On Sept. 4, 2014, the Centers for Medicare and Medicaid Services (“CMS”) published a final rule that, effective Oct. 1, 2014, implements changes to the Medicare and Medicaid Electronic Health Record Incentive Program in light of industry-wide difficulties in transitioning to EHR technology certified to the 2014 Edition EHR certification criteria (“2014 Edition CEHRT”) during calendar year 2014 for eligible professionals and fiscal year 2014 for eligible hospitals and critical access hospitals. CMS makes no changes to the existing 2014 reporting periods or the requirement in future reporting periods to report for a full year.[1] This final rule also extends Stage 2 for an additional year for those providers first demonstrating meaningful use in 2011 or 2012. Instead of starting Stage 3 in 2016, those providers will now start Stage 3 in 2017. The timeframe for Stage 3 implementation by providers that first demonstrated meaningful use after 2012 is unchanged by this final rule.
Kevin Alonso
Prior to these changes, providers were required to use 2014 Edition CEHRT to demonstrate either Stage 1 or Stage 2 meaningful use in 2014. The shortened 2014 attestation periods implemented in the 2012 final rule were aimed at helping providers make the transition from 2011 Edition CEHRT to 2014 Edition CEHRT, but delays affecting the availability of, and the ability of providers to implement, 2014 Edition CEHRT meant that many providers still might be unable to demonstrate meaningful use, despite their best efforts.
To provide some additional flexibility, CMS will now provide three alternatives routes to demonstrate meaningful use in 2014 for providers facing such difficulties: (1) using 2011 Edition CEHRT only, (2) using a combination of 2011 and 2014 Edition CEHRT, or (3) using 2014 Edition CEHRT for Stage 1 objectives and measures in 2014 for providers scheduled to begin Stage 2. These alternatives will also provide some flexibility in the objectives and measures that providers must meet to demonstrate meaningful use, as summarized in the chart below.[2]
Congresswoman Renee Ellmers (R-NC-02) released the following statement after introducing H.R. 5481 – The Flexibility in Health IT Reporting (Flex-IT) Act of 2014:
“Healthcare providers have faced enormous obstacles while working to meet numerous federal requirements over the past decade. Obamacare has caused many serious problems throughout this industry, yet there are other requirements hampering the industry’s ability to function while threatening their ability to provide excellent, focused care.
“The meaningful use program has many important provisions that seek to usher our healthcare providers into the digital age. But instead of working with doctors and hospitals, HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans. Dealing with these inflexible mandates is causing doctors, nurses, and their staff to focus more on avoiding financial penalties and less on their patients.
Congressman Jim Matheson
“The Health IT Reporting Act will provide the flexibility providers need while ensuring that the goal of upgrading their technologies is still being managed. I’m excited to introduce this important bill and look forward to it quickly moving on to a vote.”
Congresswoman Renee Ellmers introduced H.R. 5481 – the Flexibility in Health IT Reporting Act of 2014. The legislation would allow healthcare providers to receive the flexibility they need to successfully comply with meaningful use program.
On August 29th, the HHS published a short-sighted final rule, maintaining a provision that requires providers to perform a full-year EHR reporting period in 2015. According to Ellmers, “The Flex-IT Act will allow providers to report their health IT upgrades in 2015 through a 90-day reporting period as opposed to a full year. This shortened reporting period would be an important first step in addressing the many challenges faced by doctors, hospitals and other medical providers due to the inflexible mandates of the meaningful use program.”
HIMSS released the following infographic that summarizes the findings of 25 years of health IT from its annual leadership surveys. It’s a pretty good depiction of how health IT has changed in the last quarter century. Looking back on the past twenty five years in healthcare, something are fairly interesting. For example, physicians in 1993 said they would not adopt their use in healthcare until they became easier to use. The sentiment still remains, to a certain degree, especially in regard to systems like electronic health records.
Another interesting factoid, is that in 1994, 14 percent predicted that digital patient information would be shared nationwide in one to three years.
Finally, the number of health IT priorities that has changed in the course of the last 25 years is either alarming or inspiring, based on the level of change in the space and how quickly things continue to change. However, the number of changes and their frequency remind me of a dog on a trail stalking down one scent after another without a real sense of purpose – Y2K, HIPAA, patient safety, reducing medical errors, financial survival, meaningful use, etc.
U.S. patients are likely to face growing challenges in access to care if shifting patterns in medical practice configurations and physician workforce trends continue. This is one of the key findings of a major new survey of 20,000 physicians commissioned by The Physicians Foundation, a nonprofit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients
According to the research, titled “2014 Survey of America’s Physicians: Practice Patterns and Perspectives,” 81 percent of physicians describe themselves as either over-extended or at full capacity, while only 19 percent indicate they have time to see more patients. Forty-four percent of physicians surveyed plan to take steps that would reduce patient access to their services, including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking non-clinical jobs, leading to the potential loss of tens of thousands of full-time-equivalents (FTEs). As the ranks of Medicare and Medicaid patients increase – in 2011, more than 75 million baby boomers began turning 65 and qualifying for Medicare – and millions of new patients are insured through the Affordable Care Act, patient access to care could pose significant health delivery and policy challenges.
“America’s physician workforce is undergoing significant changes,” said Walker Ray, M.D., vice president of The Physicians Foundation and chair of its Research Committee. “Physicians are younger, more are working in employed practice settings and more are leaving private practice. This new guard of physicians report having less capacity to take on additional patients. These trends carry significant implications for patient access to care. With more physicians retiring and an increasing number of doctors, particularly younger physicians, planning to switch in whole or in part to concierge medicine, we could see a limiting effect on physician supply and, ultimately, on the ability of the U.S. healthcare system to properly care for millions of new patients.”
In honor of National Health IT Week Sept. 15-19, 2014, American Sentinel University offers tips to health IT professionals for gaining a competitive edge in the healthcare marketplace.
A recent study by HIMSS shows demand for qualified health IT professionals are at an all-time high and a candidate’s skill set is the differentiating factor when filling a position. The skill most desired is that of an IT professional that has clinical workflow and terminology experience. American Sentinel offers specialization in healthcare, giving students a competitive advantage in the clinical IT environment.
“Technology and healthcare are two ever-changing industries. When the two collide it creates dynamic and exciting challenges for health IT professionals,” says Blair Smith, Ph.D., dean of Informatics-Management-Technology programs at American Sentinel University. “Electronic Medical Record (EMR) implementation has become the focal point and while it offers tremendous capabilities, it also creates a multitude of challenges for today’s IT professionals. Those with in-demand skills will find themselves far more marketable.”
At the top of the list of challenges includes data management, application management, BYOD, patient privacy, HIPAA compliance, business intelligence and analytics and risk management.
The HIMSS study found that a higher percentage of respondents said that their organizations were interested in either training current employees or hiring recent graduates to fill needed positions, but 85 percent of respondents said their organizations faced barriers meeting their health IT needs. The majority cited a lack of qualified talent and 40 percent of those surveyed said they have open positions for which they cannot find qualified talent.
Guest post by Rhonda Collins, MSN, RN, chief nursing officer of Vocera.
Studies show that cell phones can carry more bacteria than a toilet seat. This is a disturbing topic for anyone, but should be duly noted by those of us in healthcare. With hospital cell phone policies changing, it’s crucial that we focus on infection control as a priority for any mobile communication device in the hospital. A Spyglass Consulting Group survey revealed that regardless of a hospital’s device policy, staff nurses are using personal smartphones to support clinical communications and workflow. In addition, a whopping 51 percent of hospitals plan to invest in or evaluate their smartphone solutions over the next 18 months.
This movement toward a more mobile healthcare workforce is an exciting change that will allow clinicians to become more connected to both patients and colleagues. While this change will make a sizeable impact on the way that hospitals operate, devices that are surrounded by the sickest patients are of greater concern as they can transfer bacteria both to and from the patient. This poses potential harm to everyone in the environment.
The Centers for Disease Control and Prevention (CDC) found that one out of every 25 hospital patients contracts a healthcare-associated infection (HAI). This means that about 722,000 patients face hospital acquired infections annually. The most common HAI that hospitals are seeing today include pneumonia (22 percent), surgical site infections (22 percent), gastrointestinal infections (17 percent), urinary tract infections (13 percent) and bloodstream infections (10 percent), all urgent and uncomfortable situations that pose a major threat to patient safety.
In a letter to HHS Secretary Sylvia M. Burwell, the College of Healthcare Information Management Executives (CHIME), the Association of Medical Directors of Information Systems (AMDIS) and 15 other healthcare organizations issued an immediate call to action to adjust the 2015 EHR reporting period to help hundreds of thousands of providers meet Meaningful Use Stage 2 requirements in an effective and safe manner.
Responding to the Centers for Medicaid and Medicare Services’ (CMS) final rule on meaningful use flexibility, the letter states the agency’s decision to require a full-year of reporting using 2014 Edition certified EHR technology (CEHRT) in 2015 puts many eligible hospitals and physicians at risk of not meeting Meaningful Use next year and hinders the forward trajectory of the program.
“We implore you to take immediate action by shortening the 2015 EHR reporting period to 90 days and by adding flexibility in how providers meet the Stage 2 requirements,” the letter states. “The additional time and flexibility afforded by these modifications will help hundreds of thousands of providers meet Stage 2 requirements in an effective and safe manner. This will reinforce investments made to date and it will ensure continued momentum towards the goals of Stage 3, including enhanced care coordination and interoperability.”
For the ninth year, national health IT week is in full swing, from Sept. 15 – 19, 2014. Those in healthcare, policy makers and stakeholders have come together to “collaborative forum for public and private healthcare constituents to discuss the value of health information technology (IT) for the U.S. healthcare system.”
HIMSS is again hosting a lineup of events and activities centered in the DC. According to the organization, the event is designed as health IT continues its advancement to “improve the quality of healthcare delivery, increase patient safety, decrease medical errors, and strengthen the interaction between patients and healthcare providers.”
For those of us in health IT, NHIT Week is a forum, a conversation starter and an awareness builder that assembles healthcare constituents dedicated to working together to elevate the necessity of advancing health through the best use of information technology. As a brand awareness campaign, the effort is paying off and bringing about deeper conversations with health IT game changers, leaders and those who wish to learn more about the ramifications of the technology on the overall landscape.
That said, and because of the importance of the event, I asked a few folks for their reaction to NHIT Week. Their responses follow:
Arvind Subramanian, president and CEO, Wolters Kluwer Health, Clinical Solutions
Arvind Subramanian
Vision, innovation, hard work and perseverance are foundational to any significant change for the better. These are fundamental components of the health IT movement—an ever-evolving landscape that has experienced tremendous successes, along with its share of challenges.
National Health IT Week offers a platform for celebrating progress and expanding awareness of the tremendous potential of health IT to advance healthcare’s broader goals of improved outcomes and lower costs. It’s an opportunity for those deeply involved in the movement and those watching it unfold from a distance to come together and remember what forms the core of its agenda: improving the human experience and saving lives.
Here at Wolters Kluwer Health, we have the advantage of seeing the outcomes associated with advances in clinical content integration, clinical knowledge management and data analytics every day. Whether it’s a highly effective response to a public health crisis or the ability to mitigate adverse outcomes through real-time patient surveillance, our clients are experiencing a transformation to more highly-effective care delivery.
