Category Archives: Hospitals

Blumenthal Letter #21: 2010 ONC Update [and Welcome to 2010 ONC Conference]

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2010 ONC Update
Dr. David BlumenthalA Message from Dr. David Blumenthal, the National Coordinator for Health Information TechnologyDecember 10, 2010
Accessed from ONC site 12/13/2010.

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 other HHS agencies are dedicated to improving the nation’s health care through health information technology (health IT).

Since the Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law in February 2009, we have established a number of initiatives that will help make it possible for providers to achieve meaningful use and for Americans to benefit from electronic health records as part of a modernized, interconnected, and vastly improved system of care delivery.

This year alone, we have established a number of important policies and programs to help lay the foundation for providers to begin their journey toward meaningful use. These include: 

It’s been a busy year for health IT at HHS.

We are looking forward to discussing more about all of our HITECH initiatives to date, as well as our future activities, at the upcoming 2010 ONC Update Meeting on December 14 and 15.

Over the course of this two-day meeting, we are offering a number of sessions that will give participants a better understanding of the HITECH regulations and the role that HITECH plays in health system change and health care reform. Some session topics include:

  • HITECH programs that support providers in achieving meaningful use
  • How HITECH initiatives will promote consumer empowerment and public engagement
  • Privacy and security policies

Our panelists and invited speakers include HHS Secretary Kathleen Sebelius and leaders from CDC, CMS, OCR, ONC and organizations who have a stake in our work. We are excited about the opportunity to share information and ideas.

The plenary sessions at this meeting will be streamed through a live webcast. Details about the webcast are available on the ONC website: http://healthit.hhs.gov/ONCMeeting2010.

Thank you in advance for joining us at the 2010 ONC Update Meeting and for supporting our vision of a higher quality, safer, and more efficient health care system enabled by health information technology.

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  ONC’s Health IT News list.

Beacon Community Videos: ‘Improving Health Through Health Information Technology’ Posted on ONC site

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‘Improving Health Through Health Information Technology’
Video, description and Web site of each Beacon Community Program Awardee by the Office of the National Coordinator(ONC)  for Health IT’ was posted on ONC’s site on December 8.

“The Beacon Community Cooperative Agreement Program provides funding to 17 selected communities throughout the United States that have already made inroads in the development of secure, private, and accurate systems of electronic health record (EHR) adoption and health information exchange. The Beacon Program will support these communities to build and strengthen their health information technology (health IT) infrastructure and exchange capabilities to improve care coordination, increase the quality of care, and slow the growth of health care spending.”

Beacon Community Program

Beacon Community Program

These are excerpts accessed on December 9, 2010:

The 17 Beacon Communities will focus on specific and measurable improvement goals in the three vital areas for health systems improvement: quality, cost-efficiency, and population health, to demonstrate the ability of health IT to transform local health care systems. The goals vary according to the needs and priorities of each community. For instance, some communities will focus in the care for chronic conditions such as asthma, heart failure, and diabetes to illustrate how costs can be reduced and patient care improved through the collection, analysis, and sharing of clinical data.

Beacon Communities

Listed below are the 17 Beacon Communities, their awards, and snapshot of their goals. To view further information about a specific Beacon Community, click the name of the community.

Beacon Community

Award Amount

Goal
Bangor Beacon Community, Brewer, ME $12,749,740 Improve the health of patients with diabetes, lung disease, heart disease, and asthma by enhancing care management; improving access to, and use of, adult immunization data; preventing unnecessary ED visits and re-admissions to hospitals; and facilitating access to patient records using health information technology.
Beacon Community of the Inland Northwest, Spokane, WA $15,702,479 Increase care coordination for patients with diabetes in rural areas and expand the existing health information exchange to provide a higher level of connectivity throughout the region.
Central Indiana Beacon Community, Indianapolis, IN $16,008,431 Expand the country’s largest Health Information Exchange to new community providers in order to improve cholesterol and blood sugar control for diabetic patients and reduce preventable re-admissions through telemonitoring of high risk chronic disease patients after hospital discharge.
Colorado Beacon Community, Grand Junction, CO $11,878,279 Demonstrate how costs can be reduced and patient care improved, through the collection, analysis, and sharing of clinical data, and the redesign of primary care practices and clinics.
Crescent City Beacon Community, New Orleans, LA $13,525,434 Reduce racial health disparities and improve control of diabetes and smoking cessation rates by linking technically isolated health systems, providers, and hospitals; and empower patients by increasing their access to Personal Health Records.
Delta BLUES Beacon Community, Stoneville, MS $14,666,156 Improve access to care for diabetic patients through the meaningful use of electronic health records and health information exchange by primary care providers in the Mississippi Delta, and increase the efficiency of health care in the area by reducing excess health care costs for patients with diabetes through the use of electronic health record.
Greater Cincinnati Beacon Community, Cincinnati, OH $13,775,630 Develop new quality improvement and care coordination initiatives focusing on patients with pediatric asthma, adult diabetes, and encouraging smoking cessation, and provide better clinical information and IT “decision support” tools to physicians, health systems, federally qualified health centers, and critical access hospitals.
Greater Tulsa Health Access Network Beacon Community, Tulsa, OK $12,043,948 Leverage broad community partnerships with hospitals, providers, payers, and government agencies to expand a community-wide care coordination system, which will increase appropriate referrals for cancer screenings, decrease unnecessary specialist visits and (with telemedicine) increase access to care for patients with diabetes.
Hawaii County Beacon Community, Hilo, HI $16,091,390 Improve the health of the Hawaii Island residents through implementation of a series of healthcare system improvements and interventions across independent hospitals, physicians and physician groups. Engaging patients in their own healthcare is also a primary focus.
Keystone Beacon Community, Danville, PA $16,069,110 Establish community-wide care coordination through the expanded availability and use of health information technology for both clinicians and patients in a five-county area to enhance care for patients with pulmonary disease and congestive heart failure.
Rhode Island Beacon Community, Providence, RI $15,914,787 Improve the management of care through several health information technology initiatives to support Rhode Island’s transition to the Patient Centered Medical Home model, which create systems to measure and report processes and outcomes that drive improved quality, reduce health care costs, and improve health outcomes.
San Diego Beacon Community, San Diego, CA $15,275,115 Expand electronic health information exchange to enable providers to improve medical care decisions and overall care quality, to empower patients to engage in their own health management, and to reduce unnecessary and redundant testing.
Southeast Michigan Beacon Community, Detroit, MI $16,224,370 Make long-term, sustainable improvements in the quality and efficiency of diabetes care through leveraging existing and new technologies across health care settings, and providing practical support to help clinicians, nurses, and other health professionals make the best use of electronic health data.
Southeastern Minnesota Beacon Community, Rochester, MN $12,284,770 Enhance patient care management, reduce costs associated with hospitalization and emergency services for patients with diabetes and childhood asthma, and reduce health disparities for underserved populations and rural communities.
Southern Piedmont Beacon Community, Concord, NC $15,907,622 Increase use health information technology, including health information exchange among providers and increased patient access to health records to improve coordination of care, encourage patient involvement in their own medical care, and improve health outcomes while controlling cost.
Utah Beacon Community, Salt Lake City, UT $15,790,181 Improve the management and coordination of care for patients with diabetes and other life-threatening conditions, decrease unnecessary costs in the health care system, and improve public health.
Western New York Beacon Community, Buffalo, NY $16,092,485 Expand the Western New York network, close gaps in service, and improve health outcomes for patients with diabetes.

ONC Fact Sheet: Beacon Community Program

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ONC Fact Sheet: Get the Facts on Beacon Community Program
Published on ONC site 12/3/2010.

Improving the nation’s health care through health information technology (health IT) is a major initiative for the U.S. Department of Health and Human Services (HHS). 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 other HHS agencies are working together to assist health care providers with the adoption and meaningful use of electronic health records.

ONC’s Beacon Community Program will help guide the way to a transformed health care system. The program will fund more than a dozen demonstration communities that have already made inroads into the adoption of health information technology (health IT), including electronic health records and health information exchange. Beacon Communities will advance new, innovative ways to improve care coordination, improve the quality of care, and slow the growth of health care spending.

About the Beacon Communities
The goal of the Beacon Community Program is simple: to show how health IT tools and resources can contribute to communities’ efforts to  make breakthrough advancements in health care quality, safety, efficiency, and in public health at the community level and to demonstrate that these gains are sustainable and replicable.

In May 2010, ONC awarded 15 grants totaling $220 million to communities across the country that are leading the way in health IT. Two additional grants totaling $30 million were awarded in September 2010. Communities will use funding to:

  • Build and strengthen their health IT infrastructure and exchange capabilities
  • Demonstrate how meaningful use of electronic health records and health IT can lead to  improvements in health care quality, reductions in unnecessary costs, and gains in public health
  • Provide support and guidance to other communities for achieving meaningful use and measurable health care improvements and cost savings

Communities will work with other Health Information Technology for Economic and Clinical Health (HITECH) Act programs, including the Regional Extension Center Program and State Health Information Exchange Program, to:

  • Develop and disseminate best practices for adopting and using health IT to improve quality and cost outcomes
  • Foster national goals for widespread meaningful use of health IT

The Beacon Community Program will also support the development of secure nationwide health information exchange strategies to improve the health care of all Americans.

The HITECH Act establishes programs to accelerate the meaningful use of health IT. The aim is to improve both the health of Americans and the performance of our nation’s health care system.

For More Information About:

Download Get the Facts about Beacon Community Program [PDF - 270 KB]

CMS offers two choices in counting ED patients toward ‘meaningful use’

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CMS FAQ plus Outpatient Observation Services and Place of Service Defined
Which Emergency Department patients should be included in the denominators of meaningful use measures?
Published 09/15/2010 11:48 AM   |    Updated 12/01/2010 10:54 AM   |    Answer ID 10126
Excerpted from FAQs on CMS site on 12/5/2010.A number of measures for Meaningful Use objectives for eligible hospitals and critical access hospitals (CAHs) include patients admitted to the Emergency Department (ED). Which ED patients should be included in the denominators of these measures for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs? 

On September 17, 2010, we issued an FAQ that explained that our intent to include in the denominator visits to the emergency department (ED) of sufficient duration and complexity that all of the Meaningful Use objectives for which the ED is included would be relevant.  Therefore we explained that eligible hospitals and CAHs should count in the denominator patients admitted to the inpatient part of the hospital through the ED, as well as patients who initially present to the ED and who are treated in the ED’s observation unit or who otherwise receive observation services.  

Since that response was issued, we have received questions regarding which observation services should be included.  We have also received responses noting that the plain language of the regulation would allow for a reading that counts all emergency department visits, and not just those identified in our September 17th FAQ.  

Therefore, we are revising our FAQ to allow eligible hospitals and CAHs, as an alternative, for Stage 1 of Meaningful Use, to use a method that is consistent with the plain language of the regulation.  There are two methods for calculating ED admissions for the denominators for measures associated with Stage 1 of Meaningful Use objectives. Eligible hospitals and CAHs must select one of the methods below for calculating ED admissions to be applied consistently to all denominators for the measures. That is, eligible hospitals and CAHs must choose either the “Observation Services method” or the “All ED Visits method” to be used with all measures. Providers cannot calculate the denominator of some measures using the “Observation Services method,” while using the “All ED Visits method” for the denominator of other measures. Before attesting, eligible hospitals and CAHs will have to indicate which method they used in the calculation of denominators.  

Observation Services method.
The denominator should include the following visits to the ED: 
          –The patient is admitted to the inpatient setting (place of service (POS) 21) through the ED.  In this situation, the orders entered in the ED using certified EHR technology would count for purposes of determining the computerized provider order entry (CPOE) Meaningful Use measure.  Similarly, other actions taken within the ED would count for purposes of determining Meaningful Use.

          –The patient initially presented to the ED and is treated in the ED’s observation unit or otherwise receives observation services. Details on observation services can be found in the Medicare Benefit Policy Manual, Chapter 6, Section 20.6. Patients who receive observation services under both POS 22 and POS 23 should be included in the denominator.

All ED Visits method. An alternate method for computing admissions to the ED is to include all ED visits (POS 23 only) in the denominator for all measures requiring inclusion of ED admissions. All actions taken in the inpatient or emergency departments (POS 21 and 23) of the hospital would count for purposes of determining meaningful use.

For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.
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Related Excerpts  from Medicare Benefit Policy Manual 

1.  Outpatient Observation Services Defined

Chapter 6 – Hospital Services Covered Under Part B
(Rev. 128, 05-28-10)
[PDF VERSION]

20.6 – Outpatient Observation Services
(Rev. 107, Issued: 05-22-09, Effective: 07-01-09, Implementation: 07-06-09)
A. Outpatient Observation Services Defined 
Observation care is a well-defined set of specific, clinically appropriate services, which include ongoing short term treatment, assessment, and reassessment before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital. Observation services are commonly ordered for patients who present to the emergency department and who then require a significant period of treatment or monitoring in order to make a decision concerning their admission or discharge.  Observation services are covered only when provided by the order of a physician or another individual authorized by State licensure law and hospital staff bylaws to admit patients to the hospital or to order outpatient tests. In the majority of cases, the decision whether to discharge a patient from the hospital following resolution of the reason for the observation care or to admit the patient as an inpatient can be made in less than 48 hours, usually in less than 24 hours. In only rare and exceptional cases do reasonable and necessary outpatient observation services span more than 48 hours. Hospitals may bill for patients who are directly referred to the hospital for outpatient observation services. A direct referral occurs when a physician in the community refers a patient to the hospital for outpatient observation, bypassing the clinic or emergency department (ED) visit. Effective for services furnished on or after January 1, 2003, hospitals may bill for patients directly referred for observation services.  

See, Pub. 100-04, Medicare Claims Processing Manual, chapter 4, section 290, at http://www.cms.hhs.gov/manuals/downloads/clm104c04.pdf  for billing and payment instructions for outpatient observation services.

Future updates will be issued in a Recurring Update Notification.

B. Coverage of Outpatient Observation Services
When a physician orders that a patient receive observation care, the patient’s status is that of an outpatient. The purpose of observation is to determine the need for further treatment or for inpatient admission. Thus, a patient receiving observation services may improve and be released, or be admitted as an inpatient (see Pub. 100-02, Medicare Benefit Policy Manual, Chapter 1, Section 10 “Covered Inpatient Hospital Services Covered Under Part A” at http://www.cms.hhs.gov/manuals/Downloads/bp102c01.pdf ). For more information on correct reporting of observation services, see Pub. 100-04, Medicare Claims Processing Manual, chapter 4, section 290.2.2.)  All hospital observation services, regardless of the duration of the observation care, that are medically reasonable and necessary are covered by Medicare. Observation services are reported using HCPCS code G0378 (Hospital observation service, per hour). Beginning January 1, 2008, HCPCS code G0378 for hourly observation services is assigned status indicator N, signifying that its payment is always packaged. No separate payment is made for observation services reported with HCPCS code G0378. In most circumstances, observation services are supportive and ancillary to the other separately payable services provided to a patient. In certain circumstances when observation care is billed in conjunction with a high level clinic visit (Level 5), high level Type A emergency department visit (Level 4 or 5), high level Type B emergency department visit (Level 5), critical care services, or direct referral for observation services as an integral part of a patient’s extended encounter of care, payment may be made for the entire extended care encounter through one of two composite APCs when certain criteria are met. For information about billing and payment methodology for observation services in years prior to CY 2008, see Pub. 100-04, Medicare Claims Processing Manual, Chapter 4, §§290.3-290.4. For information about payment for extended assessment and management under composite APCs, see §290.5.Payment for all reasonable and necessary observation services is packaged into the payments for other separately payable services provided to the patient in the same encounter. Observation services packaged through assignment of status indicator N are covered OPPS services. Since the payment for these services is included in the APC payment for other separately payable services on the claim, hospitals must not bill Medicare beneficiaries directly for the packaged services.

2. Place of Service (POS) Codes Defined

Chapter 26 – Completing and Processing
Form CMS-1500 Data Set
(Rev. 1970, 05-21-10)
(Rev. 1974, 05-21-10)
[PDF VERSION]10.5 – Place of Service Codes (POS) and Definitions
(Rev. 1869; Issued: 12-11-10; Effective/Implementation Date: 03-11-10)  

21 Inpatient Hospital
A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical conditions.

22 Outpatient Hospital
A portion of a hospital which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.

23 Emergency Room-Hospital
A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. 
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ONC’s Bean Blogs: Certified EHR Technology Now Available: The Road to Meaningful Use Just Got Easier

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Certified EHR Technology Now Available: The Road to Meaningful Use Just Got Easier
Tuesday, November 30th, 2010 | Posted by: Carol Bean on ONC’s Health IT Buzz Blog and reposted here by e-Healthcare Marketing.

Health care providers who are eligible to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs now have a new tool to help them on their road to meaningful use. As of November, ONC’s official Certified Health IT Product List (CHPL) identifies EHR technologies that have been tested and certified as being technically capable of supporting those providers’ achievement of meaningful use based on Stage 1 criteria outlined in HHS rules published on July 28 of this year.

The CHPL now includes more than 90 certified EHR technologies, and the list continues to grow.

A couple of important points about the CHPL:

  1. ONC maintains the CHPL, which is the authoritative, comprehensive, aggregate list of all the EHR technologies certified by an ONC-Authorized Testing and Certification Body (ONC-ATCB). EHR technologies that have been certified by ONC-ATCBs and appear on CHPL are eligible to be used for the Medicare and Medicaid EHR Incentive Programs, and will be given a reporting number for that purpose. At the time of registration or attestation with the Centers for Medicare & Medicaid Services (CMS), eligible providers can use those reporting numbers as part of qualifying for EHR incentive payments. (This part of the process is shown on the CMS timeline for the Medicare and Medicaid EHR Incentive Programs milestones.)
  2. The Certified Health IT Product List is a snapshot of currently certified EHR technologies. Each Complete EHR and EHR Module on the CHPL has been certified by an ONC-ATCB and reported to ONC. This list is regularly updated as newly certified EHR technologies are reported to ONC.

HHS Resources for Successful Adoption of Certified EHR Technology

With certified EHR technologies now available, eligible health care providers can tap into the other resources HHS has developed to help them adopt and meaningfully use certified EHR technology.

Those resources include:

  1. Regional Extension Centers to provide on-the-ground technical assistance across the country
  2. The Health IT Workforce Development Program to prepare skilled workers for new jobs in health IT
  3. The Beacon Communities Program to highlight best practices
  4. The Medicare and Medicaid EHR Incentive Programs website. This CMS website contains educational resources and fact sheets with complete program information to help eligible providers adopt and demonstrate meaningful use and receive incentive payments.

These programs support certification policies and processes, all with the ultimate goal of improving the nation’s health through the use of EHR technology and other health information technology.

Re-Cap of ONC EHR Certification Policies and Programs

June to August

ONC established the Temporary Certification Program to authorize organizations to test and certify EHR technology and to establish the processes used for that purpose.

ONC published the Standards and Certification Criteria Final Rule. This rule outlined the capabilities EHR technologies must include to support achievement of meaningful use Stage 1 under the Medicare and Medicaid EHR Incentive Programs.

September

The first ONC Authorized Testing and Certification Bodies were named under the Temporary Certification Program and began testing and certifying EHR technologies based on criteria outlined in the Standards and Certification Criteria Final Rule.

October

ONC published the current Version 1.0 of the Certified Health IT Product List, which lists the EHR products that have been tested and certified under the Temporary Certification Program to the certification criteria adopted by the Secretary and that have been reported to and validated by ONC. In some cases EHR products will have been tested and certified to all applicable adopted certification criteria necessary to meet the definition of certified EHR technology (i.e., those designated Complete EHRs); in other cases they will have been tested and certified to a subset of all of the applicable adopted certification criteria (i.e., those designated EHR Modules), which do not on their own meet the regulatory definition of certified EHR technology.

Version 2.0 of the Certified Health IT Product List is under development and will be available in early 2011. It will provide both additional information, such as a list of the Clinical Quality Measures to which a given product was tested; as well as additional functionality, such as different ways to query and sort the data for viewing. It is also Version 2.0 of the CHPL that will be able to provide the number for reporting to CMS as described above.

As we move forward, we welcome your comments about our efforts and your experiences with implementing health IT.
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To comment directly on this ONC Health IT Buzz Blog post, click here.

ONC’s McKethan Blogs on Beacon Communities, Diabetes and Use of Health IT

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on ONC’s Health IT Buzz Blog and reposted by e-Healthcare Marketing here:

In the month of November, many Beacon Communities across the country are marking American Diabetes Month by continuing to develop new health IT strategies that can help patients and doctors better prevent and manage the disease.

Improving diabetes care using every tool available, including health IT, is as important as ever. Approximately 24 million people in the United States—7.8 percent of the population—have diabetes.  Diabetes is the seventh leading cause of death for Americans and it increases the risk for heart disease, stroke, and a number of other serious health complications.[*]

Recently, the Centers for Disease Control and Prevention (CDC) released a new analysis indicating that the number of adults with type 2 diabetes in the United States is expected to double or triple by 2050.  Right now, one in ten U.S. adults has diabetes. If trends keep heading the way CDC expects, that figure will be one in three adults by 2050.

Health IT will be extremely beneficial for modernizing health care communications between doctors, nurses, and patients, and will disproportionately benefit patients with diabetes.

Diabetics see primary care physicians for overall management of the disease. They see ophthalmologists for necessary eye exams and podiatrists for necessary foot exams – both to avoid costly and invasive complications that can arise without careful management of the disease. Patients with diabetes also frequent pharmacies, see other specialists, and occasionally end up in the hospital.

Taken together, this means that it is as important as ever to ensure that the numerous health care professionals caring for patients living with diabetes have the means to communicate with each other and have the information necessary to ensure appropriate, high quality, and well-coordinated care. For diabetic care, this means monitoring blood sugar levels, lipid levels, kidney-function tests; ensuring that appropriate medications are available; and being aware on a timely basis of diabetes-related hospitalizations that require appropriate follow-up.

To this end, health IT can be extremely useful, and these are precisely the kinds of health IT-enabled innovations that many Beacon Communities are developing right now. For example, the Mississippi Beacon Community will be using health information exchange technologies to inform  providers delivering care to diabetic patients  about other services those same patients have received from other providers in the community (e.g., to make sure eye and foot exams have been received as appropriate); expanding a medication therapy management program to follow up with diabetic patients to ensure that they  understand their medicines; implementing effective strategies for following up with patients when they are discharged from the hospital; and providing shared care managers in physician practices to use clinical decision support systems, disease registries, and other tools to ensure highly coordinated, personalized care for diabetic patients.

In the Beacons for Better Health posting that my colleague Craig Brammer and I wrote for the Health Affairs blog, we included specific examples of how two other Beacons are leveraging health IT in their communities to improve diabetes care.  We will soon share much more information about these and other Beacon Communities, and follow their stories as they learn from their early experiences.

In the meantime, we are interested in hearing about how health IT has helped improve diabetes care in your community. We invite you to comment below and share your story with us.

To locate the Beacon Community nearest you, visit healthit.hhs.gov/Beacon.

SOURCES

CDC, http://www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm,

National Diabetes Fact Sheet 2007 (CDC): http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf

USA Today: http://www.usatoday.com/yourlife/health/medical/diabetes/2010-10-22-1Adiabetes22_ST_N.htm

*Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.

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Please post your comments directly on ONC Health IT Buzz Blog.

Informatics Experts Call for New Practices by Health IT Vendors to Protect Patient Safety

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Fortify HIT Contracts With Education and Ethics to Protect Patient Safety,
Say Informatics Experts
AMIA takes position on HIT vendor contracts
For full Position Paper see home page of JAMIA http://jamia.bmj.com and look for Position Paper heading, which is in section below “Read JAMIA for free” ed block. Links to position paper and related references are provided there.

Released by AMIA on November 11, 2010 in conjunction with Annual Meeting.
Bethesda, MD–An original and progressive report on health information technology (HIT) vendors, their customers and patients, published online today, makes ground-breaking recommendations for new practices that target the reduction or elimination of tensions that currently mar relationships between many HIT vendors and their customers, specifically with regard to indemnity and error management of HIT systems. In light of the Obama Administration’s $19 billion investment in HIT, paid out in ARRA stimulus funds, these recommendations are particularly significant in helping to foster greater use of electronic health records and other tools in the transition from paper records, largely understood to be a hindrance to quality patient care.

The recommendations, adopted by AMIA— the association of informatics professionals and a trusted authority in the HIT community—strive to imbue the HIT vendor-customer relationship with transparency, veracity, and accountability through collaborative education focused on the installation, configuration and use of HIT systems, in combination with enterprise-wide ethics education to support patient safety. The recommendations are the result of deliberations by an AMIA Board-appointed Task Force. The position statement will appear in the January/February 2011 print edition of JAMIA, the scholarly peer-reviewed journal of informatics in health and biomedicine, co-published by AMIA and the BMJ Group.

“There was a need to consider, study and analyze questions of appropriate oversight,” said AMIA Board Chairwoman Nancy M. Lorenzi, PhD, Assistant Vice Chancellor for Health Affairs and Professor of Biomedical Informatics, Vanderbilt University. “With as much interest and investment in HIT as there is today, AMIA—an unbiased third party—wanted to take a fresh look at gray areas that currently exist between vendors and their customers to see where new practices could be implemented to better support patient outcomes and protect patients, who these systems ultimately serve. We think these recommendations do an excellent job of addressing fairness and balancing accountability in the HIT marketplace and in the health sector.”

The report, titled “HIT Vendors, their customers and patients: New challenges in ethics, safety, best practices and oversight,” makes specific recommendations on Contract Language, Education and Ethics, Ethical Standards, User Groups, Best Practices, and Marketing. An additional section addresses Regulation and Oversight of the HIT Industry and next steps.

The report’s first author is Kenneth W. Goodman, PhD, FACMI, director of the University of Miami Bioethics Program. Dr. Goodman chaired the Task Force responsible for the report, a group of AMIA members comprising nationwide representatives of academia, industry, and leading healthcare institutions.

“AMIA provided an important forum in which complex and sometimes conflicting positions were candidly discussed, analyzed and balanced,” said Dr. Goodman. “HIT systems are ubiquitous these days and need better oversight. These recommendations demonstrate a high-value commitment to patient safety, quality care, and innovation—healthcare goals sometimes difficult to reconcile. These recommendations,” he added, “can help individual institutions do more to support successful HIT implementation.”

Among the recommendations is contract language specified to protect patient safety and to spell out the shared responsibility that vendors and their customers have for successful implementation. “Hold harmless” clauses in contracts between vendors and purchasers or clinical users, that absolve vendors for errors or defects in their software, are declared unethical by AMIA.

The AMIA position states that “safe and successful HIT systems further require ethics education, which has become a standard part of professional development in the corporate world.” HIT vendors and their clients are urged to adopt enterprise-wide ethics education to parallel what accrediting healthcare organizations require. Standards for corporate conduct and subsequent education about such standards are also recommended. A variety of informational tools, many aimed for post-market use, are cited among best practices to assist institutions and clinical practices in achieving optimal HIT implementation.

AMIA President and CEO Edward H. Shortliffe, MD, PhD, praised the Task Force and its accomplishment. “This group of informatics and industry leaders recognized the need to meld business ethics into successful adoption of HIT. Their recommendations balance the forces that drive the competitive HIT marketplace with the practical needs of clinicians, patients, researchers, public health workers and officials. AMIA stands by their work and hopes these recommendations will be embraced by the HIT community.”

Full text of the AMIA position on HIT vendors, their customers and patients is available online at www.jamia.org as an open-access document. Its co-authors are Eta Berner, EdD, FACMI, professor of health informatics at University of Alabama at Birmingham; Mark A. Dente, MD, GE Healthcare IT; Bonnie Kaplan, PhD, FACMI, lecturer at Yale University School of Medicine, and Bioethics Center Scholar at the Interdisciplinary Center for Bioethics at Yale’s Institution for Social and Policy Studies; Ross Koppel, PhD, professor in the Sociology Department and in School of Medicine at University of Pennsylvania; Donald Rucker, MD, vice president and chief medical officer at Siemens Healthcare U.S.A.; Daniel Z. Sands, MD, MPH, FACMI, director of medical informatics at Cisco Internet Business Solutions Group, and clinical assistant professor of medicine at Harvard Medical School; and Peter Winkelstein, MD, MBA, chief of the Division of General Pediatrics at Women & Children’s Hospital of Buffalo, and chief medical informatics officer at UB/MD, the University of Buffalo Physicians Group.

AMIA, the leading professional association for informatics professionals, serves as the voice of the nation’s top biomedical and health informatics professionals and plays an important role in medicine, health care, and science, encouraging the use of data, information and knowledge to improve both human health and delivery of healthcare services.

Real-Time Availability
The AMIA position paper will be the topic of discussion at a late-breaking scientific session to be led by Dr. Goodman and two co-authors at AMIA’s 34th Annual Symposium on Biomedical and Health Informatics, on Wednesday, November 17, 2010, at 10:30 a.m.–12 p.m., at the Washington Hilton, in Washington, D.C.

Certified Health IT Product List: Ambulatory, Inpatient Tables — Alpha by Vendor as of 11/12/2010

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49 Complete EHRs for Physicians and 10 for Hospitals;
Plus 17 Modular EHRs for Physicians and 14 for Hospitals
Office of National Coordinator for Health IT’s validated list of tested and certified Electronic Health Records (EHR) units (complete and modular) has grown to 90, including 49 complete EHRs for clinician office settings and 10 for inpatient hospital settings. Another 31 EHRs have been categorized as modular EHRs with 17 for clinical office settings and 14 for inpatient hospital settings. The modular EHRs include EHRs that may lack certification in only one or more of the criteria, including security. The ONC table contains a field called “Certification Status,” which links to the approved criteria.

Selected Fields from
ONC’s Certified Health IT Product List as of Nov 12, 2010
Ambulatory and Inpatient Tables, Alpha Ordered by Vendor
ONC has added a field to CHPL list identifying each certified EHR as either ambulatory or inpatient. e-Healthcare Marketing has separated list into two tables, and alpha-ordered each table by vendor.

Excerpted from ONC CHPL List on 11/13/2010
“The Certified HIT Product List (CHPL) provides the authoritative, comprehensive listing of Complete EHRs and EHR Modules that have been tested and certified under the Temporary Certification Program maintained by the Office of the National Coordinator for Health IT (ONC). Each Complete EHR and EHR Module listed below has been certified by an ONC-Authorized Testing and Certification Body (ONC-ATCB) and reported to ONC. Only the product versions that are included on the CHPL are certified under the ONC Temporary Certification Program. Please note that the CHPL is a “snapshot” of the current list of certified products. The CHPL is updated frequently as newly certified products are reported to ONC.”

USING THE CHPL
“Certified products are identified with the name of the certifying ONC-ATCB, the ONC certification number, vendor information, product information, and product version number. The CHPL is currently sorted alphabetically, by Product Name.

“EHR products classified as Complete EHR have been certified to meet all the mandatory certification criteria as identified in the Standards and Certification Criteria Final Rule (45 CFR Part 170 Part III). Complete EHR products listed on the CHPL have been certified to meet all of the General Criteria listed in Section 170.302, plus all of the criteria applicable to a type of practice setting. (In the Final Rule, the certification criterion for Accounting for Disclosures (§ 170.302(w) ) is optional for systems or technologies seeking certification and may not appear.) The products identified as Inpatient EHR products and listed under the Inpatient Practice Setting additionally fulfill the specific criteria defined in 45 CFR Part 170.306. The Certified EHR products identified as Ambulatory EHR products and listed under the Ambulatory Practice Setting additionally fulfill all of the specific criteria defined in 45 CFR Part 170.304.

“EHR Modules are those technologies that are certified to at least one of the certification criteria as defined in the Standards and Certification Criteria Final Rule. Due to the regulatory requirement that EHR Module technologies be certified to the security criteria elaborated in the Final Rule, many EHR Modules will be certified to more than one of the regulatory criteria.

“To determine which criteria a particular product is certified to meet, click on the Certification Status link at the end of the row for that listed product. You will be taken to another table indicating which of the Certification Criteria a particular Complete EHR or EHR Module has been certified to meet.

“Please note: This is Version 1.0 of the Certified Health IT Product List (CHPL). Version 2.0 is under development and is expected to provide additional information, such as a list of the Clinical Quality Measures to which a given product was tested; and additional functionality, such as different ways to query and sort the data for viewing. The later version will also provide the above-mentioned reporting number that will be accepted by CMS for purposes of attestation under the EHR (“meaningful use”) incentives programs. Please send suggestions and comments regarding the Certified Health IT Product List (CHPL) to ONC.certification@hhs.gov, with “CHPL” in the subject line.”

Selected Fields from ONC CHPL Product Certification Overview
Not included in table below are Certifying ATCB, ONC Certification #, and Certification Criteria.
This list has been organized into two tables by e-Healthcare Marketing–Ambulatory and Inpatient.
Please see official CHPL List on ONC site for complete listing.
This list was last modified on November 12, 2010.

Ambulatory

Vendor Product Product Classification Product Ver. #
ABEL Medical Software Inc. ABELMed EHR – EMR / PM Complete EHR 11
Allscripts Allscripts PeakPractice Complete EHR 5.5
Allscripts Allscripts Professional EHR Complete EHR 9.2
Aprima Medical Software, Inc Aprima Complete EHR 2011
athenahealth, Inc athenaClinicals Complete EHR 10.1
BioMedix Vascular Solutions TRAKnet Practice Management Software Complete EHR 2
BizMatics Inc PrognoCIS Modular EHR Version 2.0
Cerner Corporation Millennium Powerchart, Healthe Exchange, IQHealth, Health Sentry, Cerner Health Record and P2 Sentinel Complete EHR 2007.19.12 and P2 Sentinel v4.2.1
Cerner Corporation Millennium Powerchart, Healthe Exchange, IQHealth, Health Sentry, Cerner Health Record and P2 Sentinel Complete EHR 2010.01.07 and P2 Sentinel v4.2.1
Cerner Corporation Millennium Powerchart, Healthe Exchange, IQHealth, Health Sentry, Cerner Health Record and P2 Sentinel Complete EHR 2010.02.01 and P2 Sentinel v4.2.1
Cerner Corporation Millennium PowerWorks, Healthe Exchange, IQHealth, Health Sentry, Cerner Health Record and P2 Sentinel Complete EHR 2007.19.12 and P2 Sentinel v4.2.1
ChartLogic, Inc. ChartLogic EMR Complete EHR 7
Compulink Advantage/EHR Complete EHR 10
CureMD Corporation CureMD EHR Complete EHR Version 10
DocPatientNetwork Doctations Complete EHR 2
DrFirst Rcopia MU Modular EHR 3.x
eClinicalWorks LLC eClinicalWorks Complete EHR 9
eClinicalWorks LLC eClinicalWorks Complete EHR 8.0.48
Emdeon Inc. Emdeon Clinician Complete EHR 7.4
empowersystems empowersystems (ambulatory) Complete EHR 1.1.57
Enable Healthcare Inc., (EHI) Mdnet Modular 3
Epic Systems Corporation EpicCare Ambulatory – Core EMR Complete EHR Summer 2009
Epic Systems Corporation EpicCare Ambulatory – Core EMR Complete EHR Spring 2008
Eyefinity/OfficeMate OfficeMate/ExamWRITER Complete EHR 10
First Insight Corp MaximEyes SQL Electronic Health Records Modular EHR 1.1.0.0
GE Healthcare Centricity Advance Complete EHR 10.1
GE Healthcare Centricity Practice Solution Complete EHR 9.5
GEMMS, Inc. GEMMS ONE Complete EHR 7.5.10
gloStream, Inc. gloEMR Complete EHR 6
Greenway Medical Technologies, Inc. PrimeSuite Complete EHR 2011
HealthFusion MediTouch EHR Complete EHR 3
ifa united i-tech Inc. ifa EMR Modular 6
Ingenix Ingenix CareTracker Modular 7
Intivia, Inc. InSync Complete EHR 5.4
Intuitive Medical Software UroChartEHR Complete EHR 4
IO Practiceware, Inc. IO Practiceware Complete EHR 7
Kabot Systems VistA++ EHR Office Edition Complete EHR 2.0.0.1
MCS – Medical Communication Systems, Inc. iPatientCare Complete EHR 10.8
Medical Informatics Engineering WebChart EHR Complete EHR Version 5.1
MedInformatix, Inc MedInformatix Complete EHR 7.5
Meditab Software, Inc. IMS Complete EHR v. 14.0
Medrium Inc. Complete Practice Management Modular MU Stage 1
Midwest Software, LLC Chiro QuickCharts Modular 2.5
NeoDeck Software NeoMed EHR Complete EHR 3
Netsmart Technologies Avatar Modular 2011
Networking Technology dba RxNT RxNT EHR Modular 7
NexTech Systems Inc. NexTech Practice 2011 Complete EHR 9.7
nextEMR, LLC nextEMR, LLC Complete EHR 1.5
NextGen Healthcare NextGen Ambulatory EHR Complete EHR 5.6 SP1
Nortec Software Inc Nortec EHR Complete EHR 7
Practice Fusion Practice Fusion Modular 2
PriMedx Solutions, LLC PriMedx EHR Complete EHR 10.8
Pulse Systems 2011 Pulse Complete EHR Complete EHR 2011
QRS, Inc. PARADIGM Modular 8.3
RelayHealth, a division of McKesson Corporation RelayClinical Platform Modular 10.2
Sage Sage Intergy Meaningful Use Edition Complete EHR 6.2
Sammy Systems SammyEHR Modular 5.1.1
Secure Infosys LLC MYEMR Complete EHR 2.4
StreamlineMD, LLC StreamlineMD Complete EHR 10.8
SuccessEHS SuccessEHS Complete EHR 6
SuiteMed Intelligent Medical Software (IMS) Complete EHR V14
T-System Technologies, Ltd. T SystemEV Modular 2.7
Universal EMR Solutions Physician’s Solution Complete EHR 5
Vision Infonet Inc., MDCare EMR Modular 4.2
WellCentive WellCentive Patient Registry Modular Version 2.0
Workflow.com, LLC workflowEHR Complete EHR 2.5

 Inpatient

Vendor Product Product Classification Product Version #
Allscripts Allscripts ED Modular 6.3 Service Release 4
Cerner Corporation Cerner Millennium Powerchart, Cerner Millennium FirstNet, Cerner Millennium ProFile, Health Sentry, Healthe Exchange, Cerner Healthe Record, IQHealth and P2 Sentinel (Powered by Sensage) Complete EHR Version 2007.19.12, P2 Sentinel Version 4.2.1
Cerner Corporation Cerner Millennium Powerchart, Cerner Millennium FirstNet, Cerner Millennium ProFile, Health Sentry, Healthe Exchange, Cerner Healthe Record, IQHealth and P2 Sentinel (Powered by Sensage) Complete EHR 2010.02.01 and P2 Sentinel v4.2.1
Cerner Corporation Cerner Millennium Powerchart, Cerner Millennium FirstNet, Cerner Millennium ProFile, Health Sentry, Healthe Exchange, Cerner Healthe Record, IQHealth and P2 Sentinel (Powered by Sensage) Complete EHR 2010.01.07 and P2 Sentinel v4.2.1
EDIMS, LLC EDIMS Modular 2.6
EHR Doctors, Inc. MediBridge for VistA/CPRS Modular 2
empowersystems empowersystems (inpatient) Complete EHR 1.1.57
Epic Systems Corporation EpicCare Inpatient – Core EMR Complete EHR Summer 2009
Epic Systems Corporation EpicCare Inpatient – Core EMR Complete EHR Spring 2008
GE Healthcare IT Centricity Enterprise, including any combination of Enterprise Orders, Gemini Orders, Centricity Enterprise Medication Reconciliation, Centricity Enterprise Discharge Instructions, Menon™ Medication Reconciliation, and Menon™ Discharge Instructions Complete EHR 6.6.3.2
Health Care Systems, Inc. HCS eMR Modular 4
MEDHOST, Inc. EDIS Modular 4.2
Netsmart Technologies Avatar Modular 2011
PeriGen PeriBirth Modular 4.3.51
Prognosis Health Information Systems ChartAccess Complete EHR 4
Siemens Medical Solutions USA Inc INVISION EHR Complete EHR 2010
Siemens Medical Solutions USA Inc INVISION EHR B2 Modular EHR 2010
Siemens Medical Solutions USA Inc INVISION EHR B3 Modular EHR 2010
Siemens Medical Solutions USA Inc INVISION EHR B4 Modular EHR 2010
Siemens Medical Solutions USA Inc Soarian EHR Complete EHR 2010
Siemens Medical Solutions USA Inc Soarian EHR B2 Modular EHR 2010
Siemens Medical Solutions USA Inc Soarian EHR B3 Modular EHR 2010
T-System Technologies, Ltd. T SystemEV Modular 2.7
Wellsoft Corporation Wellsoft EDIS Modular v11

Please see official CHPL List on ONC site for complete listing.

Accountable Care Organization Workshop: CMS, FTC, and OIG

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Summary, Audio and Transcripts from  Oct 5, 2010 Workshop on ACOs
FTC, CMS and OIG held a workshop on Accountable Care Organizations on October 5, 2010 to hear from all stakeholders.

Taft Stettinius & Holllister LLC’s summary report of the meeting on Lexology Oct 13, 2010, said ”based upon the opening comments of Don Berwick, the Administrator of CMS, FTC Chairman Jon Liebowitz, and HHS Inspector General Dan Levinson, it is clear that the agencies believe that ACOs present a significant opportunity to meet what Administrator Berwick described as the ‘triple aim’ of truly integrated health care: better care for individual patients and better health for the general population, at a lower per capita cost of achieving both without diminishing quality.”

Recordings and Transcripts for the October 5, 2010 Workshop Regarding Accountable Care Organizations, and Implications Regarding Antitrust, Physician Self-Referral, Anti-Kickback, and Civil Monetary Penalty (CMP) Laws (Posted 10/19/10) and Accessed 10/25/2010:

ONC Dir of Meaningful Use Seidman Blogs on ‘Virtual Bedside’ EHR Experience

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Meaningful Use Expert’s “Virtual Bedside” Experience with EHR
Wednesday, October 20th, 2010 | Posted by: Joshua Seidman PhD on ONC Health IT Buzz blog and republished on e-Healthcare Marketing. 

It’s scary and emotionally painful to be 500 miles away from your dad when he gets admitted to the ICU in the middle of the night. I learned that some of that fright can be alleviated and the pain can be eased a bit by online access to his health data.

With consent, I was able to access to the Boston hospital’s patient portal, one that was developed many years ago, long before most providers understood the potential power of patient-facing health IT. My dad got the medical care he needed and when he was released from the hospital, with his consent, I also got secure access to the discharge summary and instructions in an electronic file (standardized format—CCD or continuity of care document) that I could open in a browser in a human-readable format.

I learned many things in a very personal way from this experience. There’s no substitute for timely, accurate information when you’re trying to help out family from afar. I could track key markers of clinical status to understand how my dad’s recovery was progressing. Reviewing the data in real time allowed me to piece together clinical data to know what questions to discuss with his doctors. I felt empowered by the data.

Specifically, I could view lab data, both his active and inactive medications, the radiology reports (for X-rays but not other scans), the cardiology reports and ECGs themselves, and the blood cultures. In addition, getting a summary of the entire stay on the day of discharge was very useful (even if it was not yet quite complete—I understood that some additional data may be returned to clinicians a few days later).

That’s not to say that it was a completely user-friendly experience, so I have offered the hospital’s IT team my own personal thoughts on opportunities for improvement. Most importantly, there were very few links to lay content for contextualization (just a few of the labs had links and the content at those links was mediocre). I was able to make sense of all of it with help from internists I work with, but a significant portion of data would otherwise have been difficult for me to understand.

That’s absolutely NOT a reason to close off access to the patient/family (I’m clearly much better able to move forward with the raw data than no data and nobody’s forcing me or anyone else to look at it). Rather, there is infrastructure that can be built to support better understanding. Data can be linked to consumer content so that context is provided for every data element. This can be done via the HL7 Infobutton standard or an XML web services platform (for example, open-source software will soon be available from the National Library of Medicine—MedlinePlus Connect—and several other content vendors already provide similar solutions). This should be done both for the online portal and the CCD/discharge summary. In addition, Kaiser Permanente recently donated to HHS its Convergent Medical Terminology that facilitates the translation of clinical terms into consumer-friendly language.

Some data were not made available to us, such as CT scan results. Although there is a document explaining exclusions from the patient-facing portal that the hospital makes available upon request (for detail, see JAMIA article on the topic), it would be much easier if data produced on that patient but not available to patient/family was stated explicitly on each page what is not there. Without noting in the portal what diagnostic tests were performed but not reported left me wondering if critical tests were carried out and what important information the clinicians may be missing in diagnosing the case.

It’s also not clear why or how certain data are excluded. As I noted, some of the lab data were mysterious numbers upon first examination. The explanation that time is necessary for clinicians to communicate with patient/family doesn’t hold up if the patient/family is left in the dark (that is, if information is not CLEARLY communicated to the patient in some other way, which is expecting a lot more of the clinicians than is probably reasonable).

The most glaring omission was progress notes, which would have been very useful. Progress notes would seemingly be among the easier information for lay people to understand. This health system is participating in a pilot project in the outpatient setting. Pending results from the “Open Notes Project,” the hospital likely will be making those notes available for hospitalized patients and families as well.

Another functionality that the portal has available for outpatients that would have been incredibly valuable for me is secure messaging. There was no opportunity for electronic communication with the ICU or medical unit care team. Phone communication is very hard for care teams in the ICU and on the floor, so having an opportunity to exchange secure email with them would be much more convenient for them and for family members than relying solely on telephone tag.

Those areas for improvement notwithstanding, there’s no doubt that this portal is absolutely transformative from a patient/caregiver perspective. It was incredibly valuable in helping me to understand what’s going on with my dad. Now that I’ve had this experience, it would be absolutely maddening and emotionally painful if I had to go through this again without access to data. I hope that meaningful use of EHRs helps to make this kind of portal the rule rather than the exception.

Joshua J. Seidman, PhD
Director, Meaningful Use
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As of Oct 22, 2010, there were nine comments on this ONC’s Health IT Buzz blog post. To see those comments and post comments directly, click here.