Office of the National Coordinator for Health Information Technology

Stage 3 Meaningful Use proposals at White House for final review

Why do these things always seem to happen late on Friday afternoons? At least this time it’s not right before a holiday. Actually, with a bit more inspection, I see that it did happen right before a holiday.

HIMSS is reporting today that the White House’s Office of Management and Budget is “in its final stages of review” of the proposed rules for Stage 3 of the Meaningful Use EHR incentive program. OMB always goes over proposed and final regulations to measure the fiscal — and, presumably, political — impact before allowing executive-branch agencies to make public releases.

A peek at OMB’s reginfo.gov site indicates that the MU Stage 3 proposal from CMS and related ONC plan for certification of EHRs are indeed at OMB for final review.

“We are proposing the Stage 3 criteria that [eligible professionals], eligible hospitals, and [Critical Access Hospitals] must meet in order to successfully demonstrate meaningful use under the Medicare and Medicaid EHR Incentive Programs, focusing on advanced use of EHR technology to promote improved outcomes for patients. Stage 3 will also propose changes to the reporting period, timelines, and structure of the program, including providing a single definition of meaningful use. These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements,” CMS states in a rule summary on the OMB site.

A placeholder date (“02/00/2015 “) on the same page suggests that the proposal will be published in February. However, a placeholder date on the page for the forthcoming ONC certification standards indicates that the plan was supposed to come out in November.

And the date the two notices appeared on the reginfo.gov? Dec. 31, when pretty much everyone was already checked out for the extended New Year’s weekend.

Stage 3 is scheduled to start no earlier than Oct. 1, 2016, for hospitals and Jan. 1, 2017, for individual providers.

Video: Farzad Mostashari on patient engagement, ‘physician ACOs’

As I alluded to earlier, I was leaving the press room one afternoon at HIMSS14, and there I see former national health IT coordinator Dr. Farzad Mostashari hanging around Gregg Masters and Dr. Pat Salber of Health Innovation Media. It turns out, Masters and Salber had just pulled Mostashari aside to do an interview on video, but they didn’t have anyone to interview him on camera, so they asked me right there on the spot to be the interviewer. Here is the result.

Mostashari, now a visiting fellow at the Engelberg Center for Health Care Reform at the Brookings Institute in Washington, discussed how the years of searching for a business model to coordinate care and engage patients is finally starting to pay off. Always the champion of the little guy in healthcare, Mostashari also brought up the notion of physician-led ACOs, or, as he called it, the “Davids going up against the Goliaths.”

I had pretty much no preparation for this interview. It probably shows. I still think it worked out well.

Here’s a link to Salber’s post about the interview because I don’t want to steal page views. :)

I was wrong: Muntz to leave ONC

On Sept. 17, I predicted that Principal Deputy National Coordinator David Muntz would lead the Office of the National Coordinator for Health Information Technology at least on an interim or acting basis when National Coordinator Dr. Farzad Mostashari departs at the end of next week.

I was wrong.

Last night, Muntz announced his resignation in an e-mail to ONC staff:

From: Muntz, David (OS/ONC)
Sent: Wednesday, September 25, 2013 8:47 PM
Subject: Farewell to my federal family and friends

It is with a great deal of gratitude and sadness I have tendered my resignation as Principal Deputy National Coordinator for Health IT. All of the ONC staff and, for that matter, all of the federal staff with whom I worked, have been more than patient and generous as I entered the world of federal public service.

The goals and objectives of our diverse and important activities helped me understand and accept the challenges, and then embrace them. I was sustained by the spirit and talent that I encountered every step along the way. You’ve heard me say on several occasions that I’ve never seen such a group of dedicated leaders and staff. It is heartwarming and head-pleasing to have worked with all of the federal staff and to represent the providers and patients in the private and public sector who are pulling and pushing us toward a very promising future where the collective efforts will benefit the nation and the world. The people and the progress are awe inspiring. It’s been a privilege to have played any role in such a truly transformative era, much less a leadership role in all the successes we have achieved both inside and outside ONC.

I look forward to continuing to support HHS’ vision of achieving interoperability and better engaging patients from the private sector. With many wonderful memories and much gratitude, David

David S. Muntz, CHCIO, FCHIME, LCHIME, FHIMSS

Principal Deputy

HHS/Office of the National Coordinator

Also last night, Mostashari announced that Dr. Jacob Reider, director of the ONC Office of the Chief Medical Officer, will serve as acting national coordinator and Lisa Lewis, currently deputy national coordinator for operations, will be acting principal deputy, effective Oct. 4. Joy Pritts will remain as chief privacy officer and political appointee, Mostashari noted.

Mostashari also said that Muntz informed him “several weeks ago of his decision to return to the private sector to work more closely on the front-lines of medicine.”

I shall not make any further predictions about next full-time coordinator.

March ‘Health Affairs’ out tomorrow with health IT studies

The policy journal Health Affairs has just put out a media advisory noting that the March issue, which comes out tomorrow, will have at least three articles devoted to health IT. From the advisory (verbatim):

Studies on EHR:

Neil Fleming and colleagues shed light on the financial and nonfinancial resources a small practice needs to implement an EHR system. Using data from a physician network in north Texas, the authors estimate that the average cost to implement EHRs is $46,659 per physician.

Use of EHRs will be accelerated because more than four in five office-based doctors are eligible for federal “meaningful use” incentives, says Brian Bruen of George Washington University and colleagues. Their analysis also highlights gaps in eligibility that must be addressed to further increase the adoption of EHRs, including variations by specialty, size and type of practice, and location.

A paper from the Office of the National Coordinator for Health Information Technology (ONC) on the benefits of health IT:

92% of recent articles on health IT have reached positive conclusions, report Melina Beeuwkes Buntin, David Blumenthal and colleagues. In their literature review, they found that papers that assessed provider or staff satisfaction were less likely to report positive outcomes than those that did not.

The embargo on the stories lifts just after midnight Eastern time.

AdvancedMD sale to ADP shows new side of EMR consolidation

Here’s an interesting one from the world of mergers and acquisitions: Human resources and payroll services and firm Automatic Data Processing (ADP) announced Tuesday that it has purchased EMR and practice management systems vendor AdvancedMD for an undisclosed sum.

I’d say this is part of the expected consolidation that federally sanctioned certification was supposed to bring to the market, except that ADP’s only experience in healthcare to date has been in providing HR, payroll and benefits management services to approximately 13,500 physician practices. Those are the same types of services ADP offers to any business, so the AdvancedMD purchase represents uncharted territory for the company. ADP now bills itself as “uniquely positioned as an integrated, single-source provider of Medical Practice Optimization,” whatever that means.

Interestingly, I learned at HIMSS last week that at least a couple of new EMR vendors had spent tens thousands of dollars developing systems then getting products certified, but still hadn’t found or even looked very far for customers. They were at HIMSS to find marketing partners.

Right now, the EMR market doesn’t seem to be consolidating into the hands of a few, large vendors, but actually branching out. As of this evening, ONC’s Certified Health IT Products List includes 298 ambulatory systems and 129 inpatient products. That’s greater than 400 total, or about a third more than the last time I looked back in December. The market may actually be expanding faster than it’s consolidating. The ADP acquisition of AdvancedMD represents a different kind of consolidation, one with a company outside healthcare repositioning itself as a health IT vendor.

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Stage 3 Meaningful Use proposals at White House for final review

Video: Farzad Mostashari on patient engagement, ‘physician ACOs’

I was wrong: Muntz to leave ONC

March ‘Health Affairs’ out tomorrow with health IT studies

AdvancedMD sale to ADP shows new side of EMR consolidation

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