College of American Pathologists
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June 2009

Raymond D. Aller, MD
Hal Weiner

Health care IT groups propose definitions for meaningful use of EMRs Health care IT groups propose definitions for meaningful use of EMRs

“A powerful agent is the right word,” Mark Twain wrote in an essay. Giving credence to this sentence, some health care information technology associations and other groups have been working to define meaningful use of certified electronic medical records under the American Recovery and Reinvestment Act, even though the federal government has yet to ask for a formal definition.

How the Department of Health and Human Services ultimately defines meaningful use will play a key role in hospitals’ and physician practices’ efforts to obtain federal incentive payments for EMR adoption. As a result of the legislation, providers, including independent pathologists, are eligible for a $15,000 incentive payment for adopting and making meaningful use of certified electronic health records by set dates. Medicare incentives to eligible hospitals will start in October 2010, and Medicare incentives to physicians, as well as Medicaid incentives to physicians and hospitals, will start in January 2011, with decreasing payments until 2015.

In an effort to be proactive, at least a handful of associations have developed definitions and forwarded them to the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services, the HHS entities responsible for formally defining meaningful use.

One of the first recommendations issued was from the Chicago-based Healthcare Information and Management Systems Society on April 27. “Our membership represents the core constituency that will be responsible for executing the government’s definition,” says Carla Smith, executive vice president of HIMSS. “We rep-resent the ones who have to make it happen.”

HIMSS surveyed its 20,000 members, who represent the health care information technology profession, and sought public feedback to develop its definitions. The society’s primary recommendations are as follows:

• Use the Certification Commission for Healthcare Information Technology as the certifying body for EHR systems.
• Implement increasingly stringent quality metrics using intervals of not less than two years.
• Close the gap in interoperability by creating new standards and implementation guides in coordination with the Healthcare Information Technology Stan-dards Panel’s interoperability specifications and Integrating the Healthcare Enterprise’s framework.
• Reconcile the gap between certified EHR technologies and best-of-breed and open-source technologies to ensure that best-of-breed and open-source EHR systems that currently are not certified will be evaluated fairly.

The College of Healthcare Information Management Executives, Ann Arbor, Mich., also supports the use of quality metrics, as well as focusing on outcomes, re-gardless of the technology in place, along with a phased approach to encourage early adoption. Other proposals, which CHIME presented at an April subcommit-tee hearing of the National Committee on Vital and Health Statistics, an advisory body to HHS, include exploring alternative means to connectivity in the short term and connecting to a health information exchange over time. CHIME also advocates considering alternative means to using a continuity-of-care record for exchang-ing health data, at least initially, to accommodate hospitals that are unable to comply for technical or financial reasons.

Like HIMSS, the American Health Information Management Association, Chicago, recommends using CCHIT as the certifying body for EHRs. In a statement made at the April subcommittee hearing, AHIMA executive Sandra Fuller said: “AHIMA believes the most critical element of meaningful use is widespread adoption of certified EHRs and that the expectations of meaningful use need to be applied uniformly across all the industry and not vary by payer, patient, or pro-vider....Meaningful use must be evaluated on the benefits it brings to health care consumers through coordination of care. Finally, the capture of improved clinical data should provide the basis for improved secondary data use in quality and public health reporting and continued administrative simplification.”

The Markle Foundation, a New York-based nonprofit information technology think tank, released a report this spring that states: “The meaningful use definition must optimize achievability for providers and benefits to patients and consumers. Improving medication management and coordination of care provides early opportunities for such optimization. Meaningful use should initially rely on standard information types, such as recent medications and laboratory results, that are electronic and already widely adopted and that can support metrics to improve medication management and coordination of care.”

The report warns that, “If the goals and metrics are not clear before technology is commissioned and the incentives are offered, the government will risk wast-ing valuable resources and losing support from both health care providers and the public for further I.T. investments.”

Each association and organization has “a unique point of view, and sometimes those views are divergent and that’s okay,” says HIMSS’ Smith. “That’s what this is all about—to ensure that your constituents’ voices are heard.”

HHS has not acted on any of the recommended definitions nor has it issued dates for a public comment period. However, on May 18, the Office of the National Coordinator for Health Information Technology released an operating plan for implementing provisions of the American Recovery and Reinvestment Act. The plan states, in part, that: “Specific understanding of what constitutes meaningful use will be determined through a process that will include broad stakeholder input and discussion. HHS is developing milestones for major phases of the program’s activities with planned delivery dates.”

The Centers for Medicare and Medicaid Services has received a few unsolicited suggested definitions of meaningful use but will defer responses until a formal process of notice and comment has been undertaken, the agency reported to CAP TODAY.

“We will be issuing a proposed rule for the recovery act’s EHR incentives programs for Medicare and Medicaid, including the criteria for meaningful use, later this year. We will welcome comments from all interested parties and will give serious consideration to those comments in our development of a final regulation,” the agency stated.

But, according to at least one federal agency, providers shouldn’t wait for a formal definition to begin preparing to qualify for the financial incentives. At the April subcommittee hearing, Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality, which has been charged with preparing a report summarizing testimony gathered at the hearing, said providers should prepare for meaningful use by gathering quality data on specific outcomes.

“What she’s talking about is that quality and meaningful use go hand in hand,” says Matt Quinn, a special expert on health information technology with AHRQ and staff to the National Committee on Vital and Health Statistics subcommittee on quality. “This isn’t just about buying technology as much as it is using it in a meaningful way,” he told CAP TODAY. “It’s...going to be a big challenge for a lot of providers to start collecting and reporting data the way that meaningful use and ARRA will require. The time to start on these things is now.”

Fletcher-Flora Health Care Systems offering new laboratory systems Fletcher-Flora Health Care Systems offering new laboratory systems

Fletcher-Flora Health Care Systems has introduced the FFlex -eSuite MGR and FFlex eSuite ASP systems.

FFlex eSuite MGR is an entry level Web-based laboratory data-management solution for small clinical laboratories. The basic package includes order entry, result review, consolidated reporting, and quality control for a single user station and a single instrument. Additional users and instruments can be added.

FFlex eSuite ASP is the application service provider model of Fletcher-Flora’s FFlex eSuite LIS. It can be custom configured and is suited to any size laboratory.

Data Innovations marketing updated version of Instrument Manager Data Innovations marketing updated version of Instrument Manager

Data Innovations has released Instrument Manager version 8.09, the latest upgrade to its Instrument Manager connectivity and data-management system.

Among the enhancements to version 8.09 are a new specimen-management workspace pop-up preferences configuration option and enhanced integration of the Bio-Rad QC OnCall/Unity Real Time quality control data-management tool.

The new pop-up preferences option allows users to select whether to use confirmation windows and dialogue boxes and to define the default option for the dialogue boxes.

QC OnCall/Unity Real Time was enhanced to support up to nine levels of controls to be configured for each lot number.

EHR Stimulus Alliance conducts education campaign EHR Stimulus Alliance conducts education campaign

Several health care technology companies have joined forces to launch the EHR Stimulus Tour, a campaign to educate physicians nationwide about the opportunities available as an outgrowth of the American Recovery and Reinvestment Act of 2009 and, specifically, the Health Information Technology for Economic and Clinical Health, or HITECH, Act.

The tour is a product of the national Electronic Health Record Stimulus Alliance, an educational initiative spearheaded by Allscripts, Nuance, Dell, Cisco, Intuit, Microsoft, Citrix, and Intel. “Each of the partners involved has unique solutions that are crucial to EHR implementation,” says John Shagoury, president of Nuance Healthcare.

The tour, which kicked off in Houston, Tex., last month, will provide actionable information for physicians via executive briefings, roundtables, trade show presentations, Webcasts, and local meetings with alliance experts and medical groups that are experiencing success with EHRs. It will educate physicians about the details of the federal EHR incentive program, including how much money they are eligible to receive and when it will be allocated.

A partial listing of tour dates and locations and additional information are available at

Contracts Contracts

Global Med Technologies’ Wyndgate Technologies division has licensed its ElDorado Donor blood-management system and ElDorado Donor Doc electronic donor history questionnaire to MedStar Health, Beltsville, Md. MedStar is a nonprofit health care system that serves the Maryland and Washington, DC, area.

Springfield Clinic, Springfield, Ill., has announced that it will upgrade its Aspyra laboratory information system to the most recent release of Aspyra’s CyberLab LIS, version 7.2.

Dr. Aller is director of automated disease surveillance and team lead for disaster preparedness Focus B, Los Angeles County Department of Public Health. He can be reached at Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at