Original article can be found here.
In response to reader commentary on Joseph Conn’s “Will CCHIT have competition due to stimulus law?”:
I wholeheartedly agree with Dr. Robert Rowley’s assessment.
Unlike other more emotional critiques of the Certification Commission for Healthcare Information Technology, Dr. Rowley’s assessment is both rational and reasonable. Over the course of the last three years I have seen the hope of CCHIT certification dashed time and time again when a physician has trusted that buying a CCHIT-certified product meant that the product would be a good electronic health record that would help them.
Although it may initially seem counterintuitive, using CCHIT certification in lieu of the stimulus bill certification is likely to exacerbate the ongoing problem of EHR mistrust. The reason for this, as stated by Dr. Rowley, is that certification does not ensure that a system is usable or effective in a provider’s practice. It only evaluates if an EHR has a list of required functions. For example, many poorly designed EHRs require a user to go through three to four different screens to prescribe a new medication. These EHRs will pass CCHIT certification on the basis of having the function to prescribe a medication. However, providers are hard-pressed to take the extra 2-3 minutes required to write each prescription 50 times per day. This is only a small example of the pervasive lack of usability that is often found in CCHIT-certified EHRs.
While certification holds the promise of validating the usefulness of an EHR, it is another cause for the loss of confidence in EHRs. As providers learn more from their colleagues about their CCHIT EHR implementation that did not work out or as they struggle to implement their own CCHIT EHR system they recognize that CCHIT certification is not correlated to how well an EHR works.
The potential long-term consequence is to drive providers deeper into their caves and set back EHR adoption for another number of years. The short-term consequences are also severe.
CCHIT certification for an ambulatory-care EHR is up to $50,000 per year including specialty certification. Certification is required at least every two years. If a system does not pass certification the fee is lost. If certification requires additional time, the fee is $2,000/hour. These costs are unduly difficult on new entrants into the EHR vendor arena. This high price burden creates a barrier-to-entry for the most innovative and progressive EHR vendors in the marketplace; precisely the opposite effect that is wanted for the healthcare market.
Thus, the criteria already established by CCHIT actually jeopardizes the EHR marketplace through a “double whammy” of diminishing trust in EHRs, thereby reducing EHR purchases by providers, and eliminating the most innovative and least expensive EHRs, once again reducing the likelihood of purchases by providers. Even if the providers are getting $44,000 to purchase their product, they won’t use it if it slows them down.
It is my hope that the responsible individuals at the National Institute of Standards and Technology, the organization responsible for certification under the stimulus bill, realize that current CCHIT criteria are not aligned with the objectives of the stimulus bill or the physicians using EHRs.
A. Cyril Spiro, M.D.
Founding partner and general manager
M.D. Web Solutions
Tampa, Fla.
Read the original article at http://tinyurl.com/cksqn5.
This is pretty clear - CCHIT is NOT required to get stimulus payments, especially because rural areas are not going to be able to afford this technology. Nor should they. This gives us a clear opportunity to help practices adopt EHR technology that makes sense on a practice and patient level.
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There will be some major changes in the way the federal government oversees its health information technology program apart from the whopping increase in funding for IT system acquisition, according to the 300-plus pages of health IT-related language in the $787 billion, 785-page American Recovery and Reinvestment Act of 2009.
The massive stimulus bill, signed into law Tuesday by President Barack Obama, does not specifically name another Bush administration era IT body, the not-for-profit Certification Commission for Healthcare Information Technology. CCHIT was created by the American Health Information Management Association, the Healthcare Information and Management Systems Society and the National Alliance for Health Information Technology, but was promptly awarded a contract by HHS to carry out its work.
However, the new law does say that the national coordinator, in consultation with the director of the National Institute of Standards and Technology, “shall keep or recognize a program or programs for the voluntary certification of health information technology as being in compliance with applicable certification criteria under this” law.
It remains to be seen whether federal support for all three of these holdover organizations—the American Health Information Community’s successor group, the National eHealth Collaborative, the Healthcare Information Technology Standards Panel and CCHIT—in addition to the two newly created ones, is to be forthcoming.
Extending IT
Next to cost, arguably the second most commonly cited barrier to IT adoption is the difficulty in installing, configuring and maintaining these complex systems and the disruption installations have caused to clinical workflow and financial operations. A third, oft-named barrier is the lack of technical know-how, particularly among smaller outpatient clinics and physician groups.
To address those problems, the bill establishes a Health Information Technology Extension program at HHS to be run under the Office of the National Coordinator “to assist healthcare providers to adopt, implement and effectively use certified EHR technology.” In addition, the law calls for the creation of a number of regional IT extension centers, which will be affiliates of not-for-profit institutions or organizations, to assist with “the implementation, effective use, upgrading and ongoing maintenance of health information technology, including electronic health records, to healthcare providers nationwide.”
The regional extension centers will focus on helping public or not-for-profit hospitals, critical-access hospitals, federally qualified health centers and provider organizations in rural areas and those serving the uninsured, underinsured and medically underserved individuals as well as individual and small group practices.
HHS can fund only up to 50% of the cost and expenses of the capital and operating of the regional centers, although the local cost-sharing requirement can be waived “in an instance of national economic conditions, which would render this cost-share requirement detrimental to the program.”
Another intriguing program—to fund development of healthcare IT—may be couched in language under the heading of “Federal Health Information Technology.” It said that the national coordinator “shall support the development and routine updating” of certified EHR technology and authorizes the ONC to charge “a nominal fee” for its use, taking into account “the financial circumstances of small providers, low-income providers and providers located in rural or other medically underserved area.” The ONC shall “make available” these systems, “unless the secretary determines through an assessment that the needs and demands of providers are being substantially and adequately met through the marketplace.”
Multiple studies have shown that in both the physician office and the hospital markets, the smaller the office or hospital, the less likely they are to have IT systems.
In 2004, the CMS funded adaptation of the Veterans Affairs Department’s VistA clinical IT system, which is software in the public domain, for use by physicians in solo and small group practices, work that has since been handed over to the not-for-profit WorldVistA organization that offers an open-source version of VistA.
Earlier versions of the IT portion of the stimulus bill made specific mention of the VistA system and open-source software to address this market failure resulting in weak EHR adoption at small offices and hospitals, but those direct references were dropped in the final bill.
“I’ve watched the transformation of that from early versions, and I think the way it’s written it leaves the onus on the private sector to create the systems that will get us where we’re trying to go,” Rod Piechowski, senior associate director for policy at the American Hospital Association, said. Whether the private sector, with federal funding now available, will fill the gap is “a little bit difficult to predict, because the parameters to determine whether the needs of the market being met haven’t been laid out,” he said.
Joseph Dal Molin, the vice president of business development for WorldVistA, said traditional IT business models “have failed to encourage or facilitate the widespread adoption of EHR technology across the entire health system. Cost and other barriers whose roots are in the ‘legacy’ business models of the healthcare IT industry are both creating and reinforcing a digital divide in the U.S. health system.
“It is very encouraging that stimulus legislation appears to have opened up a window of opportunity for practical and fundamental innovation in how software is developed, sold and supported in health systems. This could be the first step to establishing evidence-based software evolution in the healthcare industry, something the Veterans Administration has practiced for many years, a paradigm shift that will be essential to spending money effectively and fostering real change … not just a lot more money spent on the same paradigms that haven’t worked.”
States will bear much of the burden for fulfilling President Barack Obama’s prescription of an electronic health record for every American by 2014.
Meeting that objective “is quite an ambitious goal,” said Jodi Daniel, leading off yesterday’s meeting of the State Alliance for e-Health in Washington, D.C. “We have a lot of work to do.”
Daniel directs the policy and research office of the Office of the National Coordinator for Health Information Technology. The ONC supports the Alliance through a contract with the National Governors Association in an effort to assist states with their health IT initiatives.
John Thomasian, director of the NGA Center for Best Practices, said the onus will be on states to create a “network of networks” that will constitute a national health information network.
States will have also responsibility for enforcing privacy rules and establishing sustainable business models that will “allow [NHIN] to flourish over time,” Thomasian said. “What is not quite clear is who will build the exchange and with what monies.” Although the American Recovery and Reinvestment Act of 2009 appropriates $300 million for regional efforts, “hopefully that is a floor,” Thomasian said.
States must choose the public governance model that will provide necessary oversight and funds needed to sustain an emerging health information exchange industry. Results of a NGA-sponsored study, released at yesterday’s meeting, laid out three basic models for how states might manage health data networks. The report, titled, “Public Governance Models for a Sustainable Health Information Exchange Industry,” is available on NGA’s Web site .
At one end of the spectrum, states would have a direct role in building, managing and sustaining health information exchange infrastructure. They would be “responsible for it all,” including performance, privacy, security and financial sustainability, Thomasian said.
Such an approach could “serve as a basis for broader health care reforms in some states, as it represents the infrastructure necessary to collect the information needed to develop these policies,” the report states.
The do-it-all approach might be most attractive in places with the least mature markets for HIE technology. Likely drawbacks of this model include complex financing issues and slow adoption of new technologies.
A second model would treat HIE infrastructure like a public utility with strong government oversight. This option would be attractive, the report concluded, “in states where there is significant traction of private-sector electronic HIE efforts but limited coordination or concern over the sustainability of the existing efforts.”
Attributes of such a model include familiarity, private-sector investment, sustainability and the recognition of health information exchange as an industry.
Thomasian encouraged meeting participants to think of this paradigm as the “power plant” option, noting that the Departments of Health in Rhode Island and New York are adopting similar structures.
The third model contemplated by the report is a health information exchange led by the private sector, which would make significant investments and be in a position to respond quickly to new technologies. Under such an arrangement, state government would be a stakeholder and collaborator.
The downside is that “in the absence of state government representation, there is the chance that specific populations, such as the low-income, high-risk population covered by Medicaid or specific public health programs will not be appropriately represented in electronic HIE efforts.”
Regardless of the governance models that they choose, states must move quickly to keep pace with the president’s agenda.
“Health care reform cannot wait,” Obama said in his first address to Congress last night, delivered a few blocks from where the State Alliance had met. “It must not wait, and it will not wait another year.”
One of many great letters to the President on the benefits of healthcare IT. Not only can we help save money by adopting EHR systems, but lives as well.
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Reward physicians for using health IT
You enter office during a time of unprecedented growth and opportunity in the field of health care information technology. Health care is an issue that goes beyond party affiliations and affects every citizen, and as you begin your term as president, we viagra you to continue building on the momentum this industry has gained in the past decade.
Investing in health IT, such as the adoption and advancement of electronic health records, will help bring about an interoperable health care system, which studies have shown can save upwards of $150 billion to $300 billion annually to numerous stakeholders, including the federal government and, thus, taxpayers.
Furthermore, EHR adoption improves the quality of care that physicians and other caregivers are able to provide. In times of disaster and crisis, properly constructed EHR networks enable health care professionals to access a patient’s medical records at a moment’s notice, whereby they can quickly and effectively administer the proper care.
The benefits of widespread EHR adoption are hard to ignore. Yet many physicians remain reluctant to use these solutions to their fullest potential. A key step in advancing the adoption of EHRs is the creation and support of legislation and regulations that provide monetary incentives to physicians who successfully deploy health IT systems at the point of care. EHR adoption furthers the ability for physicians to perform more accurate and widespread clinical research that can unlock new medicines and treatments that benefit the greater good, from treating common illnesses to curing chronic diseases.
We urge you to continue supporting legislation and regulations that advance health care information technology.
Justin Barnes
Vice President of Marketing and Government Affairs,
Greenway Medical Technologies
WASHINGTON – The economic stimulus package has allotted $17.2 billion to reward Medicare and Medicaid providers who can prove they are using certified healthcare IT “in a meaningful way.”
The incentives are scheduled to take effect starting Oct. 1, 2011. Experts say providers should not waste time getting prepared because there is a shortage of change management experts available to help.
According to Dave Garets, president and CEO HIMSS Analytics, 94 percent of hospitals currently don’t have enough healthcare IT in place to meet the stipulations required to receive bonuses. Under the new law, they must prove “meaningful use,” which will require capturing certain data.
Garets expects that healthcare organizations will adopt healthcare IT “with a vengeance” in 2009. He and other members of the Healthcare Information and Management and Systems Society are concerned there are “precious few” change management experts to help providers make the complicated transition to healthcare IT by 2011.
Garets said it’s not as simple as hiring a software technician to make the transition. There is a need for qualified people who know how to help with workflow adaptation and how to implement software packages so they work for the organization.
“These people are extremely valuable and extremely rare,” he said.
Payments under the American Reinvestment and Recovery Act are graduated in descending amounts for federal fiscal years 2011 and 2015. After 2015, there are penalties for providers that do not use healthcare IT. The sooner a provider is ready to go with healthcare IT, the more likely they are to cash in on the maximum possible, Garets said.
According to HIMSS leaders’ interpretation of the law, physicians can earn from $44,000 to more than $60,000 in extra payments over the five-year period, including $18,000 the first year. Incentives for hospitals will start at a base of $2 million annually.
To qualify for bonuses, providers must have certified electronic health record technology capable of providing clinical decision support to physician order entry and capturing query information relevant to healthcare quality. The system must also be able to exchange and integrate electronic health information with other sources.
The maximum payment for qualifying physicians under the stimulus package is $18,000 for the first year, $12,000 for the second year, $8,000 for the third year, $4,000 for the fourth year and $2,000 for the fifth year.
For those failing to use certified qualifying healthcare IT by 2014, Medicare payments will be reduced to 99 percent in 2015, 98 percent in 2016 and 97 percent thereafter.
Hospitals will have to submit data on clinical quality measures and other measures to be determined by the Department of Health and Human Services secretary.
Payment for hospitals is a complicated formula that includes the discharge amount and Medicare share a hospital receives.
The state is authorized to make bonus payments, beginning in 2011, to physicians who provide Medicaid services, are not hospital-based and have at least 30 percent Medicaid patient volume. Federally qualified health centers or rural health clinics with at least 30 percent Medicaid patient volume can receive up to $63,750 in incentives and will not face reductions in Medicaid payments if they do not adopt certified EHR technology.
The “meaningful use” of healthcare IT is yet to be determined by the HHS secretary under the new law.
On Monday, President Barack Obama nominated Kansas Gov. Kathleen Sebelius to fill this role. If Sebelius is confirmed by the Senate, she will also oversee standards development and select clinical quality measures used to determine providers’ worthiness for receiving healthcare IT incentives under the new law.
Post-Standard (Syracuse, NY)
February 24, 2009
President Barack Obama wants all U.S. doctors’ offices to look like CNY Family Care within five years. The 30,000-patient primary care practice in East Syracuse, NY, adopted an electronic health-record system five years ago and has been gradually phasing out paper records.
Its doctors, nurse practitioners and physician assistants recently ditched their prescription pads. Prescriptions are entered into a computer in the exam room and sent electronically to pharmacies. Any orders for follow-up patient care and visits are entered on the same computer, allowing patients to bypass the front desk on their way out.
CNY Family Care expects to go totally paperless in another year or so. “This really made us an A-plus from a B-plus,” said Fred Letourneau, the practice’s chief executive officer. “It’s much better care. We know more about what’s going on with people.”
Digitizing the nation’s health records is a top agenda item for Obama, who mentioned the issue in his inaugural address. The $787 billion stimulus program he signed into law Tuesday contains $17 billion in incentives for health care providers to adopt electronic health records. Obama sees the investment in electronic records as a way to improve quality and lower costs.
Former President George W. Bush also pushed for e-health records, creating the Office of National Coordinator for Health Information Technology to oversee the effort.
Those efforts were justified in a study published last month in the Archives of Internal Medicine that found when doctors in hospitals use health information technology to its full potential, there are fewer deaths, fewer complications and lower healthcare costs.
The study, based on a survey of doctors from 41 hospitals in Texas, found relatively modest increases in technology use had dramatic results. For example, a 10% increase in the use of electronic notes and medical records was associated with a 15% reduction in the likelihood of patient death. The study showed when doctors electronically entered their instructions for patient care, there was a 55% reduction in the likelihood of death for some procedures.
But going paperless is an ambitious goal for the U.S. healthcare industry. A survey of 2,700 U.S. doctors by the New England Journal of Medicine in July showed only 4% were using fully functional electronic health records systems. The rest still are based on paper.
It is not known exactly how many U.S. hospitals are wired. Some estimates indicate about one-third of the nation’s hospitals use computerized order-entry and medical record systems. Proponents say electronic health records can reduce medical mistakes, eliminate duplication and waste, lower costs, improve care and minimize hassle for patients.
“Patients will not have to give their address, insurance information and other basic information over and over again,” the U.S. Department of Health and Human Services says on its website. “More importantly, the information needed to treat patients effectively will be a computer click away, no matter where the patient is receiving care.”
But some people are skeptical of the claims being touted by advocates of e-health records. Ron Lagoe of the Hospital Executive Council, a Syracuse hospital planning agency, said there is not much evidence from studies yet supporting the supposed benefits of e-health records. “We have people out there living a dream, thinking this is going to accomplish something by itself,” he said.
Electronic data alone won’t lower cost and improve quality unless they are coupled with incentives designed to change the behavior of doctors and other health care providers, he said. “It is highly questionable whether large investments in electronic health care data can be justified financially.”
The aggressive push for e-health records has also prompted some consumer groups and members of Congress to call for stronger privacy protections to prevent this data from being used inappropriately.
Letourneau said digital patient records in his practice are more private now than when they were entirely paper based. That’s because anyone who works in the practice who does not need to see patient records cannot access them on their computers. “Our front-end people who schedule appointments don’t have access to medical records,” he said.
New York is providing more than $10 million in grants to help digitize health records in Central New York. That’s part of $105 million the state awarded last year around the state for health information technology projects. The bulk of the $10 million will go toward the creation of an electronic information highway that will link Central New York doctors, pharmacies, hospitals and insurers.
The goal is to make sure a patient’s health records are available no matter where they seek care in the system. That represents a big viagra from the existing highly fragmented healthcare system in which there are few incentives in place for information gathering.
The Health Advancement Collaborative of Central New York, a nonprofit planning group that represents local employers, doctors, hospitals and insurers, oversees the effort. Gov. David Paterson has said he would like to see some of the stimulus money used to accelerate the state’s adoption of health information technology.
Going paperless can be an expensive proposition for physicians. CNY Family Care, which has nine doctors, has spent about $210,000 on hardware and software.
But money is not the biggest hurdle, according to Letourneau, the practice’s CEO. “It’s the operational changes you go through that are harder and more costly. Your brain is wired to look at paper documents. The transition is hard,” he said, adding that his practice has digitized all parts of the health record except for physician progress notes that document care. Those notes will go paperless within the next 18 months.
Medicare, the federal health insurance program that covers people over 65 and the disabled, is requiring physicians to report more patient quality information. Health insurers also are inundating physicians with requests for more information.
Doctors will need to go digital to keep up with increasing demands on them for data, Letourneau said. “If you are a physician and you don’t think you will need it, you better retire. You have to have it.”
By Todd Zwillich
WebMD Health News
Reviewed by Louise Chang, MD
Feb. 17, 2009 — The economic stimulus bill signed by President Obama contains more than $140 billion in health care spending, designed mostly to ease the recession’s effects on workers and also to boost long-held goals of improving the nation’s health information infrastructure.
Most of the money is targeted to programs providing health coverage to low-income families or that help workers keep private coverage if they lose their jobs. But the new law also provides billions of dollars for medical research and incentives for doctors and hospitals to buy and use electronic medical records systems.
It also, for the first time, directly commits federal dollars to studies comparing medical treatments head-to-head in the hopes of finding out which ones work best or are the most cost-effective.
The key health care provisions of the American Recovery and Reinvestment Act of 2009 include:
Medicaid
More than 50 million Americans get medical care through Medicaid, but state governments say they may be forced to cut back on coverage to make up budget shortfalls. The bill increases federal payments by $87 billion to prevent those cuts, and also penalizes states if they do cut benefits while the extra money is available.
Private Insurance
A federal law called COBRA guarantees workers can keep their private health insurance if they lose their jobs. But those workers have to pay the full premiums themselves. The bill spends $25 billion to cover 65% of the premium costs for lower-income workers.
“It will not achieve any structural reform in the system but it will help a lot of people in the near term,” says Len Nichols, who directs the health policy program at the New American Foundation.
Health IT
Doctors, hospitals, and health insurers have been slow to acquire electronic prescribing and computerized medical records systems. The systems are expensive and many medical practices fear that any system they buy won’t be able to communicate with other systems on the market, says Henry Aaron, a senior fellow at the Brookings Institution.
The recovery bill commits $19 billion in grants and incentives for companies and practices to buy health information technology. Aaron says the money isn’t a short-term economic stimulus, but instead a “down payment” on an effort to improve efficiency and quality in the health system.
“They do hold out the promise of producing very real long-term benefits — and I emphasize long-term benefits — in the health care system,” he says.
Medical Research
The bill includes $10 billion to increase the research budget of the National Institutes of Health (NIH).The Senate originally boosted that spending by $6.5 billion, but the figure was moved higher in negotiations with the House. That’s on top of the agency’s $29 billion budget, which remained flat last year.
Medical and research groups praised the extra funding. “This bill will reverse years of flat research funding, create economic growth, and allow doctors and researchers to accelerate progress against cancer and other diseases,” Richard L. Schilsky, MD, president of the American Society of Clinical Oncologists, says in a statement.
Comparative Effectiveness
Many policy experts are calling for more studies pitting different drugs, treatments, or care regimens directly against each other. The hope is that the studies will tell policy makers, doctors, and insurance companies which treatments actually work best and which are the most cost-effective.
Both parties have called for the research, and the bill devotes $1.1 billion to comparative-effectiveness studies at NIH and other agencies.
James Weinstein, MD, a comparative-effectiveness researcher at the Dartmouth Institute for Health Policy and Clinical Practice, says the health system is full of examples of more expensive treatments that may not necessarily be better. One example is thiazide diuretics, which research suggests are just as effective as more expensive calcium channel blockers at lowering blood pressure, preventing heart attacks, and avoiding hospitalizations.
“And if the drug was the same, shouldn’t the nation think about using the drug that’s just as good for a third the price?” he tells WebMD.
The inclusion of the money in the stimulus package angered some Republicans, who argued that the new law opens the door for government or private insurers to refuse payment for certain kinds of care based on the studies. That could lead to rationing of medical care if the government takes a bigger role in national health policy as part of reform efforts.
Billions of dollars could be at stake if one drug or treatment is found to be more cost-effective than another, Aaron says. He called the studies potential “political dynamite.”
is sponsoring a digital advertising contest a la the Superbowl Doritos ad. We know a lot of comedians, actors, and general digital media enthusiasts and we’ll be leaning on these gals and guys heavily for submissions and we’re excited about the prospects.
We’re still ironing out the prize money, but there will be prize money for first, second, and third place commercials. Here’s what I know so far.
* 30 second spot
* Somewhere in there (preferably at the end, but not necessarily) Remote Imaging Solutions is mentioned, with a link to our website, http://www.remoteimagingsolutions.com. It is a commercial, after all. Apart from that, feel free to have fun with this.
* It needs to be “clean” in that we will be posting this on YouTube, Facebook, MySpace, our website, and possibly TV. So if you use curse words, bleep them a la the Budweiser “swear jar” commercial. And TV standards for nudity. Apart from that, go nuts. Have fun.
* The message that we’re trying to drive across is that relying on paper to run the office is sooo outdated. For example, places don’t *need* indoor plumbing… one *could* build an outhouse or use a porta-potty… but can you imagine an office with porta-potties outside? No way. In the same way, people don’t *need* to go paperless… but relying on paper to run an office is as backwards as having an outhouse, in our opinion. So we think the way to drive this message home is to make fun of offices that stubbornly refuse to get with the times and cling to their old paper ways like a 130 year old person who doesn’t trust indoor plumbing. This is where the creativity comes in… we don’t want to tie you down with a slogan, just this idea: Staying with paper to run an office is incredibly backward. Join the 21st century. Remote Imaging Solutions will get you there.
* We’d like submissions in by March 22nd.
* We will be doing more of these contests. I see this as a way to use our local talent (comedians and actors) and promote that talent while promoting our business.
Submissions will be judged on humor first and full credit will be given to the creators on all marketing materials. Email us at Info@remoteimagingsolutions.com for more or to submit your entry. Good luck!