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."

Will Incentives Work to Drive Adoption?

Howard J. Anderson, the Executive Editor of Health Data Management, recently noted that "consultants, analysts and software vendors are urging physician group practices to begin work immediately on selecting an electronic health records system. That's because clinics need to have a qualifying EHR system in place by the start of 2011 to qualify for maximum incentive payments under the federal economic stimulus package."

But some group practice administrators are taking a "wait and see" attitude before plunging into planning. And other administrators want to learn far more details about the incentives before they plot a strategy.

According to William Jessee, M.D., president and CEO of the Medical Group Management Association, because there are so many questions about the stimulus package's details which remain unanswered, clinics should wait to see all follow-up regulations before plotting a strategy.  "It's one of those deals where the devil is in the details," he adds.

The American Recovery and Reinvestment Act of 2009 includes $17.2 billion in Medicare and Medicaid financial incentives for hospitals and doctors using qualifying electronic health records systems. Practices must apply for either Medicare funding or Medicaid funding, not both.

Physicians who make "meaningful use" -- which is still undefined -- of a certified electronic health record system can qualify for up to $44,000 in Medicare incentives, more in certain underserved areas. And as of late March, it was not yet certain that the Certification Commission for Healthcare Information Technology (CCHIT) would, in fact, be designated as the official certifier of systems.

The economic stimulus package also includes financial penalties for practices that resist automation. It calls for Medicare payment cuts starting in 2015 for clinics that lack a qualifying EHR system. "But my reaction is people are much more concerned about 2009 and 2010 than any potential cuts for 2015," Jessee notes. "The slow economy, tight credit and potential cuts in Medicare reimbursement next year are more on the top of people's minds now."

Many physicians in group practices are heeding MGMA's advice, awaiting more details from the federal government before investing in EHRs. While some physicians perceive that electronic records will slow them down, others are more receptive to automation to improve efficiency, he acknowledges. "So we're at gridlock right now."

The Medicare and Medicaid incentives should drive physician adoption -- as soon as some of the unanswered questions have been addressed.

AMA Launches Online Tool to Assist Docs with e-Prescribing

According to Health Data Management (HDM), the American Medical Association is offering a free online learning center to provide physicians with information about electronic prescribing. The Chicago-based professional association’s learning center includes information on vendors’ products, including prices and features; calculators to estimate time savings and determine potential Medicare e-prescribing incentive payments; updates on federal and state incentive programs; and resources doctors can use to create an implementation plan.

The AMA's online learning center states that "There's never been a better time to implement an e-Prescribing system. Medicare is now offering a financial incentive to prescribers who do so. And more and more forms of financial assistance and support are becoming available to help make the change possible." 

e-Prescribing is starting to catch on with an estimated 100 million prescriptions transmitted electronically this year by more than 74,000 prescribers. Successfully implementing e-Prescribing (solutions) can directly benefit the quality of care you provide and the administrative efficiency of your practice.

Some of the key benefits discussed on the Web site include:

• Access to your patient's medication history information
• Time savings and more productive use of your staff
• Alerts and reminders that help you make better clinical decisions
• Greater convenience for your patients

Certain sections of the learning center are available only to AMA members. The center can be accessed at ama-assn.org.

HHS Secretary Designate Kathleen Sebelius Talks HIT

National interoperability standards for health information technology are key first steps in developing electronic health records and advancing health reform, said HHS Secretary Designate Kathleen Sebelius today told the U.S. Senate Committee on Health, Education, Labor and Pensions.

“Step one is to get a platform,” she told the panel, chaired by U.S. Sen. Edward Kennedy, D-Mass., “Investments are not worthwhile unless there’s a platform.” Governor Sebelius (Kansas) testified as senators began formal consideration of her nomination by President Barack Obama to lead the U.S. Department of Health and Human Services. She is also scheduled to testify before the U.S. Senate Finance Committee, which will vote whether to recommend her for the post. A full Senate vote could occur before the chamber goes into April recess.

Gov. Sebelius’ comments were in response to questioning from U.S. Sen. Barbara Mikulski, D-Maryland, who said there was “great fear over interoperability.” She said targeting billions of dollars for HIT expansion without clear national standards could lead to a “techno Katrina,” and a “fiscal and case management boondoggle.”

Gov. Sebelius said the interoperability issue would a top priority for HHS, if she is confirmed. “In the next five years HHS will set the standards for privacy and interoperability, test models, and certify the technology and offer incentives for hospitals and doctors to adopt it,” she testified.

The American Recovery and Reinvestment Act enacted in February provides $19 billion for further development and adoption of electronic health records, including over $17 billion in direct incentives to physicians and hospitals for implementing HIT solutions. President Obama is calling for widespread adoption of the technology by 2014.

In her testimony, Gov. Sebelius reiterated the Obama Administration’s focus on health care reform as an essential component of economic recovery.  “I share the President’s conviction that health care reform cannot wait, it must not wait and it will not wait another year. Inaction is not an option,” she said.  “Unless we face costs at the same time we are expanding coverage we really haven’t made as much progress as we can and we won’t have provided the pathway to prosperity for American workers, for American business, and for American families,” she said.

The governor also called for expanded access to health care in rural areas and reorienting physician payments to increase the number of primary care physicians.  Gov. Sebelius also emphasized prevention activities and personal responsibility. She called the childhood obesity epidemic a “rampant crisis that we need to address.” 

“Individuals have responsibility about what they eat, how they exercise, about the choices they make with particularly tobacco and the more we can drive that through the auspices of the agency through prevention efforts I think the better off we’re going to be in the long run,” she said.  Another priority, she said, would be providing resources for prenatal care for at-risk pregnant women.

Stimulus Focuses on Incentives

According to Allscripts, when President Barack Obama signed the American Recovery & Reinvestment Act on Feb. 17, he not only helped to stimulate the lagging U.S. economy. He also paved the way to providing every physician in America an affordable means to enter the digital era of medicine.

The health IT component of the legislation - the Hitech Act - appropriates $19 billion to encourage health care organizations to adopt what are referred to as electronic health records (EHR) and establish regional health-information exchange networks (HIE), all while ensuring that the systems safeguard critical patient data.

The act represents an enormous opportunity for health care providers. After decades of slow but steady progress toward converting our paper-based record system into an electronic one, we are taking a monumental leap forward. The Congressional Budget Office predicts 90 percent of physicians and 70 percent of hospitals will be using a comprehensive, robust EHR in a few years. As a result, the country will save billions of dollars on the provision of health care, and our citizens will receive better-informed care from a coordinated network of providers. 

But just what does the new law mean for physician groups? How can you take advantage of the billions in new funding that will be available as early as 2011? And what will happen if you fail to seize the opportunity presented by the new law?

The Hitech Act can be broken into two sections - one providing $2 billion immediately to the Department of Health and Human Services (HHS) and its subagency, the Office of the National Coordinator for Health IT (ONCHIT); and a second that sets aside $17 billion for health care providers who can demonstrate their use of a certified EHR.

There are $17 billion in incentive payments to physicians and hospitals. The government is focused on two primary goals in this legislation: first, moving physicians who have been slow to adopt EHRs to a computerized environment; and second, ensuring that patient data no longer sits in silos but instead is actively exchanged between providers to ensure that patients receive informed care.  The majority of the funds within the Hitech Act are for payments that will reward physicians and hospitals for effectively using a robust, connected EHR system. There is a program designed for those that see a large volume of Medicaid patients and another for those that accept Medicare.  There are two separate incentive programs for physicians: one provided by Medicare and another by Medicaid. 

• Medicaid: If more than 30 percent of a physician's patients pay with Medicaid (20 percent for pediatricians), then they are eligible for payments of up to $64,000 over five years. The incentives will be calculated through a formula that factors in the exact Medicaid mix of their patients, as well as amounts ranging from $25,000 in the first year to $10,000 in subsequent years. Additionally, nurse practitioners and nurse midwives are eligible for the same incentives.

• Medicare: Physicians who do not have a large Medicaid volume but do accept Medicare can earn up to $44,000 over the five years. Additionally, physicians operating in a "provider shortage area" will be eligible for an incremental increase of 10 percent, though those delivering care entirely in a hospital environment, such as anesthesiologists, pathologists and ED physicians, are not eligible for any incentives.

• Fee reductions: Providers who do not demonstrate meaningful use of an EHR by the end of 2014 will see a decrease of 1 percent in their 2015 fee schedules from Medicare. An additional decrease will be affected in 2016 and 2017, down to a total of 97 percent of the regular fee schedule. The secretary of HHS can reduce the fee schedule even further, by a maximum of 5 percent beginning in 2018, if the nationwide EHR adoption rate remains below 75 percent.

The secretary of HHS is required by the act to review all existing standards and determine the initial set of standards that will apply to the "meaningful use" criteria. All of this must be completed before the end of 2009.   To gain the maximum amount of Medicare and Medicaid incentives, physician groups must have a qualifying records system in place by 2011. Bottom line: If you want to be at the front of the line to collect those incentive payments and move your practice onto the electronic health care highway, the time to start driving is now.

e-Prescribing Key to Federal Savings

Government Health IT reports that the stimulus law’s incentives for providers to adopt health information technology will double the rate of e-prescribing and result in a $22 billion reduction in drug and medical costs in the next decade. The Pharmaceutical Care Management Association commissioned a study by Visante, a consulting firm, which indicates that the e-prescribing savings alone will more than pay for the $19 billion in adoption incentives and other health IT promotion activities required under the stimulus law.

By 2014, more than three-quarters of prescribers will be using e-prescribing, the researchers said. That is double the number anticipated after passage of the Medicare Improvements for Patients and Providers Act of 2008, which includes incentives to encourage Medicare providers to adopt e-prescribing.

Today, fewer than 15 percent of prescribers use e-prescribing, according to Visante’s report.

The report said e-prescribing saves money by:

• Informing doctors at the point of prescribing about the cost and clinical characteristics of medication options and letting doctors choose the best and most affordable drugs, including more generic drugs.
• Giving doctors the patient’s medication history so that harmful drug interactions and duplicate prescriptions can be avoided.
• Notifying doctors of pharmacy options, including mail-order and retail drug stores, to help them hold down patients’ out-of-pocket costs.
• Transmitting the prescription to the pharmacy electronically, thereby reducing waiting times and errors associated with illegible handwriting.

Besides cutting the federal government’s costs by $22 billion, the report states that health care payers will save a total of $56.2 billion under the stimulus law, titled the American Recovery and Reinvestment Act of 2009.

Although the law’s incentives will not totally offset providers’ outlays for acquiring electronic health records, the report predicts that “pay-for-performance measures implemented by the private sector will likely provide further financial inducement for providers to adopt the technology.”

Physicians Resistent to Change

According to a survey by theAmerican College of Physician Executives (ACPE), the percentage of physicians using electronic medical records has nearly doubled in five years.  ACPE found that most physicians consider EMRs “clunky” and unresponsive to their needs.  The federal $787 billion economic stimulus includes $19 billion for health information technology, including $17 billion in physician incentives to encourage adoption of health information technology. About 1,000 members of the ACPE responded to the survey, which was a repeat of a survey conducted in 2004.

Some of the findings were:

• More than 64 percent of respondents in the 2009 survey said they used electronic medical records, up from 33 percent in 2004.

• About 44 percent said their organization uses computerized order entry, while only about 33 percent used the systems five years ago. Computerized physician order entry systems are electronic prescribing systems that intercept errors when medications are ordered.

• More than 38 percent said they use pharmaceutical bar coding, up from 20 percent in 2004.

From SureScripts-RxHub to the New surescripts

SureScripts-RxHub, which operates the country's largest national electronic prescribing network, today announced that the company will henceforth be known as Surescripts®. To mark the occasion, the new Surescripts has launched The E-Prescribing Resource Center (www.surescripts.com), where doctors, pharmacists, payers, hospitals, policymakers and software vendors can go to find the latest information and advice about e-prescribing. 

Also highlighted throughout the site are Surescripts’ re-branded services. What were once presented as seven discrete services are now three, reflecting the three steps that define e-prescribing: Prescription Benefit, Prescription History and Prescription Routing. Consistent with the promise of the merger between SureScripts and RxHub, the change is part of a larger effort aimed at simplifying e-prescribing for physicians, payers, pharmacies, technology vendors and the market at large. That same principle carries over to the network upon which those services are offered – now known as the Surescripts network. To see a demonstration of how the Surescripts network and services enable e-prescribing, please visit www.surescripts.com and click on “How Electronic Prescribing Works.”

Surescripts is the result of a 2008 merger between the country’s two leading health information networks: RxHub and SureScripts. RxHub was founded in 2001 by the nation’s three largest PBMs – CVS Caremark Corporation, Express Scripts, Inc. and Medco Health Solutions, Inc. SureScripts was also formed in 2001 by the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA). Both were created with the same goal in mind – to reduce the cost and improve the safety and efficiency of a process relied on by millions of patients every day.
 
In 2008, the U.S. saw twofold growth in e-prescribing adoption and use. This continues the trend of the last three years. A review of 2006-2008 operational data from SureScripts and RxHub indicates that electronic requests for prescription information, the responses to those requests and the number of prescriptions routed electronically totaled nearly half a billion. (Note: More detailed data will be made available in the soon-to-be-released 2008 National Progress Report on E-Prescribing. Visit www.surescripts.com/report for more information.)
 
As Medicare incentives, federal stimulus funding, and new state and federal adoption initiatives take hold, the momentum behind e-prescribing is only expected to grow. However, there is a demonstrated need to support that growth with access to unbiased information and advice that allows users to realize the full benefit of the technology.
 
In the weeks and months to come, visitors to www.surescripts.com can expect to see many updates to The E-Prescribing Resource Center, including more frequent releases of state and national e-prescribing statistics and online communities for physicians and pharmacists.