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…)

ONC published a draft description of the health IT extension program in today’s Federal Register, requesting comments within two weeks—by June 11.

The extension program is called for under the HITECH Act in ARRA, the American Recovery and Reinvestment Act. It authorizes creation of a National Health Information Technology Research Center and affiliated regional extension centers to assist providers in selecting and implementing certified electronic health records.

The program also will assist providers in becoming “meaningful users” of the systems, a prerequisite to receiving bonus Medicare and Medicaid payments under a separate ARRA provision.

The extension program is to give preference to providers serving uninsured, underinsured, underserved, and special-needs populations. (more…)

The Department of Health and Human Services released its program plan for enacting the health IT incentives provisions called for in ARRA. By the end of 2009, HHS will have drafted necessary program policies and published them for public comment. These policies will include a definition of “meaningful use.”

HHS will also use this year to plan necessary support for the program, including a national outreach program.

In 2010 HHS plans to conduct outreach to eligible professionals, develop the final program rules, and create systems to monitor and evaluate the payments.

Medicare incentive payments to hospitals will begin no sooner than October 2010; payments to eligible professionals will begin no sooner than January 2011. Medicaid incentives to professionals and hospitals both will also begin no sooner than January 2011.

The American Recovery and Reinvestment Act provides $17 billion in Medicare bonus payments for eligible individuals and hospitals that adopt certified electronic health record systems. The Medicare payments run until 2016. The Medicaid payments extend until 2021.

In 2015 a series of Medicare payment reductions will begin for eligible professionals and hospitals that are not meaningful EHR users.

For the past two days the National Committee on Vital and Health Statistics has been hearing testimony from the industry on what constitutes the “meaningful use” of health IT. Defining the term is no small matter, as it triggers $17 billion in Medicare and Medicaid incentives for the adoption of electronic health record systems. The incentives are part of the American Recovery and Reinvestment Act, or ARRA.

Under the provision, an eligible professional can receive $44,000 in incentives beginning in 2011. After several years, that carrot turns into a stick. In 2015 eligible providers who are not meaningful EHR users will begin receiving reduced reimbursement. Reductions will reach 97 percent of the fee schedule in 2017.

Speaking at Tuesday’s hearings, newly named national coordinator for health IT David Blumenthal noted that defining meaningful use would also affect EHR product certification, funding, and training.

AHIMA offered comments during the hearings, advising that the elements of meaningful use improve the coordination of care, promote health information exchange, and improve the capture and use of data for secondary purposes such as quality and public health reporting. (more…)

The National Quality Forum is in the process of establishing consensus standards for the use of clinically enriched administrative data for reporting performance measures in ambulatory care. In January an NQF work group began identifying and endorsing a set of measures suitable for both public accountability and quality improvement.

Given the difficulty of reporting performance measures from paper records, healthcare has been making do by using administrative data, the only data widely available in electronic form. The trade-off is the quality of the quality measures: administrative data produce a narrow and less reliable look at the care delivered.

(In the worst case, as a Boston Globe story on Google Health related earlier this month, poorly managed use of claims data can result in outright misrepresentation of care delivered. The Journal wrote about this danger in personal health records back in April 2007.) (more…)

Many in healthcare still haven’t made their peace with HIPAA’s accounting of disclosure requirements—the provision under which covered entities, upon request, must provide patients with a record of the entities to whom they have disclosed the patient’s protected health information (PHI). They consider it an undue administrative burden for requests they rarely receive. Now new requirements in the American Recovery and Reinvestment Act have upped the accounting ante.

The law singles out covered entities that maintain PHI in electronic health records, requiring them to account for disclosures of PHI made even for purposes of treatment, payment, and healthcare operations—actions exempted under HIPAA. Under the new law, covered entities must be able to provide disclosures dating back three years from the patient request. (more…)

AHIMA has posted reviews of the American Recovery and Reinvestment Act. The law, previously known as the stimulus bill, allots approximately $19 billion to promote the adoption of health IT. It also introduces significant new privacy and security requirements for healthcare entities.

There are two overviews on the AHIMA site: the first on the general provisions of the legislation and the second specifically dedicated to the privacy provisions.

A third review identifies the reports and other submissions the law require from the Department of Health and Human Services and other federal agencies, some of which are due beginning next month.

Provisions in the law will be put into effect over the course of the next two years, with regulations, guidance, and reports still to come. AHIMA offers additional analysis and comments on industry matters at its Advocacy and Public Policy Center.

Google Health, the Internet giant’s free online personal health record service, is nearing a year old. This week the company rolled out some changes to the service, some of which the company anticipated last spring.

Users may now share their health profiles with others, such as doctors and family. Account owners grant access to others via e-mail addresses. Viewers cannot edit or share a profile. Account owners control how much of the profile others see, another change.

Google’s list of partners continues to grow. Partners are primarily national pharmacy chains that can feed medication information into Google Health accounts. However, patients of the Cleveland Clinic and Beth Israel Deaconess Medical Center can import their records through those facilities’ patient portals.

Several days ago the New York Times featured an article titled “How to Make Electronic Medical Records a Reality.” EHRs and their challenges have become a popular topic in the mainstream media. Maybe that’s what a couple billion dollars of federal money will do for a topic that’s been scuffing along.

The Times piece nicely highlights the challenge of implementing health IT in small physician practices, a primary healthcare target in the recently passed American Recovery and Reinvestment Act, or ARRA.

“There’s no way small practices can effectively implement electronic health records on their own,” says Dr. Farzad Mostashari in the article. “This is not the iPhone.” (more…)