CHIME Statement on Finalization of Meaningful Use ‘Modifications’ Rule

From Russell P. Branzell, FCHIME, CHCIO, President and CEO

This afternoon the Centers for Medicaid and Medicare Services (CMS) and the Office of the National Coordinator for Health IT (ONC) finalized a regulation granting providers additional flexibility in meeting Meaningful Use (MU) requirements in 2014. However, the final rule lacked a key provision that would ensure continued EHR adoption and MU participation

CHIME is deeply disappointed in the decision made by CMS and ONC to require 365-days of EHR reporting in 2015. This single provision has severely muted the positive impacts of this final rule. Further, it has all but ensured that industry struggles will continue well beyond 2014.

Roughly 50% of EHs and CAHs were scheduled to meet Stage 2 requirements this year and nearly 85% of EHs and CAHs will be required to meet Stage 2 requirements in 2015. Most hospitals who take advantage of new pathways made possible through this final rule will not be in a position to meet Stage 2 requirements beginning October 1, 2014. This means that penalties avoided in 2014 will come in 2015, and millions of dollars will be lost due to misguided government timelines.

Nearly every stakeholder group echoed recommendations made by CHIME to give providers the option of reporting any three-month quarter EHR reporting period in 2015. This sensible recommendation, if taken, would have assuaged industry concerns over the pace and trajectory of rulemaking; it would have pushed providers to meet a higher bar, without pushing them off the cliff; and it would have ensured the long-term vitality of the program itself. Now, the very future of Meaningful Use is in question.

Posted in ARRA, Certified EHR, EHR, Electronic Health Record, Electronic Medical Record, EMR, Healthcare IT, Meaningful Use, Meaningful Use Stage 2 | Tagged , , , , , , , , , | Comments Off

New CMS rule allows flexibility in certified EHR technology for 2014

Rule will help more providers use electronic health record technology

The Department of Health and Human Services (HHS) published a final rule today that allows health care providers more flexibility in how they use certified electronic health record (EHR) technology (CEHRT) to meet meaningful use for an EHR Incentive Program reporting period for 2014. By providing this flexibility, more providers will be able to participate and meet important meaningful use objectives like drug interaction and drug allergy checks, providing clinical summaries to patients, electronic prescribing, reporting on key public health data and reporting on quality measures.

“We listened to stakeholder feedback and provided CEHRT flexibility for 2014 to help ensure providers can continue to participate in the EHR Incentive Programs forward,” said Marilyn Tavenner, CMS administrator. “We were excited to see that there is overwhelming support for this change.”

Based on public comments and feedback from stakeholders, the Centers for Medicare & Medicaid Services (CMS) identified ways to help eligible professionals, eligible hospitals, and critical access hospitals (CAHs) implement and meaningfully use Certified EHR Technology. Specifically, eligible providers can use the 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for an EHR reporting period in 2014 for the Medicare and Medicaid EHR Incentive Programs; All eligible professionals, eligible hospitals, and CAHs are required to use the 2014 Edition CEHRT in 2015.

These updates to the EHR Incentive Programs support HHS’ commitment to implementing an effective health information technology infrastructure that elevates patient-centered care, improves health outcomes, and supports the providers that care for patients.

The rule also finalizes the extension of Stage 2 through 2016 for certain providers and announces the Stage 3 timeline, which will begin in 2017 for providers who first became meaningful EHR users in 2011 or 2012.

An updated meaningful use timeline and a chart with 2011 and 2014 CEHRT Edition options are available at http://cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-08-29.html.

For more information about the EHR Incentive Programs, please visithttp://www.cms.gov/EHRIncentivePrograms. For more information about CEHRT, please visit http://www.healthit.gov/certification.

Posted in Certified EHR, EHR, Electronic Health Record, Electronic Medical Record, EMR, Healthcare, Healthcare IT, Meaningful Use, Meaningful Use Stage 2 | Tagged , , , , , , | Comments Off

CMS Issues Final Rule on EHR Certification Flexibility, MU Stage 2 Extension, and MU Stage 3 Timeline

I can’t figure out what government process leads to final rules being regularly published at the end of the day on Friday. I know that Neil Versel from Meaningful Health IT News has hypothesized that they release it late on Friday when they want to bury the news. Maybe that’s the case, but the EHR certification flexibility doesn’t seem like something they’d want to bury. Regardless of the odd timing, CMS has just published the final rule that provides flexibility around EHR certification in the meaningful use program.

In their announcement, I’m not noticing any changes from what was in the proposed rule, but with some time we’ll know for sure if there’s any gotchas hidden in the final rule. No doubt many a meaningful use expert have just had their Labor Day weekend ruined by the announcement of this final rule.

Unfortunately, after the proposed rule was published most people loved the flexibility, but decided that it was too late for them to really benefit from the changes. I’ll be interested to see how many organizations will really benefit from these changes.

More importantly, the rule still includes the nebulous asterisk, “Only providers that could not fully implement 2014 Edition CEHRT for the EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability.” For EHR vendors that are already 2014 certified, this little asterisk feels like ONC is letting all the EHR vendors who didn’t perform well off the hook. It’s basically rewarding EHR vendors who can’t or have chosen not to keep up. Maybe that’s why the rule was published late on a Friday.

One could make the case that ONC was more worried about the doctors/hospitals whose EHR vendors failed to become 2014 certified, than the EHR vendors themselves. However, that part of the story is not likely to be told. Plus, it doesn’t take into account how a doctor/hospital whose EHR vendor is 2014 Certified will feel having to do the substantially harder MU stage 2 while their colleagues only have to do MU stage 1. (UPDATE: This EHR Certification Tool that CMS created seems to say that even if you’re on a 2014 Certified EHR and scheduled to do MU stage 2, that you can do Stage 1 or stage 2 objectives with 2014 CQMs. The chart linked at the bottom of this post says it as well. Seems like they’re being pretty open in their interpretation of “due to delays in 2014 Edition CEHRT availability”. Clear as mud?)

I’ve captured a chart showing the EHR Certification flexibility that this final rule provides:
EHR Certification Flexibility - 2014 Certified EHR

Plus, here’s the latest chart showing the meaningful use timelines:
Updated Meaningful Use Stage 3 Timeline

Other Resources and Responses:
CMS Official Press Release
CHIME’s Response
CMS’ EHR Certification Rule Tool
CMS HITECH 2014 CEHRT Flexibility Chart

We’ll keep adding other responses and commentary on the final rule as we find them.

Posted in Hospital EHR, Hospital Electronic Health Record, Hospital Electronic Medical Record, Hospital EMR, Hospital Healthcare IT, Meaningful Use | Tagged , , , , , , | Comments Off

EHRs and patient safety

If you wonder where I’ve been, I’ve, for one thing, been blogging a bit for (very little) pay over at Forbes.com and writing a lengthy cover story for the September issue of Healthcare IT News.

The Healthcare IT News piece actually breaks down into a fairly short lead story and several sidebars, which aren’t all that evident from the traditional Web version. (The digital edition has everything.) For the sake of convenience, here are links to all elements of the cover package:

Main story: “Patient safety in the balance: Questions mount about EHRs and a wide range of patient safety concerns”

Sidebars:

The issue also contains a reprint of my May 2012 blog post, written just a week after my father’s death: “Medical errors hit home.”

Happy reading, and happy Labor Day weekend.

Posted in ARRA, blogging, EMR/EHR, health it, health reform, Healthcare IT, HHS, hospitals, Meaningful Use, mobile, ONC, patient safety, personal notes | Tagged , , , , , , , , , | Comments Off

The Path to Interoperability

The following is a guest blog post by Dave Boerner, Solutions Consultant at Orion Health.

Since the inception of electronic medical records (EMR), interoperability has been a recurrent topic of discussion in our industry, as it is critical to the needs of quality care delivery. With all of the disparate technology systems that healthcare organizations use, it can be hard to assemble all of the information needed to understand a patient’s health profile and coordinate their care. It’s clear that we’re all working hard at achieving this goal, but with new systems, business models and technology developments, the perennial problem of interoperability is significantly heightened.  With the industry transition from fee-for-service to a value-oriented model, the lack of interoperability is a stumbling block for such initiatives as Patient Center Medical Home (PCMH) and Accountable Care Organization (ACO), which rely heavily on accurate, comprehensive data being readily accessible to disparate parties and systems.

In a PCMH, the team of providers that are collaborating need to share timely and accurate information in order to achieve the best care possible for their patient. Enhanced interoperability allows them access to real-time data that is consistently reliable, helping them make more informed clinical decisions. In the same vein, in an ACO, a patient’s different levels of care – from their primary care physician, to surgeon to pharmacist, all need to be bundled together to understand the cost of a treatment. A reliable method is needed to connect these networks and provide a comprehensive view of a patient’s interaction with the system. It’s clear that interoperability is essential in making value-based care a reality.

Of course, interoperability can take many forms and there are many possible paths to the desired outcome of distributed access to comprehensive and accurate patient information.  Standards efforts over the years have taken on the challenge of improving interoperability, and while achievements such as HL7, HIPAA and C-CDA have been fundamental to recent progress, standards alone fall far short of the goal.  After all, even with good intentions all around, standard-making is a fraught process, especially for vendors coming to the table with such a diversity of development cycles, foundational technologies and development priorities.  Not to mention the perverse incentives to limit interoperability and portability to retain market share.  So, despite the historic progress we have made and current initiatives such as the Office of the National Coordinator’s JASON task force, standards initiatives are likely to provide useful foundational support for interoperability, but individual organizations and larger systems will at least for the time being continue to require significant additional technology and effort dedicated to interoperability to meet their needs.

So what is a responsible health system to do? To achieve robust, real-time data exchange amongst its critical systems, organizations need something stronger than just standards. More and more healthcare executives are realizing that direct integration is the more successful approach to taking on their need for interoperability amongst systems. For simpler IT infrastructures, one to one integration of systems can work well. However, given the complexity of larger health systems and networks, the challenge of developing and managing an escalating number interfaces is untenable. This applies not only to instances of connecting systems within an organization, but also connecting systems and organizations throughout a state and region. For these more complex scenarios, utilizing an integration engine is the best practice. Rather than multiple point-to-point connections, which requires costly development, management and maintenance, the integration engine acts as a central hub, allowing all of the healthcare organization’s systems from clinical to claims to radiology to speak to each other in one universal language, no matter the vendor or the version of the technology.  Integration engines provide comprehensive support for an extensive range of communication protocols and message formats, and help interface analysts and hospital IT administrators reduce their workload while meeting complex technical challenges. Organizations can track and document patient interactions in real-time, and can proactively identify at-risk patients and deliver comprehensive intervention and ongoing care. This is the next level of care that organizations are working to achieve.

Interoperability allows for enhanced care coordination, which ultimately helps improve care quality and patient outcomes. At Orion Health, we understand that an open integration engine platform with an all access API is critical for success. Vendors, public health agencies and other health IT stakeholders are all out there fighting the good fight – working together to make complete interoperability among systems a reality. That said, past experience proves that it’s the users that will truly drive this change. Hospital and health system CIOs need to demand solutions that help enhance interoperability, and it will happen. Only with this sustained effort will complete coordination and collaboration across the continuum of care will become a reality.

About David Boerner
David Boerner works as a Solutions Consultant (pre-sales) for Orion Health where he provides technical consultation and specializes in the design and integration of EHR/HIE solutions involving Rhapsody Integration Engine.

Posted in ACO, health information exchange, Hospital EHR, Hospital Electronic Health Record, Hospital Electronic Medical Record, Hospital EMR, Hospital Healthcare IT | Tagged , , , | Comments Off

Aetna Shuts Down CarePass – What’s It Mean?

Looks like MobiHealthNews was the first to break the story that Aetna had chose to shutdown their CarePass product. This is big news since CarePass was Aetna’s baby and calling card in the mobile health world. They had a lot riding on it. Although, I think that iTriage, which Aetna acquired, was certainly the most used app under their umbrella.

If you’ve been on the mobile health/mHealth conference circuits you know that Aetna has been everywhere. Plus, the CEO of Aetna was even a keynote speaker at HIMSS (makes you wonder how much they paid for that spot). Without their CarePass product I’ll be interested to see what Aetna does in this space. Will they basically pull out almost completely?

Sure, Aetna will always take part in some way or another, but will they be pumping money into it like they’d been doing for a while now? I don’t think they will. I think we’ll see Aetna take a backseat approach to the IT part of the industry and just hop on board other people’s work like they did with iTriage.

Another piece of the MobiHealthNews article mentioned above that really intrigued me is this:

The company found no shortage of willing partners to feed data into the app. Over the two years of its existence, CarePass interfaced with MapMyFitness, LoseIt, RunKeeper, Fooducate, Jawbone, Fitbit, fatsecret, Withings, breathresearch (makers of MyBreath), Zipongo, BodyMedia, Active, Goodchime!, MoxieFit, Passage, FitSync, FitBug, BettrLife, Thryve, SparkPeople, HealthSpark, NetPulse, Earndit, FoodEssentials, Personal.com, Healthline, GoodRx, GymPact, Pilljogger, mHealthCoach, Care4Today, and meQuilibrium.

I think there’s a lesson here when it comes to API integrations. Who would have guessed that after making such a huge investment in CarePass, Aetna would just close up shop? I’m quite sure none of these companies that integrated with CarePass’ API thought CarePass would be gone. These types of integrations can be very time consuming and now all that effort is down the drain.

Although, the bigger lesson here is that just because you integrate a bunch of data from other applications doesn’t mean your app is going to be a success. It’s what you do with the data that’s integrated that matters. That’s why I’m really skeptical about Apple Health and HealthKit. Getting the data is one thing. Making that data useful is something very different.

Posted in Healthcare API, Healthcare IT, mHealth, Mobile Health Care | Tagged , , , , | Comments Off

The Forgotten Pieces of Healthcare IT

I’ve obviously been thinking a lot lately about the rest of the healthcare IT world beyond EHR software. We’ve had such a focus on EHR software, that we’ve forgotten a lot of other IT projects that need attention. I saw a quote recently that a CIO is no longer just managing the IT infrastructure. I believe that’s spot on.

A hospital CIO needs to be an integral part of the business decisions of their organization. You can’t buy a few hundred million (or a few billion) dollar EHR and not think that it won’t have a major economic impact on your organization. However, while a hospital CIO needs to do more than just IT infratructure, they still have to do the IT work as well.

I was thinking about all of the various IT projects that a hospital CIO could still be managing:

  • Internal Network
  • External Internet Connection
  • Firewalls
  • Data Center (this could be a few hundred things in itself)
  • Servers/Virtualization
  • Desktops (virtual or otherwise)
  • Mobile Devices (cell, tablets, etc.)
  • Telephony
  • Identity Management
  • Email
  • Shared Drives
  • Printers
  • Scanners
  • Biometrics

I’m sure I’m leaving some obvious ones off. Please add to the list in the comments. However, even just looking at this is pretty overwhelming. Luckily, most hospital CIOs have a lot of people helping them support all of these efforts. However, each one needs to be considered and managed.

Take a simple example like email. You’d think we’d have it down to a science and we kind of do. However, if you host it in house, you have to constantly stay on top of it, update the software, manage mailbox sizes, spam filters, etc. Whether you outsource your email or keep it in house you also have to manage all the account creation and deletion. You have to provide ongoing help desk support and training.

The point I’m trying to make is that each one of these technologies has its little nuances. It takes time and effort to do them well. Unfortunately, many of them have been transgressed as the all hands on deck EHR efforts have occurred. Now we’re heading back to clean up these messes. Looking at the list above, there are a lot of possible messes waiting for a hospital CIO.

Posted in Healthcare CIO, Hospital CIO, Hospital Healthcare IT | Tagged , | Comments Off

VCS Merges With Medkinetics and Payor Enrollment Services

HOUSTON - AUGUST 26, 2014 – Vendor Credentialing Service (VCS), a leading provider of Software as a Service (SaaS) based healthcare compliance and credentialing solutions, today announced a merger with Medkinetics and Payor Enrollment Services. The combination creates the leading provider of compliance and credentialing software covering all constituents of the healthcare community, including physicians, nurses, staff, vendors, contractors and payors. 

“Each of the three companies has an established leadership position in its respective field,” said Rick Pleczko, President and CEO of VCS. “With this merger, healthcare organizations now have a single source provider for all their credentialing and compliance needs, across their entire organization.” 
 
“We’re excited to join forces with VCS,” said Jim Cox, President of Medkinetics and Payor Enrollment Services. “The combination creates the clear leader in the industry, bringing together professionals with many years of experience in healthcare compliance with state of the art technology enabling our customers to quickly and easily solve their compliance and credentialing challenges.”


The combined company will be headquartered in Houston and will maintain operations out of Franklin, Tenn., formerly the Medkinetics and Payor Enrollment Services headquarters.


VCS is a portfolio company of The CapStreet Group, and Healthcare Growth Partners served as financial advisor to VCS and CapStreet.


Neil Kallmeyer, Managing Partner at The CapStreet Group, added, “The completion of the VCS and Medkinetics/Payor Enrollment Services merger represents VCS’s second acquisition in less than two years. We continue to pursue acquisition opportunities to further expand VCS’s product offering, solidifying the company’s position as the leading compliance and credentialing company in the healthcare industry.”

About VCS
Founded in 2006, VCS is an industry leader in compliance and credentialing Software as a Service solutions that help healthcare organizations mitigate risk and ensure compliance. For more information or to contact VCS, visit www.vcsdatabase.com or (866) 373-9725.

About Medkinetics
Founded in 1999, Medkinetics provides innovative Software as a Service solutions for healthcare organizations including provider credentialing, privileging, peer review, quality and performance improvement, and event reporting. Medkinetics’ solutions enable clients to see increased revenue, reduced cost, enhanced provider relations, and improved compliance. For more information about Medkinetics, visit www. Medkinetics.com

About Payor Enrollment Services
Payor Enrollment Services provides fast and accurate credentialing and enrollment of practices and providers with commercial and federal payors. Payor Enrollment Services streamlines processes using state of the art software – taking the burden off providers and enabling organizations to recognize reimbursements faster. For more information about Payor Enrollment Services, visit www.payorenrollment.com


About CapStreet
The CapStreet Group is a private equity firm founded in 1990 that invests in owner-managed, middle market companies headquartered in Texas and surrounding states.  CapStreet targets companies operating in diversified business service sectors, including healthcare, industrial distribution and industrial manufacturing businesses and partners with management teams and existing owners to accelerate growth and improve profitability.

About Healthcare Growth Partners
Healthcare Growth Partners (HGP) provides investment banking and strategic advisory services with an exclusive focus on health informatics and digital health. Since 2005, HGP has closed over 60 transactions representing over $1 billion in value, including sell-side, buy-side, and capital formation. The firm leverages its experienced management team, domain expertise, and deep network of contacts to provide efficient and high value processes for clients.

Posted in Healthcare, Healthcare IT | Tagged , , , | Comments Off

Monday Health IT Potpurri


This is a little bit self serving since Dan’s tweet includes a link to my article on EMR and EHR called, “If You Were an EHR, Which Would You Be?” Although, that post was 19 days ago, so it’s fantastic that Dan loved it enough to tweet it again. Plus, I’m sure that hospital readers will love that article. Side Note: Be sure to subscribe to all the other Healthcare Scene blogs here.


This shouldn’t be surprising. ACOs only require basics. Once they start requiring advanced capabilities, then they’ll built them.


Good advice from Cassie on LinkedIn. Good advice for anyone looking for a healthcare IT job is to get brushed up on LinkedIn. Not to mention uploading your health IT resume to Healthcare IT Central.

Posted in ACO, Hospital EHR, Hospital Electronic Health Record, Hospital Electronic Medical Record, Hospital EMR, Hospital Healthcare IT, Hospital IT Jobs | Tagged , , | Comments Off