ONC released a draft definition for the “meaningful use” of EHRs today, prepared by a workgroup of the Health IT Policy Committee.

The definition will in part determine which providers are eligible to receive incentive payments for the use of health IT under the American Recovery and Reinvestment Act. Providers who are “meaningful users” of health IT can receive up to $44,000 in increased Medicare and Medicaid payments over five years.

Public comments are due June 26.

The proposed definition features a series of evolving objectives and measures for 2011, 2013, and 2015. The objectives are keyed to five healthcare outcomes policy priorities identified in a 2008 report from the National Priorities Partnership, convened by the National Quality Forum.

The workgroup recommends meaningful use support the following five goals:
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The American Recovery and Reinvestment Act calls for the creation of regional health IT extension centers that help providers adopt and use health IT such as electronic health records. The Office of the National Coordinator for Health IT published a draft description of the program May 28, requesting comments by June 11.

While ONC’s draft description rightly stressed the delivery of IT assistance, the centers and their clients will require a wider range of expertise for the full preparation, deployment, and management of health information communications and technology. Different phases of EHR implementation and use require differing skills.

In its comments on the draft description, AHIMA recommended that the final program define core services that include a range of services to assist in EHR use throughout a system’s lifecycle.

This range of services includes workflow analysis, transition planning, data analysis, and training. The sample phases of an EHR lifecycle shown below illustrate the differing core services that users may require over the entire lifecycle. (more…)

AHIMA expressed support for a federal program establishing regional health IT extension centers that assist providers, but it registered concern that a program implemented ineffectively would cause confusion and contention and ultimately distract from the goal of EHR adoption and implementation.

AHIMA’s comments were in response to a draft description of the program published May 28 by the Office of the National Coordinator for Health IT. Specified under the American Recovery and Reinvestment Act, the program calls for a central Health IT Research Center with affiliated regional extension centers that provide direct assistance to providers. The centers will help providers meet requirements for receiving bonus Medicare and Medicaid payments under a separate ARRA provision.

AHIMA offered recommendations around four main comments: (more…)

The Centers for Medicare and Medicaid Services (CMS) hopes to start Recovery Audit Contractor (RAC) automated reviews in late June and July, with more complex reviews rolling out later, according to a May 29 Health Leaders report. CMS expects to begin certain complex reviews like coding and DRG validation this fall. Medical necessity complex reviews will not begin until early 2010.

“The automated reviews are less burdensome on the provider, because there’s no request for medical records,” said Marie Casey, deputy director of the Division of Recovery Audit Operations at CMS, in the news item. “They’re also easier for the RACs to manage.”

The delay for medical necessity auditing is due to the complexity of the reviews. “We’re delaying because it’s more difficult,” Casey said. “We are really trying to ensure that when there is a difference of opinion [on the medical necessity determination of the case], the RAC clearly documents their rationale.”

The delay will also help CMS roll out an issue review team, a group comprised of members from various agency divisions that will look at policy questions, such as whether the RACs have been correct in the interpretation of coding guidelines. These teams will look comprehensively at the questions before approving new issues for RAC review, according to Kathleen Wallace, a CMS representative who spoke at a May 28 Region D RAC training session held in Helena, MT.

When record requests do come, they will start sporadically but eventually fall into a pattern, at least in Region D, said HealthDataInsights president and CEO Andrea Denko, during the Helena training session.

The HISPC summary report on the work of its final phase is out. Styled an “action and implementation manual,” it presents the work of the privacy and security group’s year-long third phase.

In addition to the summary report, the seven subgroups that comprise the collaboration are presenting their work through free webinars on Tuesdays and Thursdays this month. The sessions focus on the tools and processes developed by each group, as well as how individual, local, regional, and state-level stakeholders can use them. (more…)

Can health IT help reduce disparities in quality of care caused by racial and ethnic differences, geographic isolation, poverty, and low health literacy and consumer involvement? Authors of a new Journal web-exclusive story discuss the potential of personal health records to mitigate healthcare disparities.

HIM professionals can play four important roles, the authors write:

• Advocating, designing, and testing PHR products that are sensitive to underserved populations
• Promoting PHR use within their communities
• Training both consumers and providers in PHR use
• Helping secure personal health information to both safeguard individuals and build the trust that will encourage consumer acceptance of health IT

See “Healthcare Disparities and the Role of Personal Health Records” by Jennifer Garvin, Barbara Odom-Wesley, William J. Rudman, and Rachelle S. Stewart.

For a look at the need to improve data collection in support of efforts to reduce disparities, see the April 2009 Journal feature “Data Collection and Reporting for Healthcare Disparities.”

“Present on admission indicators, hospital-acquired conditions, serious reportable events, and ‘wrong’ surgical events are each hot topics,” write the authors of a “Coding Notes” column in this month’s print issue. “However, they also can be a hot topic together, because a number of these reporting requirements are interrelated.”

Jane Cook, Cheryl D’Amato, Gail Garrett, Becky Ruhnau-Gee, Linda Hyde, and Natalie Novak sort out the relationship of POA, HACs, SREs, and “wrong” surgical site policies in “Understanding National Coverage Policies.”

In the June print issue Robert James Campbell writes on applying lean thinking techniques to healthcare. The process improvement technique can be used to identify and eliminate waste in any activity. Campbell, an assistant professor at East Carolina University in Greenville, NC, teaches the lean thinking technique to health services and health information students. Here he shares one project in which students reengineer a patient transfer process using lean thinking.

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As healthcare expenses continue to erode household, government, and provider budgets, the industry needs better methods to reduce the cost of care. One tool that can increase efficiency and value is a change management technique called lean thinking.

Lean thinking is based on the Toyota Production Model and is built upon five steps to identify and eliminate waste: value, value stream, flow, pull, and perfection. The ultimate goal of lean thinking as applied to healthcare is to provide services and products that add value to the patient by improving care in the most efficient manner possible. (more…)

The June cover article examines the field of information therapy: getting patients the information they need to better manage their health. The other features report on whether stimulus funds will pay off in health information consumers can use and the lean thinking philosophy for those organizations looking to more effectively manage their resources and staff in this tight economy. (more…)