Archive for October, 2012

Electronic Health Records Improve Ambulatory Care

17 Oct

According to a new study published in the Journal of General Internal Medicine, electronic health records (EHRs) significantly improve the quality of community-based ambulatory care.

Lisa M. Kern, M.D., M.P.H., of Weill Cornell Medical College in New York City, conducted a cross-sectional study with her colleagues of 2008 data for 466 general internists, pediatricians, and family medicine practitioners in ambulatory practices in New York. They found that 44 percent of the physicians had adopted electronic health records and 56 percent continued to use paper records for the total of 74,618 patients represented by the physicians in the study.
There were quality measures for nine types of care: eye exams, hemoglobin testing, cholesterol testing, renal function testing for diabetics, colorectal cancer screening, chlamydia screening, breast cancer screening, pediatric sore throat testing, and treatment for children with upper respiratory infections.
Physicians who used EHRs provided higher rates of care than physicians who used paper records, with a significant improvement in four measures: hemoglobin testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening.
“We found that EHR use is associated with higher quality ambulatory care. This finding occurred in a multi-payer community with concerted efforts to support EHR implementation,” wrote the authors. “In contrast to several recent national and statewide studies, which found no effect of EHR use, this study’s finding is consistent with national efforts to promote meaningful use of EHRs.”

Meaningful Use: Stage 2 Clarifying Tips

09 Oct

Newly published information from the Centers for Medicare and Medicaid Services (CMS) that specifies the Stage 2 criteria for Meaningful Use is now available for eligible professionals, hospitals, and critical access hospitals. This information includes a tip sheet giving additional details. However, providers should keep in mind that before meeting these requirements, participants must achieve meaningful use under the Stage 1 criteria.

This tip sheet offers professionals a timeline illustrating the progression of meaningful use stages from when a Medicare provider begins participation in the program. While during the first year of participation, providers must demonstrate meaningful use for a 90-day electronic health record reporting period, the subsequent years will require a full year HER reporting period.

This full-year period is defined as an entire fiscal year for hospitals or an entire calendar year for EPs, except in 2014. Providers participating only in Medicaid HER Incentive Programs are not required to demonstrate meaningful use in consecutive years. However, their movement through the stages would follow the same structure of two years meeting the criteria of each stage, including a 90-day HER reporting period during the first year. 

As stated above, the reporting rules for 2014 differ from prior years. In 2014, all providers, regardless of their stage of meaningful use, are only required to demonstrate meaningful use for a three-month reporting period. CMS will be offering this one-time three-month reporting period in order to enable providers who must upgrade to 2014 Certified HER Technology to have time to implement their new Certified HER systems. This three-month period will be restricted for Medicare providers to the quarter of either the fiscal or calendar year. Medicaid providers who are only eligible for Medicaid EGR incentives will not be restricted to a fixed reporting period, since providers do not have the same alignment needs. 

The tip sheet explains that Stage 2 retains the core and menu structure for meaningful use objectives from Stage 1. While some Stage 1 objectives were eliminated, the majority of them are core objectives under Stage 2 and the threshold that providers must prove has simply been raised. This threshold includes demonstrating meaningful use of Certified HER Technology to a larger portion of their patient populations. 

At the core of the tip sheet are two Stage 2 criteria:

  • EPs must meet 3 menu objectives and 17 core objectives selected from a total list of 6, creating a total of 20 core objectives.
  • Hospitals that are eligible and CAHs must meet 3 menu objectives and 16 core objectives selected from a list of 6, for a total of 19 core objectives.

The tip sheet concludes with a complete list of the Stage 2 core and menu objectives for all participants, including a downloadable table. 

With the next stage of meaningful use now available, health care providers have ample resources from CMS to make sure that they meet guidelines and reap the benefits.


Overview of Health Information Exchanges

08 Oct

In keeping with the current Meaningful Use legislation, agencies across the country are developing health information exchange programs. Health Information Exchanges allow for the streamlined transmission of health-related data and patient information between health care providers and ensure this exchange is secure and up-to-date.

UC-David Health System has launched a state-wide data sharing program in California. This initiative — the California Health eQuality Program — will link hospitals, emergency departments, and physicians by 2014. In addition to a four-year, $38.8 million grant through the federal economic stimulus package, officials are seeking other funding sources to expand the program past 2014.

The initiative, as described by Kenneth Kizer, Director of the Institute for Population Health Improvement, will allow health information to “flow safely and quickly between and among health care providers…”

When will the Pacific Northwest hop on the wagon? We already have. The state of Oregon launched its statewide health information exchange, called CareAccord, in May 2012. The system will improve provider communication, reduce duplicate orders and help health care providers meet the requirements for Meaningful Use, which will allow them to qualify for Medicaid and Medicare incentive programs instituted by the Obama administration beginning in 2009.

Harris Healthcare Solutions will implement Oregon’s health information exchange and Oregon Health Authority will administer the program. Harris will employ a Direct Secure Messaging System to exchange information through any internet-enabled device, meaning that patient data will be available to practitioners on everything from laptops to mobile phones.

Other additions to the data exchange in the next phase may include:

  • Data exchange between EHR systems.
  • Record search through Master Patient Index Record Locator services.
  • Connection to federal systems, including those managed by the Department of Veterans Affairs and the Social Security Administration.

Similarly, Washington State has instituted their version of Health Exchange, One Health Port Health Information Exchange (OHP HIE). According to, “This integrated physician/hospital partnership provides patients the highest quality care through a sustainable healthcare delivery system made up of over 17 partnering clinics. This relationship effectively and efficiently meets the healthcare needs of the Greater Yakima Valley region and its people.”

Participating physicians and clinics, or trading partners, will be updated regularly and posted to the One Health Port website in the Practitioner Level Provider Directory.

In addition, to ensure the availability of data transactions, OHP HIE will include a Washington State HIE Entity Level Provider Directory. This directory will list any organization wishing to post the HIE or HIO they participate through, what transactions they are prepared to send and receive, as well as routing addresses and technical contact information for each entity.

With Meaningful Use providing benefits to health care professionals across the country, an increase in state-specific data-exchange programs like those above is likely to continue and will alter the way health care information is transmitted and processed.

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