Thoughts on the future of US health IT under the Obama administration

by Mark Leavitt, MD, PhD

In December, Bruce Fried wrote in an iHealthBeat article:

“By any measure, the Obama campaign and the presidential transition team understand and have made brilliant use of technology to communicate President-elect Barack Obama’s ideas and network his supporters. The president-elect has announced that, for the first time, there will be a Chief Technology Officer for the United States. Indeed, the transition’s agenda for technology is impressive and exciting.”

I too have been in the health IT adoption battle for a couple of decades, and I agree with Bruce Fried that we are about to see a major breakthrough. The past 4 years, we’ve seen a notable uptick in EHR adoption with some leadership from the Federal government and coordinated public/private initiatives, albeit with only modest financial incentives to back them up. Now, we’ll see $5B, $10B, or $25B of new, external capital infused to drive that proposition. We’ll need to work hard to make sure it propels us in the right direction, but I’m placing my bet alongside Bruce’s for some big changes ahead.

For more of Fried’s thoughts, read With a New President and Congress Coming In, What Lies on the Horizon for Health IT Efforts?

{ 0 comments }

Hospital helps its doctors step up, and up, to EHRs

by CCHIT Staff

Score one for the onesy-twosy physician practice trying to afford an electronic health record. Add the bonus of getting the most out of what an EHR has to offer, all made possible by a hospital with an innovative community view and a subsidy to encourage participation in it.

That sums up a program recently launched by Hoag Memorial Hospital Presbyterian that leverages an exception and safe harbor from Medicare’s Stark and anti-kickback laws instituted in 2006. The measure allows hospitals to subsidize up to 85% of EHR software and implementation costs for independent physicians on their medical staffs. The Certification Commission for Healthcare Information Technology (CCHIT) has identified 56 such programs to date nationwide, totaling 153 hospitals and their doctors.

The medical staff at Hoag, a 498-bed facility in Newport Beach, Calif., has 1,200 physicians in 820 practices—an average of 1.4 doctors per practice—who are eligible for a hospital-financed subsidy of up to 60% of an impressive range of IT services. In a region of the country that combines a notably high cost of living with one of the lowest medical reimbursement rates stemming from California’s high penetration of managed care, the expense of acquiring and intelligently implementing an EHR is out of reach for the typical physician group in Orange County, says Rebecca Armato, Hoag’s director of ambulatory information services.

Besides covering a portion of the costs, Hoag has taken some distinctive steps to accommodate physician preferences and motivate doctors to participate. These small physician practices can choose among several EHR options and be assured of the same basic level of support and capabilities to manage patient care and improve the workflow of their office. The EHR products are on track to be building blocks of a planned communitywide health information exchange, linking local practices on a scale usually reserved for large medical practice models, says Armato.

EHR capabilities in common

A choice of technology
Hoag Memorial Hospital Presbyterian’s doctors will be able to choose from among the following vendors’ EHRs:
Vendor  Latest certified product
Allscripts Allscripts Professional 8.1 (formerly HealthMatics EHR Version 2007.1)
Allscripts Allscripts Allscripts Enterprise EHR (formerly Touchworks V 11.1)
eClinicalWorks eClinicalWorks 8.0
NextGen NextGen EMR 5.5.27
The foundation for this multiple-option offer to physicians is the set of capabilities in common that the four EHR products (See chart) can demonstrate as a result of being CCHIT Certified. “We know generally the functionality at a certain level is the same, it’s the look and feel that’s different,” says Armato. So physicians can elect to receive the one that they’re most comfortable with, while Hoag is able to count on common information capabilities and the Certification Commission’s process of charting a roadmap for future enhancements to data exchange, analysis and population management abilities.


The EHR vendors must apply for and attain recertification annually. Additionally, as industry standards are further developed regarding data exchange formats and terminologies, all three vendors must incorporate them into their services to physicians, which are hosted by the vendors instead of operated at physician practice sites.

The upshot is that Hoag is forcing interoperability among vendor products and facilitating vendor neutrality in the service of small, independent practices using the same information network, says Armato. It starts with certification criteria for functionality and relies on gradually higher interoperability – the ability of different EHRs to communicate with each other – built into the EHRs that meet the additional requirements of annual CCHIT certification. “We point to CCHIT (certification) as a validation of what we’re doing” to offer physicians both choice and robust technology in common, she says.

Other features subsidized by the program include a practice-management system integrated with the EHR offerings; a portal for secure communication between patients and their physicians; and consulting services to get the best and highest benefit from using the technology.

Benefits to and from doctors

With retention and recruitment of physicians a prime concern given the challenging financial environment, one way to attract and keep them is to create a flexible and affordable route to electronically creating, using and exchanging clinical and administrative information. “The hospital’s vision is the creation of a health information exchange in Orange County,” Armato says.

The strategy is to first get doctors comfortable with the technology and then create an environment for exchanging information related to patient care. Also, by making the doctors in the network more attractive to patients while enabling practitioners to deliver care more efficiently, Hoag would improve the doctor retention and recruitment picture at the same time it builds a model for leveraging clinical information among small practices. “If we have the best and brightest physicians, and they have the best tools at the point of care, the patient wins.”

Hoag additionally would benefit from reduced costs for document distribution, fewer unnecessary or duplicate tests and other welcome byproducts of sufficient information. Doctors using electronic tools can reduce errors and manage chronic illnesses better, and the new information environment can spawn a climate of relentless quality improvement. “We want the tools to be triggering those thoughts all the time.”

Free appetizer: e-prescribing

In November, Hoag began offering an electronic prescribing software product from Allscripts to get some practices started using electronic tools and recognizing the benefits. Under the Stark exception, hospitals can subsidize 100% of the cost of extending e-prescribing tools to their independent physicians, and Hoag is picking up the entire cost.

The response has been immediate: Hoag expects to have 50+ physicians using the application by year-end, and 300 by April 2009. Besides the Stark incentive, the initiative is benefiting from a federal incentive that will pay doctors a bonus equal to 2% of all allowed Medicare billings for professional services effective Jan 1, 2009. Armato sees the systems as principally identifying and avoiding medication errors and contraindications, with the Medicare incentive as, well, a bonus.

Both the EHR and e-prescribing efforts are bundled tightly with Hoag’s longer-range plan to improve care quality and simultaneously lower the cost of healthcare for both the hospital and its doctors. The next step in the IT development plan is to integrate lab and radiology reporting into the EHR applications. Next after that will be a push to create a health information exchange using industry standards.

Armato says that includes preparing to become CCHIT Certified as a health information exchange (HIE), an area of certification launched just this year. Most information that doctors need is at the community level, but if the development of an HIE eventually leads to joining the emerging state RHIO, so much the better. “I believe in the network of networks. It’s the only way these things can be accomplished.”

{ 1 comment }

Recap: Town Call on certification expansion

by CCHIT Staff

 
icon for podpress  CCHIT Town Call: Updating the EHR expansion roadmap [49:55m]: Play Now | Play in Popup | Download (35)

On December 1, 2008, CCHIT hosted a Town Call to discuss the roadmap for certification expansion and to seek guidance from the healthcare community on proposed areas of focus. To listen to the audio from that call, press the “Play” button, above, or download the MP3 file.

Questions submitted during the call are answered at the end of the call. Those questions and CCHIT’s responses are provided below.

Responses to questions

SG asked: What is the process to enroll into the Standalone ePrescribing certification pilot in February 09? If the Standalone ePrescribing certification is to be launched in July 2009, what is the process for participating in that?

You may enroll for the Standalone ePrescribing pilot at http://www.cchit.org/pilot/ The final materials for preparing and applying for certification will be published in May 2009.

Anne Diamond asked: If an organization submits for expansion as a specialty, but CCHIT thinks it should be a population, what will happen to the submission? Will that eliminate the submission until the next round?

The Commission staff will discuss the submission with the organization, recommending changes if necessary, prior to review by the Commission on Jan 13. The public comment period (Jan 15 – Feb 5) on the proposed expansion roadmap also offers another opportunity to recommend changes.

Linda King asked: Are you looking for an affirmation of the Commission’s draft roadmap decisions during the public comment review? Will you drop or add another specialty, population or domain based on public comment?

The public comment period is an opportunity to collect broad stakeholder feedback on the reliability of the proposed future roadmap. Changes to the roadmap may be made after comment is received.

Larry Ozeran asked: Perhaps I am misunderstanding your construct, but wouldn’t it make the most sense to take a modular approach to this question of special certification? In my vision, every EHR gets basic certification as in the past. Products that are specific for pediatrics may get additional features tested (e.g. growth chart) and ones for specialty inpatient care, e.g. a pediatric ICU, would similarly meet additional criteria.

Doesn’t this make each additional certification both easier to identify and easier to certify? Doesn’t the question really become not whether to create add-on certification for specialty needs, but which order to add the specialty certifications?

Some product certification expansions for special populations, care settings, specialty practice, or advanced technology can easily be built on the Commission’s existing health IT certification programs, with some additions or substitutions of criteria and modified test scripts. That worked well for child health and cardiovascular medicine. But some require much more work to fit the work flow and common practices of providers. One size doesn’t fit all. For example, we could not easily adapt earlier work to emergency department or long term care settings, or to the differences in level of practice among behavioral health providers. In prioritizing expansion options, the Commission also must consider the market readiness of products for certification. If there are no or very few identified product offerings in a given specialty area, certification may not be sustainable.

Emily Graham asked: If a specialty area has previously developed a functional model or set of specialized EHR/HIT criteria (for example, through HL7) would that be viewed favorably by CCHIT, or is that not necessary?

The availability of consensus-based standards upon which to build certification criteria is very beneficial but it is not a pre-requisite for consideration.

{ 0 comments }

CCHIT Town Call: Updating the EHR expansion roadmap

by CCHIT Staff

CCHIT is hosting a Town Call to discuss the roadmap for the expansion of EHR certification. The call will focus on providing information on the benefits of expanding certification into a new area, the readiness of that area for certification, and an estimate of the effort required to develop certification in the area.

Click here to listen to the Town Call

If the expansion of CCHIT certification is of interest to you, please download the presentation, participate in the call, or post questions to CCHIT.

Ten questions to ask CCHIT Certified product vendors

by CCHIT Staff

CCHIT Certified status is the first thing for which to look when you’re selecting an EHR. But it’s also important to remember that it’s only the first step in the selection process.

Here are some other important questions to ask EHR vendors when you’re in the midst of selecting a product for your practice:

  1. Tell me about your company. How long have you been in business? How many employees do you have doing development and offering technical service?
  2. How many physician practices do you serve? What size are they? May I speak with a few of them?
  3. How do you license your product—for a term or perpetually, by physician or user?
  4. What are your maintenance or support fees? Do they cover product upgrades?
  5. What are your service policies and guarantees?
  6. In addition to what I can expect from CCHIT Certified interoperability, what will I pay for other desired interfaces to products or sources of information?
  7. Are there third-party costs for modules or components bundled with your product? Will I need to buy some third-party products independently to make your product perform as demonstrated?
  8. Tell me about your implementation and training services. What do they cost? How long will it take until my practice is successfully up and running using your product?
  9. Are you willing to put these terms in a sales agreement?
  10. What are your plans for staying up-to-date with CCHIT’s certification requirements?

With the launch of the CCHIT Certified 08 products, vendors were given the option to publish answers to some of these questions on their certified product pages. For more information, see CCHIT Certified 08 products for Ambulatory, Inpatient, and Emergency Department.

{ 2 comments }

EHR in practice: Medical Clinic of North Texas

by CCHIT Staff

The Medical Clinic of North Texas, P.A. (MCNT) is a full-service practice in the Dallas-Fort Worth area with 34 locations and 140 providers. The practice has an active patient base of 240,000 and offers expert medical care in the areas of family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychotherapy, sports medicine, rheumatology, and diabetes education. They use NextGen Healthcare Information Systems 5.4.29.

“We knew that we had high quality physicians and provided superior care. We simply had no way to communicate this until we could generate data that objectively demonstrated our performance” said Mike Yerrid, Chief Information Officer

PDFDownload the Medical Clinic of North Texas case study.

{ 1 comment }

Three good reasons to purchase an EHR today

by CCHIT Staff

  1. Delaying could mean that you are also delaying your eligibility for pay-for-performance and other programs. It could take time—two years or more—for you to start up a new EHR system, collect data and implement a meaningful quality improvement mechanism that would lead to your receiving incentive payments under these programs. Waiting could cause you to miss several years of potential incentive payments, liability insurance discounts, and other benefits.
  2. In a competitive environment, it might be hard to catch up with medical practices that implement EHR systems sooner. Practices with EHR systems gain a head start in measuring and improving quality, increasing efficiency, and providing better service for patients.
  3. Having an EHR is becoming a notable benefit when attempting to recruit new physicians. (In fact, James Morrow, MD, mentioned this during his interview for the EHR Decisions podcast.)

For more on the benefits of purchasing an EHR, read the Physician’s Guide to CCHIT Certification.

{ 2 comments }

EHR Decisions Podcast #1: New CCHIT Certified products, EHR incentive programs

by CCHIT Staff

 
icon for podpress  CCHIT EHR Decisions #1 [11:11m]: Play Now | Play in Popup | Download (192)

Join Kris Rebillot as she talks with Mark Leavitt, MD, PhD, Chair of CCHIT; Francois de Brantes, MS, MBA, Chief Executive Officer, Bridges to Excellence; and James Morrow, MD, of North Fulton Family Medicine.

To listen online, click the “play” arrow, above. Or choose to download the audio file (mp3) and listen to it at your convenience.

Topics include:

{ 1 comment }

Ten CCHIT Certified 08 office-based EHR now available

by CCHIT Staff

CCHIT Certified EHRThe Certification Commission for Healthcare Information Technology (CCHIT®) today announced that 10 electronic health record (EHR) products for office-based physicians are the first certified under the new CCHIT Certified® 08 criteria.

The 8 new fully CCHIT Certified 08 Ambulatory EHR products are:

In addition, two products were pre-market, conditionally CCHIT Certified 08 ambulatory EHR products. Pre-market, conditionally certified EHRs are new products that haven’t yet been put into regular use at a customer clinic:

For more information, see the press release on the latest crop of CCHIT Certified products.

{ 1 comment }

The Positive Impacts of Certification – Bigger Than Anyone Realized

by Mark Leavitt, MD, PhD

It’s CCHIT’s “birthday” – and, like any anniversary, it’s always a good moment to look back and reflect on our experiences and accomplishments. The organization itself is 4 years old. And our 3-year Federal contract, awarded October 1, 2005, is just about complete (but we’ve already learned we’re getting an extension, so some government support will continue for the near future).

But nostalgia isn’t the main sentiment we’re feeling today. CCHIT was formally required at the end of its 3 year Federal contract to “look back” and assess the impact of certification on health IT adoption. We just got the results, and what we found really surprised us – in a positive way.

Bottom line: we found more than $700 million worth of incentive programs for EHR adoption, all launched since we started certifying ambulatory EHRs in 2006. And that’s not even counting the ePrescribing bonus payments which will begin in 2009.

We found some 50 hospitals helping physicians financially with EHR acquisition under the exemption to the Stark and Anti-kickback law. We found 40 incentive programs from Federal, State and local governments and from the private sector. These include pay-for-performance bonuses, grants, loans, even discounts on liability insurance – all for using a CCHIT Certified EHR.

Our staff had to work pretty hard to research and collate this data, digging through reports, news, even cold-calling hospitals, agencies, or vendors. That points out a real need: doctors must have an easy way to find out what EHR adoption incentive and assistance programs are offered in their area. We’ve created two resources to try to fulfill this need. First, we have an online database of these incentive programs. By selecting your state, you can automatically filter the database to list programs that may apply to you, including the national programs as well as state, local, or hospital-based programs. Or just download the whole report, called the CCHIT Incentive Index.

We’d like feedback on how these tools work for you. We’ll do our best to keep it updated, but we could use help with that. So please feel free to comment below, let us know if you are aware of programs we didn’t list, or tell us if you’d like to partner with us on this project another way.

Recently, we’ve seen some papers bemoaning the slow rate of health IT adoption. They raise some good issues, and I agree we still have a long journey ahead. But folks, it looks to me like the payers and purchasers of health care have put $700 million of fuel in our “adoption tank” (or maybe a better metaphor would be “charge” in our “adoption batteries”). Add to that the energy I sense every time groups of our 200 volunteers gather to collaboratively accomplish the work of certification development. So on our fourth birthday, I want to thank everyone who’s been contributing to our success. Now let’s press the accelerator down harder, using all that fuel, charge, and energy to drive us right into the future of healthcare.

{ 2 comments }