Category Archives: Hospitals

ONC Presents “Spotlight on Health IT in the News”

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Spotlight on Health IT in the News
Excerpted this new feature from Office of the National Coordinator (ONC) for Health IT  site, first  published on 1/5/2010 and updated on 1/6/2010.

  1. Blumenthal Looks Back at 2010, Offers Peek Into Plans for 2011
    Q&A with David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology
    iHealthBeat, January 3, 2011

    Dr. Blumenthal discusses the challenges ONC faced in 2010, plans for 2011, and the importance of health information technology (health IT) to the implementation of federal health reform law.

  2. Electronic Health Records: Potential to Transform Medical Education
    By Sachin H. Jain, M.D., M.B.A., Special Assistant to the National Coordinator for Health Information Technology, and Bryant A. Adibe, B.S., Executive Director, Young Achievers Foundation
    The American Journal of Managed Care, December 22, 2010

    Dr. Jain and Bryant Adibe examine the ways in which EHR adoption can lead to improved patient-centered approaches to physician training.

  3. Healthcare Information Technology Interventions to Improve Cardiovascular and Diabetes Medication Adherence
    By Sachin H. Jain, M.D., M.B.A., Special Assistant to the National Coordinator for Health Information Technology, et al.
    The American Journal of Managed Care, December 22, 2010

    This literature review discusses health IT interventions designed to improve medication adherence in cardiovascular disease and diabetes.

  4. Alternative Measures of Electronic Health Record Adoption Among Hospitals
    By Melinda J. Beeuwkes Buntin, Ph.D., Director, Office of Economic Analysis and Modeling, and Charles P. Friedman, Ph.D., Chief Scientific Officer, ONC
    The American Journal of Managed Care, December 22, 2010

    This study examines the type of EHR functions that hospitals have adopted.

  5. Using Electronic Prescribing Transaction Data to Estimate Electronic Health Record Adoption
    By Farzad Mostashari, M.D., Sc.M., Deputy National Coordinator for Programs and Policy; Melinda J. Beeuwkes Buntin, Ph.D., Director, Office of Economic Analysis and Modeling; and Emily Ruth Maxson, Duke University School of Medicine
    The American Journal of Managed Care, December 22, 2010

    This study investigates whether electronic prescribing transaction data can be used to accurately and efficiently track national and regional electronic health record adoption.

  6. Health Information Technology Is Leading Multisector Health System Transformation
    By David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology and Sachin H. Jain, M.D., M.B.A., Special Assistant to the National Coordinator for Health Information Technology
    The American Journal of Managed Care, December 17, 2010

    Dr. Blumenthal and Dr. Jain discuss the impact of the HITECH Act on health information technology (health IT) adoption and provide an overview of the content found in the journal’s special issue on health IT.

  7. Uniting the Tribes of Health System Improvement
    By Aaron McKethan, Ph.D., Program Director, and Craig Brammer, Deputy Director, Beacon Community Program
    The American Journal of Managed Care, December 17, 2010

    Dr. McKethan and Craig Brammer discuss how multiple interventions and simultaneously implemented tools are required to transform the U.S. health care system.

  8. Regional Quality Initiatives: Expanding the Partnership
    Blog post by David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology; Carolyn Clancy, M.D., Director of the Agency for Healthcare Research and Quality (AHRQ); and Risa Lavizzo-Mourey, President of The Robert Wood Johnson Foundation (RWJF)
    Health Affairs Blog, December 9, 2010

    This joint ONC, AHRQ, and RWJF blog post discusses how dozens of diverse regions of the country are benefiting from an unprecedented commitment of resources and technical expertise to help local leaders improve the quality of health care provided in their region.
  9. Perspective: Dr. David Blumenthal on Health Information Technology
    Q&A with David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology
    MDNews.com, November 19, 2010

    Dr. Blumenthal discusses provider involvement in implementation of health IT as part of a videotaped interview during the Medical Group Management Association 2010 conference, held October 24-27.

10.  Fed Health Tech Chief Talks about E-Medical Records
Q&A with David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology
The Texas Tribune, October 21, 2010

Dr. Blumenthal discusses the benefits of electronic health records and protections for patient privacy. 

11.  Beacons for Better Health
By Aaron McKethan, Ph.D., Program Director, and Craig Brammer, Deputy Director, Beacon Community Program
Health Affairs Blog, September 23, 2010

Dr. McKethan and Mr. Brammer discuss how Beacon Communities will showcase ways that health information technology is being used to support providers in delivering improved patient care.

12.  This Doctor’s Task: Get Hospitals to Go Digital
Q&A with David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology
Federal Times.com, September 13, 2010

Dr. Blumenthal elaborates on ONC’s efforts to encourage the electronic transformation of health care delivery on the national and local levels.

13.  The Push for Electronic Medical Records (listen to audio file)
Interview with David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology
Vermont Public Radio, September 9, 2010

Dr. Blumenthal speaks to Vermont Public Radio about the Vermont Information Technology Leaders Summit and how the state’s hospitals and providers can increase their electronic health records adoption.

14.  Beaconology for Beginners: A Chat with ONC’s Aaron McKethan
Aaron McKethan, Ph.D., Program Director, Beacon Community Program
CMIO Blog, September 7, 2010

Dr. McKethan chats with CMIO about producing community-level clinical performance measures as modeled by the Beacon Community Program.

15.  Strengthening the Gulf’s Health-Care Infrastructure for Generations to Come
By Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services
Huffington Post, August 27, 2010

HHS Secretary Kathleen Sebelius discusses rebuilding the health-care infrastructure to meet the Gulf communities’ long-term medical needs, including efforts by Beacon Communities to help providers move from paper files into the digital age.

16.  The New Momentum Behind Electronic Health Records
By Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services
KHN Blog, Kaiser Health News, August 26, 2010

HHS Secretary Kathleen Sebelius details the benefits of health IT adoption for the entire health care system. 

17.  Health Information Technology Program Receives $2.7 Million in Federal Funding, Graduates First Class of Students This Summer
University of Texas at Austin Website, August 26, 2010

University of Texas at Austin graduates the nation’s first class of students from its federally funded health IT workforce development program.

18.  Adoption and Meaningful Use of EHRs – The Journey Begins
By David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology; and Don Berwick, M.D., Administrator, Centers for Medicare & Medicaid Services
Health Affairs Blog, August 5, 2010

Dr. Blumenthal and Dr. Berwick explain the need for federal leadership in helping providers nationwide to adopt and utilize health IT for better quality of care.

19.  Perspective: The “Meaningful Use” Regulation for Electronic Health Records
By David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology, and Marilyn Tavenner, R.N., M.H.A., Principal Deputy Administrator, Centers for Medicare & Medicaid Services
New England Journal of Medicine, July 13, 2010

Dr. Blumenthal and Marilyn Tavenner summarize the core objectives of the CMS “Meaningful Use” regulation and how it ties payments to the achievement of advances in health care processes and outcomes.

20.  Perspective: Finding My Way to Electronic Health Records
By Surgeon General, Vice Admiral Regina M. Benjamin, M.D., M.B.A.
New England Journal of Medicine, July 13, 2010

Surgeon General Regina Benjamin shares her personal story about understanding the value of electric health records in preserving patient records when disaster strikes.

21.  Health Information Technology: Laying the Infrastructure for National Health Reform [PDF - 146 KB]
By David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology; Sachin H. Jain, M.D. M.B.A., Special Assistant to the National Coordinator for Health Information Technology; and Melinda Beeuwkes Buntin, Ph.D., Senior Economic Advisor, ONC
Health Affairs, June 2010

  1. Drs. Blumenthal, Jain, and Buntin discuss the key ways in which health IT is critical to the implementation of national health reform.

22.  Perspective: Launching HITECH
By David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology
New England Journal of Medicine, February 4, 2010

Dr. Blumenthal outlines the HITECH Act as the groundwork for an advanced electronic health information system.

CMS Opens EHR Incentive Program Registration, Issues Guides to Registration

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Registration for the Medicare and Medicaid EHR Incentive Programs is now open.
State Medicaid EHR Readiness appears to delay registration completion in those states at least for Medicaid
CMS has issued three step-by-step guides to registration  for the EHR Incentive Programs, each about 20 pages long, for Eligible Hospitals, Professionals Eligible for Medicare, and Professionals Eligible for Medicaid. For hospitals in states which are not yet ready with their Medicaid programs, the guide indicates “your file will be placed into a pending status until your state’s program is launched.” For eligible professionals in states which are not yet ready for Medicaid, they may not be able to register until those states are ready. (The EHR Information Center phone line said eligible professionals in non-ready states would not be able to register for Medicaid programs yet.) Dual-eligible hospitals, who potentially may apply for both Medicare and Medicaid are advised to indicate they will be applying for both Medicare and Medicaid EHR Incentives, even if they are not ready at this point.

We strongly recommend reading the applicable guide thoroughly and have all the information required prior to going to register. We expect more clarity to come on some issues noted above in the next few days.

CMS EHR Registration and Attestation Page
Excerpted from CMS site on 1/3/2010:
We encourage providers to register for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as possible. You can register before you have a certified EHR. Register even if you do not have an enrollment record in PECOS.

Register for the Medicare and/or Medicaid EHR Incentive Programs.

Below are step-by-step guides to help you register for EHR Incentive Programs. Choose the guide that fits your needs:

Please Note: Although the Medicaid EHR Incentive Programs will begin January 3, 2011, not all states will be ready to participate on this date. Information on when registration will be available for Medicaid EHR Incentive Programs in specific States is posted at Medicaid State Information.

Eligible Professionals:

Eligible professionals eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which incentive program they wish to participate in when they register. Before 2015, an eligible professional may switch programs only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program.
Editor’s note: We anticipate that this comment on professionals will be updated regarding Medicaid, since it appears Medicaid registration may be delayed until a state’s Medicaid program is ready.

Hospitals:
Editor’s note: Please note this is new language since registering for a state’s Medicaid program appears that it will be delayed until that state’s Medicaid program is ready. Unclear how this impacts dual-eligible hospitals.

If you represent a hospital that meets all of the following qualifications, you are dually-eligible for the Medicare and Medicaid EHR Incentive Programs:

  • You are a subsection(d) hospital in the 50 U.S. States or the District of Columbia, or you are a Critical Access Hospital (CAH); and
  • You have a CMS Certification Number ending in 0001-0879 or 1300-1399; and
  • You have 10% of your patient volume derived from Medicaid encounters.

Hospitals that are eligible for EHR incentive payments under both Medicare and Medicaid should select “Both Medicare and Medicaid” during the registration process, even if they plan to apply only for a Medicaid EHR incentive payment by adopting, implementing, or upgrading certified EHR technology. Dually-eligible hospitals can then attest through CMS for their Medicare EHR incentive payment at a later date, if they so desire.

If you fall into this category, when registering for the program you must choose “Both Medicare & Medicaid”. Please select your state from the drop-down menu on the registration screen. If your state’s program has not yet launched at the time of your registration, your file will be placed into a pending status until your state’s program is launched. That means you will not be able to complete your registration or receive an EHR incentive payment until your state’s program launches. For a list of expected program launch dates, please visit the Medicaid State Information page.

Hospitals that register only for the Medicaid program (or only the Medicare program) will not be able to manually change their registration (i.e., change to “Both Medicare and Medicaid” or from one program to the other) after a payment is initiated and this may cause significant delays in receiving a Medicare EHR incentive payment.

If you represent a hospital that falls into one of the categories below, you are eligible only for the Medicaid EHR Incentive Program:

  • Children’s hospitals;
  • Cancer hospitals; or
  • Acute care hospitals in the U.S. territories.

When registering for the program you should select “Medicaid-only” for your hospital type. You will see a list of states in a drop down menu and you must select a state. Please select your state from the drop-down menu on the registration screen.

If your state’s EHR Incentive Program has not yet launched at the time of your registration, your file will be placed into a pending status until your state’s program launches. That means you will not be able to complete your registration or receive an EHR incentive payment until your state’s program launches. For a list of expected Medicaid EHR Incentive Program launch dates, please visit the Medicaid State Information page.

The Electronic Health Record (EHR) Information Center is open to assist the EHR Provider Community with inquiries.

EHR Information Center Hours of Operation: 7:30 a.m. – 6:30 p.m. (Central Time) Monday through Friday, except federal holidays.
1-888-734-6433 (primary number) or 888-734-6563 (TTY number)

Submit an Inquiry to the EHR Information Center

ONC: CAHs and Rural Hospitals to gain add’l support from RECs–Jan 12 Deadline

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Regional Extension Centers Apply for Supplemental Funds
to Support CAHs and Rural Hospitals
from Office of National Coordinator for Health IT
REC Applications Due January 12, 2011
According to a December 28, 2010 ONC announcement, Regional Extension Centers, which support the process of achieving ‘Meaningful Use’ for eligible professionals, Critical Access Hospitals, Community Health Centers and Rural Health Clinics, may be able to receive supplemental funds to bring total to $18,000 per CAHs or Rural Hospitals under 50 beds per  facility.

Posted December 28, 2010 on ONC Site
Synopsis: “This supplement will be available to recipients of the REC awards and is intended to ensure the provision of services to CAHs and Rural Hospitals in the REC’s service area. This award will be supplemental to the REC’s existing award, and the plans, metrics and reporting requirements will be included in the REC’s cooperative agreement. It is anticipated that each REC will need a total of $18,000 per CAH and Rural Hospital that it supports through this program, beyond the funding awarded in the base REC grant. RECs in Group A will be awarded $18,000/eligible CAH and Rural Hospital approved for funding. RECs in Group B will be awarded $6,000/previously approved CAH and Rural Hospital to bring the total amount of CAH/Rural Hospital supplemental funding from $12,000/hospital to $18,000/hospital. The supplemental funds will be used to ensure the delivery of the support services for CAH and Rural Hospitals and will be tied to the same milestones that are identified in the original REC FOA (EP-HIT-09-003). As with other funding milestones identified in the original FOA, recipients will be required to use the customer relationship management tool to help in meeting the milestones associated with this project.”

Key Links:
ONC Funding Announcement
Funding Announcement PDF
List of Eligible Hospitals [XLS – 175 KB]
Grants.gov Announcement and documents

Supplemental Funding Opportunity for Regional Extension Centers to assist eligible Critical Access Hospitals (CAH) and Rural Hospitals in adopting electronic health records and using them in a meaningful way

  • Funding Opportunity Number: 2010-ONC-REC-S-01
  • Closing Date for Applications: January 12, 2011, 11:59 p.m. EST
  • Estimated Total Program Funding: $12,228,000

Excerpted from Funding Announcement Dec 28, 2010:
After the initial REC awards were made, the RECs recognized the challenges of serving CAH and Rural Hospitals were significant and therefore required greater resources than were provided. ONC recognized the unique needs of these hospitals and funded this project as a supplement to the REC funding (Funding Opportunity Number: EP-HIT-09-003). Supplemental funding can only be made available to entities with existing REC cooperative agreement awards. The purpose of the supplement was to ensure the provision of services to Critical Access Hospitals (CAH) and Rural Hospitals already defined within the scope of the cooperative agreements funded under FOA No. EP-HIT-09-003, as CAHs and Rural Hospitals are vital components of the rural health care system in the United States. These hospitals were included on the priority list for the RECs. The intent of the CAH/Rural Hospital Project is to provide additional support for staffing and expertise to assist rural CAHs and Rural Hospitals with less than 50 beds in selecting and implementing meaningful electronic health record (EHR) systems. These additional staff will work in coordination with other REC staff that will be supporting the primary care providers in the REC Service Areas.

The original cooperative agreement award was comprised of a four year project period, consisting of two budget periods. The first budget period (years 1 and 2) had a 90/10 cost share requirement and the second budget period (years 3 and 4) had a 10/90 cost share requirement. For the first budget period the grantee was responsible for contributing 1 dollar for every 9 federal dollars. For the second budget period, the grantee was responsible for contributing 9 dollars for every 1 dollar of federal funds.

In December 2010, the Secretary approved additional changes to the REC program under the authority of the cost-sharing waiver per the HITECH Act, stating that “The Secretary may provide financial support to any regional center created under this subsection for a period not to exceed four years. The Secretary may not provide more than 50 percent of the capital and annual operating and maintenance funds required to create and maintain such a center, except in an instance of national economic conditions which would render this cost share requirement detrimental to the program and upon notification to Congress as to the justification to waive the cost-share requirement.” This waiver provided changes to the REC program timeline and cost-sharing requirements. The timeline was modified to lengthen the first budget period from two years to four years. The cost-sharing requirement will now reflect a 90/10 federal/grantee cost share for all four years with the execution of a revised Notice of Grant Award (NGA).

As stated in original FOA, a positive biennial evaluation will be required for grantees to continue work in years 3 and 4 of the grant; this requirement is unchanged by the December 2010 waiver. The scope of work of the REC program also remains unchanged.

The purpose of this supplement is to further ensure the provision of services to Critical Access Hospitals (CAH) and Rural Hospitals, as described above and will make available funding to the following:

Group A: Regional Extension Centers which did not apply for supplement funding under the first supplemental funding announcement or were not funded under the first supplemental funding opportunity announcement.

Group B: Regional Extension Centers which did receive supplemental funding, and are applying for an additional $6,000 per eligible Critical Access Hospital (CAH) and Rural Hospital already defined within the scope of its cooperative agreement funded under FOA No. 2010-ONC-REC-S.

Scope of Services
Each applicant has already developed a plan for supporting priority setting (including providers at CAHs and Rural Hospitals) primary care providers in their service area to achieve meaningful use of an EHR system as part of their original application. This supplement is designed to provide support to the RECs, to ensure they can provide assistance to CAH and Rural Hospitals in their service area. In their original application, RECs stated that they were planning to work with CAH and Rural Hospitals. However, it was made known that the RECs may not have sufficient resources to carry out this endeavor.

For Group A, each funded REC will plan and implement the outreach, education, and technical assistance programs necessary to meet the objective of assisting CAHs and Rural Hospitals with less than 50 beds in its geographic service area to improve the quality and value of care they furnish by attaining or exceeding meaningful use criteria established by the Secretary of the Department of Health and Human Services (HHS). On-site technical assistance will be a key service. Selected RECs will modify their operating plans that were approved upon initial award to include specific plans for the CAH and Rural Hospital projects and will report their activities through the quarterly reporting process.

Group B will be required to modify their current operating plans, that were revised and approved per the first round of the Supplement Funding Opportunity Announcement and modify their plan to account for the additional funds ($6,000 per CAH and Rural Hospital) to further meet the objectives of assisting CAHs and Rural Hospitals with less than 50 beds in its geographic service area to improve the quality and value of care they furnish by attaining or exceeding meaningful use criteria established by the Secretary of the Department of Health and Human Services (HHS).

RECs are expected to work with both CAHs and Rural Hospitals who have not yet adopted EHR systems, and those with existing EHR systems, to assist them in achieving meaningful use of certified EHR technology. The milestones for this work will be the same as those identified in the original REC FOA (Funding Opportunity Number: EP-HIT-09-003); funds are for direct assistance only.

Subject to the limitations of eligible applicants described below in Section III, there are two types of CAHs and Rural Hospital organizations that are eligible for support through this application: (1) acute care hospitals (as defined in the SSA Section 1886(d)) with 50 or fewer beds located in a rural area and (2) a critical access hospital as defined in the SSA Section 1820(c) of the Social Security Act.

Blumenthal Reviews ONC’s 2010 Accomplishments on ONC Blog

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2010 ONC Update Meeting: Advancing the Dialogue on Health IT
Monday, December 27th, 2010 | Posted by: Dr. David Blumenthal on ONC’s Health IT Buzz blog and republished here by e-Healthcare Marketing.

Thank you to everyone who participated in the 2010 ONC Update on December 14-15, 2010 where we had the opportunity to discuss ONC’s strategies and programs, hear about your experiences in the field, assess progress to date, and get caught up on HITECH’s implementation. Video-recordings of the webcast are now available through the ONC website at http://healthit.hhs.gov/ONCMeeting2010.

The 2010 ONC Update was held in conjunction with 2010 ONC Grantee Meeting which brought together for the first time the awardees of all of the ONC programs , including the Beacon Communities Program, Regional Extension Center Program, SHARP Program, State Health Information Exchange Program, and the many Workforce Development Programs.

This year, significant strides were made in health information technology. And for us, information technology has always been a means to an end, the end of improving health, improving the health system, making the lives of our fellow Americans better, making our nation’s health professionals and institutions able to live up to their aspirations, empowering Americans to have and take control of their own health and lives. These are the reasons why the Congress and the President enacted the HITECH Act and the reason that the Office of the National Coordinator exists today.

But, of course, there are many organizations and groups that have those high aspirations. Our unique contribution comes from a core insight that good intentions have to be powered by strong capabilities. And science and technology have created for us an enormously powerful new set of tools in the form of health information technology.

We are here to make sure that those tools are used fully to realize our collective aspirations. Information is the lifeblood of medicine. As health professionals and institutions, we are only as good as the information we have about the patients that we care for. Health IT is destined to be the circulatory system for that information in the decades to come.

The last several months have been a whirlwind of activity. And it is easy to forget how much we’ve accomplished. We established the meaningful use framework, one that I think is unprecedented in the history of electronic health information systems. No other country has laid out a similar framework for what can and should be accomplished using health information technology. And on January 3, the Centers for Medicare & Medicaid Services will launch the registration process for those who wish to participate in the Medicare and Medicaid EHR Incentive Programs.

We’ve issued a standards and certification regulation. As of this week, we have five certifying bodies that are available to certify electronic health records. They’ve certified more than 200 records and modules in the several months since they’ve been in existence.

Regional extension centers – 62 of them are working hard to provide hands-on assistance to those providers that need the most help in making this transition. As of this week, 30,000 physicians have already enrolled in these extension programs across the United States.

The State Health Information Exchange Program has provided 56 states and territories with planning grants. More than 20 of these states and territories have approved implementation plans, and new implementation plans are being approved every day.

Seventeen Beacon Communities are now in place. They didn’t exist a year ago. They are paving the way toward real improvements in health and health care in the communities they serve, leveraging health information technology. The SHARP Program is tackling new challenges through research and development.

And ONC’s Workforce Development Programs are preparing a whole new workforce and creating new jobs to support the transformation of our health care system through the use of information technology. To date, we have seen almost 2,300 new enrollees in community college programs and close to 400 in University‑based Training Programs focused on health information technology. And we are well on our way in these very early stages toward meeting that target of 10,000 new health professionals trained annually during the lifetime of the program.

In addition to our grants, we have dozens of contracts that are supporting programs like the Nationwide Health Information Network. And our Health IT Policy Committee and Health IT Standards Committee continue to provide enormously valuable guidance on the many policies and standards that are needed to support execution against our mission.

All of these efforts not only play a critical role in our strategy related to the improvement of health and health care through information technology, but also provide the foundation for health systems change and upcoming reforms in how we deliver and pay for care.

As we look to 2011, there will be many challenges. Driving change is hard. And it takes leadership, commitment and the ability to move forward – despite the many obstacles that each of you will encounter. I hope your sense of contributing something unique to health care and the American people – for most certainly you are – balances the incredibly hard work that you are undertaking. Someday you will look back and realize that you were present at the creation of something big.

Thanks again, and we look forward to our continued collaboration in the new year.
###To comment directly on ONC’s Health IT Buzz Blog, click here.
See Blumenthal Letter #22 on e-Healthcare Marketing.

Blumenthal Letter #22: Ready for Jan 3 EHR Incentives Registration?

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Registration for EHR Incentive Programs
Starts January 3, 2011: Are You Ready?

Dr. David Blumenthal

Dr. David Blumenthal

A Message from Dr. David Blumenthal, the National Coordinator for Health Information Technology
December 27, 2010
Published by ONC on 12/27/2010 and republished here.

The New Year is just around the corner, and so is another milestone in our nation’s work to improve health care through health information technology. Starting on January 3, 2011, eligible health care professionals, hospitals, and critical access hospitals may register to participate in the Medicare and Medicaid EHR Incentive Programs.

This is an auspicious time. Nearly two years ago, the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009, was signed into law. Since then Department of Health and Human Services (HHS) agencies like the Office of the National Coordinator for Health Information Technology (ONC), the Centers for Medicare & Medicaid Services (CMS), the Office for Civil Rights (OCR), and others have implemented HITECH policies and programs to help providers adopt and achieve meaningful use of certified electronic health record technology and ensure that electronic health information remains private and secure.

[See Blumenthal's review of 2010, originally posted on ONC's Health IT Buzz blog.]

Why Become a Meaningful User?

Qualify for financial incentives from the federal government
Eligible professionals who demonstrate meaningful use have the opportunity to receive incentive payments through the Medicare and Medicaid EHR Incentive Programs—up to $44,000 from Medicare, or $63,750 from Medicaid.  Under both Medicare and Medicaid, eligible hospitals may receive millions of dollars for implementing and meaningfully using certified EHR technology. Providers can get started now with the help of financial incentives from the federal government. If they wait, those incentives may not be available. And financial penalties are scheduled to take effect in five years. 

Build a sustainable medical practice
The next generation of health care professionals will expect and demand that their own medical facility home have a state-of-the-art information system.  Becoming a meaningful user of electronic health records will allow providers who are building their practices to recruit and retain talented young clinicians.

Improve the safety and quality of health care 
The meaningful use of electronic health records will help health care providers and hospitals offer higher quality and safer care. By adopting electronic health records in a meaningful way, providers and hospitals can:

  • See the whole picture. All of a patient’s health information—medical history, diagnoses, medications, lab and test results—is in one place. Providers don’t have to settle for a snapshot when they can have the entire album.
  • Coordinate care. Providers involved in a patient’s care can access, enter, and share information in an electronic health record.
  • Make better decisions. With more comprehensive health information at their fingertips, providers can make better testing, diagnostic, and treatment decisions.
  • Save time and money. Providers who have implemented electronic health records say they spend less time searching for paper charts, transcribing, calling labs or pharmacies, reporting, and fixing coding errors.

ONC and CMS: Here To Help

Registration for the incentive programs may be close at hand, but so is assistance. If you need help in registering for the Medicare and Medicaid EHR Incentive Programs or selecting a certified EHR system, ONC and CMS have resources and services to help you.

  • The Medicare and Medicaid EHR Incentive Programs website contains educational resources and fact sheets with information to help eligible professionals and hospitals adopt, implement, and upgrade certified EHR technology and demonstrate meaningful use to receive EHR incentive payments.
  • Regional Extension Centers, which cover every region of the country, provide on-the-ground technical assistance to health care providers working to adopt and meaningfully use certified EHR technology.
  • The Health IT Workforce Development Program prepares skilled workers for new jobs in health IT.

Connecting to Your Community
ONC also has other programs in place to help advance the meaningful use of certified EHR technology and health information exchange:

As 2010 comes to a close, we are well on our way as a nation to achieving the benefits of widespread adoption of EHRs. If you haven’t made any preparations to register to receive incentive payments, I encourage you to get started now. Resolve today to become a meaningful user in 2011.

Sincerely,
David Blumenthal, MD, MPP
National Coordinator for Health Information Technology 
The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.

For more information and to receive regular updates from the Office of the National Coordinator for Health Information Technology, please subscribe to our Health IT News list.

Directions for CMS EHR Incentives Registration

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Registration and Attestation Begins January 3, 2011
Program Directions
Excerpted from CMS EHR Incentives Program on 12/26/2010.

Registration for the Medicare and Medicaid EHR Incentive Programs opens on January 3, 2011. We encourage providers to register for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as possible. You can register before you have a certified EHR. Register even if you do not have an enrollment record in PECOS.

A link to Registration will be available on CMS EHR Incentives Program site.

Please Note: Although the Medicaid EHR Incentive Programs will begin January 3, 2011, not all states will be ready to participate on this date. Information on when registration will be available for Medicaid EHR Incentive Programs in specific States is posted at Medicaid State Information.

“It is important for a dually-eligible hospital to select “Both Medicare and Medicaid” from the start of registration in order to maintain this option.” Hospitals and Eligible Professionals should read the notes below under the heading “What else do I need to know about registration?”

[Registration for state Medicaid programs opens in the following states on January 3, 2011:

* Alaska
* Iowa
* Kentucky
* Louisiana
* Oklahoma
* Michigan
* Mississippi
* North Carolina
* South Carolina
* Tennessee
* Texas

Registration for state Medicaid programs opens in the following states in February 2011:

* California
* Missouri
* North Dakota

Other states likely will launch their Medicaid EHR Incentive Programs during the spring and summer of 2011.]

e-Healthcare Marketing note: It’s important for hospitals and eligible professionals in ALL STATES to register when registration opens and not delay registering on the CMS site until their state Medicaid programs are ready. See further note below in red under the heading “What else do I need to know about registration?

What can you do now for the Medicare and Medicaid EHR Incentive Programs?

Make sure you have enrollment records in the appropriate systems. You’ll need:

  • A National Provider Identifier (NPI)
    • All eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must have a National Provider Identifier (NPI) to participate in the Medicare and Medicaid EHR Incentive Programs.
  • An enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS)
    • All eligible hospitals and Medicare eligible professionals must have an enrollment record in PECOS to participate in the EHR Incentive Programs. (Note: Eligible professionals who are only participating in the Medicaid EHR Incentive Program are not required to be enrolled in PECOS.)
    • If you do not have an enrollment record in PECOS, you should still register for the Medicare and Medicaid EHR Incentive Programs.

CMS Identity and Access Management (I&A) User ID and Password

  • Eligible Professionals:
    • Eligible professionals can use the same User ID and Password they use for the National Plan and Provider Enumeration System (NPPES). This is also the same User ID and Password that is used to access PECOS.
    • If you do not have an active User ID and Password for NPPES or PECOS, request them via Identity & Access Management. You will need your type 2 NPI, your Taxpayer Identification Number (TIN), and your address from IRS Form CP-575. You will also need to mail a copy of IRS Form CP-575 as directed.
  • Hospitals/Critical Access Hospitals:
    • Authorized Officials can use the same User ID and Password they use to access PECOS.
    • If you do not have an Authorized Official with access to PECOS, request a User ID and Password via Identity & Access Management. You will need your type 2 NPI, your Taxpayer Identification Number (TIN), and your address from the IRS Form CP-575. You will need to mail a copy of the IRS Form CP-575 as directed.
    • Additional hospital staff will need to request access to the “EHR Incentive Programs” application through Identity & Access Management and be approved by the Hospital’s Authorized Official.

What information will you need when you register?

Registering for the Medicare and Medicaid EHR Incentive Programs is easy when you have the following information available during the process:

Eligible Professionals

  • National Provider Identifier (NPI).
  • National Plan and Provider Enumeration System (NPPES) User ID and Password.
  • Payee Tax Identification Number (if you are reassigning your benefits).
  • Payee National Provider Identifier (NPI)(if you are reassigning your benefits).

Hospitals

  • CMS Identity and Access Management (I&A) User ID and Password.
  • CMS Certification Number (CCN).
  • National Provider Identifier (NPI).
  • Hospital Tax Identification Number.

NOTE: You do not have to provide information on the certified EHR technology you are using when you register. However, this information is required when you attest.

What else do I need to know about registration?

Hospitals:
Hospitals that are eligible for EHR incentive payments under both Medicare and Medicaid should select “Both Medicare and Medicaid” during the registration process, even if they plan to apply only for a Medicaid EHR incentive payment by adopting, implementing, or upgrading certified EHR technology. Dually-eligible hospitals can then attest through CMS for their Medicare EHR incentive payment at a later date, if they so desire. It is important for a dually-eligible hospital to select “Both Medicare and Medicaid” from the start of registration in order to maintain this option.

Hospitals that register only for the Medicaid program (or only the Medicare program) will not be able to manually change their registration (i.e., change to “Both Medicare and Medicaid” or from one program to the other) after a payment is initiated and this may cause significant delays in receiving a Medicare EHR incentive payment.

Eligible Professionals:
Eligible professionals eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which incentive program they wish to participate in when they register. Before 2015, an eligible professional may switch programs only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program.

The Electronic Health Record (EHR) Information Center is open to assist the EHR Provider Community with inquiries.
Hours of operation are:

8:30 a.m. – 4:30 p.m. (Central Time) Monday through Friday (except federal holidays)
1-888-734-6433 (primary number) or 888-734-6563 (TTY number)

Submit an Inquiry to the EHR Information Center

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Downloads
Medicare EP PECOS Notification [PDF, 119KB]
Hospital PECOS Notification [PDF, 160KB]
Related Links Inside CMS
Frequently Asked Questions (FAQs)
Excerpted from CMS Page Modified on 12/23/2010 8:41:41 AM

See e-Healthcare Marketing post for December 23, 2010 press release from ONC and CMS.

EHR INCENTIVES REGISTRATION STARTS JAN. 3, 2011

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ELECTRONIC HEALTH RECORDS INCENTIVES REGISTRATION STARTS JAN. 3, 2011

CMS, ONC Outline Resources to Assist Eligible Providers
CMS Press Release on December 22, 2010

Today the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) announced the availability of registration for the Medicare and Medicaid electronic health record (EHR) incentive programs.  CMS and ONC encouraged broad participation and outlined online and in-person resources that are in place to assist eligible professionals and eligible hospitals who wish to participate.

Beginning Jan. 3, 2011, registration will be available for eligible health care professionals and eligible hospitals who wish to participate in the Medicare EHR incentive program.

On January 3, registration in the Medicaid EHR Incentive Program will also be available in Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee, and Texas.  In February, registration will open in California, Missouri, and North Dakota.  Other states likely will launch their Medicaid EHR Incentive Programs during the spring and summer of 2011.

[See e-Healthcare Marketing post on registration directions.]

“With the start of registration, these landmark programs get underway, and patients, providers, and the nation can begin to enjoy the benefits of widespread adoption of electronic health records,” said CMS Administrator Donald Berwick, MD.  “CMS has many resources available to help providers register and participate, and we look forward to working with eligible professionals and eligible hospitals to facilitate the process, beginning on January 3rd and going forward.”

“It’s time to get connected,” said David Blumenthal, MD, MPP, National Coordinator for Health Information Technology.  “ONC and CMS have worked together over many months to prepare for the startup on January 3rd. ONC’s Certified HIT Product List includes more than 130 certified EHR systems or modules and is updated frequently.  ONC also has hands-on assistance available across the country through 62 Regional Extension Centers

We look forward to continuing to work with CMS to assist eligible providers in 2011 and future years.”

Eligible professionals and eligible hospitals must register in order to participate in the Medicare and Medicaid EHR incentive programs.  They can do so, starting Jan. 3, 2011, at a registration site maintained by CMS.

To prepare for registration, interested providers should first familiarize themselves with the incentive programs’ requirements by visiting CMS’ Official Web Site for the Medicare and Medicaid EHR Incentive Programs.  The site provides general and detailed information on the programs, including tabs on the path to payment, eligibility, meaningful use, certified EHR technology, and frequently asked questions.

CMS announced the following key dates for the Medicare and Medicaid incentive programs’ first year:

  • Jan. 3, 2011 – Registration for the Medicare EHR incentive program begins.
  • Jan. 3, 2011 –States that are ready may launch their incentive programs for Medicaid providers.
  • January 2011 – Some state agencies begin issuing Medicaid EHR incentive payments.
  • April 2011 – Attestation for the Medicare EHR incentive program begins.
  • May 2011 – Issuing of Medicare EHR incentive payments expected to begin.
  • July 3, 2011 – Last day for eligible hospitals to begin their 90-day reporting period to demonstrate meaningful use for the Medicare EHR incentive program for federal FY 2011.
  • Sept. 30, 2011 – Federal FY 2011 payment year ends at midnight for eligible hospitals and critical access hospitals (CAHs).
  • Oct. 3, 2011 – Last day for eligible professionals to begin their 90-day reporting period for calendar year 2011 to demonstrate meaningful use for the Medicare EHR incentive program.
  • Nov. 30, 2011 – Last day for eligible hospitals and CAHs to register and attest to receive an incentive payment for federal fiscal year 2011.
  • Dec. 31, 2011 – Calendar 2011 payment year ends for eligible professionals.

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act of 2009, Medicare and Medicaid incentive payments will be available to eligible professionals, eligible hospitals, and critical access hospitals (CAHs) when they adopt certified EHR technology and successfully demonstrate “meaningful use” of the technology in ways that improve quality, safety, and effectiveness of patient-centered care.

Professionals who meet the eligibility requirements for both the Medicare and Medicaid EHR incentive programs must select which program they wish to participate in when they register.  They cannot participate in both programs; however, after receiving payment, they may change their program selection once before 2015.  Hospitals that are eligible for both programs can receive payments from both Medicare and Medicaid.

Some states will launch their Medicaid EHR incentive programs beginning Jan. 3, 2011, but most will launch their programs during the spring and summer.  Eligible providers with questions about their state’s launch date should contact their state Medicaid agency.  Eligible providers seeking to participate in the Medicaid programs must initiate registration at CMS’ registration site but must complete the process through an eligibility verification site maintained by their state Medicaid agency.

Under the EHR incentive programs, eligible professionals can receive as much as $44,000 over a five-year period through Medicare.  For Medicaid, eligible professionals can receive as much as $63,750 over six years.  Under both Medicare and Medicaid, eligible hospitals may receive millions of dollars for implementing and meaningfully using certified EHR technology.

“The benefits of EHRs are widely recognized, and support for the incentive programs is strong in the health care field and among policymakers,” Dr. Berwick said. “The changeover from paper to electronic records will be challenging for clinicians and hospitals, but CMS and ONC have taken steps to ease the transition.  We’ve provided flexibility in meeting the meaningful use requirements, both agencies have conducted extensive outreach, and we have the resources in place to help providers acquire certified EHR technology and meet the programs’ requirements.  Immediate registration is not required, but we encourage eligible providers to sign up as soon as they have certified EHR technology and are prepared to participate.  We are ready to help.”

#  #  #  #  #  #  #

VERY IMPORTANT NOTICE FROM CMS WEB SITE
Hospitals:
Hospitals that are eligible for EHR incentive payments under both Medicare and Medicaid should select “Both Medicare and Medicaid” during the registration process, even if they plan to apply only for a Medicaid EHR incentive payment by adopting, implementing, or upgrading certified EHR technology. Dually-eligible hospitals can then attest through CMS for their Medicare EHR incentive payment at a later date, if they so desire. It is important for a dually-eligible hospital to select “Both Medicare and Medicaid” from the start of registration in order to maintain this option.

Hospitals that register only for the Medicaid program (or only the Medicare program) will not be able to manually change their registration (i.e., change to “Both Medicare and Medicaid” or from one program to the other) after a payment is initiated and this may cause significant delays in receiving a Medicare EHR incentive payment.

Eligible Professionals:
Eligible professionals eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which incentive program they wish to participate in when they register. Before 2015, an eligible professional may switch programs only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program.

The Electronic Health Record (EHR) Information Center is open to assist the EHR Provider Community with inquiries.
Hours of operation are:

8:30 a.m. – 4:30 p.m. (Central Time) Monday through Friday (except federal holidays)
1-888-734-6433 (primary number) or 888-734-6563 (TTY number)

Submit an Inquiry to the EHR Information Center
###

See e-Healthcare Marketing post on registration directions.

Health IT Special Issue of The American Journal of Managed Care: Dec 2010

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AJMC Publishes Health Information Technology Special Issue Online Dec 20, 2010
“Featuring scholarly articles and perspectives from policymakers, payers, providers, pharmaceutical companies, health IT vendors, health services researchers, patients, and medical educators, this [December 2010 special] issue of  The American Journal of Managed Care is a reflection” of  “the  dramatic growth of interest in the potential for HIT to improve health and healthcare delivery,” writes Sachin H. Jain, MD, MBA and David Blumenthal, MD, MPP in their introductory article titled “Health Information Technology Is Leading Multisector Health System Transformation.”  Both Jain and Blumenthal are with the Office of the National Coordinator for Health Information Technology.

Authors of 23 Articles in Special Issue
Sachin H. Jain, MD, MBA; and, David Blumenthal, MD, MPP; Cynthia L. Bero, MPH; and Thomas H. Lee, MD; Aaron McKethan, PhD; and Craig Brammer; John Glaser, PhD; Pete Stark; Newt Gingrich, PhD, MA; and Malik Hasan, MD; James N. Ciriello, MS; and Nalin Kulatilaka, PhD, MS; Seth B. Cohen, MBA, MPA; Kurt D. Grote, MD; Wayne E. Pietraszek, MBA; and Francois Laflamme, MBA; Amol S. Navathe, MD, PhD; and Patrick H. Conway, MD, MSc; Reed V. Tuckson, MD; Denenn Vojta, MD; and Andrew M. Slavitt, MBA; Marc M. Triola, MD; Erica Friedman, MD; Christopher Cimino, MD; Enid M. Geyer, MLS, MBA; Jo Wiederhorn, MSW; and Crystal Mainiero; Nancy L. Davis, PhD; Lloyd Myers, RPh; and Zachary E. Myers; Bryant A. Adibe, BS; and Sachin H. Jain, MD, MBA; Spencer S. Jones, PhD; John L. Adams, PhD; Eric C. Schneider, MD; Jeanne S. Ringel, PhD; and Elizabeth A. McGlynn, PhD; Jeffrey L. Schnipper, MD, MPH; Jeffrey A. Linder, MD, MPH; Matvey B. Palchuk, MD, MS; D. Tony Yu, MD; Kerry E. McColgan, BA; Lynn A. Volk, MHS; Ruslana Tsurikova, MA; Andrea J. Melnikas, BA; Jonathan S. Einbinder, MD, MBA; and Blackford Middleton, MD, MPH, MS;Alexander S. Misono, BA; Sarah L. Cutrona, MD, MPH; Niteesh K. Choudhry, MD, PhD; Michael A. Fischer, MD, MS; Margaret R. Stedman, PhD; Joshua N. Liberman, PhD; Troyen A. Brennan, MD, JD; Sachin H. Jain, MD, MBA; and William H. Shrank, MD, MSHS; Amir Dan Rubin, MBA, MHSA; and Virginia A. McFerran, MA; Fredric E. Blavin, MS; Melinda J. Beeuwkes Buntin, PhD; and Charles P. Friedman, PhD Robert D. Hill, PhD; Marilyn K. Luptak, PhD, MSW; Randall W. Rupper, MD, MPH; Byron Bair, MD; Cherie Peterson, RN, MS; Nancy Dailey, MSN, RN-BC; and Bret L. Hicken, PhD, MSPH; Jeffrey A. Linder, MD, MPH; Jeffrey L. Schnipper, MD, MPH; Ruslana Tsurikova, Msc, MA; D. Tony Yu, MD, MPH; Lynn A. Volk, MHS; Andrea J. Melnikas, MPH; Matvey B. Palchuk, MD, MS; Maya Olsha-Yehiav, MS; and Blackford Middleton, MD, MPH, MSc; Emily Ruth Maxson, BS; Melinda J. Beeuwkes Buntin, PhD; and Farzad Mostashari, MD, ScM; Daniel C. Armijo, MHSA; Eric J. Lammers, MPP; and Dean G. Smith, PhD; Katlyn L. Nemani, BA.

Look for an upcoming post on e-Healthcare Marketing reviewing this special issue of AJMC.

Colleen Woods Asks “Where are the NJ Healthcare Innovators?!!”

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From: Colleen Woods, NJ Health IT Coordinator
To: New Jersey Healthcare Innovators,
NJ Health IT Community
Re: Calling for Innovations for Supplemental ONC Funding
Date: Dec 21, 2010
High PriorityMost of you are aware that the Office of the National Coordinator issued a supplemental funding opportunity to the State Health Information Exchange Cooperative Agreement Program.  As required, on December 10th,2010,  I responded that New Jersey would apply for the supplemental funding, knowing that we have many exciting projects in place that could be advanced with just a bit of additional funds.

There are five challenge “themes” that the feds view as potential barriers to full national health information exchange. They are seeking innovative ideas/solutions from those of you who know healthcare delivery the best.  The themes are:
  • Achieving Health Goals through Health Information Exchange
  • Improving Long Term and Post Acute Care Transitions
  • Consumer Mediated Information Exchange
  • Enabling Advance Query for Patient Care
  • Fostering Distributed Population-Level Analytics

For more information please see a PDF of the  ONC’s funding announcement: http://goo.gl/oGc7Q

Or to see all the funding documents, go to Grants.gov:http://goo.gl/0dk3i

I know there are a lot of good ideas and projects already underway that would qualify for this funding opportunity. (Jeff, Becky, Jim, Tom, Dave, Tom, Linda, Lou, Judy, Neal, Al, Bob et al…..) , but the award requires a quick response.  Applications need to be sent to by the NJ State Coordinator’s Office ONC by January 5th, 2011. I would proud to submit any ideas you have that would meet the ONC challenge.  Please feel free to call me to discuss.

My best wishes to you and your families for a Happy Holiday Season!

Colleen

Colleen Woods
NJ Health IT Coordinator
Governor’s Office
(609)777-2609
colleen.woods@gov.state.nj.us

Synopsis of the Supplemental State HIE Challenge Program
“This funding announcement for the Health Information Exchange Challenge Program encourages breakthrough progress for nationwide health information exchange in five challenge areas identified as key needs since Federal and State governments began implementation of the HITECH Act. The awards will fund the development of technology and approaches that will be developed in pilot sites and then shared, reused, and leveraged by other states and communities to increase nationwide interoperability. The five themes include: 1. Achieving health goals through health information exchange 2. Improving long-term and post-acute care transitions 3. Giving patients access to their own health information 4. Developing tools and approaches to search for and share granular patient data (such as specific lab results for a given time period) 5. Fostering strategies for population-level analysis Awards will range between $1 million and $2 million each, and will be in the form of supplemental funding to State Health Information Exchange Cooperative Agreements, which have provided approximately half a billion dollars to states and State designated entities to enable health information exchange. Funding for this initiative is approximately $16 million which ONC anticipates will support 10 awards.”
–Synopsis from grants.gov

New EHR FAQs Added to ONC/CMS sites on eRx, Clinical Info Exchange

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CMS and ONC both Add to FAQs related to Health Information Exchange on 12/12/2010
Link to PDF of ONC’s 22 Regulations FAQs. Note FAQ #21 not yet posted.
The following FAQs were excerpted on 12/18/2010.

ONC Question [12-10-022-1]:
Does the certification criterion pertaining to electronic prescribing, which references certain content exchange standards (i.e., NCPDP SCRIPT 8.1 and NCPDP SCRIPT 10.6), require that a Complete EHR or EHR Module be capable of electronically exchanging information with only external recipients (i.e., recipients that are not part of that legal entity) according to the appropriate standard (and implementation specifications) or does it apply more broadly?

Answer:
For the certification criterion pertaining to electronic prescribing (45 CFR 170.304(b)), which references those two content exchange standards adopted at 45 CFR 170.205(b) and the vocabulary standard 170.207(d) (i.e., any source vocabulary that is included in RxNorm), a Complete EHR or EHR Module must be certified as being capable of electronically generating and transmitting prescriptions and prescription-related information to external recipients in accordance with the appropriate adopted standard(s) (and implementation specifications). These standards were adopted for the purpose of enabling a user of Certified EHR Technology to “exchange” electronically certain health information, as indicated in the first sentence of the regulatory section and the section title, and as alluded to in various other parts of the Standards and Certification Criteria Interim Final and Final Rules.

We intended the capability required by this certification criterion and the referenced standards and implementation specifications to apply to the electronic exchange of prescription information between different legal entities (e.g., from an eligible professional’s Certified EHR Technology to a pharmacy that is not part of the eligible professional’s legal entity), to complement how CMS has generally described “exchange” in the context of meaningful use as information “sent between different legal entities with distinct certified EHR technology or other system that can accept the information….” (75 FR 44361-62). In the Standards and Certification Criteria Interim Final Rule and in the Standards and Certification Criteria final rule, we discussed current Medicare Part D electronic prescribing regulatory requirements for using NCPDP SCRIPT 8.1, and the anticipated use of NCPDP SCRIPT 10.6. (75 FR 2031-32, 75 FR 44625-26). In both rules, we also had explained that the purpose of the adopted standards and certification criteria was not to specify how or when Certified EHR Technology must be used, but only what capabilities Certified EHR Technology must include. (75 FR 2022-23, 75 FR 44592-93). We sought to align the adopted standards, implementation specifications, and certification criteria with certain already established regulatory requirements to ensure that Certified EHR Technology would provide a base-level of capabilities to assist users in meeting those other regulatory requirements. (See, for example, 75 FR 44591, and 75 FR 44598.) Then, when discussing electronic prescribing, we referred to the adopted NCPDP SCRIPT standard as a standard required under the Medicare Part D e-prescribing regulations when “an entity sends prescriptions outside the entity (for example, from an HMO to a non-HMO pharmacy)….” (75 FR 2031-32, 75 FR 44592). Consequently, with respect to the capability a Complete EHR or EHR Module must demonstrate in order to be certified to the certification criterion adopted at 170.304(b), a Complete EHR or EHR Module must be capable of electronically transmitting prescriptions and prescription-related information to external recipients according to NCPDP SCRIPT 8.1 or 10.6 in addition to the adopted vocabulary standard for medications at 45 CFR 170.207(d).

This approach is consistent with a principle we established in the Standards and Certification Criteria Interim Final Rule where we sought to ensure that eligible health care providers seeking to meaningfully use Certified EHR Technology and engaging in electronic exchange would be able to do so in a manner that would be compliant with other applicable law. Thus, with respect to electronic prescribing, we adopted NCPDP SCRIPT 8.1 and 10.6 to ensure that when an eligible professional electronically transmits a prescription or prescription-related information for Medicare Part D covered drugs for Medicare Part D eligible individuals to, for example, a pharmacy that is not part of the legal entity of the eligible professional, the eligible professional would be able to do so using Certified EHR Technology and also comply with the Medicare Part D e-prescribing rules.

See CMS FAQ 10284 [ or immediately below] for information about how these transmissions should be counted.

CMS Question 10284 FAQ on EHR Incentive Program
For the meaningful use objective of “generate and transmit prescriptions electronically (eRx)” for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program, how should the numerator and denominator be calculated? Should electronic prescriptions fulfilled by an internal pharmacy be included in the numerator?
Published 12/17/2010 11:34 AM   |    Updated 12/17/2010 11:41 AM   |    Answer ID 10284

ANSWER
The denominator for this objective consists of the number of prescriptions written for drugs requiring a prescription in order to be dispensed, other than controlled substances, during the EHR reporting period. The numerator consists of the number of prescriptions in the denominator generated and transmitted electronically using certified EHR technology. In order to meet the measure of this objective, 40 percent of all permissible prescriptions written by the EP must be generated and transmitted electronically according to the applicable certification criteria and associated standards adopted for certified EHR technology as specified by the Office of the National Coordinator for Health IT (ONC).

ONC has released an FAQ stating that “with respect to the capability a Complete EHR or EHR Module must demonstrate in order to be certified to the certification criterion adopted at 170.304(b), a Complete EHR or EHR Module must be capable of electronically transmitting prescriptions to external recipients according to NCPDP SCRIPT 8.1 or 10.6 in addition to the adopted vocabulary standard for medications (45 CFR 170.207(d)).”  Given such FAQ, prescriptions transmitted electronically within an organization (the same legal entity) would not need to use these NCPDP standards. However, an EP’s EHR must meet all applicable certification criteria and be certified as having the capability of meeting the external transmission requirements of §170.304(b).  In addition, the EHR that is used to transmit prescriptions within the organization would need to be Certified EHR Technology.

The EP would include in the numerator and denominator both types of electronic transmissions (those within and outside the organization) for the measure of this objective. We further clarify that for purposes of counting prescriptions “generated and transmitted electronically,” we consider the generation and transmission of prescriptions to occur constructively if the prescriber and dispenser are the same person and/or are accessing the same record in an integrated EHR to creating an order in a system that is electronically transmitted to an internal pharmacy.

For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.

ONC Question [12-10-023-1]:
Could an interface that transmits lab results in HL7 message format between a hospital laboratory system and a physician’s EHR (presuming that the transmissions were occurring between two different legal entities) satisfy the certification criteria related to the exchange of key clinical information in 45 CFR 170.304(i) and 45 CFR 170.306(f)? If not, please specify the required data types and exchange characteristics that must be part of the required clinical information exchange.

Answer:
As implied in the question, for certification a Complete EHR or an EHR Module must have the capability to electronically receive and display, and transmit certain key clinical information in accordance with one of two separate certification criteria (45 CFR 170.304(i) or 45 CFR 170.306(f)), depending on the setting for which the EHR technology is designed (ambulatory or inpatient, respectively). Generally speaking, these certification criteria require two types of information exchange capabilities – the capability to:

  1. Electronically receive and display a patient’s summary record, from other providers and organizations including, at a minimum, diagnostic tests results, problem list, medication list, and medication allergy list in accordance with the continuity of care document (CCD) standard (and the HITSP/C321 implementation specifications) or the continuity of care record (CCR) standard and that upon receipt of a patient summary record formatted according to the alternative standard, display it in human readable format.
  2. Electronically transmit a patient summary record to other providers and organizations including, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list using the CCD standard (and the HITSP/C32 implementation specifications) or the CCR standard while also representing specific named data elements (problems, laboratory test results, and medications) according to adopted standards.

Note: The above uses language from 45 CFR 170.304(i). The certification criterion adopted at 45 CFR 170.306(f) also includes “procedures” as a required, standardized data element within these exchange capabilities.

Therefore, an interface that transmits lab results in HL7 message format between a hospital laboratory system and a physician’s EHR (where the transmission is occurring between two different legal entities) would not qualify as an exchange of key clinical information that complies with the requirements of either of these two certification criteria. The interface would not satisfy the required capabilities included within the adopted certification criteria, and more specifically, the ability to transmit a patient summary record in accordance with the CCD standard (and the HITSP/C32 implementation specifications) or the CCR standard.

1HITSP Summary Documents Using HL7 Continuity of Care Document (CCD)