Regulation Archives

Health-care providers still have a lot of work to do to meet key health IT requirements expected under the government's Stage 2 "meaningful use" standard, a new industry report finds.

CSC, an IT consulting firm based in Falls Church, Va., says the following essential areas require immediate attention:

• Electronic patient access to personal health information.


• Electronic capture of physician notes, including diagnosis and treatment, and rationale for excluding patients from treatment recommendations.


• Electronic exchange of patient information from one provider to another.

Only 12 percent of hospital chief information officers in a survey said they were prepared to allow patients to view and download their information; 24 percent said they couldn't yet transmit summary-of-care records when a patient left the hospital. And only 25 percent said they can meet proposed Stage 2 requirements for electronic physician notes.

The problem is twofold, they said: vendor products and operational readiness.

Expected Stage 2 goals for electronic medication administration (eMar) have been easier to reach, with 86 percent of the survey's respondents saying they are prepared to implement eMar in at least one hospital unit, as required.

The report combines information from early attesters to meaningful use with results of a survey of CIOs belonging to the College of Healthcare Information Management Executives.

Final rules for Stage 2 meaningful use are supposed to be published in July, but a delay is likely because the Centers for Medicare and Medicaid Services missed a December 2011 target date for releasing an early version of the rules.

While health-care professionals seem to love iPads, health IT professionals are less enamored with the consumer-friendly tablet computers, according to a new industry report.

Doctors and others are more likely to use technology they like, which could help chief information officers get everyone on board in using electronic health records and other health IT systems. But iPads in particular are challenging to integrate into existing health IT, according to the report from BizTechReports, "Diagnosis Danger: Governance and Security Issues Cause IT Concerns About iPad in Healthcare Settings."

"There is a sense of concern among healthcare IT executives that pressure to meet the demands of end-users to support consumer-grade computing and communications devices like the iPad is coming at the expense of other important priorities," the researchers reported.

Areas of concern reported by the 100 hospital and clinic CIOs and other health IT executives interviewed by BizTechReports, an independent, Washington, D.C.-based research group, include:

• Compliance with privacy governance requirements.


• The need to manage risk while sharing health information with other users.


• The ability to quickly react to and remediate data breaches.


• Integration with end-to-end productivity systems.

For example, electronic patient records are not meant to be managed on consumer-grade technology like the iPad, according to the report. It's also difficult to enter information from an iPad into an enterprise system like an EHR. Nor do iPads have mechanical keyboards or USB ports that can attach devices such as barcode scanners, severely limiting the number of applications they can support.

Panasonic Solutions Co. teamed with BizTechReports to produce the study.

Here are the top 10 developments in health IT for 2011, straight from the national coordinator for health IT. Dr. Farzad Mostashari released the month-by-month list Jan. 6 on his Health IT Buzz blog:

• January: Medicare and Medicaid electronic health record incentive programs launched. Since then, "the marketplace of certified products has grown quickly, interest in meaningful use among providers and hospitals is sky-high, and the pace of incentive payments has continued to accelerate," Mostashari said. More than $1.8 billion in incentives had been paid to more than 20,000 health-care providers and 1,200 hospitals as of Nov. 30.


• February: ONC launched Direct Project, providing "a simple, secure, standards-based way for providers and other participants to send encrypted health information directly to trusted recipients over the Internet - a kind of 'health email,'" Mostashari said. Multiple vendors and states are implementing the system.


• March: The Health and Human Services Department, ONC's parent agency, released its National Quality Strategy, a framework to guide efforts to improve health-care, with health IT as a critical component.


• April: The "Summer of Standards" kicked off, a series of standards and interoperability forums to support Stage 2 standards and certification requirements for EHR incentive programs, resulting in consensus being reached on the Consolidated Clinical Document Architecture. Mostashari described the architecture as a "single, broadly supported electronic data standard for patient care transitions."


• June: The Investing in Innovations (i2) program used challenges and prizes to promote innovations in health IT. Several i2 challenges have been launched since, including a call to create applications "activating and empowering patients to improve their heart health."


• July: Health IT training curriculum was released on the open market in July. Employment continued growing in the health IT workforce, which added more than 50,000 jobs between 2008 and 2010, according to the Bureau of Labor Statistics.


• September: HHS' Office for Civil Rights issued its first report to Congress on breaches of protected health information. Breaches now must be reported to HHS, those affected, and in some cases the news media.


• September: ONC formally launched its Consumer e-Health Program, with the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention proposing regulations making it easier for patients to access lab data. More than 250 organizations covering more than 100 million people, including Aetna, the Mayo Clinic and AARP, have "agreed to make health information easily available to consumers," Mostashari said.


• October: ONC's 62 Regional Extension Centers passed their goals to enroll 100,000 "priority" primary-care providers nationwide, and by mid-December had enrolled 116,000 providers requesting help with EHR implementation, including 70 percent of rural primary-care providers.


• November: A CDC survey of office-based physicians showed the percentage of nonhospital-based physicians with a basic EHR doubled from 17 percent in 2008 to 34 percent in 2011, with nearly 40 percent of primary-care physicians adopting an EHR. The proportion of hospitals operating EHRs with the functionality required in the Medicare and Medicaid incentive programs rose from 2 percent to 41 percent, among hospitals eligible for the incentives.

Electronic health records top a list of 10 technologies hospitals need to watch in 2012, according to a report released today by ECRI Institute.

"Technology is increasingly a top management concern, and is no longer confined to clinical and technical decision making. Themes emerging on our 2012 list reflect ongoing impacts of health-care reform initiatives and new technology developments that emphasize patient-centered care," says Jeffrey C. Lerner, president and CEO of ECRI Institute, in a news release. ECRI, based in Plymouth Meeting, Pa., is an independent, not-for-profit organization that focuses on improving health care.

Hospitals need to focus on meeting Stage 2 meaningful-use criteria this year to continue qualifying for federal health IT reimbursements, the organization notes in its report, "ECRI Institute's Top 10 C-Suite Watch List: Hospital Technology Issues for 2012."

The report cites Stage 2 criteria including:

• Increasing the threshold for computerized physician order entry from 30 percent under Stage 1 criteria to 60 percent.


• Requiring that vital signs be recorded electronically for 80 percent of patients, up from 50 percent under Stage 1.


• Recording how the patient prefers to receive communications.


• Enabling Web-based access to inpatient records.

After developing a medical-device integration plan, hospitals will have to determine how they will share the information with health information exchanges, the report notes. "The IT challenges, as well as contractual issues (e.g., with your state or regional health information exchange) related to integration seem unending."

The report is available, with registration, through the ECRI Institute website.

If you were preoccupied last week with the seasonal imperative to give gifts, you may have missed an announcement, put out by the Office of the National Coordinator, that its gifts come with strings attached.

ONC announced in the Federal Register that it would create databases to track, monitor and assess the performance of individuals who receive grants intended to promote development of an interoperable system for sharing health information.

The "ONC Health IT Dashboard" will assess the progress of providers who receive incentive funds to spur the "meaningful use" of electronic health records as well as providers who participate in other health IT programs, including regional extension centers.

The program will take effect within 30 days, according to the announcement.

The country's largest consortium of health insurance providers has publicly endorsed federal initiatives that promote consumers' awareness of health IT.

"Health information technology has the power to transform the way healthcare is delivered and significantly increase safety, efficiency and the quality of care for all Americans," the Blue Cross and Blue Shield Association said in a statement released Dec. 22.

The association, a national federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield companies, "strongly supports initiatives to advance health information technology and ... efforts by the Office of the National Coordinator 'to engage and empower individuals to be partners in their health through information technology.'"

Moreover, the association is encouraging others to follow its lead, calling on "entities that touch Americans' lives to pledge to empower individuals to be partners in their health through health IT."

The association says it and its companies have been "at the forefront" of efforts to promote broad adoption of health IT. It cited a record of developing national standards for personal health records, promoting health-care providers' use of electronic prescribing and electronic medial records, and advancing the health care sector's adoption of interoperable health IT.

"Our shared vision for the future of healthcare in America includes the use of health information technology to drive safer and better care for all Americans," the association said in the news release. "We look forward to working with the administration and others to help promote consumer awareness and engagement in health IT."

Health-care providers lose an average of $2.24 million every time private patient information is compromised by security breaches, costing doctors and hospitals nationwide an estimated $6.5 billion annually, a new study estimates.

The per-breach cost, which rose 10 percent this year, includes an average of $250,000 in legal fees, according to the Ponemon Institute's "Second Annual Benchmark Study on Patient Privacy and Data Security."

The frequency of data breaches among the 72 health-care organizations interviewed for the study increased by one-third this year compared with last year. Nearly all of the providers surveyed, 96 percent, reported at least one data breach in the last two years; the average number was four. The typical breach compromised 2,575 patient records, up from 1,769 last year.

"I don't see this getting better any time soon," says Larry Ponemon, founder of the Traverse City, Mich.-based Ponemon Institute, which researches information and privacy-management issues. Cash-starved providers are trimming IT security and privacy budgets, he says in a news release, particularly at not-for-profit hospitals and small clinics.

The report blames "employee mistakes and sloppiness" for a majority of the breaches, along with errors by third parties, including subcontractors. Nearly three out of 10 breaches led to identity theft, the respondents said, up 26 percent from 2010.

The explosion in the use of unsecured mobile devices is a major threat to data security, the report concludes. Half of the providers that reported using mobile computing devices said they had done nothing to protect the security of the data on them.

The Ponemon Institute survey was sponsored by ID Experts, a Portland, Ore.-based IT security services provider. The report can be downloaded at the ID Experts website (registration required.)

The U.S. Department of Health and Human Services is relaxing its timetable for health-care providers to meet stricter standards for "meaningful use" of electronic health records, a move HHS says is intended to speed and ease adoption of health IT.

Doctors and hospitals that began participating in Medicare EHR incentive programs this year have another year, until 2014, to meet the second stage of standards for meaningful use, HHS said in an announcement released this week. Providers that adopt EHRs in 2012 would continue to have until 2014 to meet Stage 2 meaningful-use standards.

Health-care providers whose EHRs meet meaningful-use standards are eligible for up to $44,000 in Medicare incentives and $63,750 in Medicaid incentives, so meeting those standards is critical. But health IT organizations and industry professionals have urged for several months that the deadline for meeting tougher, Stage 2 meaningful-use standards be pushed back to 2014. Dr. Farzad Mostashari, the national coordinator for health IT, recently agreed with those recommendations.

The HHS-announced delay also presumably gives Mostashari's office more time to settle on its requirements for Stage 2 meaningful-use standards.

HHS also intends to offer education and training to doctors and hospitals that have registered for EHR incentive programs through Medicare and Medicaid--but have not yet achieved meaningful use. The outreach will complement the efforts of regional extension centers, local nonprofit groups that help smaller practices and hospitals navigate the world of health IT, HHS said.

Six out of 10 radiologists plan to use electronic health records and achieve "meaningful use" standards, but only 6 percent think they have a good understanding of what meaningful use means, a new study shows.

Nearly 40 percent of 216 radiologists surveyed by the health-care vendor consulting firm KLAS said they either don't understand federal meaningful use guidelines or they worry that the use of EHRs could create new inefficiencies.

"These numbers should be a wake-up call for the radiology industry," said Emily Crane, research director for KLAS and author of the study, "Radiologists' Take on Meaningful Use," conducted by KLAS and the Radiological Society of North America.

The results are disappointing because most radiologists are eligible for "some or all" of the $44,000 incentive available to health-care providers that achieve EHR meaningful use, Crane said. She noted that providers will be penalized if they don't achieve meaningful use by 2015.

Some of the respondents said they did not believe current meaningful-use guidelines take radiology into consideration. They argued for including clinical decision support, especially for referring physicians, to ensure the correct imaging test is ordered, KLAS said in a news release.

Radiologists were unenthusiastic about giving patients the ability to access electronic records or to track radiation doses, according to the release.

The vast majority of states have provided a path for Medicaid providers to receive financial incentives for implementing electronic health records. Of those that have not -- 11 states plus the District of Columbia and several territories -- their ranks will thin further in December.

Registration for Medicaid incentives through the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, opened last week in Arkansas, Delaware, Montana, New Jersey, New York and North Dakota, CMS announced. They joined 33 other states that had opened registration programs earlier this year.

Colorado, Kansas, South Dakota and Wyoming are expected to open registration in December, according to a CMS timeline.

Minnesota, Nebraska, Virginia and the District of Columbia expect to launch their registration programs in the first quarter of next year. New Hampshire and Nevada anticipate following in the second quarter, with Idaho predicting its rollout for September 2012.

CMS said it did not have projected launch dates yet for Hawaii, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands.

The Medicaid EHR Incentive Program is administered state by state. Medical professionals must demonstrate that their EHRs meet meaningful-use standards to qualify for up to $63,750 in Medicaid incentives over a six-year period.