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Eyes Wide Shut Meaningful Use Series

For those of you who read Hospital EMR and EHR but don’t read EMR and HIPAA (which from our latest survey is far too many of you), I wanted to highlight a series of blog posts by Mandi Bishop that I believe will be of extreme interest to those reading this site.

In this series called Eyes Wide Shut, Mandi gives some really amazing in the trenches views into how a large organization is dealing with the challenges of meaningful use and meaningful use stage 2 in particular.

Here’s a small sample from the latest entry in the series titled “Eyes Wide Shut: Meaningful Use Stage 2 Incentive Program Hardships“:

In my January update on Meaningful Use Stage 2 readiness, I painted a dismal picture of a large IDN’s journey towards attestation, and expressed concern for patient safety resulting from the rush to implement and adopt what equates to, at best, beta-release health IT. Given the resounding cries for help from the healthcare provider community, including this February 2014 letter to HHS Secretary Kathleen Sebelius, I know my experience isn’t unique. So, when rumors ran rampant at HIMSS 2014 that CMS and the ONC would make a Meaningful Use announcement, I was hopeful that relief may be in sight.

Like AHA , I was disappointed in CMS Administrator Marilyn Tavenner’s announcement. The new Stage 2 hardship exemptions will now include an explicit criteria for “difficulty implementing 2014-certified EHR technology” – a claim which will be evaluated on a case-by-case basis, and may result in a delay of the penalty phase of the Stage 2 mandate. But it does nothing to extend the incentive phase of Stage 2 – without which, many healthcare providers would not have budgeted for participation in the program, at all, including the IDN profiled in this series. So how does this help providers like mine?

In that post, Mandi also tries to not just complain about the challenges they face, but also offer some solutions. You can see her full list of ideas in the post, but I especially like the simplicity of her last line “Consider applying the hardship exemption deadline extension to the incentive program participants.”

We need more in the trenches people like Mandi sharing their stories and solutions for others to see. Otherwise, the regulators sit in their office in DC and don’t know the details of why they should adjust. If you’re someone reading this that would like to tell your story as well, I’d be happy to give you the platform. Just drop me a note on our contact us page.

March 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Large Health Systems May Miss Stage 2 Deadline

Usually, it’s the small institutions that are having fits when an IT program deadline is approaching. This time around, it’s the big boys that are struggling.

Intermountain Healthcare has announced that the organization will probably not attest to Stage 2 of the Meaningful Use program this year over concerns about patient safety, according to iHealthBeat

In an interview with HealthLeaders Media, CIO Marc Probst said that with the organization transitioning from its own EMR to EMR software from Cerner, all the software will not be running at all of the locations by the end of this year. This isn’t surprising after the relatively recent announcement that Intermountain would be switching to Cerner.

It’s not clear what it says about the success of the Meaningful Use Stage 2 program, other than that Intermountain has other priorities, but it does make you wonder what other large health systems will take a similar posture.

After all, ONC Chief Medical Officer Jacob Rieder (who also spoke with HealthLeaders) said that other large institutions are reporting similar situations. As amazing as it sounds considering the money involved, I won’t be surprised if we see more institutions following similar paths. There are a decent number of hospitals that haven’t even selected an EHR software.

According to Reider, it will be easier for small providers to meet Stage 2 requirements, given that they generally don’t have to plan as far into the future. But when it comes to large health systems, it seems that achieving this year’s Meaningful Use goal is a bridge too far.

March 4, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Technology and Focusing on the Patient Video

I had a chance to sit down with Dr. Nick van Terheyden, CMIO at Nuance Healthcare, to discuss some of the latest topics in healthcare IT: meaningful use stage 2, ACOs, ICD-10, and patient engagement. Dr. Nick gives a lot of valuable insights into healthcare IT trends and also the shift to a more patient focused healthcare environment. I hope you enjoy the video interview with Dr. Nick embedded below:

You can see a full list of future and past live video interviews on our EHR Video Interview Schedule.

September 26, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Most US Hospitals Are Ready For Meaningful Use Stage 2

So, it looks like most US hospitals are prepared for Meaningful Use Stage 2. New data from HIMSS suggests that approximately 68 percent of US hospitals have purchased technology from a software vendor that has been certified to the 2014 Edition certification criteria, according to Healthcare IT News.

The HIMSS report, Hospital Readiness to Meet Meaningful Use Stage 2, was released this week during National Health IT Week in Washington, D.C.

Researchers found that at least 60 percent of hospitals in their sample had met requirements for at least nine of the core metrics that define Stage 2 Meaningful Use. They also found that roughly 70 percent of respondents are actively moving toward meeting stage two meaningful use requirements across all metrics, Healthcare IT News reports.

These latest findings from HIMSS fit well with other data from previous reports done by the organization. The 24th Annual HIMSS Leadership Survey, which was released this February, found that 75 percent of respondents expected their organization to qualify for Stage 2 incentives in 2014.

Things aren’t nearly so rosy, however, when it comes to Stage 2 compliance for physicians. Several trade groups have written to HHS asking the agency to postpone or even put on hold the requirements of Stage 2.  In August, for example, the MGMA wrote a letter to HHS asking the agency to put Stage 2 requirements on an indefinite moratorium for practices that have successfully nailed Stage 1 Meaningful Use requirements.

The MGMA argues that it’s unfair to expect medical practices to comply with Stage 2 Meaningful Use as of yet, given that at present there are only 75 products and 21 complete EMRs for ambulatory care which are currently certified for Stage 2 criteria. As I see it, they have an excellent point.

This is an untenable situation. It’s all well and good that hospitals are approaching Stage 2 readiness, but if ambulatory care is being left behind, Meaningful Use Stage 2 can’t be said to be accomplishing its true purpose. I believe HHS will grant the request of MGMA and other groups like it – and ease Stage 2 deadlines for ambulatory care providers – or it risks creating a digital divide between hospitals and medical practices which does no one any good.

September 19, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Will Hospitals Be Penalized If Their EHR Vendor Isn’t 2014 EHR Certified?

Let me state the obvious. An EHR implementation in a hospital is a time consuming and expensive effort. While the idea of switching EMR software is a palpable discussion in the ambulatory space, it is a much more difficult discussion in the hospital EMR space. I heard one hospital CIO whose hospital decided to switch EHR software say it took them 2 years to make this decision. The idea of switching EMR software is not even a discussion point for many hospital CIOs.

With this in mind, I was intrigued by today’s #HITsm chat where we talked about meaningful use stage 2. More than a few people suggested that many EHR vendors are going to fail to meet the meaningful use stage 2 requirements and be 2014 EHR certified. I’ve personally suggested that I don’t think this will be the case. EHR vendors have far too much to lose to not be certified. However, more than a few people disagree with me on this subject, so I started to consider what this would mean for an organization.

For those of you who also read EMR and HIPAA, you might remember my post earlier this year called EHR Penalties after Meaningful Use Failure. In it I discuss how damaging it would be for a hospital that makes a sincere commitment to EHR and meaningful use to then fails to get the EHR incentive money because they fall short of meaningful use or fail an MU audit.

A similar situation could occur if a hospital’s EHR vendor isn’t able to meet the meaningful use stage 2 EHR certification requirements. What does the hospital do in this case? Will they miss out on the EHR incentive money and also suffer the EHR penalties because their EHR vendor wasn’t ready for meaningful use stage 2?

Like I said, I’ll still be surprised (especially in the hospital EHR space) if all the hospital EHR vendors don’t become 2014 EHR certified. However, if they don’t, a lot of hospitals will be put in a precarious position.

My guess is that if this happens, ONC will make an exception in the penalties for not being a meaningful user. I can’t imagine them penalizing a hospital who’s trying to be a meaningful user of an EHR and can’t because of their EHR vendor’s inability to perform. Although this would start a slippery slope of exceptions.

Either way, I want to dig into this topic more. How many EHR vendors won’t have their EHR certified for meaningful use stage 2? What are the timelines for them to complete this certification and then for hospitals to implement everything for MU stage 2?

August 30, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

AHA, AMA Seek More Flexible Meaningful Use Requirements

The American Hospital Association and the American Medical Association have sent a joint letter to HHS Secretary Kathleen Sebelius asking for more flexibility in the requirements for the Meaningful Use program, iHealthBeat reports.

The two trade groups, which called the program’s requirements “overly burdensome,” argue that as the current Meaningful Use program is structured, it’s too hard for some providers to keep up. “[W]e believe that the best way to move the program forward and ensure that no providers, particularly small and rural ones, are left behind is to realign the meaningful use program’s current requirements to ensure a safe, orderly transition to Stage 2,” the letter adds.

The letter makes four recommendations to improve the Meaningful Use program for providers, iHealthBeat notes:

* Let providers meet Stage 1 requirements using either a 2011- or 2014-certified EMR

* Set up a 90-day reporting period for the first year of each new stage of the program, applicable to all providers;

* Give providers increased flexibility to meet Stage 2 Meaningful Use requirements

* Extend each stage of the Meaningful Use  program to a minimum term of three years for all providers

The AHA submitted also submitted testimony to the Senate Finance Committee last week asking legislators to give providers more flexibility within the Meaningful Use program.

As things stand, unless current requirements for electronic clinical quality measures are changed, “clinicians [will be] spending extensive amounts of time working for the EHRs” rather than having the EMRs work for them, the trade group suggested.

As part of its testimony, the AHA presented case studies drawn from four separate hospitals. Based on the issues arising at these hospitals, the group recommended several changes to MU, including using fewer, better-tested electronic quality reporting measures, starting with Stage 2, and making EMRs and electronic clinical quality measure reporting tools more flexible to align data capture with the nuances of workflow.

July 30, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

CCHIT Who?

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.

July 11, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospitals, Health Systems Don’t Feel Prepared For Meaningful Use Stage 2

A new survey by KPMG confirms what most us would have guessed — that hospital and health system leaders aren’t that sure they’re ready to meet Meaningful Use Stage 2 requirements.

The study, which was conducted last month, found that 47 percent of hospital and health system business leaders surveyed were only somewhat confident in their readiness to meet Stage 2 requirements. Just over one-third (36 percent) said they were confident, and four percent weren’t confident at all, KPMG found. Another 11 percent said they didn’t know what their level of readiness was.

Respondents are also worried about meeting privacy and security standards included in both Stage 2 and HIPAA. Forty-seven percent of respondents were only somewhat comfortable with their organization’s ability to meet all parts of HIPAA, including the need for new annual risk assessments and protecting patient-identifiable information. Eight percent of respondents said they weren’t comfortable at all, 13  percent said they weren’t sure and 31 percent said they were comfortable, KPMG reported.

To help close the readiness gap, hospitals and health systems are bringing in outside help. Thirty percent of respondents said their organization had hired new or additional team members to help complete EMR deployment. And 22 percent said they’d hired outside contractors to get the job done.

So why are so many healthcare business leaders insecure about Stage 2?  When asked to name the biggest challenge in complying with Stage 2 requirements, 29 percent cited training and change management issues.

Tied for second were lack of monitoring processes to ensure sustained demonstration of MU, and capturing relevant data as part of the clinical workflow, at 19 percent each. Twelve percent named lack of a dedicated Meaningful Use team, and 6 percent availability of appropriate certified vendor technology. Fourteen percent said “other.”

December 31, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

What HIMSS Told Congress

This week, a House subcommittee held a hearing entitled “Is ‘Meaningful Use’ Delivering Meaningful Results?: An Examination of Health  Information Technology Standards and Interoperability.”  The hearing follows a recent furor over Meaningful Use’s benefits, in which HHS head Kathleen Sebelius was written a stinging letter by a quartet of Congressman arguing that the program might not be pulling its weight.

Lots of interesting discussion took place at the hearing — see a report from the indefatigable HIT blogger and expert Brian Ahier for more background — but for the purposes of this item, I’m focusing on what HIMSS had to say.

HIMSS, which obviously has a massive stake in the topic discussed, is a big Meaningful Use fan. The trade group argues that “Meaningful Use and the Stage 2 regulations allow the healthcare community to continue the necessary steps to ensure health information technology will support the transformation of healthcare delivery in the United States.”

Not surprisingly, HIMSS showed up in full color at the hearing, ready to defend MU and the progress of health IT generally. HIMSS offered Congress seven recommendations as to how to keep the MU train moving, Ahier reports. Here’s my favorites:

  1. Direct the administration to initiate an appropriate study of a nationwide patient data matching strategy with a report back to Congress.
  2. Support harmonization of federal and state privacy laws and regulations to encourage the exchange of health information across health systems, payers, and vendor systems.
  3. Continue to support and sponsor pilot programs addressing the collection, analysis and management of clinical data for quality reporting purposes to assist providers and provider organizations make informed decisions for public health, patient care and business purposes.
  4. Preclude any additional delay in the nationwide implementation of ICD-10, International Classification of Diseases beyond the current October 1, 2014 deadline.

Other than the ICD-10 recommendation, which will probably be battled down to the last millisecond by some groups, I’m betting most readers would consider these to be reasonable steps. But I could be wrong. And I don’t see a lot here on the nitty-gritty of interoperability, which was the focus of the Congressmen’s ire in the first  place.  Folks, what would you add to/subtract from this list?

November 16, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

Meaningful Use Stage 3 Draft On The Way

Well, it looks like we’ve got a new set of MU regulations afoot. Though we don’t even have a final version of Meaningful Use Stage 2 regs in place yet, HHS apparently plans to issue Meaningful Use Stage 3 draft regulations sometime in August.

According to HealthcareInformatics, ONC plans to make sure Stage 2 and Stage 3 square by September or October of this year.  (Why it would make sense to issue Stage 3 now, before Stage 2 has even been field tested, is a question clearly for wiser heads than my own. To me it just doesn’t make sense…)

The magazine reports that the core of Meaningful Use Stage 3 recommendations is likely to be as follows. It says providers and hospitals will be asked to have an EMR in place which:

  • Tracks individual care goals;
  • Records care team members, their roles, and their contact information across care settings;
  • Tracks tasks/steps and responsible party;
  • Feeds population health management;
  • Facilitates reconciliation of medications, problem lists, goals, and plan of care; and
  • Allows for input and viewing by all care team members, the patient and their caregivers.

And it says that potential measures would be:

  • A platform for collaborative care exists and is being used for at least 20 percent of patients.
  • Receiving care team members in a care transition access information for at least 10 percent of patients having an active collaborative care plan.

To me, the idea of having two other sets of MU standards swimming around out there when people are still struggling with Stage 1 is not a smart move. But hey, given all the delays in getting standards out there, maybe we should just be glad that they’re getting done!

August 9, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.