Nevada's federal stimulus-funded quest to switch to paperless health care records continues with a bill to authorize the project.

The Senate Health and Human Services Committee on Thursday combed through SB43, a bill creating a structure to implement a $6.1 million electronic health records grant from the American Recovery and Reinvestment Act.

Electronic health care records, a priority of President Barack Obama's administration, would allow doctors and hospitals to easily share records rather than storing large archives of paper documents. Officials say the digital format will allow electronic prescriptions, reduce human error arising from transferring the records or illegible handwriting, and reduce potentially costly and harmful duplication of tests.

Nevada officials also say transferring medical records to an electronic format will also bring jobs.

Nevada's federal stimulus-funded quest to switch to paperless health care records continues with a bill to authorize the project.

The Senate Health and Human Services Committee on Thursday combed through SB43, a bill creating a structure to implement a $6.1 million electronic health records grant from the American Recovery and Reinvestment Act.

Electronic health care records, a priority of President Barack Obama's administration, would allow doctors and hospitals to easily share records rather than storing large archives of paper documents. Officials say the digital format will allow electronic prescriptions, reduce human error arising from transferring the records or illegible handwriting, and reduce potentially costly and harmful duplication of tests.

Nevada officials also say transferring medical records to an electronic format will also bring jobs.

The following four EHRs have been approved for Meaningful Use:

ECareSoft eCS as an inpatient Complete EHR, by the Drummond Group;

 MacPractice MD 4.1 as an ambulatory Complete EHR, by the Certification Commission for Health Information Technology;

Meditech 6.0 Health Care Information System as an inpatient Complete EHR, by the Drummond Group; and

LSS Data Systems Client/Server Medical and Practice Management v5.6.4 as an ambulatory Complete EHR, by the Drummond Group.

Registration for the Medicare incentive program for meaningful use of electronic health records, as well as Medicaid MU programs in 11 states, started on January 3, 2011. Hospitals and eligible professionals soon registering and completing a 90-day reporting period under the Medicare program could attest meaningful use in April and receive incentive checks in May. Early Medicaid attestation under a much simpler method for demonstrating meaningful use could result in checks being cut in January or February.

From AHA...

ONC clarifies certified EHR meaningful use requirements 

Hospitals must "possess" electronic health record technology certified against all 24 meaningful use objectives, and "demonstrate" meaningful use of 19 objectives in order to qualify for Medicare and Medicaid incentive payments and avoid future payment penalties, the Office of the National Coordinator for Health Information Technology said today in updated guidance. To possess the technology, a hospital must have either the physical technology or a contract that provides "a legally enforceable right…to access and use" the technology at its discretion, ONC states. The degree to which a hospital implements the technology is not a factor in determining "possession." The guidance can be found in ONC FAQs 17 and 21, which revise previous ONC guidance in response to concerns from the AHA and others that requiring providers to implement EHRs certified against all 24 objectives would remove flexibility provided in the Centers for Medicare & Medicaid Services' final rule, delay hospitals' attempts to achieve meaningful use, increase costs and negatively impact competition in the vendor marketplace. "We are very pleased that ONC heard our concerns and has provided additional guidance on this question," said Chantal Worzala, director of policy at the AHA. "We will be carefully reviewing this complex new guidance in the coming weeks and monitoring how the market responds to determine if it can be operationalized."

CMS to publish meaningful use clarifications soon

By Mary Mosquera
Wednesday, October 20, 2010

The Centers for Medicare and Medicaid Services is about to publish a notice to correct inconsistencies in the meaningful use final rule, its top e-health official said, as well as guidance for providers on how to meet quality measures required by the health IT incentive program.

Both documents are now in the federal clearance process, the last step before publication, said Tony Trenkle, director of CMS’ Office of e-Health Standards and Services, at a meeting Oct. 20 of the Health IT Policy Committee.

CMS also has answered 106 frequently asked questions to date about meaningful use on its Web site, which the agency is revising to make it easier to sort. It is  also working with the Office of the National Coordinator to make a joint presentation of meaningful use information for the public.

Turning their attention to the future, committee members wrestled with how high to raise the incentive bar for the next stage of meaningful use.

The discussion revolved around whether changes in the second stage 2013 incentives should be incremental, building on first stage data collection requirements, or whether providers should be pushed to take bigger steps toward improving and tracking patient outcomes.

Dr. David Blumenthal, the national health IT coordinator, said that although the HITECH Act stipulates the time frame for meaningful use, the committee should not pull back its ambitions just to meet the deadline.

“I would encourage us not to curtail our ideals and vision simply because we are anxious about the time  frame or we may miss the opportunity to conceptualize a very important set of possibilities,” he said.

The committee favors establishing 2015’s stage 3 objectives and then working backward to the second stage measures in 2013, said Dr. Paul Tang, chairman of the meaningful use work group.

“We need to signal what we would like to have happen in stage 3 and then we can have stage 2 as a checkpoint on the way to stage 3, Tang 
said. “We have to remember that this is a program not about buying software but about measuring and improving outcomes for individual and population health,” he said.

Blumenthal said several key issues remain unfinished from stage 1 deliberations, including creating a technical infrastructure for health information exchange and the work of the Privacy and Security Tiger Team, whose job he described as “(protecting) information both at rest and in transit so the public has confidence and trust in the health systems’ ability to steward their health information capably.”

Latanya Sweeney, a committee member and director of the data privacy lab at Carnegie Mellon University, urged the committee to include privacy measures in future  meaningful use criteria because they were largely absent in the 2011 requirements.

“The fact that the meaningful use final rule has zero privacy measures and incentives is not good,” she said. “The idea of privacy not being part of the incentive structure and left to a regulatory hammer over someone’s head makes for a difficult regulation and loses the beautiful notion of meaningful use and incentives.”

While committee members are grappling with how to move forward, other changes are underway that overlap meaningful use policymaking. For instance, under the health reform law, HHS will develop a national quality strategy and models for accountable care organizations.

Meanwhile, providers are deploying Version 10 of the International Classification of Diseases (ICD-10) billing and diagnostic code, which will replace the current ICD-9 code set in 2012.

Trenkle said it was critical to make sure that all these activities do not “create a disconnect or inhibitors.” And Blumenthal said, “We can’t ignore the fact that we are part of a much larger enterprise.”

Feds to build 'data warehouse' of health claims

The U.S. Office of Personnel Management plans to create a national "health claims data warehouse," according to an announcement published in the Federal Register.

The database will be stocked with personally identifiable healthcare data, including individuals' names, addresses and Social Security numbers as well as a wealth of healthcare information such as diagnoses and treatments, providers involved and charges. The data will be gathered via daily regular feeds from health insurers that cover current federal employees and retirees, military personnel, postal workers and their families. It also will include data from participants in the national pre-existing-conditions insurance program and the multistate option plan created under the Patient Protection and Affordable Care Act, according to the announcement.

The data will be mined to "actively manage all three programs to ensure the best value for enrollees and taxpayers," according to the statement from the Office of Personnel Management.

Data also will be used by law enforcement agencies at the federal, state and local levels. Medical records information from the database also could be routinely disclosed "to researchers and analysts inside and outside the federal government for the purpose of conducting research on healthcare and health insurance trends and topical issues," according to the announcement. Public comments on the project are requested, but "this action will be effective without further notice on Nov. 15" unless "comments are received that would result in a contrary determination." — Joseph Conn / HITS staff writer

Providers

Complete EHRs for Eligible Providers (CCHIT)

1. ABEL Medical Software, Inc. for ABELMed EHR – EMR/PM, version 11
2. Allscripts, Allscripts Professional EHR, version 9.2
3. Aprima Medical Software, Inc. for Aprima, version 2011
4. athenahealth, Inc. for athenaclinicals, version 10.10
5. CureMD Corporation for CureMD EHR, version 10
6. The DocPatientNetwork.com for Doctations, version 2.0
7. Epic Systems Corporation for EpicCare Ambulatory – Core EMR, version Spring 2008
8. GE Healthcare for Centricity Advance, version 10.1
9. gloStream, Inc. for gloEMR, version 6.0
10. Intuitive Medical Software for UroChartEHR, version 4.0
11. MCS – Medical Communication Systems, Inc. for iPatientCare, version 4.0
12. Medical Informatics Engineering for WebChart EHR, version 5.1
13. meditab Software, Inc. for IMS, version 14.0
14. NeoDeck Software for NeoMed EHR, version 3.0
15. NextGen Healthcare for NextGen Ambulatory EHR, version 5.6
16. Nortec Software Inc for Nortec Ambulatory EHR, version 7.0
17. Pulse Systems for 2011 Pulse Complete EHR, version 2011
18. SuccessEHS for SuccessEHS, version 6.0

EHR Modules for Eligible Providers (CCHIT)

1. Allscripts for Allscripts Peak Practice, version 5.5
2. eClinicalWorks LLC for eClinicalWorks, version 8.0.48
3. NexTech Systems, Inc. for NexTech Practice 2011, version 9.7
4. nextEMR, LLC for nextEMR, LLC, version 1.5.0.0
5. Sammy Systems for SammyEHR, version 1.1.248
6. Universal EMR Solutions for Physician’s Solution, version 5.0
7. Vision Infonet Inc., for MDCare EMR, version 4.2
8. WellCentive for WellCentive Registry, version 2.0

Complete EHRs for Eligible Providers (Drummond)

1. ChartLogic, Inc for ChartLogic EMR 7, version not noted

EHR Modules for Eligible Providers (Drummond)

1. ifa united i-tech Inc. for ifa EMR, modules 170.302.A-J, 170.302.M, 170.302.O-V (specialized to ophthalmology)
2. QRS INC. for PARADIGM, version 8.3, modules 170.302.A-W, 170.304.A,  170.304.C-J

Hospitals

Complete EHRs for Hospitals (CCHIT)

1. Epic Systems Corporation for EpicCare Inpatient – Core EMR, version Spring 2008

EHR Modules for Hospitals (CCHIT)

1. Allscripts for Allscripts ED, version 6.3
2. Health Care Systems, Inc. for HCS eMR, version 4.0
3. PeriGen for PeriBirth, version 4.3.50
4. Prognosis Health Information Systems for ChartAccess, version 4
5. T-System Technologies for T-SystemEV, version 2.7
6. Wellsoft Corporation for WellsoftEDS, version 11

From Modern Healthcare

Moving on to Stage 2 of meaningful use

Just as the starting gun is about to fire for hospitals seeking to meet Stage 1 criteria for the meaningful use of electronic health records in the first payment year of the stimulus law's health information technology subsidy program, healthcare policy advisers to the federal government are talking about time frames for ratcheting up criteria for Stage 2.During a meeting this week of the federally chartered Health IT Policy Committee, George Hripcsak, co-chairman of a special work group on the meaningful-use criteria, went over a proposed schedule for developing the second round of standards providers must meet to get paid for effectively using an EHR system. The first "payment year" begins Oct. 1 for hospitals and Jan. 1, 2011, for eligible office-based physicians

— Joseph Conn / HITS staff writer

Are You Ready?

From Information Week

EHR revenue to hit $3 billion in 2013

A study by Frost & Sullivan predicts that revenue for the U.S. ambulatory electronic health record market will double from $1.3 billion in 2009 to an estimated $2.6 billion in 2012. Further, by 2013, the market will reach its peak, posting revenue of $3 billion. However, by 2016 market saturation will have occurred and revenue is expected to fall to $1.4 billion. 

EHR revenue to hit $3 billion in 2013

A study by Frost & Sullivan predicts that revenue for the U.S. ambulatory electronic health record market will double from $1.3 billion in 2009 to an estimated $2.6 billion in 2012. Further, by 2013, the market will reach its peak, posting revenue of $3 billion. However, by 2016 market saturation will have occurred and revenue is expected to fall to $1.4 billion.