Dr. Blumenthal’s Letter on “Meaningful Use” of Electronic Health Records

Here is Dr. Blumental’s latest letter on what constitutes “meaningful use” of EHRS. The letter is helpful in gaining shared vision on this topic. E-Health Designs, LLC believes that until we have EMRs, CPRs, PHRs, and PHMTs which provide for some degree of built-in clinical decision support for clinicians and consumers, we won’t really attain “meaningful use’. We are headed in the right direction, though. Clearly the EHR needs to be more than just a file cabinet that collects text based information.  Per previous guidance from GartnerResearch, it would be advisable that the EHR move from a Collector to a Documentor, to an Assistant, Colleague, and Mentor for the clinician.  We need to collect or be able to produce structured clinical observations for use in decision support, and to facilitate biosurveillance and pharmacovigilance.

Full text of letter:

“Meaningful” Progress Toward Electronic Health Information Exchange

A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology

I recently reported on our announcement of State Health Information Technology Grants and grants to establish Health Information Technology Regional Extension Centers, as authorized under the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions of the American Recovery and Reinvestment Act of 2009 (the Recovery Act).

Today I want to discuss the important term “meaningful use” of electronic health records (EHRs) – both as a concept that underlies the movement toward an electronic health care environment and as a practical set of standards that will be issued as a proposed regulation by the end of 2009.

The HITECH Act provisions of the Recovery Act create a truly historic opportunity to transform our health system through unprecedented investments in the development of a nationwide electronic health information system. This system will ultimately help facilitate, inform, measure, and sustain improvements in the quality, efficiency, and safety of health care available to every American. Simply put, health professionals will be able to give better care, and their patients’ experience of care will improve, leading to better health outcomes overall.

As many of you are aware, the HITECH Act provides incentive payments to doctors and hospitals that adopt and meaningfully use health information technology. Eligible physicians, including those in solo or small practices, can receive up to $44,000 over five years under Medicare or $63,750 over six years under Medicaid for being meaningful users of certified electronic health records. Hospitals that become meaningful EHR users could receive up to four years of financial incentive payments under Medicare beginning in 2011, and up to six years of incentive payments under Medicaid beginning in October 2010.

The HITECH Act’s financial incentives demonstrate Congress’ and the Administration’s commitment to help those who want to improve their care delivery, and will serve as a catalyst to accelerate and smooth the path to HIT adoption by more individual providers and organizations. The dollars are tangible evidence of a national determination to bring health care into the 21st century.

The Office of the National Coordinator for Health Information Technology (ONC) is charged with coordinating nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. ONC is working with the Centers for Medicare & Medicaid Services (CMS), through an open and transparent process, on efforts to officially designate what constitutes “meaningful use.”

ONC has already engaged in a broad range of efforts to support the development of a formal definition of meaningful use. The HITECH Act designated a federal advisory committee, the HIT Policy Committee, with broad representation from major health care constituencies, to provide recommendations to ONC on meaningful use. The HIT Policy Committee has provided two sets of recommendations, informed by input from a variety of stakeholders. ONC and CMS have also conducted a series of listening sessions to solicit feedback from more than 200 representatives of various constituent groups and an open comment period where over 800 public comments were submitted and reviewed. The second set of recommendations on meaningful use was issued at a July 16 HIT Policy Committee meeting and details can be found at healthit.hhs.gov/policycommittee.

CMS is expected to publish a formal definition of meaningful use, for the purposes of receiving the Medicare and Medicaid incentive payments, by December 31, 2009. At that time, the public will be able to comment on the definition, and such comments will be considered in reaching any final definition of the term.

By focusing on “meaningful use,” we recognize that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care. Meaningful use of EHRs, we anticipate, will also enable providers to reduce the amount of time spent on duplicative paperwork and gain more time to spend with their patients throughout the day. It will lead us toward improvements and sustainability of our health care system that can only be attained with the help of a reliable and secure nationwide electronic health information system.

The concept of meaningful use is simple and inspiring, but we recognize that it becomes significantly more complex at a policy and regulatory level. As a result, we expect that any formal definition of “meaningful use” must include specific activities health care providers need to undertake to qualify for incentives from the federal government.

Ultimately, we believe “meaningful use” should embody the goals of a transformed health system. Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety, and quality.

What’s next?

As stated above, the next step in our process is a notice of proposed rulemaking in late 2009 with a public comment period in early 2010. As this process unfolds, we will continue to talk and share experiences about transitioning to EHRs, and to help deepen understanding among physicians and hospitals about the use of EHRs. We will also present programs designed to help smooth the transition process, and identify activities physicians and hospitals can engage in now to promote adoption of EHRs. As efforts advance, we will turn our attention to other necessary supporting programs, some of which you will hear more about in the coming weeks, including defining what constitutes a “certified” EHR, which is one of the requirements to qualify for Medicare and Medicaid incentives.

In the meantime, what can providers do to move toward becoming “meaningful users” – even in the absence of a formal definition? Naturally, while understanding that the final definition will be adopted through a formal rulemaking process, it will be helpful to be as familiar as possible with the discussion of meaningful use criteria to date. (You will find that information posted athealthit.hhs.gov/meaningfuluse.)

Armed with an understanding of the discussion of meaningful use as it unfolds, providers can begin to consider how their own practices or organizations might be reshaped to enhance the efficiency and quality of care through the use of an electronic health record system. Be assured you will not be alone as you seek to adopt an EHR system. Through our recently announced collaborative HITECH grants programs and others to be initiated later this year, we will continue to support providers in moving forward. Additional details about the grants are also available in my previous update and at healthit.hhs.gov/HITECHgrants.

To some providers, particularly small or already stretched physician practices or small, rural hospitals, the path toward meaningful use may still seem arduous. To others, who would just prefer to stick with the “status quo,” it may seem like an unwanted intrusion. We believe that the time has come for coordinated action. The price of inaction – in adverse events, lost patient lives, delayed or improper treatments, unnecessary procedures, excessive costs, and so on – is just too high, and will only get worse.

There is much at stake and much to do. We must relieve the crushing burden of health care costs in this country by improving efficiency, and assuring the highest level of patient care and safety regardless of geography or demographics. By using current technologies in a meaningful way, as well as technology to be developed in the future, we will take great strides toward solving some of the most vexing problems facing our health care system and creating a new platform for innovative solutions to health care.

I look forward to providing periodic updates, and to continued interactions with all the communities that have so much to gain from this profound transformation.

Sincerely,

David Blumenthal, MD, MPP
National Coordinator for Health Information Technology
U.S. Department of Health and Human Services”

One CIO’s Journey In Selecting and Implementing an EMR

http://emr-journey.blogspot.com/

Follow the CIO of Children’s Hospital, Oakland, as he leads the selection and implementation of an EMR

Healthcare IT Effectivness

Dr. Bumenthal’s latest thoughts on the need for more research on the effectivness of healthcare IT. Unfortunately, its a catch 22. Many CEOs/CIOS won’t invest in healthcare IT until more solid ROI numbers are available; but until we place healthcare IT into production, its difficult to measure its impact on outcomes. Some effectiveness can be tested in the lab, and through Congressional Special Interest Projects and SBIRS overseen by U.S. Årmy TATRC and others.

http://www.fiercehealthit.com/story/blumenthal-more-research-needed-health-it-effectiveness/2009-09-21

EHR, EMR, PHR, PHMT, CPR, HIE, RHIO Confusion Reigns

Consumers and healthcare professionals remained confused about the meanings of healthcare information technology terms, despite HHS/ONC for Healthcare IT funding “official definitions” from the National Association for Healthcare IT.   It is important that all come to consensus on what is meant by the many healthcare information technology terms.

Standard definitions by the National Alliance for Health Information Technology (which recently ceased operations shortly after delivering its healthcare IT terminology report):

Electronic medical record: Information on a patient that can be created, gathered, managed and consulted by authorized clinicians and staff in one health care organization.

Electronic health record: Information on a patient that conforms to nationally recognized interoperability standards. It can be created, managed and consulted by authorized clinicians and staff across more than one group.

Personal health record: Information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources. It is controlled by the patient.

Health information exchange: Electronic movement of health information among organizations according to nationally recognized standards.

Health information organization: A body that oversees and governs the exchange of health information among organizations according to nationally recognized standards.

Regional health information organization: A body that brings together health care stakeholders within a defined geographic area and governs health information exchange among them to improve health and care.

See also http://healthit.hhs.gov/portal/server.pt?open=512&objID=1256&parentname=CommunityPage&parentid=8&mode=2&in_hi_userid=10741&cached=true

Back in 2005, Gartner defined the term EHR as the larger government led effort to consolidate all health information into a longitudinal health record.

Note that the Gartner Term, “Computerized Patient Record” (CPR) was not addressed by the HHS group.  Gartner defined CPRs as large hospital-based systems that integrate clinicals and financials.  Examples are Epic, Cerner, GE Centricity, Eclypsis, Meditech.  Gartner defined functionalites necessary for various generational levels of the CPR.

Other glossaries:

Personal Health Record (PHR) Confusion

Great article on confusion over the PHR Term. With the advent of the NHIN, HIE, Microsoft HealthVault, Google Health, and RelayHealth, along with traditional medical journals maintained by the patient. the PHR can mean many things to many people.

http://chilmarkresearch.com/2009/09/09/time-to-kill-the-phr-term-part-1/

http://chilmarkresearch.com/2009/09/10/time-to-kill-the-phr-term-part-2/

Nuance Dragon Naturally Speaking, Medical Demonstration with AHLTA, DOD Electronic Health Record

Demonstration of how clinicians can dictate into AHLTA, DOD’s Electronic Health Record, using Nuance Dragon Naturally Speaking, Medical, at the point of care to turn voice into text.

http://www.nuance.com/mhs/videos.asp

Nuance Dragon Naturally Speaking, Medical, can be used for front end speech recognition with just about any EHR, EMR, CPR, resulting in increased clinician satisfaction and increases in patient through-put in some cases.

Compare this with the early vision of the Electronic Health Record in this 1961 video:

http://www.youtube.com/watch?v=t-aiKlIc6uk

We are moving in the right direction, but it is taking a long time.

Its almost 2010, and many hospitals don’t even have the equivalent of the 1961 system!

Primer on RxNorm

http://www.clinicalarchitecture.com/rxnorm-basics—screen-cast/

15 minute video on RxNorm from ClinicalArchitecture.com

Critical for health information exchange and pharmacovigilance.

NHIN Connect Viability

Chilmark Research post on the viability of NHIN Connect.

Great summary of recent NHIN Connect Seminar attended by over 1200 individuals.

http://chilmarkresearch.com/2009/07/01/connect-health-info-exchange/

NHIN 2.0 Gateway Code Released

I recently attended an outstanding NHIN connect training conference, attended by over 1200 representatives from government, industry and academia.

I have worked with many of the key individuals in the companies in the HIE space.

The momentum for actually establishing the NHIN is high.

There are many new cutting edge technologies and standards involved.

The latest NHIN 2.0 code can be found at:  http://www.connectopensource.org/display/NHINR2/

Release+2.0+Home;jsessionid=C2640BB1D07CF4D900963717596B3BE2

If you need independent, objective advice or implementation assistance regarding the NHIN, please e-mail me or call.

Robert E. Connors, FACHE, PMP, CEO, E-Health Designs, LLC to attend NHIN Connect Training, 29 and 30 June 2009

Robert E. Connors, FACHE, PMP, CEO, E-Health Designs, LLC will attend NHIN Connect Training, 29 and 30 June 2009, and is available to meet with clients in the evenings.