Category Archives: ‘Meaningful Use’

Directions for CMS EHR Incentives Registration

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Registration and Attestation Begins January 3, 2011
Program Directions
Excerpted from CMS EHR Incentives Program on 12/26/2010.

Registration for the Medicare and Medicaid EHR Incentive Programs opens on January 3, 2011. We encourage providers to register for the Medicare and/or Medicaid EHR Incentive Program(s) as soon as possible. You can register before you have a certified EHR. Register even if you do not have an enrollment record in PECOS.

A link to Registration will be available on CMS EHR Incentives Program site.

Please Note: Although the Medicaid EHR Incentive Programs will begin January 3, 2011, not all states will be ready to participate on this date. Information on when registration will be available for Medicaid EHR Incentive Programs in specific States is posted at Medicaid State Information.

“It is important for a dually-eligible hospital to select “Both Medicare and Medicaid” from the start of registration in order to maintain this option.” Hospitals and Eligible Professionals should read the notes below under the heading “What else do I need to know about registration?”

[Registration for state Medicaid programs opens in the following states on January 3, 2011:

* Alaska
* Iowa
* Kentucky
* Louisiana
* Oklahoma
* Michigan
* Mississippi
* North Carolina
* South Carolina
* Tennessee
* Texas

Registration for state Medicaid programs opens in the following states in February 2011:

* California
* Missouri
* North Dakota

Other states likely will launch their Medicaid EHR Incentive Programs during the spring and summer of 2011.]

e-Healthcare Marketing note: It’s important for hospitals and eligible professionals in ALL STATES to register when registration opens and not delay registering on the CMS site until their state Medicaid programs are ready. See further note below in red under the heading “What else do I need to know about registration?

What can you do now for the Medicare and Medicaid EHR Incentive Programs?

Make sure you have enrollment records in the appropriate systems. You’ll need:

  • A National Provider Identifier (NPI)
    • All eligible professionals, eligible hospitals, and critical access hospitals (CAHs) must have a National Provider Identifier (NPI) to participate in the Medicare and Medicaid EHR Incentive Programs.
  • An enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS)
    • All eligible hospitals and Medicare eligible professionals must have an enrollment record in PECOS to participate in the EHR Incentive Programs. (Note: Eligible professionals who are only participating in the Medicaid EHR Incentive Program are not required to be enrolled in PECOS.)
    • If you do not have an enrollment record in PECOS, you should still register for the Medicare and Medicaid EHR Incentive Programs.

CMS Identity and Access Management (I&A) User ID and Password

  • Eligible Professionals:
    • Eligible professionals can use the same User ID and Password they use for the National Plan and Provider Enumeration System (NPPES). This is also the same User ID and Password that is used to access PECOS.
    • If you do not have an active User ID and Password for NPPES or PECOS, request them via Identity & Access Management. You will need your type 2 NPI, your Taxpayer Identification Number (TIN), and your address from IRS Form CP-575. You will also need to mail a copy of IRS Form CP-575 as directed.
  • Hospitals/Critical Access Hospitals:
    • Authorized Officials can use the same User ID and Password they use to access PECOS.
    • If you do not have an Authorized Official with access to PECOS, request a User ID and Password via Identity & Access Management. You will need your type 2 NPI, your Taxpayer Identification Number (TIN), and your address from the IRS Form CP-575. You will need to mail a copy of the IRS Form CP-575 as directed.
    • Additional hospital staff will need to request access to the “EHR Incentive Programs” application through Identity & Access Management and be approved by the Hospital’s Authorized Official.

What information will you need when you register?

Registering for the Medicare and Medicaid EHR Incentive Programs is easy when you have the following information available during the process:

Eligible Professionals

  • National Provider Identifier (NPI).
  • National Plan and Provider Enumeration System (NPPES) User ID and Password.
  • Payee Tax Identification Number (if you are reassigning your benefits).
  • Payee National Provider Identifier (NPI)(if you are reassigning your benefits).

Hospitals

  • CMS Identity and Access Management (I&A) User ID and Password.
  • CMS Certification Number (CCN).
  • National Provider Identifier (NPI).
  • Hospital Tax Identification Number.

NOTE: You do not have to provide information on the certified EHR technology you are using when you register. However, this information is required when you attest.

What else do I need to know about registration?

Hospitals:
Hospitals that are eligible for EHR incentive payments under both Medicare and Medicaid should select “Both Medicare and Medicaid” during the registration process, even if they plan to apply only for a Medicaid EHR incentive payment by adopting, implementing, or upgrading certified EHR technology. Dually-eligible hospitals can then attest through CMS for their Medicare EHR incentive payment at a later date, if they so desire. It is important for a dually-eligible hospital to select “Both Medicare and Medicaid” from the start of registration in order to maintain this option.

Hospitals that register only for the Medicaid program (or only the Medicare program) will not be able to manually change their registration (i.e., change to “Both Medicare and Medicaid” or from one program to the other) after a payment is initiated and this may cause significant delays in receiving a Medicare EHR incentive payment.

Eligible Professionals:
Eligible professionals eligible for both the Medicare and Medicaid EHR Incentive Programs must choose which incentive program they wish to participate in when they register. Before 2015, an eligible professional may switch programs only once after the first incentive payment is initiated. Most eligible professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program.

The Electronic Health Record (EHR) Information Center is open to assist the EHR Provider Community with inquiries.
Hours of operation are:

8:30 a.m. – 4:30 p.m. (Central Time) Monday through Friday (except federal holidays)
1-888-734-6433 (primary number) or 888-734-6563 (TTY number)

Submit an Inquiry to the EHR Information Center

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Downloads
Medicare EP PECOS Notification [PDF, 119KB]
Hospital PECOS Notification [PDF, 160KB]
Related Links Inside CMS
Frequently Asked Questions (FAQs)
Excerpted from CMS Page Modified on 12/23/2010 8:41:41 AM

See e-Healthcare Marketing post for December 23, 2010 press release from ONC and CMS.

Health IT Special Issue of The American Journal of Managed Care: Dec 2010

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AJMC Publishes Health Information Technology Special Issue Online Dec 20, 2010
“Featuring scholarly articles and perspectives from policymakers, payers, providers, pharmaceutical companies, health IT vendors, health services researchers, patients, and medical educators, this [December 2010 special] issue of  The American Journal of Managed Care is a reflection” of  “the  dramatic growth of interest in the potential for HIT to improve health and healthcare delivery,” writes Sachin H. Jain, MD, MBA and David Blumenthal, MD, MPP in their introductory article titled “Health Information Technology Is Leading Multisector Health System Transformation.”  Both Jain and Blumenthal are with the Office of the National Coordinator for Health Information Technology.

Authors of 23 Articles in Special Issue
Sachin H. Jain, MD, MBA; and, David Blumenthal, MD, MPP; Cynthia L. Bero, MPH; and Thomas H. Lee, MD; Aaron McKethan, PhD; and Craig Brammer; John Glaser, PhD; Pete Stark; Newt Gingrich, PhD, MA; and Malik Hasan, MD; James N. Ciriello, MS; and Nalin Kulatilaka, PhD, MS; Seth B. Cohen, MBA, MPA; Kurt D. Grote, MD; Wayne E. Pietraszek, MBA; and Francois Laflamme, MBA; Amol S. Navathe, MD, PhD; and Patrick H. Conway, MD, MSc; Reed V. Tuckson, MD; Denenn Vojta, MD; and Andrew M. Slavitt, MBA; Marc M. Triola, MD; Erica Friedman, MD; Christopher Cimino, MD; Enid M. Geyer, MLS, MBA; Jo Wiederhorn, MSW; and Crystal Mainiero; Nancy L. Davis, PhD; Lloyd Myers, RPh; and Zachary E. Myers; Bryant A. Adibe, BS; and Sachin H. Jain, MD, MBA; Spencer S. Jones, PhD; John L. Adams, PhD; Eric C. Schneider, MD; Jeanne S. Ringel, PhD; and Elizabeth A. McGlynn, PhD; Jeffrey L. Schnipper, MD, MPH; Jeffrey A. Linder, MD, MPH; Matvey B. Palchuk, MD, MS; D. Tony Yu, MD; Kerry E. McColgan, BA; Lynn A. Volk, MHS; Ruslana Tsurikova, MA; Andrea J. Melnikas, BA; Jonathan S. Einbinder, MD, MBA; and Blackford Middleton, MD, MPH, MS;Alexander S. Misono, BA; Sarah L. Cutrona, MD, MPH; Niteesh K. Choudhry, MD, PhD; Michael A. Fischer, MD, MS; Margaret R. Stedman, PhD; Joshua N. Liberman, PhD; Troyen A. Brennan, MD, JD; Sachin H. Jain, MD, MBA; and William H. Shrank, MD, MSHS; Amir Dan Rubin, MBA, MHSA; and Virginia A. McFerran, MA; Fredric E. Blavin, MS; Melinda J. Beeuwkes Buntin, PhD; and Charles P. Friedman, PhD Robert D. Hill, PhD; Marilyn K. Luptak, PhD, MSW; Randall W. Rupper, MD, MPH; Byron Bair, MD; Cherie Peterson, RN, MS; Nancy Dailey, MSN, RN-BC; and Bret L. Hicken, PhD, MSPH; Jeffrey A. Linder, MD, MPH; Jeffrey L. Schnipper, MD, MPH; Ruslana Tsurikova, Msc, MA; D. Tony Yu, MD, MPH; Lynn A. Volk, MHS; Andrea J. Melnikas, MPH; Matvey B. Palchuk, MD, MS; Maya Olsha-Yehiav, MS; and Blackford Middleton, MD, MPH, MSc; Emily Ruth Maxson, BS; Melinda J. Beeuwkes Buntin, PhD; and Farzad Mostashari, MD, ScM; Daniel C. Armijo, MHSA; Eric J. Lammers, MPP; and Dean G. Smith, PhD; Katlyn L. Nemani, BA.

Look for an upcoming post on e-Healthcare Marketing reviewing this special issue of AJMC.

Supplemental Challenge Funding to State HIE Programs: FAQs, Slides, Audio from Tech Assistance Call

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Supplemental Challenge Funding to State HIE  Programs
FAQs, Slides, Audio from Technical Assistance Conference Call
Excerpted from ONC sites on Dec 23, 2010

  • Closing Date for Applications from State HIEs: January 05, 2011 at 5:00 PM, EST
  • Estimated Total Program Funding: $16,296,562
    Technical Assistance Call
Supports awards in five challenge areas to enable nationwide health information exchange:
§Achieving health goals through health information exchange
§Improving long-term and post-acute care transitions
§Consumer-mediated information exchange
§Enabling enhanced query for patient care
§Fostering population-level analytics

FAQs
PDF Version

1. How do I determine if my organization is an eligible applicant for this funding opportunity?
Current direct award recipients of the State HIE Cooperative Agreement program are eligible to apply for this funding opportunity. To determine if your organization is the eligible entity in your state, review the most recent Notice of Grant Award for the State HIE Cooperative Agreement Program. The direct award recipient is listed in Box 11 “Recipient Organization.” There are 56 eligible organizations for this funding opportunity.

2. Can we apply for funding to support an unfunded project we discussed in our State Plan submitted under the State HIE Cooperative Agreement program?
Funds under this announcement cannot be used to fund activities already presented in the Strategic and Operational Plans and funded as part of the scope of work under the State HIE Cooperative Agreement. Funds cannot be used to supplant or replace current public or private funding of projects. Funds also cannot be used to supplant ongoing or usual activities of any organization involved in the project. However, if a project was presented in the State Plan but clearly not funded with public or private monies and is not part of ongoing scope of work of an affiliated organization, it may be submitted as part of a project under this funding opportunity.

3. As part of our proposed project, we will contract with a vendor to develop software for use by providers in the project. Please clarify what is meant by “Any IT system components (e.g., software, data models, etc.) developed by the awardees under this funding opportunity will be made available to any state.” Does this mean any IT development must be open source?
No, IT development does not have to be open source. The purpose of this program is to fund innovative technology development and approaches in pilot sites that will then be shared, reused, and leveraged by other states and communities to increase nationwide interoperability. Anything developed with funds under this cooperative agreement must be accessible and usable outside of the pilot site. Successful awardees must demonstrate how the tools, systems, or models developed under this cooperative agreement will be easily adapted and implemented beyond the pilot scope of work.

4. Can we propose a project with a geographic area that overlaps with a Beacon awardee?
While nothing in this funding announcement prohibits an overlap in targeted geographic areas, the scope of work must be different for both projects; funds under this announcement cannot be used to supplant or replace current public or private funding.

5. How should the budget documentation be presented in the application?
Applicants are required to submit a one-year budget for each year of the project period. Please remember that the challenge grants period of performance (project period) ends at the
same time as the current cooperative agreement. Therefore, budgets should only be submitted for the remaining three years in the cooperative agreement since the project periods will be married. Applicants are suggested to use the format included as Appendix A of the Funding Opportunity Announcement. Applicants are also encouraged to refer to Appendix J of the State HIE Cooperative Agreement FOA, which provides an example of the level of detail sought.
A combined multi-year Budget Narrative/Justification, as well as a detailed Budget Narrative/Justification for each year of potential grant funding is also required. Instructions were provided in Appendix I of the State HIE Cooperative Agreement FOA that pertain to completing the SF 424.

6. Can the eligible entity apply for this funding opportunity and then contract or subgrant the substantive work to an outside entity?
The direct award recipient must have direct oversight and accountability for the project. When preparing the budget, the six contractual elements required to be submitted when subawarding a substantial portion of the programmatic work must be included. These are:
I. Name of Contractor: Who is the contractor
II. Method of Selection: ? Identify the name of the proposed contractor and indicate whether the contract is with an institution or organization.
How was the contractor selected
III. Period of Performance: ? State whether the contract is sole source or competitive bid. If an organization is the sole source for the contract, include an explanation as to why this institution is the only able to perform contract services.
How long is the contract period
IV. Scope of Work: ? Specify the beginning and ending dates of the contract.
What will the contractor do
V. Method of Accountability: ? Describe in outcome terms the specific services/tasks to be performed by the contractor as related to the accomplishment of program objectives. Deliverables should be clearly defined.
How will the contractor be monitored
VI. Itemized budget and justification: Provide an itemized budget with appropriate justification. If applicable, include any indirect cost paid under the contract and indirect cost used. Provide a copy of the negotiated indirect cost rate agreement. ? Describe how the progress and performance of the contractor will be monitored during and on close of the contract period. Identify who will be responsible for supervising the contract.

7. Can my state’s eligible entity request funding for more than one challenge theme?
Eligible entities may submit one application per challenge theme; therefore, no more than five applications are permitted from each eligible entity. Each application must clearly indicate the challenge theme addressed. Approximately 10 awards will be made; it is possible for an eligible entity to receive more than one award.

8. Can letters of commitment to the State Health Information Exchange Cooperative Agreement be used to demonstrate commitment to this initiative?
Yes. However, applicants are strongly encouraged to include letters of commitment from key program partners and stakeholders that are specific to the project proposed in the application.

9. Some staff supported under the State HIE Cooperative Agreement would be proposed in our application to support the challenge project. Is that allowable? Can we rebudget our State HIE Cooperative Agreement to reflect the staffing shifts?
Applicants are advised that the scope of work and budget for this application must be separate from the funded scope of work in the State Health Information Exchange cooperative agreement. In the event that staff may overlap, please note that ONC will develop a process for successful applicants to finalize the scope of work, staffing, and budget to ensure that successful performance of the Health Information Exchange cooperative agreement is not jeopardized and to assure that funds are not supplanted.

PDF of Funding Announcement
Health Information Exchange Challenge Program Funding Opportunity Announcement

See previous e-Healthcare Marketing post on Challenge Program.

Colleen Woods Asks “Where are the NJ Healthcare Innovators?!!”

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From: Colleen Woods, NJ Health IT Coordinator
To: New Jersey Healthcare Innovators,
NJ Health IT Community
Re: Calling for Innovations for Supplemental ONC Funding
Date: Dec 21, 2010
High PriorityMost of you are aware that the Office of the National Coordinator issued a supplemental funding opportunity to the State Health Information Exchange Cooperative Agreement Program.  As required, on December 10th,2010,  I responded that New Jersey would apply for the supplemental funding, knowing that we have many exciting projects in place that could be advanced with just a bit of additional funds.

There are five challenge “themes” that the feds view as potential barriers to full national health information exchange. They are seeking innovative ideas/solutions from those of you who know healthcare delivery the best.  The themes are:
  • Achieving Health Goals through Health Information Exchange
  • Improving Long Term and Post Acute Care Transitions
  • Consumer Mediated Information Exchange
  • Enabling Advance Query for Patient Care
  • Fostering Distributed Population-Level Analytics

For more information please see a PDF of the  ONC’s funding announcement: http://goo.gl/oGc7Q

Or to see all the funding documents, go to Grants.gov:http://goo.gl/0dk3i

I know there are a lot of good ideas and projects already underway that would qualify for this funding opportunity. (Jeff, Becky, Jim, Tom, Dave, Tom, Linda, Lou, Judy, Neal, Al, Bob et al…..) , but the award requires a quick response.  Applications need to be sent to by the NJ State Coordinator’s Office ONC by January 5th, 2011. I would proud to submit any ideas you have that would meet the ONC challenge.  Please feel free to call me to discuss.

My best wishes to you and your families for a Happy Holiday Season!

Colleen

Colleen Woods
NJ Health IT Coordinator
Governor’s Office
(609)777-2609
colleen.woods@gov.state.nj.us

Synopsis of the Supplemental State HIE Challenge Program
“This funding announcement for the Health Information Exchange Challenge Program encourages breakthrough progress for nationwide health information exchange in five challenge areas identified as key needs since Federal and State governments began implementation of the HITECH Act. The awards will fund the development of technology and approaches that will be developed in pilot sites and then shared, reused, and leveraged by other states and communities to increase nationwide interoperability. The five themes include: 1. Achieving health goals through health information exchange 2. Improving long-term and post-acute care transitions 3. Giving patients access to their own health information 4. Developing tools and approaches to search for and share granular patient data (such as specific lab results for a given time period) 5. Fostering strategies for population-level analysis Awards will range between $1 million and $2 million each, and will be in the form of supplemental funding to State Health Information Exchange Cooperative Agreements, which have provided approximately half a billion dollars to states and State designated entities to enable health information exchange. Funding for this initiative is approximately $16 million which ONC anticipates will support 10 awards.”
–Synopsis from grants.gov

New EHR FAQs Added to ONC/CMS sites on eRx, Clinical Info Exchange

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CMS and ONC both Add to FAQs related to Health Information Exchange on 12/12/2010
Link to PDF of ONC’s 22 Regulations FAQs. Note FAQ #21 not yet posted.
The following FAQs were excerpted on 12/18/2010.

ONC Question [12-10-022-1]:
Does the certification criterion pertaining to electronic prescribing, which references certain content exchange standards (i.e., NCPDP SCRIPT 8.1 and NCPDP SCRIPT 10.6), require that a Complete EHR or EHR Module be capable of electronically exchanging information with only external recipients (i.e., recipients that are not part of that legal entity) according to the appropriate standard (and implementation specifications) or does it apply more broadly?

Answer:
For the certification criterion pertaining to electronic prescribing (45 CFR 170.304(b)), which references those two content exchange standards adopted at 45 CFR 170.205(b) and the vocabulary standard 170.207(d) (i.e., any source vocabulary that is included in RxNorm), a Complete EHR or EHR Module must be certified as being capable of electronically generating and transmitting prescriptions and prescription-related information to external recipients in accordance with the appropriate adopted standard(s) (and implementation specifications). These standards were adopted for the purpose of enabling a user of Certified EHR Technology to “exchange” electronically certain health information, as indicated in the first sentence of the regulatory section and the section title, and as alluded to in various other parts of the Standards and Certification Criteria Interim Final and Final Rules.

We intended the capability required by this certification criterion and the referenced standards and implementation specifications to apply to the electronic exchange of prescription information between different legal entities (e.g., from an eligible professional’s Certified EHR Technology to a pharmacy that is not part of the eligible professional’s legal entity), to complement how CMS has generally described “exchange” in the context of meaningful use as information “sent between different legal entities with distinct certified EHR technology or other system that can accept the information….” (75 FR 44361-62). In the Standards and Certification Criteria Interim Final Rule and in the Standards and Certification Criteria final rule, we discussed current Medicare Part D electronic prescribing regulatory requirements for using NCPDP SCRIPT 8.1, and the anticipated use of NCPDP SCRIPT 10.6. (75 FR 2031-32, 75 FR 44625-26). In both rules, we also had explained that the purpose of the adopted standards and certification criteria was not to specify how or when Certified EHR Technology must be used, but only what capabilities Certified EHR Technology must include. (75 FR 2022-23, 75 FR 44592-93). We sought to align the adopted standards, implementation specifications, and certification criteria with certain already established regulatory requirements to ensure that Certified EHR Technology would provide a base-level of capabilities to assist users in meeting those other regulatory requirements. (See, for example, 75 FR 44591, and 75 FR 44598.) Then, when discussing electronic prescribing, we referred to the adopted NCPDP SCRIPT standard as a standard required under the Medicare Part D e-prescribing regulations when “an entity sends prescriptions outside the entity (for example, from an HMO to a non-HMO pharmacy)….” (75 FR 2031-32, 75 FR 44592). Consequently, with respect to the capability a Complete EHR or EHR Module must demonstrate in order to be certified to the certification criterion adopted at 170.304(b), a Complete EHR or EHR Module must be capable of electronically transmitting prescriptions and prescription-related information to external recipients according to NCPDP SCRIPT 8.1 or 10.6 in addition to the adopted vocabulary standard for medications at 45 CFR 170.207(d).

This approach is consistent with a principle we established in the Standards and Certification Criteria Interim Final Rule where we sought to ensure that eligible health care providers seeking to meaningfully use Certified EHR Technology and engaging in electronic exchange would be able to do so in a manner that would be compliant with other applicable law. Thus, with respect to electronic prescribing, we adopted NCPDP SCRIPT 8.1 and 10.6 to ensure that when an eligible professional electronically transmits a prescription or prescription-related information for Medicare Part D covered drugs for Medicare Part D eligible individuals to, for example, a pharmacy that is not part of the legal entity of the eligible professional, the eligible professional would be able to do so using Certified EHR Technology and also comply with the Medicare Part D e-prescribing rules.

See CMS FAQ 10284 [ or immediately below] for information about how these transmissions should be counted.

CMS Question 10284 FAQ on EHR Incentive Program
For the meaningful use objective of “generate and transmit prescriptions electronically (eRx)” for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program, how should the numerator and denominator be calculated? Should electronic prescriptions fulfilled by an internal pharmacy be included in the numerator?
Published 12/17/2010 11:34 AM   |    Updated 12/17/2010 11:41 AM   |    Answer ID 10284

ANSWER
The denominator for this objective consists of the number of prescriptions written for drugs requiring a prescription in order to be dispensed, other than controlled substances, during the EHR reporting period. The numerator consists of the number of prescriptions in the denominator generated and transmitted electronically using certified EHR technology. In order to meet the measure of this objective, 40 percent of all permissible prescriptions written by the EP must be generated and transmitted electronically according to the applicable certification criteria and associated standards adopted for certified EHR technology as specified by the Office of the National Coordinator for Health IT (ONC).

ONC has released an FAQ stating that “with respect to the capability a Complete EHR or EHR Module must demonstrate in order to be certified to the certification criterion adopted at 170.304(b), a Complete EHR or EHR Module must be capable of electronically transmitting prescriptions to external recipients according to NCPDP SCRIPT 8.1 or 10.6 in addition to the adopted vocabulary standard for medications (45 CFR 170.207(d)).”  Given such FAQ, prescriptions transmitted electronically within an organization (the same legal entity) would not need to use these NCPDP standards. However, an EP’s EHR must meet all applicable certification criteria and be certified as having the capability of meeting the external transmission requirements of §170.304(b).  In addition, the EHR that is used to transmit prescriptions within the organization would need to be Certified EHR Technology.

The EP would include in the numerator and denominator both types of electronic transmissions (those within and outside the organization) for the measure of this objective. We further clarify that for purposes of counting prescriptions “generated and transmitted electronically,” we consider the generation and transmission of prescriptions to occur constructively if the prescriber and dispenser are the same person and/or are accessing the same record in an integrated EHR to creating an order in a system that is electronically transmitted to an internal pharmacy.

For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.

ONC Question [12-10-023-1]:
Could an interface that transmits lab results in HL7 message format between a hospital laboratory system and a physician’s EHR (presuming that the transmissions were occurring between two different legal entities) satisfy the certification criteria related to the exchange of key clinical information in 45 CFR 170.304(i) and 45 CFR 170.306(f)? If not, please specify the required data types and exchange characteristics that must be part of the required clinical information exchange.

Answer:
As implied in the question, for certification a Complete EHR or an EHR Module must have the capability to electronically receive and display, and transmit certain key clinical information in accordance with one of two separate certification criteria (45 CFR 170.304(i) or 45 CFR 170.306(f)), depending on the setting for which the EHR technology is designed (ambulatory or inpatient, respectively). Generally speaking, these certification criteria require two types of information exchange capabilities – the capability to:

  1. Electronically receive and display a patient’s summary record, from other providers and organizations including, at a minimum, diagnostic tests results, problem list, medication list, and medication allergy list in accordance with the continuity of care document (CCD) standard (and the HITSP/C321 implementation specifications) or the continuity of care record (CCR) standard and that upon receipt of a patient summary record formatted according to the alternative standard, display it in human readable format.
  2. Electronically transmit a patient summary record to other providers and organizations including, at a minimum, diagnostic test results, problem list, medication list, and medication allergy list using the CCD standard (and the HITSP/C32 implementation specifications) or the CCR standard while also representing specific named data elements (problems, laboratory test results, and medications) according to adopted standards.

Note: The above uses language from 45 CFR 170.304(i). The certification criterion adopted at 45 CFR 170.306(f) also includes “procedures” as a required, standardized data element within these exchange capabilities.

Therefore, an interface that transmits lab results in HL7 message format between a hospital laboratory system and a physician’s EHR (where the transmission is occurring between two different legal entities) would not qualify as an exchange of key clinical information that complies with the requirements of either of these two certification criteria. The interface would not satisfy the required capabilities included within the adopted certification criteria, and more specifically, the ability to transmit a patient summary record in accordance with the CCD standard (and the HITSP/C32 implementation specifications) or the CCR standard.

1HITSP Summary Documents Using HL7 Continuity of Care Document (CCD)

Illinois, Wisconsin, New Hampshire Plans Brings to 18 ONC’s Approved Strategic and Operational Plans

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Eighteen States/SDEs with Approved Strategic and Operational Plans

Excerpted from State HIE Toolkit 12/22/2010

Illinois announced that their plans were approved by ONC on Dec 21, 2010. With recent addtions of Wisconsin, New Hampshire, Idaho, North Carolina, Vermont, and Washington, this brings total to 18 the number of states with approved strategic and operational plans listed on ONC’s State HIE Toolkit. Approved plans include California, Delaware, Idaho, Illinois, Maine, Maryland, Michigan, Nebraska, New Mexico, North Carolina, South Carolina, Tennessee, Texas, Utah, Vermont, and Washington.

Illinois HIE Strategic and Operational Plan

Here are the links to Illinois’s approved plans from Illinois HIE site.

http://www.hie.illinois.gov/sop.html 

State HIE Toolkit Updated 12/21/2010

The list below represents the currently approved state specific strategic and operational plans for creating Health Information Exchange capacity. [Note: Several state plans have not yet been published. State of Washington’s original submission and ONC response are shown, but final plan has not yet been published. Most of the links go to PDF files.] While Illinois has been added to ONC’s State HIE Toolkit chart (not yet shown below),  links to Illinois plan have not yet been added on ONC site.

The list below represents the currently approved state specific strategic and operational plans for creating Health Information Exchange capacity.

State

Strategic /Operational Plans

and

State Summaries

 Entity Responsible for Grant Plan Approval Date
California

Strategic and Operational Plans

To view the documents separately click here (easier download)

 California Health and Human Services Agency 6/16/2010
Delaware  Pending Delaware Health Information Network 5/17/2010
Idaho  Pending Idaho Health Data Exchange 12/7/2010
Illinois  Pending Illinois Department of Healthcare and Family Services 12/20/2010
Maryland Strategic and Operational Plans The Maryland Department of Health and Mental Hygiene 5/14/2010
Michigan

Strategic and Operational Plans

Amendment 1

 Michigan Department of Health 11/29/2010
Nebraska Strategic and Operational Plans Nebraska Department of Administrative Services 11/5/2010
New Hampshire  Pending New Hampshire Department of Health and Human Services 12/10/2010
New Mexico Strategic and Operational Plans LCF Research, New Mexico 1/25/2010
North Carolina

Strategic and Operational Plans

State Summary

 North Carolina Department of State Treasurer 11/3/2010
Oregon  Pending State of Oregon 12/10/2010
South Carolina Strategic and Operational Plans South Carolina Department of Health & Human Services 8/30/2010
Tennessee

Strategic and Operational Plans

Gap Analysis

State Summary

 State of Tennessee 9/17/2010
Texas Strategic and Operational Plans Texas Health and Human Services Commission 11/3/2010
Utah Strategic and Operational Plans Utah Department of Health 5/12/2010
Vermont Strategic and Operational Plans Vermont Department of Human Services 10/26/2010
Washington  Pending Washington Health Care Authority 12/10/2010
Wisconsin  Pending Wisconsin Department of Health and Family Services 12/20/2010

See e-Healthcare Marketing post for 32 State Health Information Exchange Plans, last updated on November 21, 2010. The Nov 21 update still needs to be reviewed and revised based on plan revisions not yet captured in that post.

‘Health IT: Making Health Care Better’: Commentary on America’s Health Rankings Site

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‘Health IT: Making Health Care Better’ by Sachin Jain
On the Web site dedicated for 20 years to using data to promote better health in the United States, Sachin H. Jain, MD, MBA, wrote a commentary on the role of the national HITECH initiative to collect and exchange health information for better patient care.  Titled  “Health IT: Making Health Care Better,” Jain’s commentary appears on the 21st Edition of America’s Health Rankings®: A Call to Action for Individuals and Their Communities. Jain is special assistant to the National Coordinator for Health Information Technology.

Jain discusses using electronic health records to improve patient quality management, encourage better clincal decisions, providing health information where and when it is needed, and getting information from here to there.

To read Jain’s commentary, click here.

ONC’s Kendall blogs about ‘Regional Extension Centers Supporting EHR Adoption’

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Regional Extension Centers Supporting EHR Adoption
Tuesday, December 14th, 2010 | Posted by: Mat Kendall Director Office of Provider Adoption Support on ONC Health IT Buzz blog and republished here by e-Healthcare Marketing.

The Regional Extension Centers (RECs) located across the country play a critical role in advancing the use of health information technology (health IT). They are charged with guiding some 100,000 health care providers in their efforts to establish and meaningfully use electronic health records in their practices. They offer a variety of services including outreach and education, and on-the-ground assistance.

With a total of 62 RECs, we are in every area of the U.S. to assist health care providers in their transition to electronic health records. To ensure that these critical partners have the knowledge and tools they need to assist their area’s health care providers, leaders from ONC’s Office of Provider Adoption Support  spend a good deal of time on the road meeting with REC staff members.

So far we’ve held workshops and seminars on topics like meaningful use, privacy and security, vendor selection, and workforce development.  We’ve had the chance to participate in events where leaders from different RECs come together to network and share best practices.  And we’ve learned about new ways we can support our RECs in their mission to help health care providers adopt electronic health records.

We are now implementing several new initiatives as a result of what we’ve learned from our REC partners:

  • An interactive online community that houses a wealth of tools and resources for RECs to obtain strategic health IT support and exchange ideas
  • An Outreach, Education, and Marketing Guide to assist RECs in their outreach efforts
  • A Meaningful Use Vanguard (MUV) cohort to showcase and reward health care providers who are true health IT ambassadors
  • Outreach campaigns to assist RECs in their recruitment of participating health care providers
  • Partnering with EHR vendors to identify best practices for working together to meet the needs of providers

These initiatives are only the beginning.

Our RECs are in the field, actively recruiting and signing on providers to their services. To date, our RECs have enrolled over 28,000 providers and for the last 12 weeks, the RECs across the country have enrolled on average over 1,000 providers a week.   Some RECs, such as Mississippi and Maine have enrolled over 60% of their overall primary care provider target.  Others, such as Colorado, the California Health Information Partnership Service Organization, Massachusetts, North Carolina, New York City Washington/Idaho RECs have enrolled over 1,000 providers in the last few weeks.

We are looking forward to hearing more about the RECs and their accomplishments at the 2010 ONC Update Meeting, December 14-15, in Washington D.C. This meeting will be a great opportunity to continue our dialogue with the RECs and learn about other ways we can support them. We want to ensure that the RECs are fully equipped to help our nation’s health care providers become meaningful users of electronic health records.

To find out more about the REC program in general, visit healthit.hhs.gov/REC.
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To post comments directly on ONC Health IT Buzz blog post, please click here.

Meaningful Use Vanguard Program
To see an example at a state REC level of the Meaningful Use Vanguard Program launched November 15, 2010, see the “The West Virginia Regional HIT Extension Center (WVRHITEC) [which] has established a new physician-to-physician outreach and education program designed to assist and help foster more widespread adoption and use of electronic health record systems in West Virginia.” Click here.

Blumenthal Letter #21: 2010 ONC Update [and Welcome to 2010 ONC Conference]

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2010 ONC Update
Dr. David BlumenthalA Message from Dr. David Blumenthal, the National Coordinator for Health Information TechnologyDecember 10, 2010
Accessed from ONC site 12/13/2010.

The Office of the National Coordinator for Health Information Technology (ONC), the Centers for Medicare & Medicaid Services (CMS), the Office for Civil Rights (OCR), and other HHS agencies are dedicated to improving the nation’s health care through health information technology (health IT).

Since the Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law in February 2009, we have established a number of initiatives that will help make it possible for providers to achieve meaningful use and for Americans to benefit from electronic health records as part of a modernized, interconnected, and vastly improved system of care delivery.

This year alone, we have established a number of important policies and programs to help lay the foundation for providers to begin their journey toward meaningful use. These include: 

It’s been a busy year for health IT at HHS.

We are looking forward to discussing more about all of our HITECH initiatives to date, as well as our future activities, at the upcoming 2010 ONC Update Meeting on December 14 and 15.

Over the course of this two-day meeting, we are offering a number of sessions that will give participants a better understanding of the HITECH regulations and the role that HITECH plays in health system change and health care reform. Some session topics include:

  • HITECH programs that support providers in achieving meaningful use
  • How HITECH initiatives will promote consumer empowerment and public engagement
  • Privacy and security policies

Our panelists and invited speakers include HHS Secretary Kathleen Sebelius and leaders from CDC, CMS, OCR, ONC and organizations who have a stake in our work. We are excited about the opportunity to share information and ideas.

The plenary sessions at this meeting will be streamed through a live webcast. Details about the webcast are available on the ONC website: http://healthit.hhs.gov/ONCMeeting2010.

Thank you in advance for joining us at the 2010 ONC Update Meeting and for supporting our vision of a higher quality, safer, and more efficient health care system enabled by health information technology.

Sincerely,
David Blumenthal, MD, MPP
National Coordinator for Health Information Technology

The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.

For more information and to receive regular updates from the Office of the National Coordinator for Health Information Technology, please subscribe to  ONC’s Health IT News list.

Two New EHR Testing and Certification Labs; CHPL List shows Additional Software Required

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ONC Site Reflects Changes: Additional Test Labs and Additional Software
Two new ONC-Authorized Testing and Certification Bodies (ATCBs) were authorized on December 10, 2010 to test and certify complete EHRs and EHR modules: Mechanicsburg, PA-based ICSA Labs and Denver, CO-based SLI Global Solutions.

Also, the CHPL list or Certified HIT Product List which “provides the authoritative, comprehensive listing of Complete EHRs and EHR Modules that have been tested and certified under the Temporary Certification Program” has been modified to reflect “additional software required.” While most of the additional software required impacts ambulatory systems, it also impacts a number of  Inpatient systems. Email software appears to be the most needed software. In many cases additional components by the vendor are required as well. This area of additional software needs to be further reviewed by this blog and purchasers. The latest list is dated December 4, 2010, but was accessed on December 11, 2010.

ONC-Authorized Testing and Certification Bodies
Excerpted from Office of National Coordinator for Health IT site on 12/11/2010
The following organizations have been selected as ONC-Authorized Testing and Certification Bodies (ATCBs):
  • ICSA Labs – Mechanicsburg PA
    Date of authorization: December 10, 2010.
    Scope of authorization: Complete EHR and EHR Modules.
  • SLI Global Solutions – Denver CO
    Date of authorization: December 10, 2010.
    Scope of authorization: Complete EHR and EHR Modules.
  • Certification Commission for Health Information Technology (CCHIT) – Chicago, Ill.
    Date of authorization: September 3, 2010.
    Scope of authorization: Complete EHR and EHR Modules.
  • Drummond Group, Inc. (DGI) – Austin, Texas.
    Date of authorization: September 3, 2010.
    Scope of authorization: Complete EHR and EHR Modules.
  • InfoGard Laboratories, Inc. – San Luis Obispo, CA
    Date of authorization: September 24, 2010.
    Scope of authorization: Complete EHR and EHR Modules.

The organizations listed above have been authorized to perform Complete EHR and/or EHR Module testing and certification. These ONC-ATCBs are required to test and certify EHRs to the applicable certification criteria adopted by the Secretary under subpart C of Part 170 Part II and Part III as stipulated in the Standards and Certification Criteria Final Rule.

Certification by an ATCB will signify to eligible professionals, hospitals, and critical access hospitals that an EHR technology has the capabilities necessary to support their efforts to meet the goals and objectives of meaningful use.

Learn more about ONC-ATCBs: