Guest Column by Val Van’t Hul, Meaningful Use Project Manager, DocuTAP.
Val Van’t Hul
Providers at urgent care centers around the country are preparing to attest for either Stage 1 or Stage 2 meaningful use this year, and knowing the differences in reporting periods can make a huge difference in the process. Reporting periods vary depending on which stage an eligible professional (EP) is in, and whether a provider is attesting through the Medicaid or Medicare EHR incentive program.
To further explain this process, here are the reporting periods for 2014 indicated by the Centers for Medicare & Medicaid Services (CMS):
Medicaid
An EP must select any 90-day reporting period that falls within the 2014 calendar year. Since Medicaid is state government-based, urgent care centers are tasked with researching any particular rules and regulations that pertain to their location, as these vary from state to state.
Medicare
An EP participating in the first year of meaningful use (Stage 1, year 1) must select any 90-day reporting period. However, to avoid the 2015 payment adjustment the EP must begin the reporting period by July 1 and submit attestation data by October 1, 2014. This grace period is designed to help clinics that are still working out best practices and processes for attestation.
Medicare – An EP who is beyond their first year of Meaningful Use (Stage 1, year 2 or beyond) must select a three-month reporting period that is fixed to the quarter of the calendar year (i.e. July to September or October to December). There is not one quarter that is better than others for reporting, but clinics should keep in mind that there should be ample time to implement any changes in clinical workflow prior to the start of the reporting period. If an EHR vendor is properly certified for Meaningful Use and the urgent care client can begin the process, they may choose a later reporting period to allow time to properly order their workflow.
Meaningful Use Tracking & Reporting
Urgent care centers should monitor clinical workflow progress often to benchmark the eligible professional’s progress in working toward achieving Meaningful Use objectives. It is wise to run meaningful use reports from the EHR software, as well as conduct a provider analysis every few weeks to find out where and how adjustments need to be made in the progression toward these objectives. If EPs are falling below a preferred threshold in any area, this benchmarking provides ample time to get up-to-speed on clinic initiatives.
In addition to implementing tracking measures, it is necessary to understand the importance of delineating between “yes or no” and numerator/denominator reports. While the former are fairly self-explanatory (i.e. as with drug interaction checks), clinics should take careful documentation measures to prove compliance, including taking regular screenshots of what is happening in a clinic’s EHR software system during the reporting period. For example, when pop-ups of patient medicinal allergies occur, a screenshot of this notification, along with a date/time stamp, should be taken and a copy kept on file for up to six years, as this is the standard amount of time for which CMS may audit the eligible professionals.
What follows is a fascinating graphic from NueMD, which asks a simple, yet provocative question: Is meaningful use helping or hurting EHR adoption?
CMS launched the program to “reward healthcare practitioners for adopting electronic health records and increasing efficiency within their practice.” According to the graphic, and the research complied here, 2013 was a successful year by all accounts as far as EHR adoption is concerned. However, as pointed out by NueMD, attestation of meaningful use is slowing.
Particularly alarming are the figures from the small practice space, with 50 percent or so of these physicians groups implementing the technology, yet only 25 percent or so of this group attesting and receiving incentives for doing so.
Additionally, satisfaction with using EHR technology also has dramatically decreased for those who might be called technology champions while those who might be labeled as EHR “haters” have begun to hate the technology even more.
Finally, of those deciding to make the technology switch to a new system cite lack of system functionality as the primary reason for doing so. So, of the physicians that are not implementing the systems, are they simply deciding to absorb the financial penalties mandated by the feds? If that’s the case, what will the outcome of meaningful use be?
And, if efficiencies are not gained, as promised, are we really any closer to an improved healthcare system where physicians, especially those in small practices, actually get to spend time with the patients they desire to serve?
Guest post by Dr. Alex Backer, founder and CEO, QLess.
We’ve all been there—sitting for hours in a waiting room of patients requiring medical care. With only a nine-month-old copy of TIME magazine to entertain you, your mind will likely wander to your fellow patients. What ails them? Avian flu? Tuberculosis? The measles? It’s no wonder that patients who have to endure long waits and exposure to other ailments either walk away or become less than enamored with their healthcare provider.
Nearly one in four patients echo the same complaint when visiting an urgent care center, hospital or their primary care physician: time spent waiting, and waiting and waiting some more before they are seen. People are impatient when it comes to waiting for anything. This is even worse when related to medical attention. Long waits at medical offices create an awful first impression and a stressful atmosphere that also adversely effects staff. Worst of all, the long waits and the resulting issues could be so easily avoided.
So how do you ease the pain for your patients and staff? Start by defining how you like to be treated when visiting medical offices or other service providers. Then share a commitment across your team to maintain a patient experience based on respect, thoughtfulness and efficiency. Lay down ground rules and targets that are achievable and actively promote these to your team and patients. On an ongoing basis, recognize and praise your team’s achievements in meeting goals and going beyond in their efforts to engage patients effectively.
Technology can also play a huge role in eliminating waiting room frustrations. Wait management solutions take the pain out of appointment setting and management for both your patients and your office. Beyond the improvement this offers to the patient experience, time slots are optimized and resources aligned automatically.
How It Works
Virtually everyone carries a mobile device. So why not empower patients to interact with you via their phones, or even their computers? QLess, a wait technology provider of mobile queue solutions, offers a simple-to-use and easy-to-monitor-and-manage solution that does the following:
Guest post by Travis Good, M.D., CEO and co-founder of Catalyze, Inc.
Even if a bit delayed, the power and value of cloud-based technologies is starting to seep into healthcare. With each new cloud-based technology piloted or taken to scale by a healthcare organization, other institutions and corporations become more willing to roll the dice on deploying cloud-based technology. While still slow, it is happening, but not where you may think. Instead of found in the typical core applications of EHR or practice management systems, we find cloud-based technologies being introduced into the innovative health technology areas of virtual care delivery and patient self-reporting. Those areas are breaking down the barriers to cloud adoption in healthcare and that pace is increasing.
Cloud-based technology acceptance, along with everything else in the healthcare industry is moving faster than ever before. Accountable care, bundled payments, patient satisfaction, continuous care and the consumerization of healthcare are catalyzing changes to a very large, slow moving, highly regulated and risk averse industry. Technology and technology enabled services are essential for riding out these waves of change.
Every healthcare segment has seen these paradigm shifts and is trying to carve out a piece of the new pie. Large medical centers and health systems want to commercialize tools created in-house. Payers are building technology geared toward new forms of care delivery and price transparency, while biopharma is building technology to deliver continuous care powered by data from its core products – devices and medicines. All three of these healthcare segments can build technologies that utilize cloud computing and thus reap the following benefits:
A more nimble organization
Consumption of only the resources needed
Access to technology and apps across geographic barriers
Compliance and Cloud Computing
With recent changes to HIPAA that went into affect as part of the HITECH and HIPAA Omnibus Rule in 2013, a surge in compliance interest has developed, especially with compliance as it relates to cloud computing. The HIPAA Omnibus Rule created a new segment within the string of compliance leading back to covered entities. The new “subcontractor” segment is something of which every healthcare compliance officer must be aware. In much the same way as a business associate processes, transmits or stores ePHI for a “covered entity,” a subcontractor will also process, transmit, or store ePHI for “business associates.” And, subcontractors, like business associates, are required to sign business associate agreements (BAAs). These agreements outline the obligations of each party in meeting different aspects of HIPAA compliance rules, and delegate the risk based on different types of possible ePHI breaches.
In creating this new “subcontractor” entity, the Omnibus Rule accounted for the paradigm shift in technology development and cloud computing. The most commonly used example of a subcontractor is found in a cloud hosting provider like Amazon (AWS) or Rackspace; yet, many other types of services exist that could be considered subcontractors.
As data and services are being accessed via Web services (typically APIs), a huge number of BLANK-as-a-Service offerings have emerged. Many modern applications utilize third-party APIs for features and functionality to speed time-to-market, while adding value to users. Using simple to consume APIs, modern applications can tap into databases, messaging (SMS, Push, email or voice), usage metrics, logging, customer support, data sources, backup and so forth.
Guest post by Lysa Myers, security researcher, ESET
In my last post, I discussed the steps to performing a healthcare IT risk assessment. Once you’ve determined the risks within your environment, an important part of addressing those risks is to set up policies about acceptable use – formally known as Acceptable Use Policies (AUP) – for your staff members and then to train your staff accordingly.
The weakest link in most security chains is the human element, namely people thwarting protections put in place, intentionally or by mistake, or simply through lack of understanding. But how do you set up policies and train people if neither you nor the people on your staff are particularly security-savvy?
Trainings and Templates
If you’re starting at or near ground zero when it comes to information security knowledge, the first question to ask is: Would be better to train someone to become your security guru, or to simply improve overall knowledge within the organization and establish common-sense usage policies?
Unless you have someone in your organization who is dedicated to IT tasks, it may be difficult to mandate security training, but it’s wise to have a security-conscious person handling your infrastructure. At a minimum, when you train the rest of your staff on their security roles and responsibilities, your IT personnel should go through at least as much training: they will likely be in charge of setting up the protections that are to be used by the rest of the organization.
If you have a smaller healthcare organization, you can still create an AUP, without a security guru. In fact, having a less complex organization simplifies the definition process. In this case, something which is focused on healthcare and yet very simple, where you can “fill in the blanks” could be quite helpful: HealthIT.gov provides a template that could work well for smaller organizations.
The College of Healthcare Information Management Executives (CHIME) welcomes today’s announcement from the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC),on a proposed rule that would give healthcare organizations and professionals a greater chance to continue participation in the Meaningful Use program in 2014.
While the proposed changes are complex, CHIME believes the adjustments will ensure broad program participation and will enable providers to continue their meaningfuluUse journey.
“If the government acts quickly to finalize the proposed rule, it will provide the flexibility needed for our members and their organizations to adequately optimize newly deployed technology and ensure success of the program,” said CHIME President and CEO Russell P. Branzell, FCHIME, CHCIO.
According to the proposed rule, eligible professionals, eligible hospitals and critical access hospitals will be allowed to use 2011 Edition Certified EHR Technology (CEHRT), 2014 Edition CEHRT or a combination of the two Editions to meet meaningful use requirements in 2014. Because providers are at various Stages and are scheduled to meet different Stage requirements in 2014, CMS and ONC also have proposed giving providers the option of meeting Stage 1 requirements or Stage 2 requirements.
HHS publishes a new proposed rule that would provide eligible professionals, eligible hospitals, and critical access hospitals more flexibility in how they use certified electronic health record (EHR) technology (CEHRT) to meet meaningful use. The proposed rule, from the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), would let providers use the 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for the EHR reporting period in 2014 for the Medicare and Medicaid EHR Incentive Programs.
Beginning in 2015, all eligible hospitals and professionals would still be required to report using 2014 Edition CEHRT. Since the Medicare and Medicaid EHR Incentive Programs began in 2011, more than 370,000 hospitals and professionals nationwide have received an incentive payment.
“We have seen tremendous participation in the EHR Incentive Programs since they began,” said CMS Administrator Marilyn Tavenner. “By extending Stage 2, we are being receptive to stakeholder feedback to ensure providers can continue to meet meaningful use and keep momentum moving forward.”
The proposed rule also includes a provision that would formalize CMS and ONC’s previously stated intention to extend Stage 2 through 2016 and begin Stage 3 in 2017. These proposed changes would address concerns raised by stakeholders and will encourage the continued adoption of Certified EHR Technology.
“Increasing the adoption of EHRs is key to improving the nation’s health care system and the steps we are taking today will give new options to those who, through no fault of their own, have been unable to get the new 2014 Edition technology, including those at high risk, such as smaller providers and rural hospitals,” said Karen DeSalvo, M.D., M.P.H, M.Sc., national coordinator for health information technology.
The United States, Canada and Mexico have adopted a set of principles and guidelines on how the three countries’ governments will share in advance public information and communications products during health emergencies of mutual interest. U.S. Health and Human Services Secretary Kathleen Sebelius, Canada’s Minister of Health Rona Ambrose and Mexico’s Secretary of Health Mercedes Juan signed a Declaration of Intent, formally adopting the principles and guidelines, at a trilateral meeting today during the 67th World Health Assembly in Geneva, Switzerland.
“The United States, Canada and Mexico have had a long and close relationship in supporting and improving our collective ability to respond to public health events and emergencies of mutual interest when they arise,” Secretary Sebelius said. “This declaration reinforces our joint efforts to strengthen our national capabilities to communicate effectively with our respective populations.”
“Infectious diseases are not limited by countries’ borders, and neither are the ways through which we receive the news,” said Minister Ambrose. “This Declaration will help our countries work together on the essential task of communicating more effectively on public health issues, which will protect the health of all of our citizens.”
“The collaboration between the three North American countries has proved to be an extraordinary contribution to strengthening the security of health in the region,” said Secretary Juan. “The clear, transparent and timely exchange of information has been, and will remain, a central pillar of this cooperation, particularly for responding to public health emergencies.”
The Declaration of Intent calls on the three countries to:
