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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:

  1. Interviews with physician leaders who have implemented patient portals (or online access for patients)
  2. A snapshot of the national HIT opinion survey results
  3. A full executive summary of the national HIT opinion survey results

 

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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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September 5, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Mark Versel, 1944-2012

My father passed away late last Friday night from a most insidious disease called multiple system atrophy (MSA). It’s a rare, progressive, neurodegenerative condition that presents itself with symptoms similar to those of Parkinson’s disease, but it is far more aggressive and debilitating. Essentially, muscles stop working until the disease kills you. In my dad’s case, he ultimately lost the ability to breathe.

Nobody knows the cause of MSA and there is no cure. There really aren’t even any effective treatments. You can only treat the symptoms with medications designed for Parkinson’s to address muscle stiffness, balance and such, and with physical and speech therapy, but that’s like standing in front a speeding train with a stop sign. It’s a futile battle.

My dad never had any real health issues other than sciatica until he was diagnosed with what was thought to be Parkinson’s less than five years ago (MSA didn’t really come into the picture until maybe a year and a half ago). He ate well, exercised somewhat regularly and generally took pretty good care of himself before the disease came along. Now he’s dead at the relatively young age of 68 after an excruciatingly fast decline that kept him hospitalized for his final month.

He fought the disease valiantly and courageously, but he never got the chance to retire. He was forced to stop working because he was physically unable to continue. He never even got to come home to die. The end came so fast that we didn’t get past the first hospice discussion.

As sad as it is to lose my dad in the way that I did, I want something positive to come out of his ordeal. He was selfless, kind and generous in life, and my family intends to carry on his legacy in some way that we haven’t had time to figure out just yet. I want to use his memory and my little corner of the Internet to help educate people about MSA and about patient safety.

What does patient safety have to do with this, you ask? My dad had pretty terrible care at a poorly run community hospital near his home for more than three weeks before he was transferred to the wonderful Georgetown University Hospital in Washington for what turned out to be his final days. The contrast was striking.

The community hospital was a place of inadequate communication, broken processes, obsolete workflows, neglect and harm. My dad came in with what turned out to be a urinary-tract infection. They treated that with antibiotics, but he developed pneumonia in a matter of days—a condition a doctor admitted he had acquired in the hospital. So he was transferred to intensive care, where the hospital could make a lot more money despite being responsible for the complication. (Perverse incentives rule in American healthcare.) My dad was a Medicare beneficiary, so you and I, as taxpayers, get ripped off by the incompetence.

Meanwhile, the clinicians there, who had been trained to treat the acute symptoms, neglected the MSA for more than a week, even taking him off his regular meds for several days, during which time my dad’s muscles continued to stiffen. Physical therapy was essential to prevent further atrophy. The order went in for him to receive physical and occupational therapy at least three times a week, but the PT and OT were nowhere to be found for a week or more.

Meds that had been ordered didn’t get delivered. One night while I was there, a perky medical assistant or tech or someone of that ilk burst into the room announcing it was time for an AccuCheck test, and nearly went through with taking a small blood sample before I stepped in to ask what was going on. She explained that it was a test for blood sugar (who would know what AccuCheck was if they didn’t have diabetes or some familiarity with the healthcare industry?) only after I enquired, but I stopped her to tell her that my dad did not have diabetes. Because of the MSA, he had difficulty speaking and would not have been able to stop someone acting so quickly. It turned out that the tech had gone to the wrong room. The hospital did require clinicians to scan bar codes before administering tests and meds, but who knows if the system really worked?

Later that evening, the nurse nearly gave my dad an eye drop that had not been ordered. The proper instructions were to administer an ophthalmic drug orally, but only if he had excess saliva. The nurse didn’t see that part of the note, despite the fact that the ICU had a partial EHR (Cerner, for those of you keeping score at home) with electronic medication lists.

The infectious disease specialist at the community hospital was not even familiar with MSA — and he didn’t bother to tell us that for three weeks. It should be his professional duty to call in an experienced neurologist or consult with my dad’s personal physician.

Worst of all, my dad stopped breathing for a few seconds last week under questionable circumstances and was intubated, despite the fact that he had an advance directive on file specifically stating that he did not want to be intubated.

At Georgetown, we saw nothing but compassion and competence. Care was well coordinated. People talked to each other. Clinicians huddled together during shift changes to discuss all the patients on the ward. The medical director of the ICU, a pulmonologist, personally managed my dad’s case. The neurologists at this major teaching hospital had seen MSA before, but that didn’t stop them from talking with my dad’s personal physician. It was too late to save my dad’s life, but he died comfortably and with dignity at Georgetown, without the needless agony he endured at the other place.

I am now vowing to dedicate my own career to educating as many people about MSA as possible and about the danger of uncoordinated care and poorly designed workflows. Interestingly, one of the last stories I wrote before my father passed and before I took leave was a piece in InformationWeek about patient engagement. I love the mantra of the Society for Participatory Medicine that I mentioned in the story: “Nothing about me without me.”

Every patient should live by those words. And every healthcare facility should respect that concept.

Rest in peace, Dad. You have not died in vain.

UPDATE, April 2013: If you would like to make a donation to MSA support and research, please visit our family’s fundraising page, which is helping the Multiple System Atrophy Coalition. Thank you.

May 17, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.