“In America, innovation doesn’t just change our lives, it’s how we make a living,” he said. “Our free enterprise system is what drives innovation. But because it’s not always profitable for companies to invest in basic research, throughout history our government has provided cutting-edge scientists and inventors with the support that they need. That’s what planted the seeds for the Internet. That’s what helped make possible things like computer chips and GPS.”

In 2009, Obama signed the American Recovery and Reinvestment Act into law, supporting healthcare IT innovators for developing and healthcare providers for adopting healthcare IT. Many observers have said without this support, the healthcare industry would not make it over the tipping point to health information exchange.

[Read more about ARRA funding for healthcare IT.]

The Obama Administration has faced a steep uphill battle with Republicans over the federal deficit, and he took the issue head on in his speech, siding with Republicans in the need for fiscal responsibility. As in the past, he nodded toward keeping programs that could help to lower costs in the future. For healthcare, this means the advancement of healthcare IT to lower costs and increase quality of care. It also means retaining grant programs such as the Beacon Communities, state HIE exchanges and accountable care organization pilots – all funded as part of the Accountable Care Act.

“I recognize that some in this Chamber have already proposed deeper cuts, and I’m willing to eliminate whatever we can honestly afford to do without,” he said. “But let’s make sure that we’re not doing it on the backs of our most vulnerable citizens. And let’s make sure what we’re cutting is really excess weight. Cutting the deficit by gutting our investments in innovation and education is like lightening an overloaded airplane by removing its engine. It may feel like you’re flying high at first, but it won’t take long before you’ll feel the impact.

Obama called for the expansion of America’s infrastructure, including high-speed wireless connection in rural areas. “Within the next five years, we will make it possible for business to deploy the next generation of high-speed wireless coverage to 98 percent of all Americans,” he said. “This isn’t just about a faster internet and fewer dropped calls. It’s about connecting every part of America to the digital age. More broadband access means patients will be able to have face-to-face video chats with their doctors.”

[See more ways the digital age has improved patient care.]

Obama said America has made great strides over the last two years in using technology and getting rid of waste. “Veterans can now download their electronic medical records with a click of the mouse,” he added.

Justin Barnes, chairman emeritus of the Healthcare Information and Management Systems Society’s EHR Association and vice president of government affairs at Greenway Medical, has been closely tied with advising the White House and Congress on healthcare IT since 2003.

“This is the eighth year in a row that healthcare IT has been a part or prominent part of the president’s State of the Union Address,” Barnes noted following the speech. “While the debate will certainly continue on exactly how we go about creating and implementing policy, it was very encouraging to hear the increased vigor supporting additional investments in innovation around biomedical research and information technology.”

Despite a rousing speech, the proof will be in the policies, Barnes said. “That is certainly what keeps many of us engaged to collaborate and help educate while watching out for how these policies can effect care providers, patients, hospitals and all of us as taxpayers. I believe we all have the common goal though to create a smarter, more sustainable healthcare system in America.”

HealthcareITNews
January 26, 2011

The passing of the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) has resulted in a continued increase in the number of Health Information Exchanges (HIEs) across the United States. The Pennsylvania eHealth Initiative (PAeHI) remains active in its role “to bring together Pennsylvania’s health care and business stakeholders to develop a vision and a plan for the future of health information technology (HIT) and the secure exchange of health information in Pennsylvania”. How to maintain financial sustainability is a major question raised by community, regional, and state-level HIEs. PAeHI’s 2008 White Paper titled “Building a Sustainable Model for Health Information Exchange in Pennsylvania” laid the foundation for financial sustainability discussions and actions. Recognizing its ongoing importance, PAeHI has now completed this second White Paper to further inform Pennsylvania stakeholders about HIE financial sustainability models deployed and contemplated nationally and in Pennsylvania. Key areas addressed within the White Paper include trends and demographics; approaches for thinking about sustainability; prior planning efforts by the Pennsylvania Health Information Exchange (PHIX) and PAeHI; interview findings with leaders from 11 leading national HIEs on their models and experiences; findings from 26 representatives from 13 Pennsylvania stakeholder groups; current Pennsylvania HIT/HIE initiatives; an assessment of opportunities; and a possible go-forward strategy.

Read more on the PAeHI White Paper Project

A patient shows up at the emergency room unconscious and unable to give a history. Another patient arrives at his primary care physician’s office 3 days after an emergency room visit, and the primary doctor has received no information. A specialist sees a third patient for a consultation and receives none of the critical records needed to help her make the consultation efficient and effective. These scenarios and many others like them, unfortunately, are all too commonplace. The consequences of incomplete information at the point-of-care can be inconvenience, inefficiency, increased costs, and adverse, even life-threatening outcomes for patients.

The major reasons for lack of sharing health information include the fragmented nature of the United States healthcare system and the fee-for-service business model, a model that does not include financial support for health information exchange. Further, most health information technology (HIT) programs are not interoperable, that is, they do not speak to each other.

Health information exchange (HIE), in its current definition, is the electronic sharing of health-related information between disparate partners, based on nationally recognized standards for interoperability, privacy, and security. Without sharing, silos of information persist, physicians function with incomplete information, and tests are unnecessarily  repeated. Information-sharing is particularly important for care coordination of care for older with complicated conditions; chronic disease management; natural disaster and biosurveillance response; and care for a mobile military, veteran, and civilian patient population.

Recognizing these obstacles to sharing, the federal government has taken an active role in promoting HIE as a key component of healthcare reform. In this article, we will describe the
current landscape of HIE in the United States, how different parties are trying to expand it, current obstacles to the expansion, and the future possibilities.

THE HITECH ACT AND HIE
In 2004, President Bush set the goal of an interoperable electronic health record (EHR) system for all Americans by 2014 and established the office of the national coordinator for HIT (ONC). Initial progress towards the goal was slow until the passage of the American Recovery and Reinvestment Act (ARRA) of 2009, which included the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act funded multiple federal programs to promote the adoption of HIT, particularly EHR systems and HIE at the local, state, and national level.

The basic building block for this national strategy is the EHR, which inputs, processes, and stores digital health information for hospitals and outpatient practices. Health information organizations (HIOs) are the organizations that provide the governance,technology infrastructure, and security to exchange health information. A regional health information organization (RHIO) is simply an HIO that covers a defined geographic area, such as a city, region, state or multi-state area. HIOs have the ability to collect and aggregate health data from multiple organizations and electronically share information with EHRs.

The HITECH Act included a Medicare and Medicaid reimbursement program for eligible professionals who use certified EHRs and demonstrate “meaningful use.” Stage 1 meaningful use included the general objectives of e-prescribing, structured data collection, quality reporting, clinical decision support, patient engagement, security assurance, and HIE. HIE is necessary to provide a hospital discharge summary, electronically exchange key clinical information among providers, report quality measures to Medicare/Medicaid or states, perform medication reconciliation, transmit electronic immunization data to immunization registries, and submit electronic syndromic surveillance data to public health agencies.

Currently, most HIE occurs as part of an existing HIO. HITECH funded a new option for statewide and interstate exchange known as the State Health Information Exchange Cooperative Agreement Program, discussed in a later section.

CONNECTING PRACTICES, HOSPITALS, AND CITIES
Approximately 234 HIOs exist in varying operational stages, according to a 2010 study by eHealth Initiative, a not-for-profit organization that has conducted annual HIO surveys since 2005. Seventy-three HIOs claimed to be operational (exchanging some type of health data), and 18 claimed to be sustainable (no federal funding in the past year, operational status, and receiving revenue equal to or exceeding costs). More than half of the HIOs offered the following core services: clinical messaging (electronic test delivery of lab and radiology results, medication data, outpatient visits, and emergency room visits), EHR connectivity, clinical documentation, and alerts to physicians. Fewer than half of the HIOs survey offered the following newer advanced services: e-prescribing, Web-based EHR-HIE combination, public health reporting, telemedicine, medication reconciliation, emergency room use data, transcription, voice recognition, business analytics/intelligence, value-based reimbursement (pay for performance), credentialing, research, clinical decision support, consumer portal, claims clearing house, care coordination, and picture archiving and communication systems.

HIOs such as HealthBridge, located in Cincinnati, Ohio, and Indiana Health Information Exchange,located in Indianapolis, Indiana, are performing well financially and have the support of the medical community. On the other hand, failures such as the Santa Barbara County Care Data Exchange have dissolved primarily due to lack of perceived value by the healthcare community.

In 2010, the State HIE Cooperative Agreement Program funded (via $548 million) 56 states, eligible territories, and qualified state designated entities. The overall goal was to promote standards based statewide and interstate information sharing to meet meaningful use, particularly where none exists currently. Statewide HIE will need to be interoperable with existing HIOs, significant data providers and users (such as Medicaid), and the Nationwide Health Information Network (NHIN).

The NHIN is a collection of standards, protocols, and services that enables the secure exchange of health information over the Internet. Instead of being a specific network, it is actually a “network of networks” connecting disparate healthcare organizations, to include HIOs, federal agencies, and integrated networks. The NHIN primarily will provide a means for large civilian and federal health organizations, to include HIOs, to share information securely. As an example, MedVirginia is sharing information with the Social Security Administration via the NHIN to expedite disability determinations.

WHERE’S THE MONEY?

HIE participation for any given healthcare provider is fundamentally a business decision. The expected net benefit to the provider must be positive so that expected benefits exceed expected costs. These benefits can be monetary in nature, accruing through efficiencies in running a practice or a clinic, or through better use of a reimbursement mechanism. They also can be non-monetary, yielding superior health outcomes through better case management while not affecting the bottom line for the business.

Potential models include monthly or annual pricing on a per physician basis (subscription model), pricing on a per-transaction basis, or some combination of the above (for instance, a monthly fee plus per-record usage cost). Approximately half of the operational HIOs charge physicians a user fee as well as an additional fee to create an electronic interface between an EHR and the HIO. Participants must be willing to collaborate, rather than compete, in data exchange and must be willing to pay operating costs. Organizations must have enough participants to create a “network effect” (enough customers to make it worthwhile) and create subsequent economies of scale to be successful.

One of the more immediate benefits for physicians to participate in information exchange would be to comply with meaningful use objectives as part of the Medicare and Medicaid EHR reimbursement program. Very few HIOs can meet all pertinent meaningful use objectives at this time, however.

Participation in successful HIOs likely will mean access to an increasing number of administrative and clinical tools such as business analytics, telemedicine, clinical decision support, centralized credentialing, research opportunities, and a variety of reports.

According to the latest eHealth Initiative survey, many HIOs report reduced staff time spent handling or filing lab and radiology results and handling prescription issues. Another potential benefit would be creating one EHR-HIO interface to receive results, as opposed to multiple EHR interfaces to outside labs,hospitals, and imaging centers.

NUMEROUS TECHNICAL AND FINANCIAL OBSTACLES
Physicians may object to any change in workflow, user fees, and EHR interface charges to participate in HIE. They may believe that the benefits accrue more to others, such as payers and state and federal governments.

The most commonly reported obstacle for HIE is a long-term sustainable business plan that does not depend on federal funding. HIOs must have the trust of multiple partners that traditionally have been competitors in the market place. HIOs must provide services that have perceived value to a wide audience, such as clinicians, hospital executives, and practice managers. The lack of widely proven return on investment may cause some clinicians to choose faxes and mail over electronic sharing.

HIE also is impeded by a lack of a universal patient identifier that would greatly improve retrieval of the correct patient record. Another administrative obstacle for all HIT initiatives is privacy and security. HIOs will store voluminous data for thousands of patients that can be breached without adequate protection. Further, depending on the state, patients will need to sign an opt-in or opt-out agreement to allow record sharing. HIE participation could raise new legal issues regarding responsibility for reviewing all pertinent information on a patient.

For electronic record-sharing to take place, data standards need to be developed and adopted. The current document standard is known as a continuity of care record or continuity of care document. Both are XML-derived patient summaries that are similar to a problem summary list but are in a format that can be both generated and read by most EHR systems.

ALTERNATIVES ARISE
Although the government approach currently favors HIOs and statewide health exchanges, other models have been proposed. Some favor an approach called health record banking. This approach is consumercentric and particularly appeals to privacy advocates. Each consumer (patient) would directly control who can access his or her account. Patients would authorize their providers to “deposit” and “withdraw” information from their secure online personal health information. It has even been suggested that the consumer would bear the cost of a nominal subscription fee. To date, however, patients have shown little inclination to adopt electronic personal health records, even though several systems are now available for free from organizations such as Google and Microsoft as well as health insurers.

Another proposed option is to use a nationwide electronic messaging system that already exists, such as Surescripts. Surescripts is the primary messaging system between physicians and pharmacies used in this country for the transmission of electronic prescriptions. Surescripts proposes becoming a health information service provider that offers the ability to exchange clinical messages and patient encounters over a standards-based network between providers. The company plans to offer this service in 2011 and support it by a subscription fee.

Additionally, the government recently has proposed a simpler alternative to HIOs called the DIRECT Project. In this option, which could be available as early as 2011, physicians will be able to push encrypted clinical messages between healthcare partners. Pilot tests will be under way in early 2011, and further details are forthcoming.

THE FUTURE OF HIE

Some see the role of the HIO as an “infomediary” or information-hosting organization that reuses data for more than clinical medicine, such as public health and research purposes. Several HIE vendors are planning to add Web-based EHRs, practice management systems, and business analytics to allow for fully integrated clinical and financial functions. A few HIOs are offering services such as transcription, credentialing, reporting (public health, quality and pay for performance), and patient access to health data through a portal and personal health records. In spite of approximately a dozen successful HIOs, HIOs remain expensive and complex.

Further, the viability of the new State HIE Cooperative Agreement Program is uncertain. States will be required to charge for HIE use, and it is unknown how this requirement will be viewed by data providers and users.

If you haven’t already done so, you will need to make a business decision whether to purchase a certified EHR to receive federal government reimbursement. As part of that decision and as an aid to achieving meaningful use, you also should determine how you will share medical information in the future. Ascertain whether you can use an existing HIO, a new statewide HIE, or a simpler solution such as the DIRECT project or the SureScripts network.

The degree of uncertainty regarding both EHRs and HIE is substantial, but so are the potential benefits to you and your patients. Mature and successful HIE is a rarity today but likely will be standard operating procedure in the foreseeable future.

2010 Advanstar Communications Inc..

Source:  Modern Medicine.com
View Full Article: http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=700603&pageID=1&sk=&date=

June 2, 10:45am – 11:45am

Indianapolis Marriott Downtown
350 West Maryland Street
Indianapolis, IN 46225
The development of a robust health information infrastructure continues to be key to improving the quality and cost of healthcare. Federal mandates will soon accelerate the process for health information exchange to improve efficiency and reduce health care costs nationwide.  Any strides that are made in solving the complex issues of health IT will surely benefit all government agencies in solving their own challenges, especially with regard to privacy and security. This session discusses current developments and the changes that lie ahead including the HITECH Act which seeks to streamline healthcare and reduce costs through the use of health information technology. It is important for healthcare information technology and security professionals to understand the law and how to implement the right structures to ensure compliance.

For More Information Visit http://www.govtech.com/events/indianadgs2010

To understand the potential of shared health records, consider the Bottone family.

Almost everyone agrees that health information technology could create more effective and more efficient systems in the medical world but we still face a number of hurdles in terms of widespread adoption. Journal News Editor Laura Landro discusses some of the challenges facing the medical industry as they look to digitize health records.

Born prematurely with nonfunctioning kidneys, 4-year-old Jacob Bottone has been through dialysis, angioplasty and a kidney transplant, and seen more specialists than most people will see in a lifetime. His doctors and hospitals had electronic medical-records systems, but no way to access each other’s, so his parents had to collect his growing paper medical records in a large accordion folder, haul it from doctor to doctor, explain his medical history over and over again, and often wait for hours while referrals and test results were retrieved and faxed around to different providers. “It was getting to be a bit of nightmare,” says his father, Jason Bottone.

Enter electronic information exchange.

Three leading health-care providers in Colorado’s Front Range region recently teamed up in an electronic health-record exchange program that will allow them to share data on more than a million Colorado residents, including Jacob. The three—Children’s Hospital in Denver, Kaiser Permanente Colorado’s physician group and Exempla Healthcare, which operates Saint Joseph and two other hospitals in Denver—have agreed to share their records on a secure network that will allow clinics, doctors’ offices and hospitals to exchange data on common patients instantly, including lab reports, radiology images and medical history.

Instead of keeping a tattered list of Jacob’s medications in the boy’s diaper bag, his mother, Heather, knows that his doctors at either Kaiser or Children’s Hospital can call them up instantly on a computer. When the family rushed Jacob to the emergency room in December, fearing a rejection of his transplanted kidney, they called ahead to Children’s, where staffers pulled up notes from his latest doctors’ appointments. (Fortunately, he was suffering only gas pains caused by a virus common to transplant patients.) As for the accordion file, dubbed “Jacob’s Bible” by the family, “we don’t have to carry it around anymore,” says Mr. Bottone.

Unfortunately, programs like this are still a rarity. For starters, only about 10% of the nation’s hospitals and less than 7% of doctors’ offices have full-fledged electronic medical records. And those that have electronic records typically don’t share them with others unless they’re part of the same health system. Among the reasons: With dozens of different vendors, information systems often can’t easily talk to each other. In addition, health-care providers often view their information about patients as proprietary. And concern about violating privacy laws has made many hospitals reluctant to join information-exchange efforts.

But those barriers are expected to come down as the federal government prepares to dole out $19 billion in economic-stimulus funds for health-care providers to adopt electronic medical records. To qualify, doctors and hospitals must not only invest in electronic medical records, but also demonstrate “meaningful use” of the systems, including the ability to exchange information with other providers. If they fail to do so, their Medicare payments will be cut.

By 2015, “Americans ought to be able to expect there will be a relatively widespread exchange of health information in a safe and secure way,” says H. Stephen Lieber, CEO of the Healthcare Information and Management Systems Society, whose members include professionals in health-information technology.

The stimulus funds include about $700 million for states to help create information exchanges that would link multiple providers in a state or region. At present there are essentially two kinds of exchanges—though the terminology is fluid and some arrangements overlap, making it difficult to precisely quantify the extent of record sharing.

Regional Successes
So-called regional health-information organizations, known as RHIOs, typically are overseen by a state or local nonprofit organization that coordinates the exchange of information among competing providers in their area over a common network. The other kind of exchange is an agreement directly between competing health providers to share data. This is often called an HIE, for health-information exchange, though that term is sometimes used more broadly.

The eHealth Initiative, a nonprofit group that promotes health IT, counts at least 193 active initiatives of all kinds to exchange information in the U.S., but not all are off the ground; 57 reported they were operational last year, a 36% increase from 42 in 2008. However, a study published in the journal Health Affairs last year found that most RHIOs were focused on exchanging test results alone, and only 41% reported receiving sufficient revenue from participating providers to cover operating costs. The study concluded that RHIOs’ “scope remains limited and their viability uncertain.”

To be sure, some RHIOs have been successful. HealthBridge, started in 1997 in the greater Cincinnati-northern Kentucky area, includes 24 hospitals and close to 5,000 doctors’ offices. They share lab tests, radiology reports and other results over a secure electronic network that enables different information systems to communicate with each other.

Patients aren’t the only ones to benefit: The system saves its members an estimated $20 million annually just in staff, fax and postage costs for records transfers, says HealthBridge’s policy director, Trudi Matthews. And HealthBridge is extending its reach, working with three other regional exchanges in Ohio and Indiana to connect their systems, so if a baby goes to a hospital in Indianapolis, a pediatrician in Cincinnati can access the test results and radiology notes.

Direct exchanges of data between competing providers also remain rare, according to a recent study by research firm KLAS Enterprises LLC. Jason Hess, the study’s author, says the number is low in part due to technological barriers from incompatible records systems. And several other issues have yet to be fully resolved, including privacy and cost concerns. “If I am a hospital exchanging information with a competing hospital down the street,” Mr. Hess says, “at what point am I not responsible for what happens to that information?”

It also isn’t always clear who would pay for what in an information-sharing system, or whether doctors would be willing to accept images and tests from another hospital. Some doctors might distrust a CT scan, for instance, from another hospital system and be hesitant to base their prognosis on it. And hospitals make money from doing their own tests and procedures, another disincentive to share information.

National Ambitions
The ultimate goal is to move beyond regional efforts and create a national health-information network, says David Lansky, chief executive of the Pacific Business Group on Health, a coalition of large health-care purchasers, and a member of a national advisory committee on health-information technology. Such a network will need a set of “policies, standards and services that allow the Internet to be used for meaningful exchange to improve health and health care,” Dr. Lansky says. “And that is about trust—coming up with rules and agreements that give us the trust to share information with each other.”

The Denver-area providers say trust is largely what helped them agree on their health-information exchange. And they had another big advantage: All three partners happened to have medical-record systems purchased from the same vendor, Epic Systems Corp. of Verona, Wis. There also were personal relationships to draw on; both hospital partners admit many children who are patients of Kaiser pediatricians, for example.

Executives at Children’s Hospital and Exempla say the main hurdles in the deal were administrative and legal, such as developing procedures for obtaining legal consent from patients to transfer their records electronically when they register at a hospital or clinic, and ensuring proper identification of patients, like those with similar names.

Though the electronic medical records were already in place, the partners had to make some new investments. Children’s Hospital spent close to $50,000 to make the transition and invested about 1,000 hours of labor; Exempla spent $200,000 on equipment and labor costs for the project.

“We never batted an eye at the investment,” says Exempla’s senior vice president and chief information officer, David Pecoraro. “The impetus was to provide safer and better care.”

Ms. Landro is an assistant managing editor for The Wall Street Journal and writes the paper’s Informed Patient column. She can be reached at laura.landro@wsj.com.

Source:  WSJ.COM

Health information technology (HIT) holds promise to better coordinate patient care, reduce costs, improve quality – and daily life for physician practices. That’s the idea behind development of a variety of federal HIT grants under the American Recovery and Reinvestment Act, and Indiana is seeing a flow of those dollars. To date three rounds of grant funding have sent funds to our state.

What does that mean to you? If you already have an electronic health record (EHR), you may get assistance with an upgrade or gain access to a pool of potential employees who are skilled in HIT – a benefit for any office. You may also see improved connectivity, allowing you to exchange data with other medical offices, laboratories, pharmacies, clinics and hospitals – providing quicker, easier access to test results and referred patient information.

If you do not have an EHR, you may qualify for thousands of dollars in assistance to get one. You’ll be able to tap into experts for consultation, and selection and implementation information. Then when you do conclude your EMR implementation, you’ll find lab reports, hospital notes and other important details about your patients are immediately available to you.

First bucket – Regional Extension Centers
 
In February, the U.S. Department of Health and Human Services awarded nearly $1 billion to advance the use of HIT nationwide. In Indiana, Purdue University was granted $12 million and HealthBridge (serving 19 southern Indiana counties) was granted $9.7 million to create Regional Extension Centers (RECs).

RECs will help you and other health care providers qualify for federal incentive dollars for the purchase or update of an EHR. The RECs will take a hands-on approach to assist with selection, implementation, project management and achievement of meaningful use of EHRs. The attention of the RECs will be on small primary care practices (less than 10 physicians), particularly those in rural areas. Each of 32 RECs across the country is tasked with supporting 1,000 providers.

According to the directive in the Federal Register, the RECs must: “…provide technical assistance and disseminate best practices and other information…” Read the full directive here.
 
Second bucket – For skilled workers

Two additional entities in the state also received large grants in February. Ivy Tech Community College and the Indianapolis Private Industry Council were awarded about $5 million each. Their job? These entities will help develop the skilled labor force that will be needed when the mass of health professionals in our state begin using HIT.

The $5 million for each entity will advance training and employment services to ensure that medical offices and others have access to technical and other support. Unemployed and displaced workers can receive training for IT, nursing and allied health careers.
 
Third bucket – For health information exchange
 
In mid-March, another grant of $10.3 million was announced for our state. It will support the State Health Information Exchange Cooperative Agreement Program, led by BioCrossroads, to improve the quality and reach of Indiana’s existing health information delivery systems.

A new non-profit entity has been created to spearhead the effort; it’s called Indiana Health Information Technology, Inc. (IHIT).

IHIT will serve as a governance and contracting structure for the purpose of extending HIT networks to all corners of the state. That means IHIT will work with the following health information exchanges (HIOs) already operating here:

• Indiana Health Information Exchange
• HealthLinc
• MedWeb
• Michiana Health Information Network
• HealthBridge

These exchanges securely transfer clinical test results, reports and other medical information between physicians groups, clinics and hospital networks. The grant will allow IHIT to build upon our already firm foundation by enhancing the availability and adoption of these critical existing services to other, more rural areas of the state.

Among other things, IHIT and the five current HIOs will:

• Expand the infrastructure statewide to add more connectivity and interoperability, especially in underserved areas
• Establish standard formats for delivery of clinical messages so communication between two entities in the statewide system can be sent and received seamlessly
• Expand electronic quality reporting, public health reporting and other clinical summaries relevant to meaningful use guidelines
• Develop a system to identify patient records and match them to specific individual’s health information across all providers
• Adopt nomenclature that is normalized and based on national standards
• Build a clinical repository with data from Medicaid patient records for better information on that patient population

“Indiana is really the nation’s leader in using HIOs for the rapid deployment of electronic health information through our health care system,” said David Johnson, BioCrossroads president and CEO. “Our efforts here will serve as a model for many other areas of the country as the federal government mandates progress toward better health outcomes through the meaningful use of patient information.”
 

ISMA e-Reports, 3/31/2010

Who is eligible for the stimulus HIT incentives?

Those defined as an “eligible professional” (EP).Under Medicare that means a doctor of medicine or osteopathy who is not hospital based can qualify for incentive payments based on an amount equal to 75 percent of allowed Medicare Part B charges.

Under Medicaid, a physician, dentist, certified nurse midwife, nurse practitioner or physician assistant in a rural health clinic or federally qualified health center is eligible if Medicaid patients are 30 percent of patient volume. For pediatricians that’s reduced to 20 percent. You cannot get incentives under both Medicare and Medicaid. More details are expected.

Can hospital-owned physician practices get paid for EHR participation?

If hospital-owned practices provide a substantial amount of their services outside the hospital, they might qualify for the stimulus funds. It is not yet clear whether incentives would flow through the hospital or through the providers.

Physicians solely hospital-based (ER doctors, anesthesiologist, pathologists, etc.) are not eligible, since the hospital incurs the EHR expense.

How will the Centers for Medicare & Medicaid Services (CMS) pay the incentive – through individual checks once a year, once a month?

Medicare and Medicaid EPs would receive a single, consolidated, annual incentive payment. Medicare EPs would be paid electronically via their Medicare contractor. Medicaid EPs would receive payment from either the state Medicaid agency or a designated intermediary (i.e., a Medicaid HMO).

Payments would be distributed on a rolling basis, as soon as you have: 1) demonstrated meaningful use for the applicable reporting period (90 consecutive days for first year or the calendar year for subsequent years); and 2) reached the threshold for maximum payment.

How can practices already using an EHR benefit?

Incentives are available to both new and early adopters of EHRs. However, all EHRs must meet certification/qualification requirements. Early adopters may need to upgrade to newer versions of their EHR products, depending on the standards rule. Federal agencies are required to develop standards on interoperability, security and more. Stay tuned for more details.

How will I know if my EHR is certified?

The independent Certification Commission for Healthcare Information Technology (CCHIT) has been certifying EHR systems since 2006. For purposes of qualifying products for stimulus incentives, CCHIT anticipates, but has not yet received, federal accreditation. Keep checking the CCHIT Web site.

Is there an Internet forum or bulletin board where I can get updates on HIT developments?

Yes. Visit here to join the Health-IT Listserv and stay current on information.

How do we file or apply so Medicare/Medicaid knows to reimburse us?
CMS will conduct outreach efforts later this year to ensure you understand all policies and requirements related to eligibility, selection of either Medicare or Medicaid, incentive payments and demonstration of meaningful use.

See March 6 ISMA Reports for details about recently announced Indiana Regional Extension Centers. These entities will educate, assist and “hold your hand” to help you obtain EHR incentive dollars. The centers are expected to be operational next month, providing technical assistance by defined geographic area.

To read more of the AMA question and answer document, visit here. For an AMA Webinar series, visit here.

*Based on Notice of Proposed Rule Making by CMS on 12/30/09 and subject to comment period. Subject to change.

ISMA e-Reports

 3/17/2010

The recently enacted stimulus bill — the American Recovery and Reinvestment Act of 2009 (ARRA) — touches almost every aspect of the U.S. economy. Health care is no exception. In fact, the ARRA is historic health care legislation of the type rarely produced by our famously incremental federal government. The law prevents dramatic state cuts in Medicaid, expands funding for preventive health care services and health care research, and helps the unemployed buy health insurance. But perhaps its most profound effect on doctors and patients will result from its unprecedented $19 billion program to promote the adoption and use of health information technology (HIT) and especially electronic health records (EHRs).

Full New England Journal Article

Indianapolis Business Journal
J.K. Wall -  jwall@ibj.com
Sat. March 07 – 2009

Grab a partner and dance. Fast.

The stimulus bill passed last month essentially sets a five-year time line for doctors to start using electronic medical records and for states to figure out how to exchange those records from doctor to doctor.

That has prompted Indiana businesses and not-for-profits that deal in medical records to look for partners to help them meet the challenge and capitalize on the opportunity.

The potential market is substantial. Even before the stimulus bill, the U.S. health care information technology industry spent $28 billion annually. The stimulus bill provides incentives that could pump $31 billion more into the market over the next decade.

Full story

Physicians Can Earn Tens of Thousands in IT Incentives, But They Must Act Quickly to Achieve the Biggest Benefit and Avoid Penalties.

Over the next decade, the federal government is projected to spend more than $35 billion on Medicare and Medicaid bonuses to physicians, hospitals and others that adopt certified electronic health records. Because of the Medicare penalties that eventually will apply to nonadopters, however, the net spending level will be only about $20 billion over 10 years.

Full story