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Sampling of opinions on meaningful use Stage 2

I’ve been an absentee blogger yet again the last few weeks. Here’s something to chew on while I get caught up, a sampling of all the statements I received regarding the Stage 2 final rules for meaningful use, in the order I received them. Most interesting are what the consumer groups had to say because CMS lowered the threshold for sharing records through a patient portal to a laughable 5 percent of patients, down from the proposed (and almost equally laughable) level of 10 percent. Patients need to speak up and demand access to their own records. Providers need to stop fighting the inevitable.

National Partnership for Women & Families

Leading Consumer Advocate Lauds Stage 2 Meaningful Use Final Rule for Promoting Better Communication Among Doctors, Fewer Medical Errors and Lower Health Costs

Statement of Christine Bechtel, Vice President, National Partnership for Women & Families

“The Stage 2 Final Rule released by the Centers for Medicare & Medicaid Services (CMS) this afternoon is a huge step forward. It brings us closer to the days when fewer overwhelmed patients and their family caregivers struggle to keep track of tests, diagnoses and medications; beg their doctors to talk to one another; suffer avoidable medical errors; and pay for duplicative and unnecessary care. The rule issued today offers the promise of better, more efficient care, improved safety and fewer hospital readmissions.

We are pleased that the new rule gives patients the ability to go online and view, download and transmit their health information from the Electronic Health Record (EHR) to secure places of their choosing. A recent public opinion survey commissioned by the National Partnership for Women & Families found that this kind of feature helps consumers see great value in physicians’ use of EHRs, and helps them have more trust in electronic systems. The fact that this is now a core requirement, and will apply to the hospital setting as well as to physicians, is key to finally recognizing the critical role patients play as partners in their own care. This is a huge advance that will allow patients to be more actively engaged in their care. It helps realize the potential of health IT in ways the nation needs.

It is good that the new rule also recognizes the essential role that providers and their staff play in encouraging patients to use this online access. It does that by holding physicians and hospitals accountable for ensuring that 5 percent of their patient population logs in once during the year.

In addition, enabling patients to download and transmit their health information electronically will help foster more of the kind of information sharing that is desperately needed to facilitate care coordination, improve safety and reduce costs. Patients play a key role in information sharing, and this rule gives patients the tools they need to do just that.

The rule’s requirements that a summary of care document be sent from one provider to the next for at least one of every two transitions of care or referrals is a good step. CMS is also requiring 10 percent of those transmissions to be electronic. And providers will have to show they are capable of sending these documents to providers who have different EHRs.

Improving care coordination and patient engagement through these criteria (information sharing requirements and online access for patients) are cornerstones of building the foundation of interoperability that will support health system reform. So many new models of care like Accountable Care Organizations and medical homes will crumble without this bedrock foundation. This is a good day for consumers who urgently need a more efficient, safer, better coordinated health care system.”

Click the links below for:

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American Health Information Management Association

Meaningful Use Stage 2 Final Rule:

AHIMA Provides Initial Comments on CMS Ruling

CHICAGO – Aug. 23, 2012 – Today the final rule on the Electronic Health Record Incentive Program Stage 2 Meaningful Use (MU2) was announced by the Centers for Medicare and Medicaid Services (CMS). This act focuses on incentive payments to eligible professionals, hospitals and critical access hospitals participating in this program that successfully demonstrate meaningful use of certified electronic health record (EHR) technology.

A full analysis of this complex ruling announced as part of the American Recovery and Reinvestment Act – Health Information Technology for Economic and Clinical Health (ARRA-HITECH) will be forthcoming from the American Health Information Management Association (AHIMA). AHIMA is the preeminent nonprofit association representing Health Information Management (HIM) professionals on the front lines for implementing the rule.

While AHIMA studies the complete text of the rule and its scope, the following points have been included:

Consistent with the proposed regulation, health information technology (HIT) measures will allow for patients to have the ability to view online, download, and transmit their health information within four business days of the information being available.
CMS continues to acknowledge and align Clinical Quality Measures with other reporting programs to reduce burden and duplication of efforts.
All HIT Menu Set measures have been transitioned to the Core Set of measures with the exception of electronic syndromic surveillance data and advance directives.

“We are encouraged to see CMS’ continued push toward actively exchanging health information to improve coordination of care thus improving patient safety,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE. “We are also pleased to learn of CMS’ continued commitment toward engaging patients and families in their healthcare through the ability to view online, download and transmit their health information. We believe patients must be partners and work side-by-side with their providers to achieve the best possible healthcare outcomes.”

According to Thomas Gordon, the 2014 compliance date CMS provided will enable the industry – providers, hospitals and vendors – the appropriate time to plan and implement the necessary changes.

“As HIM professionals, we are a critical component to the reporting of clinical and HIT quality measures in achieving meaningful use,” said Allison Viola, MBA, RHIA, senior director of federal relations at AHIMA. “We are pleased to see that CMS has heard our calls for increased alignment of quality reporting programs and acknowledgement of making an effort to reduce the reporting burden and duplication of reporting. We also stand ready to support patients and their ability to have online access to their health information to ensure its privacy, integrity, and timeliness for their continued care.”

Live webinars to discuss the rule’s provisions will be available free for AHIMA members and for $59 for non-members. Visit ahima.org for the schedule and registration information.

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Society for Participatory Medicine

Statement of Sarah Krug, president of the Society for Participatory Medicine:

“Although we’re disappointed this final rule does not give patients next-day access to their electronic medical record after they leave the hospital, we believe that on balance the Stage 2 Meaningful Use requirements go a long ways towards patient empowerment and feature a number of important patient-centered innovations. Patients must be full partners in access to their health information so they can be full partners in their care. For that reason, the Society for Participatory Medicine intends to keep a sharp eye on how the new Meaningful Use rules are actually implemented.”

Healthcare Information and Management Systems Society

HIMSS Statement on Release of Meaningful Use Stage 2 and Standards & Certification Criteria Final Rules

August 24, 2012 – (Washington, DC) – HIMSS appreciates the release of the Meaningful Use Stage 2 and Standards & Certification Criteria final rules by the U.S. Department of Health and Human Services. The Stage 2 regulations allow the healthcare community to continue the necessary steps to ensure health information technology will support the transformation of healthcare delivery in the United States.

In our initial review of the Medicare and Medicaid Programs; Electronic Health Record Incentive Program–Stage 2 Final Rule from the Centers for Medicare and Medicaid, HIMSS has identified several significant policy decisions, including:

Setting the Meaningful Use Stage 2 start date as 2014, which will maximize the number of eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) prepared to meet Stage 2 requirements
Allowing a 90-day reporting period in Year 1 of Stage 2, which is consistent with HIMSS’ recommendations on the proposed rule
Accepting 2013 as the attestation deadline for EPs, EHs, and CAHs to avoid a Medicare payment adjustment, and allowing for exceptions, including limited availability of information technology
Finalizing Clinical Quality Measure submission specifications for EPs, EHs, and CAHs

ONC’s efforts in the Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition appear to streamline the administrative process of certifying EHR products. We note that the Final Rule both adopts and concurs with a number of HIMSS recommendations. The HIMSS response to the proposed rule had requested several points of clarity and additional specification around certain criterion, and we commend the government’s thorough review and inclusion of additional information to clarify many topics.

We are assessing impacts of each Final Rule regarding Clinical Quality Measurement, reporting options, standards specifications, and alignment with other federal quality reporting and performance improvement programs.

We look forward to continuing to work with the federal government and our members to ensure that the EHR Incentive Program makes impactful improvements to the quality of healthcare delivery in the United States.

Stay tuned for in-depth analysis on HIMSS’ Meaningful Use OneSource; a webinar series in September; and a full slate of Meaningful Use education and exhibition activities at HIMSS13, including a new Meaningful Use Experience.

MGMA-ACMPE

Statement from Susan Turney, MD, MS, president and CEO of MGMA-ACMPE

“MGMA is pleased that the Centers for Medicare & Medicaid Services (CMS) responded to our concerns regarding several of the proposed Stage 2 meaningful use requirements. Extending the start for stage 2 until 2014 was a necessary step to permit medical groups sufficient time to implement new software. Permitting group reporting will reduce administrative burden, as will lowering the thresholds for achieving certain measures such as mandatory online access and electronic exchange of summary of care documents. MGMA supports the rule’s expanded list of exclusions and believes it will allow physicians to achieve meaningful use with fewer hurdles.”

Health IT Now Coalition

Health IT Now Coalition Expresses Concern over Meaningful Use Stage 2 Final Rule
Stresses clinical exchange measures are insufficient

WASHINGTON – The Centers for Medicare and Medicaid Services (CMS) today issued its final rule detailing criteria for Stage 2 of the federal electronic health-record system incentive program. The following should be attributed to Joel White, executive director of the Health IT Now Coalition<http://www.healthitnow.org>:

“While we are encouraged that ONC and CMS have recognized that care coordination cannot be achieved exclusively through directed exchange, the rule still fails to adequately address the core issue of interoperability. Providers, developers, and state health information exchanges have already adopted and implemented more mature and scalable standards that are functioning well in the market today.

“More could and should have been done to support the interoperability requirements necessary for advanced payment and delivery reforms to operate optimally. The measures for clinical exchange laid out in the Stage 2 final rule will likely not be sufficient.”

Health IT Now is a coalition to promote the rapid deployment of heath information technology (health IT). Health IT will benefit patients and health care consumers while supporting health practitioners to make smart decisions about patient care and save money. For more information, visit www.healthitnow.org<http://www.healthitnow.org>.

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College of Healthcare Information Management Executives

The College of Healthcare Information Management Executives (CHIME) today issued a statement in response to final rules on Stage 2 of the EHR Incentive Payments program, also known as Meaningful Use:

“CHIME applauds efforts made by officials at the Department of Health and Human Services in working diligently to prepare final rules on Stage 2 of the EHR Incentive Payments program,” said CHIME President and CEO Richard A. Correll.

“We commend the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT for seeing the wisdom and practicality of heeding many of CHIME’s recommendations, filed during the spring public comment period. By allowing providers to demonstrate Meaningful Use through a 90-day EHR reporting period for 2014, government rule-makers have ensured greater levels of program success. And by including additional measures to the menu set, providers have a better chance of receiving funds for meeting Stage 2.

“However, we also recognize that these points are conciliatory and that many details may need further clarification. The final rule still puts providers at risk of not demonstrating meaningful use based on measures that are outside their control, such as requiring 5 percent of patients to view, download or transmit their health information during a 3-month period. Some areas of clarification include some of the exclusionary language as well as nuances around health information exchange provisions, clinical quality measures and accessing images through a certified EHR.

“CHIME will continue to delve into this sizable and weighty effort, including the technical specifications and certification criteria,” Correll added.

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ACA decision is a beginning, not an end, to health reform

I’ve spent a lot of time on social media since Thursday morning debating the meaning of the Supreme Court’s rather stunning decision on the Patient Protection and Affordable Care Act. It was stunning in that Chief Justice John Roberts, a George W. Bush appointee, sided with the four liberal-minded justices, but also stunning in that the court went against conventional wisdom by upholding the individual mandate on the grounds that it was a legal exercise of Congress’ constitutional right to levy taxes.

I had to remind a lot of people that this decision neither solves the crisis, as supporters have claimed, or turns us into the Soviet Union, as some on the lunatic fringe have suggested. Expanding insurance only throws more money at the same problem. This was my first tweet after I learned of the decision:

Breaking news: American #healthcare still sucks. It's quality, stupid. #ACA #hcr #SCOTUS #Obamacare

June 28, 2012 7:11 am via UberSocial for BlackBerry ReplyRetweetFavorite

@nversel

Neil Versel

The cynic in me likes to point out that the individual mandate was an idea first conceived by the conservative Heritage Foundation and championed in Massachusetts by Mitt Romney. Both somehow now oppose the idea. The law that ultimately passed Congress was written by Liz Fowler, a top legal counsel to Max Baucus’ Senate Finance Committee who previously was a lobbyist for WellPoint. Her reward for doing the bidding of the insurance industry was for Obama to appoint her deputy director of the Office of Consumer Information and Oversight at HHS. This was insider dealing at its finest, as much a gift to insurers as the 2003 Medicare Prescription Drug, Improvement and Modernization Act was a gift to Big Pharma.

Of course, I initially was misinformed about the Supreme Court ruling because CNN jumped the gun (as did Fox News) and erroneously reported that the court had struck down the individual mandate on the grounds that it violated the Interstate Commerce clause of the Constitution. But so were millions of others.

I suppose that was fitting, since the national media have for more than two years been misinforming the public about what is really in the law. There are small but real elements of actual care reform — not just an insurance expansion — in there, but very few have been reported. The actual reform has been drowned out by ideologues on both sides. Here’s a handy explanation of most of what’s really there (it’s a good list but not exhaustive). The insurance expansion, the only thing people are talking about, really is just throwing more money at the problem. There is a lot more work to be done to fix our broken system.

What I consider real reform in the ACA includes accountable care organizations and the creation of the Center for Medicare and Medicaid Innovation. Along with the innovation center, CMS also gets the power to expand pilot programs that are successful at saving money or producing better outcomes. In the past, successful “demonstrations” would need specific authorization from Congress, which could take years.

Notice that there isn’t a whole lot specific to IT. That’s because the “meaningful use” incentive program for EHRs was authorized by the 2009 American Recovery and Reinvestment Act. Another key element of real reform that also is not part of the ACA is Medicare’s new policy of not reimbursing for certain preventable hospital readmissions within 30 days of discharge.

We need more attention to quality of care. Many have argued that tort reform needs to be part of the equation, too, because defensive medicine leads to duplicative and often unnecessary care. Perhaps, but lawsuits are a small issue compared to the problem of medical errors. Cut down on mistakes and you cut down on malpractice suits. Properly implemented EHRs and health information exchange — and I do mean properly implemented — will help by improving communication between providers so everybody involved with a patient’s care knows exactly what’s going on at all times.

All of these facts lead me to conclude that true healthcare reform hasn’t really happened yet. Look at this Supreme Court ruling as a beginning, not an end, to reform.

Yes, you do have a right to your health records

Lest anyone forget — including the American Hospital Association, which wants to take 30 days post-discharge to supply copies of medical records to patients — HIPAA explicitly gives patients the right to access their own records. This is not new. The HIPAA privacy rules have been in force since 2002. Yet, far too many patients have no idea of this right and far too many providers don’t inform patients of this right or do what they can to prevent access.

Fortunately, the HHS Office for Civil Rights, which enforces HIPAA privacy and security standards, is trying to change that with an outreach campaign, including this video.

Unfortunately, the video has been viewed just 556 times as of this writing. Equally unfortunately, the video directs viewers to visit HHS.gov/OCR. But the real information you need is at http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. I found that page using Google, not by trying to navigate the menu, which is not very intuitive, even for someone who knows the healthcare industry. I can’t imagine the average consumer finding that page without help or plain old dumb luck.

Various HHS agencies are trying hard to disseminate messages to the public. I think of AHRQ’s Questions are the Answer campaign. I’ve seen poster-size ads around Chicago telling people to visit ahrq.gov for a list of questions they should be asking their healthcare providers, but the better link, not mentioned in the ads, is ahrq.gov/questions.

For that matter — and I mentioned this to one of the AHRQ higher-ups at the HIMSS conference a few months ago — how many people really know what the Agency for Healthcare Research and Quality is? Wouldn’t it be better to have a more memorable URL? The Obama administration is good at setting up URLs for programs it wants to promote for political reasons — think recovery.gov and even the consumer-friendly healthcare.gov — but the less-politicized divisions such as AHRQ (remember, Director Dr. Carolyn Clancy is a career professional who has run AHRQ for two presidents since 2003) and OCR haven’t done so. They need to come up with easy-to-remember URLs that the general public can remember. Bureaucrat-speak just isn’t getting the job done.

Meantime, physicians need to become more patient-friendly, too. I invite you to check out this Salon article from a few weeks ago entitled, “Listen up, doctors: Here’s how to talk to your patients.” Please share with family, friends and, yes, your doctors. Share the OCR video, too. If OCR can’t make the information easy to find, I will.

Health reform is so much more than insurance

The headline above shouldn’t surprise regular readers or anyone who knows me. I’ve been saying for a couple of years to anyone who asks me about “Obamacare” or any other aspect of healthcare reform—and many people who haven’t asked—that the public debate and media coverage have been about insurance reform, not care reform, and health insurance is not the same thing as healthcare. I’ve publicly chided the national media, too.

Maybe that is changing. Last month, attorney Philip K. Howard, chairman of advocacy group Common Good (an organization working to “fill the substance void in the 2012 election by offering new solutions to fix broken government”), wrote in The Atlantic that no matter what the Supreme Court does with the Patient Protection and Affordable Care Act, healthcare still will remain inefficient and expensive. “The Affordable Care Act, aka Obamacare, strives for universal coverage. While it encourages pilots for more efficient delivery systems, the overall effect is to exacerbate the unaffordability of American health care. In this sense, the upcoming Supreme Court decision on constitutionality is just a side skirmish,” Howard said.

In other words, as I’ve been arguing for two years, the insurance expansion of this supposed comprehensive “healthcare reform” legislation is simply throwing more money at the same problem. Having insurance doesn’t assure you good care, nor will it by itself even reduce overall costs. It just shifts costs. There was more reform in the HITECH section of the 2009 American Recovery and Reinvestment Act, in the form of the $27 billion incentive program for “meaningful use” of electronic health records than there is in the part of the ACA being widely debated in this election year.

That’s why, as I pointed out Friday, I was happy to see that investigative journalism organization ProPublica has started a Facebook community for people to share stories of patient harm. And today, the New York Times discussed actual healthcare quality in one of its Sunday editorials (h/t Jane Sarasohn-Kahn). The Times highlighted efforts at Virginia Mason Medical Center in Seattle, Cincinnati Children’s Hospital Medical Center and hospital alliance Premier, saying, “It is a measure of how dysfunctional the system has become that these successful experiments — based on medical sense, sound research and efficiencies — seem so revolutionary.” Indeed.

By the way, my recent, controversial post arguing that faxing should be considered malpractice isn’t a new thought I’ve had. I just rediscovered my January 2011 commentary in Columbia Journalism Review about media coverage of telephone-based “telemedicine.” I ended the piece by advising fellow journalists to “start asking the health-care organizations you cover why they still rely on old-fashioned telephones and fax machines.” Malpractice or not, legal or not, it’s more than a decade into the 21st century, yet we still view healthcare through a 20th-century lens.

Or, as I also like to say, it’s quality, stupid.

Sen. Whitehouse, make some more noise, please

I have railed more often than I can count against politicians and the national media for misleading or at least failing to inform the public on what health reform is all about. For me, it was quite refreshing to see an interview in the Washington Post with Sen. Sheldon Whitehouse (D-R.I.), attempting to shed some light on the parts of reform that have nothing to do with insurance.

“The Affordable Care Act is mostly known as an insurance expansion, expected to extend coverage to more than 30 million Americans,” started the post by Sarah Kliff. “But … a big chunk of the law is dedicated something arguably more ambitious: an overhaul of the American business model for medicine. ‘This is a very significant piece of the bill that has received virtually no attention because it’s so non-controversial,’ Sen. Sheldon Whitehouse (D-R.I.) told me in a recent interview.”

On Thursday, Whitehouse released a 52-page document outlining what he sees as the 47 changes the Patient Protection and Affordable Care Act is making to how care is delivered. That doesn’t even count the reforms in the HITECH section of the American Recovery and Reinvestment Act from a year earlier, by the way.

Health IT, of course, is a big part of reform.”The HITECH Act took important steps to restructure financial incentives to shift the pattern of health IT adoption. The HITECH Act’s Medicare and Medicaid incentive payments are encouraging doctors and hospitals to adopt and “meaningfully use” certified
electronic health records,” Whitehouse noted.

Also from that report:

Health information technology (IT) will radically transform the health care industry, and is the essential, underlying framework for health care delivery system reform. The ACA’s payment reforms, pilot projects, and other delivery system reforms are built with the expectation of having IT-enabled providers. In particular, the shift to new models of care, like ACOs, will rely heavily on information exchange and reporting quality outcomes. Indeed, the formation of ACOs is contingent on having providers “online” to transfer information and patient records, and report quality measures.

Whitehouse did discuss ACOs with the Washington Post, but there’s a reason why the interview appears on a page called the WonkBlog. This stuff is too complicated and wonky for the average person.

What isn’t complicated is explaining that throwing more money at a broken system, as the insurance expansion does, will not lower the cost of care. It also isn’t complicated to explain that tens of thousands of Americans needlessly die each year due to medical errors or low-quality care. Yet, more than a few defenders of the ACA have said that the insurance mandate would help guarantee “quality care” for millions.

Wrong!

The insurance expansion guarantees insurance coverage. It does not guarantee quality care. Whoever wins Friday’s Mega Millions drawing wouldn’t necessarily be able to buy quality care, either. Nor would Bill Gates, for that matter. You can’t get quality care unless you’re willing to address the causes of errors and adverse events. Period.

Sen. Whitehouse seems to understand that. I doubt too many other members of Congress do, despite the fact that a former colleague, the late Rep. John Murtha (D-Pa.), who had the “Cadillac” coverage so many people covet, died as a result of a medical error.

Video: Dell Healthcare Think Tank at HIMSS12

The video from the Dell Healthcare Think Tank dinner at HIMSS12 last week, which I participated in, is now available. It’s long, but if you’re into health IT policy and healthcare reform, it probably is worth your time.

HIMSS12 notes

I’ve just returned home from HIMSS12. As usual, it was a grueling week, made more grueling by the fact that I arrived a day earlier than usual. But I do have to say that this was the least stressful HIMSS I have been to in years.

Maybe it’s because the conference layout within the massive Venetian-Palazzo-Sands Expo complex was surprisingly compact for my purposes, and I didn’t have to do as much walking as normal. Maybe it was because I only set foot on the show floor once, thanks, in part, to the announcement of the Stage 2 “meaningful use” proposed rules on Wednesday, which caused me to cancel one vendor meeting (in the exhibit hall) and cut another one (in the media interview room) short so I could knock out my story for InformationWeek. Or maybe it’s because I spent too much time in the casinos. Let’s go with the first two, OK?

HIMSS12 broke all kinds of records, drawing 37,032 attendees, beating last year’s former record of 31,500 by nearly 18 percent. The final exhibitor count was 1,123, also the most ever. After I tweeted the attendance figure, at least one person thought this rapid growth was an indication that the conference was “jumping the shark”:

jumping the shark? RT @nversel: #HIMSS12 draws record 37,032 attendees, crushing last year's mark of 31,500. http://t.co/Mw1TDYSA #HealthIT

February 24, 2012 3:36 pm via TweetDeck ReplyRetweetFavorite

@apearson

Aaron Pearson

I have thought in recent years than HIMSS may be becoming too big for its own good. This time around, I heard mixed reviews.

Personally, like I said, it was less stressful than normal. It’s always good to catch up with old friends, particularly my media colleagues. This year, I also met up with a couple of friends from back home who happen to work for vendors. We kept the fun going all the way back to Chicago, since at least three other health IT reporters and a few others I know were on the same flight as me.

I also have to say I had a wonderful time on a “Meet the Bloggers” panel on Wednesday afternoon, where I joined Healthcare Scene capo John Lynn, fellow Healthcare Scene contributor Jennifer Dennard, Carissa Caramanis O’Brien of Aetna and moderator Brian Ahier for some lively dialogue about social media in health IT. I know that at least one audience member took some video, and I’ll link to that once it’s posted.

Later that evening, I saw nearly every one of the same people at Dell’s Healthcare Think Tank dinner, where I participated in a roundtable discussion about health IT with a bunch of supposed experts. It was streamed live, and I believe the video will be archived. Many of the participants, including myself, tweeted about it, using the hashtag #DoMoreHIT. I really am adamant about the public needing to be explained the difference between health insurance and healthcare.

Speaking about misunderstandings, I am in 100 percent agreement with something Dr. Wendy Sue Swanson, a.k.a. Seattle Mama Doc, said during an engaging presentation Monday at the HIMSS/CHIME CIO Forum. She made the astute observation that there needs to be better distinction between expertise and merely experience when it comes to celebrities being held up as “experts” in healthcare and medicine. Let’s just say that Swanson, as a pediatrician, is no fan of some of the things Jenny McCarthy and Dr. Mehmet Oz have told wide audiences.

There definitely were some people among the 37,000 who were not enamored with the cheerleading at HIMSS. There was talk around the press room that HHS really dropped the ball by not having the meaningful use Stage 2 proposal out a week earlier, before the conference started. In reality, blame the delay on the White House. Every federal rule-making has to be vetted by the bean counters and political operatives in the Office of Management and Budget, and it’s hard to tell how long the OMB review will take once an administrative agency, in this case, HHS, sends the text over.

I admit, I was wrong in expecting the plan to be out earlier, too. Instead, we got the news Wednesday morning and saw the text Thursday morning, forcing thousands of people to scramble to scour the proposed rules.

I know HIMSS had a team at the ready, who dropped everything to read the proposal and get a preliminary analysis out by the end of the day Thursday. Lots of consulting firms did the same. I’ll save some of the commentary I received for another post.

The wireless Internet in the Venetian’s meeting areas was truly terrible. Either that, or I need to replace my aging laptop. I’m thinking both.

I had no trouble getting my e-mail over the Wi-Fi network, but I really couldn’t do anything on the Web unless I was hard-wired to one of the limited number of Ethernet cords in the press room, and those workstations filled up fast. Bandwidth was particularly poor on Thursday, when I presume thousands of people were downloading the Stage 2 PDF. CMS officials said the Federal Register site crashed from the heavy demand, and I’m sure a lot of it came from inside the Venetian and the Sands Expo.

There didn’t seem to be enough attention paid to safety of EHRs, at least according to Dr. Scot Silverstein of the Health Care Renewal blog, who wrote this scathing critique of the sideshow the exhibit hall has become, making Las Vegas perhaps “fitting for people who gamble with people’s lives to make a buck.”

Personally, I thought ONC and CMS took the recent Institute of Medicine report on EHR-related adverse events pretty seriously. Plus, one of the IOM report authors, Dr. David Classen, presented about the study findings at the physician symposium on Monday and again during the main conference.

Mobile may also have gotten a bit of a short shrift, despite the recent launch of mHIMSS and last’s week’s news that HIMSS had taken over the mHealth Summit from the NIH Foundation. The mobile pavilion was relegated to the lower level of the Sands, the area with low ceilings and support pillars every 30 feet or so. (I called that hall “the dungeon.”) I have a feeling you will like Brian Dolan’s commentary in MobiHealthNews next week. I’m still figuring out what I will write for that publication, but I have to say I did hear some positive things about mobile health this week.

I still don’t know what GE and Microsoft are doing with Caradigm, their joint venture in healthcare connectivity and health information exchange that didn’t have a name until a couple of weeks ago. The name and the introductory reception they held Tuesday evening at HIMSS seemed a bit rushed, IMHO. The Web address the venture reserved, www.caradigm.com, currently redirects to a GE page. Other than the fact that Microsoft is shifting its Amalga assets to Caradigm, I’m at a loss.

Popular topics this year were the expected meaningful use and ICD-10, plus the buzzwords of the moment, business analytics and big data. I’d be happy I never hear the word “solution” as a synonym for “product” or “service” again. To me, that represents lazy marketing. Get yourself a thesaurus.

Video: Jonathan Bush at HIMSS12

As has become custom, I carved out some time at HIMSS to interview Jonathan Bush, the always outspoken and insightful CEO of athenahealth. This time, instead of meeting in some sterile conference room, we got together just before the start of athenahealth’s annual HIMSS party, which happened to be at Ghostbar at the top of the Palms hotel in Las Vegas.

The setting, on the balcony of the 55th floor, tied into the company’s embrace of the cloud. The staff of both the bar and of athenahealth did a great job finding a single spotlight on the balcony, overlooking the bright lights of the Strip. Yeah, there’s a shadow on Bush’s face and you can hear the wind at times, but I think it adds to rather than disrupts the vibe.

As usual, we joke around a lot, but we also get into some serious discussions about ICD-10, meaningful use, health IT innovation and even my involvement with Health eVillages, a subject that came up because athenahealth has a health IT charity effort of its own in India. (Speaking of HealtheVillages, co-founder Donato Trumato is presenting a case study at HIMSS Thursday morning. It’s at 9:45 a.m. PST in Marco Polo 803 on the first floor of the Venetian. I’ll probably be waiting for the media availability of Dr. Farzad Mostashari at that time. Something about meaningful use Stage 2.)

Enjoy the video. I know I did.

Jonathan Bush at HIMSS12 from Neil Versel on Vimeo.

Yes, the Stage 2 ‘meaningful use’ proposal will be out before HIMSS

There have been a lot of reports of late that HHS will publish its notice of proposed rulemaking for Stage 2 of the “meaningful use” EHR incentive program some time in February. That information is based on an e-mail update from CMS.

I can go one better than that: The proposal will be out in the next three weeks or so, before the start of the annual HIMSS conference on Feb. 21. How do I know this? Check out educational session No. 90 from the HIMSS 12 program, set for the morning of Wednesday, Feb. 22. Speakers haven’t been announced yet, but here’s the description: “An overview of the recently published Stage 2 Notice of Proposed Rulemaking for the EHR Incentive Programs, including changes to Stage 1 requirements, new meaningful use requirements for Stage 2, and changes to clinical quality measure reporting for eligible professionals and eligible hospitals.”

Yep, the NPRM will have been “recently published” by the time HIMSS rolls around.

Mostashari, Chopra get down to ‘Meaningful Yoose’ rap

Now it makes sense.

A couple weeks ago, I got the latest update from fictional EHR vendor Extormity:

Extormity to Federal Health IT Leaders – ‘Take a chill pill, fellas.’

Brantley Whittington, fictional CEO of make-believe electronic health record vendor Extormity, is urging Aneesh Chopra, Farzad Mostashari and Todd Park to tone down their optimism and exuberance about the clinical benefits and cost savings associated with implementing health information technology.

Whittington, speaking to reporters from the offices of a K Street lobbying firm in Washington, D.C., expressed dismay at the unbridled enthusiasm exhibited by White House, ONC and HHS officials. “For years, vendors like Extormity have worked hard to cultivate a healthcare IT culture that combines complexity with closed-mindedness, creating a pervasive and stifling sense of futility.”

“Instead of the sober and staid leadership we are accustomed to, these gentlemen are inspiring new models of industry development,” added Whittington. “The Direct Project is a great example of supercharged public/private collaboration designed to simplify the flow of health information without spending a dime of taxpayer money. This may benefit patients and providers, but the lack of convoluted infrastructure does little for the Extormity bottom line.”

“While I have been known to muster up some counterfeit fervor for shareholder meetings, the consistent passion and zeal demonstrated by these officials is proving disruptive to those of us dedicated to proprietary and expensive solutions,” added Whittington. “I suggest dialing back the levels on the gusto meter to preserve the status quo, stifle meaningful innovation and ensure consistent and sizable returns to a handful of large healthcare IT vendors.”

Chopra, Mostashari and Park are exuberant, that’s for sure. The first time I saw Park and Chopra share a stage together, I labeled them the “anti-bureaucrats.” I have since added Mostashari to that category. But it was only over the weekend that I learned that Mostashari and Chopra were getting down to the “Meaningful Yoose” rap from Dr. Ross Martin at a recent ONC meeting.

Here is the video of that spectacle, courtesy of John Lynn. (Unfortunately, I cannot find an embeddable version.)

Perhaps this is why Mr. Whittington wants the anti-bureaucrats to tone it down. Or perhaps (more likely) extormity feels threatened by innovation. Yeah, let’s go with the latter.

N.B. I am writing this while 33,000 feet above northeastern New Mexico, just about to cross into the Texas Panhandle, on a flight from Tucson to Chicago. I love me some Wi-Fi in the sky!