The 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.
Meaningful Use
“Meaningful Use” is the type of use that eligible hospitals and eligible professionals must make of a certified electronic health record in order to qualify for Medicare incentive dollars under the HITECH Act.
CMS Releases Proposed Rule for Stage 2 Meaningful Use of Electronic Health Records
On Thursday, February 23, 2012, the Centers for Medicare and Medicaid Services (CMS), pursuant to the Health Information Technology for Economic and Clinical Health (HITECH) Act, released a 455-page Proposed Rule specifying the Stage 2 criteria that eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid incentives related to electronic health records (EHRs). The Proposed Rule also proposes to modify certain Stage 1 criteria, as well as criteria that apply regardless of Stage, as previously published in the Final Rule on July 28, 2010 in the Federal Register. The proposed provisions related to Medicaid (calculations of patient volume and hospital eligibility) would take effect shortly after the finalization of the Proposed Rule and would not be subject to the proposed one-year delay for Stage 2 meaningful use of a certified EHR. The Proposed Rule states that the changes to Stage 1 would take effect for 2013, but that most changes would be optional until 2014. Last but not least, the Proposed Rule addresses the Medicare payment adjustments that will take place for EPs, eligible hospitals and CAHs who fail to demonstrate a meaningful use of certified EHRs by 2015 and proposed exceptions to such adjustments.
Early Meaningful Users Promised Stage 2 Extension
On November 30, 2011, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius issued a press release announcing proposed steps to encourage physicians and hospitals to adopt electronic health records (EHRs) this year and receive incentive payments made available under the Health Information Technology for Economic and Clinical Health (HITECH) Act), which was part of the American Recovery and Reinvestment Act of 2009 (ARRA).
Under the HITECH Act, physicians and hospitals have the opportunity to earn financial incentives from Medicare and Medicaid if they demonstrate the adoption and meaningful use of certified EHRs in a series of three stages. Under the current rules, physicians and hospitals that adopt EHRs in 2011 and attest to meeting Stage 1 meaningful use standards by February 28, 2012 must meet Stage 2 standards in 2013. If they wait until 2012 to attest to Stage 1, providers could delay Stage 2 compliance until 2014. To encourage more providers to adopt EHRs in 2011, instead of waiting until 2012, HHS proposes to allow providers who qualify for Stage 1 meaningful use in 2011 an extension until 2014 to meet Stage 2 standards. HHS clarified that providers first attesting to meaningful use in 2011 qualify for both 2011 and 2012 incentive payments.
These proposed steps are consistent with June 2011 recommendations from the Health IT Policy Committee (HITPC). As we reported this summer, HITPC advocated that providers who begin to attest to meaningful use in 2011 be provided an extra year “to phase in the stage 2 expectations (i.e., Stage 2 for those who attest in 2011 would begin in 2014).” HHS listened!
HHS intends to publish this extension in the Stage 2 meaningful use Notice of Proposed Rulemaking (NPRM) in February 2012.
At the same time, HHS also released new data from the Centers for Disease Control and Prevention (CDC) showing increased adoption of EHRs by physicians. The CDC report documented that physicians’ adoption of health information technology (IT) doubled in two years, and 52% of physicians intend to apply for meaningful use incentives, up from 41% in 2010. Click here to access additional information about achieving meaningful use, including the CDC report.
ONC Announces Text4Health Task Force
In an article titled, “Use of electronic communications with patients,” posted to this blog on December 18, 2009, I discussed the stated goal under the Health Information Technology for Economic and Clinical Health (HITECH) Act to “[p]rovide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health.” The article explored whether and to what extent patient messaging, including text messaging, might be used to achieve this HITECH Act goal. The U.S. Department of Health and Human Services (HHS) also is exploring ways to integrate text messaging into individual health management. On September 19, 2011, HHS announced the formation of the Text4Health Task Force, with specific recommendations that support health text messaging and mobile health (mHealth) programs. The HHS press release states: “The department has been actively exploring means to capitalize on the rapid proliferation of mobile phone technology and platforms, such as text messaging, to develop programs and/or partnerships with the overall aim of improving public health outcomes.” The HHS press release cites certain smoking cessation programs that utilize text messaging as representative of the direction in which this technology can be further exploited to improve population health. Among its recommendations, the Text4Health Task Force includes a recommendation related to electronic health records (EHRs) and, more specifically, recommends that “HHS align health text messaging/mHealth activities with other HHS Health IT priorities.” To read the HHS Text4Health Task Force recommendations, click here.
Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010
Update: The text of HR 6072 is now available on the Library of Congress webpage here.
On Friday, July 30, 2010, Rep. Zack Space (D-OH) and several other representatives, introduced HR 6072, the Electronic Health Record Incentives for Multi-Campus Hospitals Act of 2010 (Multi-campus Hospital Act). If passed, this Act would reduce the disparity in payment of electronic health record (EHR) incentives between multi-hospital systems that file a Medicare cost report for the entire system under one CMS Certification Number (CCN) and systems that file a Medicare cost report for each hospital in the system with a separate CCN. A multi-hospital system in the latter group, under the current CMS Final Rule for Meaningful Use (MU), would receive, in the aggregate, a proportionately larger EHR incentive amount than a system in the first group.
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