Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

5 Ways Your Certified EHR Can Help Boost Your MIPS Score

Posted on February 5, 2018 I Written By

The following is a guest blog post by Lisa Eramo, a regular contributor to Kareo’s Go Practice Blog.

How did you do in the first year of reporting under the Quality Payment Program? Are you expecting a negative payment adjustment under the Merit-based Incentive Payment System (MIPS)? Or did you only submit the minimum data necessary in 2017 to avoid this adjustment? The good news is that you can get on track to report critical MIPS measures in 2018 that will safeguard and perhaps even enhance your revenue in 2020 and beyond.

In fact, your electronic health record (EHR) technology may already include various features that can help increase your MIPS score, says Marina Verdara, senior training specialist at Kareo. All you need to do is take advantage of them. Verdara discusses five ways in which medical practices should be able to capitalize on their EHR to improve performance under MIPS.

  1. Use an EHR Certified With the 2015 Criteria

Technology certified using the 2015 criteria supports interoperability across the care continuum, and it also enables physicians to earn additional revenue under MIPS, says Verdara. According to the Medicare Access and CHIP Reauthorization Act final rule, physicians earn a one-time bonus of 10 percentage points under the advancing care information (ACI) performance category of MIPS when they report objectives and measures using only 2015 edition certified electronic health record technology during calendar year 2018. In 2018, 25% of a physician’s MIPS score is tied to ACI.

“The federal rule indicates the clinician will earn a 10% bonus to their ACI score if they report using only a 2015 CEHRT, but they will determine this based on the measures submitted,” Verdara explains. “Therefore, a clinician can switch anytime during 2018 as long as they can report at least 90 days for the ACI category.”

In addition to this bonus, clinicians are eligible to receive a bonus of 10 percentage points applied to the ACI category if they report Stage 3 objectives and measures, says Verdara. They can do this if their certified EMR can document and track these measures. Refer to Table 7 in the MACRA final rule for more information about these measures.

  1. Choose Applicable Quality Measures

In 2018, 50% of your MIPS score is based on the quality measures you submit. Your 2015 Certified EHR should support your quality measure selection. “For instance, our physicians have an easy-to-use tool within our EHR that prompts them to narrow down measures that are most applicable for their specialty,” says Verdara. Customers can contact them directly for more information about each measure, its specifications, and what CMS is looking for when calculating numerators and denominators.

When using your EHR to choose measures, Verdara suggests running a report for all of the quality measures your vendor supports, including those you may not plan to submit for attestation. That’s because the data could reveal one or more measures you hadn’t anticipated as advantageous for your practice that could ultimately boost your score, she adds.

Examine the entire report, and identify your top 10 measures (i.e., those on which you’ve performed most effectively). Now dig into the data. Are each of these measures applicable for your specialty? If so, focus on data capture for those 10 measures. If some of your top 10 measures are in other specialties, eliminate those from your workflow and choose ones that are relevant. “Make sure you understand how to document and improve the score for that measure,” says Verdara.

Ultimately, submit all 10 measures to CMS even though only six are required, says Verdara. During the submission process, the CMS attestation website automatically scores each measure based on available benchmarks, and physicians have an opportunity to remove the measures on which they’ve performed most poorly prior to final submission.

  1. Don’t Overlook Reporting Opportunities

Your EHR should be looking out for reporting opportunities so that you can focus on patient care. Verdara provides the example of smoking cessation counseling. Physicians commonly perform this type of counseling but may not receive credit under MIPS because they don’t check the box indicating the work was done. “We have built-in guides to help physicians understand why they might be missing out on a particular quality metric,” says Verdara, adding that physicians should be able to look to their EHR to prompt and guide them to understand where missed opportunities may lie.

  1. Use Clinical Decision Support to Enhance MIPS Performance

Your EHR should also provide prompts to remind physicians about age- and condition-specific preventive screenings and care that, when provided to patients, can help improve MIPS scores. Physicians using Kareo, for example, can improve performance on MIPS measures related to influenza and age-specific immunizations as well as screening for clinical depression, high blood pressure, and more, all of which directly translate to higher scores, says Verdara. “It helps the physician provide better care,” she adds. “It’s a win-win for the clinician and the patient.”

  1. Run Clinical Reports to Pinpoint Opportunities for Care Improvement

MIPS reports not only allow for attestation, but they also help practices understand what they do well—and what needs improvement, says Verdara. For example, practices tracking patients whose hemoglobin A1C is greater than 9% during the performance period can use this report for MIPS attestation and to improve outcomes. More specifically, they can reach out to patients with a poor A1C to provide additional counseling and guidance. “This is a good one to track because diabetes is an epidemic,” says Verdara. “It helps practices target patients who are non-compliant.” The same is true for measures related to controlling high blood pressure and asthma.

To learn more about MACRA, visit https://qpp.cms.gov/.

About Lisa Eramo
Lisa Eramo is a regular contributor to Kareo’s Go Practice Blog, as well as other healthcare publications, websites and blogs, including the AHIMA Journal. Her focus areas are medical coding, clinical documentation improvement and healthcare quality/efficiency.  Kareo is a proud sponsor of Healthcare Scene.

Why Clinicians Need a 2015 Certified EHR

Posted on January 11, 2018 I Written By

The following is a guest blog post by Lisa Eramo, a regular contributor to Kareo’s Go Practice Blog.

What does “2015 Certified EHR” mean to practicing clinicians? The once-flooded EHR market is now whittling down to those vendors equipped to respond to regulatory and industry changes. The Office of the National Coordinator (ONC) for Health Information Technology listed more than 4,000 EHRs with 2014 certification criteria, according to the most recent data from healthIT.gov. And to date, only about 200 EHRs have passed the rigorous 2015 certification criteria.

However, beyond the fact that 2015 is indeed the most recent certification criteria as issued by the HHS, why should medical practices care?  

When vendors certify their EHRs, physicians—and patients—are ultimately the beneficiaries, says Beth Onofri, EHR and industry advisor at Kareo, who led the 2015 Certification process for the Kareo Clinical EHR. Physicians benefit because the technology allows them to easily attest that they’ve met quality requirements specified in the Medicare Access and CHIP Reauthorization Act (MACRA). This includes Advancing Care Information (ACI)-related measures that help physicians boost their payments. ACI accounts for 25 percent of a physician’s performance score that dictates reimbursement under the Merit-based Incentive Payment System (MIPS). Patients benefit because they’re able to access and exchange their own health information more easily than ever before. It’s a win-win all around, says Onofri.

“The 2015 criteria require functionality supporting unprecedented patient engagement, care coordination, and information exchange, all of which bodes well for physicians striving to improve outcomes.”
—Beth Onofri, EHR and Industry Advisor at Kareo

Although using a certified EHR is important, implementing one that’s certified using only the 2015 criteria (not the 2014 criteria or a combination of the two) is a critical piece of the puzzle under MACRA, says Onofri. EHRs certified with the 2015 criteria help pave the way for physicians to receive a bonus in 2018. In addition, the 2015 criteria require functionality that supports unprecedented patient engagement, care coordination, and information exchange, all of which bodes well for physicians striving to improve outcomes.

Still, many physicians aren’t aware of how the 2015 certification criteria can help their practices, says Onofri.

Of the 60 different 2015 certification criteria, Onofri says these five are particularly helpful for practices seeking to improve the quality of the care they provide, ultimately fostering accurate payments under value-based payment reform:

1. View, download, and transmit health information to a third party

The 2015 criteria require a secure method of access (usually through a patient portal) as well as the ability to send information to an unsecured email address of the patient’s choice, says Onofri. The idea is that offering various access options improves overall patient engagement and outcomes.

She suggests creating a brochure that explains to patients how they can access and use the portal, including how to view, download, and transmit their health information. Another idea is to recruit a volunteer who can show patients how to use the portal while they wait in the waiting area. “There needs to be a strong advocate in each practice to make sure that these functionalities are implemented and used,” she adds. “Those practices with an advocate are the ones that will succeed.”

2. Secure messaging

This functionality allows physicians to send messages to—and receive messages from—patients in a secure manner, helping to improve engagement and communication. Practices must define how they’ll use secure messaging, including who will respond and what types of questions they’ll permit (e.g., fulfill appointment requests vs. answering clinical inquiries). “There are a small percentage of doctors who will want to answer their own messages, but there is a larger percentage of doctors who will want their staff to answer the emails and, if necessary, escalate to the provider,” says Onofri.

3. Patient health information capture

This functionality allows physicians to accept patient-generated health data into the EHR. For example, Onofri notes that the Kareo Clinical 2015 Edition EHR allows patients to record their health information at home to easily upload the information to their portal and transmit it securely to the physician for shared decision-making. The idea is that access to more comprehensive health data can help physicians prevent and manage disease—and it could be a game-changer in terms of population health management.

Start small when rolling out this functionality, she says. For instance, encourage patients with high blood pressure to upload their blood readings daily before engaging a second population (e.g., those with diabetes who upload their glucose levels).

4. Transitions of care

This functionality calls for interoperable documents that include key health data (e.g., name, date of birth, and medications) as well as standardized format for exchange. A transition of care summary provides critical information as patients transfer between different physicians at different health organizations or even distinct levels of care within the same organization.

“It’s not uncommon for our providers to send the referral right as they are completing the note with the patient in the room,” says Onofri. “This obviously speeds the care coordination for patients in terms of seeing another doctor.” The only caveat is that practices must compile a list of direct email addresses for physicians to whom patients are frequently referred, she adds.

5. Application programming interfaces (APIs)

“This is one of those requirements that is the foundation of things to come,” says Onofri. “It’s the first step toward interoperability.” API functionality will eventually allow patients to aggregate data from multiple sources in a web or mobile application of their choice.

Physicians who take the time to explore each of these 2015 certification functionalities may be more likely to improve outcomes and reap financial rewards under MACRA, says Onofri. “The improved functionality is there—is your practice taking advantage of it?”

About Lisa Eramo
Lisa Eramo is a regular contributor to Kareo’s Go Practice Blog, as well as other healthcare publications, websites and blogs, including the AHIMA Journal. Her focus areas are medical coding, clinical documentation improvement and healthcare quality/efficiency.  Kareo is a proud sponsor of Healthcare Scene.

eClinicalWorks Settlement Hasn’t Led To Customer Defections, Yet

Posted on August 7, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Loyalty is a funny thing. You’d think that when a vendor let you down spectacularly, you wouldn’t do business with them anymore. But the truth is, when it comes to health IT it’s not that simple. In many cases, vendor-customer relationships are more like marriages than formal agreements. Even if things start to go south, customers have so much invested in their vendor relationship that backing out may not seem like a realistic possibility.

Yes, I’m pontificating here, but not without a point. What I’m responding to here is a recent KLAS survey which found that while many customers of the now-tarnished eClinicalWorks have lost confidence in the company, many are still on board for now.

As many readers will know, in May eCW settled a whistleblower suit against the company for $155 million. The suit, which was brought by the US Department of Justice, asserted that the vendor got certified for incentive payments by putting deceptive kludges in place.

After agreeing to pay a massive penalty to the feds and putting a “Coprrporate Integrity Agreement” in place, it’s little wonder that some customers don’t trust eCW anymore. But the reality of the situation is that they’re not exactly free to jump ship either.

The study, which was reported on in HIT Consultant, found that 66% of customers polled by KLAS said their perception of eCW had moderately or significantly worsened after the settlement. Meanwhile, 34% of current eCW customers plan to look elsewhere when they make their next health IT investment.

Another third of respondents said they felt stuck in their current eCW contract, though they would consider switching vendors when the contract expires or they have more resources to invest. Still, only 4% of KLAS respondents said they were leaving specifically because of the settlement.

Meanwhile, there’s apparently a subset of eCW customers who aren’t that worried about the settlement or its implications. One-third of respondents said that it had little impact on them, and some noted that eCW is probably just the first of many vendors whose meaningful use certification will be called into question.

The reality is that while eCW customers were a bit shaken by the settlement, it didn’t exactly come as a shock that the vendor was playing it close to the edge, with one-fifth noting that the settlement was “unsurprising.”

I would tend to side with the eCW customers who predict that this settlement is the tip of the iceberg, and that it’s likely to come out that other health IT vendors were gaming the certification process. The question is whether these settlements will merely inconvenience providers or lead to serious problems of their own. If the feds ever decide that providers should have known about faked certifications, the game will get a lot more complicated.

AMIA Shares Recommendations On Health IT-Friendly Policymaking

Posted on April 17, 2017 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The American Medical Informatics Association has released the findings from a new paper addressing health IT policy, including recommendation on how policymakers can support patient access to health data, interoperability for clinicians and patient care-related research and innovation.

As the group accurately notes, the US healthcare system has transformed itself into a digital industry at astonishing speed, largely during the past five years. Nonetheless, many healthcare organizations haven’t unlocked the value of these new tools, in part because their technical infrastructure is largely a collection of disparate systems which don’t work together well.

The paper, which is published in the Journal of the American Medical Informatics Association, offers several policy recommendations intended to help health IT better support value-based health, care and research. The paper argues that governments should implement specific policy to:

  • Enable patients to have better access to clinical data by standardizing data flow
  • Improve access to patient-generated data compiled by mHealth apps and related technologies
  • Engage patients in research by improving ways to alert clinicians and patients about research opportunities, while seeing to it that researchers manage consent effectively
  • Enable patient participation in and contribution to care delivery and health management by harmonizing standards for various classes of patient-generated data
  • Improve interoperability using APIs, which may demand that policymakers require adherence to chosen data standards
  • Develop and implement a documentation-simplification framework to fuel an overhaul of quality measurement, ensure availability of coded EHRs clinical data and support reimbursement requirements redesign
  • Develop and implement an app-vetting process emphasizing safety and effectiveness, to include creating a knowledgebase of trusted sources, possibly as part of clinical practice improvement under MIPS
  • Create a policy framework for research and innovation, to include policies to aid data access for research conducted by HIPAA-covered entities and increase needed data standardization
  • Foster an ecosystem connecting safe, effective and secure health applications

To meet these goals, AMIA issued a set of “Policy Action Items” which address immediate, near-term and future policy initiatives. They include:

  • Clarifying a patient’s HIPAA “right to access” to include a right to all data maintained by a covered entity’s designated record set;
  • Encourage continued adoption of 2015 Edition Certified Health IT, which will allow standards-based APIs published in the public domain to be composed of standard features which can continue to be deployed by providers; and
  • Make effective Common Rule revisions as finalized in the January 19, 2017 issue of the Federal Register

In looking at this material, I noted with interest AMIA’s thinking on the appropriate premises for current health IT policy. The group offered some worthwhile suggestions on how health IT leaders can leverage health data effectively, such as giving patients easy access to their mHealth data and engaging them in the research process.

Given that they overlap with suggestions I’ve seen elsewhere, we may be getting somewhere as an industry. In fact, it seems to me that we’re approaching industry consensus on some issues which, despite seeming relatively straightforward have been the subject of professional disputes.

As I see it, AMIA stands as good a chance as any other healthcare entity at getting these policies implemented. I look forward to seeing how much progress it makes in drawing attention to these issues.

FHIR Product Director Speaks Out On FHIR Hype

Posted on June 6, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

To date, all signs suggest that the FHIR standard set has tremendous promise, and that FHIR adoption is growing by leaps and bounds. In fact, one well-connected developer I spoke with recently argues that FHIR will be integrated into ONC’s EHR certification standards by 2017, when MACRA demands its much ballyhooed “widespread interoperability.”

However, like any other new technology or standard, FHIR is susceptible to being over-hyped. And when the one suggesting that FHIR fandom is getting out of control is Grahame Grieve, FHIR product director, his arguments definitely deserve a listen.

In a recent blog post, Grieve notes that the Gartner hype cycle predicts that a new technology will keep generating enthusiasm until it hits the peak of inflated expectations. Only after falling into te trough of disillusionment and climbing the slope of enlightenment does it reach the plateau of productivity, the Gartner model suggests.

Now, a guy who’s driving FHIR’s development could be forgiven for sucking up the praise and excitement around the emerging standard and enjoying the moment. Instead, though, it seems that Grieve thinks people are getting ahead of themselves.

To his way of thinking, the rate of hype speech around FHIR continues to expand. As he sees it, people are “[making] wildly inflated claims about what is possible, (wilfully) misunderstanding the limitations of the technology, and evangelizing the technology for all sorts of ill judged applications.”

As Grieve sees it, the biggest cloud of smoke around FHIR is that it will “solve interoperability.” And, he flatly states, it’s not going to do that, and can’t:

FHIR is two things: a technology, and a culture. I’m proud of both of those things…But people who think that [interoperability] will be solved anytime soon don’t understand the constraints we work under…We have severely limited ability to standardise the practice of healthcare or medicine. We just have to accept them as they are. So we can’t provide prescriptive information models. We can’t force vendors or institutions to do things the same way. We can’t force them to share particular kinds of information at particular times. All we can do is describe a common way to do it, if people want to do it.

The reality is that while FHIR works as a means of sharing information out of an EHR, it can’t force different stakeholders (such as departments, vendors or governments) to cooperate successfully on sharing data, he notes. So while the FHIR culture can help get things done, the FHIR standard — like other standards efforts — is just a tool.

To be sure, FHIR seems to have legs, and efforts like the Argonaut Project — which is working to develop a first-generation FHIR-based API and Core Data Services specification — are likely to keep moving full steam ahead.

But as Grieve sees it, it’s important to keep the pace of FHIR work deliberate and keep fundamentals like solid processes and well-tested specifications in mind: “If we can get that right — and it’s a work in process — then the trough of despair won’t be as deep as it might.”

Bad Boy EMR List, EMR Apology Letter, and Direct Primary Care

Posted on August 3, 2014 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 always liked the idea of a bad boy EMR list. I’ve called it a meaningful EHR certification before. Or an EMR naughty and nice list. It’s a hard thing to do well…especially if you want to make a business of it.


I’ve posted a number of images lie this before. It’s always interesting to see what they say. This one actually looks like it’s trying to help them meet their MU patient engagement requirements as much as it’s trying to explain the EHR implementation delay. I’ve seen quite a few of these signs in hospitals I’ve visited. Getting patients signed up on the portal is a challenging thing for hospitals.


I need to dig into the direct primary care model a lot more, but it’s one of the really interesting alternative care models that’s worth watching.

Eyes Wide Shut – Patient Engagement Pitfalls Prior to Meaningful Use Reporting Period

Posted on June 30, 2014 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She 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.

July 1, 2015 – the start of the Meaningful Use Stage 1 Year 2 reporting period for the hospital facilities within this provider integrated delivery network (IDN). The day the 50% online access measure gets real. The day the inpatient summary CCDA MUST be made available online within 36 hours of discharge. The day we must overcome a steady 65% patient portal decline rate.

A quick recap for those who haven’t followed this series (and refresher for those who have): this IDN has multiple hospital facilities, primary care, and specialty practices, on disparate EMRs, all connecting to an HIE and one enterprise patient portal. There are 8 primary EMRs and more than 20 distinct patient identification (MRN) pools. And many entities within this IDN are attempting to attest to Meaningful Use Stage 2 this year.

For the purposes of this post, I’m ignoring CMS and the ONC’s new proposed rule that would, if adopted, allow entities to attest to Meaningful Use Stage 1 OR 2 measures, using 2011 OR 2014 CEHRT (or some combination thereof). Even if the proposed rule were sensible, it came too late for the hospitals which must start their reporting period in the third calendar quarter of 2014 in order to complete before the start of the fiscal year on October 1. For this IDN, the proposed rule isn’t changing anything.

Believe me, I would have welcomed change.

The purpose of the so-called “patient engagement” core measures is just that: engage patients in their healthcare, and liberate the data so that patients are empowered to have meaningful conversations with their providers, and to make informed health decisions. The intent is a good one. The result of releasing the EMR’s compilation of chart data to recently-discharged patients may not be.

I answered the phone on a Saturday, while standing in the middle of a shopping mall with my 12 year-old daughter, to discover a distraught man and one of my help desk representatives on the line. The man’s wife had been recently released from the hospital; they had been provided patient portal access to receive and review her records, and they were bewildered by the information given. The medications listed on the document were not the same as those his wife regularly takes, the lab section did not have any context provided for why the tests were ordered or what the results mean, there were a number of lab results missing that he knew had been performed, and the problems list did not seem to have any correlation to the diagnoses provided for the encounter.

Just the kind of call an IT geek wants to receive.

How do you explain to an 84 year-old man that his wife’s inpatient summary record contains only a snapshot of the information that was captured during that specific hospital encounter, by resources at each point in the patient experience, with widely-varied roles and educational backgrounds, with varied attention to detail, and only a vague awareness of how that information would then be pulled together and presented by technology that was built to meet the bare minimum standards for perfect-world test scenarios required by government mandates?

How do you tell him that the lab results are only what was available at time of discharge, not the pathology reports that had to be sent out for analysis and would not come back in time to meet the 36-hour deadline?

How do you tell him that the reasons there are so many discrepancies between what he sees on the document and what is available on the full chart are data entry errors, new workflow processes that have not yet been widely adopted by each member of the care team, and technical differences between EMRs in the interpretation of the IHE’s XML standards for how these CCDA documents were to be created?

EMR vendors have responded to that last question with, “If you use our tethered portal, you won’t have that problem. Our portal can present the data from our CCDA just fine.” But this doesn’t take into account the patient experience. As a consumer, I ask you: would you use online banking if you had to sign on to a different website, with a different username and password, for each account within the same bank? Why should it be acceptable for managing health information online to be less convenient than managing financial information?

How do hospital clinical and IT staff navigate this increasingly-frequent scenario that is occurring: explaining the data that patients now see?

I’m working hard to establish a clear delineation between answering technical and clinical questions, because I am not – by any stretch of the imagination – a clinician. I can explain deviations in the records presentation, I can explain the data that is and is not available – and why (which is NOT generally well-received), and I can explain the logical processes for patients to get their clinical questions answered.

Solving the other half of this equation – clinicians who understand the technical nuances which have become patient-facing, and who incorporate that knowledge into regular patient engagement to insure patients understand the limitations of their newly-liberated data – proves more challenging. In order to engage patients in the way the CMS Meaningful Use program mandates, have we effectively created a new hybrid role requirement for our healthcare providers?

And what fresh new hell have we created for some patients who seek wisdom from all this information they’ve been given?

Caveat – if you’re reading this, it’s likely you’re not the kind of patient who needs much explaining. You’re likely to do your own research on the data that’s presented on your CCDA outputs, and you have the context of the entire Meaningful Use initiative to understand why information is presented the way it is. But think – can your grandma read it and understand it on HER own?

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 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.

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.

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 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.

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 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 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.