ONC Issues Proposed Rule for Two EHR Certification Programs

Kathie McDonald-McClure EHR Certification Standards, Electronic Health Records, Eligible Professional Incentives, Health Information Technology, HITECH Law, Hospital EHR Stimulus, Meaningful Use , , , , ,

On March 2, 2010, the Office of National Coordinator (ONC) issued its proposed rulemaking respecting the certification standards that an eligible health care provider’s electronic health record must satisfy in order to qualify for incentives under the Health Information Technology for Clinical and Economic Health Act (HITECH Act), which was part of the American Recovery and Reinvestment Act of 2009 (ARRA). The ONC proposes establishing two certification programs:

1) A temporary certification program whereby the ONC would authorize organizations to test and certify Complete EHRs and/or EHR Modules, thereby assuring the availability of Certified EHR Technology prior to the date on which health care providers seeking the incentive payments may begin demonstrating meaningful use of Certified EHR Technology; and

2) A permanent certification program that would replace the temporary certification program. The permanent certification program would separate the responsibilities for performing testing and certification, introduce accreditation requirements, establish requirements for certification bodies authorized by the ONC related to the surveillance of Certified EHR Technology, and would include the potential for certification bodies authorized by the ONC to certify other types of health information technology besides Complete EHRs and EHR Modules.

The comment period for the proposed rule will be established once it is published in the Federal Register. In the meantime, you can read the proposed rule on the ONC’s webpage.

List of HIT Grant Recipients under ARRA

Kathie McDonald-McClure Health Information Technology, State HIT Grants & Loans

For more up-to-date information about ARRA grants related to EHRs, see the page titled “Grants” which can be found at the top of this blog’s home page. 

A complete listing of the Health Information Exchange (HIEs), Regional Extention Centers (RECs) and job training recipients of HIT grants under the Health Information Technology for Economic and Clinical Health (“HITECH”) of the American Recovery and Reinvestment Act of 2009 (“ARRA”) is available through the HHS Newsroom webpage here.  To date, 40 state agencies, 32 RIEs, and 55 job training participants have received awards totaling over $1 billion.

Conversion to electronic health record and retention of paper records

Kathie McDonald-McClure Electronic Health Records, Federal Law Resources, Health Information Technology, HITECH Law, Privacy & Security , , ,

Editor’s Note: Due to the continued popularity of this post, this article was reviewed and updated on September 30, 2013. For the later version, click here.

Update: On August 8, 2010, Medicare issued MLN Matters Article SE1022 on Medical Record Retention and Media Formats for Medical Records, which states that the Centers for Medicare and Medicaid Services (CMS) requires records of providers submitting cost reports (most hospitals) to be retained in their original or legally reproduced form (which may be electronic), for at least 5 years after closure of the cost report.

Many hospitals have electronic health records (EHRs) that are hybrid digital records. While the hospital may be using electronic data entry in the ER, inpatient nursing care, pharmacy, lab, and pre-op anesthesia, oftentimes, these EHRs are not integrated and, thus, are not merged into a single EHR. The short-term solution may have been to scan printed records from some department, like lab or pharmacy, into the patient’s on-line digital record. As a result, the hospital’s “electronic health record” contains information that is not captured in a “coded format.”  For one, this will not meet the Stage One “meaningful use” criteria under the HITECH Act.

But let’s assume that the hospital can overcome this hurdle by working with vendors to integrate these records in a way that will meet HITECH EHR certification standards.  If the hospital has been maintaining certain portions of patient records in a paper format, what does it do with those paper records after converting to an EHR?   If the hospital scans all the paper patient records into its EHR, how long should the hospital retain the paper record after it is scanned into their EHR? 

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Can hospitals benefit from HITECH Act stimulus funds for their non-hospital based, employed physicians?

Kathie McDonald-McClure Eligible Professional Incentives, Health Information Technology, HITECH Law, Hospital EHR Stimulus, Physician EMR Stimulus , ,

IMPORTANT NOTICE:  This article was originally written in June 2009, before HHS released the Proposed Rule on “meaningful use” on December 30, 2009 and before President Obama signed the Continuing Extension Act of 2010. Under the Proposed Rule, the determining factor of whether a physician is “hospital-based” under the Medicare incentive program was to be his or her “site of service” on the claim, specifically, “21” for hospital inpatient, “22” for hospital outpatient, and “23” for emergency department.  If 90% or more of a physician’s claims had these places of service codes, then CMS would have deemed such physician to be “hospital-based” and ineligible for the incentive. However, on April 15, 2010, President Obama signed the Extension Act, which amended the HITECH Act language by replacing the words “outpatient setting” with the words “emergency room setting.”  Accordingly, CMS will not be able to deem a physician practicing in a hospital outpatient setting, such as an urgent care clinic, ineligible for the incentive soley on this basis.  If an employed or contracted physician practicing in an outpatient setting is eligible (EP), the hospital should take steps to ensure the incentive awarded to such EP due to the meaningful use of a certified EHR in that hospital’s outpatient setting is appropriately assigned to the employing or contracting hospital.

Article Summary: This article explores the potential for hospitals to obtain the HITECH Act incentives made available to “eligible professionals.” Hospital-based physicians who meet the “hospital-based” definition are not eligible for the eligible professional incentives. The definition of “hospital-based” contains several terms, including “hospital setting,” that are not clearly defined and, importantly, the HITECH Act leaves some discretion in the Secretary of Health & Human Services (HHS) to further define it. If the objective is to prevent hospitals from being paid twice for the same electronic medical record (EMR), then the exclusion of “hospital-based” physicians makes sense. However, if hospital-owned physician clinics or practices must implement specially designed health information technology (HIT) that will enable such physicians to make a “meaningful use” of the EMR, then the hospital owner might be advised to consider this in formulating its business and financial strategy for a totally integrated HIT system-wide.

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Kentucky joins 13 other states with CMS grants for EHR implementation

Kathie McDonald-McClure Health Information Technology, HITECH Law, State HIT Grants & Loans , , , ,

On Thursday, January 21, 2010, CMS announced that Alaska, Kentucky, South Carolina and Wisconsin, would receive federal matching funds for EHR implementation under the American Recovery and Reinvestment Act of 2009 (ARRA).  Kentucky’s grant is $2.6 million.  CMS indicated that the grant will be used to study EHR implementation activities in the state, to establish the state’s Medicaid HIT incentive program, and to evaluate provider eligibility for the Medicaid incentive funds under the HITECH Act, which was part of ARRA.  CMS has now made EHR grants to 14 states: Alaska, California, Georgia, Idaho, Iowa, Kentucky, Montana, New York, South Carolina, Texas, U.S. Virgin Islands, Tennessee, Pennsylvania, and Wisconsin.

Although the HITECH Act allows states to use federal matching funds to establish EHR loan programs for providers who need this avenue of support, there was no mention that the grant money would be used for that purpose.  This could leave some professionals who have a low or non-existant Medicare patient base and an insufficient Medicaid patient base to qualify for the Medicaid EHR incentives (e.g., some pediatricians), without access to EHR stimulus funds under ARRA.

To read the CMS press release on Kentucky’s grant, go here.  Information for this story also was gathered from Healthcare IT News and HealthImaging.com.