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Washington Debrief: Legislation Would Extend EHR Incentives to Safety Net Providers, Clinics

July 15, 2013
by Jeff Smith, Director of Public Policy at CHIME
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Jeff Smith, Director of Public Policy at CHIME

The week following July 4 was certainly a busy one in Washington for Health IT.  New reports from Health Affairs were released, finding upward trends of electronic health record (EHR) adoption; future congressional hearings were set and a bill encouraging further EHR adoption among low-income clinicians was released.  Amid this torrent of activity, CHIME Public Policy pressed forward with its ever-ambitious agenda, meeting with officials at ONC and a prominent member of the House Energy & Commerce Committee.  This is the Washington Debrief, covering what CIOs need to know from the week that was July 7, 2013.

EHR Adoption on the Rise, Research Concludes

No matter how one slices it, adoption of electronic health records is increasing among hospitals and physicians.  According to an article published in the journal Health Affairs, “Adoption Of Electronic Health Records Grows Rapidly, But Fewer Than Half Of US Hospitals Had At Least A Basic System In 2012,” the percentage of hospitals with a basic electronic health record system tripled from 9 percent in 2008 to 44 percent in 2012.  And another new study posted by the peer-reviewed journal found that the percentage of office-based physicians with a basic electronic health record system grew to 40 percent last year, up from 25 percent in 2010.  “The nation’s health care system is in the midst of an enormous change as hospitals and ambulatory care providers transition from paper-based to electronic record keeping systems,” said one of studies.

This bit of encouraging news was not without a tinge of reality.  Namely, the hospital report found that the “digital divide” among urban and rural facilities was growing and only 5 percent of hospitals could meet a proxy for Meaningful Stage 2 in 2012.  And on the physician side, CMS reported this week that 17 percent of successful Meaningful Users in 2011 did not make the cut in 2012.  According to feedback gathered by CMS, reasons for this “dropout” ranged from unforeseen costs, program complexity, vendor issues or simply missed the deadline.

Despite some of this sobering news, health IT adoption is trending in the right direction and one can rightly point towards the EHR Incentive Payments program as being a significant driver.  As the industry progresses towards higher adoption and further Stages of Meaningful Use, it will be important to keep a careful eye on those who fall off the “escalator.”  And it will be prudent to reassess policies as complex and dynamic as Meaningful Use.

ONC Undertakes Patient Data-Matching Effort

For months – and even years – CHIME Public Policy has been trying to educate federal officials and congressional leaders on the dangers of patient mismatches.  In a world of increasing exchange and automated integration of data, the fundamental need to make sure patient data is matched to the right patient has never been so great.  ONC has received the message, and is beginning an environmental scan of patient data-matching.  The aim of the effort is to understand how various groups are looking at misidentification of patients and to see if there are scalable policies that could be adopted industry-wide.  CHIME will play an active role – through its StateNet Workgroup on Patient Matching – and by working closely with the agency as it prepares to disseminate survey questions to the industry.

In addition, CHIME and CHIME StateNet will be hosting ONC in a July 24 webinar to explain how they intend to identify core inhibitors to accurate patient identification and propose solutions. Speakers Lee Stevens, a program manager for the State Health Information Exchange (HIE) at ONC and Genevieve Morris, senior associate at Audacious Inquiry, will discuss ONC’s patient matching efforts and explain the role CHIME StateNet can play.  Click here to register.

Health IT Policy Committee Considers Recommendations for Stage 3 CQMs and Query Exchange

The July meeting of the Health IT Policy Committee met in Washington recently and they considered workgroup recommendations on CQMs, patient record query exchange and provider directories under Stage 3 of Meaningful Use.  In discussing the proper approach to CQM development, the Policy Committee favored an “alternative approach” that opens the process to any eligible health professional, as opposed a conservative approach that would limit development to professional societies and integrated delivery networks.  The Committee also heard recommendations from the Interoperability Workgroup which recommended that querying systems for patient information have the ability to:

  • Electronically query external EHR systems;
  • Identify the address and security of a clinical source;
  • Show authenticating credentials;
  • Present patient-identifying information; and
  • Record transactions being requested.

For those systems responding to queries, the workgroup recommended that systems be able to:

  • Respond to electronic requests from external EHR systems;
  • Validate the requester's authenticating credentials;
  • Match patient information;
  • Assess the "robustness of authorization for specific patient-level request;"
  • Automatically respond to requests based on robustness;
  • Locate and respond with patient records or a notice that no such record will be sent; and
  • Record the transaction and disclosure.

New Legislation Would Extend EHR Incentives to Safety Net Providers, Clinics

Four lawmakers recently unveiled legislation in the Senate and the House of Representatives that would help health clinics and providers serving vulnerable to, low-income patients qualify for incentive payments under Meaningful Use.  Senators Jay Rockefeller (D-W.V.), Sheldon Whitehouse (D-R.I.) and Al Franken (D-Minn.) reintroduced legislation previously introduced by Senator John Kerry (D-Mass.) before he became Secretary of State called the Medicaid Information Technology to Enhance Community Health (MITECH) Act (S.1268).  “We can’t get serious about improving care and reducing costs for our most vulnerable populations without leveraging the full promise of electronic health records,” said Senator Rockefeller in a statement.  Congresswoman Lois Capps (D-Calif.-24) introduced companion legislation today in the House of Representatives.

Just In:  Senate Finance Committee to Hear From ONC, CMS on EHR Adoption

The Senate Finance Committee released details of hearing set for July 17 entitled: “Health Information Technology: A Building Block to Quality Health Care.”  The hearing will feature witness testimony from Farzad Mostashari, M.D., ScM, National Coordinator for Health Information Technology and Patrick Conway, M.D., MSc, Chief Medical Officer and Director, Acting Director of CMS Innovation Center.

Now open! CHIME State Public Policy Award for CIO Leadership

The CHIME State Public Policy Award will be presented during National Health IT Week on September 18 in Washington, DC.  (Winner need not be present, but it’s encouraged!)  This award recognizes the contribution of a CHIME member engaged in educating policy makers at the state-level on the value of health IT and its role in patient care.  You may nominate yourself or a colleague.  Submission deadline: Aug. 2, 2013

Edited by Gabriel Perna

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