Walker Family Medicine adopts OmniMD EMR/ PMS solution

Tarrytown, NY- OmniMD, one of the leading healthcare information technology companies, which provides Electronic Medical Records (EMR), Practice Management (PMS) and other Healthcare IT products and services to the providers and clinics across the nation, has announced today that Walker Family Medicine (WFM) located in Willcox, Arizona has adopted the companys EMR and PMS solution in order to improve the quality at point of care.

WFM decided to implement an Electronic Medical Record (EMR) system from day one to access patient medical records, to improve the quality at point of care, to increase productivity and reduce medical errors. Besides the financial benefits, the major objective was to enhance the quality of care as well as the satisfaction of its patients.

"After comparing many EMRs, I determined that OmniMD was the best software for my new clinic. I run a high volume family practice clinic with two mid-level providers. OmniMD is used for scheduling, reminder calls, medical records, insurance and patient billing. OmniMD is a critical tool for my practice. It is a very good software, but I am also very pleased with the level of service OmniMD provides with their technical support team, Dr. Walker (Board Certified in Family Practice) says.

Dr. Walker is pleased with the performance of the OmniMD solution, which allows her to access and maintain entire patient medical records promptly. The system allows the clinic to customize templates as per their specialty, at the same time multiple providers can access a single chart at once. In case of a Specialty Provider, the system allows the sharing of charts among providers and staff across multiple locations. OmniMD Medical Billing System can electronically track claim status, payments and work flow of the billing team. OmniMD Patient Portal allows patients to register on-line, update and view their information, request an appointment, order an Rx refill and view lab reports.

About Walker Family Medicine
The Walker Family Medicine (WFM) team has worked together for over five years while serving the Willcox community. They are committed to providing patient-centered care in order to maintain their community's health. WFM provides routine healthcare for children, including immunizations. WFM also has associations with pediatric specialists. WFM provides routine women's healthcare. This care includes annual gynecological exams, family planning, pre -and post- menopausal counseling and treatment.

WFM has Urgent Care services. The clinic is available to care for patients basic urgent healthcare needs, such as simple lacerations, sprains, fracture diagnosis and care. They are associated with Charles Leighton Hospice and they provide referrals when appropriate. For more information, please visit www.walkerfamilymedicine.com

About OmniMD
OmniMD is a division of Integrated Systems Management, Inc. (ISM), a leader in software development, system integration, business and technology consulting for fortune 500 companies since 1989.

OmniMD integrated Electronic Health Records (EHR) and Practice Management (PMS) product and services, offers unparalleled reliability, ease-of-use, efficiency, and customizability. The solution is a HIPPA compliant, web-enabled and support device, which can range from tablet PCs, handhelds to desktop computers. The solution is SureScripts Certified, which also provides real-time alerts for drug-drug, drug allergy and other interactions based on a patients EMR. The solution captures complete documentation such as HPI, ROS and Physical Exams, Assessment & Plan to complete patient visits. The system follows HL7 standards for information sharing and integration across practices and hospitals. The solution is secured by Thawte, which uses 128bit encryption and digital certificates to ensure complete data security. OmniMD received a 5-star rating in the AC Group survey in 2006. For more information, please visit Medical Billing Services.

Interoperable Electronic Prescribing In The United States: A Progress Report

Although the vast majority of U.S. physicians still handwrite prescriptions, adoption of electronic prescribing is slowly growing. Major barriers to adoption remain, including the inability to electronically submit prescriptions for controlled substances and confusion about standards for data exchange. Federal and state governments and private insurers are using payment and policy incentives to boost e-prescribing because they still believe in its promise for improving the quality and efficiency of health care. However, additional efforts and further investments are needed to reap the benefits of e-prescribing on a national scale.

ELECTRONIC PRESCRIBING BURST ONTO THE health policy scene in 2003 with passage of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). MMA created a prescription drug benefit for Medicare beneficiaries (Part D) and required that Part D plans support an “electronic prescription program,” should any of their providers and pharmacies voluntarily choose to prescribe using computer systems. MMA also called for the adoption and testing of specific technical standards for the data exchange transactions that Part D plans would use.

Medicare and other payers are particularly interested in fostering the use of e-prescribing because it could provide information at the point of care to improve the quality and safety of medication use while lowering medication costs.2 Health plans that have sponsored e-prescribing programs expect an initial return on investment (ROI) simply through increased generic drug use and formulary compliance. For example, the Health Alliance Plan of Michigan estimated a five-year ROI of more than $14 million, based on the 2005 and 2006 improvement in its generic use rate. A new study based on e-prescribing in Massachusetts found that physicians who adopted e-prescribing systems with the ability to check formulary status increased their prescribing of generics and other lower-cost options, resulting in a conservative estimate of savings for consumers and insurers of $845,000 per 100,000 patients per year. Such savings could be particularly important for Medicare, which spent $42.2 billion in 2007 for beneficiaries’ prescription drugs. Such savings also could become increasingly important for private insurers that are facing decreasing investment earnings and enrollment because of the recent economic crisis.

With the impetus from Medicare, e-prescribing has gained momentum. In many areas of the United States, payers, employers, pharmacies, technology partners, professional associations, state governments, legislators, and other stakeholders are working to spur its adoption through incentive payments; legislation; and funding for software, hardware, and connectivity fees.

Since 2006 we have seen a dramatic rise in volume for key transactions: prescription transmissions, eligibility checks, formulary and benefit information, medication history requests in ambulatory settings, and medication requests for patients in acute care settings (Exhibit 1). The numbers reflect both maturing of the market as well as expanding use by prescribers, which is still primarily occurring among early adopters. Read MOre Electronic Prescription

Government Provides Incentives to Encourage E-Prescriptions

Under the Medicare Improvements for Patients and Providers Act (MIPPA) providers who implement e-prescription programs are eligible for incentives. Offices are looking for medical software to help them implement this program and reap the rewards.

The E-Prescription Incentive Program

In 2003 the Medicare Modernization Act (MMA) included provisions for electronic prescriptions. Growing evidence that e-prescriptions reduce medication errors and protect patient safety, as well as physician liability, has motivated many medical offices to convert over but many doctors still depend on paper prescriptions.

This in part led to the creation of the 2009 Electronic Prescribing Incentive Program that rewards providers who use e-prescriptions for their Medicare Part B claims. In 2009 a qualified e-prescriber will be eligible for a 2% incentive payment. The hope is that most or even all providers will seek out medical software that supports e-prescription and adopt that system for growing numbers of patients. The goal is not only to improve public safety but to make Medicare filing more cost effective and save money.

Qualification for the Program

The requirements for participation in the program are quite simple. The medical software used must be able to do the following, quoted directly from the measure specifications:

- Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs) if available

- Select medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts

- Provide information related to lower cost, therapeutically appropriate alternatives (if any). (The availability of an e-prescribing system to receive tiered formulary information, if available, would meet this requirement for 2009)

- Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan (if available) More Read Electronic Prescription

Healthcare Update: Obama Holds Town Hall Meeting In New Hampshire

President Obama held a town hall meeting in New Hampshire today, Tuesday, August 11, in an effort to calm fears over the Democrats’ legislative initiatives to reform healthcare in this country. The meeting was structured, and no visible emotional outbursts were seen as in other meetings with lawmakers across the country.

Obama answered questions posed by attendees, emphatically telling the audience that the current healthcare system solely benefits the insurance industry. With 46 million in the country without health insurance, he tried to reassure his audience that they would be able to keep their current coverage and doctor and that the government would not be “in charge”. Obama hammered on the fact that the government and insurance bureaucrats should not be meddling, that pre-existing conditions will be covered and that insurance companies would not be able to drop or deny coverage or water down coverage. Many of the questions on voter’s minds that were expected to be answered, especially with respect to employers and small businesses, were not addressed.

Numerous recent polls show support for healthcare reform is eroding, and the President’s numbers are dropping as well over fears that a government takeover of our healthcare system in the U.S. will lead to a Canadian style system with long waits for treatments and referrals.

The President’s message today was supposed to address people who already have insurance through their employers and highlight how his proposals would affect them. HAI monitored the town hall meeting and didn’t find the retool of the White House message to have answered those questions. Another town hall meeting with Obama is scheduled for Bozeman, Montana on Friday, and on Saturday, Obama will be in Grand Junction, Colorado.

Meanwhile, the White House has opened a Reality Check website with a viral tool aimed at online healthcare combat on everything from rationing to euthanasia. The website incorporates lessons learned from the Obama presidential campaign, and shows the White House is becoming more aggressive in dispelling what they call misinformation in the healthcare debates.

The August Congressional Recess is not even half over, and Democratic lawmakers are very much at risk of losing control of the public debate over healthcare reform, facing wary constituents and facing a barrage of accusations and criticism over their writing of the legislation prior to leaving Washington. Powerful groups on both sides of the debate are using the August recess to hammer home to lawmakers that there are very serious political consequences to the healthcare issue. Read More EMR Stimulus Package

Government Provides Incentives to Encourage E-Prescriptions

Under the Medicare Improvements for Patients and Providers Act (MIPPA) providers who implement e-prescription programs are eligible for incentives. Offices are looking for medical software to help them implement this program and reap the rewards.

The E-Prescription Incentive Program

In 2003 the Medicare Modernization Act (MMA) included provisions for electronic prescriptions. Growing evidence that e-prescriptions reduce medication errors and protect patient safety, as well as physician liability, has motivated many medical offices to convert over but many doctors still depend on paper prescriptions.

This in part led to the creation of the 2009 Electronic Prescribing Incentive Program that rewards providers who use e-prescriptions for their Medicare Part B claims. In 2009 a qualified e-prescriber will be eligible for a 2% incentive payment. The hope is that most or even all providers will seek out medical software that supports e-prescription and adopt that system for growing numbers of patients. The goal is not only to improve public safety but to make Medicare filing more cost effective and save money.

Qualification for the Program

The requirements for participation in the program are quite simple. The medical software used must be able to do the following, quoted directly from the measure specifications:

- Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs) if available

- Select medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts

- Provide information related to lower cost, therapeutically appropriate alternatives (if any). (The availability of an e-prescribing system to receive tiered formulary information, if available, would meet this requirement for 2009)

- Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan (if available)

In addition, at least 10% of a participating provider’s Medicare Part B services must be made up of specific procedure codes detailed in the measure. More information can be found at http://www.cms.hhs.gov/ERxIncentive/06_E-Prescribing_Measure.asp

What Software Is Required?

There are a number of medical software options available to providers. Many EMR systems include an option for e-prescriptions. The software used doesn’t have to be CCHIT certified which allows a number of inexpensive and free EMR systems to be considered. Read More Electronic Prescription

Healthcare providers see certainty on meaningful use

The requirements for what health IT users need to do to meet the meaningful use dictates of the stimulus law are now clearer, with the focus apparently swinging to how the IT certification process will handle them.

Healthcare providers finally have some certainty about what they need to do to be meaningful users of health IT, said Dr. Bruce Taffel, chief medical officer of SharedHealth, an healthcare information exchange and application provider.

Dr. David Blumenthal, the national health IT coordinator, and the HIT Policy Committee, a public/private organization, approved July 16 a list of 28 health IT functions and corresponding quality and efficiency improvement measures for 2011 that become progressively more rigorous in 2013 and 2015.

The schedule is aggressive and the criteria will be difficult for some to achieve.

“The recommendations provide more clarity at this stage, although there’s still a lot more work to be done,” Taffel said today.

The goals for meaningful use are for providers to electronically capture data, report quality measures and use the data to track patients’ medical conditions. Under the American Recovery and Reinvestment Act, providers will be eligible for increased Medicare and Medicaid payments beginning in 2011 if they demonstrate meaningful use of their certified health IT. The payments end after 2015 when health IT should be broadly adopted.

“The committee shaped their recommendations on meaningful use and the progression to achieve that on the basis of what we can do today, what the current condition is and with a fairly reasonable explanation of how you begin phasing in much of this,” Taffel said.

The policy committee also made its first recommendations on the certification process of electronic health records. Currently, the Certification Commission for Health IT (CCHIT) is the sole certifying and testing organization. The HIT Policy Committee wants more competition.

Multiple groups will be needed to perform certifications because so many more providers will seek to have the service conform to the stimulus, said Paul Egerman, retired businessman and chair of the committee’s certification and adoption work group. Read More EMR

Study places EHRs at core of saving cardiac patients? lives

An EHR program that cut cardiac deaths by 73 percent has also kept patients healthy two years later, according to a new study.

The Kaiser Permanente program in Denver linked coronary artery disease patients and teams of pharmacists, nurses, primary care doctors and cardiologists with an electronic health record to help keep the patients healthy two years after they left the program by keeping them in touch with their caregivers electronically, according to a randomized study.

The study, which was funded by the American College of Clinical Pharmacy, is published in The American Journal of Managed Care this month. It is the first randomized study to evaluate a follow-up system for patients discharged from a cardiovascular risk reduction service, researchers said.

The Clinical Pharmacy Cardiac Risk Service at Kaiser Permanente Colorado combines Kaiser Permanente’s HealthConnect EHR with patient outreach, education, lifestyle adjustments and medication management.

The two-year randomized trial of 421 patients found that patients discharged from the program kept their lipid and blood pressure levels at controlled, healthy levels by receiving electronic reminders.

“Because lack of adherence to medications and failure to maintain treatment goals are so high among heart disease patients, we wanted to find out what would happen to the patients after they were discharged from the program but remained in contact with the healthcare system through our electronic health record,” said the study’s lead author, Kari L. Olson, a clinical pharmacy specialist with Kaiser Permanente Colorado’s Cardiac Risk Reduction program. “The takeaway message here is that we can help support patients in maintaining treatment goals and medication adherence, which is often a challenge with most chronic conditions. Using technology and integrated systems already in place, we can help keep patients healthy for longer and deliver continuity of care in a cost-efficient manner.” Read More EMR

Do You Qualify for a $63,750 Medicaid EHR Bonus?

A new report estimates that as many as 45,000 office-based physicians who participate in Medicaid and use electronic health records, or EHRs, could collect as much as $63,750 paid out over a six-year period as part of the American Recovery and Reinvestment Act of 2009.

Notably, about 9,800 primary care physicians — defined by report authors as family physicians, internists and general practitioners — could qualify for the bonuses.

Boosting Health Information Technology in Medicaid: The Potential Effect of the American Recovery and Reinvestment was issued by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, an arm of George Washington University’s School of Public Health and Health Services in Washington.

The report provides insight into federal EHR funding efforts, according to Leighton Ku, Ph.D., M.P.H., professor of health policy at George Washington University and one of four report authors. He said the team wanted to research the little-explored Medicaid payout because it pays significantly more money than the $44,000 maximum provided by a similar Medicare program.

Ku noted that HHS’ bonus payment rules prevent “double dipping” from the Medicare and Medicaid programs. But “If you’re eligible for both (programs),” said Ku, “you’re probably better off taking the Medicaid money.”

HHS is anxious to expedite EHR implementation and is investing $49 billion in the two programs to help ensure that 40 percent of America’s physicians are up to speed with health information technology by 2012.

That goal may be difficult to attain. According to 2006 data from the National Ambulatory Medical Care Survey, only 15 percent of U.S. physicians have fully implemented EHRs; another 16 percent have begun the implementation process, and 69 percent do not use an EHR system.

Medicaid Bonus Criteria

To receive the Medicaid bonus, physicians must meet criteria beyond using a certified EHR. For example, to qualify for the full bonus, at least 30 percent of a physician’s patient panel must be enrolled in Medicaid.

Physicians who practice in federally qualified health centers or rural health clinics have less stringent criteria — they need only claim that 30 percent of their patients are “needy individuals.” As such, the patients must be covered by Medicaid, provided with free care or billed on a sliding-fee scale.

The authors point out that “after-the-fact debt forgiveness is not sufficient to classify a provider as one who serves ‘needy’ patient who are uncovered by Medicaid.” Read More EMR Stimulus Package

Docs see money faster with automation

HUDSON, IA – Full-practice automation seems to pay off for many small physician offices, but others who choose only select areas to convert are feeling the positive financial effects as well.

Kurt Kastendieck, MD, a family practitioner in Sante Fe, N.M., is in the process of automating his practice and finds his e-prescribing tool to be particularly useful.

“It works well,” he said. “Things like refill communications are automatically sent back. It saves an amazing amount of time.”

The e-prescribing program came with Kastendieck’s EHR, which he installed two years ago. He also bills through the system.

Larger pharmacies are better equipped for e-prescribing, but not many smaller pharmacies are, Kastendieck said. Some still take prescriptions by phone or fax.

The e-prescribing tool calculates and produces a 24-hour turnaround bill through the clearinghouse and on to the insurance company. Kastendieck said reimbursement now averages two weeks from a patient’s visit.

Automation, such as e-prescribing, helps improve a doctor’s quality of life, said Kastendieck. one doesn’t need a complete EHR, only Internet access.

Theresa Dickson, who manages her husband’s solo general surgery practice in Dennison, Texas, says electronic billing technology brings the money in quicker, even without an EHR.

“The few practices I know of out there that paper bill their claims simply budget the practice to allow for the 45 day delay in payment as opposed to 20-30 days that we experience,” she said.

Dickson said many IT companies say an EHR will save money because physicians will need less room to store charts. However, Dickson says the monthly fees for the use of an EHR often outweighs the cost of hard copy storage.

“I have seen monthly fees of $500 to $1,500 a month for one doctor,” she said. “We are not being reimbursed by our major carriers enough to offset that cost. In our particular community, real estate is relatively inexpensive, so for me personally it would cost me less to store charts.” Read More EMR

Electronic Health Records: The $20 Billion Prescription

WASHINGTON (ISNS) –The progress and problems in developing a national system of electronic medical records topped the agenda Thursday as the Obama Administration’s “best and brightest” from the world of science, medicine and technology gathered in Washington for the inaugural meeting of the President’s Council of Advisors on Science and Technology (PCAST).

David Blumenthal, the national coordinator for health information technology, said there was an “appalling lack of use of technology” in the U.S. medical record-keeping system. “Only 20 percent of physicians and 10 percent of hospitals have meaningful electronic records,” he told the 21-member panel. The transition from the paper-based medical record-keeping system to an electronic one is a priority in President Barack Obama’s push for health care reform, Blumenthal said, as a way to save money over the long run and improve the quality of health care.

In February, Obama signed the American Recovery and Reinvestment Act, which would put $20 billion toward what Blumenthal called a “completely revised, interoperable, integrated health information system.” The system, which is supposed to be functional by 2014, will actually be many different electronic records systems developed by private companies that meet a host of federal standards and requirements that are currently being developed.

“Paper records put us in a suboptimal position [to improve health care],” said Eric Lander, a co-chair of PCAST and the director of the Broad Institute, a medical genetics research program in Cambridge, Mass., run by both Harvard University and the Massachusetts Institute of Technology. An electronic records system, in addition to allowing a patient’s medical records to be shared among doctors, could allow medical researchers to “mine data and combine data” to do faster, more sophisticated medical studies, he said.

Blumenthal said the point of the system isn’t the technology itself, but how that technology is used. “There is very little about the health care system that doesn’t concern us or that we can’t affect in some way,” he said. “We are enabling information to be more accurate and available at the point of care.”

“Use” is one of three area of concern for the scientists and others developing the records system. The other areas focus on getting doctors and hospitals to adopt the electronic system, and, once they have it, how to use it to efficiently exchange information. Read More EMR Stimulus Package

Interoperable Electronic Prescribing In The United States: A Progress Report

Although the vast majority of U.S. physicians still handwrite prescriptions, adoption of electronic prescribing is slowly growing. Major barriers to adoption remain, including the inability to electronically submit prescriptions for controlled substances and confusion about standards for data exchange. Federal and state governments and private insurers are using payment and policy incentives to boost e-prescribing because they still believe in its promise for improving the quality and efficiency of health care. However, additional efforts and further investments are needed to reap the benefits of e-prescribing on a national scale.

ELECTRONIC PRESCRIBING BURST ONTO THE health policy scene in 2003 with passage of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). MMA created a prescription drug benefit for Medicare beneficiaries (Part D) and required that Part D plans support an “electronic prescription program,” should any of their providers and pharmacies voluntarily choose to prescribe using computer systems. MMA also called for the adoption and testing of specific technical standards for the data exchange transactions that Part D plans would use.

Medicare and other payers are particularly interested in fostering the use of e-prescribing because it could provide information at the point of care to improve the quality and safety of medication use while lowering medication costs.2 Health plans that have sponsored e-prescribing programs expect an initial return on investment (ROI) simply through increased generic drug use and formulary compliance. For example, the Health Alliance Plan of Michigan estimated a five-year ROI of more than $14 million, based on the 2005 and 2006 improvement in its generic use rate. A new study based on e-prescribing in Massachusetts found that physicians who adopted e-prescribing systems with the ability to check formulary status increased their prescribing of generics and other lower-cost options, resulting in a conservative estimate of savings for consumers and insurers of $845,000 per 100,000 patients per year. Such savings could be particularly important for Medicare, which spent $42.2 billion in 2007 for beneficiaries’ prescription drugs. Such savings also could become increasingly important for private insurers that are facing decreasing investment earnings and enrollment because of the recent economic crisis.

With the impetus from Medicare, e-prescribing has gained momentum. In many areas of the United States, payers, employers, pharmacies, technology partners, professional associations, state governments, legislators, and other stakeholders are working to spur its adoption through incentive payments; legislation; and funding for software, hardware, and connectivity fees.

Since 2006 we have seen a dramatic rise in volume for key transactions: prescription transmissions, eligibility checks, formulary and benefit information, medication history requests in ambulatory settings, and medication requests for patients in acute care settings (Exhibit 1). The numbers reflect both maturing of the market as well as expanding use by prescribers, which is still primarily occurring among early adopters. Read More Electronic Prescription

HHS Issues Privacy Guidance Promising to Rule by Reason

The Department of Health and Human Services (”HHS”) issued comprehensible, no surprises guidance under the final HIPAA privacy rule that went into effect on April 14, 2001. From the perspective of all but the health care provider community, the guidance was pretty much a nonevent; HHS addresses issues that are primarily of relevance to providers. If there is a message that resonates with all covered entities under the rule, it is that the sky is not falling and a rule of reason will be the Government’s compliance mantra. On the other hand, covered entities (and others affected by the rule) should not hold out hope that the rule will still change in any significant way. Any implementation activities delayed on that basis should now move forward.

The absence of any real policy change in the guidance was widely expected. When HHS reopened the comment period earlier this year, there was initial widespread speculation (fueled to some degree by the new administration) that the Bush administration would delay the rule’s effective date and go back to the drawing board on some of the more controversial issues. The issues thought likely to be revisited included preemption of state laws, “minimum necessary” use and disclosure, the need for business associate contracts, and oral versus electronic transmission of data. This speculation was short lived. Although HHS Secretary Tommy Thompson simultaneously allowed the rule to go effective on April 14 and promised soon to issue guidelines and/or modifications, the most knowledgeable observers doubted he would support any modification without following the notice and comment requirements of the Administrative Procedure Act (”APA”). This collective wisdom was right. The July 6 guidance clarifies several controversial provisions and only portends modifications (that will be made in accordance with the APA) in at least four areas. These planned modifications are at the margin of the rule and will have no significant effects on implementation efforts.

Guideline Overview – Plenty for Providers but Only Snippets for the Rest of the Health Care Community

Much of the guidance addresses “common sense” interpretations of the privacy rule in the context of a debate that has, on occasion, focused on extreme views. Overall, there is little that is new. As anticipated, HHS does not address some of the more controversial provisions of the rule, such as a parent’s guaranteed access to a child’s health records and the perimeters of “minimum necessary,” both of which it now intends to address through rule modification. It is also silent on the preemption of state laws.

For health plans, the guidance is of much more limited relevance than for providers. But one key message should be heard by all covered entities, not just providers: the guidance stresses the reasonableness of compliance efforts by covered entities. In the minimum necessary discussion, for example, HHS states that covered entities have “substantial discretion” in implementing the minimum necessary standard and may rely on “standard protocols” for routine disclosures. Further, this standard “is intended to make covered entities evaluate their practices and enhance protections as needed to prevent unnecessary or inappropriate access to [protected health information]. It is intended to reflect and be consistent with, not override, professional judgments and standards.” Although the guidance focuses on “disclosure” versus “use” of protected health information, it implies that covered entities will be required to be reasonable in all their actions, not adhere to wooden absolutes. Thus, HHS is unlikely to nitpick a covered entity’s implementation of the rule or its day-to-day operation under the rule, where its actions are “reasonable” for a covered entity of its size and sophistication.

In terms of actual guidance for health plans, there are a few items of interest. First, the overlap between “treatment, payment and health care operations” (”TPO”) and “marketing,” is discussed with a clarification that certain marketing communications must receive an authorization (or at least an opt-out opportunity) even if they also fit within payment or health care operations. Thus, if an action constitutes both marketing and health care operations, the health plan must meet all HIPAA requirements concerning marketing communications.

Second, the guidance arguably “clarifies” that when a health plan must obtain protected health information from a provider to complete certain Coordination of Benefits (”COB”) or third-party payer transactions, the health plan must first receive the patient’s authorization. HHS explains that since “the provider’s disclosure is for the TPO purposes of the plan [and not the provider], it would not be covered by the provider’s consent” obtained from the same patient. Putting aside the question of how often this COB fact pattern actually arises, to many this clarification seems more like a misreading of the final rule. For example, some believe that the rule provides that if the consent given to the provider relates to TPO, it does not matter if it is for the purposes of the TPO of the provider or the TPO of the plan. However, the rule and preamble appear silent on this issue, leaving one to ask if HHS has inadvertently modified the rule. Clearly, the ramifications for other TPO issues are great. Read More Electronic Prescription

State Governments Join Push For Health IT

State governments around the country are working to facilitate, and in some cases, enhance, Washington’s stimulus-funded incentives for doctors and hospitals that adopt new health information technology. “A group of the nation’s governors and state officials has released a guide for state implementation of the Health Information Technology for Economic and Clinical Health Act,” the formal name for the portion of the stimulus bill, McKnight’s Long-Term Care News reports. A key recommendation is that state leaders create health information exchanges so providers can readily share information to improve coordination of care (8/7).

Meanwhile, members of the National Lieutenant Governors Association called for support of “advance interoperable health IT and its adoption among providers” in a resolution this week, Modern Healthcare reports. They call on states to adopt systems with the stamp of approval of the Certification Commission for Health Information Technology, a group affiliated with an e-health industry association (DerGurahian, 8/6). EMR Stimulus Package

Louisiana creates loan program for EHR purchases

Louisiana Gov. Bobby Jindal signed into law a bill that would create a loan program for physicians and hospitals hoping to buy an electronic health record system.

The Electronic Health Records Loan Program Act, signed July 9, gives the Louisiana Dept. of Health and Hospitals the authority to apply for $25 million in federal stimulus funds in order to administer loans for EHR purchases. The measure also included $5 million in matching funds from the state, a requirement under the American Recovery and Reinvestment Act. The state will learn later this year if it will get the federal grant.

“This is another step in updating and improving Louisiana’s health delivery system for all Louisianians,” Jindal said in a prepared statement.

The measure builds on legislation passed in 2007 that helped seven rural hospitals acquire EHRs. The law also established the Louisiana Rural Health Information Exchange. In 2008, additional funding allowed another seven rural hospitals to become connected.

To qualify for the loans, the purchased EHR system must be certified by the body eventually chosen by the U.S. Dept. of Health and Human Services for such approval. Loans could also apply to fully integrated telemedicine systems.

Acknowledging upfront costs are a barrier that the incentives wouldn’t help alleviate, many EHR vendors also launched financing options for physician practices as a result of the stimulus. General Electric Co., for example, is giving practices the options of deferring payments until incentives start being paid in 2011.

Jenny Smith, health information technology project manager for the Louisiana Health Care Quality Forum, which is the state-designated entity for distributing all grants coming out under the federal stimulus package, said details are still being worked out in terms of the loan agreements. Work groups consisting of several stakeholders in the state are currently working on structuring the loan program, she said. EMR

State Alliance for e-Health issues HIT exchange guidance

The State Alliance for e-Health issued new guidance on Tuesday for state health information exchanges.

The executive-level organization, composed of governors, state legislators, attorney generals and state commissioners, included information on how states can lead the way in using health IT as they begin instituting the federal Health Information Technology for Economic and Clinical Health (HITECH) Act.

The HITECH Act, enacted as part of the 2009 American Recovery and Reinvestment Act, expands the role of states in fostering health information exchange and adoption of electronic health records over the next five years.

“Governors understand that swift and thoughtful action is needed at the state level to plan and implement a national system of health information exchange,” said Tennessee Gov. Phil Bredesen, co-chairman of the alliance. “Widespread adoption and use of electronic health records provides a critical foundation for improving health outcomes and cost-effectiveness.”

The report recommends actions states should take now to qualify for the HITECH Act, including:

* Preparing or updating the state plan for HIE adoption;
* Engaging stakeholders;
* Establishing a state leadership office to manage the different phases of HIE implementation;
* Preparing state agencies to participate;
* Implementing privacy strategies and reforms;
* Determining the HIE business model;
* Creating a communications strategy; and
* Establishing opportunities for health IT training and education.
Read More EMR Stimulus Package

?Meaningful use? revisions receive mixed reviews

Providers looking to make decisions about technology will find the revised “meaningful use” definition helpful, but the implementation timeline might still be challenging, professionals say.

The federal Health Information Technology Policy Committee approved updated recommendations from its meaningful use work group during a conference. The revised definition for the meaningful use of electronic health records includes changes to computer physician order-entry criteria and speeds up the schedule for granting real-time access to patient information through personal health records. The 2011 measures are being established with a focus on data capture and sharing, according to the work group’s recommendations.

Overall, the revisions “have some nice granularity to them,” said Brian Jacobs, a critical-care physician and chief medical information officer of 230-bed Children’s National Medical Center, Washington. As the medical center finishes components of its EHR, the revised measures will serve as guidelines for what it needs to focus on, he said. The medical center is already available for the full, first-year IT adoption incentive payment under the American Recovery and Reinvestment Act of 2009 because it meets the 2011 criteria now. EMR

Electronic health records facing a tough sell to doctors

Dr. David Blumenthal, the Obama Administration’s national coordinator for health information technology, can recall the day he became a true believer in the potential of electronic health records. He was about to order a lung scan when the computer in his Boston hospital alerted him to a similar image already in the file. The patient was spared an unnecessary dose of radiation and the health care system was spared the cost of an unnecessary test.

Such experiences, he said, “suggest… how small victories… can lead us to be better physicians, higher quality physicians.” That thinking is informing his actions as head of the Office of the National Coordinator, which wants doctors to use electronic medical records as part of a broader effort to modernize the health care system.

Blumenthal’s office, along with two advisory panels, reported Thursday on their progress in developing the framework for the $33 billion health information technology initiative. The undertaking, which began with the February passage of the stimulus bill, has required that they define key terms, such as “meaningful use,” that will guide doctors as they adopt electronic health records. They are also setting the minimum requirements physicians will have to meet in order to receive financial incentives.

For Blumenthal, the most difficult challenge will be to convince doctors that participating is worth it. Even with assistance from the federal government, physicians will have to spend big money on the digital transition. And the return on their investment is murky. Blumenthal must show doctors how this program is good for them by identifying goals for improvements, and ultimately, savings in their practices. Read More EMR

Obama says he will reform US healthcare by end of year

US PRESIDENT Barack Obama has promised to overhaul the American healthcare system by the end of this year – without Republican support if necessary.

Speaking in Indiana after a town hall meeting to promote his economic policies, the president said he would prefer to sign a bipartisan healthcare Bill but it was not yet clear if negotiations with Republicans would prove fruitful.

“Sometime in September we’re going to have to make an assessment,” he told MSNBC. “I promise you, we will pass reform by the end of this year because the American people need it.”

Mr Obama told his audience in Elkhart, which experienced the sharpest unemployment rise in the US last year, that he would issue $2.4 billion in taxpayer grants to create electric cars and tens of thousands of jobs.

“For too long, we failed to invest in this kind of innovative work, even as countries like China and Japan were racing ahead,” he said.

“That’s why this announcement is so important – this represents the largest investment in this kind of technology in American history.”

Mr Obama identified energy, innovation, healthcare and education as the pillars of the new US economy he wants to build from the wreckage of the recession.

“Now, there are a lot of people out there who are looking to defend the status quo. There are those who want to seek political advantage. They want to oppose these efforts.

“Some of them caused the problems that we got now in the first place, and then suddenly they’re blaming other folks for it. They don’t want to be constructive. They don’t want to be constructive; they just want to get in the usual political fights back and forth,” he said to applause.

“But you and I know the truth. We know that even in the hardest times, against the toughest odds, we have never surrendered. We don’t give up. We don’t surrender our fates to chance. We have always endured. We have worked hard, and we have fought for our future.

“Our parents had to fight for their future; our grandparents had to fight for their future. That’s the tradition of America.

“This country wasn’t built just by griping and complaining. It was built by hard work and taking risks. And that’s what we have to do today.”

Republicans, who have opposed all Mr Obama’s key proposals, from the economic stimulus package to healthcare reform, see in the president’s declining popularity an opportunity to make gains in next year’s congressional elections. More Read EMR Stimulus Package

Spring Hill collects more on medical bills than county

The Spring Hill fire district has collected at least 90 percent of its medical billing nearly every year since 2003 - a double-digit improvement compared to the county’s fire and rescue services.

For the five annual billing cycles beginning September 2003 and ending September 2008, Spring Hill Fire Rescue collected 90 to 91 percent of its net charges for patients who were transported and-or treated.

On average, the district failed to collect less than $208,500 per year since September 2003, according to records obtained by Hernando Today.

“That’s not too bad. That’s actually a pretty good number,” said Rajeev Rajagopal, co-owner of Managed Outsource Solutions out of Tulsa, Okla. “Whenever you’re dealing with ambulance calls, you have a lot of patients who may not have enough money for medical bills. That definitely falls into play.”

A perfect score is impossible because sometimes the patients are deceased by the time the billing process is filed, said Spring Hill Fire Chief Mike Rampino.

“I’m very happy about it,” the chief said about the numbers from the past six years. “It’s something to be proud of. We’re doing the best we can with what we have, and I’m proud of what they do.”

Hernando County Fire Rescue’s numbers also are considered better than average. For the billing cycle from April 1, 2007, to March 31, 2008, the department collected 80 percent of what it charged. During the same period the following year, the county collected 74 percent, but that number is likely to increase as some patients complete their payment plans, said Hernando County Fire Chief Mike Nickerson.

“Our net collection rate of 75 to 80 percent is consistent with, or higher than, the regional average and is an improvement from the average 70 percent collection rate by our previous billing company, dating back to 2006 and prior,” Nickerson said. Read More Medical Billing Outsourcing

Electronic health records overlooked in healthcare debate

One part of President Obama’s healthcare agenda that has been nudged out of the spotlight is the push to create a nationwide network of electronic health records (EHR) by 2014. McKnight’s will hold a webcast on this issue later this month.

Even though a deadline is in place, EHR faces significant challenges toward implementation. One of the main factors holding back EHR adoption is the sheer cost of the undertaking, according to CNNMoney.com. Depending on the size of the facility, an EHR system can cost tens of millions of dollars to implement, and take years to get off the ground. One Kentucky hospital system will require $80 million and three years to fully implement an effective EHR system, CNN reported. Convincing physicians to change their long-held practices can be a challenge as well, according to the report. Smaller rural facilities face other challenges, including lack of training and resistance to change. The long-term care industry has long been considered ahead of the curve in EHR adoption practices. Read More EMR