John at Chilmark Research posted a note about the importance of how ONC and HHS define the terms “meaningful use” and “certified EHR.” I wanted to echo his comment so here it is:

Note: We can not emphasize enough just how important these two terms (meaningful use & certified EHRs) are to the market. These terms will literally define the HIT market for the next decade and whether you are an HIT vendor or one looking to adopt an HIT solution, having a clear understanding of what these terms mean and their implications will be critical to your success.

Basically, the $36.3 million in EHR stimulus money is dependent on “meaningful use of certified EHRs.” That’s a lot of money and influence on two terms. I hope as many people as possible will participate in today’s HIT policy committee meeting which should work to define “certified EHR.”

Graham over at EMRUpdate found a really crazy bill being proposed in New Jersey that would make the use of non CCHIT certified EHR illegal.

Here’s the sections of the bill that seems to capture the crux of what’s being proposed:

“· On or after January 1, 2011, no person or entity is permitted to sell, offer for sale, give, furnish, or otherwise distribute to any person or entity in this State a health information technology product that has not been certified by CCHIT. A person or entity that violates this provision is liable to a civil penalty of not less than $1,000 for the first violation, not less than $2,500 for the second violation, and $5,000 for the third and each subsequent violation, to be collected pursuant to the “Penalty Enforcement Law of 1999,” P.L.1999, c.274 (C.2A:58-10 et seq.).

· The bill defines “health information technology product” to mean a system, program, application, or other product that is based upon technology which is used to electronically collect, store, retrieve, and transfer clinical, administrative, and financial health information.”
…
” 5. (New section) a. The Director of the Division of Consumer Affairs in the Department of Law and Public Safety, in consultation with the Office for e-HIT in the Department of Banking and Insurance and the Commissioner of Health and Senior Services, shall require that, on or after a date to be determined by the Office for e-HIT and in accordance with requirements established by that office pursuant to and in furtherance of the purposes of subparagraph (a) of paragraph (1) of subsection b. of section 8 of P.L.2007, c.330 (C.17:1D-1), each health care professional who is licensed or otherwise authorized, pursuant to Title 45 or Title 52 of the Revised Statutes, to practice a health care profession that is regulated by a professional and occupational licensing board within the division or by the director, shall purchase, rent, lease, or otherwise acquire for use in that person’s professional practice only those health information technology products that have been certified by the Certification Commission for Healthcare Information Technology.”

I’m really kind of speechless. If you read this blog regularly, you know that’s pretty rare. As Graham points out, why would they want to pre-empt whatever rules ONCHIT puts in place for EHR? I also wonder how they plan on enforcing this act. Plus, what is this senator really thinking? I think that each of these bills should require a full disclosure as to the impacts both good and bad and the reasoning behind even proposing such an idea. Reminds me a lot of the senator who called for an open source EMR, but this is much crazier.

Seriously, what’s the basis for this senator wanting to have it illegal for someone to use any EHR other than a CCHIT certified EHR? I’ve asked many times for some sort of study (independent hopefully) that shows that CCHIT certified EHR have a higher implementation success rate, or improve patient care, or save doctors time or any other benefit over the non CCHIT certified EHR out there. So far no one has produced such a finding. I’d suggest we haven’t found that study since the results of said study would find the opposite.

All I can say is that I’m glad that I don’t live in New Jersey and for their sake I hope this bill fails miserably.

A little while back, the Health Care blog has a pretty interesting post talking about how to define the term EHR. Normally, this debate would just be an academic debate which in the end nobody would really care about. You may remember my rant about EMR versus EHR which was really just me complaining the Google didn’t recognize both terms and send more traffic to my website (just being honest) along with me feeling like there’s little practical difference in the terms EMR and EHR(despite others disagreement).

Instead of EHR being basically a marketing tool for EMR vendors, the HITECH act’s use of the word “certified EHR” has made the meaning of this term rather important. Well, at least it’s important if you care about the $18 billion that they plan on spending on EHR software.

The above linked article suggested that ONCHIT should adopt the term “EHR technology” to replace the terms EMR and EHR. They suggested that the term would be defined as “An information technology tool, such as a software program or application, that is used to create, consume, manage or transport health data in electronic or digital form.”

This discussion reminds me of my previous post Hospital CIO’s take on CCHIT. In it, this hospital CIO suggests that a problem with CCHIT certification is that it assumes that only one program would provide all the needed EHR functionality. However, maybe the best implementation is a group of programs that are more effective than an individual EHR could accomplish.

What is becoming more clear to me is that the government really needs to start focusing on the results it wants to achieve as opposed to trying to prescribe what IT implementation will best achieve those results. Let’s leave the academics of defining EHR to the academics.

As I’ve been writing and reading about ARRA and the HITECH Act, I’ve had a few moments to consider the impact that things like the HIT Policy Committee will have on the future of EMR adoption in the US. Between that committee, ONCHIT and HHS the decisions they make will have far reaching impact on EHR adoption. I’ll leave the question of whether they’ll have a good or bad impact to another post.

Instead, I couldn’t help but wonder what impact bloggers and various EMR related websites and forums can have on EMR adoption. More specifically, I’ve been asking myself what kind of impact does this blog have on overall EMR adoption including both selection and implementation. Maybe I should be asking myself the question of how much impact could EMR bloggers have on influencing the HIT policy committee, ONCHIT and HHS, but I think that’s basically falling on deaf ears.

Instead, I think that bloggers like myself can have a real lasting impact on specific readers lives. Hopefully those who visit my blog get a better understanding of why they should implement an EMR. I hope they find some guidance on how to select an EMR and avoid various EMR sales miscommunication. At a minimum, I think the people who have bought the high volume scanners I suggested will be really glad they found this blog. I’m not sure why else people visit this blog.

Maybe this is all a little too personal, but I’d love to hear people’s thoughts on the impacts blogs and other EMR related resources have on EMR adoption. I’d like to think that blog like mine can have a good impact on the EMR world and aren’t just a nice place for those in the industry to sit around the virtual water cooler.

Either way, as I write future posts, I’ll be taking some of this into consideration. I think this will also give me a little bit of added motivation to complete a series of e-Books on EMR selection and EMR implementation. Hopefully those can provide some real targeted and valuable information to improve those two vital areas of EHR adoption.

John over at Chilmark Research has a really good find on his blog. He quotes the new head of ONC, David Blumenthal, from an article in the New England Journal of Medicine (NEJM) where Blumenthal talks about the certified EHR requirement in the HITECH act. Here’s the quote:

ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT.

I find it really interesting how two people can take the same quote different directions. Chilmark Research gives a nice little rant about how you can’t certify usability, quality and efficiency in an EHR. I agree with him on most points and I definitely agree that the market is much better at these three items than some government certification body.

However, I don’t feel like this was what Blumenthal meant in the above quote. I don’t think Blumenthal was trying to say that the certification would need to certify user-friendly, quality and efficient EHR software. Instead, I see the above quote meaning that the current CCHIT certification isn’t good enough, because it has certified a bunch of unusable EHR (a topic we’ve talked about many times before). Sounds to me that Blumenthal is making a case for why the government shouldn’t use the CCHIT certification. At least not in its current form. Essentially Blumenthal is saying that CCHIT isn’t good enough to meet the goals of HITECH.

This seems like a ray of hope for myself and others who think that selecting CCHIT certification as the certified EHR requirement of the HITECH act is the worst decision the government could make. Albeit still just a ray.

What Blumenthal means about “tightening the certification process” is up for debate. He could mean something like what John from Chilmark research describes. Basically some convoluted method of measuring usability, quality and efficiency of an EHR system. Or it could mean that the certification process will need to be tightened so that unneeded requirements are removed and it gets cut down to what will help an EHR achieve the ambitious goals of the HITECH act.

Of course, in the end the certified EHR criteria will probably land somewhere in between. However, this quote did give me some hope that Blumenthal realizes the impact that it will have on EHR adoption if many of the currently unusable certified EHR gain wide adoption thanks to the $18 billion in EHR stimulus money.

I do think John from Chilmark Research does make a nice conclusion to his post:

Suggesting that we tighten the certification process is heading in the wrong direction. Instead, we need to actually relax the certification process to encourage innovation in the HIT market allowing developers to create solutions that will truly provide value to their users while concurrently meeting the broader objectives of delivering better care and better outcomes. Creating light certification criteria and focusing more on what outcomes we wish to see occur as a result of broad HIT adoption is where Blumenthal and his staff need to focus their energies.

I’m always happy to have people smarter than me do a guest post on EMR and HIPAA.  There’s far too much going on with Health Care IT for me to be able to cover everything that’s going on.  So, I’d like to thank Randy Pickard for sending in the following guest post about the HITECH stimulus act.

There is almost a Kafkaesque quality to the likely short term impact of the stimulus package upon adoption of Electronic Health Records (EHR) systems. The passage of the stimulus package will probably serve as a speed bump to EHR adoption until the details of the act have been spelled out. Up until the passage of the stimulus package, adoption of EHR systems has been proceeding slowly but steadily. However, the vaguely defined promise of $17 billion in reimbursements for EHR if unknown criteria are met could result in gridlock among purchasers in the short term while they wait for finalization of the provisions of the stimulus package’s Health Information Technology for Economic and Clinical Health Act (HITECH Act).  

A quick glance at the income statements of four publicly traded vendors that receive a significant portion of their revenues from EHR systems provides an indication of steady revenue growth from EHR sales. Income has been increasing by 10% or more per year for these four vendors, Allscripts, Cerner Corp., Eclipse, and NextGen.  (Although the increases in income is not simply due to EHR related sales. Acquisitions of other vendors and sales of other software products has also contributed to the revenue totals).

It seems likely that the revenue for these firms from new EHR sales will be greatly reduced in the near term, as purchasers sit on their hands waiting for answers to questions about how they can obtain reimbursement for their EHR spending. The HITECH Act designated that reimbursement would only be provided if a certified EHR was implemented. However, the certification standard is to be developed by an office (ONCHIT) that has not been staffed yet, with a coordinator that has not been named yet by the Secretary of HHS, who has not been appointed yet. Further, the bill indicates that reimbursement will go to establishments that show “meaningful use” of health IT, an undefined description that will likely deter healthcare organizations from rushing to purchase an EHR system. Given that the details of the plan to stimulate the adoption of EHR’s are far from being flushed out, is it any wonder that the Congressional Budget Office has estimated that a mere 2.3 percent of the health IT funds would be distributed in fiscal years 2009 and 2010?

About the Author – Randy Pickard is Vice President of Product Innovation for User Centric, Inc. a user experience research firm. User Centric recently released EHR and PHR white papers: How to Select an Electronic Health Record System that Healthcare Professionals Can Use and Google Health vs. Microsoft HealthVault: Consumers Compare Online Personal Health Record (PHR) Applications

Thanks Randy! If you’re interested in doing a guest post, feel free to Contact EMR and HIPAA.

I predict that “meaningful EHR user” will become the most overused term in EHR and Healthcare IT adoption over the next year.  Since the term seems to be the cornerstone of receiving a part of the $20 billion EMR stimulus package, then I thought it might be a good idea to understand how HHS might define what a “meaningful EHR user” will need to do.

Luckily Patricia King, a health care attorney in Illinois, posted the criteria for being a meaningful EHR user on NetDoc as follows.

To be a “meaningful EHR user”, the physician must satisfy three criteria:

• The physician must use “certified EHR technology” in a meaningful manner, including electronic prescribing. The law calls for creation of a health information technology (HIT) Policy Committee, and an HIT Standards Committee. The HIT Policy Committee will focus on development of a nationwide health information infrastructure, while the HIT Standards Committee will recommend standards, implementation specifications and certification criteria. The Office of the National Coordinator for Health Information Technology (ONCHIT) is to adopt an initial set of standards, implementation specifications and certification criteria before December 31, 2009.
• The physician must demonstrate that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination.
• The physician must submit information on clinical quality measures specified by HHS.

Sound confusing enough?  Well, it’s going to be confusing until HHS is able to define what a certified EHR will look like (let’s all hope that it’s not synonymous with CCHIT certification) along with defining how the EHR should be able to exchange information.

I’ll be very interested to watch how HHS plans to implement these things.  I wonder if the frenetic pace that President Obama is basically requireing will end up being good or bad for health care IT and EHR adoption.

One thing we know for sure is that we’re in for an interesting ride.