Electronic Health Records Transition

On February 17, 2009 the American Recovery and Reinvestment Act of 2009 was signed into law by the federal government. Included in this law is $19.2 billion that is intended to be used to increase the use of Electronic Health Records (EHR) by physicians and hospitals; this portion of the bill is called the Health Information Technology for Economic and Clinical Health Act or the HITECH Act.

Experior Networks is working with physicians and hospitals to ensure they have the bandwidth, storage and security capabilities needed to transport large patient files securely across both LANs and WANs as they move to implement use of EHR systems. The following is a brief outline of some of the key requirements needed for physicians and hospitals to qualify and receive incentive payments from the HITECH Act.

The government firmly believes in the benefits of using electronic health records and is ready to invest federal resources to proliferate its use. A qualified EHR is defined as the following:

An electronic record of health--related information on an individual that:

  • Includes patient demographic and clinical health information;
  • Has the capacity to:
    • Provide clinical decision support;
    • Support physician order entry;
    • Capture and query information relevant to health care quality;
    • Exchange electronic health information with, and integrate such information from other sources.

EHR Technology is further defined and certified using three distinct levels.

Level 1

Complete EHR

EHR technology that has been developed to meet all applicable certification criteria adopted by the Secretary. Complete EHR is not meant to limit the capabilities that a complete EHR can include. Rather, it is meant to encompass EHR technology that can perform all of the applicable capabilities required by certification criteria adopted by the Secretary and distinguish it from EHR technology that cannot perform those capabilities.

Level 2

EHR Module

Any service, component, or combination thereof that can meet the requirements of at least one certification criterion adopted by the Secretary.

  1. An interface or other software program that provides the capability to exchange electronic health information;
  2. An open source software program that enables individuals on line access to certain health information maintained by EHR technology;
  3. A clinical decision support rules engine;
  4. A software program used to submit public health information to public health authorities and a quality measure reporting service or software program.

Level 3

Certified EHR Technology

EMR technology certified by standards adopted by the Secretary HHS. A Complete EHR or a combination of EHR Modules, each of which meets the requirements included in the definition of a Qualified EHR and has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary.

Meaningful Use

The Meaningful Use Rule, which was released in a proposed form at the end of 2009 and was finalized in July 2010, outlined in much greater detail what physicians and other participating providers will need to do to qualify for the HITECH incentive payments.

  • Providers will need to prove Meaningful Use of their EHR for at least 90 continuous days in 2011 in order to earn an incentive, and then for the entire year each subsequent year;
  • Physicians need to prove that they have met functional objectives with their use of the EHR product to be considered "meaningful users" (see below);
  • Clinical quality measures will need to be submitted by a provider on a Core set of measures, as well as a specialty-specific subgroup; providers will be able to file for an exception if none of the 89 proposed measures matches with their specialty.

Specific Quality Measures are available for the following specialties:

  • Cardiology
  • Endocrinology
  • Gastroenterology
  • Nephrology
  • Neurology
  • Obstetrics and Gynecology
  • Oncology
  • Radiology
  • Ophthalmology
  • Pediatrics
  • Podiatry
  • Primary Care
  • Proceduralist/Surgery
  • Psychiatry
  • Pulmonology

Physicians will be paid on a rolling basis as soon as they have proven to CMS that they have met all the functional objectives of the Meaningful Use Requirement and have hit the maximum amount for the year. CMS will then issue a single annual, consolidated payment.

  • All reporting will be done by attestation in 2011, moving to an electronic form in later years;
  • The requirements related to Meaningful Use will become more challenging beginning 2013.

Standards and Certification

Qualified EHR technology means that the EHR is certified to meet standards and includes patient demographic and clinical health information, has the capacity to provide decision support for physician order entry and to capture and query healthcare quality information, and to exchange electronic health information with other sources.

As part of HITECH's requirements related to the review of all existing standards, the ONC released at the end of 2009 the initial set of standards that will affect the Meaningful Use criteria related to certified products and implementation specifications.

Privacy Expansion

As part of the HITECH Act, Federal privacy and security laws (HIPAA) were expanded to protect patient health information, including:

  • Defining which actions constitute a breach (including some inadvertent disclosures);
  • Imposing restrictions on certain disclosures, sales, and marketing of protected health information;
  • Requiring an accounting of disclosures to a patient upon request;
  • Authorizing increased civil monetary penalties for HIPAA violations;
  • Granting authority to state attorneys general to enforce HIPAA.

Summary of Significant Stage 1

Meaningful Use Requirements
  • The total amount that any Eligible Provider (EP) can obtain is $44,000 over a 5-year period;
  • The payment year and year of payment has been combined; thus, an EP must use the system the year that they expect payment;
  • The first payment year is 2011 and it is a special year in that it is the only year the EP is not required to use a certified EHR for the entire year. For 2011, an EP only needs to use a certified EHR for 90 consecutive days;
  • EPs are defined as ambulatory physicians whose Medicare charges are generated from ambulatory settings. Thus, if the EP is billing on UB4 or under a hospital Tax ID number the EP would most likely not qualify for the stimulus dollars. If 90% of the medical charges that a physician bills is from a "Hospital" facility, they would not qualify for "Meaningful Use" stimulus money;
  • Reporting requirements have been changed to reflect mostly individual patients both Medicare and non-Medicare as opposed to clinical visits or episodes;
  • For the most part, the intent of meaningful use criteria is directed toward the EP not the support staff of the EP.

Stimulus Payments to Physicians and Hospitals

The two primary goals for the stimulus payments in this legislation are moving physicians who have been slow to adopt Electronic Health Records to a computerized environment, and ensuring that patient data no longer sits in silos within individual provider organizations but instead is actively and securely exchanged between healthcare professionals. Therefore, the vast majority of the funds within the HITECH Act are assigned to payments that will reward physicians and hospitals for effectively using a robust, connected EHR system.

There is a program designed for those that see large volumes of Medicaid patients, and another for those that accept Medicare. In order to qualify for the incentives, both physicians and hospitals have to demonstrate:

  1. Use of a certified EHR product with Computerized Ordering, eRx capability, and decision support capabilities that meet current HHS standards;
  2. Connectivity to other providers to improve access to the full view of a patient's health history;
  3. Ability to report on their use of the technology to HHS.

The incentives include payments for up to six years but provide the largest payments early in the program, and those that don't demonstrate Meaningful Use of an EHR under the Medicare component of the program will eventually be penalized through lower payments. The incentive payments begin in 2011 to ensure providers have time to adopt and learn to use the EHR; penalties begin in 2015.

To find out how Experior Networks can help you integrate an EHR solution into your existing LAN, please contact us to set up an appointment.