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AHA Asks Congress To Reduce Health IT Regulations for Medicare Providers

Posted on September 22, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The American Hospital Association has sent a letter to Congress asking members to reduce regulatory burdens for Medicare providers, including mandates affecting a wide range of health IT services.

The letter, which is addressed to the House Ways and Means Health subcommittee, notes that in 2016, CMS and other HHS agencies released 49 rules impacting hospitals and health systems, which make up nearly 24,000 pages of text.

“In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field’s ability to absorb them,” says the letter, which was signed by Thomas Nickels, executive vice president of government relations and public policy for the AHA. The letter came with a list of specific changes AHA is proposing.

Proposals of potential interest to health IT leaders include the following. The AHA is asking Congress to:

  • Expand Medicare coverage of telehealth to patients outside of rural areas and expand the types of technology that can be used. It also suggests that CMS should automatically reimburse for Medicare-covered services when delivered via telehealth unless there’s an individual exception.
  • Remove HIPAA barriers to sharing patient medical information with providers that don’t have a direct relationship with that patient, in the interests of improving care coordination and outcomes in a clinically-integrated setting.
  • Cancel Stage 3 of the Meaningful Use program, institute a 90-day reporting period for future program years and eliminate the all-or-nothing approach to compliance.
  • Suspend eCQM reporting requirements, given how difficult it is at present to pull outside data into certified EHRs for quality reporting.
  • Remove requirements that hospitals attest that they have bought technology which supports health data interoperability, as well as that they responded quickly and in good faith to requests for exchange with others. At present, hospitals could face penalties for technical issues outside their control.
  • Refocus the ONC to address a narrower scope of issues, largely EMR standards and certification, including testing products to assure health data interoperability.

I am actually somewhat surprised to say that these proposals seem to be largely reasonable. Typically, when they’re developed by trade groups, they tend to be a bit too stacked in favor of that group’s subgroup of concerns. (By the way, I’m not taking a position on the rest of the regulatory ideas the AHA put forth.)

For example, expanding Medicare telehealth coverage seems prudent. Given their age, level of chronic illness and attendant mobility issues, telehealth could potentially do great things for Medicare beneficiaries.

Though it should be done carefully, tweaking HIPAA rules to address the realities of clinical integration could be a good thing. Certainly, no one is suggesting that we ought to throw the rulebook out the window, it probably makes sense to square it with today’s clinical realities.

Also, the idea of torquing down MU 3 makes some sense to me as well, given the uncertainties around the entirety of MU. I don’t know if limiting future reporting to 90-day intervals is wise, but I wouldn’t take it off of the table.

In other words, despite spending much of my career ripping apart trade groups’ legislative proposals, I find myself in the unusual position of supporting the majority of the ones I list above. I hope Congress gives these suggestions some serious consideration.

Patient Safety Benefits of EHR, EHR Design, and RIP CCHIT

Posted on November 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Here’s a quick look at some interesting tweets out their in the healthcare IT and EHR Twitterverse.


I’ve heard this argument from Epic before. There’s certainly an argument to make for improved patient safety on one system. However, that’s likely because our current systems aren’t interoperable. If they were interoperable, then having one massive system wouldn’t be better for patient safety. Considering, the EHR world is going to be a heterogeneous EHR environment, we need to make it so multiple systems isn’t a patient safety issue.


Ouch! I’ve described them as big billing engines, but I think a tool designed for insurance auditors might be more descriptive. Lately there has been a new layer added. EHR is now a tool for meaningful use auditors as well.


CCHIT being gone won’t likely have much impact on healthcare and EHR. They were basically gone for a number of years already. Although, I think their departure is a good thing for healthcare IT and EHR. I’d just still love to see EHR certification disappear as well. EHR certification is not meaningful.

What Can We Expect with Meaningful Use Stage 3?

Posted on October 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The incomparable John Halamka, CIO of Beth Israel Deaconess Medical Center and Co-Chair of the HIT Standards Committee, has a good post up on his blog talking about the future of standards, certification and meaningful use stage 3. Here’s one excerpt about MU stage 3 and EHR certificaiton:

Meaningful Use Stage 3 regulations are currently in draft and will be released as NPRM before the end of the year. My hope for these regulations is that they will be less prescriptive than previous stages, reducing the burden of implementation for providers and vendors.

It’s purely my opinion, but I’m optimistic that simplification will happen, given that the 2015 Certification Rule is likely to decouple Meaningful Use and certification. Certification is likely to be incremental year to year without the tidal wave of requirements we’ve seen in the past. Certification of health IT (not just EHRs) will be with us for a long time and may be leveraged by more programs than just the EHR incentive programs. Imagine that modules for patient generated data (such as wearables), health information exchange (HISPs), and analytics services (such as those used for care management by ACOs) could be certified and used in any combination to achieve outcomes.

I’m really hopeful that Halamka is right and that MU stage 3 will be dramatically simpler. However, in government work, I’m rarely confident that something will be simple. In fact, his comments about ongoing certification are sad too. Anyone who’s had to work with supposedly certified CCD documents from multiple EHR vendors that should be “standard” knows what I mean. Because of examples like this, I’m not a fan of government certification setting the standard, but Halamka might be right that they may use EHR certification to try.

What will be interesting to me is what motivation organizations will have to continue on with meaningful use stage 3. The EHR incentive money will be gone. Certainly the EHR penalties are a pretty sizable motivation for many organizations. Although, probably not as sizable as many think when you compare it against even the MU 2 burden (another reason why MU 3 needs to be simpler). Also, I still wouldn’t be surprised if we had an ICD-10 Delay-esque move by the AMA or some other healthcare organization to remove the EHR penalties. It will be a little harder since the penalties are hard revenue that has to be accounted for, but don’t put it past a good lobbyist.

CMS Issues Final Rule on EHR Certification Flexibility, MU Stage 2 Extension, and MU Stage 3 Timeline

Posted on August 29, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I can’t figure out what government process leads to final rules being regularly published at the end of the day on Friday. I know that Neil Versel from Meaningful Health IT News has hypothesized that they release it late on Friday when they want to bury the news. Maybe that’s the case, but the EHR certification flexibility doesn’t seem like something they’d want to bury. Regardless of the odd timing, CMS has just published the final rule that provides flexibility around EHR certification in the meaningful use program.

In their announcement, I’m not noticing any changes from what was in the proposed rule, but with some time we’ll know for sure if there’s any gotchas hidden in the final rule. No doubt many a meaningful use expert have just had their Labor Day weekend ruined by the announcement of this final rule.

Unfortunately, after the proposed rule was published most people loved the flexibility, but decided that it was too late for them to really benefit from the changes. I’ll be interested to see how many organizations will really benefit from these changes.

More importantly, the rule still includes the nebulous asterisk, “Only providers that could not fully implement 2014 Edition CEHRT for the EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability.” For EHR vendors that are already 2014 certified, this little asterisk feels like ONC is letting all the EHR vendors who didn’t perform well off the hook. It’s basically rewarding EHR vendors who can’t or have chosen not to keep up. Maybe that’s why the rule was published late on a Friday.

One could make the case that ONC was more worried about the doctors/hospitals whose EHR vendors failed to become 2014 certified, than the EHR vendors themselves. However, that part of the story is not likely to be told. Plus, it doesn’t take into account how a doctor/hospital whose EHR vendor is 2014 Certified will feel having to do the substantially harder MU stage 2 while their colleagues only have to do MU stage 1. (UPDATE: This EHR Certification Tool that CMS created seems to say that even if you’re on a 2014 Certified EHR and scheduled to do MU stage 2, that you can do Stage 1 or stage 2 objectives with 2014 CQMs. The chart linked at the bottom of this post says it as well. Seems like they’re being pretty open in their interpretation of “due to delays in 2014 Edition CEHRT availability”. Clear as mud?)

I’ve captured a chart showing the EHR Certification flexibility that this final rule provides:
EHR Certification Flexibility - 2014 Certified EHR

Plus, here’s the latest chart showing the meaningful use timelines:
Updated Meaningful Use Stage 3 Timeline

Other Resources and Responses:
CMS Official Press Release
CHIME’s Response
CMS’ EHR Certification Rule Tool
CMS HITECH 2014 CEHRT Flexibility Chart

We’ll keep adding other responses and commentary on the final rule as we find them.

Has Epic Fostered Any Real Healthcare Innovation?

Posted on August 13, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I saw the following tweet and was really struck by the question.

I think we could broaden the question even more and ask if any EHR vendor has really fostered healthcare innovation. I’m sorry to say that I can’t think of any real major innovation from any of the top hospital EHR companies. They all seem very incremental in their process and focused on replicating previous processes in the digital world.

Considering the balance sheets of these companies, that seems to have been a really smart business decision. However, I think it’s missing out on the real opportunity of what technology can do to help healthcare.

I’ve said before that I think that the current EHR crop was possibly the baseline that would be needed to really innovate healthcare. I hope that’s right. Although, I’m scared that these closed EHR systems are going to try and lock in the status quo as opposed to enabling the future healthcare innovation.

Of course, I’ll also round out this conversation with a mention of meaningful use. The past 3-5 years meaningful use has defined the development roadmap for EHR companies. Show me the last press release from an EHR company about some innovation they achieved. Unfortunately, I haven’t found any and that’s because all of the press releases have been about EHR certification and meaningful use. Meaningful use has sucked the innovation opportunity out of EHR software. We’ll see if that changes in a post-meaningful use era.

A Meaningful EHR Certification

Posted on April 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In many ways this post could be considered a continuation of my previous post on data liberation. I’ve really loved the idea of a creating a meaningful EHR Certification and that could include data liberation. Let’s be honest for a minute. Do any of you find value in the current EHR certification?

You know that a certification is screwed up when it requires certain interoperability standards and then when you go to actually implement the sharing of data between two systems you find out that the two systems are working on two different standards. They are close standards, but close doesn’t count with standards. Many have asked the question, “What did the EHR certification do if it couldn’t test the standard?” I have no answer to that question.

Now imagine we created an EHR certification that actually did require a standard for interoperability. Not a flavor of a standard, or something that closely resembles a standard. I’m talking about a standard. Would hospitals find this useful? I think so.

Another example of a meaningful EHR certification could be certifying that an EHR vendor will not hold your EHR data hostage. Think about how beneficial that would be to the industry. Instead of EHR vendors trying to trap your data in their system, they could focus on providing the end user what they need so the end user never wants to leave that EHR. What a beautiful shift that would be for our industry.

There could be many more things that could be meaningfully certified. However, this would be a simple and good place to start. I have no doubt that some would be resistant to this certification. That’s why those who do become meaningfully certified need to get the proper boost in PR that a meaningful certification should deserve. No EHR vendor wants to be caste as the EHR vendor who can’t figure out the standard and that holds its customers hostage. Yet, that’s what they’re able to get away with today.

What do you think of this idea?

Feds Plan EMR Certification For Specialty Facilities

Posted on August 13, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Federal HIT leaders are planning to set up a voluntary program for testing and certification of EMRs used by behavioral health, long-term care and post-acute care, according to a story in Modern Healthcare. 

As things currently stand, they’re off the hook, as ARRA doesn’t require long-term or behavioral health facilities to buy certified EMRs.

These plans came to light last week at a webinar held by outgoing ONC head Farzad Mostashari, who said that his office is working on what the scope of such a program should be, MH reports. The webinar was held to discuss government officials’ reaction to public comments on how to improve interoperability.

In its original request for input, federal regulators noted that 4 in 10 hospitals were sending lab and radiology information to outside providers, though only one in four were  exchanging medication lists and clinical summaries, Modern Healthcare said.

Meanwhile, only 6 percent of long-term acute-care hospitals, 4 percent of rehab hospitals and 2 percent of psychiatric hospitals had even a basic EMR, the feds reported.

Launching these specialty-focused options seems like a logical next step for the certification program, and a long-delayed one at that. EMR certification has been a fact of life for several years, since then-ONC chief David Brailer kicked off the formation of the CCHIT.

Over the long haul, however, such new certification options may not be worth much unless they’re better matched to provider needs. My colleague John, for one, thinks the certification will have to change to actually offer value to doctors and healthcare organizations.

What do you think, readers?  Do you think certification programs for EMRs are a waste of time, or do you see them doing anything meaningful to improve care?

CCHIT Who?

Posted on July 11, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those who have been following my blog posts since I first started blogging 8+ years ago on EMR & HIPAA, you’ll know that I was one of the biggest critics of CCHIT and EHR certification in general. I still think that EHR certification is useless, but at least it’s gotten better since ONC took over the EHR Certification and there are now a group of EHR certification bodies competing for business.

In fact, today I was thinking how CCHIT has essentially been pushed into the darkness. You could make the case that Drummond Group and ICSA Labs are more influential when it comes to EHR certification than CCHIT. Although, the reality is that most healthcare organizations couldn’t care less who certifies their EHR software. They just want to know that they can get their EHR incentive money.

Considering the announcement of the new ONC Health IT mark for EHR certification, I think we’ll continue to see the EHR Certification body brands continue to diminish. Although, next week we should see the press releases coming out about EHR certification for meaningful use stage 2.

I have been wishing for quite a while that there was an actual meaningful certification (pun intended). I’m talking about an EHR certification that actually provide value to doctors and healthcare organizations. As it stands now, I think that EHR certification is an added expense which adds little value. However, the HITECH act makes it necessary.

ONC Proposes New EMR Vendor Fee

Posted on April 12, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

It looks like federal budget balancing fervor could soon have an impact on EMR vendors (See also this post on EHR Incentive and Sequestration). As part of President Obama’s current budget proposal, the ONC is suggesting that health IT vendors pay about $1 million in fees to help pay for its certification and standards work, reports Modern Healthcare. Collection of the fee, which would probably begin late in the fiscal year, would be collected by ONC-Authorized Certification Bodies.

The proposal is part of the ONC’s section of the overall budget proposal released this week by the Obama Administration. The president’s budget is already causing a stir in healthcare circles outside of IT, as it calls for $5.6 billion in Medicare payment cuts for fiscal 2014.

So what has caused the ONC to look for fresh revenue?  One key reason is that ONC’s $2 billion appropriation from ARRA is scheduled to expire at the end of fiscal 2013, and the agency needs new funds to stay on its feet.

By its logic, the improved testing and certification programs will help vendors save time and money, which justifies their kicking in some money to support the process, Modern Healthcare says.

Not only would the funds gear up the certification program, it would also help maintain ONC’s Certified Health IT product list, as well as its development work around standards for interoperability and policy docs related to HIT certification, the magazine reports.

Without a doubt, the proposed fees will make vendors unhappy, but as I see it they’re just not large enough to justify a major uprising by the health IT community.  The only real issue I see is whether the fees are going to be proportionate to the size of the vendor; if I were a small ambulatory player I’d be quite upset if I paid the same fee as Epic or Cerner.

Otherwise, this fee seems like a relatively small issue, particularly if ONC does a good job of using the funds to improve the certification program. Let’s hope it works out that way.

CCHIT Inpatient EHR Certification Numbers

Posted on October 9, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve long had an interest in EHR certification. While the idea of certifying software sounds good on face, once you start digging in it starts to stink. At least I make my bias known up front. My least favorite phrase when it comes to EHR certification is that it provides an “assurance” to the EHR buyer. EHR certification doesn’t assure the EHR buyer of anything useful.

Considering my long interest in EHR certification, I decided I’d take a quick look at the various CCHIT EHR certifications that have been done in this new post-HITECH Act era of EHR certification. The number of EHR vendors is quite interesting as reported on the CCHIT website (I’ll look into the other ONC-ATCB in future posts).

In my quick count of ONC ATCB certified EHR products I counted 31 Hospital EHR (trying to take out the duplicates from the same EMR company). A number of those are ED EHR, but it’s interesting to see the scale of inpatient hospital EHR software that are certified by CCHIT.

Just for fun, I took at look at the full CCHIT certification for inpatient EHR. Only 4 inpatient EHR were listed.

The message here is that hospitals don’t use CCHIT’s full certification as a differentiator when they’re selecting an EHR. All they seem to care about is ONC-ATCB EHR Certification. While I still think it’s mostly redundant to meaningful use, I appreciate that it’s a step in the right direction.

When I first started Hospital EMR and EHR, I started this list of Hospital EHR vendors. It still needs some work, but I’d love to hear of other Hospital EHR companies that I should add to the list.