Standards 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.

A major U.S. Department of Health and Human Services contractor has fallen behind in its efforts to promote electronic health records, concluded the General Accountability Office in a Jan. 13 report.

The contractor, the not-for-profit National Quality Foundation, or NQF, failed to deliver five of eight projects related to electronic health records activity on time, according to the report, "Health Care Quality Measurement: HHS Should Address Contractor Performance and Plan for Needed Measures."

NQF converted existing quality measures to an electronic format compatible with EHRs -- 113 measures, according to the report. The retooling will allow data from EHRs to be exchanged and used for measuring quality of health care. The project deadline was September 2011, but the project was not completed until December, GAO said.

NQF also was required to convene an expert review panel to examine the retooled measures to ensure proper formatting and correct logic. The panel was convened in June, five months later than required.

As of August 2011, NQF had failed to meet timelines on 18 of 26 projects in nine contract categories during the first two years of the four-year HHS contract, the report said.

HHS and NQF officials listed several factors that they said contributed to the extended project timeframes. According to HHS, the first set of 44 retooled measures had errors requiring correction, including errors in electronic coding. Both organizations also said the estimated timeframes were "overly ambitious, given the scope and complexity of the work." HHS officials said "the technical complexity and labor required to complete the project were greater than anticipated."

NQF officials said HHS also modified the scope of work, requiring the company to hire extra staff to handle the work.

HHS officials told the auditors that they rely on NQF to inform them of problems in its monthly progress reports, but the GAO said the agency did not use available monitoring tools required under its contract with NQF. "These tools could have helped to provide an opportunity for HHS to make any appropriate changes to NQF's projects," the GAO said.

The GAO recommended that HHS:

• Use monitoring tools required under the NQF contract to obtain detailed and timely information on the company's performance and use that information to inform changes to timeframes, projects and cost estimates through the remainder of the contract.


• Ensure that testing of the electronic versions of the measures retooled by NQF to be used in the Medicare and Medicaid EHR incentive programs be completed in a timely manner to identify potential errors and address implementation issues.


• Develop a comprehensive plan that identifies the quality-measurement needs of HHS programs and initiatives and provides a strategy for using NQF's work product to meet those needs.

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.

As you resolve not to smoke, overeat or work too much in 2012, the website SearchHealthIT issues its list of five health IT trends not to watch in the new year:

• Electronic medical records: EMRs are generally in-house records for tracking patient data and improving quality of care. It's electronic health records, which can be shared among caregivers and accessed electronically by patients, that bear watching, website editor Brian Eastwood writes in a blog post.


• Personal health records: The market doesn't seem to be going anywhere right now, and questions are being raised about privacy.


• Hospital information systems and clinical information systems: Like EMRs, the data compiled by these systems is not easily shared among providers or through a health information exchange.


• Computerized physician order entry: Adoption is low, in part because they're geared toward hospitals, not the physicians using them. They're "slow to adapt to the tablet PCs and smartphones that physicians have more than happily embraced," Eastwood writes.


• Regional health information organizations: While more than 250 of these organizations exist nationwide, the terminology and its acronym (RHIO) appear to be going out of fashion.

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."

Mobile health may be the future of health IT, but it can't fulfill its promise unless broadband Internet is "ubiquitous" nationwide, says the chairman of the Federal Communications Commission.

"Done right, this will unleash innovations and breakthroughs in how care is delivered -- from improvements in remote diagnostics and treatment, to new devices that can save lives while helping contain rising health care costs," FCC Chairman Julius Genachowski said in a keynote speech this week at the mHealth Summit, presented by the Foundation for the National Institutes of Health.

He said the FCC's health strategy has three main components: promoting connectivity, ensuring optimal allocation and management of the broadband spectrum, and enabling the development of wireless medical devices.

Although broadband Internet is increasingly available, it is not yet ubiquitous, Genachowski said in his prepared remarks. Roughly 20 million Americans live in areas lacking broadband infrastructure, and another 80 million do not subscribe to broadband services in their homes. Additionally, as many as three in 10 rural medical clinics lack adequate broadband service, he said, leaving them unable to use telemedicine services or easily exchange electronic health records with other providers.

A recent FCC agreement to modernize the Universal Service Fund, the main federal program supporting rural communication networks, will help deliver broadband to all Americans by the end of the decade, he said. The agreement includes a goal to get broadband to all rural "community anchor institutions," including hospitals and clinics. A separate program is "specifically focused on expanding rural health-care connectivity," he said.

The FCC also plans to expand the radio frequency spectrum for mobile broadband dramatically by 2020, he said, allowing "robust, reliable wireless data communications," including mobile communications inside hospitals.

The plan is to get broadcasters that currently own much of the spectrum to voluntarily auction it off to mobile providers, Genachowski said. Another plan involves harnessing more unlicensed spectrum for medical applications that rely on Wi-Fi and Bluetooth technologies.

The FCC's mHealth strategy also addresses medical devices. There are plans to help developers of mobile applications and devices tap into technologies that use spectrum in new ways, or in some cases allowing expanded use of spectrum, he said.

"Last week we authorized Second Sight Medical Products to market a retinal prosthesis that exceeds our ordinary power limits, but that will help restore functional sight for individuals with certain eye diseases while preventing harm to the operation of other devices," he said.

The FCC also has begun allowing medical micropower networks to access the broadband spectrum, he said. Patients with spinal-cord and traumatic-brain injuries, strokes and other neuromusculoskeletal disorders use the networks.

Next year, the commission plans to introduce a program to accelerate development of health devices that use mobile spectrum and reduce restriction on testing by university and other researchers, he said.

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.

The Office of the National Coordinator for Health IT, the federal agency that is leading efforts to digitize health records, gets a vote of no confidence from hospital IT executives for its role in developing health information exchanges.

More than 60 percent of hospital chief information officers responding to a one-day "snap survey" by HealthsystemCIO.com described the jumble of local, state, regional and national initiatives as a "confused mess," according to the website. More than nine of 10 respondents said those initiatives are duplicating efforts.

The CIOs overwhelmingly blame the ONC. None of the respondents characterized the agency's leadership on the information exchanges as "very good," and just 3.8 percent termed it "good." For nearly half, the response was "not so good."

Even so, close to 70 percent said they intend to exchange patient information with a competing health system. "This is the best for patient care and [it] only makes sense to participate," one respondent said.

Health information exchanges are key to the success of the federal government's health IT initiatives. They will enable sharing of digital patient records among doctors' offices, hospitals and other providers, but they're being set up differently in every state and region.

More than 60 percent of survey respondents said technical standards for the exchanges are either ready or will be within two years, but several noted in comments that other issues remain unresolved.

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.