E-Health Designs, LLC

EHR Meaningful Use Video from HHS

EHR Meaningful Use Press Conference from HHS

Mobile Electronic Health Records

Unisys, Inc. recently completed a study on the acceptability and usability of Mobile Electronic Health Record physical form factors for the Department of Defense. The report is publicly available and is attached for those interested.

MEHR Study Final Report v1.1 092908

Eligible Provider Meaningful Use Criteria

As first reported in HIMSS Healthcare IT News, 31 Dec 2009:

WASHINGTON – On Dec. 30, the Centers for Medicare and Medicaid Services issued a notice of proposed rulemaking that outlines provisions governing the Medicare and Medicaid EHR incentive programs, including a proposed definition for the central concept of “meaningful use” of EHR technology (see related story). In order for professionals and hospitals to be eligible to receive payments under the incentive programs, provided through the Recovery Act, they must be able to demonstrate meaningful use of a certified EHR system.

The following list of 25 Stage 1 Meaningful Use criteria for eligible providers was taken from the proposed rule: “Medicare and Medicaid Programs; Electronic Health Record Incentive Program.” A second list, for eligible hospitals, is provided here. You can download the full 556-page document at http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf

[1] Objective: Use CPOE
Measure: CPOE is used for at least 80 percent of all orders

[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks
Measure: The EP has enabled this functionality

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.

[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

[5] Objective: Maintain active medication list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

[6] Objective: Maintain active medication allergy list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.

[7] Objective: Record demographics.
Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data

[8] Objective: Record and chart changes in vital signs.
Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.

[9] Objective: Record smoking status for patients 13 years old or older
Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded

[10] Objective: Incorporate clinical lab-test results into EHR as structured data.
Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

[11] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
Measure: Generate at least one report listing patients of the EP with a specific condition.

[12] Objective: Report ambulatory quality measures to CMS or the States.
Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule.

[13] Objective: Send reminders to patients per patient preference for preventive/ follow-up care
Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over

[14] Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules
Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3.

[15] Objective: Check insurance eligibility electronically from public and private payers
Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP

[16] Objective: Submit claims electronically to public and private payers.
Measure: At least 80 percent of all claims filed electronically by the EP.

[17] Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request
Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours.

[18] Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)
Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information

[19] Objective: Provide clinical summaries to patients for each office visit.
Measure: Clinical summaries provided to patients for at least 80 percent of all office visits.

[20] Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.

[21] Objective: Perform medication reconciliation at relevant encounters and each transition of care.
Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care.

[22] Objective: Provide summary care record for each transition of care and referral.
Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals.

[23] Objective: Capability to submit electronic data to immunization registries and actual submission where required and accepted.
Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries.

[24] Objective: Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.
Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically).

[25] Objective: Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.
Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary

Eligible Hospital Meaningful Use Criteria

As reported in HIMSS Health IT News, December 30, 2009:

WASHINGTON – On December 30, the Centers for Medicare and Medicaid Services issued a notice of proposed rulemaking that outlines provisions governing the Medicare and Medicaid EHR incentive programs, including a proposed definition for the central concept of “meaningful use” of EHR technology (see related story). In order for professionals and hospitals to be eligible to receive payments under the incentive programs, provided through the Recovery Act, they must be able to demonstrate meaningful use of a certified EHR system.

The following list of 23 Stage 1 Meaningful Use criteria for eligible hospitals was taken from the proposed rule: “Medicare and Medicaid Programs; Electronic Health Record Incentive Program.” A second list, for eligible providers, is provided here. You can download the full 556-page document at http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf

[1] Objective: Use of CPOE for orders (any type) directly entered by authorizing provider (for example, MD, DO, RN, PA, NP)
Measure: CPOE is used for at least 10 percent of all orders

[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks
Measure: The eligible hospital has enabled this functionality

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT
Measure: At least 80 percent of all unique patients admitted to the eligible hospital have at least one entry or an indication of none recorded as structured data.

[4] Hospital Objective: Maintain active medication list.
Measure: At least 80 percent of all unique patients admitted by the eligible hospital have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

[5] Objective: Maintain active medication allergy list.
Measure: At least 80 percent of all unique patients admitted to the eligible hospital have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.

[6] Objective: Record demographics.
Measure: At least 80 percent of all unique patients admitted to the eligible hospital have demographics recorded as structured data

[7] Objective: Record and chart changes in vital signs.
Measure: For at least 80 percent of all unique patients age 2 and over admitted to the eligible hospital, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.

[8] Objective: Record smoking status for patients 13 years old or older
Measure: At least 80 percent of all unique patients 13 years old or older admitted to the eligible hospital have “smoking status” recorded

[9] Objective: Incorporate clinical lab-test results into EHR as structured data.
Measure: At least 50 percent of all clinical lab tests results ordered by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

[10] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach
Measure: Generate at least one report listing patients of the eligible hospital with a specific condition.

[11] Objective: Report hospital quality measures to CMS or the States.
Measure: For 2011, an eligible hospital would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an eligible hospital would electronically submit the measures are discussed in section II.A.3. of this proposed rule.

[12] Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules
Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the Eligible Hospital is responsible for as described further in section II.A.3
13] Objective: Check insurance eligibility electronically from public and private payers
Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients admitted to an eligible hospital

[14] Objective: Submit claims electronically to public and private payers.
Measure: At least 80 percent of all claims filed electronically by the EP or the eligible hospital.

[15] Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, allergies, discharge summary, and procedures), upon request.
Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours.

[16] Objective: Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request.
Measure: At least 80 percent of all patients who are discharged from an eligible hospital and who request an electronic copy of their discharge instructions and procedures are provided it.

[17] Eligible Hospital Objective: Capability to exchange key clinical information (for example, discharge summary, procedures, problem list, medication list, allergies, diagnostic test results), among providers of care and patient authorized entities electronically.
Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.

[18] Objective: Perform medication reconciliation at relevant encounters and each transition of care.
Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care.

[19] Objective: Provide summary care record for each transition of care and referral.
Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals.

[20] Objective: Capability to submit electronic data to immunization registries and actual submission where required and accepted.
Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries.

[21] Objective: Capability to provide electronic submission of reportable lab results to public health agencies and actual submission where it can be received.
Measure: Performed at least one test of certified EHR technology capacity to provide electronic submission of reportable lab results to public health agencies (unless none of the public health agencies to which eligible hospital submits such information have the capacity to receive the information electronically).

[22] Objective: Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.
Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an eligible hospital submits such information have the capacity to receive the information electronically).

[23] Objective: Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.
Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary

What is NHIN Direct?

What is NHIN Direct?
What is the NHIN Limited Production Exchange?
How do they work together?
What about CONNECT?

If you have questions about ONC’s efforts to create a comprehensive infrastructure for secure health information exchange, you won’t want to miss the next NHIN University class -

NHIN 103: ONC Initiatives for Health Information Exchange and their Continuing Evolution – on Monday, April 19!

By participating in this class, students will become familiar with:
* The core elements of the ONC’s Nationwide Health Information Network (NHIN) program
* The NHIN Limited Production Exchange and the capabilities supported today
* The FHA CONNECT solution and how this solution can be used by adopters today
* The NHIN Direct project to expand the NHIN specifications and how this project complements the other NHIN initiatives

Register Now for NHIN University!
________________________________

NHIN 103: ONC Initiatives for Health Information Exchange and their Continuing Evolution (NEW TITLE!)
DATE: Monday, April 19, 2010 TIME: 1:00 – 2:30 pm ET

FACULTY:

* Douglas Fridsma, MD, PhD – Acting Director, Office of Standards and Interoperabilty, Office of the National Coordinator for Health IT (ONC)
* Rich Kernan – NHIN Specification Factory Lead (Contractor), ONC
* David Riley, BS, PAC – CONNECT Initiative Lead (Contractor), Federal Health Architecture, ONC
WEBINAR: https://nationalehealthevents.webex.com/nationalehealthevents/onstage/g.php?t=a&d=669956907

AUDIOCONFERENCE: (866) 699-3239 or (408) 792-6300 (Please join the event with a computer system first and follow the audio instructions on the screen.)

ACCESS/EVENT CODE: 669 956 907

ATTENDEE ID: You will receive this number when you join the event first with a computer connection.

If you are not available to attend, the webinar will be recorded and posted to the NeHC website – www.NationaleHealth.org/NHIN-U – following the class.

The Nationwide Health Information Network (NHIN) and Virtual Lifetime Electronic Record (VLER) and Why They Are Important to the Department of Defense (DOD)

http://www.health.mil/MHSBlog/Article.aspx?ID=764

LCDR Steve Steffensen, MC, USN, Chief Medical Information Officer for the U.S. Army Telemedicine and Advanced Technology Research Center, Fort Detrick, MD, and the Military Health System’s Coordinator for the Nationwide Health Information Network (NHIN) and Virtual Lifetime Electronic Record (VLER), discusses both projects.

Healthwise, Inc. CEO Comments on HL-7 InfoButton Standard

January 28, 2010

The Info-Button Standard: Bringing Meaningful Use to the Patient

By DON KEMPER, CEO HEALTHWISE

“Regardless of the U.S. administration’s “meaningful use” requirements, if health information technology (HIT) is to become meaningful for patients, it must include the prescription of information and tools to help each patient better manage his or her own care.

Ask patients what they want from HIT systems, and they will tell you three things:

- “Tell me my diagnosis, what will happen, and what I can do myself to better manage the problem.”

- “Tell me my medical tests results and what they mean to me.”

- “Tell me my treatment options, and help me participate in the treatment decisions.”

The soon-to-be-finalized HL7 International Context-Aware Information Retrieval standard (nicknamed the HL7 “Infobutton” standard) makes it far easier for providers of electronic health records (EHRs) and personal health records (PHRs) to deliver just what the patient wants. And that is what will put the meaning into meaningful.

Using the HL7 Infobutton Standard for Information Prescriptions

The HL7 Infobutton standard has been widely adopted since 2007. It facilitates the delivery of a set of standardized information about the patient, the provider, and the activity of a specific care encounter or moment in care. An Infobutton manager (or equivalent) accessed by an EHR application can then pull from that set the information it needs for any relevant use case. In most cases the Infobutton has been used to bring up decision support information for the clinician.

This same HL7 standard can also be used to trigger relevant, helpful patient education orders or “information prescriptions”—for the patient. While the knowledge request can be triggered by the click of a button, the button click is not always necessary. The information prescriptions can be automatically generated, based on the context of the patient’s particular moment in care, for presentation in a handout or secure message, or on the personal health record (PHR).

In an EHR, a clinician triggers a knowledge request to a content provider. (A knowledge request differs from a query, because it returns tailored, targeted, and relevant information instead of the overabundance of documents with varying degrees of relevance that a standard query might deliver.) The content provider responds with a list of patient information prescriptions appropriate for that patient and that specific care encounter.

In the PHR, the request can be launched by the patient or automatically triggered by a scheduled appointment, a preventive service that is due, a medical test report, or any other clinical event. The content provider responds with relevant Web-based consumer health content.

By having both synchronous and asynchronous triggers, systems can generate relevant, helpful information at every point in the health care continuum. In all cases, the knowledge request and response protocols are defined by the HL7 Infobutton standard. This minimizes development effort and provides a single consumer content integration solution for both HIT developers and content providers.

Download the full white paper: “Getting Patients to Meaningful Use: Using the HL7 Infobutton Standard for Information Prescriptions (PDF)”

As chairman and CEO of Healthwise Mr. Kemper is a passionate advocate for raising the quality of patient engagement in health care. By prescribing prevention, self-management, and decision-support tools relevant to each patient’s needs, clinicians can engage and motivate their patients to become active partners in their health and wellness.

Mr. Kemper co-authored Information Therapy: Prescribed Information as a Reimbursable Medical Service with Molly Mettler. The Ix book lays out both the concept and the practical details of how
information prescriptions will become a core and expected part of health care.

More information about Healthwise can be found at http://www.healthwise.org/”

Biomedical Informatics Handbook, WikiPedia

From one of my LinkedIn groups:

“New Free Handbook on Biomedical Informatics has 250+ articles

In another striking innovation in the world of electronic publications and Web 2.0, the online encyclopedia Wikipedia, in its English version, has published today a new online Wikibook entitled “Handbook of Biomedical Informatics “, version 1.0, after more than 5 months of organization work. The book is based on articles published on the subject by Wikipedia.

Access to and the download of the book are totally free, with no need for registration of the user at the address:

http://en.wikipedia.org/wiki/Book:Biomedicalnformatics

The book has 276 pages in its PDF version, and gathers, organizes and classifies all the knowledge amassed by the Wikipedia articles on topics in health informatics, telehealth, standards and classifications in health informatics, and related topics, organized into 21 sections and more than 250 entries. Thus, it is considered one of the most comprehensive and complete books in the area.

Users can generate in real-time and download their own copy in PDF, or request a printed copy to a print shop operated by the Wikipedia Foundation. The final file is 4.7 MB.

The most interesting aspect of this new form of publication created by Wikipedia is that, due to the dynamic nature of Wikipedia articles, the book will remain in permanent updating process, i.e, the book will literally change daily.

The organizer of the book is Prof.Dr. Renato ME Sabbatini, former president and current director of Education and Professional Training of the Brazilian Society of Health Informatics, president of the Edumed for Education in Medicine and Health, Campinas, SP, Brazil, and retired adjunct professor of the Faculty of Medical Sciences UNICAMP, where he was also the founder and director of the Center for Biomedical Informatics for 20 years.

The Board of Professional Education and Training of the Brazilian Society of Health Informatics officially adopted the “Handbook of Biomedical Informatics” as a reference source and textbook for its educational programs, as well as the basic study material to obtain the official title of specialist in Health Informatics, to be launched in 2010. “

Government Releases First EHR “Meaningful Use” Criteria

As reported in Healthcare IT News, “The government delivered on Wednesday the long-awaited definition of meaningful use of electronic health record technology, and it came wrapped in about 700 pages of proposed regulation.

[1] Objective: Use CPOE
Measure: CPOE is used for at least 80 percent of all orders

[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks
Measure: The EP has enabled this functionality

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.

[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

[5] Objective: Maintain active medication list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

[6] Objective: Maintain active medication allergy list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.

[7] Objective: Record demographics.
Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data

[8] Objective: Record and chart changes in vital signs.
Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.

[9] Objective: Record smoking status for patients 13 years old or older
Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded

[10] Objective: Incorporate clinical lab-test results into EHR as structured data.
Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

[11] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
Measure: Generate at least one report listing patients of the EP with a specific condition.

[12] Objective: Report ambulatory quality measures to CMS or the States.
Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule.

[13] Objective: Send reminders to patients per patient preference for preventive/ follow-up care
Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over

[14] Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules
Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3.

[15] Objective: Check insurance eligibility electronically from public and private payers
Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP

[16] Objective: Submit claims electronically to public and private payers.
Measure: At least 80 percent of all claims filed electronically by the EP.

[17] Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request
Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours.

[18] Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)
Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information

[19] Objective: Provide clinical summaries to patients for each office visit.
Measure: Clinical summaries provided to patients for at least 80 percent of all office visits.

[20]  Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.

[21] Objective: Perform medication reconciliation at relevant encounters and each transition of care.
Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care.

[22] Objective: Provide summary care record for each transition of care and referral.
Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals.

[23] Objective: Capability to submit electronic data to immunization registries and actual submission where required and accepted.
Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries.

[24] Objective: Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.
Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically).

[25] Objective: Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.
Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary.

Healthcare Reform Proposals as of 30 Nov 2009

Synopsis_health_reform_side_by_side_Nov_30_20091 (2)