Each Patient Counts: Massachusetts Medical Society Weblog

AMA: Proposed “Meaningful Use” EHR Timetable is Too Aggressive

The American Medical Association and 81 state and specialty medical societies told federal officials last week that proposed milestones for the physician installation of electronic health records is too aggressive because physicians “lack the necessary infrastructure, standards, and systems” to achieve the council’s proposed timetable.

The Massachusetts Medical Society was one of the state medical societies co-signing the letter.

The letter proposes a detailed alternate timetable that “is aimed at ensuring that the bar is not set too high or too low; one that is reasonable and ensures that all eligible physicians in all size practices and specialties are able to take advantage of the incentives specified” in the stimulus bill.

The letter states that the path to widespread use of EHRs should last several years. It also stated that specific check points should be met before moving from one implementation phase to the next. “This check point will help ensure not only physician readiness and the capacity of the system to meet these goals,” said the letter, “but will also help assure continued access to safe, quality care for patients.”

The federal stimulus bill signed into law earlier this year gives physicians up to $44,000 in Medicaid or Medicare incentives starting in 2012 if they can demonstrate a “meaningful use” of electronic health records. Physicians and hospitals have been awaiting the specific definition of “meaningful use” since then. The Health Information Technology Council, a new entity created by the stimulus bill, released its proposed timeline on June 16 and accepted comments through June 26.

The council will now review the comments and is expected to issue final standards by the end of the year.

AMA Federation letter

AMA Federation Proposed Timetable

State Seeking Input on How to Spend Health IT Funds

The Massachusetts Health Information Technology Council has scheduled five hearings to hear suggestions how it should implement electronic health records (EHRs) and health information exchanges (HIE) for physicians and hospitals across the state.

Depending on who's doing the estimating, Massachusetts will get between $40 million and $70 million over the next year from the federal stimulus bill to promote EHRs and HIEs. What should we spend it on? The council wants to hear suggestions.

The hearings will be held at five locations from April 13 to April 28.

April 13
6:00 – 8:00 pm
Massachusetts Medical Society
860 Winter St.
Waltham, MA

April 14
10:30 am – 12:30 pm
Baystate Educational Center (up to 75 people)
361 Whitney Avenue
Holyoke, MA

April 22
10:30 am – 12:30 pm
Plymouth South Middle School
488 Long Pond Rd
Plymouth

April 27
10:00 am – 12:00 pm Boston
1 Ashburton Place
21st floor, Conference Rooms 2 & 3
Boston
(This hearing will focus specifically on issues pertaining to public health)
 
April 28
10:00 am – 12:00 pm
Worcester City Hall
Levi Lincoln Chamber
455 Main Street
Worcester

Here are the questions that the council says it wants to explore:

1. What are the greatest barriers and challenges facing physicians and hospitals in implementing EHRs/HIEs that will qualify for Medicare and Medicaid incentive payments?
   Are there different types of barriers for Primary Care, Specialists or different specialties?
2. What implementation strategies should the Commonwealth pursue to assist hospitals, physicians, health centers, and others to qualify for federal incentive payments to adopt and implement Electronic Health Records (EHRs) with a Health Information Exchange (HIE)?
   Should we prioritize by provider types?
   Should HIE be a high priority where there is substantial penetration of EHRs?
3. What types of financing strategies, should the Commonwealth consider to assist hospitals and physicians to implement EHRs and HIEs?
   How should the State prioritize using its limited funds?
4. What other kinds of assistance do physicians and hospitals require to adopt these technologies?
5. Under the Federal Stimulus bill, there are significant changes to the Privacy rules/HIPAA which create conflicts between HIE and privacy. How should information be exchanged or shared without compromising the security of the data, and the privacy of the patient?
6. What are the major challenges that Public Health Hospitals and community health centers will encounter and how can stimulus funds assist them?
7. How can the state best ensure that EHR/HIE implementation will enhance population health and allow local communities and the state to enhance public health reporting and surveillance?
8. What outcomes should the federal government and the state track to document the benefit of EHR/CPOE on health care quality?
9. What experiences have you had with EHRs or HIE? What lessons have you learned from this experience?  What lessons learned from North Adams, Newburyport and Brockton should the state take into account while developing and implementing a statewide plan?
10. What can the role of the state be to enhance the position of local HIT companies for a national role?
11. Does the availability of federal stimulus funding in the form of Medicaid/Medicare incentive payments change your views on the adoption and use of EHRs? Why or why not?
12. Have you already received assistance from a hospital, independent practice association, non profit or government organization in the implementation or use of an electronic health record? If so, has the assistance been effective?
13. What are the aspects of EHR/HIE that are most important to consumers? (e.g., patient portal, clinical decision support, privacy)
14. How can the private sector help to accelerate HIT implementation?

"Health Affairs" Tackles Health IT and Spotlights the Mass. eHealth Collaborative

The new edition of Health Affairs, published today, is called "Stimulating Health IT." It is devoted almost entirely to the challenge of implementing comprehensive health IT systems throughout the country.

It relies heavily on case studies of EHR pilot projects. In two articles of local interest, Massachusetts eHealth Collaborative Executive Director Micky Tripathi co-authors articles about the results of his nationally renowned program.

• In one article, Tripathi and the director of the Primary Care Information project in New York City, describe how they led successful efforts in their respective communities to implement broad-scale EHR adoption. The approaches contrast in many ways, but they share four broad lessons.
• The second article, written Tripathi and three associates at the eHealth Collaborative, outlines how they were able to persuade 90% of patients in their communities to voluntarily allow their personal health information to be added to the community's health information exchange, while being very upfront and forthcoming with the patients about the difficult issues of privacy and consent.

This entire issue of Health Affairs is worthy of careful reading. A subscription is needed to read the full text of most articles.

The Health IT Money: What’s Coming to Massachusetts?

The Massachusetts Medical Society has published an overview of how the new federal health IT funds could affect the Massachusetts health care system over the next five years. The complete picture will take many months to develop, but we can pass along some preliminary details.

The funding will come in two pools:

• A relatively small pool of loans and grants, directed mostly to states, colleges and state-designated agencies. It's believed that most of these loans and grants will be used to help develop regional health information exchanges, but other IT projects are eligible. A lot of this money will be available within the next year.
• A much larger pool of Medicare bonuses paid directly to qualifying physicians and hospitals after they install EHRs , starting in 2011 for up to five years.

The full analysis is available here, along with links to supporting documentation and other background information.