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Private Payers Need to Join Humana, CMS With EHR Subsidies

Posted on June 30, 2011 I Written By

Ever since the American Recovery and Reinvestment Act became law in February 2009, giving birth to the phrase “meaningful use,” I’ve wondered when private insurers would follow the federal government’s lead and start offering financial carrots and sticks for using and not using EHRs. After all, one of the purposes of the Medicare and Medicaid incentive program was to address the fact that payers tend to reap the greatest financial gains from hospitals and physicians adopting EHRs, even though most if not all of the cost of acquiring the technology falls on the provider.

Federal officials have made it clear all along that “meaningful use” is just that, the meaningful use of the technology. The government was not simply going to write checks so providers could go out and buy technology. As the country’s largest purchaser of  healthcare services, CMS wanted some value for its money (not exactly something you hear every day when it comes to government spending).

I’d been hearing for years that major commercial health insurers also were willing to share some of the savings from EHR adoption, but not until the largest payer of them all, Medicare, did so first. The private sector usually does follow Medicare’s lead when it comes to major policy shifts. Medicare now has done so, but private payers have been mostly silent. Mostly.

This month, as InformationWeek reports, Humana teamed up with Allscripts Healthcare Solutions to offer physician practices financial incentives for purchasing Allscripts EHR systems. The deal is similar to one Humana cut last year with Athenahealth. A few Blue Cross and Blue Shield plans, notably in Massachusetts and Rhode Island, have led similar programs at the state level, with eClinicalWorks the main partner.

But unless I’m forgetting something, Humana is the only big payer that has jumped into the game. Where are the UnitedHealthcares, Aetnas, Cignas and WellPoints of the world?

Payers, it’s time to make good on the lip service you gave years ago and start passing on some of the savings you will realize from Medicare, Medicaid and hundreds of thousands of providers spending billions of dollars on EHR technology and health information exchange efforts.

 

Jim Tate’s EHR Incentive Roadmap Resource

Posted on June 29, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


HITECH Answers has just released the 3rd edition of Jim Tate’s The Incentive Roadmap® The Meaningful Use of Certified Technology: Stage 1 A Manual for Medical Practices. Version 3.0 of the manual that has been helping practices, consultants and vendors across the country understand the step-by-step process of achieving meaningful use is now available. Written by Jim Tate, a nationally recognized expert on the CMS EHR Incentive Program, certified technology and Meaningful Use objectives,The Incentive Roadmap® looks at what steps are needed to get ready for meaningful use and is downloaded immediately upon purchase.

I consider Jim Tate one of the foremost experts on meaningful use and certified EHR. So, I was excited when he decided to publish a resource on the details of the EHR incentive program.

In The Incentive Roadmap®, Jim Tate covers all of the details that you need to know if you’re considering participation in the EHR incentive program.

The first section is actually incredibly valuable since it covers who is eligible for the EHR incentive money and also includes a comparison of the various EHR incentive programs. Plus, it walks a clinic through the process of determining which program it is eligible for. Certainly many people have already gone through this process, but for the rest of you this is a great resource that will guide you through the EHR incentive options.

The next section of the The Incentive Roadmap® covers the details of the meaningful use criteria. This is the section that I think most people will be interested in having now. Certainly many of these details can be found on the CMS website and we’ve covered a lot of them in our Meaningful Use Monday series. However, if you want to get all of the meaningful use details in one place without all the legalese that CMS loves to provide, then check out the The Incentive Roadmap®.

I also love a later section of the The Incentive Roadmap® where Jim Tate provides some practical strategy advice on how a clinic should approach meaningful use.

I know I’ll be keeping my copy of The Incentive Roadmap® close by as a reference. It’s a lot easier to go through than the HHS/CMS/ONC websites.

EMR is the Health Care ERP

Posted on June 28, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I know I’ve written about ERP and EMR before, but the more I think about the EMR selection and implementation process, the more I see the same issues that are experienced with an ERP implementation.

The one issue that is a bit different about EMR versus ERP is that there are only a small handful of ERP vendors to choose from. However, we have 300-600 to choose from in the EMR world. That’s an important and challenging difference.

However, the similarities to ERP are many. One of the most striking is how the EMR like the ERP is something that’s going to be used and have an effect on the entire organization. As such, the need to manage the participation of multiple stakeholders is so key.

The key to a successful ERP implementation is to have a great project leader.  Someone who is great at working with various departments. They are great listeners who hear and understand each departments needs. Then, they have to be great at making the case for each depaartment’s needs.

The same is true for EMR. You need an EMR implementation champion who is great at listening to all areas of the clinic: nurses, doctors, front desk, billing, medical records, etc. Sometimes this can be done well by a physician lead, but is more likely to be a practice manager, IT support (if they have project management skills), or an outside consultant. 

It’s easy to underestimate the challenge of “herding sheep.” Done right, it can work very well. Done wrong and your clinic is likely going to have the opportunity to try again after the failed EMR implementation.

There are other comparisons worth considering, but this one was striking me today. I’ll be interested to hear stories and experiences from those who have implemented an EMR. Did you have a strong leader to help pacify the different stakeholders in your clinic? 

Meaningful Use Measures: Clinical Summaries – Meaningful Use Monday

Posted on June 27, 2011 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Meaningful Use Core Measure: Provide clinical summaries to patients for more than 50% of all office visits within 3 business days.

Exclusion: Any EP who has no office visits during the reporting period.

The clinical summary provides clinical information associated with a specific recent visit. (It does not encompass the entire patient chart.) This measure may appear daunting upon first reading of the requirements, but the guidance below should make it achievable. 

The clinical summary can be delivered by one of two means: electronic media, (e.g., patient portal, secure e-mail, CD or USB fob), or a printed copy. According to advice received from CMS, the easiest way for a physician to meet this measure is to employ a patient portal as the default option. Following each office visit, the EP (or staff) simply uploads the clinical summary to the portal and advises the patient how to access it there. It is only if the patient requests a paper copy that it has to be printed and handed to him or sent by FAX or mail.

Whether the patient accesses the portal or not, the EP will have satisfied the requirement. It is the availability of the clinical summary within the 3-day timeframe—not the patient’s actions—that counts.

As for the content of a clinical summary, the measure defines it to include a comprehensive amount of information, some of which goes beyond the basics typically captured in a digital chart, for example, topics discussed, date of next appointment, tests that should be scheduled with contact information, etc. However, the measure specifications go on to say that to be counted in the numerator of the measure, clinical summaries can be limited to information recorded in the EHR.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Did You Know?

Posted on June 26, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This is a great video that does a great job showing how big the world is, how fast technology is growing and a number of amazing perspectives about what’s going on in the world. I’d seen this video a while back, but Wes Kemp just emailed it to me again and it was great to be reminded of the amazing world we’re living in. I hope you’ll enjoy it as well:

Lots of Investment in Healthcare IT

Posted on June 24, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There’s been a ton of interesting news about investment in healthcare IT lately. Much of what I’m seeing is happening in the mobile health space. No doubt mobile health is a really exciting market right now and I think it’s also really exciting because the cost to develop a mobile health app these days is so low.

Here are some interesting investment groups, incubators, etc that are focusing on healthcare IT:
Healthbox – A leading venture capital firm and incubator for startup companies launched Healthbox to focus exclusively on the healthcare industry. They offer $50,000 in seed capital, along with standard incubator services (office, mentor/leaders, etc) and are based out of Chicago. The program will culminate in an investor’s day (I might have to get Neil Versel to attend the investor’s day).

Rock Health – Another startup seed-accelerator program that offers $20,000 along with mentorship and office space for 5 months. It just started this month in San Francisco and has connections to a lot of the major players in healthcare.

Blueprint Health – A startup accelerator based in New York City. It provides $20,000 of seed capital along with mentorship and a work environment to be able to build your idea. They’re initially planning for 10 companies.

Startup Health – This isn’t an investment vehicle yet, but I could see it becoming one very quickly. It’s part of the Startup America Partnership and has some big names like Time Warner Chairman and CEO, Steve Krein, Esther Dyson, and the founders of Health 2.0 Matthew Holt and Indu Subaiya.

I’m guessing that there are even more programs that I’m missing. I’d love to learn about others in the comments as well. Either way, it’s exciting to see all this investment happening in healthcare applications.

How Serious Is the Security Threat to Connected Medical Devices?

Posted on June 23, 2011 I Written By

I’m in New York City this week for the second Mobile Health Expo, which wrapped up Thursday afternoon. You may have seen the story I wrote for InformationWeek based on one session related to the security of networked medical devices.

Since I just do news and not commentary for InformationWeek, I figured EMR and HIPAA—specifically, the HIPAA part— was the perfect forum to discuss a small controversy that I may have stirred up with that story.

The two presenters from Indianapolis-based security firm eProtex talked about how connected medical devices have recently been popping up all over the place. “As little as two years ago, we checked some hospitals and found that there was less than one networked clinical device per bed,” eProtex Executive Director Earl Reber said.

With network connection and exposure to the Internet came heightened threats from viruses and malware, both internal and external, Reber and eProtex Chief Security Officer Derek Brost said. Sometimes it’s because devices are so old that they still run DOS and simply weren’t built for the HIPAA era. Other times, the greater reliance on various versions of Windows makes medical devices vulnerable to attacks.

Often, Brost said, hospitals are trying to protecting the wrong assets. “It’s not the actual medical device in most cases [that is at risk]. It’s the individual patient’s health information,” he said.

All this makes a lot of sense, though it is important to note that the warnings are coming from a security vendor with a real interest in selling products and services to prevent and combat insidious threats to medical equipment and other connected devices such as smartphones and tablets.

This was not lost on at least one person, “ZigZagZeke.” In a comment titled “Ignorance,” this poster said in no uncertain terms:

The speaker is using scare tactics to try to make sales of his protection software. Makers of such software are desperately trying to convince people that their Apple products need protection, because as more and more users switch to Apple, sales of anti-virus software are declining. This use of scare tactics is know by an acronym: FUD, which stands for “fear, uncertainty, and doubt.” It is the speaker’s only hope.

I suspect some of the criticism was directed at me for not differentiating between malware and viruses or between Linux/Unix/Macintosh and Windows.

Did I screw up here by not pressing the speakers on these differences, or are Apple devices and operating systems becoming just as vulnerable to data corruption as Windows? Windows became a prime target not just because of security holes, but because of its ubiquity. Now, the iPad and iPhone seem to rule at least the physician market. Wouldn’t that critical mass put Apple iOS in the crosshairs of a growing number of hackers and malware spreaders?

So what’s the real story here? As devices get connected to EMRs and hospital networks and produce more protected health information (PHI), should healthcare providers be concerned about greater HIPAA liability? If so, where should they focus prevention efforts?

CCHIT Has Become Irrelevant

Posted on June 22, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those of you that are relatively new to EMR and HIPAA, you might not appreciate this post as much as long time readers of EMR and HIPAA. A few years back, I admit that I was pretty harsh on CCHIT and their EHR certification. I remember one guy stopping me at a conference and after realizing who I was asked, “so what’s your issue with CCHIT?” I was happy to answer that I thought they misled the industry (doctors in particular) by saying that the CCHIT certification provided an assurance that the EHR was a good EHR. They never came outright and said this, but that’s what EMR sales people would communicate during the sales process.

In fact, EHR certification was incorrectly seen by many doctors and practice managers as the stamp of approval on an EHR being of higher quality, more effective, easier to use, and was more likely to lead to a successful EHR implementation. EHR certification today still has some of these issues. However, the fact is that the EHR certification doesn’t certify any of the great list above. If EHR certification of any kind (CCHIT or otherwise) could somehow assure: a higher implementation success rate, a better level of patient care, a higher quality user experience, a financial benefit, or any other number of quality benefits, then I’d support it wholeheartedly. The problem is that it doesn’t, and so they can’t make that assurance.

So, yes, I do take issue with an EHR certification which misleads doctors. Even if it’s the EHR salespeople that do the misleading.

I still remember the kickback I got on this post I did where I said CCHIT Was Marginalized and the post a bit later where I said that the CCHIT process was irrelevant. Today, I came across an article on CMIO with some interesting quotes from CCHIT Chair, Karen Bell. Here’s a quote from that article.

In addition, the Office of the National Coordinator for Health IT’s (ONC) new program has provided two new reasons for certification: proof that an EHR can do the things that the government wants it to do, and to enable eligible providers and hospitals to get EHR incentive money.

“The idea is not to assure the product will do all things that are desired for patient care, instead, the idea is to stimulate innovation,” said Bell. As a result, the program is considered a major success because more than 700 certified health IT products are now on the ONC website. “The idea was to get a lot of new products started. This is a very different reason for certification than what we began doing several years ago,” she said.

However, just because CCHIT or another ONC-Authorized Testing and Certification Body (ONC-ATCB) doesn’t test and certify for a particular ability, that doesn’t mean the EHRs don’t have it. “It’s just up to [the provider] to make sure the vendors have it,” said Bell.

I first want to applaud Karen Bell and CCHIT for finally describing the true description of what EHR provides a clinic assurance that:
1. The EHR does what the government wants
2. You are eligible for the EHR incentive money
Then, she even goes on to say that it’s up to the providers to make sure the vendors have the right capabilities for their clinic.

I imagine Karen and CCHIT would still probably say that the CCHIT “complete” EHR certification provides assurance that…< fill in the blank >, which the ONC-ATCB EHR certification doesn’t provide. The happy part for me is that even if CCHIT says this, no one is really listening to that message anymore.

Yes, CCHIT has essentially become irrelevant.

I can’t remember anyone in the past year asking me about CCHIT certification. From my experience, many people care about ONC-ATCB EHR certification, but they really couldn’t care less if it comes from CCHIT, Drummond Group, ICSA Labs, SLI Global, or InfoGuard (That’s all of them right?). Have any of you had other experiences?

I also do enjoy the irony of this post coming right after my post about differentiation of EMR companies (Jabba vs Han Solo). CCHIT is the reason that I know so much about the challenge of EHR differentiation. CCHIT’s efforts provided some very valuable (and lengthy) discussions over the past 5 years about ways to help doctors differentiate between the 300+ EHR vendors. As you can see from my comments above, I was just never satisfied with CCHIT being the differentiating factor. As you can see from my post yesterday, I’m still searching for a satisfactory alternative for differentiating EHRs. Until then, we’ll keep providing an independent voice a midst all the noise.

Exposing the Jabba the Hutt EHRs and Finding the Han Solo EHRs

Posted on June 21, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve had some interesting reactions to my post about the various characteristics of a Jabba the Hutt EHR Vendor. One of the more interesting conversations happened by email with a reader named Richard. Yes, I have lots of interesting back channel discussions.

After a lengthy email exchange, I asked Richard if I could post our discussion on the blog so you could participate as well. He agreed and even commented, “I look forward to an expansion of our discussion.” So, here you go (or at least scroll to the bottom for a short summary of my feelings).

The conversation started with this email that Richard sent me:

I understand your reluctance to name names in your article, BUT… this is exactly what is needed.

I’ve taken a few days to ruminate over what I was going to suggest and I’d like to hear your thoughts on this if you have time.

With your readership, I suspect there are plenty of users and observers of current packages and lots of opinions. Why not set up something like a Wiki-EMR site to provide a resource that will allow everyone to provide input into the details making “Jabba” and “Han Solo” EMR systems and see where it goes? Maybe it could eliminate some of the BS surrounding some of these systems and help others who are trying to sort out there own future needs. I’m sure there are plenty of people out there who want, need and are willing to provide information on the state and future of EMR and what is BS and what isn’t. I certainly would. Let me know your (or your readers) thoughts.

Richard

Here was my response:

Hi Richard,
Yes, this is something I’ve thought a lot about. The key question for me is how to publish some sort of “authenticated” information. Most systems are so easily gamed and/or abused that they basically have no worth. I haven’t figured out a scalable way to be able to provide information that is actual data and not provided with undue influence.

As I read your email, I wondered if some sort of combination of LinkedIn might be the key. At least then any review that’s done would be tied to an individual. Although, by doing so, you’d then discourage many of the most interesting reviews and feedback because their name would be explicitly tied to the review.

Along these same lines I’ve wondered how I could provide a “Meaningful EHR Certification” that wasn’t based on a pass/fail system that has no value. Instead it was a mixture of qualitative and quantitative data that would actually be of value to the reader. Scaling that up is the challenge I have with that idea. Not to mention figuring out the right financial model for it.

So, as you can see I’m with you on wanting more specific information out there, but not sure how to overcome the abuse and the scale that you need for it to be valuable.

As a side note, I do have a wiki page: http://emrandhipaa.com/wiki/Main_Page and it even has an EMR and EHR Matrix of companies. Although I closed registrations since spammers were getting into it.

Richard then provided this response:

It seems to me that user editing must be do-able if Wikipedia has found a way. Additionally, I think that unvarnished truth through comments creditable or not (but differentiateable ) would be a place for insiders or knowledgeable users and IT pros to vent. I realize that it is open to abuse, but a user moderated (or whatever Wikipedia uses) forum will turn upon such miscreants and their abuse might well backfire. I realize it is quite a project, but I’ll bet there are a handful of your readers, if not many more, that would gladly help put something this critical in place. If this can be pulled off, it might create “the world’s foremost authority” * in EMR.

I don’t know much at all about this, but I have a feeling that so much is riding on all of this and that there is a vacuum of useful, meaningful and understandable information that is needed to make this whole thing work. I know there must be something prescient sounding I could offer here, but it might be just indigestion that’s giving me this feeling. John, there must be some other smart guys around; try to round up some and see what they think.

Then I offered this response which shows I’ve been on Wikipedia far too much:

I’ve been rolling around something like this since I first started blogging about EMR. Wikipedia’s a bad comparison because it tries to formulate 1 truth instead of a series of opinions about something. Plus, Wikipedia relies on the masses of people (we don’t have enough mass) and even they get to a point where they regularly lock pages after abuse happens. Wikipedia’s a crazy community once you get into it. There are flame wars and battles on Wikipedia that rage in the background that most people don’t realize are happening.

Travel and hotel sites are a better comparison actually. Since reviews of hotels are more similar to a review of an EMR. The hotel owner wants to put the best reviews on there and can plant good reviews amongst many other ways to game the ratings and review systems. I read an interesting story about how Trip Advisor tried to deal with this. Unfortunately, it put on the image of successfully battling it, but didn’t do that well. Matters much less when you’re talking about a hotel versus an EMR.

I agree that it could become the authority on EMR software if it’s done right. Although, for me to do it, I have to find a model that’s authentic, honest, reliable, scalable and that makes sense economically. At least until I sell off a company for a few million. Then, maybe I can cut out the economical requirement.

Then Richard commented:

I didn’t realize that abuse was that rampant and that a fix was so difficult. I think I see some of the problems. You almost need a cadre of “fair witnesses” to explore the opinions and observations of users and provide incorruptible analysis. Not a promising outlook.

I’d be happy to assist this enterprise in any way I can, but don’t think I would bring anything very useful to the table. I feel you may be the right person to bring something like this to fruition, but the resources needed may be out of reach. It’s too bad there isn’t a Consumer Reports -like group out there for something like this. Maybe some group has enough vested in the outcome of shake-out to fund independent assessment and provide a forum for users.

I know very little about the technology involved in EMR, I am more aware of the medical business and needs for improvement in record and information management. Additionally, if cost containment can’t be managed and a “best practices” can’t be incorporated into every patient’s care then our society may be doomed economically (even morally). You’re doing something valuable, so keep it up, there must be a way to sort out the players and the technology so we can get on with the real need which is getting something useful and beneficial installed for quality patient care. Even getting this discussion broadened is worthwhile.

Well, there you go. If you made it through that, then you must really care about EHR and healthcare IT like I do.

In summary, I think it’s quite clear that it’s an incredible challenge for those searching for EHR software to find reliable information. The need for good EHR vendor information is extraordinary and no one has cornered that market…yet? There is no “consumer reports” for EHR software.

I haven’t yet identified a model that’s authentic, honest, reliable, scalable and that makes sense economically to deliver said “consumer reports for EHR software.” (or maybe I’m just too lazy, scared, busy, etc to try)

I do think that this site and the other members of the Healthcare Scene blog network provide a valuable independent resource for those selecting and implementing an EMR. My free EHR selection e-book was one effort to help providers in the EHR selection process in a very targeted way.

Are there other things that I (we) could do to help even more? I’m sure. If you have ideas, I’m interested to hear. You see my off the top of my head criteria above.

If nothing else, we can reach Richard’s goal of “broadening the discussion”

Clearing the Air on the Smoking Measures – Meaningful Use Monday

Posted on June 20, 2011 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

Smoking is a major and costly health problem. Because it is such a high priority for CMS, smoking is addressed in the Stage 1 meaningful use requirements by three distinct measures, which has caused a fair amount of confusion. I will try to clarify.

The first is a core meaningful use measure. Therefore, every eligible professional (EP) must satisfy this requirement, unless they can attest to meeting the exclusion.

Core Meaningful Use Measure: Record Smoking Status

More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data.

Exclusion: Any EP who sees no patients 13 years or older.

Description:

  • Smoking status must be recorded as one of the following 6 categories: current every day smoker; current some day smoker; former smoker; never smoker; smoker, current status unknown; unknown if ever smoked.
  • The information does not have to be updated at every visit—it simply has to be in the patient’s record, (i.e., no need to ask a non-smoker whether he has taken up the habit yet!)

The other two smoking-related measures are clinical quality measures. There is a different minimum age for the patient population—18, as opposed to 13—and these measures encompass tobacco use in addition to smoking. EPs must report on 6 CQMs—3 Core CQMs and 3 Additional CQMs. Like all CQMs (for Stage 1 meaningful use), neither of these measures have required thresholds that must be met.

The Core CQM (NQF 0028 – Preventive Care and Screening Measure Pair, defined below) must be reported by all providers—there are no exclusions, even if the EP’s EHR generates zero denominators for this measure. In that case, the EP reports zero and must also select and report on an alternate core CQM. This is a 2-part measure that assesses the intervention/treatment provided related to smoking cessation, e.g., counseling and/or medication, and it is based on a 2-year timeframe.

The Additional CQM: (NQF 0027 – Smoking and Tobacco Use Cessation, Medical Assistance, defined below) is one of the 38 Additional CQMs, from which EPs must select and report on three, so this measure is an option, not a requirement. It sounds a lot like NQF 0028 above, unless you read the extremely detailed measure specifications. (We’ll leave that responsibility to the EHR vendors, since the CQM data EPs report must be generated by the EHR!) The major difference is that this measure only involves advice and counseling—it does not ask about intervention—and it has a shorter measurement period than NQF 0028.

——

NQF 0028: Core Clinical Quality Measure: Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment, b. Tobacco Cessation Intervention

a) Percentage of patients aged 18 years and older who have been seen for at least 2 office visits who were queried about tobacco use one or more times with 24 months

b) Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months and have been seen for at least 2 office visits who received cessation intervention.

NQF 0027: Additional Clinical Quality measure: Smoking and Tobacco Use Cessation, Medical Assistance: a. Advising Smokers and Tobacco Users to Quit, b. Discussing Smoking and Tobacco Use Cessation Medications, c. Discussing Smoking and Tobacco Use Cessation Strategies

Percentage of patients 18 years of age or older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use, or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies.

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.