HIPAA Privacy Rule Changes on the Horizon

The Department of Health and Human Services Office for Civil Rights in 2010 published a proposed rule, mandated under the HITECH Act, to make multiple changes to the HIPAA privacy, security and enforcement rules.

OCR is now in the late stages of finalizing an “omnibus” final rule that would make significant changes to those HIPAA rules, and the breach notification rule. Following are a series of privacy rule changes proposed by the government.

Expanding Associates

The OCR proposes to make requirements under the privacy and security rules applicable to business associates in the same manner they presently apply to covered entities.

In addition, it would expand the definition of “business associate” to include health information exchanges, health information organizations, electronic prescribing gateways, patient safety organizations and vendors selling personal health records for covered entities to offer to patients.

Satisfactory Assurances

The proposed rule would require business associates to obtain "satisfactory assurances" from subcontractors that they will comply with applicable requirements of the privacy and security rules.

Existing contracts between business associates and subcontractors can be grandfathered for up to one year beyond the rule's compliance date. OCR estimates 1.5 million business associates may have to bring subcontractors into compliance.

Redefining 'Marketing'

The OCR would restrict marketing activities by redefining "marketing," which will limit health-related communications that may be considered "health care operations."

The proposed rule would require covered entities receiving payment for making certain communications to obtain authorization from individuals before making the communications.

PHI Authorization
One proposed change is to define uses and disclosures of protected health information for which individual authorization is required, such as the sale of PHI.

In the proposed rule, OCR asks for additional public comment on uses and disclosures of PHI for research purposes.

Firming up Fundraising

OCR proposes to require recipients of fundraising communications be given a clear and conspicuous opportunity to opt out of receiving future communications, making clear that opting out will not affect future treatment of the individual.

Fundraising communications may not be sent to individuals who have not expressly opted to receive them. Privacy notices must include a statement that an organization intends to send such communications and that an individual can opt out

Patient Control

Changes on the table include requiring notice of privacy practices to include a description of the uses and disclosures of protected health information that require an authorization.

In addition, individuals would be allowed to request restriction of disclosures of PHI, unless otherwise required by law, if the restriction applies solely to a service fully paid out-of-pocket.

The proposed changes would also strengthen the right of individuals to obtain their electronic health records

Increasing Financial Penalties

The OCR wants to increase civil money penalties for violations of requirements to ensure the privacy and security of protected health information, with fines of up to $1.5 million in a single calendar year for violations of the same requirement.

-Health Data Management

Meaningful Use Deadline Nears for Eligible Professionals

The Centers for Medicare and Medicaid Services reminds physicians and other non-hospital providers that Oct. 3 is the last day for eligible professionals to begin their 90-day reporting period for the first year of Stage 1 electronic health records meaningful use incentive payments.


The reporting year for eligible professionals ends on Dec. 31, and Feb. 29, 2012, is the last day for eligible professionals to register and attest to receive an incentive payment for calendar year 2011. CMS encourages early registration and not waiting until ready to attest in case problems arise during the registration process.


The hospital meaningful use program runs on the federal fiscal year and Nov. 30 is the last data to register and attest to receive an incentive payment for FY 2011.




Joseph Goedert
HDM Breaking News, September 26, 2011

CHIME: Slow Down on Tying Metadata to Meaningful Use

The College of Healthcare Information Management Executives is urging federal officials to slow down on initiatives to tie use of metadata to electronic health records meaningful use measures.

The Office of National Coordinator for Health Information Technology is moving on a fast track to quickly incorporate use of metadata in EHRs to facilitate health information exchange and give patients more control over the sharing of their data, following recommendations in late 2010 from the President's Council of Advisors on Science and Technology.

ONC, for instance, recently announced it will launch two pilot projects covering the use of metadata to support data exchange, and wants some degree of metadata use in Stage 2 meaningful use measures. But CHIME, which represents health care CIOs and other information technology leaders, says the initiatives aren't ready for prime time.

"Despite the impressive amount of resources put forth on this endeavor, by ONC and others, CHIME simply cannot support the inclusion of metadata standards in the next notice of proposed rulemaking to support meaningful use Stage 2," according to a comment letter to ONC. "We do not believe enough progress has been made, or evidence gathered, to support the technologies and strategies needed to include metadata standards as part of meaningful use Stage 2. We do not believe that the meaningful use regulatory schema is the appropriate venue to mandate unproven standards or incomplete protocols."

CHIME recommends ONC move forward with metadata initiatives "to fully vet the range of possible standards and assemble the needed implementation processes." The comment letter is available here.

Joseph Goedert
HDM Breaking News, September 23, 2011

More EHR Meaningful Use Certifications Announced

Four electronic health records products from three vendors in recent days received federally deemed certification for meeting one or more Stage 1 meaningful use requirements. They are:

* Navigating Cancer's Patient Engagement Portal, version 3.9, as an EHR Module from Drummond Group;

* California Medical Systems' Practice Expert EMR, version 2011.100.1.1, as a Complete EHR, from Drummond Group; and

* Iatric Systems' Public Health Reportable Lab Results Interface, version 1.5, as an EHR Module, from the Certification Commission for Health Information Technology. The vendor's Meaningful Use Manager application, previously certified in June, also has received additional EHR Module certification from CCHIT for its Clinical Quality Measures component.


Joseph Goedert
HDM Breaking News, September 19, 2011

Study: CPOE Requirements in MU Stages 2 and 3 May Cut Mortality

A new study published in Health Affairs suggests that Stage 1 meaningful use criteria for use of computerized physician order entry systems is probably too low to significantly lower mortality rates among heart patients, but higher levels of mandated use in Stages 2 and 3 "is more consistently associated with lower mortality."

Stage 1 of meaningful use requires electronic orders for at least 30 percent of eligible patients. The Stage 2 measure likely will be 60 percent with Stage 3 at 80 percent.

Researchers at RAND Corp. studied data from the American Hospital Association Annual Survey database, comparing medication orders written electronically with manual orders. "We relied on self-reported ranges--for example, 26 to 50 percent of patients--of the use of electronic medication ordering and did not have direct measures against which to validate these reports," according to the study. "It was not possible to match our data exactly to the thresholds prescribed in the meaningful use regulations because our data used ranges instead of, for example, a threshold of 30 percent of patients. Therefore, we were not able to simulate the impact of the uptake of electronic medication ordering at the exact thresholds prescribed in the meaningful use regulations. However, our data did provide thresholds that approximate those of the regulations, and we believe that the results of our simulation will be informative to policy makers."

Hospitals that reported any level of use of electronic medication orders had lower mortality rates for three conditions studied. "In unadjusted comparisons, any use at all of electronic medication ordering was associated with significantly lower mortality from heart attack, heart failure and pneumonia," according to the study. "Adjusted comparisons confirmed a statistically significant relationship between the use of electronic medication ordering and mortality rates for heart attack and heart failure, but not for pneumonia."

The study also compared mortality rates among hospitals with different levels of electronic medication order entry. Results showed relationships between the level of electronic ordering and lower mortality from heart attack and heart failure, but not pneumonia. In particular, a relatively lower level of electronic ordering was associated with lower heart attack mortality, while a level of more than 50 percent for heart patients more consistently showed lower mortality for both heart attack and heart failure patients.

The authors hypothesize that failure to find improved mortality rates among patients with pneumonia may be attributable to different patterns of use across conditions, or that different conditions are more or less sensitive to use of electronic ordering. "For instance, the features offered in computerized provider order entry systems may be more useful in safely managing medications for complex chronic conditions such as heart failure than they are for acute conditions such as pneumonia."



Joseph Goedert
HDM Breaking News, September 15, 2011

Privacy, EHR Policy Changes Coming in Federal Health I.T. Plan

More changes to health information privacy rules, and a stronger push for electronic health records interoperability, could be forthcoming under the final Federal Health I.T. Strategic Plan for the next five years from Health and Human Services' Office of the National Coordinator for Health Information Technology.
ONC released a draft plan for comment in May. While the final plan is out, the agency stresses it a "living document" that will be updated as warranted.

Under the final plan, HHS has begun a process of exploring broader privacy and security policies that may be necessary to ensure trust in health information exchange. "One of the major areas being addressed through this process is pursing policy changes that would afford individuals more meaningful choice as to whether their information may be exchanged electronically," according to the plan. "ONC is also assessing technical solutions that could support more granular patient choice and data segmentation that could support a patient's choice to share only certain parts of their record during information exchange."

HHS in the plan reaffirms support for research at the National Institute of Standards and Technology to refine usability testing for electronic health records. The tests would use protocols targeting improved safety and efficiency. "This work will occur in a transparent process, engaging EHR developers, researchers and other stakeholders," according to the strategic plan. "We will also work on greater transparency and better guidance for EHR users and purchasers with regard to EHR usability."

Further, ONC will study ways to improve the ability of providers to change EHR products to better support their needs by improving data portability. "Reducing the cost associated with switching EHR products while increasing data fluidity and choice can help drive market competition to improve the usability of EHR products."

Another component of the strategic plan includes the launching this month of a national campaign to increase consumer awareness of the transition to EHRs, how to access their health information, using I.T. to better manage health, and rights to access and protect their health information.

ONC in the plan also reiterates its support of a recommendation from the HIT Policy Committee to extend by one year Stage 1 of EHR meaningful use for providers attesting in 2011, and notes it has made the recommendation to the Centers for Medicare and Medicaid Services. The strategic plan is available here.


Joseph Goedert
HDM Breaking News, September 13, 2011

New Patient Access Rights Will Challenge HIM Departments

The HITECH Act gives consumers the right to access their electronic health records in an electronic format. But many security experts believe that under final rules, giving patients the records on a CD or thumb drive won't meet the intent of the law, says Lou Ann Wiedemann, director of professional practice resources at the American Health Information Management Association in Chicago.

She believes 'electronic' will mean access to a particular patient's records in a provider's EHR via a Web portal or a cloud computing application, "and not an electronic version of your EHR," Wiedemann says. "The industry is hoping CD or a thumb drive will be okay, but everyone is waiting on the final rule before they start to plan how to do this."

During an educational session at AHIMA's annual convention, Oct. 1-6 in Salt Lake City, Wiedemann will walk attendees through understanding patient rights to access their electronic records and request amendments to the records, a first step toward compliance following release of a final rule.

With patient demand for electronic copies of health records unknown, providers likely will have to retain their current processes for printing and delivering records on paper. Health information management departments, however, will have to develop an education program for patients getting an electronic version, Wiedemann says. "On paper, progress notes are in yellow and the problem list is in blue, but when printed from an EHR it's a different format and not visually distinct, so be prepared to field questions and engage in consumer education."

Educational session 6423, "Understanding Patient Access and Amendments," is scheduled at 1:00 p.m. on October 4.



Joseph Goedert
HDM Breaking News, September 10, 2011

What's the Best Strategy for Financing EHRs?

When it comes to financing health care operations, Juan Ruiz knows the importance of getting the best deal.

He's the director of finance at St. Patrick's Home, a 264-bed skilled nursing home in the Bronx. The home is mid-way through an EHR implementation, from HealthMedx. The project represents a nearly $250,000 outlay, software, hardware and network infrastructure included.

And that's just one financial ball Ruiz has to juggle. Two years ago, the home replaced its boiler system, which came to $500,000. And looking ahead, the 20-year-old facility will need to upgrade its laundry facilities, install a new generator, renovate its bathrooms, and replace about 100 of its beds.

The beds alone represent a $120,000-plus hit to the checkbook. "We have to project our costs three to four years down the road," says Ruiz. He takes a conservative approach to financing, setting aside money each year to fund depreciation of assets--despite the fact that the state eased such requirements a few years ago in light of the economic downturn. "It is extremely expensive running a nursing home."

In an industry with universally tight margins, Ruiz's financial juggling act typifies what hospitals and group practices must go through to install clinical technology and manage to stay in business.

While the EHR incentive program has enticed providers to spend big on electronic records, financing the purchase is invariably a challenge. First and foremost, the systems are expensive. A lucky few providers can fund EHR implementations out of operations, but they still need to set aside capital budgets and explore external financing vehicles for other outlays.

And bargain hunters often find to their regret that the cheapest software isn't the best deal when considering the total cost of ownership and the investments necessary to qualify for government incentives.

Purchasing an EHR, says Ruiz, is an exercise in patience. St. Patrick's Home did a three-year software search, in which it considered two local and three national vendors, finally settling on the HealthMedx system. It will handle clinical documentation, financial management and patient admissions. The integrated clinical/billing package replaces a standalone billing system.

During the vendor evaluation period, St. Patrick's considered financing options along the way. It could have gone with a much cheaper EHR system-one vendor came in at half the cost of the HealthMedx suite-but that would have been a penny-wise, pound-foolish decision, Ruiz says, since the HealthMedx package includes better service terms.

In addition, the vendor has developed and maintains the entire software package. The cheaper vendor merely bolted on applications from other companies. "We wound up financing more, but we will be better off in the long run," Ruiz says.

St. Patrick's will finance about three-fourths of the cost of the EHR through First American Health Care Finance, a specialized health care lender located in Rochester, N.Y. The rest will come from its capital budget-the facility could have financed all the EHR through its capital budget, but needed to consider its other looming outlays, Ruiz says. There was no shortage of banks willing to work with the nursing facility to finance the EHR purchase, and Ruiz considered two other banks in-depth. Eventually, he settled on American because of its industry expertise and service commitments. "They will have a dedicated project manager to handle the invoices and keep track of any over-runs," he says. "They have experience and they are big on the EHR."

"Capital Punishment," Gary Baldwin's feature story in the September issue of Health Data Management, explores EHR financing options and pitfalls to avoid.


Gary Baldwin
HDM Breaking News, September 9, 2011

Sharing the Lessons of Meaningful Use

On one level, the meaningful use electronic record incentive program is all about the money. Many providers, especially small practices, jumped head first into the program because the financial incentives made it possible to automate at little or no cost-if they got those incentive checks.

Take Springfield (Ohio) Center for Family Medicine, where all six physicians have attested to meaningful use, with four by mid-July having received $18,000 first-year checks from the Medicare incentive program, and the other two awaiting payment.

That money is already flowing downstream at the practice, which purchased a document management and imaging system along with workstations, all integrated with the electronic records and practice management systems of Horsham, Pa.-based NextGen Healthcare Information Systems, says Cindy Brewer, office manager. The EHR and the purchase of ancillary technology would not have been done without the incentive payments, she adds. "We've wanted to do it but didn't know when the finances were going to be there."

The incentives also did the job at 25-bed Hemphill County Hospital in Canadian, Texas. The hospital implemented the core clinical information system of Houston-based Prognosis Health Information Systems in February 2010.

Without the incentive funds attached to the initiative, an EHR would have been a much lower priority and taken a lot longer to come to fruition, "and would not have had strong executive backing that this is where we're going," says Patrick Murfee, information technology director.

The trek to meaningful use has produced numerous technological and workplace lessons for those who have done it, but this is just the first step in a long haul project to revamp processes via EHRs, and the true payoffs, financially and clinically, are further down the road.

Joseph Goedert
HDM Breaking News, September 7, 2011

Athenahealth Dashboard Tracks MU Progress, Issues

Physician software and billing services vendor athenahealth Inc. has introduced an online dashboard that clients using its electronic health records system--and users of other EHR systems--can use to assess the progress athenahealth users are making in meeting EHR meaningful use requirements.

The publicly available dashboard looks at athenahealth's entire national client base against all meaningful use measures for eligible professionals, and is designed to enable clients, prospects, policymakers and others see apples to apples data on how thousands of physicians are doing on each measure, according to the company.

Currently, 11 percent of athenahealth physician clients participating in meaningful use have attested to Medicare requirements, and 63.3 percent are two or fewer measures away from being ready to attest.

The dashboard gives data--updated bi-weekly--on physicians' performance on each meaningful use measure. For instance, the dashboard has found that meeting the measure to provide a clinical summary of an office visit within three business days of the visit is especially difficult to meet because of required behavior and workflow changes.

The dashboard is available at: athenahealth.com/hitech


Joseph Goedert
HDM Breaking News, September 8, 2011

Certifiers Add to List of EHR Products Supporting Meaningful Use

Specific products from four electronic health records vendors recently joined the list of certified applications that support one or more Stage 1 meaningful use criteria. They are:

* Merge Healthcare's OrthoEMR v4.0 for orthopedics, as an ambulatory Complete EHR, from Drummond Group;

* Streamline Health Solutions' AccessAnyWare v5.1 document management system, as an EHR Module, from Drummond Group;

* VitalHealth Software's VitalHealth EHR version 1.8 for small practices, as an ambulatory Complete EHR, from the Certification Commission for Health Information Technology; and

* Tranquilmoney Inc.'s PracticeTracker, version 8.0, as an ambulatory Complete EHR, from Drummond Group.


- Joseph Goedert
HDM Breaking News, September 6, 2011

Providers, Vendors Ramp Up Mobile Apps

A delivery system and three vendors have recently announced new health information technology applications for mobile computing devices. They include:

* Carolinas HealthCare System in Charlotte, N.C., has introduced CMC Health, its first mobile app. It enables consumers to find a location within the delivery system and get contact information and GPS directions, check wait times, and search for a physician by name, specialty, practice, ZIP code and keywords. The delivery system this fall will launch an expanded version to support its women's health program.

* Healthcare Blue Book has a free iPhone app that provides treatment price information to consumers. An enhanced app that employers can purchase lets their employees search for in-network providers who offer the best value. "There is no reason a patient should pay $3,500 for an MRI when you can get the same quality test for $700 at another location," says Jeffrey Rice, M.D., CEO at Healthcare Blue Book. The apps are available at the Apple App Store.

* Greenway Medical Technologies has launched a new PrimeMOBILE app for the iPad and iPad 2 to access the vendor's practice management, electronic health record and health information exchange systems. The company issued an app for the iPhone last year and plans an Android version this fall.

* Intelligent Medical Objects now has its IMO Problem and IMO Procedure terminologies available on iPhone and iPad applications. The company's terminology products have been available as embedded components in electronic health records systems from Allscripts, Cerner, Epic, Greenway and NextGen, among others, as well as via a Web portal. The mobile and EHR-accessed terminologies support ICD-9-CM, CPT, SNOMED CT, HCPCS, RxNorm, ICD-10-CA and ICD-10 WHO. The company in October will release ICD-10-CM for EHRs and mobile devices

Joseph Goedert
HDM Breaking News, September 6, 2011

CMS Issues Final Medicare E-Prescribing Rule

The Centers for Medicare and Medicaid Services has issued a final rule making changes to Medicare's Electronic Prescribing Incentive program. The rule is available now and will be published in the Federal Register on Sept. 6.

As expected, CMS has finalized a proposal to better align the eRx Incentive program with the electronic health record meaningful use incentive program. Under the final rule, EHRs that have received meaningful use certification are deemed to qualify for the eRx Incentive program.

The new rule also finalizes ways for providers to get a "hardship exemption" from the eRx program to avoid reimbursement penalties for non-participation. For instance, an eligible professional who has registered to participate in the Medicare or Medicaid EHR incentive programs and has adopted certified EHR technology can request a hardship exemption from the eRx program.

Even if an eligible professional practices in a state where the Medicaid EHR incentive program is not yet fully implemented, the EP can still register for the program and then seek an exemption from the eRx program.

The deadline for submitting hardship exemption requests, detailed in the final rule, is Nov. 1, 2011.


Joseph Goedert
HDM Breaking News, August 31, 2011

September 9th Medicare & Medicaid EHR Incentive Programs National Provider Call

Hear the Experts Discuss the EHR Incentive Programs


Date: Friday, September 9

Time: 1:30-3:00 p.m. ET

Agenda: During the call, CMS experts will discuss the following topics:

• Path to Payment
• Highlights of Registration and Attestation Processes
• Third Party Proxy
• Troubleshooting
• Helpful Resources
There will also be a Q&A session where experts will address your questions and concerns.

Registration: Register Now for this informative session. Registration will close at 1:30 p.m. on September 8, or when available space has been filled. No exceptions will be made, so please register early.

Presentation Materials: The presentation will be available prior to the call on the presentation section of the CMS EHR website.