FerrumIT Blog

As usual, there’s a burgeoning trend in technology and people in Northern California smell the money. “The push to implement electronic healthcare records could mean hundreds of millions of dollars pouring into Silicon Valley,” notes the Silicon Valley/San Jose Business Journal.

This time, though, the money won’t necessarily be going to all the high-tech companies that call the Bay Area home. At least not directly, and that’s where the math gets a little fuzzy. The Business Journal is referring to the federal stimulus dollars in the form of Medicare and Medicaid incentive payments for achieving “meaningful use” of EMRs, and as we’ve often reported, that cash may not add to a provider’s top line, just help offset some of the cost for the technology.

Still, the numbers appear staggering when extrapolated across a large organization. Stanford Hospital and Clinics CMIO Dr. Pravene Nath estimates that as many as 1,000 affiliated physicians could qualify for the extra reimbursements. At up to $44,000 per doctor, meaningful use could be worth as much as $44 million to Stanford physicians. And that doesn’t even include the hospital’s potential bonus of several million dollars. “We don’t yet know the exact amount the hospital could receive, but it’s enough money that it’s a huge incentive for us,” Nath is quoted as saying. “We absolutely intend to get it.”

We then run into yet another case of the non-healthcare media misunderstanding what’s truly going on when the Business Journal reporter brings up Lucille Packard Children’s Hospital, which is a Stanford facility. Pediatric providers, of course, don’t do a whole lot of Medicare business. “To address this problem, the federal government added a provision that allows hospitals such as Children’s Hospital to qualify if they demonstrate “meaningful use” of EHRs,” the publication erroneously reports.

“At Children’s Hospital, digitizing records and processes already has an impact on patient care. A system that allows physicians to make orders digitally was correlated with a 20 percent decrease in mortality rates at the hospital over an 18-month period,” the story says.

Meaningful use, as FierceEMR readers are keenly aware, applies to anyone seeking American Recovery and Reinvestment Act (not “Federal Recovery and Reinvestment Act,” as the Business Journal says) bonuses for EMR/EHR implementation. The difference for pediatric facilities is that their threshold for qualifying for Medicaid incentives is lower–they need 20 percent of their patients to be on Medicaid, vs. 30 percent for adult and general provider organizations. Either way, quality improvement matters.

The education process continues.

To read more–and do so at your own peril:
- see this story from the Silicon Valley/San Jose Business Journal (subscription req.)

Kudos to InformationWeek‘s Marianne Kolbasuk McGee for scoring a comprehensive interview with Dr. David Blumenthal, who’s been hard to pin down since he took the job as national health IT coordinator in April 2009. While Blumenthal is legally prohibited from discussing what’s going to be in the final rules for meaningful use until HHS actually issues the standards, he is happy to discuss physician adoption of EHRs, the penalties for non-compliance with meaningful use and the legislation that created the health IT subsidy program.

While Medicare and Medicaid penalties for not using EHRs don’t kick in until 2015, Blumenthal says it’s important for providers to get on board with meaningful use sooner rather than later. “In future stages of meaningful use, our goal is to make sure that information follows patients. Organizations that participate in the care of patients must support the gathering of information in ways that meet the full needs of patients regardless of where they get their care,” he tells McGee.

Blumenthal believes physicians will see the value of their practices plummet if they don’t adopt EHRs. Older doctors may have trouble selling their practices and will struggle to recruit younger doctors. “This new generation of physicians isn’t going to tolerate a paper world,” Blumenthal says.

And preparing for retirement should no longer be an excuse to resist technology, according to Blumenthal. “If you’re a 50- to 60-year-old physician, you’re in the prime of your professional career and your patient panel is expanding. You probably want to bring on a new partner-maybe two or three-so you’ll be recruiting. There’s a physician shortage, so what’s going to make your practice competitive?”

He also says that paper charts “are just not adequate” for reporting to Accountable Care Organizations unless practices continue to rely on claims data and incomplete documentation.

For more of Blumenthal’s remarks:
- read this Q&A in InformationWeek

Health IT adoption is gaining steam, but many have been unable to articulate the value of EMRs within their organizations and, significantly, to the public, a new report suggests. Still, people are optimistic about the future, but worry that the transition to ICD-10 coding and HIPAA 5010 transactions could slow momentum.

The “National Progress Report on eHealth,” supported by the Commonwealth Fund and released by the broad-based, nonprofit eHealth Initiative, is an update on a 2007 study meant to identify trends that have emerged since passage of the American Recovery and Reinvestment Act in February 2009. For the report, the eHealth Initiative surveyed more than 100 healthcare professionals in each of five focus areas: aligning incentives; engaging consumers; improving population health; managing privacy, security & confidentiality; and transforming care delivery.

“Contributors to the report found that, while considerable progress has been made over the past three years, challenges remain,” eHI CEO Jennifer Covich Bordenick says in a press release. “Coordinating public- and private-sector efforts, and communicating the true value of HIT and HIE to consumers will be critical as we move forward.”

Specifically, 61 percent of respondents said “significant” progress has been made in EMR and HIT adoption since 2007, but 55 percent disagreed with the statement that the value of health IT is clearly understood. In fact, two-thirds said that efforts to educate the public about EMRs and health information exchange have been ineffective, though nearly as many thought Regional Extension Centers and the related National Health Information Technology Research Center would be important to educating providers about the value of health IT.

For greater detail:
- read this TMCnet story
- see this eHealth Initiative press release
- view the full report (.pdf)

How do we know the rules for meaningful use will be out any day now? CMS has sent its regulatory language to the White House Office of Management and Budget for review, the final stage in the rulemaking process.

Health Data Management reports that OMB has received the regulations for meaningful use and the related final EHR certification criteria, the latter developed by the Office of the National Coordinator for Health Information Technology. Once OMB signs off, both rules will be released for viewing at the Federal Register Public Inspection Desk while they await official publication. HHS officials publicly released proposed criteria for meaningful use and an interim final rule on certification Dec. 30, but they were not published until Jan. 13.

With the rules at OMB, CMS can’t give an exact date for release, but the Medicare and Medicaid agency stands by its forecast of early summer, according to Health Data Management. CMS had slipped from its earlier targets of late spring, then the end of June. FierceEMR reported last week that the final rules will be out by July 14, which is next Wednesday.

For more:
- read this Health Data Management update

A new report from Frost and Sullivan has some high hopes for VoIP and SIP services. The research firm has painted another rosy picture where IP communications rule. The firm sees VoIP and SIP Trunking services beating the market downturn and instead build on their previous growth.

According to the research firm’s ’North American VoIP Access and SIP Trunking Services Markets’ report, the market earned revenues of $717.3 million in 2009, but it could reach $3.9 billion in 2016. While most enterprise systems currently run on PBX with gateways, the firm believes the move to SIP would be inevitable as companies upgrade and deploy more complete unified communications (UC) solutions.

For more:
- read the TMC article

Desktop and mobile VoIP software maker, CounterPath, has released a new version of its Bria softphone. The Bria 3.1 is being billed as the perfect softphone for replacing deskphones and integrating with new unified communications (UC) upgrades.

The Bria 3.1 is a secure standards-based softphone that include HD 1280x720p video calls. The upgrade sees an improved user interface (UI) and organization structure to make features easier to access. The Bria has also expanded its interoperability with equipment from major vendors like Alcatel-Lucent, Avaya, BroadSoft, Cisco, NEC and Nokia Siemens Networks as well as Asterisk-based telephony systems.

Another new feature coming to this latest upgrade is multiple account support. Users can now choose on the fly which account to use for voice, IM and HD calling.

For more:
- read the release

The FCC’s Local Telephone Competition report has announced some big news for the VoIP industry. IP communications is on the rise with 21 million end-users taking advantage of VoIP subscriptions from cable, traditional telcos or VoIP providers.

The report noted that there were 162 million wireline retail local telephone service connections as of the end of 2008. Of that figure, 141 million were traditional switched access lines while 21 million were VoIP subscribers. With numbers like that it seems VoIP still has a long way to go before it replaces all the telephones in the U.S., but with the FCC’s plans for the all-IP network, these numbers may be shifting more in the coming years.

For more:
- see the FCC release here
- read FierceTelecom’s take here

Hot on the heels of a Computer Sciences Corp. report telling private health insurers to get with the federal EMR and quality-reporting incentive program, the same consulting firm has issued a paper advising hospitals and doctors to start assessing whether their chosen systems will meet newly published rules governing EMR certification in the short term.

“Given that the process of certifying systems will start soon, providers should ask their vendors when they plan to apply for certification,” write Erica Drazen, managing partner of CSC’s Healthcare Group, and Jim D’Itri, a partner in the Falls Church, Va.-based company’s Healthcare Strategy and Operations Group. “Because meaningful use incentives require a currently certified system, and the requirements will increase in 2013, system purchases and implementation plans should consider current and expected future requirements,” they add.

“For example, bedside medication administration with bar code verification was not proposed as a Stage 1 requirement; however, it is almost certainly a future requirement for meaningful use incentives. Therefore, this capability should be included in any IT strategy or selection. Any vendor contracts should have provisions that include updates to meet future certification criteria as part of regular covered maintenance.”

Providers must use certified technology to earn Medicare and Medicaid bonus payments.

ONC two weeks ago issued final rules for a temporary program that will govern EMR certification through the end of 2011. Private entities, including the Certification Commission for Health Information Technology, must apply to be authorized certification bodies based on ONC’s testing criteria. National health IT coordinator Dr. David Blumenthal expects the first batch of certified EMRs to be ready by the fall.

For more:
- see this CSC “Update on Certification” issue brief (.pdf)
- take a look at this Healthcare IT News story

Many dates have been thrown around regarding when CMS plans to publish its final rule for meaningful use. This highly anticipated regulation, of course, will spell out how providers and organizations can become eligible for HITECH’s electronic health record incentive payments.

Some news outlets have reported that July 13 is the magic date. That sounds about right, give or take a few days. FierceEMR spoke with a CMS official directly involved in writing and publishing the final regulation, and she assures us that although there’s no “official” publication date (CMS missed its own self-imposed June 30 deadline), “I would be very surprised if it’s published any later than July 14.”

“We hoped to have it out by the end of June, but it’s looking more like mid-July,” the official told us this week. “There are so many moving parts and so many people are involved. This is a long regulation.” No doubt! The proposed rule was thicker than many novels. We expect nothing less from the final reg.

CMS also plans to unveil its plan for aligning its Physician Quality Reporting Initiative (PQRI) with the EHR incentive program in mid-July. “We propose to include many ARRA core clinical quality measures in the PQRI program, to demonstrate meaningful use of EHR and quality of care furnished to individuals,” CMS states in an advanced copy of the proposed reg, CMIO magazine reports. “We propose the selection of these measures to meet the requirements of planning the integration of PQRI and EHR reporting.”

For more information:
- read this Government Health IT article
- read the CMIO article
- bookmark the Federal Register’s Table of Contents, where the final rule will appear

About 32 percent of healthcare organizations already use some form of cloud computing, and 73 percent report that they plan to move more applications to the cloud, according to a study from consulting firm Accenture.

While healthcare trails most other sectors of the economy in terms of IT adoption, those numbers are in line with what Accenture found in other industries. In manufacturing, 32 percent said they currently were using cloud-based applications, compared to 35 percent in retail and 29 percent in education. Similarly, 75 percent of survey respondents in the technology and government sectors have plans to make greater use of cloud computing in the future.

“Cloud computing is a newer technology and compared to existing IT is newer and more cost advantageous,” particularly for small physician practices, Accenture senior research analyst Dadong Wan says in an interview with InformationWeek. The cloud offers the kinds of “economies of scale” that customers can’t get with in-house servers, according to Wan.

The Accenture analyst also says that security with cloud computing actually is tighter than what typical healthcare organizations might find within their own walls because vendors can’t afford to have vulnerable systems. “Cloud players’ livelihood is protecting data,” Wan explains.

IDC backs up Accenture’s findings by reporting that cloud computing in general will grow by 27 percent a year, generating $55 billion in revenue by 2014, compared to $16 billion today. IDC sees 5 percent growth for on-site IT services in that same time frame.

To learn more:
- check out this InformationWeek story
- see this news brief from EDL Consulting