Stimulus package Archives

The nation's health IT czar polished off his crystal ball this week and predicted five major health IT trends for the year. Dr. Farzad Mostashari, national coordinator for health IT, shared the prognostications on his office's Health IT Buzz blog:

• Meaningful use takes off. Mostashari projects that at least 100,000 providers will demonstrate that their electronic health records meet ONC standards for "meaningful use" by the end of the year, enabling them to receive Medicare or Medicaid incentive payments.


• Health information exchanges turn a corner. "ONC efforts are critical," he writes. "Robust policies that protect information and create public trust will galvanize rapid growth and innovation in health information exchange.


• The dots connect between health IT and payment reform. Pay-for-service models lead to higher costs, he argues, just as health IT helps hospitals and practices to move away from traditional pay models. "We are headed toward a virtuous cycle where payment reform improves the business case for using health IT and greater use of health IT improves the chances that new payment models will succeed."


• Consumers take advantage of eHealth resources. Mobile apps and other technological advances make it easier for patients to become more involved in improving their health, Mostashari says.


• Innovation drives improvement. Efforts in 2012 will focus on improving the usability of EHRs, he says.

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.

The District of Columbia is shifting away from a formal health information exchange to a less-robust email system for sharing medical data among providers, citing problems with financing and physician compliance as reasons for the shift.

Bids are due Jan. 13 for contractors seeking to build an email platform for D.C. physicians and hospitals to exchange information by the end of June, the Washington Business Journal reported Tuesday. The district can renew the one-year contract for three more years, the newspaper said.

The email system should be able to eventually plug into a nationwide health information exchange, the paper reported.

The D.C. Primary Care Association shut down its D.C. Regional Health Information Organization in October, citing lack of funding, according to the paper. Federal health IT grants that would have gone to the regional health exchange now will go to the email network, to be called Direct Project.

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.

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 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.

Federal stimulus money helped to pump up the value of stocks in 11 health care technology companies by 82 percent since President Obama took office, well above the 51 percent growth in the Standard & Poor's stock index over the same period, according to an analysis by USA Today.

The 2009 economic stimulus bill included up to $30 billion earmarked for health IT spending in the form of incentive payments for health care providers achieving meaningful use of electronic health records. Purchasing and implementing EHRs can be expensive, especially for small medical practices. The incentive cash promotes EHR adoption, an Obama administration priority, by helping practices to recoup some implementation costs.

The benefit to health IT companies has been enormous, according to the USA Today report, which says the $20 billion "boost in companies' value far exceeds the amount spent so far" under the stimulus bill.

The newspaper noted that shares of industry leader Cerner rose 194 percent, or $6.5 billion, as Cerner's clients received $100 million in incentives for achieving meaningful use. Shares of major competitor Allscripts Healthcare Solutions rose by 134 percent, while Athenahealth's stock value doubled.

About one-third of the nation's primary care providers have signed up with a national assistance network for help in purchasing, installing and using electronic health records, the Office of the National Coordinator for Health IT announced this week.

More than half of the 100,000 primary care providers registering with their local ONC regional extension center are in small private practices or a consortium of small practices, ONC officials said Thursday on the Health IT Buzz blog. The average small practice registering for EHR implementation assistance has just two physicians, ONC said.

The other providers were community health centers, public hospitals, and providers in underserved areas, including critical-access hospitals and rural health clinics.

ONC proclaimed that the 100,000 milestone means "momentum is building" for meaningful use of EHRs by the nation's primary care physicians and clinics.

"This evidence demonstrates that [regional extension centers] are working with the practices and organizations the program was designed to help -- the providers with the least resources to make the transformation to meaningful use of EHRs," ONC said on the blog.

RECs help practices with EHR implementation and project management, health IT education and training, vendor selection and financial consultation, practice and workflow redesign, privacy and security, ongoing technical assistance, and connecting with state and national health information exchanges.

"The RECs are playing an integral role in helping providers on the path to EHR adoption," Dr. Farzad Mostashari, the national coordinator for health IT, said in a news release. "This compelling milestone demonstrates strong interest in adoption and meaningful use among community health centers, small practices and rural providers that can lead to improvements in health and health care."

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.