ONC: 2011 CRITERIA TO BE BASIC
The federal government intends to implement a basic level of initial 2011 criteria for meaningful use of electronic health records systems to determine who will receive Medicare and Medicaid incentives under the American Recovery and Reinvestment Act. The meaningful use criteria then will get tougher in 2013 and 2015.
That's the word from David Hunt, M.D., chief medical officer in the Office of the National Coordinator for Health Information Technology. Because the start of the incentive program in 2011 will be here "in the blink of an eye," the government's meaningful use definition must focus on goals that hospitals and physicians "can achieve quickly and reasonably," Hunt stressed. Thus, the Centers for Medicare and Medicaid Services primarily will be seeking evidence in 2011 that providers have purchased and are using EHRs, he said.
"You have to be able to send data and CMS has to be able to receive it," Hunt said. "The big thing for 2011 is that you actually acquire this equipment and start using it."
While explaining three major periods of phasing in meaningful use criteria for EHRs, Hunt labeled 2011 as a period of "structure," 2013 a period of "process" and 2015 a period of "outcomes."
Criteria in 2013 will focus on process measures to demonstrate providers have started to meaningfully use EHRs, Hunt noted. Goals and objectives for 2015 criteria will be heavily outcomes-oriented. "This is where we start to see results," he said, pointing to eventual efforts to measure the actual impact EHRs have on the quality of care. -JG
KEYNOTER OUTLINES CHALLENGES
The $2 billion in information technology "jump start" funds within the American Recovery and Reinvestment Act puts the Office of the National Coordinator for Health Information Technology in a difficult political position, said Dan Rode, vice president of policy and government relations at the American Health Information Management Association.
The discretionary funds can be spent as National Coordinator David Blumenthal, M.D., sees fit, to advance development of a national health information network. "That's a real political decision for the ONC," Rode, the Summit's keynoter, said. "We've given $2 billion to the office and said, 'Go out and spend it wisely.' We'll have governors and other policymakers across the nation deciding if the money was properly distributed."
Likewise, rules for Medicare and Medicaid incentives for meaningful use of electronic health records, particularly Medicaid, will be done in a highly political environment, Rode noted. And with that could come high reporting burdens for providers. "If these are the good goals, then how do we measure them and measure them in ways that don't become a burden themselves?" -JG
BREACH RULES REQUIRE NEW LOOK AT HIPAA
New federal requirements under the American Recovery and Reinvestment Act governing the notification of breaches of protected health information bring major changes to the HIPAA privacy and security rules, said Steven J. Fox, a partner in the Washington law firm Post & Schell. "You do have to really start over with HIPAA," he told attendees at Health Data Management's Health IT Stimulus Summit in Boston. "You're going to have to do new education."
And that training will need to continue on a rolling basis during the next year as new guidance and rules are published to replace an interim rule from the Department of Health and Human Services that became affective on Sept. 23. An interim rule from the Federal Trade Commission, covering protection of personal health records, became effective on Sept. 17.
Health care organizations must update their privacy and security policies and procedures to ensure an adequate response to breach incidents, Fox noted. Not only does ARRA strengthen privacy and security rules, but it also gives state attorneys general the right to enforce HIPAA privacy and security rules. "I can see some of them wanting to get in on this," he added.
Organizations this year should reassess their security risks and make corrections, such as installing encryption on electronic devices, e-mail systems and home-based work computers, Fox advised. "You're not required to do encryption, but it makes a lot of sense," he said. -JG
TRAINING CALLED ESSENTIAL TO EHR SUCCESS
A key strategy for successfully rolling out an electronic health record at a group practice is providing custom training for users with different technology skills and personalities, the CEO of a practice with 235 physicians says.
Guthrie Clinic in Sayre, Pa., divided doctors into 11 groups for training purposes, says Joseph Scopelliti, M.D. president and CEO. For example, he jokes, some were labeled as "tech-savvy but grumpy" while others were "easy-going but uniformed." Then the practice developed 11 targeted training programs to meet doctors' specific needs.
Practices that want to implement EHRs on a short timeframe to qualify for maximum Medicare and Medicaid incentives under the American Recovery and Reinvestment Act must devote significant internal resources to training rather than relying heavily on their EHR vendor, Scopelliti says. "We took our vendor's training playbook and expanded it tenfold," he says.
The CEO warned practice managers to avoid training doctors too early in the process. Guthrie provided 12 hours of training four days before go-live at each site, plus another four hours of training on go-live. -HA
EHR SUBSIDIES REQUIRE CFO SUPPORT
Hospitals launching programs to offer subsidies to help area physicians adopt electronic health records should prepare for skepticism from their finance departments, a veteran of two such programs says.
"Finance views it as a big change for a hospital to sell something other than health care services," says Doug Blair, director of ambulatory technology at Christ Hospital in Cincinnati. "But hospitals sell bubble gum in their gift shops," he notes, so they already have experience in accounting for retail sales of merchandise.
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