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:
U.S. health services merger and acquisition (M&A) total deal value rose 152 percent to $12.3 billion during the first quarter of 2014 compared to the same period in 2013, according to Q1 2014 US health services deals insights, a quarterly analysis of M&A trends and outlook for the health services sector issued today by PwC US.
“While deal activity held steady during the first quarter of this year compared to Q1 2013, having deal value jump 152 percent is an indication of renewed confidence in the industry as the dust settles from the implementation of the Affordable Care Act,” said Brett Hickman, partner and PwC’s U.S. healthcare deals leader. “Several indicators that we track point to robust M&A activity for the rest of the year. The impetus for greater alignment and size remains unchanged in the hospital sector – and for managed care deals, an increase is likely as these companies work to meet the required ACA milestones. Combined with positive signs we’re seeing in the other health services sectors, we’re optimistic that there will be heightened deal activity in 2014.”
In the first quarter of 2014, the total volume of deals remained consistent with the same period in 2013. From a sector perspective, hospital deal volume experienced a decrease when compared to Q1 2013, down from 21 in Q1 2013 to 12 in Q1 2014, a nearly 43 percent drop-off. However, deal value increased from $320 million in Q1 2013 to $388 million in Q1 2014. According to PwC, the softened deal activity during the first three months of 2014 does not necessarily indicate a slowdown. Hospitals continue to assess strategic alternatives, specifically addressing their market position, long-term strategy and the recent large transactions which have reinforced a “bigger is better” mentality within the hospital sector.
M&A activity in the managed care sector was up slightly in Q1 2014 as deal volume increased 150 percent relative to Q1 2013. Deal value was not disclosed for any of the deals announced in Q1 2014.
The long-term care sector has started the first quarter of 2014 where it left off in 2013, leading the sectors in both volume and value, as well as making gains over the first quarter in 2013. Long-term care deals highlighted in the quarter, in conjunction with positive operating trends, will continue to build confidence in decision makers and help support strong M&A trends in this sector.
Home health and rehabilitation have started at a slower pace, with smaller volumes and values recorded compared to the first quarter in 2013. There were just two deals in the home health and hospice sector (values were not released) and six deals in the rehabilitation sector.
Guest post by Egor Kobelev, software delivery manager — healthcare, DataArt.
There are a lot of organizational and technical challenges health information exchanges (HIEs) struggle with while trying to deploy and maintain their platforms. One of the most complex organizational and administrative challenges is to achieve sustainability. While that is often an ultimate goal for HIEs, there is a huge amount of smaller technical challenges to meet, and the way those challenges are responded to often makes a difference for future HIE sustainability.
One of those typical tasks in the industry is a patient look up and mapping. There is a well-known issue when it comes to any sort of health data integration – the lack of a global unique patient identifier. Thousands of existing healthcare providers and payers use their own internal identifiers and there is no easy way to establish a relation between these. Social Security Numbers or similar national identifiers, while useful in some of scenarios, are not suitable for the purposes of healthcare record identification, primarily because of the risks of HIPAA rules violation.
The good part of the story is the amount of talks regarding a National Patient Identifier (NPI). For instance, HIMSS is proactively driving the initiative of introducing NPI, so that eventually patient mapping, which is currently a challenge, will be routine. However, the reality is that we are pretty far away from having NPI legislated and deployed in healthcare organizations nation-wide. At the same time, as many as 8 percent to 14 percent of patient records have errors caused by mismatching patient identifiers, which in turn causes hundreds of millions of dollars in spending to repair and reconcile the records. So, while we are waiting for NPI to come, what would be a solution which is HIPAA compliant, provides high accuracy, throughput, and minimizes manual interventions at the same time?
As clearly identified in the PCAST Report on Health Information Technology (2011), and as echoed in the recent GAO report Electronic Health Record Programs — Participation Has Increased, but Action Needed to Achieve Goals Including Improved Quality of Care (2014), healthcare continues to have a data problem. The country has invested significantly to advance EHR adoption.
In simpler terms, healthcare data is messy and makes for building of accurate, actionable metadata a problem. It’s clear that the next generation of standards that are being developed by the numerous committees and acronyms and professional societies tackling measure development, harmonization and testing will now need to address the relevance of each measure.
More than a decade ago, a coalition of purchasers, payers and providers came together across Wisconsin to form the Wisconsin Collaborative for Healthcare Quality (www.wchq.org). Groundbreaking initiatives like Get with the Guidelines, Leapfrog and JCAHO revealed that “quality” and “healthcare” could be used in the same sentence (or displayed on a website). These efforts were largely inpatient-focused. Measurement in the outpatient setting, long considered the keystone of payment reform, was an unsolved riddle. WCHQ, at the urging of the IOM, IHI and others accepted the challenge of tackling performance in the ambulatory arena.
At the direction of some very engaged employers, and with input from most of the state’s payers, WCHQ was charged with one very simple goal — apples to apples quality measurement, regardless of health IT infrastructure. The focus had to include both processes of care and outcomes. Oh, and if health systems didn’t have any health IT in place, data still needed to be included for these groups in the measurement effort. What transpired over an 18-month period was remarkable. With unwavering support from administrative and clinical leadership, health systems rolled up their sleeves and dug into their very messy data. Each Monday, we would devise a fiendish list of new tasks to be completed in the next four business days.
Guest post by Diane D. Homan, MD and Adam Lokeh, MD.
As the healthcare industry unwraps the next phase of population health management (PHM), providers are increasingly embracing its promise to drive success with healthcare’s triple aim of improving population health, enhancing patient experiences and reducing costs. It’s a 180-degree shift in thinking for many providers who have been conditioned to long-standing fee-for-service models, one that will require a coordinated care effort and an advanced technological infrastructure to support decision-making based on the latest industry evidence.
As regulatory initiatives, such as meaningful use and value-based purchasing converge to up the ante on improved outcomes, the proactive premise of PHM will be critical to success. A foundational component to effective implementation of a PHM model is a clinical decision support (CDS) strategy that drives standardization of care based on best practices.
For Rush-Copley Medical Center, the first step in this process was deployment of evidence-based order sets and a complete clinical content management solution— ProVation Order Sets, powered by UpToDate Decision Support. The decision to leverage evidence-based order sets at the point of care has proven advantageous on many fronts, from supporting recent responses to public health crises to raising the bar on outcomes improvement and laying a foundation of accountability across the continuum.
Reducing Variation for Improved Response
Getting clinicians on the same page and helping them to adopt industry best practices in their day-to-day workflows is certainly a key element in bending the quality curve, but ensuring that variations are minimized in a public health crisis is absolutely critical to success.
A 210-bed hospital serving the greater Fox Valley region of Illinois, including the state’s second largest city, Aurora, Rush-Copley uncovered an outbreak of tuberculosis (TB) in late 2009 following two admissions over the course of two months. In cooperation with the Kane County Health Department, an investigation traced the outbreak back to a homeless shelter, which, in turn, presented a considerable challenge to containing the outbreak as the population was highly transient.
With evidence-based order sets and an advanced clinical content management solution already deployed to address standardization of care, the clinical team was able to quickly deploy a point-of-care strategy for identifying at-risk patients, apply isolation management tactics and develop collaborative efforts throughout the community to minimize exposure. The strategy was three-fold: 1) contain the epidemic, 2) provide highest quality treatment based on industry best practices and 3) avoid duplication of services.
Guest post by Gil Lalo, director of enterprise architecture, C/D/H.
Microsoft’s Xbox 360 ranks among the best-selling game consoles in the world , and its latest iteration, Xbox One, comes with a much faster processor, tight integration with Skype, voice recognition capabilities and an amazing motion sensitive camera attachment called the Kinect.
Aside from gaming, the device has shown remarkable promise in healthcare as creativity meets practicality and talented people from various clinical disciplines develop applications that exploit some native Xbox platform features. Here are some recent examples:
Long-distance Stroke Rehabilitation
Software company Jintronix uses the Microsoft Kinect software development kit (SDK) to capture movement from the body’s 48 skeletal points on a 3-D camera. With Kinect’s capture technology, Jintronix and Microsoft’s Stroke Recovery system created cost-effective programs for clinicians and patients. Therapists can use them at the office to see more patients at a time, and patients get cheaper, efficient therapy sessions in the convenience of their own homes.
Microsoft’s Stroke Recovery with Kinect has three main programs: one evaluates manual dexterity and coordination with a timed game in which patients pick up blocks and place them in a box; another challenges them to achieve a target body position; the third is an outer-space game that assesses reflexes. All three provide immediate scores and reinforcement.
Maintaining a Sterile Environment in the Operating Room
The Sunnybrook Health Sciences Centre in Canada is one hospital already using Kinect in its operating rooms to reduce hygiene and infection issues. The contactless control of Kinect is enabling doctors and surgeons to view patient notes, scans and x-ray images without touching surfaces, such as a computer mouse or keyboard, which could be infected with bacteria. This has reduced time spent on standard operations and procedures as doctors can wash and disinfect their hands less frequently.
