What’s that low thrum? It’s the sound of the “meaningful use” definition” fading in the distance as healthcare providers now scramble away to put pieces of the EHT compliance puzzle into position. But wait! What’s that shrieking bleat ahead? “EHR PRIVACY,” the next issue du ARRA. The DHHS-convened Tiger group will command the headlines and attract legitimate attention over the next few months especially as the public comment period for proposed modifications to the HIPAA Privacy & Security Rules ends September 13, 2010.

The latest from the Tiger Group’s progress is succinctly captured by Modern Healthcare.com and Healthcare IT New.com. Follow these links to learn the most recent developments.

Tiger Group's EHR Privacy Conundrum: Modern HealthCare News

Privacy and security recommendations approved: Healthcare IT News

Below are two links to substantive accounts of the latest MU evolution. The first, released yesterday, is an explication by HHS National HIT Coordinator Dr. D. Blumenthal & CMS deputy administrator M. Tavenner. Given tables summarize new Core and Menu Set objectives.

The second link takes you to HISTalk’s Inga, who had by early morning today, compiled a straight-forward contrast, sort of a “then-and-now,” as regards MU after yesterday’s announcement by HHS.

You’ve probably spent the last 24 hours squinting at as many websites & sources as we have. Trying to keep you up-to-date while avoiding information overload & repetition, the blogmasters extend what we’d like to call a representative sample of our latest research done for you by our agents in the field.

Meaningful Use Regulation for EHR

Inga's Comparison

The recently published PriceWaterhouseCoopers Health Research Institute report, Ready or Not: On the Road to the meaningful use of EHRs and health IT, has circulated through the blogmasters desk, and in our continuing effort to keep you informed, we’ve produced the following abstract…

After surveying 120 CIO’s and another handful of healthcare executives, the PwC report adds heft to the impact of the ARRA’s Meaningful Use (MU).

The report makes many keen assertions including:

• “Health systems will need to transform the way they deliver care, so they can sustain performance and grow revenue in the future.”
• Successfully achieving meaningful use “hinges on closer integration with key constituents” (physicians, health insurers, patients).
• Health systems that already have connected with physicians, patients, and health insurers around MU are “more likely to be applying for government incentives” than those that haven’t. But only half of respondents expected to apply for incentives in 2011. (By 2014, 90% expect to be applying).
• Health systems that have included patients in the planning are “more confident about meeting MU standards.”
• “Implementing MU can enhance hospital-physician alignment.”
• Most health systems are failing to connect with health insurers around MU.
• 80% of CIO’s are more than concerned about meeting MU requirements by deadlines. (An American Hospital Association survey reports that 55% of hospitals expect to incur penalties.)
• “The benefits of achieving MU outweigh the challenges.” Those benefits include improve healthcare quality, disease management, coordination of care, improved alignment with physicians, increased productivity, market advantage, and improved alignment with payers.

But PwC identified four barriers to attaining MU: Lack of MU standards clarity, shortage of skilled IT staff, vendor readiness, limited capacity of existing infrastructure . . .

and proffered five benchmarks to achieve compliance: Establish governance, balance compliance against competing priorities, forge new public-private ventures, make the patient the purpose, collaborate with physicians and health insurers.

Interested in what happens now with healthcare reform? All the fervor has died down and we’re on to the next top issue (Arizona anyone?), but when will we start see the effect... Well, on July 1^st of this year people who have been unable to get health insurance because of preexisting conditions will be able to purchase subsidized coverage via a national high risk pool. On September 23^rd insurers will be banned from dropping people if they develop an illness, the dependent coverage age will extend to 26, no child will be denied because of a preexisting condition, and there will be no annual or lifetime limits. For more details read this, but in 2014 the entire law should be phased in.

That’s a brief synopsis of what’s going to happen in the coming months as a directive straight from the Patient Care and Affordability Act, but what else is going to be indirectly affected? One thing I keep reading is about the number of physicians practicing medicine. It was hard enough to practice with CMS issues, malpractice concerns, and hospital struggles…will the new law make it better for physicians to practice medicine in this country? What about the HITECH push, how is that effecting doctors?

What do you think?

More Reading:

Glamour Answers Pressing Questions

An Employer's Guide to Healthcare Reform

I Have to Buy...or else.

By: Bill W. Childs

I had the honor of meeting with David Blumenthal at HIMSS last week along with selected CIO’s, physicians, and vendor representatives. Our discussions centered on the costs and benefits of the ARRA and Meaningful Use criteria.

My Concerns:

1. Time lines for ARRA, Meaningful Use, HIPAA 5010, and ICD-10 are too tight. Some providers (with anywhere from one to ten facilities)who have been working on these efforts for years, can easily reach meaningful use criteria. However, there are many large and small providers who will not be able to meet the time lines as established.  “Too many guidelines; too little time”.
2. The cost of these efforts is beyond the ability for 80% of providers. It will take a great deal to implement and prove the needed requirements to reach meaningful use and history shows that it will cost much more than most people expect.
3. There is not enough industry experienced talent to get these projects implemented. As an industry observer for more than 30 years, I can already see providers hiring bodies that are not talented enough to get the job done. Implementing these systems is a very difficult task, and many of the most talented are already on the assignment.

My Peers' Concerns (in addition to those listed above):

1. The board and “C” suite lack of understanding the full impact of the effort (time, cost, talent, change, security, and interactions with entities not under their control).
2. The cost of sustaining these Herculean efforts.
3. The cost and effort to report to all of the new agencies and on all of the new data requirements.

My session with Blumenthal was enlightening. Not only were some of my concerns confirmed, but I was also made aware of other aspects to be apprehensive about.  Here is one silver lining though: The effort and direction is a good thing. HIT, if built properly, implemented properly, and maintained the right way with updates as necessary, is the only technology introduced to healthcare delivery systems that has the potential to reduce costs and eliminate errors, thus improving quality.

What are your major concerns? What efforts and ideas would you like to applaud? 

By: Mary Ann Ciccone

As part of ARRA, Medicare and Medicaid will provide reimbursement incentives to physicians and hospitals who become “meaningful users” of EMR. This effort will begin in 2011 and end by 2015 at which time all providers will be expected to utilize EMR. Changes will be implemented in stages and include data sharing, compliance with HIPPA and state laws, evidence based order sets, the engagement of patients and families, and care coordination. The final draft recommendations that will define meaningful use were published by the ONC for Health IT in December 2009. Eligible facilities and providers can incorporate these guidelines into projects currently in progress to meet the requirements.  

The result of following the meaningful use guidelines for all stages will be improved and more efficient patient care through the use of disease prevention and reduction of medication errors, greater communication between providers, efficiency in meeting reporting mandates and claims submissions, and lower healthcare costs.

 The recommendations for Stage 1 are listed below.

Source: HHS website for meaningful use.

Just in case you haven’t been able to find it one of the other dozens of sites publishing the link here is the HITECH: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology and here’s how you get paid (warning 556 pages).

Mr. HISTalk summarized the finer or most relevant points here. And over at HealthcareITNews.com “Stakeholders have mixed reviews on proposed requirements” while Government HealthIT profiles groups that aren’t happy with the definition.  

We all knew it’d be a mixed bag right? What do you think of the proposal? Have you (are you) going to read it or will you just look for an effective summary? Let us know what your thoughts and questions are in the comment section.

They’ve got their list and they’re checking it twice…meaningful use is still on everyone’s mind. CHIME just completed a survey of 176 of their member CIOs on their “ability to implement the standards recommended by the HIT Standards Committee in time to meet currently established deadlines.” Most of the CIOs admitted that they are concerned. In the words of David Muntz, Senior VP and CIO at Baylor Health Care System in Dallas: “Early attempts at standardization were not rousing successes. It’s hard to believe that we will be able to adapt to new standards in time to qualify for the rewards from the stimulus. I’m hopeful we’ll be there before the penalties are levied.” (from CHIME summary).

Over at HealthcareITnews.com the CIOs from Sharp HealthCare, Brigham & Women’s, and Shriners Hospitals for Children discuss what meaningful use means to them and their hospitals: CIOs Discuss Meaningful Use.

 Those three sound like they are ready and waiting for their incentives.

How prepared are you?

By: Susan Sitarchuk, Healthcare Executive

While the majority of Health Facilities CIOs and Executives are scrambling to get information on accredited EMR systems and to get a handle on what is truly defined as “Meaningful Use” there exists another population of Healthcare Executives who are actually seeing the money. Who are these lucky people? These folks are the people who struggled endlessly prior to February 2009 and ARRA to get government sponsored funds: the Grant Department of Health Facilities and Teaching Hospitals.

In the old days, prior to February 2009, the grant writers would have to jump through large hoops to secure funding for the clinical studies and research that is so vital to healthcare. They were in charge of putting together volumes of documentation that were sent to the governing bodies that dole out federal grant monies. This process could take months to acquire all of the correct documentation to secure the most funding and while compiling all of the information needed, the health facilities may not have received any of the intended monies at the end of this road because the funding had run dry.

Well times have changed. These folks are now able to more easily write a grant request and go after the money made available by ARRA. Here is the nice part; they are actually getting the funding very quickly. There is a sum of grant money that was made available by the US government under the ARRA and each month the government website is updated with new grants. Through ARRA states have allotted grant money for particular research and studies.

The University of Pennsylvania (UPenn) has received more than $30 million in research funding from ARRA, awards that fund more than 100 studies in gene therapy, robotics, public education, neurological disorders, tobacco’s effect on health, and more. One such award is a $500,000 NSF grant to continue research into haptography, the science of capturing and recreating the feel of real surfaces. Not only does the field appeal to young scientists and encourages engineering careers, but the applications are widespread and include robotics assisted surgery, medical training and simulation, interactive museum exhibits, online shopping, and stroke rehabilitation. Other grants that UPenn has been awarded enable the purchase of high end instrumentation equipment to be used for biomedical research. Also, grants were awarded to supplemental research into the genome and for upgrades to core facilities to support biomedical and/or behavioral research.

This is just the tip of the iceberg; more funds are being released on a daily basis. Due to ARRA, 2010 should continue to deliver positive growth in the research arena. Healthcare facilities need to get organized and go after these funds. HIT departments must, regularly, pursue federally funded grant money as well as the monies that they will be eligible for when they have an accredited EMR system and can prove “meaningful use” of that product. With more money available for research grants and improvements in IT, the economy and our health have a better future.

By: John Smaling, Executive Vice President

As the final definition of various ARRA related requirements take shape, financial incentives and impending penalties will most assuredly lead to an upswing in ambulatory software implementations. A number of those initiatives, sponsored by acute care organizations, will be large-scale implementations that involve large numbers of practices, and lots of physicians, spanning multiple specialties. With heavy participation by the acute care IT organization, these types of initiatives will introduce a number of complexities that I believe will challenge both vendors and customers, while exposing the differences in approach adopted by the ambulatory software vendors, and those typically employed during acute care implementations.

Historically, ambulatory software vendors have dealt with physician practices ranging from single practitioners, to large, multi-specialty group practices. In the course of deploying their solutions to this customer base, vendors have developed planning, implementation and support strategies that have worked for this profile of clients. I believe that this dynamic will oftentimes differ from the typical hospital customer in many ways, among them:

1. Acute care customers will have different goals and objectives than the typical physician practice in the areas of standardization, data normalization, reporting, and outcomes. For example, a common goal of the acute care organization is to achieve a comprehensive medical record that encompasses both practice and hospital based episodes and the level of integration required to accomplish this will likely be atypical for many ambulatory vendors.

2. Acute care enterprises will generally have larger and more experienced IT teams who have stronger views on infrastructure, security, project management, process and systems management than that found in physician practices.

3. There will be differing views from the acute care customer with respect to the level of individuality required from practice to practice. Many acute care organizations will feel that one physician practice operates essentially like every other practice, and their vision of standard workflows, process, and customization may be far different than the desires and perceptions of their constituent practice groups. The ambulatory vendor needs to understand this potential conflict in views and understand how to arbitrate these differences to meet their customer’s goals and objectives.

4. Acute care software vendors generally hold similar views with respect to the transition from install mode to support mode, and the manner in which they structure their support arrangements with customers. Ambulatory vendors, given their physician practice orientation, oftentimes adopt vastly different approaches than acute care vendors.

5. Decision-making and dealing with complex organizational dynamics, even in a relatively large physician practice is far different than can be found in an acute care organization. The importance of well defined governance, change control, and related process is not something that ambulatory software vendors have had to address to the extent that they will encounter in the future as they engage more acute care organizations.

While this listing is by no means comprehensive, it amplifies some of the key areas that will require adjustment by both parties. Taking the time to dialogue during the sales cycle to understand the many key elements of such initiatives is warranted. Understanding differences such as those mentioned above early in the relationship will help to either promote mutual respect and workable solutions, or to avoid an unproductive relationship and ill fated technology investment.