The big news of the week just came out of CMS at 4 PM EST on a Friday. Feels like they’re trying to bury the news story, but maybe it was just the way the timing worked out. Either way, there’s no way anyone who lives in the EHR and meaningful use would miss the announcement (not to mention I’ve already seen it posted on every major health IT news site). CMS is proposing an extension of meaningful use stage 2 another year through 2016 and so that means a delay in meaningful use stage 3 until 2017.
Here’s how Robert Tagalicod, Director, Office of E-Health Standards and Services, CMS and Jacob Reider, MD, Acting National Coordinator for Health Information Technology, ONC described the change in meaningful use timeline:
Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers that have completed at least two years in Stage 2. The goal of this change is two-fold: first, to allow CMS and ONC to focus efforts on the successful implementation of the enhanced patient engagement, interoperability and health information exchange requirements in Stage 2; and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.
The phased approach to program participation helps providers move from creating information in Stage 1, to exchanging health information in Stage 2, to focusing on improved outcomes in Stage 3. This approach has allowed us to support an aggressive yet smart transition for providers.
Meaningful Use Stage 2 and 3
This shouldn’t come as a surprise to many. In fact, we’d been discussing the possible meaningful use stage 2 extension in the comments of my post: ICD-10 will be delayed. We thought meaningful use delay was possible, and now it’s happened.
I do like that this delay gives CMS and ONC more breathing room to know what to include in meaningful use stage 3. Plus, maybe they’ll get the MU Stage 3 certification requirements out in plenty of time for EHR vendors to be able to update their software.
One thing that is really interesting about this delay is that meaningful use stage 3 won’t go into effect until after the Medicare EHR incentive money is over. The Medicare EHR incentive money is only scheduled to be paid through 2016. Medicaid wasn’t implementing MU stage 3 until year 6, so I expect there’s no change there. While you won’t have to show MU stage 3 for Medicare EHR incentive money, you will have to attest to meaningful use stage 3 in 2017 if you want to avoid the EHR penalties (Payment Adjustments if you prefer CMS’ terminology). In 2017, those EHR penalties will be at 3%.
Many have called for a delay to meaningful use stage 2 as well, but that didn’t happen today.
2015 Edition EHR Certification
The other part of the CMS announcement is the 2015 Edition EHR certification. They propose having an additional 2015 EHR certification that sounds like it would amount to an update to the 2014 edition. The 2015 edition would fix any issues with the 2014 edition and update any changes to interoperability standards. Sounds like an EHR certification patch.
The catch is that EHR vendors that are 2014 Edition EHR certified wouldn’t have to do 2015 Edition. This is good since we don’t need software vendors having to certify again (as much as certifying bodies would love the new revenue). Although, I won’t be surprised if most EHR vendors take the new standards in the 2015 edition and update their software to those standards. Let’s just hope that if they choose to do so, it doesn’t kill their 2014 Edition EHR certification. We should all be using the latest and greatest standards. Even more important, we need to all be on the same standard.
What do you think of the announcement? I look forward to hearing your thoughts in the comments.
HIMSS Response – HIMSS Supports Stage 2 Extension
CHIME Response – Meaningful Use Timeline Shift Does Not Afford Flexibility in 2014
A group of researchers have completed a study which found new links between patients’ genetic profile and specific diseases by mining EMR data, reports a story in iHealthBeat.
The research, which was conducted by the Electronic Medical Records and Genomics Network, a consortium of medical research institutions including the Mayo Clinic and Vanderbilt University School of Medicine, analyzed data from about 13,000 of EMRs.
The participants then grouped about 15,000 billing codes contained in the EMRs into 1,600 disease categories. Next, they looked for links to diseases in EMRs which contained DNA data.
The researchers, whose study was published in the journal Nature Biotechnology, found 63 new genetic links to diseases, ranging from skin cancer to anemia, iHealthBeat said.
The EMR study method, which is known as a phenome-wide association study, is a departure from the 13-year old genome-wide association model, which has been used to search for common mutations in the DNA of patients of people with the same diseases.
Co-author Joshua Denny, a biomedical informatics researcher at Vanderbilt, says that the newer method can help link seemingly unrelated symptoms, detect potentially harmful side effects of a drug, and help find new uses for drugs.
This is just the tip of the iceberg where translation medicine and EMRs are concerned. Using EMRs to conduct genomic research is becoming an increasingly popular exercise, cutting across a wide range of clinical disciplines.
And it’s not just institutional academic research houses getting into the act. For example, this summer a large northern Virginia hospital announced that it had struck a deal with a Massachusetts analytics firm to see if data mined from EMRs can better predict the risk of preterm live birth.
Now, genomics research is not for just any hospital — it’s obviously a major undertaking — but I think it’s likely more hospitals will get into the game. By this time next year I think there will be a crop of interesting new genomics projects mining EMRs. Although, it will be interesting to see how the 23andMe FDA battle impacts this as well.
One thing’s for sure about patient portals: They’re a hot commodity.
What’s less clear is how much good they’re doing for health care.
The popularity of patient portals stems from Meaningful Use Stage 2 patient-engagement requirements. The market for the products is expected to approach $900 million by 2017, up from $280 million in 2012, according to a report from Mountain View, Calif.-based research firm Frost & Sullivan.
Patients like at least one aspect of the portals — the ability to access their own medical records. In a recent Accenture study, more than 40 percent of consumers who can’t access their own records online said they’d consider switching doctors in order to get access.
But several recent studies suggest that currently available products have a way to go before they can consistently improve care, reduce costs or perhaps even increase patient engagement.
In a review of 46 studies, researchers found little evidence that portals were helping much of anything. The doctors from Veterans Affairs Greater Los Angeles Healthcare System and other institutions wrote that it’s “unlikely that patient portals will have substantial effects on utilization or efficiency, at least in the near term.”
Some of the limitations of the products, they wrote, included “disparities in who accesses these portals and instances of suboptimal patient attitudes of their worth.” The portals typically gave patients options such as looking at their test results, refilling prescriptions and communicating with doctors.
Patient portals likely are most beneficial, the authors wrote, when they’re part of a more comprehensive quality-improvement strategy.
Another study also found that patients, in many cases, fail to see the value of a portal — or at least some parts of it. In questions about hypothetical features, consumers showed interest in “back-office” tasks such as seeing their own medical records. But clinical digital communication capabilities, such as online video consultations with doctors, failed to impress.
The bottom line was that patient portals “may act as a complement to health-care service delivery, while substitution for clinical in-person interactions may not be viewed positively.” In other words, most people just don’t seem to be ready to give up face time with their primary-care physician.
When MU2 starts on Jan. 1, physicians will be required to give their patients electronic access to their health records. The requirement went into effect for hospitals in October.
The U.S. health care system is, with government prodding, investing a huge sum in patient portals. The idea sounds empowering for patients. But given the lack of solid evidence for a benefit at this point, it’s concerning to think the money might be better spent on something else. Let’s hope that vendors and providers are soon able to turn portals into something with tangible benefits for quality care.
We all know that October 1, 2014 is the date when ICD-10 will go live in the US (if you didn’t know that shame on you, but you know now). There have been plenty of rumblings that ICD-10 is going to be delayed…again. In fact, I even hypothesized that the Healthcare.gov debacle could prompt HHS to delay ICD-10 again.
While I think that there are plenty of reasons why they could choose to delay ICD-10, I now think that there’s no way HHS is going to delay ICD-10 (meaningful use may be another story). There’s so much momentum behind ICD-10 and with the previous delays, I think HHS will go forward with ICD-10 regardless of whatever reasons people come up with for delay.
Is your organization ready for ICD-10? What do you think about the possibilities of a delay? I’m interested to know your views in the comments, but for those too shy to comment I’ve embedded a poll below where you can rate delay or not on a scale from 1 to 5.
In a more complex question to answer, I’m also interested to know if readers think their IT and EHR vendors will be ready for ICD-10. Vote in the poll below.
Check out all of our ICD-10 Tuesdays series of ICD-10 related blog posts.
I’m so excited. Things are coming together for a really big announcement next Monday. I’m really excited about what we’ve put together and I think many readers will be interested in it as well. I’ve leaked the idea a little bit on Twitter, but I should be able to announce a lot more details next Monday. Watch for that next week.
Until then, it seems really appropriate at this time of Thanks to take a few seconds to recognize the many sponsors who support the work we do here at EMR and HIPAA. It’s been a really great 6 months and we’ve received a lot of amazing support. In fact, I’m really pleased by the variety of healthcare IT companies that are supporting the work we do.
I hope you’ll take a second to look over these new and renewing sponsors to see if they can help you solve some of your pressing issues.
interfaceMD – This EHR company is quite unique. Rather than try and explain their unique approach to EHR and EHR implementation, take a second and watch this video interview I did with interfaceMD CEO Joel Kanick. I think many of the things he shares will resonate with small practices out there. Joel and interfaceMD have taken a really holistic approach to implementing an EHR and all the IT in between. Check them out if you want to see what I mean.
Proven Backup – One of the biggest risks of any EHR is not having a proper backup. Unfortunately, many don’t pay attention to their backup plans until it’s too late. The best way I’ve seen to solve this is to do a mock situation where your database is corrupt. What will it take you to restore from backup? Do you have a backup that works? The beauty is that there are relatively inexpensive backup offerings like the one from Proven Backup. Done correctly, your EHR backup can be much more robust and less risky than paper ever could be.
Colocation America – One of the major features of all healthcare IT is the need for some sort of hosting. Colocation America offers a wide variety of hosting options for applications and organizations of all sizes. As a past server admin and data center manager myself, I can’t ever imagine building my own data center again. The service a hosting company like Colocation America provides is impossible for small organizations to build on their own and is likely out of reach for even the largest organizations.
HealthFusion – Some might not recognize this name, but might be more familiar with HealthFusion’s MediTouch EHR software. If you want to find out what’s unique about Health Fusion, check out this interview with HealthFusion’s Co-Founder and CEO. I was really interested with HealthFusion’s efforts to incorporate the native iPad interface in their EHR very early on. I don’t know many other EHR vendors who can say that “every EHR function that can be performed on the desktop can also be performed on the iPad.”
Doc Halo – HIPAA secure texting is starting to hit healthcare in a really big way. Many in healthcare have found the value of a simple text message communication. However, every healthcare compliance department is scared about the HIPAA implications of such text messages. The answer to this is to empower the end users to have the simplicity of a text message, but done on a secure platform like Doc Halo. If you want to learn more, the Doc Halo CEO has been contributing a number of blog posts on the subject as well.
gMed – If you are a gastroenterologist, then you need to take a look at gMed’s EHR solution. I’ve always been a fan of the specialty specific EHR software. They can offer a unique experience that gets washed over by most of the EHR vendors who want to apply a one size fits all approach to EHR. If you’re interested in Gastroenterology, you’ll want to check out this excellent whitepaper on the Future of Gastroenterology.
The Breakaway Group (A Xerox Company) – Many of you may recognize this company since they’ve been doing a monthly series of blog posts called Breakaway Thinking. You can expect a lot more amazing content on EMR and HIPAA from the talented people at The Breakaway Group. They have a lot of first hand experience with EHR training and ICD-10 training. Being on the front lines provides them some really interesting insight into the industry.
I’m always thankful for the ongoing support of our renewing sponsors. So, a big thanks to all of the companies listed below for renewing their support of us. It’s great to look over so many of these companies who have been supporting us for so many years. Here’s to many more years working together.
Ambir – Advertising since 1/2010
Amazing Charts – Advertising since 5/2011
Cerner – Advertising since 9/2011
simplifyMD – Advertising since 9/2012
Canon – Advertising since 10/2012
Look for the really big announcement next Monday.