Home Forums Discussions General Discussion HITECH, Meaningful Use and Incentives

OK, no comments on how difficult, stupid or whatever the incentive are. If we take that as a given, does anyone know when all of this starts?

When are we supposed to start following the Core and Menu sets? Is it January 1, 2011?

How will it work? Who will monitor it? Will we send in reports, etc.?

TIA for keeping it informational and not being critical of the process. There are plenty of other threads for that.

Please double check - after skimming 800 + pages- my gross understanding at this point is

1. all EMRs will have to be certified - this time by the ???-ONC - which begins sometime in Aug 2010.
2. Providers can "register" beginning Jan 2011
3. Awards will be based on meeting requirements for 90 days
4. Reporting (attestations) can begin as early as April 2011
5. Monetary awards can be distributed as early as May 2011

seems simple enough?

Gino

Thanks.

I also think you have until July 2011 to start using it to get the 2011 money. It will be interesting to see how they check this to assure you're meeting the requirements. It may simply be that we sign a letter saying we're doing it but rarely is the government that simple.

I upgrade to v5 this week for several reasons but one is to get my staff in the groove for eRX, entering meds to check interactions, and all that jazz.

Travis,

At first, when I saw the requirements it looked overwhelming. But, taking them one by one, especially the way they grade it: Will follow a disease state over time and show how it affects outcome. Need to do: Show this with one patient. (something like that)

As for the ability to electronically connect with other physicians, that's a little weird. I am looking at an easy way to do that. Technically, one could use DropBox, although I don't like the way you cannot actually delete information off there.

Travis,

ePrescribe is awesome. But, forget out interactions. I turned that off within an hour. Hell, it has Bactroban cream interacting with Bactroban ointment. I exaggerate (although I should check), but the yellow and red just overwhelms the senses. If you could choose warn at D level or warn at C level, it would be nice. Plus, you can't separate interactions from allergies so it is all or nothing. It's definitely an area that needs a huge improvement.

Odd Bert. I just posted a question about CCR and how to electronically communicate that with other docs. Not sure how to do it. I would suspect shipping it in an email as a big no-no. Giving a patient a CD with their health info also sounds a bit pricey and plus, as a consultant, I prefer to have all the info about the patient before the day of their appt so I can review it all and assure I have everything I need.

eRX checks will get annoying if it tells me everything on the planet. I'm waiting on SureScripts to send me whatever they send me to get eRX official.

Another thing. I'm reviewing the criteria and I realize that these are primary care issues through and through. I don't do immunizations, rarely do too much labwork, don't order preventive exams/tests, don't order a ton of medications, don't send patients preventive or f/u care reminders, don't even know what a clinical-decision support rule is.

The main 15 are reasonable and doable. The additional 10 that I have to pick 5 of are not a specialists use but I can do 5 of them just because v5 has the ability (not that I would need to do them)

Agreed, that I do not have to do that many, but only would to qualify. I read somewher (I thought) about different criteria for surgeons. Can't recall.

I honestly think it's the government's responsibility to come up with a way to communicate with other doctors. However, 3rd party programs such as Certified Mail would probably work since all of the correspondence stays on a secure server. I used to use it to meet HIPAA requirements, but too many doctors refused to use it.

As far s eRx, it should be rathe quick and seamless to get set up with SureScripts. If you aren't getting it set up, I would ping support and get someone to help. I did it that way, and I was set up in less than an hour.

I just read over a summary of the "Meaningful Use" hoops we will have to jump through in order to qualify.

http://healthcarereform.nejm.org?p=3732

Like others have said, some criteria are easy and some are not.

Much of the data, for example smoking status of patient, is already in my notes, but not in the required structured format.

I hope that Amazing Charts will phase in these criteria over the next 5 or so releases. It would be nice to go ahead and start working on codifying some of the data. It would also be nice if the program had an option (perhaps a checkbox in administrative options) that could be turned on to force me (or one of my staff members) to answer the smoking question during a patient visit if it is blank.

Lots of work ahead of us.

How are we going to get that smoking data in the right format in AC? Seems like these criteria begin to pigeonhole the EMR companies a bit. Now instead of an open box for social history with templates, we will probably have to click a drop down menu or click a button like the Allergies to have another box come up to pick out the smoking status. I guess it would be nice if we could just right click in the box and that would bring up our normal templates as well as an area with radio buttons like "Doesn't smoke", "Smokes 1ppd", "Smokes 2ppd", etc

Also, with the new requirements of a problem list being "structured data", does the "right click/template" use become useless in the Assessment area? Essentially, we have to enter the Problem through the Diagnosis box which adds it to the Problem List. This makes the right click templates useless.

What would be nice is to right click and use templates just like we do now. When you click on those templated items, the enter in the Assessment exactly like the Diagnosis list or Problem List.

I tried to format my templates exactly like AC puts the diagnosis in the assessment box but they don't register. Shucks

work in progress - i am looking at using the social history health maintenance/intervention options to capture smoking data. unfortunately it seems limited to "current smoker" or "former smoker" options only. These are structured and can be reported. MU requires >50% of pts > age 13 to have smoking status assessed. Knowing that in 3 months 20 people admitted to either smoking or having smoked is an incomplete numerator. I am looking for other ways to collect "no hxo smoking" - perhaps it is an easy programming fix?

gino

There is an ICD 9M code for "Tobacco Use" (several, actually), which could be used in the assessment section. This would be searchable, structured data.

That's a great idea. Thanks John.

I've found that access to data on AC is constrained. We are want to track lots of metrics for our care teams and using AC to do so is a work around at best. What we need is direct access to a read only copy of the dbase so that we can create our own reports. Anyone else having similar issues?

I was going to try to create an item in tracked data for the adolescent smoking info with a Y/N option. Problem is I still don't know how to access and manipulate that data.
Would like to use it for vanderbilt scores etc.

Great to see many of you at the recent AAFP and AAP shows.

Let me provide an update on where we are with meaningful use (MU) and ARRA/ONC certification, and our current plan for upcoming enhancements. We are currently working on adding all the required fields as well as incorporating this directly into the office flow that will allow easy addition of MU data data as one documents ones notes. This is slated for V5.2, and we expect to apply for certification this year so that all our practices will have more than enough time during 2011 (the first year of MU incentive payments). Keep in mind that a provider need only attest to using their EHR meaninfully, and only has to perform "meaningful use" for a total of 90 days in 2011.

The big picture of our upcoming releases are:

V5.1 (expected to be released to beta testing in the next week or so). This version has improved eRX refill ability (and is SureScripts certified), and should have our iPhone "AC On-Call" app to allow after-hours documentation of patient phone calls.

V5.2 - expected to be released by years end, and expected to be ARRA/HITECH certified for MU as well as the ability to generate reports to allow incentive payments (this version may be renamed V6 depending on certification requirements).

V6 - expected to be released early in 2011 and contain our Practice Managment ties for eligibility, direct clearinghouse connection, etc.

Also, our new website and payportal is in final testing, and expected within the next few weeks. With our upcoming price increase to $1995 per provider for an initial license and then $995 for annual maintenance, support and eRx thereafter), we felt it important to provide our existing users the means to purchase additional years at our current price. We will notify you before the price increase takes effect to ensure our existing users have the opportunity to pre-purchase maintenance/support before the price increases.

Sounds good.

I appreciate that.

Thanks ... looking forward to these.

Jon, what is a pay portal?

We are going to have a paient portal soon, which one works best with AC?

Can I volunteer to beta test?

Lois

RE: Deadline for meaningful use adoption

I saw in some hospital newsletter than meaningful use needed to be adopted 90 days before the governments fiscal year start of Oct 1, 2011. (this would be adoption by July 1, 2011)

I thought it was 90 days before end of calendar year 2011.

Anybody know about this?
...Ken

According to the CMS "Final Rule" summary:


So it would seem that the last day to begin the reporting period is October 3, 2011 (90 days prior to the end of calendar year 2011).

Also, from the timeline on the CMS EHR Incentive website, the last day for Eligible Providers (EPs) to register & attest for the 2011 Incentive payment is February 29, 2012.

The hospital newsletter may be referring to the EHR reporting period for hospitals, which follows the fiscal year 2011 (October 1, 2010 ? September 30, 2011).

This is from one of the Medicare fact sheets on Meaningful Use:
"For the first year for which an EP [eligible professional] applies for and receives an incentive payment, the EHR Reporting Period is 90 days for any continuous period beginning and ending within the year. For every year after the first payment year, the EHR reporting period is the entire year.
A Payment Year equals a Calendar Year (CY)."

So that seems to mean the deadline for adoption is 10/1/11 to get payment for 2011.

Must have just beat me to it, John.
At least we found the same answer.

Brilliant minds often come to the same conclusion!

Has anyone heard any news with respect to how the current political transformations in Congress might change funding of meaningful use?

"Healthcare IT is a nonpartisan issue," Allscripts Healthcare Solutions CEO [and Obama healthcare IT advisor] Glen Tullman told the Wall Street Journal Health Blog. Plus, as the Journal points out, Republican threats to repeal "healthcare reform" generally refer to this year's Patient Protection and Affordable Care Act. The estimated $27 billion in "meaningful use" incentives come from the American Recovery and Reinvestment Act, passed in 2009.
It's highly unlikely GOP leadership will try to roll back the HITECH portion of ARRA, said Politico healthcare reporter Jennifer Haberkorn, who spoke at a HIMSS press briefing last Friday. "It's not on the radar," she said, according to Healthcare IT News. "The attitude on [Capitol] Hill is that health IT funding is creating jobs."


http://www.fierceemr.com/story/alls...oll-back-hitech/2010-11-11#ixzz15A5LzfxU
Subscribe: http://www.fierceemr.com/signup?sourceform=Viral-Tynt-FierceEMR-FierceEMR


Of course, the cynics among us say we were never going to see the money in the first place....

Thank you for the information, Jon. It does sound encouraging. I imagine many of us have mixed feelings about whether the government should mandate (or incentivize) how medicine is practiced. Nevertheless, if best practices and preventive measures are appropriately encouraged in the right way, it is conceivable that quality of healthcare could improve (if we all learn from each other, as with this user board, for example) as costs are incrementally contained (appropriate primary care practices reducing to some extent the more expensive hospital procedures and costs). Of course, it remains to be seen whether governmental bureaucracy will ruin such idealistic hopes ...

Here is an update on where Amazing Charts is with regards to Practice Management and Meaningful Use:

Our Practice Management module is (mostly) on track for beta release in the first quarter of 2011. Many of our users have played a significant role in designing this full-featured billing program. The delay is due to new Federal requirements for EHRs, specifically the requirment that EHRs be ONC-ATCB (aka Meaningful Use) Certified. We have been working since July (when the final rules were completed by HHS) to add the dozens of new features and reporting tools necessary to receive certification.

Amazing Charts is 100% dedicated to achieving all stages of Meaningful Use Certification, as using an EHR that has this certification is one of the requirements to receive up to $44K in ARRA/HITECH stimulus money. Our built-in Meaningful Use Wizard will make collecting and submitting the required reports a (relatviely) easy task. Learn more about the stimulus money earmarked for providers on our website.

Last week we applied for Meaningful Use Certification testing, and we anticipate receiving this certification by years end (well before the last 90 days of 2011 discussed above). As always, Amazing Charts enhancements - including the Meaningful Use Certified version which will be V6.0 - are provided at no additional cost to clients who subscribe to our Guardian Angel Support & Maintenance service. (Don't forget the 12/1 price increase, so if you don't subscribe to our maintenance service, do so before the end of the month.)

Jon

Just my opinion but the price increase should come AFTER the certification. Practice Fusion looks very appealing now.
Joe

The cost of PF may be appealing, but I cannot imagine depending on the internet always being 100% reliable and fast. I would never go with a web-based EHR. And then there is the annoyance and screen space taken up with ads. I am surprised the price increase has not occurred long ago. The expense of certification must be quite significant.

I looked at Practice Fusion for a friend who was considering it. It is much less robust and creates a very basic note without more work.

IFF you pay to remove the adds, AC is cheaper after about 24 months.

If you keep the adds, of course, PF is cheaper. But it still is not as good as AC, IMHO