FerrumIT Blog

HHS has announced more than $100 million in grants to 10 states for health IT in order to improve care and efficiency for children who receive insurance through Medicaid and the Children’s Health Insurance Program (CHIP). Through multi-state collaborations, the money eventually will reach 18 states, the agency says.

Two of the grant recipients will develop a new pediatric EMR with the funding, while eight states will test a new set of quality measures specific to children’s health, according to HHS.

“These grants will test the most current theories of how to improve the quality of care delivered to children,” said Cindy Mann, director of the CMS Center for Medicaid and State Operations, says in a press release. “These awards will help create the foundation for a more responsive and effective national system of high quality healthcare for children.”

The money, to be awarded over a five-year period, is from the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), and not the American Recovery and Reinvestment Act.

For more information:
- see this HHS press release
- take a look at this Healthcare IT News story

We’ve been hearing for more than a month that some constituencies within HHS were interested in easing some of the requirements for meaningful use of EMRs. Now, the Health IT Policy Committee’s workgroup on meaningful use is recommending that the agency do exactly that.

As the proposed requirements now stand, physicians and hospitals will have to meet 25 different measures to earn federal subsidies for EMRs in 2011 and 2012. But the workgroup now is suggesting that CMS drop drop as many as six of those measures that some see as onerous. “You can do things that are easy to measure, and you want to make sure it’s done for some but not measures that force more manual labor,” workgroup co-chair Dr. George Hripcsak said at a meeting last week, Government Health IT reports.

The other co-chair, Dr. Paul Tang, said that other Policy Committee workgroups are considering additional changes to the current proposal. He did not elaborate. The committee will take the recommendations from its workgroups and submit any proposed revisions to HHS by March 1. HHS is taking public comments on meaningful use through mid-March, and will finalize its regulations in the spring.

For more information:
- see this Government Health IT story

Former national health IT coordinator Dr. David Brailer is “pretty impressed” with the proposed criteria for meaningful use of EMRs that HHS officials published Dec. 30.

According to Brailer, who now runs an investment fund in San Francisco, the proposal is an outgrowth of much of the work he did as the first head of the Office of the National Coordinator for Health Information Technology from 2004 to 2006. Then, ONC didn’t have much money, but it was able to convene standards-harmonization activities, fund creation of an EMR certification mechanism, test various means of health information exchange and provide some direction for health IT initiatives.

“The meaningful use criteria are highly consistent with what we did,” Brailer says in an interview with Healthcare IT News. “It feels right to me.” He says the plan is the result of the “hand of thoughtful policy” that is more substantive than symbolic.

Still, Brailer is critical of the decision by Congress to put the EMR incentive program in the broad, $787 billion American Recovery and Reinvestment Act, a bill that passed largely along party lines less than a month after President Obama took office. “It puts more risks on healthcare IT adoption than are necessary,” he says. Given its history of rolling back planned Medicare fee cuts year after year, Congress may later vote to delay or eliminate penalties for non-use of EMRs that are scheduled to take effect in 2015.

For more on Brailer’s views:
- see this Healthcare IT News story

All the pundits, vendors and interest groups have weighed in on the Dec. 30 proposal for “meaningful use” of EMRs, but what do the people who actually have to demonstrate meaningful use to earn Medicare bonus payments think?

According to a survey from Computer Sciences Corp., hospitals on average are about halfway toward meeting the proposed criteria, and only one-quarter of those queried have 70 percent of the requirements covered, suggesting that HHS and CMS may have set the bar too high. For hospitals, the program starts Oct. 1, 2010, the first year of federal fiscal year 2011. “A projection of our results to the U.S. distribution of hospitals by size indicates that our survey likely overstated readiness slightly,” CSC says in its survey report. The consulting firm interviewed executives at 58 hospitals nationwide last fall before CMS released its proposed rule, but after a federal advisory panel floated a preliminary plan.

Readiness appears high in the areas of privacy and security, according to CSC, though hospitals seem to be unclear about new, tighter HIPAA protections authorized by the American Recovery and Reinvestment Act. Respondents also seem to be lagging in their ability to report on compliance with quality measures. “Many hospitals report they have the required capabilities but they are not in active use. About two-thirds have assessed where their current systems have gaps that must be filled to achieve meaningful use,” the consulting firm reports.

To learn more:
- take a look at this NextGov story
- download the CSC report (.pdf)

With federal stimulus money–about $546 million funneled into state grants promoting health information exchange projects–illuminating the way, healthcare software vendors are evaluating their offerings to see how EMRs and health information exchanges can work together to create a true marketplace and business advantage.

Connecting EMRs through HIEs, which should help facilitate access to and retrieval of timely clinical data on patients, can cut back dramatically on expenses. A single-clinician practice, for example, could waste thousands of dollars a year dealing with referrals, consults, radiology and other orders alone. Integrating exchanges to be more than storage devices for clinical information could be a great step toward productivity and profit improvement across healthcare.

In this market, business advantage may mean acquisition. Lawson Software, for example, recently announced a $160 million deal to acquire Healthvision, a Dallas-based company providing integration and application technology and related services to hospitals and large healthcare organizations. MEDecision, a vendor of payer-centric care management technology, also plans to expand its HIE strategy this spring by unveiling new products related to its acquisition last year of HxTechnologies, a provider of HIE services.

The HIE market is heating up, according to Scott Storrer, MEDecision CEO. “We’re adding over a 100 employees to support that growth,” he says in an interview with Information Week.

To learn more:
- read this InformationWeek article

There are only three types of lies: Lies, damned lies and statistics. And in the spirit of Benjamin Disraeli (or Mark Twain or whoever actually originated that phrase) comes the annual National Ambulatory Medical Care Survey from the CDC, which estimates that 43.9 percent of office-based U.S. physicians used some form of EMR or EHR in 2009. That number, considered a preliminary estimate, is up slightly from 41.5 percent in 2008. Compare and contrast that to the less than 20 percent of physicians said to be EMR users in a highly publicized New England Journal of Medicine paper in 2008.

Breaking down the numbers leads to a little more sanity. About 20.5 percent of respondents say they had a basic system capable of recording patient demographics, problem lists, clinical notes, medication orders and of viewing test results. Just 6.3 percent had fully functional EMRs, with medical histories, electronic order entry, drug interaction checking, highlighting of abnormal readings and reminders for guideline-based interventions, the CDC says.

The CDC survey is based on self-reported data, so there is always the chance for bias. I guess we won’t know some real numbers until 2012, after a year of practices seeking Medicare and Medicaid bonuses for EMR use.

For more information:
- take a look at this Healthcare IT News story
- see this piece from CMIO
- read the CDC’s preliminary report (.pdf)

Just in time for the big push to make EMRs the norm in healthcare comes this wet blanket from Press Ganey Associates: Physician satisfaction with in-hospital EMRs is declining.

“Most negative physician comments about EMRs coalesce around two themes: They are difficult and time-consuming to use [layers of screens, multiple sign-ons, not intuitive so that it can take many minutes to do a task that previously took 30 seconds], and carry some negative implications for patient safety,” South Bend, Ind.-based Press Ganey, which tracks physician and patient satisfaction rates, reports.

According to the just-released 2009 Hospital Pulse Report: Physician Perspectives on American Hospitals, physicians say EMRs often lack a clear summary of care patients have received during current hospitalizations. Doctors also are frustrated with not being able to access test results and nursing documentation on the same system, and with the fact that medication lists often are historical rather than current. Still, most physicians surveyed believe EMR systems can be improved to provide them with what they need.

“Many, if not most, hospitals are just now implementing EMRs that the physicians have to use for order entry or to access information,” Christina Dempsey, Press Ganey’s senior vice president for patient flow, says. “The lower satisfaction may indeed simply be the learning curve associated with this new tool and may improve as physicians become more accustomed to the technology and the technology is updated and adapted to meet physicians’ concerns.”

To learn more:
- read the Press Ganey report (.pdf)
- take a look at this Press Ganey press release

Just days after announcing that vendor satisfaction for ambulatory EMRs dropped in 2009, KLAS Enterprises reports that emergency departments are starting to favor a single-vendor over the best-of-breed strategy when it comes to ED information systems.

Among organizations looking to replace their current EDIS, 72 percent of the more than 500 respondents plan to dump a best-of-breed installation for an enterprise product. That’s more than twice what the rate was in a 2005 KLAS survey. But the new report also says customers of enterprise systems from Cerner, Eclipsys, McKesson and Meditech are disappointed with what they have, citing problems with functionality for clinicians.

“With the exception of Epic, EDIS solutions from the large enterprise vendors consistently score well below the KLAS average for software satisfaction–while five of the top six rated offerings are best-of-breed products,” study author Steve VanWagenen says, according to Healthcare IT News. “That gap underscores the challenge many CIOs face in choosing between an ED solution that’s an extension of the EMR versus a product more tailored to the needs of clinicians.”

To learn more:
- read this Healthcare IT News story
- order the KLAS report