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ONC Health IT Dashboard – Meaningful Use Monday

Posted on October 1, 2012 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.

As many of you know, I’m spending this Monday traveling to the AHIMA conference in Chicago. It’s my first time to Chicago, but my second time to AHIMA. I have a full schedule of meetings and I’m really excited for the event. Also, we’re holding a tweetup Monday night if any readers are at the event or live in Chicago. Watch @ehrandhit and @HealthITMKTG for more details.

Since I’ll be traveling, I thought it would be fun to do a little bit of open source/crowd source style discussion on meaningful use. Instead of me pointing out the various aspects of meaningful use and other trends, I’m interested to hear your thoughts.

I’d also challenge readers to take a look at the ONC Health IT Dashboard. Browse through the data and then come back and share with us any interesting data that you find in the reports.

Leave your thoughts in the comments of this post, or if you’re too shy for that feel free to share your thoughts on the EMR and HIPAA contact us page. We always love hearing our readers perspectives. Anything is fair game. I look forward to reading your comments and responses.

A Fun (and Educational) Look at Privacy and Security – Meaningful Use Monday

Posted on September 24, 2012 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.

One of the most common sources of confusion about the meaningful use requirements is the Privacy and Security Risk Analysis measure. As I discussed in a past Meaningful Use Monday post, according to CMS, practices that are HIPAA compliant are likely in pretty good shape on this measure. For those physicians, what’s needed is documentation of the steps that were taken to review HIPAA compliance, the deficiencies identified, and what was done to remediate these exposures. (For more information, see the meaningful use chapter in ONC’s “Guide to Privacy and Security of Health Information.”)

This begs the question, “What exactly is HIPAA compliance?” I recently came upon the “Privacy and Security Training Game” that was created by ONC’s Chief Privacy Officer and couldn’t resist playing. While a lot of the information provided is quite basic for those with expertise in the privacy and security arena, as you progress through the game, the questions become more challenging. It’s definitely a fun way to introduce staff to the issues and increase awareness about the importance of safeguarding patient information.

Check out all of the past Meaningful Use Monday posts.

EHR Certification Results Published – Meaningful Use Monday

Posted on September 17, 2012 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.

We haven’t done many posts recently about EHR certification which is an integral part of getting to the Meaningful Use promised land. Although, when I read this post by EHR certification expert, Jim Tate, I thought it was worthy of pointing out and starting some discussion on the EHR certification requirements. Here’s a quote from the post that I found quite interesting:

Please allow me to report one final nuance to all this… A vendor can apply for 2011 Edition certification after 10/04/2012 but they will pay a price. They will be exposed to new ONC certification requirements: ”We also require that test results used for EHR technology certification be made publicly available” and “we require that ONC-ACBs ensure that EHR technology developers include in their marketing materials and communications notification to potential purchasers any additional types of costs that an EP, EH, or CAH would pay to implement their certified Complete EHR or certified EHR Module in order to attempt to meet MU objectives and measures”.

I find the idea that the ONC-ACBs have to publish the EHR certification test results quite interesting. What I’m not sure is whether this will really provide much value to those evaluating an EHR company. I know Jim Tate reads this blog and so hopefully he can chime in with any knowledge he has about the subject. Although, I wonder if the results that an ONC-ACB posts about an EHR will provide little value. Will the report essentially be a pass/fail report or will it provide more detailed information about what was found during the EHR certification process? Do we know what these reports will look like?

The later comment that requires an EHR company to disclose additional types of costs is quite intriguing. No doubt there are many EHR companies that have hid behind their hidden EHR costs in the past, so I love the requirement. I’m just not sure what enforcement mechanisms are available to ensure that EHR companies are following this requirement. Are their penalties for not doing this? Is there a reporting mechanism to report marketing that doesn’t follow this? As we all know, a rule without enforcement and penalties isn’t much of a rule at all.

Final Rule for Stage 2 Brings Some Changes to Stage 1 – Meaningful Use Monday

Posted on September 10, 2012 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.

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.

Although Stage 2 requirements don’t become effective until 2014, the Final Rule for Stage 2 contains some changes that apply—or can apply—to providers before then, and some that will apply to all physicians in 2014, even those still in Stage 1. These changes fall into 3 categories in terms of timing:  those that are effective in 2013, those that can be adopted in 2013 at the physician’s discretion, and those that are implemented in 2014.

Effective 2013:

  • Conducting a test of the EHR’s capability to exchange clinical information (Stage 1 Core Measure 14) will be dropped from the requirements. It will be replaced in Stage 2 by measures that require actual and ongoing exchange of information.
  • A new exclusion for the ePrescribing requirement is being added for physicians who have no pharmacy within 10 miles that accepts electronic prescriptions.

At Physician’s Discretion in 2013 (and required in 2014):

  • The Vital Signs measure will be restructured to separate the reporting of height and weight from the reporting of blood pressure. This is good news for those specialists who consider some, but not all 3 of the vital signs, relevant to their practice. Along with this change in the measure are revised minimum ages: blood pressure reporting will be required for patients age 3 and over instead of age 2, and height (or length) and weight will be required for all patients, even those under 2.
  • An alternate calculation for CPOE will help physicians—again, likely specialists—who do not prescribe frequently enough to meet the Stage 1 (30%) threshold. The denominator will be limited to “medication orders created by the EP during the EHR reporting period,” instead of “unique patients with at least one medication in their medication list.”

Effective 2014:

  • Currently, in Stage 1, if a provider attests to an exclusion for any menu measures, these measures can be counted towards the menu requirement. In Stage 2, this will no longer be true—excluded measures will not satisfy the menu requirement if there are other measures on which the provider could report instead. This will also apply to providers who are still reporting under Stage 1 in 2014—a change which those providers will likely perceive as inequitable since it did not apply to the earlier attesters. Those physicians who qualify for multiple exclusions—specialists, once again—will find that the menu set is really no longer a menu, as they will be left with few, if any, choices. 

So, while physicians do not have to focus on Stage 2 just yet, they should consider whether they might benefit from the 2013 changes described above.

Meaningful Use Stage 2 Final Rule: What You Need to Know—At Least For Now – Meaningful Use Monday

Posted on August 27, 2012 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.

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.

Without delving into all the specifics detailed in the 672-page Final Rule for Stage 2, what is important to comprehend—for now—is how Stage 2 raises the bar set by Stage 1 and how it intensifies the focus on health information exchange and patient engagement.

The following are some highlights of Stage 2:

  • The Final Rule not only confirms 2014 as the earliest effective date for Stage 2 (as expected), but it provides additional leeway for providers and for vendors by limiting the Stage 2 reporting period to 90 days in 2014, instead of a full year.
  • EPs must meet or exclude all 17 core measures and must meet—not “meet or exclude”—3 of the 6 menu measures. (Unlike Stage 1, exclusions of menu measures do not count unless the EP cannot find 3 relevant menu measures.)
  • All Stage 1 menu measures except syndromic surveillance become core measures.
  • 5 new menu measures have been added: access to imaging results, family history, progress notes, reporting to cancer registries, and reporting to specialized registries.
  • Stage 2 increases most Stage 1 thresholds.
  • CPOE is expanded to include lab and radiology orders, in addition to prescriptions.
  • Patient portals play an important role as a means of providing patients with access to their medical records. Physicians will have to ensure that at least 5% of the patients they see actually view, download or transmit their health information and that over 5% of the patients seen send them a secure e-mail message containing clinical information, (i.e., not just a request for an appointment.)
  • Clinical summaries of office visits must be available to patients within 1 day, instead of the 3-day timeframe in Stage 1.
  • The Stage 1 measure requiring a test of the ability to exchange clinical data with another provider has been dropped effective 2013, in favor of a more robust 2014 Stage 2 requirement for ongoing exchange of a significantly more extensive data set.
  • EPs will report on 9 of 64 clinical quality measures, and after the provider’s first incentive year, the CQM data must be submitted electronically, rather than by attestation.
  • In an effort to streamline the reporting process, Stage 2 offers opportunities for batch reporting by group practices and for consolidated CQM reporting for PQRS and meaningful use.
  • Penalties and hardship exemptions are defined, establishing October 1, 2014 as the latest date by which an EP can attest for the first time and avoid a 1% payment adjustment in 2015.

More information about Stage 2 will follow in future Meaningful Use Monday posts.

Planning for Stage 3 is Underway – Meaningful Use Monday

Posted on August 20, 2012 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.

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.

At the HIT Policy Committee’s meeting on August 1st, the Meaningful Use Workgroup presented its preliminary recommendations for meaningful use Stage 3. Giving plenty of advance warning regarding its intentions for Stage 3, the Policy Committee hopes to avoid the type of timing issues that led to the postponement of Stage 2. The committee plans to send its final recommendations to HHS by May 2013, well in advance of the earliest timeline for Stage 3—2016. In light of this schedule, the initial recommendations are being formulated before we know how Stage 2 will be finalized and before we can fully evaluate Stage 1. Hopefully, as the planning process advances, the committee will have the time to take into account the experience of participating providers. 

As outlined in the preliminary recommendations, Stage 3 would intensify Stage 2’s emphasis on interoperability and patient engagement and expand on care coordination, quality and safety, and population health. It would foster a new model of care that is team-based, outcome-oriented, and geared toward population management. To accomplish this, it would include—among other requirements —expansion of clinical decision support, including tracking of compliance; electronic management of referrals; and enabling patients to update or correct information that is in their chart. 

Lest you think that a plan for Stage 3 means that the end is now in sight, sit back and take a deep breath. The plan envisions a Stage 4!

Meaningful Use Infographic – Meaningful Use Monday

Posted on August 13, 2012 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.

It seems that everyone (including myself) love infographics. So, I was really glad to see that Greenway (Full Disclosure: They advertise on the site, but they didn’t ask me to post this. I found it on my own.) put together an Infographic with the Meaningful Use stats. They offer the following important details on the data for the meaningful use infographic:

  • Payment and registration statistics as of May 2012
  • Top Specialties participating in Medicare MU 2011
  • Meaningful Use attestations by Region 2011
  • Money available for Eligible Providers
  • Who is eligible to participate
  • Necessary steps to achieve Meaningful Use

How Should Locum Tenens Attest to Meaningful Use for the Medicaid EHR Incentive Program? – Meaningful Use Monday

Posted on August 6, 2012 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.


Jessica Shenfeld, Esq. is the founding partner at The Law Office of Jessica Shenfeld, a boutique law firm that caters to physicians’ legal needs. She is also CEO of EHR Incentive Help, Inc., which helps physicians satisfy the Meaningful Use criteria and apply for the Medicare/Medicaid EHR Incentive Program benefits. For more information, visit http://jessicashenfeld.com/healthcare-legal-services/ehr-incentive/.

A reader asked about the best way for a locum tenens to attest to Meaningful Use for the Medicaid EHR Incentive Program. As you may know, the phrase “locum tenens” is Latin for “place holder” or “substitute.” Locum tenentes physicians – like substitute teachers – may receive assignments that vary in length from a couple weeks to many months. As such, a locum tenens physician can work in multiple clinic/office locations over any given ninety-day period. This issue addressed below applies not only to locum tenens, but also to any doctor that works in multiple practice locations and wants to apply for the EHR Incentive Program as an individual eligible professional (EP). The reader’s question breaks down into two separate questions:
1. What location should the doctor use to demonstrate Meaningful Use?
2. What patient data should the doctor use to calculate the patient volume threshold – that at least 30% of the patients the EP treated were Medicaid patients?

The important point to remember is that doctors that work at more than one clinical practice site are NOT required to use data from all sites to support their demonstration of meaningful use and the patient volume threshold.

1. Meaningful Use: Under the Medicaid EHR Incentive Program, an EP must have at least 50% of their of their patient encounters during the EHR reporting period at a practice/location or practices/locations equipped with certified EHR technology capable of meeting all of the meaningful use objectives. In lay terms, that means that in order to receive the Medicaid EHR incentive, a doctor must have had a certified EHR system installed (either adopted, implemented, or upgraded) in at least half locations where they practiced over any 90-day period in the prior calendar year.

2. Patient Volume: In order to be eligible for the Medicaid EHR Incentive Program, at least 30% of an EP’s patients over that same 90-day reporting period must have been Medicaid patients. This calculation is called the “patient volume” calculation, and it may be calculated differently in each state. The answer that applies in New York is that EPs may choose one (or more) clinical practice sites in order to calculate their patient volume. While the calculation does not need to include all practice sites, at least one of the sites from which patient data is drawn must have certified EHR technology. In other words, if an EP practices in two locations, one with certified EHR technology and one without, the EP must include the patient volume from the site that includes the certified EHR technology. In this example, the EP has the choice as to whether he wants to include the patient volume from the site without certified EHR technology to calculate patient volume calculation.

Although the reader asked about the Medicaid EHR Incentive Program, a locum tenens can apply for the Medicare EHR Incentive Program using the framework outlined above with one exception: to establish Meaningful Use, at least half the practice sites where the locum tenens worked over a 90-day period in that same calendar year must have had a certified EHR system capable of meeting the Meaningful Use requirements. The patient volume analysis above applies to both Medicaid and Medicare.

MU Attestation Audits – Meaningful Use Monday

Posted on July 30, 2012 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.

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.

By definition, attestation is based on the honor system—that is, at least until you find yourself the subject of an audit. CMS has launched its anticipated program, and some physicians who have received an EHR incentive payment recently received a letter from the designated auditing firm, Figloiozzi and Company

Although there is no way to predict which physicians will be audited, providing the information requested should not be too onerous a task for those “lucky” ones who are tapped. Providers are being asked to show proof that they possess a certified EHR and to substantiate the data they reported for the core and menu measures—specifically, via “a report from their EHR system that ties to their attestation.” Since all certified EHRs generate an automated measure calculation report and a clinical quality measure report, that documentation should be readily accessible. It would not surprise me if they are also asked to provide documentation of the security and risk analysis that the practice conducted to ensure HIPAA compliance. For suggestions regarding the type of data to retain to support your attestation, see the Meaningful Use Monday post, MU Attestation: Save Your Documentation.

Based on material published by the auditors and by CMS on its EHR Incentives website, it does not seem that the audits will be so detailed as to require site visits or reviews at the patient chart-level. My sense is that CMS is looking to identify failures to comply with the major requirements—adopting and using a certified EHR to meet the meaningful use measures and reporting accurately on the data generated by that EHR. 

(If you have been audited and would like to share your experience, please post a comment.)

Multi-Site Providers Who Don’t Have Certified EHR in All Locations – Meaningful Use Monday

Posted on July 16, 2012 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.

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.

A reader asked how a physician meets meaningful use when some of his encounters occur at a nursing home where there is no certified EHR. Specifically, she wanted to know if the physician was expected to bring his own EHR (hardware and software) to the facility to document encounters there. The answer is “no”—he limits his reporting to encounters that take place in the clinic setting. 

A somewhat similar situation is faced by physicians who are affiliated with two (or more) different practices, where not all of the practices(s) are equipped with certified ambulatory EHR technology. In this case, the physician reports on the encounters where a certified EHR is available. The only caveat is that to be eligible for an EHR incentive, the physician must have at least 50% of his encounters at location(s) that do have a certified EHR.

If you have other questions you’d like answered about meaningful use or the EHR incentive money. Please send in your question on our contact us page.