Earning incentives for meaningful use requires your EMR system to communicate with other technology systems outside your office. But how do you make that happen?

Many physicians are working to adopt an electronic medical record, or have recently done so. But if they plan to use the EMR to earn government financial incentive bonuses, they’re going to need to make their EMRs talk to other EMRs and health information technology systems.

The key to earning incentive pay — up to $44,000 per physician from Medicare or $64,000 from Medicaid — is to become a “meaningful user” of your EMR. The government has made it clear that the key to meaningful use is your ability to participate in a health information exchange. In other words, your EMR must be able to connect with IT systems in other practices, hospitals, labs or other locations to send and receive data.

The movement or exchange of data can take on many forms, including exchanging clinical notes with other physicians and requesting and receiving a patient’s entire medical history. The sophistication of data exchange will grow and develop over time, but right now experts say physicians should be prepared to take baby steps.

The first of those steps is installing an EMR capable of talking to other systems outside of your practice. Think of it as the difference between having a computer and having a computer that is connected to the Internet.
The large number of EMR systems on the market might make finding one capable of meeting the right technical criteria seem overwhelming. But the government has made it simpler to find a system that will handle the exchange of data required under meaningful use.

The Office of the National Coordinator for Health Information Technology has developed a set of technical requirements that EMR systems must meet to ensure that they are capable of exchanging data with other systems. The ONC is approving organizations that will test and certify EMRs for their ability to meet these requirements.

Even though the first two certifying bodies, the Certification Commission for Health Information Technology and the Drummond Group, were only approved in August, the criteria an EMR must meet to be certified has been in the hands of EMR vendors for several months. Most are offering a guarantee that their products will be certified so that physicians don’t have to wait to make a purchase.

The next step is developing electronic communication with other entities outside your practice. It could be pharmacies, labs, other practices, insurers, a local hospital or other ancillary practices with whom you now communicate by mail, phone or fax.

Road to meaningful use
The term health information exchange describes the act of exchanging data between two or more health care organizations. But it also can refer to the network on which that information is exchanged. A regional health information organization is a more formal HIE run by a business entity and designed to coordinate the exchange of data between health care organizations across a predetermined geographical region, such as a state. The two terms, HIE and RHIO, often are used interchangeably.

There won’t be many options in most areas in terms of which HIE or RHIO you participate with, experts say. Your local hospital (or hospitals) might connect with you and its affiliated physicians to create its own local HIE. Or, there might be a formal RHIO that any physician in that region can be a part of. Or there might be both.

Each RHIO or HIE is governed and managed in its own way. Each one exchanges different types of data and is capable of accomplishing different tasks. Each has its own business structure. One might allow you to request information on a particular patient, and if that information is there, you are charged for what you use, normally a few cents per transaction. The HIE also could be membership-based, requiring a monthly subscription fee, normally less than $100 per physician.

So how do you choose? Experts say you first should determine what information you would like to exchange or have access to.

The final rule for stage 1 of meaningful use requires physicians to have the ability to send prescriptions and hospital-based medication orders electronically, which are both on the list of 15 required objectives. There is another list of 10 objectives, from which physicians can choose five. They include tasks such as reporting electronically to state immunization registries and providing summary-of-care records to other physicians.

Experts say practices need to map out their own road to meaningful use and choose objectives from the ONC’s list accordingly. The HIE you choose will need to accommodate the data exchange required under your chosen objectives.

Greg DeBor, partner in the health care division of the Falls Church, Va.-based consulting firm CSC, said the first thing physicians should consider when developing this plan are referral patterns and how they fit into their workflows.

He said referral patterns are important, because if there is one primary hospital to which a practice refers patients, the practice should focus on how it can exchange patient information with that hospital to make the referral process smoother.

“If, on the other hand, you practice across different entities or communities or across state lines, you have to consider either which HIE, or how many HIEs, you might need to participate in, in order to get the benefit that those HIEs will deliver in terms of supporting your workflow,” DeBor said.

“The whole point of these health information exchanges is to provide each of the clinicians, both the physician who is treating the patient and the physician who previously treated the patient, with the best up-to-date information possible,” said Barry Chaiken, MD, MPH, a fellow with the Healthcare Information and Management Systems Society and chief medical officer of Imprivata, a health IT software vendor based in Lexington, Mass. The goal is to go to the HIE that will be the best source of information, depending on who your patients are, and where else they may have been treated.

DeBor said practices should consider how they want to approach health system reform when deciding on their information-exchanging objectives.

For example, a practice wanting to become a patient-centered medical home will want to find an HIE that allows the exchange of data such as patient summary charts and problem lists between various physicians on a patient’s care team, he said. If a practice wants to be part of an accountable care organization, it probably would need an HIE with the ability to send and receive data to and from public health sites.

Many HIEs also are serving as the regional extension centers charged with helping physicians meet meaningful use. So even if sophisticated data exchange isn’t in the short-term goals for a practice right now, many HIE activities are geared toward helping physicians meet meaningful use. That reason alone might make it worth a physician’s time to get involved with one, experts say.

Meeting physician needs
Physicians can help the HIEs’ development in ways that will benefit them best. Experts say the key to any HIE’s success is to create value for the physicians it is trying to attract, which is why many are still evolving. Chances are, if a practice finds that the local HIE or RHIO is not offering the exchange capabilities it needs, others will find them inadequate as well.

Christina Galanis, executive director of Southern Tier HealthLink, a RHIO in New York, said physicians have been a great influence in the way her exchange has evolved.

“One of the most appreciated [aspects of the HIE] in our community is for the health information exchange to move its electronic referral data to a recipient who has an EMR,” she said. “That is perceived to be of great value to physicians.”

Without that ability, it has to fax information to the referred physician, which would cost up to $15,000 per doctor per year because of photocopying, faxing and keying in information from a chart, she said. This transfer capability is one the organization decided to add due to physician demand.

Deb Bass, interim executive director of the Nebraska Health Information Initiative, said her organization has been named by the state as a regional extension center to help doctors achieve meaningful use. That has been its greatest selling point, she said. In addition to HIE services, NeHII offers a complete package with an EMR.

Bass said some physicians might need to take things one piece at a time and not take advantage of everything an HIE offers right away.

Stephan Thome, MD, an oncologist in Omaha, Neb., said the most important thing for him was e-prescribing, a function of the NeHII system.

Dr. Thome hasn’t implemented an EMR yet, but he said he found the benefits of having e-prescribing and medication lists for his patients far more important than meeting the meaningful use criteria starting next year. He plans to apply for the meaningful use bonus later so he can take his time adopting a system.

Whether or not a physician should wait to take advantage of all the local HIE has to offer is a difficult decision, experts say. Though the actual participation in a data exchange is limited to only a few functions for stage 1 meaningful use, stage 2 will make more demands.

“If those HIE activities, whether they are hospital-sponsored or community- or state-sponsored, aren’t mapping themselves to HIE and don’t have an answer for how they’ll help physicians receive their meaningful use incentives, they will be out of business in the next year,” DeBor said. “You can kind of safely assume there’s a strong effort under way to align those things.”
 
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Virtual Global, a West Virginia corporation, is a provider of cloud-enabled enterprise IT solutions, including the TeamHost™ cloud platform for creating and deploying SaaS systems without programming; HealthCapsule™, a toolkit for creating secure Health IT solutions; TeamLeader™, a project management 2.0 software for tracking and reporting on virtual teams in real-time; and cloudipedia.com, a website that brings cloud computing information to the masses. Since 1995, Virtual Global’s platform technologies have served commercial and federal customers worldwide with enterprise-class IT needs.

by: David Blumenthal and Don Berwick

Editor’s Note: The post below is by David Blumenthal, National Coordinator for Health Information Technology, and Don Berwick, Administrator of the Centers for Medicare and Medicaid Services.

On July 13, with the issuance of two regulations defining and supporting “meaningful use” of electronic health records (EHRs), our nation began in earnest its journey toward ubiquitous and effective use of health information technology. In considering the significance of this moment, it is useful to remember the events and energies that have brought us to this starting point, and to understand the many different elements that will support this initiative. 

The proximate event leading us to the July 13 announcement was the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act, in February 2009. This act makes available unprecedented resources to support the nation’s transition to EHRs. In the months since its enactment, extensive preparations have been made. These constitute the operational supports for a multiyear, multiphase campaign of EHR adoption and use. But behind these preparations lies a longer and deeper history that has prepared us to seize this moment.

It was six years ago that the Office of the National Coordinator for Health Information Technology (ONC) was created. The recognition of the need for a federal leadership role reflected a growing professional and bipartisan consensus regarding the potential benefits of health information technology (IT). In the intervening years, we have also seen an increasing understanding of both the opportunities and the barriers to the dissemination of electronic health information systems.

Of even greater importance, it was a decade ago that the Institute of Medicine (IOM) published findings regarding safety and quality of health care in America in a pair of groundbreaking studies: To Err Is Human and The Quality Chasm. Those findings altered the nation’s understanding of its health care system and the results it was achieving, as well as highlighting the great potential for improvement. The IOM reports played an important part in illustrating both the need for improved information systems in health care and the potential for electronic data to help fill that need.

Finally, it has been more than 20 years since pioneering health care institutions began developing early digital systems to support clinicians and improve patient care. Some of the successes and the failures along that road are well-known; others made their contribution with less notice. All of them deserve our appreciation. Both of the authors are beneficiaries of those efforts; both of us are able to testify now to the potential of health IT because we benefited in our practice of medicine from the efforts of early adopters and EHR technology developers.

This brief history demonstrates that our nation has undergone a long learning process in preparation for the initiative we are now undertaking. A review of the pages of Health Affairs itself would reveal a layered progression of discovery and understanding. For some years, we have reviewed the evidence and considered the questions: “Is the technology ready for significant national investment?” and “How is such investment to be made?”

HITECH: Answering The Questions

Congress answered those questions in HITECH, not only by providing significant new resources, but equally importantly by creating a multifaceted structure of standards, supports, and protections that reflect the learning of many years. Since enactment of HITECH, the ONC, the Centers for Medicare and Medicaid Services (CMS), other federal and state agencies, and a myriad of stakeholders have been working to assemble and launch the many elements of a national EHR initiative.

First, Congress found that universal adoption and meaningful use of EHRs can indeed yield unique and substantial benefits that are urgently needed in our health care system—to improve individual and public health, support providers in the delivery of care, empower patients, and improve cost-effectiveness. At the same time, the implementation of health IT must be synergistic with other efforts. A modernized health IT system will be a resource for the innovation, spread of ideas, rewards for excellence, patient empowerment, and transparency that are all envisioned in the Patient Protection and Affordable Care Act.

To help achieve those benefits, HITECH authorized significant federal expenditure over a ten-year period: up to an estimated $27 billion in incentive payments through Medicare and Medicaid to support clinicians and hospitals in the adoption and use of EHRs. This projected federal spending recognizes both the real financial challenges that providers face in acquiring EHR systems, as well as the potential benefits to the nation as a whole from such investment.

Second, Congress made clear that HITECH’s incentive payments are not intended merely to support acquisition of EHR technology for its own sake. Simple digitalization of information does not produce the benefits we seek. Instead, as outlined by the law, it is the “meaningful use” of EHR systems that creates new value—including the capacity to make a patient’s information available when and where it is needed, and the capacity to improve patient safety and quality of care. To achieve those goals for the meaningful use of EHRs, the Department of Health and Human Services (HHS) developed three companion regulations: 

• A CMS regulation defining the meaningful use objectives that providers must meet in the initial years to qualify for incentive payments (announced July 13);
• An ONC regulation specifying the standards, implementation specifications, and certification criteria that EHR systems must meet in order to be certified as capable of supporting the meaningful use requirements (announced July 13); and
• An additional ONC regulation initiating a rapid certification process, so that qualified EHR systems can be made available quickly, and providers can have confidence that the systems they acquire will successfully perform the functions required to obtain incentive payments (announced June 18.) A permanent certification process will be put in place shortly.

Third, HHS continues to build the protections necessary for an EHR-based health care system. Privacy and security are the bedrock of building trust, a “must-have” component for the success of health IT. On July 8, the HHS Office for Civil Rights announced a proposed rule strengthening protections under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The proposed rule would expand individuals’ right to access their information and restrict certain disclosures of protected health information to health plans; extend the application of important privacy and security requirements to the business associates of entities already covered under HIPAA; establish new limitations on the use and disclosure of protected health information for marketing and fund-raising purposes; and prohibit the sale of protected health information without patient authorization.

Finally, Congress provided a variety of supports to assist providers in adopting and using EHRs, and to help enable EHR technology to keep moving forward: 

• The Health Information Technology Extension Program ($643 million). A nationwide network of Regional Extension Centers (RECs) will provide technical assistance to clinicians, especially those who provide primary care services in smaller practices. Clinicians in such practices deliver the majority of primary care services but have the lowest rates of EHR adoption and the least access to resources to help them implement and use EHRs. The RECs’ goal is to provide outreach and support services to at least 100,000 high-priority primary care providers within two years. A Health IT Research Center will also provide support materials, especially to clinicians serving patient populations with special needs. 
• The State Health Information Exchange Cooperative Agreement Program ($564 million). This grant program is helping states to rapidly build capacity for exchanging health information. The ability to exchange information is vital to realizing the benefits of EHRs, and state leadership is essential to achieving this. 
• The Health IT Workforce Training Program ($118 million). There is a national shortage of health IT professionals who can help clinicians and hospitals achieve meaningful use. The workforce training program will support education of health IT personnel, including curriculum development, funds for community college programs, and competency examinations. 
• The Beacon Community Program ($235 million). This grant program has identified leading communities where health and IT goals are being combined to demonstrate improved health and care results. They will focus on achieving measurable health and efficiency improvements over a compressed time frame, and they will provide lessons that can be transferred to other communities in the United States. 
• The Strategic Health IT Advanced Research Projects (SHARP) Program ($60 million). This grant program will fund research to address key issues for health IT use that could impede progress in adoption and meaningful use. 

In addition, the ONC continues to develop a National Health Information Network, a secure means for exchanging health information to ensure that the information follows the patient.

Thus, since enactment of HITECH, a constellation of efforts has been assembled and coordinated to carry out a national initiative on EHR adoption. These go well beyond the simple authorization of bonus payments through Medicare and Medicaid. They focus on achieving health results through meaningful use of EHRs. They address the bedrock issues of privacy, security, and public trust in health IT. And they include new programs to support providers in adopting and using EHR systems.

July 13: Beginning The Journey In Earnest  

July 13 marked the beginning of a national EHR initiative. On that day, with the many other elements in place, the final CMS regulation on incentive payments and meaningful use was announced, as was the final ONC regulation on standards and certification.

In the final CMS regulation, significant changes were made from the rule published last January, to better enable providers to meet the requirements of meaningful use and qualify for incentive payments. The total number of objectives to be met in Stage 1 (2011-12), as well as the thresholds associated with those objectives, were reduced.

Other changes were also made in response to the more than 2,000 comments received. We recognize the challenge that providers face in making the transition to EHRs. Our goals for EHR adoption and use remain high, but they must be attainable by the average clinician and hospital. We have sought to make our objectives for meaningful use both ambitious and achievable.

The issuance of these two final rules and the launch of a national incentive campaign affirm and carry out the goals set by Congress and the President. After many years of discussion and learning, the time for action is here. EHR systems will not be perfect as we embark on this transformation. We will learn and adjust as we move through this multiyear process. And for smaller practices and hospitals especially we want to offer assistance. 

But we believe the time for waiting is over. EHR adoption and meaningful use hold the promise of safer, higher-quality care for patients. They will enable health care professionals to serve with greater effectiveness and confidence. They will enhance public health and make more cost-effective use of our nation’s unparalleled health care resources. 

It is our privilege to be able to help our health care colleagues bring about these improvements. It is our pledge to work closely and productively with them to achieve these goals.

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Virtual Global, a West Virginia corporation, is a provider of cloud-enabled enterprise IT solutions, including the TeamHost™ cloud platform for creating and deploying SaaS systems without programming; HealthCapsule™, a toolkit for creating secure Health IT solutions; TeamLeader™, a project management 2.0 software for tracking and reporting on virtual teams in real-time; and cloudipedia.com, a website that brings cloud computing information to the masses. Since 1995, Virtual Global’s platform technologies have served commercial and federal customers worldwide with enterprise-class IT needs.

(Health and Human Services Department Documents and Publications/ContentWorks via COMTEX) — SUMMARY: The Department of Health and Human Services (HHS) is issuing this final rule to complete the adoption of an initial set of standards, implementation specifications, and certification criteria, and to more closely align such standards, implementation specifications, and certification criteria with final meaningful use Stage 1 objectives and measures. Adopted certification criteria establish the required capabilities and specify the related standards and implementation specifications that certified electronic health record (EHR) technology will need to include to, at a minimum, support the achievement of meaningful use Stage 1 by eligible professionals, eligible hospitals, and/or critical access hospitals (hereafter, references to “eligible hospitals” in this final rule shall mean “eligible hospitals and/or critical access hospitals”) under the Medicare and Medicaid EHR Incentive Programs. Complete EHRs and EHR Modules will be tested and certified according to adopted certification criteria to ensure that they have properly implemented adopted standards and implementation specifications and otherwise comply with the adopted certification criteria.

DATES: Effective Date: This final rule is effective August 27, 2010. The incorporation by reference of certain publications listed in the rule is approved by the Director of the Federal Register as of August 27, 2010.

FOR FURTHER INFORMATION CONTACT: Steven Posnack, Director, Federal Policy Division, Office of Policy and Planning, Office of the National Coordinator for Health Information Technology, 202-690-7151.

News posted by Virtual Global:

Virtual Global, a West Virginia corporation, is a provider of cloud-enabled enterprise IT solutions, including the TeamHost™ cloud platform for creating and deploying SaaS systems without programming; HealthCapsule™, a toolkit for creating secure Health IT solutions; TeamLeader™, a project management 2.0 software for tracking and reporting on virtual teams in real-time; and cloudipedia.com, a website that brings cloud computing information to the masses. Since 1995, Virtual Global’s platform technologies have served commercial and federal customers worldwide with enterprise-class IT needs.

Verizon announced on Wednesday a new cloud-based service offering for healthcare providers that will handle the sharing of patient information electronically between disparate platforms.

The new service, called the Verizon Health Information Exchange , consolidates clinical patient data from various providers and translates it into a standardized format that can then be accessed via a secure Web portal.

Kannan Sreedhar, vice president of Verizon Connected Health Care Solutions, said the service will address interoperability issues currently hindering physicians, hospitals and insurance companies from sharing patient information because of the myriad of applications used to create, and formats being used to store, the data.

“Providing secure access to patient data will enable health care organizations to make a quantum leap forward in the deployment of IT to meet critical business and patient-care issues,” he said in a statement.

Users of the service will be able to share data across states and regions, requesting patient data via the Web portal regardless of the IT systems and specific protocols the providers use, Verizon said.

Because the Verizon Health Information Exchange will be delivered via Verizon’s cloud computing platform, health care organizations will be able to use their current IT systems, processes and workflows, without large additional capital expenditures, the company stated.

The service charges based on a health provider’s patient record volume.

Verizon is using technology from several database, medical application vendors and service providers — including MEDfx, MedVirginia and Oracle — to deliver key features of the service, including: clinical dashboard, record locator service, cross- enterprise patient index and secure clinical messaging.

“The ability to dynamically scale technical resources and pay for those used are key benefits of health information exchange platforms hosted in the cloud,” Lynne Dunbrack, program director of IDC Health Insights said in a statement.

“Cloud-based platforms will appeal to small to mid-sized organizations looking to shift technology investment from capex to opex and to large regional or statewide initiatives that need to establish connectivity with myriad stakeholders with divergent needs and interoperability requirements,” she said.

MedVirginia Inc. , a regional health information exchange (RHIO) located in Richmond, plans to use Verizon’s Health Information Exchange service.

Formed in 2000 by a consortium of Virginia health care providers, MedVirginia launched its health information exchange in 2006. Michael Matthews, CEO of of MedVirginia, said the RHIO’s needs enhanced functionality, flexibility, performance and scalability.

“The cloud-based Verizon Health Information Exchange meets those requirements,” Matthews said.

Verizon said its service meets federal standards for privacy under the Health Insurance Portability and Accountability Act, and it also complies with requirements under the Nationwide Health Information Network, which is under the Office of the National Coordinator for Health Information Technology to support the secure exchange of health information over the Internet.

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas’s RSS feed . His e-mail address is lmearian@computerworld.com .

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News posted by Virtual Global:

Virtual Global, a West Virginia corporation, is a provider of cloud-enabled enterprise IT solutions, including the TeamHost™ cloud platform for creating and deploying SaaS systems without programming; HealthCapsule™, a toolkit for creating secure Health IT solutions; TeamLeader™, a project management 2.0 software for tracking and reporting on virtual teams in real-time; and cloudipedia.com, a website that brings cloud computing information to the masses. Since 1995, Virtual Global’s platform technologies have served commercial and federal customers worldwide with enterprise-class IT needs.

Newswise — A computer security invention patented* a decade ago at the National Institute of Standards and Technology (NIST) is now poised to help safeguard patient privacy in hospitals.

The invention—an algorithm that can be built into a larger piece of software—is designed to control access to information systems, and it has attracted the attention of a company that is putting it to use in the health care field. John Barkley, the algorithm’s creator, says the idea could solve one of the pervasive issues in the country’s health care system.

“We think this software will provide dramatically improved security and privacy to patients,” says Barkley, now retired from NIST’s Software and Systems Division and now consulting with Virtual Global, which is commercializing the product. “It solves the problem of overly broad access to patient information, which is widespread.”

Barkley’s efforts stretch back to the 1980s, when the computer tools available for protecting electronic information were poor. Generally, access to information was available to anyone whose name was on a specific list of authorized users, but a large organization might have thousands of restricted files, each with its own access list—making security management awkward. Help came with the creation of Role-Based Access Control (RBAC), in which a person’s job function, not name, was the key to accessing a particular file. However, even RBAC could allow large numbers of people to have unlimited access to information—a particular problem in health care, where it is crucial but difficult to guarantee patient privacy.

“We didn’t invent RBAC, but we wanted to systematize it and standardize it,” says Richard Kuhn of NIST’s Computer Security Division and Barkley’s former supervisor. “While we were working on this, John [Barkley] came up with a way to control access by using RBAC within the context of a lengthy, multistep task, and I suggested he patent it.”

In essence, the patent covers a method of ensuring that access to information is available to those who need it, but only when necessary. For example, at a hospital, the patient admission procedure involves a number of steps, and in each step someone needs access to the patient’s medical records for a specific purpose, like registering the patient or verifying their insurance information.

“Once you’ve been admitted to the hospital, the admissions staff doesn’t necessarily need access to your records anymore. But in many hospitals, those staff members nonetheless continue to have access to every record on file,” Barkley explains. “Using the algorithm we patented, those staffers would only be able to access your record during admission processing. After that, they would find your information unavailable—though the doctor who was treating you would still have access to it.”

NIST released a Small Business Innovation Research solicitation in an effort to find a company to develop a product from the patent in 2008, which happened to be when Virtual Global, Inc., was searching for a way to protect electronic records for its clients. The company purchased the rights to it shortly thereafter and integrated the invention into its “HealthCapsule” cloud platform. Virtual Global is now using HealthCapsule to create a pilot security system for LIFE Pittsburgh, a long-term care facility.

* J. Barkley. “Workflow Management Employing Role-Based Access Control,” U.S. Patent No. 6,088,679. July 11, 2000. Available at http://www.itl.nist.gov/div897/staff/barkley/6088679.pdf

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News posted by Virtual Global:

Virtual Global, a West Virginia corporation, is a provider of cloud-enabled enterprise IT solutions, including the TeamHost™ cloud platform for creating and deploying SaaS systems without programming; HealthCapsule™, a toolkit for creating secure Health IT solutions; TeamLeader™, a project management 2.0 software for tracking and reporting on virtual teams in real-time; and cloudipedia.com, a website that brings cloud computing information to the masses. Since 1995, Virtual Global’s platform technologies have served commercial and federal customers worldwide with enterprise-class IT needs.