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EHR Certification Flexibility Final Rule Commentary and Analysis

Posted on September 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

The news came out late on Friday that the EHR Certification flexibility was published as a final rule. I covered my initial take on the EHR Certification Flexibility on Hospital EMR and EHR. I’ve now had a chance to dig through the delicious 90 pages of government rule making and comments that make up the final rule. For those following along at home, you can skip to page 10 of the document to start the fun read. Although, I’ll also direct you to specific sections that might be of interest to you below.

In this post, I’ll just cover the EHR certification flexibility. You can see the meaningful use extension and delay timelines here. Here’s the important chart when talking about the EHR Certification flexibility (CMS Calls it CEHRT):
2014 EHR Certification Flexibility - CEHRT

The EHR Certification flexibility has a number of major talking points:

  • What Does “unable to fully implement” and “2014 Edition CEHRT availability delays” mean?
  • Fairness of EHR Certification Flexibility
  • 90 Day Reporting Period in 2015 Instead of 365 Days
  • Future Audits

What Does “unable to fully implement” and “2014 Edition CEHRT availability delays” mean?
On page 62 of the rule is the best description of the rule’s intent. It says that if you want to take advantage of this EHR flexibility, then they (Eligible providers or hospitals) “must attest that they are unable to fully implement 2014 Edition CEHRT because of issues related to 2014 Edition CEHRT availability delays when they attest to the meaningful use objectives and measures.” This basically covers the asterisk in the chart above.

This piece of the rule was so unclear that CMS in the final rule used 12 pages (pg. 36-48) to describe when this rule would apply and when it would not apply. CMS tried to make this apply as broadly as possible, but I think they also wanted to encourage as many organizations as possible to not use the exception.

My short summary of these 12 pages is: If you have the 2014 Certified EHR software and can attest to meaningful use stage 2, then you better go ahead and do it. Trying to find a loophole that allows you to avoid meaningful use stage 2 and just do MU stage 1 puts you at risk during a future meaningful use audit.

Of course, if you’re EHR vendor hasn’t provided you the proper software/updates/training, etc that you require to attest to meaningful use stage 2, then this rule will apply. CMS’ intent seems pretty clear. If you can attest to meaningful use stage 2, then you should. However, if your EHR vendor prevents you from being able to attest, then they don’t want to hold the providers accountable for the EHR vendors failure. Although, CMS notes multiple times in the final rule that they don’t want to point blame at the EHR vendors since it could have been other outside issues (ie. final rule was late, ONC-ACB’s were backlogged, etc) that caused the EHR vendors to not be ready.

I wonder if one of the unintended side effects of this rule will be EHR vendors taking their sweet time releasing and rolling out their 2014 Certified EHR product and updates. It’s too late for this in the hospital setting since hospitals have to do a full year of MU 2 on a 2014 Certified EHR starting October 1, 2014. However, the same might not be true on the ambulatory side where they have until the end of the year to start on meaningful use stage 2.

I’ll be interested to see how many organizations are able to take advantage of this delay. Had this rule been finalized in early 2014, it would be a very different story. However, at this late date, I’m not sure that many providers or hospitals will be able to change course.

I mostly feel bad for those organizations that rushed their EHR implementations onto barely-beta-tested 2014 Certified EHR software and will now have no choice but to go forward with meaningful use stage 2. This change in rule makes many of these organizations wish they’d slowed their implementation to make sure they’d done it right and they’d have also only been required to do MU stage 1.

Fairness of EHR Certification Flexibility
The last paragraph above highlights part of the reason why many providers feel that this EHR certification flexibility is unfair. While it’s not a direct penalty on organizations that were on top of things, the change rewards those organizations that didn’t take the risks, push their EHR vendors, and push their implementation timelines to meet the MU stage 2 requirements. The reward an organization gets for going after MU stage 2 is that they have to do a lot more work (Yes, MU2 is A LOT more work) while their procrastinating competitors get to do the much simpler MU1.

This was such an important complaint that CMS addressed these comments in two different places in the final rule (pg. 21-22 and pg. 48-50). CMS tries to argue that in their research they didn’t see providers that were deliberately trying to delay MU stage 2, but found that providers wanted to do MU stage 2, but their EHR vendors weren’t ready. I’d suggest that CMS may want to dig a little deeper.

However, let’s set providers aside for now and assume that they all want to do MU stage 2, but their EHR vendors just aren’t ready for it. This EHR certification flexibility still lets EHR vendors who procrastinated their 2014 EHR certification off the hook. In fact, it rewards them and their users for not performing well. Once again, CMS doesn’t want to point the finger at EHR vendors, but will blame themselves for not finalizing the rule fast enough and ONC-ACB’s for having a backlog. However, if you’re an EHR vendor who’s been 2014 Certified for a while now, no doubt this rule makes you angry since it rewards your competitors in a big way (intended or otherwise).

Certainly there are a lot of reasons why an EHR vendor isn’t yet ready to be 2014 Certified. However, most of them have little to do with the rule making process and the EHR certification backlog. Some freely admit it, and others hide behind excuses. I think CMS realized this EHR Certification flexibility would benefit these EHR vendors, but they didn’t want to punish the providers who use these EHR software.

I still think the simple solution here was to extend this same flexibility to all providers and all EHR vendors. However, in the final rule CMS argues that doing so would reduced the amount of meaningful use stage 2 data that they’d have available to make the adjustments needed to meaningful use stage 3. I understand how a provider doing MU stage 2 this year might feel like the government’s guinea pig. We need you to do MU stage 2 so we can figure out how to make it right in MU stage 3. CMS also argues that they need more people on meaningful use stage 2 in order to push their agenda and the intent of the HITECH act forward. What doesn’t seem aligned to me is the goals of meaningful use and providers’ goals. I think that’s why we see such a disconnect.

90 Day Reporting Period in 2015 Instead of 365 Days
This seems to be one of the most heated discussion points with the final rule. CHIME President and CEO, Russell P. Branzell, even suggested that “Now, the very future of Meaningful Use is in question.”

CMS’ comments about this (pg. 34-36) basically say that a change to the EHR reporting periods was not part of this proposed rule. Then, they offered this reason for why they’re not considering changes to the reporting periods:

We are not considering changes to the EHR reporting periods for 2015 or subsequent years in this final rule for the same reasons we are not considering changing the edition of CEHRT required for 2015 or subsequent years. Changes to the EHR reporting period would put the forward progress of the program at risk, and cause further delay in implementing effective health IT infrastructure. In addition, further changes to the reporting period would create further misalignment with the CMS quality reporting programs like PQRS and IQR, which would increase the reporting burden on providers and negatively impact quality reporting data integrity.

What this comment doesn’t seem to consider is what will happen if almost no organizations choose to attest to meaningful use because of the 365 day reporting period. Talk about killing the “forward progress” of the program. From a financial perspective, maybe that’s great for the MU program. CMS will pay out less incentive money and they’ll make back a bunch more money in the eventual penalties. However, it seems counter to the goal of increasing participation in the program. Personally, I’m not sure that the end of organization’s participation in meaningful use would be such a bad thing for healthcare. It would lead back to a more rationale EHR marketplace.

Future Audits
On page 55-56, the final rule addresses the concerns over audits. We can be sure that some organizations will be audited on whether they were “unable to fully implement 2014 Edition CEHRT because of issues related to 2014 Edition CEHRT availability delays.” Sadly, the final rule doesn’t give any details on what documentation you should keep to illustrate that you meet these requirements for which you will have to attest. The final rule just says that they’ll provide guidance to the auditors on this final rule and that audit determinations are finalized on a case by case basis that will cover the varied circumstances that will exist.

This wouldn’t give me much comfort if I was going through an audit. Not to mention comfort that the auditors wouldn’t interpret something differently. I’ll defer other audit advice to my auditor friends, since I’m not an audit expert. However, in this case you likely know how far you’re stretching the rule or not. That will likely determine how comfortable you’ll be if an audit comes your way. Now you can see why my advice is still, “If you have the 2014 Certified EHR software and can attest to meaningful use stage 2, then you better go ahead and do it.

Conclusion
I really see the meaningful use program on extremely shaky ground. I don’t think this final rule does much to relieve any of that pressure. In fact, in some ways it will solidify people’s bad feelings towards the program. We’ll see for sure how this plays out once we see the final numbers on how many organizations attest to meaningful use stage 2. I don’t think those numbers are going to be pretty and 2015 could even be worse.

Note: For those following along at home (or work), here’s the final rule that I reference above.

EHR Vendors Need to Expand Their Definition of Customer Service

Posted on July 21, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

Living in Las Vegas I likely have a skewed idea of what customer service means. In the tech world, we have Zappos headquarters in downtown Las Vegas. Most of you are likely familiar with Zappos unique approach to customer service. They really have taken customer service to the next level and created an entire company culture around the customer service they provide. The same could be said for the experience that the various casinos on the strip offer their customers. They do a really amazing job at most casinos providing an amazing customer service experience.

With this background, I find it really smart of Kareo to open an office in Las Vegas. Although, that’s not really the point of this post. Instead, I want to focus on the idea that most EHR vendors need expand their idea of customer service.

As I look at the world of EHR customer service I see so many organization lacking. Certainly we see examples of terrible EHR customer service that include calling into a call center in another country where the person doesn’t speak English and has no power to actually solve a user’s problems (Disclaimer: I don’t have a problem with call centers in other countries if they are well trained and can actually solve problems). Of course, the same thing can apply to a call center in the US who can’t solve the users’ actual problems. Both are terrible customer service and a problem in the industry. However, there’s a far more painful problem that I don’t think most EHR vendors consider a part of their customer service plan and 99% of EHR vendors have done terrible at this.

Adding new features and accommodating an EHR user’s feature request is just as much a part of the EHR customer service experience as the person who answers the phone. I can assure you that every EHR vendor out there would get rated an F the past few years when it comes to this form of EHR customer service. Why do I know this? I know this because every EHR vendor has been focused on meaningful use that they haven’t had the time to add any meaningful EHR user feature requests and features outside of meaningful use.

This isn’t EHR vendors’ fault. The end users have required it and EHR vendors have had to spend the time doing it. However, EHR customer service has suffered as a consequence. Don’t believe me. Look through all the EHR press releases that have been released over the past couple years. Find me the plethora of press releases that talk about the innovations that EHR vendors have created for their end users that aren’t related to meaningful use. I get the press releases and they’re MIA.

That’s not to say that EHR vendors have done nothing for end users. They’ve made some incremental progress on a few things, but meaningful use has zapped their development time. Stage 2 was even worse. I look forward to the new day where EHR vendors can focus on great customer service and EHR features and not just MU.

Patient Engagement vs. Patient Education: What’s the Difference?

Posted on June 3, 2014 I Written By

The following is a guest blog post by Jamie Verkamp, Chief Speaking Officer at (e)Merge.
Jamie Verkamp
Healthcare organizations often see attesting to the Measures included in Meaningful Use Stage 2 as a burdensome checklist which results in a massive resource drain in exchange for inadequate financial compensation. MU Stage 2 Measure 7 is one such oft-maligned requirement for attestation. This Measure requires that online access to records is provided to 50% of patients and that 5% of patients execute the viewing, download, or transmission of their online health information.  Organizations should not see Measures regarding patient engagement as intimidating or inconvenient. Instead, these Measures seeking to improve patient engagement should be seen as an opportunity to create more loyal, involved, and empowered patients.  The importance of engaging our patients in their own health shows itself in current statistics relating to personal health.  According to a study by TeleVox, roughly 83% of Americans don’t follow treatment plans as prescribed by their physicians.  Adding to that, 42% of Americans feel they would be more likely to follow their care plan if they received some form of motivation to participate.  By giving patients a channel to monitor and participate in their own health, organizations can develop a more educated population capable of producing greater outcomes.

Understanding the reasoning behind the Measures driving patient engagement is the first step; now, we must educate our patient population on the value of logging in and connecting with their information. While the frequency of patients physically visiting their provider’s office is somewhat inconsistent, this is often the most successful way to encourage electronic patient access. Patient facing staff members should be well educated on electronic patient access and be prepared to answer questions as they arise. Physically walking patients through the engagement process of maneuvering their electronic access, or providing video tutorials with simple instructions in the office lobby can increase patient engagement substantially. Consider setting up a station in the waiting room to allow patients to sign up for the service, thus solving the issue of forgotten motivation.

However, organizations must seek to include in their engagement plan the younger and healthier population who may not enter the physical office space outside of unforeseen emergency visits or more often than their annual checkup requires. Looking online to relate with these patients can be beneficial, as this has been found to be where this demographic spends the majority of their time and communication engaging with brands and services.  Providing information and education on an organization’s website, Facebook, Twitter, or even YouTube page through video promotion can assist in sparking an interest with this patient population.  Many times, those likely to engage in a patient engagement offering remain unaware of its availability due to a lack of communication from the healthcare organization.  From the practice standpoint, we must understand our work is not done once the portal is merely completed; rather this is when the real challenge presents itself.

In today’s society, consumers are bombarded with promotional emails and routinely asked for their contact information so further communication can be established.  With this in mind, consumers are more cautious as to what and how much information they provide to companies.  Unfortunately, for the healthcare industry, this includes a cautious nature toward information shared with healthcare organizations.   With this barrier in place, administrators must actively engage with their patients to educate them on the benefits of becoming involved in electronically managing their care.  Before consumers choose to willingly hand over their personal contact information, they will likely need to understand the reasons for doing so and what advantages they will receive.

Convenience has become one of the most desired aspects of communication and buying behaviors in consumers today.  As a society, we have adopted a “need it now” expectation.  With the ease portable technology has brought to our information search, patients and consumers count on service when they desire it.   This is especially true when it comes to customer service; consumers are becoming less patient and beginning to expect service when they desire.  In a recent study, it was found businesses offering a “Live Chat” option online saw a 15% increase in conversions. Explaining to patients the ease of communication with physicians and key staff members through the portal can be a helpful start in creating buy in.  Communication via the portal includes direct messaging, appointment reminders, and more. Informing patients of potential time saving factors in appointments down the road and quicker access to lab results can also establish and pique interest.  In many instances, finding the optimal moment to address the patient portal can create successful outcomes.  Patients burdened by numerous prescription refill requirements or those frustrated with waiting in line to pay a bill can be directed back to the convenience of a patient portal to handle all of these items at their own computer at home.

As a whole, those looking to meet this Stage 2 requirement must focus their attention on creating personalized communication with patients.  Standardized information will not entice patients and may easily be looked over.  Begin to examine which staff members may be the best fit for providing patient education and focus on educating patients on what they will get out of participating, not just simply meeting your Measure 7 requirements.   Potential touch points can be found within your signage, billing communications, appointment reminders and especially on your practice website and social sites.

According to HealthIT.gov, Meaningful Use Stage 3 will continue with the goal of driving patient engagement and improving outcomes.  This will include, “patient access to self-management tools”. The options for healthcare organizations are clear:

1. An organization can meet the bare minimum for the Stage 2 requirements using a patchwork of initiatives which produce minimally satisfying results while have no significant effect on the patient experience. Then repeat the entire process for the applicable Measures in Stage 3.

2. An organization can have a well-articulated and executable plan. In doing so, the practice, hospital or healthcare organization can commit to utilizing technology for the optimization of patient care, get a full return on investment from the Patient Portal, and simultaneously grow their business through the competitive advantage of a successful online presence. Initiating this push now will further develop readiness for Stage 3 as the implementation date approaches and with productive workflows in place, administrators can free themselves to focus on other Measures for attestation.

So which option will your organization choose? It’s not going to be easy, but change seldom is. Every industry experiences social and digital evolution, now it is healthcare’s turn.

About Jamie Verkamp
This article is a result of a partnership between (e)Merge, a medical growth consulting firm and DataFile Technologies, an outsourced medical records management and compliance company. Jamie Verkamp leads (e)Merge as Managing Partner and Chief Speaking Officer, she works shoulder to shoulder with medical professionals the healthcare industry to improve the patient experience and see measurable growth in clients‘ customer service efforts, referral volumes and bottom lines. DataFile Technologies is led by Janine Akers, CEO. DataFile’s passion for compliance allows them to be thought leaders in HIPAA interpretation while executing innovative medical records workflow solutions on behalf of their clients. Our companies produce white papers, speaking engagements, and videos to keep health professionals up to date on the latest industry topics.

Lack of Rec Support Cause of Meaningful Use Stage 2 Slowdown?

Posted on May 21, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

By now, I imagine that most of you have read about the meaningful use stage 2 delay and EHR certification flexibility. The details and interpretation are still going on, but it’s a big change to the current meaningful use program. Although, the biggest question I hear asked is if the change leaves enough time for organizations to change course. I think the rule has to be open for 60 days of comment before it becomes final. We’ll see if that leaves people enough time.

We’ll see if this change will provide some relief to a meaningful use program that I described as on the ropes. In response to that post, Deborah Sherl, BSN, RN, CHTS, CHPS, made an interesting comment on a possible cause of the meaningful use stage 2

@ John Lynn…. of course I am slightly biased on the topic of the rapid response & deployment of Stage 1 vs Stage 2. A great amount of Stage 1 success was ushered in with the amazing assistance of professional consultants across the country for those EPs & EHs that were willing to use us…. and we were called the Regional Extension Centers Health IT workforce.

Now that the federal grant is done (Feb.2014) Stage 2 implementations are possibly stalled not only by overburdened EMR vendors, but lack of project management forces that were provided by the RECS. Many RECs have built sustainable business models but are no longer “free” services as was perceived while under the HITECH grant.

I find this a very interesting hypothesis. I’m not sure that it accurately reflects why many organizations chose not to attest to MU stage 2, but it certainly didn’t help things. In fact, it adds one more log to the already burning fire. Think about what happens with MU stage 2. We’re going to pay them less incentive money, require them to do substantially more, and oh yeah…those “free” REC support resources are now gone too. Plus, your EHR vendor may or may not be ready either.

I think the changes to the EHR Certification requirements and delay of meaningful use stage 2 are good. Although, I’m hoping this is just the start of HHS blowing up meaningful use and making it dramatically simpler and more meaningful.

Healthcare Risks, Privacy Risks, and Blowing Up MU

Posted on May 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.


All of healthcare has risks. The key is getting a good grasp of all the risks. Are we doing that really well in healthcare IT and EHR?


I repeatedly find that most people are happy to give up some privacy risk for the potential for better health. This increases even more when someone is seriously sick. Privacy becomes even less important to them.


I always love to see tweets from someone I’ve never met or heard of tweeting out my articles. Tim did a good job summarizing my post about blowing up meaningful use. The post has gotten some good traction and a great discussion. I’m sure that they won’t take my exact approach, but I hope that it will help push ONC to move MU in a direction of extreme simplification.

Your EHR Vendor Isn’t Certified – How Should You Approach MU Stage 2?

Posted on May 12, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

A recent study conducted by Wells Fargo Securities stated “Over 700 EHR vendors had solutions certified for Stage 1, but at this point about 40 have been certified for Stage 2. While there is still time, we believe 300-500 vendors will ultimately disappear from the government program.”

We talked about the possibility of many EHR vendors not being 2014 certified in our interview with John Squire. This is a real possibility for many EHR vendors. It will be interesting to see which ones choose not to tell their customers that they won’t be ready until it’s too late to switch EHR. I think that will say something about the company.

Allscripts has put out a whitepaper that looks at some of the meaningful use stage 2 challenges and what you should do to make sure you’re ready.

  • Where to begin with Meaningful Use Stage 2
  • The new requirements for Stage 2 attestation
  • Technology upgrade and replacement considerations
  • Meaningful Use reporting
  • Transitioning to population health management

I find the idea of using MU stage 2 as a way to get ready for population health pretty interesting. I know this is a challenge when an organization is overwhelmed by the day to day life of someone in healthcare.

Considering the abysmal meaningful use stage 2 numbers that were released, it seems that many organizations could benefit from some meaningful use stage 2 help this whitepaper provides. I’d be interested to hear if people think that MU stage 2 does help their organization move towards population health management. Is that a reasonable goal you can work on as you work on MU stage 2? Reminds me of those who are doing CDI (clinical documentation improvement) projects alongside their ICD-10 work.

Did We Miss the Patient Engagement Opportunity with Meaningful Use?

Posted on May 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

One of the most controversial parts of meaningful use is the requirement that a certain percentage of patients engage with the office. The argument goes that the doctor shouldn’t be rewarded or punished based on the actions of someone (the patients) they don’t control. Regardless of the controversy, the requirement remains that doctors have to engage with a certain number of patients if they want to get the meaningful use money.

I’m personally a fan of patient engagement and think there’s a lot of value that will come from more engagement with patients. This reminds me of Dr. CT Lin’s presentation and research on patient engagement. We need to find more ways to make patient engagement an easy reality in healthcare.

The problem I keep running into with the meaningful use patient engagement requirement is that meaningful use requires a certified EHR to meet that requirement. There are a whole suite of patient engagement apps that provide a useful and logical engagement between doctor and patient. However, none of them can be used to meet the meaningful use patient engagement criteria. Yes, I know the patient engagement app could become modularly certified, but that’s really overkill for many of these apps. It really doesn’t make any sense for them to be certified. The software doesn’t get better (and an argument can be made that the software becomes worse) if they become modularly certified as an EHR.

Because of this issue, the requirement basically relegates EHR vendors to implement some sort of after thought (usually) patient portal. Then, the doctors have to try and force patients to use a patient portal just to meet a requirement. Plus, many are “gaming” this patient engagement number in the way a patient signs up and engages in the portal.

Wouldn’t it be so much better to allow the patient engagement to happen on a non-certified EHR? Why does this need to happen on a certified EHR? EHR vendors aren’t focused on patient engagement, and so it shouldn’t be a surprise that they’re not creating amazing patient engagement tools. Think about how much more effective the patient engagement would be if it happened on a software that was working and thinking every day about how they can make that engagement work for the patient and the provider.

I’d love to see ONC make an exception on this requirement that would allow patient engagement to occur on something other than the certified EHR. I imagine if they did this, they could even raise the bar when it comes to what percentage of patients they should engage with electronically. If they don’t, we’ll have a bunch of lame duck patient portals that are really only used to meet the MU requirement. What a terrible missed opportunity that would be.

Lack of 2014 Certified EHRs

Posted on April 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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 was asked recently by an EHR vendor about the disconnect between the number of 2011 Certified EHR and the number of 2014 Certified EHR. I haven’t looked through the ONC-CHPL site recently, but you can easily run the number of certified EHR vendors there. Of course, there’s a major difference in the number of 2011 certified EHR versus 2014 certified EHR. However, I don’t think it’s for the reason most people give.

Every EHR vendor that gets 2014 Certified likes to proclaim that they’re one of the few EHR vendors that was “able” to get 2014 Certified. They like to point to the vast number of EHR that haven’t bridged from being 2011 Certified to being 2014 Certified as a sign that their company is special because they were able to complete the “more advanced” certification. While no one would argue that the 2014 Certification takes a lot more work, I think it’s misleading for EHR companies to proclaim themselves victor because they’re “one of the few” EHR vendors to be 2014 Certified.

First of all, there are over 1000 2014 Certified EHR products on ONC-CPHL as of today and hundreds of them (223 to be exact – 29 inpatient and 194 ambulatory) are even certified as complete EHR. Plus, I’ve heard from EHR vendors and certifying bodies that there’s often a delay in ONC putting the certified EHR up on ONC-CPHL. So, how many more are 2014 Certified that aren’t on the list…yet.

Another issue with this number is that there is still time for EHR vendors to finish their 2014 EHR certification. Yes, we’re getting close, but no doubt we’ll see a wave of last minute EHR certifications from EHR vendors. It’s kind of like many of you reading this that are sitting on your taxes and we’ll have a rush of tax filings in the next few days. It’s not a perfect comparison since EHR certification is more complex and there are a limited number of EHR Certification slots from the ONC-ATCB’s, but be sure there are some waiting until the last minute.

It’s also worth considering that I saw one report that talked about the hundreds (or it might have been thousands) of 2011 Certified EHR that never actually had any doctors attest using their software. If none of your users actually attested using your EHR software, then would it make any business sense to go after the 2014 EHR certification? We can be sure those will drop out, but I expect that a large majority of these aren’t really “EHR” software in the true sense. They’re likely modularly certified and add-ons to EHR software.

To date, I only know of one EHR software that’s comes out and shunned 2014 Certified EHR status. I’m sure we’ll see more than just this one before the deadline, but my guess is that 90% of the market (ie. actual EHR users) already have 2014 Certified EHR software available to them and 99% of the market will have 2014 certified EHR available if they want by the deadline.

I don’t think 2014 EHR certification is going to be a differentiating factor for any of the major EHR players. All the major players realize that being 2014 Certified is essential to their livelihood and a cost of doing business.

Of course, the same can’t be said for doctors. There are plenty of ways for doctors to stay in business while shunning 2014 Certified EHR software and meaningful use stage 2. I’m still really interested to see how that plays out.

Eyes Wide Shut: Meaningful Use Stage 2 Incentive Program Hardships

Posted on March 5, 2014 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

In my January update on Meaningful Use Stage 2 readiness, I painted a dismal picture of a large IDN’s journey towards attestation, and expressed concern for patient safety resulting from the rush to implement and adopt what equates to, at best, beta-release health IT. Given the resounding cries for help from the healthcare provider community, including this February 2014 letter to HHS Secretary Kathleen Sebelius, I know my experience isn’t unique. So, when rumors ran rampant at HIMSS 2014 that CMS and the ONC would make a Meaningful Use announcement, I was hopeful that relief may be in sight.

Like AHA , I was disappointed in CMS Administrator Marilyn Tavenner’s announcement. The new Stage 2 hardship exemptions will now include an explicit criteria for “difficulty implementing 2014-certified EHR technology” – a claim which will be evaluated on a case-by-case basis, and may result in a delay of the penalty phase of the Stage 2 mandate. But it does nothing to extend the incentive phase of Stage 2 – without which, many healthcare providers would not have budgeted for participation in the program, at all, including the IDN profiled in this series. So how does this help providers like mine?

Quick update on my IDN’s progress towards Stage 2 attestation, with $MM in target incentive dollars at stake. We must meet ALL measures; there is no opportunity to defer one. The Transition of Care (both populating it appropriately, and transmitting it via Direct) is the primary point of concern.

The hospital EHR is ready to generate and transmit both Inpatient Summary and Transition of Care C-CDAs. The workflow to populate the ToC required data elements adds more than 4 minutes to the depart process, which will cause operational impacts. None of the ambulatory providers in the IDN have Direct, yet; there is no one available to receive an electronic ToC. Skilled resources to implement Direct with the EHR upgrades are not available until 6-12 weeks after each upgrade is complete.

None of the 3 remaining in-scope ambulatory EHRs have successfully completed their 2014 software upgrades. 2 of the 3 haven’t started their upgrades. 1 has not provided a DATE for the upgrade.

None of the ambulatory EHRs comes with a Clinical Summary C-CDA configured out-of-the-box. 1 creates a provider-facing Transition of Care C-CDA, but does not produce the patient-facing Clinical Summary. (How did this product become CEHRT for 2014 measures?) Once the C-CDA is configured, each EHR requires its own systems integrator to develop the interface to send the clinical document to an external system.

Consultant costs continue to mount, as each new wrinkle arises. And with each wrinkle, the ability to meet the incentive program deadlines, safely, diminishes.

Playing devil’s advocate, I’d say the IDN should have negotiated its vendor contracts to include penalty clauses sufficient to cover the losses of a missed incentive program deadline – or, worst case scenario, to cover the cost of a rip-and-replace should the EHR vendor not acquire certification, or have certification revoked. The terms and conditions should have covered every nuance of the functionality required for Stage 2 measures.

But wait, CMS is still clarifying its Stage 2 measures via FAQs. Can’t expect a vendor to build software to specifications that weren’t explicitly defined, or to sign a contract that requires adherence to unknown criteria.

So, what COULD CMS and the ONC do about it? How about finalizing your requirements BEFORE issuing measures and certification criteria? Since that ship’s already sailed, change the CEHRT certification process.

1. Require vendors to submit heuristics on both initial implementation and upgrades, indicating the typical timeline from kick-off to go-live, number of internal and external resources (i.e., third-party systems integrators), and cost.
2. Require vendors to submit customer-base profile detailing known customers planning to implement and/or upgrade within calendar year. AND require implementation/upgrade planning to incorporate 3 months of QA time post-implementation/upgrade, prior to go-live with real patients.
3. Require vendors to submit human resource strategy, and hiring and training program explicitly defined to support the customer-base profile submitted, with the typical timeframes and project resource/cost profiles submitted.
4. Require vendor products to be self-contained to achieve certification – meaning, no additional third-party purchase (software or professional services) would be necessary in order to implement and/or upgrade to the certified version and have all CMS-required functionality.
5. Require vendor products to prove the CEHRT-baseline functionality is available as configurable OOTB, not only available via customization. SHOW ME THE C-CDA, with all required data elements populated via workflow in the UI, not via some developer on the back-end in a carefully-orchestrated test patient demo script.
6. Require vendor products adhere to an SLA for max number of clicks required to execute the task. It is not Meaningful Use if it’s prohibitively challenging to access and use in a clinical setting.

Finally, CMS could redefine the incentive program parameters to include scenarios like mine. Despite the heroic efforts being made across the enterprise, this IDN is not likely to make it, with the fault squarely on the CEHRT vendors’ inability to deliver fully-functional products in a timely manner with skilled resources available to support the installation, configuration, and deployment. Morale will significantly decline, next year’s budget will be short the $MM that was slated for further health IT improvements, and the likelihood that it will continue with Stage 3 becomes negligible. Vendor lawsuits may ensue, and the incentive dollar targets may be recouped, but the cost incurred by the organization, its clinicians, and its patients is irrecoverable.

Consider applying the hardship exemption deadline extension to the incentive program participants.

Meaningful Use Playbook 2014: Overcoming Adversity – Breakaway Thinking

Posted on February 19, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
broncos
I apologize in advance, but I am still mourning the Super Bowl loss of the Denver Broncos. I can’t stop replaying each moment and thinking of alternative scenarios. What if Peyton Manning utilized a quick huddle instead of audibles and hand-signals? What if Denver’s defense had better protected Peyton? What if the Broncos had scored more than eight points?

Regardless of the what-ifs and wounds resulting from the loss, the team has to step up and prepare for the next season, if they want to finish at the top. In the healthcare world, providers must also change their playbook and approach, if they wish to capitalize on the next phase of Meaningful Use.

For the past year, providers have been scrambling to select, implement or optimize a new electronic health record system to meet federal requirements for Meaningful Use Stage 1. Adding to providers’ challenges is the evolving nature of the rules for achieving meaningful use incentives; federal agency Centers for Medicare and Medicaid Services (CMS) is constantly updating the Meaningful Use Playbook. Similar to football players at the end of the season, providers are tired and wounded. However, they must be aware of and prepare to take on the new requirements for 2014. Otherwise, they risk future penalties and foregoing funds. To help healthcare providers prepare for this new season, here is a summary of changes taking effect this year.

  • Three-month reporting period
    All providers are now required, regardless of their stage of meaningful use, to demonstrate meaningful use for a three-month EHR reporting period. Medicare providers may elect to report clinical quality measures (CQM) for the entire year or select an optional, three-month reporting period for CQMs that is identical to their meaningful use reporting.
  • Exclusions and vital sign objectives
    All eligible professionals, eligible hospitals and critical access hospitals are now responsible for adhering to the latest changes in Meaningful Use Stage 1. This includes new requirements for electing exclusions toward menu objectives, age limits for recording and charting changes to vital signs, and new exclusions toward reporting height, weight and blood pressure.
  • View, download and transmit all health information or admissions online
    To better align with the new capabilities of certified EHR technology, CMS is replacing Meaningful Use Stage 1 objectives for accessing information online with the capacity to view, download and transmit this information.
  • Reporting of clinical quality measures
    All providers, regardless of their stage of meaningful use, must report on clinical quality measures to CMS. Eligible hospitals must report 16 of the 29 CQMs and eligible providers must report 9 of the 64 CQMs.(Source)

For providers making the leap to Stage 2 of meaningful use, this is only the beginning. Not only must they abide to the changes mentioned above, but they also need to plan and execute a strategy for integrating diverse IT systems and engaging patients. Neither are simple tasks. However, just as I believe that Peyton can shake this last performance and finish strong next year, I believe in the resiliency of providers too. With the right leadership and planning, they will take patient care to the next level.

Omaha! Omaha! Omaha!
Carrie Yasemin Paykoc
Xerox is a sponsor of the Breakaway Thinking series of blog posts.