Accelerating e-Prescribing

Blumenthal Asks for Revised Recommendations on "Meaningful Use"

President Obama's point man on health care information technology has asked a key working group to revise its recommendations on what constitutes "meaningful use" of electronic health records, a pivotal term that will decide which physicians can obtain billions in federal EHR money. David Blumenthal, MD, national coordinator for health information technology, declined to specify why he asked the Health IT Policy Committee's meaningful use working group to amend the recommendations it released June 16. The panel is tasked with advising the government on a policy framework for the development and adoption of a nationwide health IT infrastructure. Dr. Blumenthal spoke last week at CHT's member meeting which focused on health information technology.

"We had a lively discussion, and it was decided after considerable input on the topic of meaningful use that we would take it back to discussion to work on it a little bit longer," Dr. Blumenthal said. He said the committee expects to unveil revised recommendations by July 16, the date of its next scheduled meeting.

The health information technology community is following the EHR meaningful use debate with much interest. The federal stimulus bill provides approximately $19 billion in net Medicare and Medicaid incentives for physicians, hospitals and others not only to adopt certified EHRs but also to use them in a meaningful way. The incentives start with bonuses for early adopters but turn into penalties for those who don't act fast enough.

Physicians with approved EHRs in place before 2011 or 2012 will be eligible for the maximum Medicare incentive payments allowed by the stimulus package. Doctors who have not adopted an EHR before 2015 and who fail to obtain a hardship exemption will see a 1% cut to Medicare pay, a reduction that phases up to 3% for 2017 and remains each year after that.

In a general sense, meaningful users have been defined as physicians who demonstrate to the government that they are using electronic prescribing, that their technology is connected in a manner that provides for electronic exchange of health data to improve quality of care, and that they submit information to the government on clinical quality measures.  But for the past month, the meaningful user working group has been trying to detail exactly what objectives physicians would need to meet to earn the Medicare incentives.

"Our goal is to try to make it possible for as many physicians and hospitals as possible to be meaningful users by 2011," he said.  Health policy experts note the importance of practices getting a jump on using an EHR system.

Microsoft Partners with AMA to Create Physician Portal for HealthVault

CHT Member Microsoft and the American Medical Association have created an online physician portal. As a result of the collaborative partnership, physicians will be able to access a patient's Microsoft HealthVault account, with that patient's permission, through the AMA physician portal. The portal itself is set to allow one-stop access for technical systems, such as electronic medical records and e-prescribing, and clinical resources physicians need to run a practice. The first partnership announced was with DrFirst, a Rockville, Md.-based e-prescribing vendor.

According to Amednews, "The use of electronic medical records, and health information technology overall, holds great promise for improving patient care and increasing practice efficiency," said AMA President J. James Rohack, MD, in a statement. "The addition of Microsoft's HealthVault on our AMA portal will enable patients using HealthVault to share more comprehensive health information with their physicians. Having ready access to patient information can help physicians make treatment decisions and reduce the time spent gathering this information, resulting in more face-to-face time with patients."

Joseph M. Heyman, MD, immediate past chair of the AMA Board of Trustees, said the Association will vet potential partners to find the "best of breed" systems that will be available for download and use through the portal.

The Web-based portal will also offer a personalized clinical library for users and will have a direct messaging capability through which physicians can exchange clinical notes, referrals and charts with other physician users. The portal, which has been in development for more than a year, is being tested by members of the Michigan State Medical Society. It is expected to launch nationwide next year.

"With the pending launch of [its] portal, the AMA is addressing a demand within the medical community for tools that enable physicians to join the move toward online health in a seamless, intuitive way," said David Cerino, general manager of the Consumer Health Solutions Group at Microsoft, in a statement.

HealthVault, launched in 2007, is a patient-controlled platform on which patients can store a host of health and wellness information. Microsoft has partnered with a range of health IT developers to make other systems interoperable with HealthVault.

AMA Urges Physicians to Move Ahead on HIT Adoption

There is growing concern that physicians will continue to drag their feet when it comes to HIT adoption.  According to AMNews, experts say it will be easier on you, and your practice, to buy now and tweak later. "Time is your enemy," said Mark Garsombke, an attorney with the Milwaukee law firm Whyte Hirschboeck Dudek. Waiting to buy could mean a delay in qualifying for incentives, he said. Physicians have been waiting for the definition of "meaningful use" which is expected to be released later this week.

Details included in the Health Information Technology for Economic and Clinical Health Act, or HITECH Act, the provision of the ARRA that created the incentives, have hinted at what physicians can expect in the meaningful use definition:

• Qualifying EMR systems must be certified. Pat Wise, RN, vice president of health information services for the Healthcare Information and Management Systems Society, said because the Certification Commission for Health Information Technology is currently the only certifying body up and running, she expects early meaningful use requirements will include CCHIT certification.
• Systems must include electronic prescribing. According to Wise, the administration has made clear that e-prescribing will be one of the key components of meaningful use. The Centers for Medicare & Medicaid Services is already offering incentives to physicians who e-prescribe.
• Systems must be used for quality reporting. Incentive programs already exist under CMS's Physician Quality Reporting Initiative. The meaningful use guidelines are expected to include and build on those performance measures.
• Systems must be capable of exchanging information with other systems. The HITECH Act makes it clear the administration is still working toward a national health data exchange whose foundation will be EMRs.

Ben Quirk, senior partner of TempDev, a San Jose, Calif.-based EMR consultancy said practices that have bought or are buying systems from big-name vendors have a little less to worry about. He said these vendors have the resources to make the necessary upgrades to their products to meet meaningful use. Many of them are already assuring clients they will make any necessary changes or updates, and a few are even offering money-back guarantees if they don't.

And experts say there are steps practices can take to help them ensure their system is compatible with the future meaningful use definition:

• Talk to vendors. Grill them on what steps they are willing to take to ensure their clients will meet meaningful use. Ask them to put any promises in writing. Practices using small vendors should get contingency plans in writing in the event the vendor goes out of business or is bought out by another company.
• Focus attention on the practice holdouts if you're already using EMRs. Many practices that don't require EMR use have doctors still using paper. Now is a good time to get to the core of their concerns with using health IT, Quirk said. Incentives will be available on a per-physician basis, so physicians not using the systems will be leaving money -- up to $44,000 per doctor -- on the table, he said.
• Start e-prescribing. Incentive money is already available to physicians who prescribe electronically. This is sure to be part of the meaningful use requirements. The sooner you start, the quicker you'll be up and running by 2011, experts say.
• Begin participation in the Physician Quality Reporting Initiative. This is also something that is sure to be a requirement and something physicians can get paid to do now.
• Explore additional functionalities, such as clinical decision support tools. Wise said it's likely there will be some level of clinical decision support use required. Many systems don't have these functions. Computerized physician order entry is also likely to be required.

Wise said even if you want to wait until the definitions for meaningful use are released to make the purchase, doing your homework now can save time later. There are many systems out there as well as functions existing EMR users could add. It's always a good idea to compare prices and research vendors.

"That kind of preparatory work can be absolutely invaluable," Wise said. "And that kind of preparatory work can also make the difference between making a good, wise selection when you do decide to make the purchase as opposed to a selection that might come back and not give you the functionality that you desire."