ONC | Hospital EMR and EHR

EMRs Have Certifications Yanked

A California EMR developer has become the first to have its certification for Meaningful Use taken away by the ONC.

EHRMagic-Ambulatory and EHRMagic-Inpatient, both of which were developed by Santa Fe Springs, Calif.-based EMRMagic, failed to meet certification requirements, reports EMR Thoughts.

The de-certification process began when ONC and ONC-authorized certification body InfoGard Laboratories were notified that the EHRMagic products didn’t meet Meaningful Use certification requirements.

InfoGard Laboratories analyzed the information sent along with the notification and contacted the vendor. It then began the process of ONC-ACB required surveillance activities, according to HIN. At that point, InfoGard decided to test the two products for compliance with certain requirements. EHRMagic’s products were then retested, and failed to meet criteria for Meaningful Use certification.

Fortunately for the company’s customers, no providers had yet attempted Meaningful Use attestation using these products. One can only imagine the frustration they would have faced if they attempted to attest in good faith and found out that the EMR product they were using wasn’t capable of supporting MU certification.

I’m left wondering whether providers would have grounds for a lawsuit against the offending vendor if they attempted certification with a product that didn’t support Meaningful Use, particularly if the vendor had any idea that this might be the case.

Realistically, it seems likely at some point in the future, some provider will be left high and dry by a certified product that shouldn’t have gotten the go-ahead. My guess is that things will get nasty pretty quickly!

ONC Proposes New EMR Vendor Fee

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.

Best Of Breed Systems Lead In Battle For Meaningful Use Dollars

This week, Modern Healthcare published a very interesting analysis of ONC and CMS data on which vendors were used for Meaningful Use attestation. The results suggest that the battle for market dominance may be closer than it looks when it comes to producing results that count. Perhaps more importantly, the data suggests that best-of-breed systems may have a stronger foothold than unified systems (see more below).

According to Modern Healthcare, four vendors stood out as leader in the complete inpatient EMR market:

* Epic Systems, with 370 hospitals customers, or 17.9 percent of 2,071 hospitals which have attested using one of the four

* Meditech, with 323 hospitals, or 15.6 percent

* CPSI, with 313 hospitals, or 15.1 percent

* Cerner Corp., with 208 hospitals, or 10 percent

All told, these top four players have sold 1,214 hospitals a complete inpatient EMR system. That’s represents 58.6 percent of all systems sold to hospitals that have gotten a Medicare incentive check using a complete inpatient EMR. The top 10 vendors swelling such systems, meanwhile, have sold them to 1,902 hospitals, owning almost 92 percent of this niche, Modern Healthcare notes.

It’s important to note, however, that best-of-breed implementations have won even more Meaningful Use dollars, the analysis suggests. In fact, 2,438 hospitals using modular inpatient EMRs have achieved Meaningful Use. According to Modern Healthcare research, three developers lead the modular inpatient EMRs hospitals have used for this purpose:

* Meditech, with 637 hospitals, or 26.1 percent

* Cerner, with 530 hospitals, or 21.7 percent

* HCA Information & Technology Services, with 274 hospitals, or 11.2 percent

Collectively these vendors account for 59.1 percent of modular inpatient EMR market, the analysis shows.

I thought it was quite noteworthy that a larger share of hospitals are using best-of-breed inpatient systems to achieve Meaningful Use than complete inpatient systems. It would be interesting to find out if interoperability was one of the reasons hospitals are making this choice — since we know that the big vendors are shaky on the concept at best.

Contest Offers Prizes For CCD Redesign

When EMRs are the gossip of the week at TechCrunch (a popular tech startup website), you know our little EMR thang has gone mainstream. And TechCrunch is indeed one of a series of sites trumpeting the news of a design challenge intended to make the Continuity of Care Document more usable.

The White House’s Health Design Challenge, working with a community of philanthropic angels and mentors known as Designer Fund, asks designers to transform the CCD (and by extension the Blue Button output) from a consumer-hostile mess into something easily used by the following groups:

An underserved inner-city parent with lower health literacy
A senior citizen that has a hard time reading
A young adult who is engaged with technology and mobile devices
An adult whose first language is not English
A patient with breast cancer receiving care from multiple providers
A busy mom managing her kids’ health and helping her aging parents

The ONC and VA, which seem to be spearheading the effort, are providing for twelve winners. First place for best overall design gets $16K, second place $6K and third place $4K. They’re also distributing $8K per category across winners for best medical/problem history section, best medication section and best lab summaries.

The design is expected to not only improve the visual layout of the record, it’s also supposed to make it easier for a patient to manage their health, enable medical professionals to digest information more efficiently and help caregivers support patients. Tall order for a messed-up text file? Well, we’ll see what design superbrains can do.

In part because the VA hopes to use the new designs to support its Blue Button initiative and its MyHealtheVet patient portal, all entries have to be submitted under a Creative Commons license. Curators will select a final design — which may include elements from various winning entries — and open source the code on code-sharing commuity Github.

EMR Overbilling Investigations Sling Mud At Meaningful Use Program

In the wake of an expose in The New York Times claiming that upcoding and overbilling was increasing with the use of EMRs, and members of Congress riding the claim, I guess ONC had no choice but to take the allegations seriously. So fearless leader Farzad Mostashari, M.D. has asked the advisory HIT Policy Committee to study whether providers are using EMRs to upcode Medicare bills.

I suppose you can tell from how I put that that I’m far from convinced EMRs are generating massive amounts of illegitimate bills, but the idea is “out there” now and dangerous to the future of HITECH objectives. So I suppose it’s a good thing that ONC is investigating.

Dr. Mostashari wants to find out whether EMRs tend to foster the use of higher billing codes by encouraging doctors to cut and paste information from one patient encounter to another, according to an interview with the Center for Public Integrity. He’s also asking the policy committee to determine whether some EMR functions prompt physicians to overbill.

All of this leaves me sort of uneasy.

Don’t get me wrong, I’m not suggesting that EMRs aren’t generating any upcoding issues at all. We all know that many physicians feel pressured to cut and paste text in an effort to get through their heavy workloads, particularly if they’re not otherwise comfortable with their system.

Also, I can’t deny that there are bad apples in every profession, including medicine, who could conceivably be taking advantage of the newness of the technology to reap a profit.

No, my concerns are more that countless providers will have one more thing to worry about as they use the new technology, and that policymakers will view EMRs with a level of suspicion they hadn’t before. We’re at a tricky point in the overall EMR adoption curve, and bad vibes and publicity are the last thing we need. Meaningful Use compliance is tough enough as it is.

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October 31, 2012 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Meaningful Use

Tags:Hospital EHR Hospital Electronic Health Records Hospital Electronic Medical Records Hospital EMR Meaningful Use Medicare ONC Revenue Cycle Management

ONC Wants 1,000 More Smaller Hospitals To Be Meaningful Users

As I’ve written about here in the past, small rural/critical access hospitals are struggling to keep up with Meaningful Use. These hospitals — typically 50 beds or less — are isolated, underfunded, short on staff and clinicians and sometimes without affordable connectivity options.

That’s a shame, because having telemedical functions and EMR connectivity may be far more important for these hospitals than for big academic or urban behemoths. In situations where the nearest specialist may be a day’s drive away, being able to communicate and collaborate with remote specialists can be a lifesaver.

Aware of these concerns, ONC has launched a campaign intended to get 1,000 critical access and small rural hospitals meaningfully using certified EMR technology by the end of 2014.

To help small hospitals get their legs under them, ONC has committed to spending up to $30 million for Regional Extension Centers targeting these facilities. Though ONC is shooting for 1,000 new Meaningful User hospitals , it’s willing to fund services for up to 1,501 of them. That would bring the total to more than 2,700 rural/critical access hospitals on the MU roster.

The obvious question, given the obstacles the smaller facilities face, is just how realistic ONC’s expectations are. Sure, getting them hooked up with REC services is a good thing, but is it enough to get them across the finish line?

One comment on the ONC blog had this to say on the subject of the CAH/rural hospital campaign:

The best chance for success (in my humble opinion), is a joint effort between public (REC) and private sectors. There are consulting firms with specific MU experience sitting on the bench that can provide incredible value to this process. The RECs are trying to keep up with demand while servicing thousands of ambulatory providers. If there is a way to facilitate collaboration between pubic & private sectors in a way that fosters success of this initiative, that would ensure the ONC would hit their goal of 1,000 hospitals to MU by 2014.

I think the poster is on to something. While the RECs are fine, and have the best of intentions, they’ve already got their hands full. Whether it’s a public/private partnership, an assist from state government, additional grants or other mechanisms, I think it will take more than REC funding to get the job done here.

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!

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August 9, 2012 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Hospital IT Systems Meaningful Use

Tags:Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Meaningful Use Stage 2 Meaningful Use Stage 3 ONC

Doctors Fear EMRs Will Mess Up E&M Coding

Here’s one more example of technology clashing with habit. Apparently, even when EMRs are ready to code for doctors, Medicare physicians often hand-code anyway, according to the HHS Office of the Inspector General.

The OIG study, which was requested by ONC, looked at how Medicare docs use EMRs to assign and document codes for evaluation and management services. According to the study, 57 percent of Medicare physicians use an EMR, and of those, 90 percent use their systems to document E&M services.

The rub is that most of that 90 percent assign codes manually, rather than letting the system do the work, the report notes. That’s not surprising, however, given that doctors are on the hook if HHS finds fraudulent upcoding whether it’s the software’s fault or not.

How can the industry cope with this issue? I liked the suggestion made by Susan Fenton, PhD, assistant professor at the College of Health Professions at Texas State University.

In an interview with American Medical News, she argues that HHS and the Department of Justice should get together to certify coding capabilities of given EMRs. She also recommends that the two agencies should agree that physicians not be held liable if something was coded wrong, as long as the practice didn’t alter the software. (The American Medical Association has made similar recommendations.)

Honestly, I think the compulsion to do hand-coding goes deeper than a fear of getting slapped by the DoJ or HHS. If you don’t feel comfortable with an EMR, you’re likely to do as much of your work as you can in “the old way.” Heck, I know I would. But the very reasonable fear of government sanctions makes the situation much worse. Certifying bodies, start your engines.

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July 25, 2012 I Written By Anne Zieger

Filed Under: Hospital EHR Hospital EMR Hospital Healthcare IT

Tags:AMA E&M Coding Hospital EHR Hospital Electronic Health Records Hospital Electronic Medical Records Hospital EMR Medical Coding Medicare ONC Susan Fenton Texas State University

PHR Concept Maturing, But Still Not Popular With Consumers

Folks, what do you think would happen if you asked, say, five or ten of your non-HIT friends what a PHR was? And if you explained it to them, how many would actually have used one? Thirty percent? Twenty percent? My friends ranked at about ten.

Given the benefits that would result if patients paid close attention to their health data, it’s certainly a shame that few know what PHRs are. It’s not as though we in the industry aren’t trying to get the word out and the tools into the right hands, but so far progress is slow and many promotional efforts are quite new.

Take government. Just last week ONC launched its own effort trying to move the PHR puck forward on the ice. The ONC launched a video contest, “What’s In Your Health Record??” in which individuals and groups are invited to submit short videos explaining how PHR use has improved their care. The agency plans to hand out six awards totaling $7,200 to lucky winners.

Private industry hasn’t given up either. In June, the AARP launched a partnership with Microsoft in which the senior advocacy group set plans to offer an “AARP Health Record.” The Health Record, which is powered by Microsoft HealthVault, is free to AARP members. I haven’t found a stat telling me just how many seniors have signed up, but color me skeptical.

I’ve been carping about the flaws in the PHR concept for several years now, and I have to admit that it’s matured. Originally, most of the benefit of the PHR was supposed to be that it offered extra access to medical data in an emergency situation. Clearly, that can’t have been a compelling proposition, because it didn’t exactly drive consumers to use them.

Today, though, the idea of the PHR has broadened into a patient self-advocacy tool, one which — if used appropriately — can concretely reduce risks and improve the quality of care. There’s even consumer-lite friendly versions of PHRs, such as the intriguing Cake.com.

But the reality is, many patients simply don’t feel up to or don’t bother to pay that much attention to what their doctor is doing. It’s going to take a lot more outreach, and a lot more education, to get patients on board.

A Big Year Coming For HIEs, With Epic Leading the Way

Folks, I’m afraid that when it comes to Epic, I haven’t followed the old “if you have nothing nice to say, don’t say anything” rule. In fact, I’ve been a fairly ruthless critic of the company, whose veni, vidi, vici attitude rubs me the wrong way.

That being said, I was fascinated to note that Epic may be at forefront of hospital EMR vendors enabling health information exchange. If Epic’s own claims are to be believed, it’s a force for clinical data sharing unlike most out there today.

A couple of days ago, ONC chief Farzad Mostashari told the Health IT Policy Committee that he expects to see a big ramp-up in HIE implementations this year. He believes that the necessary elements for interoperability are falling into place, including standards, identity authentication certificates, governance requirements and the availability of directories.

Mostashari cited efforts by Epic as a model for what can be accomplished in 2012. And Judy Faulkner, Epic CEO and a policy committee member, told members that hospitals using its product have already exchanged 800,000 documents nationally. She expects users to begin sharing documents overseas, as well.

What’s more, Faulkner contends that as standards fall into place, sharing across vendors will be”almost equally as simple” as Epic-to-Epic sharing. I find it hard to imagine, but if she and her team can pull that off, it will indeed be impressive.

I’m rather skeptical that it will be as easy as Faulkner suggests, for practical reasons as much as technical ones. And given that Faulkner has asserted that hospitals should go all-Epic rather than mix and match systems, it’s hard to imagine Epic as a “we interoperate” kinda company.

On the other hand, given Epic’s status as a market leader, this may be one of the few chances the industry has had to pull together and find a common way to share data. As much as it sticks in my craw, and believe me, it does, I have to admit that Faulkner & Co. may have something there.

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February 3, 2012 I Written By Anne Zieger

Filed Under: Healthcare CIO HIE HIE Vendor Hospital EHR Hospital EHR Company Hospital EHR Vendor Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital EMR Company Hospital EMR Vendor Hospital Healthcare IT

Tags:Epic Systems Farzad Mostashari Health Information Exchange HIE Hospital EHR Hospital Electronic Health Records Hospital Electronic Medical Records Hospital EMR ONC

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