New Guide for Privacy and Security of Health Information in EHRs

Lock and KeyThe Office of the National Coordinator for Health Information Technology (ONCHIT) recently released a 47-page Guide to Privacy and Security of Health Information.  The Guide provides direction to providers on protecting patient privacy and securing their health information in an electronic health record (EHR) for purposes of complying with the Heath Insurance Portability and Accountability Act (HIPAA) as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act. The Guide also addresses compliance with certain Meaningful Use (MU) standards that have been promulgated pursuant to the HITECH Act’s incentive program for adopting and implementing EHRs.

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Certified EHRs Expected to Transmit Data for Medicare’s New Hospital Inpatient Value-Based Purchasing Program

On January 13, 2011, the Centers for Medicare and Medicaid Services (CMS) released its Proposed Rule on the Medicare Hospital Inpatient Value-Based Purchasing (VBP) Program. The VPB Program is being established per the directive of the Patient Protection and Affordable Access to Care Act of 2010 (PPACA). CMS is to begin making incentive payments under the VBP Program for discharges on or after October 1, 2012.

Seven years before PPACA required CMS to establish the VBP Incentive Program, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) gave CMS authority to establish the Hospital Inpatient Quality Reporting (IQR) Program. The clinical quality measures that CMS has adopted for the IQR Program will feed into the measures for the VBP Program.

The IQR Program measures were generally based on recommendations from the National Quality Forum (NQF), a voluntary consensus standard-setting organization with a diverse representation of consumer, purchaser, provider, academic, clinical, and other health care stakeholder organizations. The IQR measures began as a set of 10 quality indicators that have since expanded to 45 clinical quality measures for the FY 2011 IQR program payment determination. The FY 2011 IQR hospital measures focus on four topics: 1) Acute Myocardial Infarction (AMI); 2) Heart Failure (HF); 3) Pneumonia (PN); and 4) Surgical Care Improvement Project (SCIP).

So how does this relate to the Health Information Technology for Economic and Clinical Health Act (HITECH Act) and a hospital’s “meaningful use” of a “certified EHR“? Ahhh, there is a method to the madness. As the CMS VBP Proposed Rule points out, the Hospital IQR program and the Hospital VBP Program have “important areas of overlap and synergy with regard to the reporting of quality measures under the HITECH Act.”

CMS notes in the Proposed Rule that the certification standards for EHRs under the HITECH Act are directed at enabling EHR submission of quality measures. CMS is striving “to align the [VPB] measures with the adoption of meaningful use standards for health information technology (HIT), so the collection of performance information is part of care delivery.” As a result, CMS anticipates that hospitals will use their certified EHRs for the reporting of clinical quality measures under both the Hospital IQR program and the subsequent Hospital VBP Program.

The proposed initial measures for the FY 2013 Hospital VBP Program include 18 measures. Of these 18 measures, 17 measures will focus on the four clinical process of care topics set forth for the 2011 IQR Program (AMI, HF, PN, and SCIP), and will add Healthcare-Associated Infections (HAI). The 18th measure will include a measure from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) that will fall under a patient experience of care domain.

The proposed performance period is to begin July 1, 2011 and will continue through March 31, 2012 for the FY 2013 payment determination. This is already less than five months away! Another reason for Eligible Hospitals under the HITECH Act to focus on implementation of a certified EHR. Did I hear someone ask how the VBP incentive payments will be funded? Answer: By a reduction of the Fiscal Year 2013 base operating DRG payments for each discharge of 1%. “What one hand giveth, the other hand taketh away.” (Unknown)

For more information about the IQR Program, visit QualityNet.  For additional details about the VBP Program, see the Proposed Rule.  CMS will accept comments on the VBP Proposed Rule until March 8, 2011.  CMS expects to issue a final rule in 2012.

EHR Certification Organizations and Certified EHRs

Just to recap where we are today, the U.S. Health & Human Services Department (HHS) Office of National Coordinator for Health Information Technology (ONC) has authorized three organizations to perform complete EHR and/or EHR module testing and certification under the Temporary Certification Program Rules. Certification means that the EHR or EHR module has the capabilities necessary to support the efforts of eligible hospitals and eligible professionals in meeting the Meaningful Use requirements under Final Rule issued by Centers for Medicare and Medicaid Services (CMS) for Meaningful Use.  The three ONC-Authorized Testing & Certification Bodies (ATCBs) to date are Certification Commission for Health Information Technology (CCHIT), Drummond Group, Inc. (Drummond), and InfoGuard Laboratories, Inc. (InfoGuard). For additional information about the ONC process for achieving ATCB status, as well as more information about Standards & Certification generally, see the ONC webpage.

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CMS Holds Training Teleconference on EHR Final Rules

On Thursday, July 22, 2010, the Centers for Medicare and Medicaid Services (CMS) held a publicly available teleconference to give an overview of the 800+ page Final Rule on Meaningful Use (MU) under the HITECH Act, as well as an overview of the Final and Proposed Rules on Temporary & Permanent Certification Program and the Final Rule on the Standards and Certification Criteria for electronic health records (EHRs).  CMS is making an “encore recording” of the 90-minute teleconference available until 11:00 pm, Saturday, July 24, 2010.  Call toll-free, 1-800-642-1689 and enter the conference ID 87841621 to hear the encore recording.  CMS will post an audio recording link to the teleconference on its EHR Incentive Programs website sometime in August 2010.  The slides accompanying the audio are available on that same website, here (scroll to Downloads and click on the links for the July 22, 2010 Training materials). 

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HHS Releases Final Rule on “Meaningful Use” of Electronic Health Records

Update: On December 29, 2010, HHS published in the Federal Register a “Correcting Amendment” to its Final Rule on Meaningful Use, which can be viewed here.

HHS Secretary Kathleen Sebelius wasted no time in putting the brand new CMS Director to work on July 13, 2010, in announcing the release of two rules under the Health Information Technology for Clinical and Economic Health Act (HITECH), including the Final Rule on Meaningful Use and the Final Rule on Initial Set of EHR Standards and Certification Criteria. Donald M. Berwick, MD, MPP, FRCP, was sworn in as Director of the Centers for Medicare and Medicaid Services on Monday afternoon, July 12, 2010, and by the next morning was primed to discuss the important role of health information technology (HIT) in America. In addition to Dr. Berwick’s participation at the press briefing, other participants included David Blumenthal, MD, the Chief Coordinator for the HHS Office of National Coordinator of HIT (ONC), Regina Benjamin, MD, U.S. Surgeon General, and Regina Holiday, an individual who shared a personal experience involving access to health information and how such access impacts the care of patients. 

Quick Reference: The CMS Fact Sheet on both Final Rules is available here. 

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