such as focusing only on organizations with not-quite-so-deep pockets that are willing to settle without a fight.

What Has $564 million Bought Us?

Sens. Lamar Alexander (R-TN), Richard Burr (R-NC), and Mike Enzi (R-WY) ask the General Accounting Office to review the ONC-funded health information exchanges to determine what exactly the exchanges created with the government’s $564 million in grant money.

It’s a valid concern, given the significant number of providers and regions still lacking electronic exchange capabilities and the millions that have been spent.

Physicians Reject Stage 2 Attestation

Fifty-five percent of physicians say they won’t attest for Stage 2 MU in 2015, according to a SERMO survey of about 2,000 physicians. Respondents cite several reasons for not attesting including financial concerns, difficulty engaging older patients, and lack of software usability.

Given the lackluster Stage 2 attestation numbers so far, the findings are not particularly surprising. It will be interesting to see what CMS and ONC intend to do in the face of the overwhelming evidence that many providers simply don’t think it is worth the effort.

On To Stage 3

The Office of Management and Budget is currently reviewing the proposed Stage 3 MU rules and will likely publish them in February. CMS states that Stage 3 will include changes to the reporting period, timelines, and structure of the program, including a single definition of Meaningful Use. CMS also adds that “these changes will provide a flexible, yet clearer, framework to ensure future sustainability of the EHR program and reduce confusion from multiple stage requirements.”

Can’t wait to see what is included. And, I can’t help but be a little amused that it’s been six years since the passage of the HITECH legislation and we are just now getting a definition for “Meaningful Use.”

Show Me the Money

Allina Health and Health Catalyst sign a $100 million definitive agreement to combine technologies, clinical content, and front-line personnel.

Rush University Medical Center will implement Merge Healthcare’s cardiology PACS.

Healthcare operating system platform provider Par80 closes $10.5 million in Series A funding led by Atlas Ventures, Founder Collective, and CHV Capital.

Health analytics provider Apervita, formerly knowns as Pervasive Health, completes an $18 million Series A round of funding led by GE Ventures and Baird Capital.

Teledermatology provider PocketDerm raises $2.85 million from an undisclosed investor.

Caremerge, developers of a care coordination platform, raises $4 million in a second round of funding. Investors include Cambia Health Solutions, GE Ventures, Arsenal Health, and Ziegler-LinkAge Longevity Fund.

HIT Newser: The Doctor Will Facetime You Now

Dec 14, 2014• 5

By MICHELLE RONAN NOTEBOOM

ONC Plans for the Future

The ONC releases an updated five-year strategic plan that stresses interoperability, patient engagement, and the expansion of IT across the care continuum. The document updates the previous strategic plan released in 2011that focused heavily on the Meaningful Use program. Maybe the ONC is not quite dead yet after all.

McKesson Ventures Into Startups

McKesson announces the creation of McKesson Ventures, a venture capital fund that will invest in early-stage and growth-stage healthcare companies attacking healthcare business challenges. Tom Rodgers, who was most recently with Cambia Health, was named managing director of the fund’s investment portfolio.

Stage 2 Attestations Still Lagging

Fewer than four percent of eligible physicians and 35 of hospitals have attested to Stage 2 Meaningful Use, according to the newly released numbers from CMS. The AMA, CHIME, HIMSS and MGMA quickly reiterated the call to shorten the reporting period for 2015 to 90 days. As of November, 2014 CMS has paid $16.6 billion in EHR incentives since the program’s inception.Continue reading…

RIP Meaningful Use Born 2009 – Died 2014???

Nov 26, 2014• 17

BOB WACHTER, MD

The policy known as Meaningful Use was designed to ensure that clinicians and hospitals actually used the computers they bought with the help of government subsidies. In the last few months, though, it has become clear that the policy is failing. Moreover, the federal office that administers it is losing leaders faster than American Idol is losing viewers.

Because I believe that Meaningful Use is now doing more harm than good, I see these events as positive developments. To understand why, we need to review the history of federal health IT policy, including the historical accident that gave birth to Meaningful Use.

I date the start of the modern era of health IT to January 20, 2004 when, in his State of the Union address, President George W. Bush made it a national goal to wire the U.S. healthcare system. A few months later, he created the Office of the National Coordinator for Health Information Technology (ONC), and gave it a budget of $42 million to get the ball rolling.

Sometimes the Best Choice is the Simplest One

Sep 5, 2014• 1

By NICK VAN TERHEYDEN

CMS recently announced another change to health IT policy in order to offer healthcare providers greater flexibility. But what will the unintended consequences of this latest change be?

Over the Labor Day weekend, CMS announced that the Meaningful Use Stage 2 deadline will be extended through 2016 in order to offer more options and greater flexibility to providers for the certified use of EHRs. In the interest of full disclosure, I found the timing to be strange— a rule published over a holiday weekend seems an odd choice, particularly when it is being touted as a benefit to the industry and the impact on healthcare provider organizations and clinicians, alike, is monumental.

Unfortunately, I think the additional flexibility allotted by this rule is the latest example of the unintended consequences of health IT regulations. In an effort to make things easier and give healthcare providers more leeway, they have, in fact, made the situation unnecessarily more complex.

Agility is not healthcare’s strong suit

It seems at this point, too many options, or waffling between them (for instance the new ICD-10 transition deadline), can be more crippling than stringent regulations, particularly when there is so much on the line. Healthcare organizations don’t have the wherewithal to vacillate with implementations; they are wrestling with string-tight budgets and constantly shifting rules require large cultural and behavioral changes. As a result, as Dr. John Halamka noted, health IT agendas are being constantly hijacked by regulatory changes, such as Meaningful Use and ICD-10.

It now seems that hospital administrative teams and physicians again must endure constantly shifting rules that they’ve been coping with for years under Meaningful Use. As Dr. Ben Kanter, former CMIO of Palomar Health, so astutely noted “A computer system is a tool, just as a scalpel is a tool. What if a surgeon’s scalpel changed every few weeks? How is it possible to deliver good care if the primary tool you are using keeps changing on an irregular basis?”Continue reading…

The Case For Payers to Oppose Meaningful Use

Aug 13, 2014• 12

By NICHOLAS ORLOWSKI

The Meaningful Use program is at a critical inflection point. On one hand, the payers could jump on the MU bandwagon, follow Medicare’s example and demand provider MU attestation.

On the other hand, they could throw private practice a bone and help them weather the storm until MU goes away or loses its teeth. Let me explain.

Payers could take the easy money and penalize according to the upcoming ACA “adjustment” schedule. Lots of people think this is inevitable. This would certainly provide an easy way to increase payer revenue and is as simple as letting the practices [continue] to do all the work.

However, this would be incredibly short-sighted.

Meaningful use, as things stand in 2014, has not been shown to improve patient care. Indeed, it is common for Stage 1 attesting MDs to abandon the program during Stage 2, with many doctors citing lack of efficacy of the program. Stage 3 MU is projected to have even worse results.

What this tells me is that the stress and time-cost of MDs and their staff is not worth the benefits of Meaningful Use. Don’t get me wrong – there are some great things in the MU guidelines, and we are implementing them in the software we create, but they are overshadowed by the onerous, less-effective 5% and it’s all or nothing. There is no MU wiggle-room. These days you have to have real grit and determination to stay in private practice, no matter your specialty.

Without financial support or legislative reform, Meaningful Use will eventually drive independent doctors out of business.

That’s bad news for payers.

The Case for Dropping MU Stages 2 and 3

May 17, 2014• 31

By DALE SANDERS

Physicians are lining up against Meaningful Use.

In a detailed letter sent this week to CMS Administrator Marilyn Tavenner and National Coordinator Karen DeSalvo, MD, the American Medical Association presented a long list of ideas to make Meaningful Use better for doctors.

The AMA warned that “unless significant changes are made to the current program and future stages,” doctors will drop out of the meaningful use program, patients will suffer as existing EHRs fail to migrate data for coordinated care, thousands of doctors will incur financial penalties, and new delivery models requiring data will be jeopardized.”

All of which is true. But the AMA didn’t go far enough.

Meaningful use is well intentioned, but like a teacher who “teaches to the test,” the program has created a byzantine system that might pass the test of meaningful use stages, but is not producing meaningful results for patients and clinicians.

A formal study published in the April 2014 issue of JAMA Internal Medicine reveals there’s no correlation between quality of care and meaningful use adherence. This study validates what common sense has told many of us for the last few years.

Meaningful Use Stage 1 was a jump-start for EMR adoption in the industry. That’s a good thing, I suppose, although meaningful use also created a false economic demand for mediocre products. It’s time to put an end to the federal meaningful use program, eliminate the costly administrative overhead of meaningful use, remove the government subsidies that also create perverse incentives, and let “survival of the fittest” play a bigger part in the process.

Let the fruits of EMR utilization go to the organizations that commit, on their own and without government incentives, to maximizing the value of their EMR investments toward quality improvement, cost reduction, and clinical efficiency.

An Unfunded Mandate For Behavioral Health

May 13, 2014

By EDMUND BILLINGS, MD

Why politics, parity and performance requirements mean behavioral health hospitals should adopt now.

Imagine you go to work one day and your boss says all employees will be evaluated based on the performance of a new set of job skills that require additional training and, perhaps, new computer hardware and software. The boss also announces that some employees will be reimbursed for the cost of acquiring these skills and tools. You aren’t among this privileged group.

In government, this is called an unfunded mandate. The unlucky employee in this case is psychiatric hospitals, who aren’t eligible for Meaningful Use incentives even while Congress and the Obama administration have legislated greater accountability:

A precursor to the 2010 Affordable Care Act (ACA), the Mental Health Parity and Addiction Equity Act of 2008 mandated that insurers must make the financial cost of benefits—co-pays, deductibles, out-of-pocket maximums—equal for psychiatric and physical care.

By making behavioral health an Essential Health Benefit, the ACA requires health plans to cover mental health on par with other types of care.

On October 1, 2012, CMS launched the Inpatient Psychiatric Facility Quality Reporting Program (IPFQR), a pay-for-reporting program in which facilities could lose federal dollars by not providing data on Hospital Based Inpatient Psychiatric Services (HBIPS):

Screening for violence risk, psycho trauma Hx, patient strengths
Hours of physical restraint use
Hours of seclusion use
Patients discharged on multiple antipsychotic medications
Patients discharged on multiple antipsychotic medications with appropriate justification
Post discharge continuing care plan created
Post discharge continuing care plan transmitted to next level of care provider upon discharge

Whether explicit or implicit, these programs amount to unfunded EHR mandates. How so?

Organizations still on paper records will find it expensive and inefficient to capture events and collect results for both reporting to government and submitting claims to insurance companies. Hospitals will need to train clinicians to document post-discharge continuity of care plans.

They will have to train staff to send plans by snail mail or fax to the provider at the next level. Then they will also need to do chart reviews to assure that all these steps took place and the data is recorded in a spreadsheet or database. Any quality improvement process that requires benchmarking and scoreboarding of performance based on these measures will be a tremendous challenge using paper records.

Congratulations, Doctor, On Your Federally-Subsidized “Hardship”

Mar 13, 2014• 32

By Dan Haley

At HIMSS 2014, the health information technology’s (HIT) largest annual confab, the bestest-best news we heard from a policy perspective, and maybe even an industry perspective, was the Centers for Medicare & Medicaid Services’ (CMS) dual announcement that there will be no further delays for either Meaningful Use Stage 2 (MU-2) or ICD-10.

Perhaps we should have immediately directed our gaze skyward in search of the second shoe preparing to drop.

As it turns out, CMS de facto back-doored an MU-2 delay by issuing broad “hardship” exemptions from scheduled MU-2 penalties. To wit: any provider whose health IT vendor is unprepared to meet MU-2 deadlines, established lo these many months ago, is eligible for a “hardship” exemption.

Few would disagree with the notion that it’s unproductive to criticize policy without offering constructive ideas to fix the underlying problems.

Here, the underlying problem is easy to define: it is in point of irrefutable fact fundamentally unfair to penalize care providers for their vendors’ failings—especially when the very government proposing to penalize them put its seal of approval on the vendors’ foreheads to begin with.

CMS’s move to exempt providers from those penalties is correctly motivated, but it seeks to ease the provider pain without addressing its cause.

Instead of issuing a blanket exemption for use of unprepared vendors, CMS should:

Waive penalties only for those providers who take steps to replace their inferior technologies with systems that can meet the demands of the 21^st century’s information economy;
Publish lists of health IT vendors whose systems are the basis for a hardship exemption, along with an accounting of how many of those 21 billion dollars have been paid to subsidize those vendors’ products; and
Immediately initiate a reevaluation of the MU certification of any vendor whose products form the basis for a hardship exemption.

This proposal might seem bold, but if we’re truly looking to advance health care through the application and use of EHR, then what I’ve outlined above simply represents necessary and sound public policy. Current practice rewards vendors whose products are falling short by perpetuating subsidies for those products.

The federal government should stop paying doctors to implement health IT that cannot meet the standards of the program under which the payments are issued. That’s just a no-brainer.

An EHR should not be a federally-subsidized “hardship.”

What A Green Three Ring Binder Says About the State of Meaningful Use and Health Information Exchange

Feb 24, 2014• 5

By Rob Cronin

The photo says it all.

The green notebook and pen represent the latest and greatest health IT innovations used by the hospital nurse to record my wife’s health information in the hours before her surgery to re-attach a fully torn Achilles tendon.

(Apologies for the cheeky intro and to my wife and anyone else for any HIPAA violations I may have committed in the capturing of this image).

It’s not that the hospital does not have an electronic health record.

They do – from a vendor widely considered a leader in the industry: Meditech. Same goes with the physician practice where she receives all her care and where her surgeon and primary care doctor are based.

They too have an EHR from another leading vendor: NextGen.

The problem? These systems are not connected. Thus, confirming the not so surprising news that health data interoperability has yet to make its debut in our corner of the NYC burbs.

Fortunately for my wife, she is well on her way to recovery (a bit more reluctant to juggle a soccer ball with her son in airport passenger lounges, but nevertheless feeling much better…and mobile). By everyone’s estimation – hers, mine, friends who suffered the same injury and friends who happen to be doctors – she received high quality care.

What’s more, we feel the overall patient experience at our physician practice and the hospital was quite good. That said, I cannot help but ask myself a series of ‘what ifs?’

What if…we forgot to mention a medication she was taking and there was a bad reaction with medication they administered as part of the surgery or afterwards?

What if… the anesthesiologist or surgeon couldn’t read the nurse’s handwriting?

What if the next time we go to the hospital, it is a visit to the emergency room and the attending clinicians have no ability to pull any of my family’s health records and we are not exactly thinking clearly enough to recall details related to medical history?