Free EMR Thoughts Newsletter Want to receive the latest EMR Thoughts, Healthcare IT happenings, and EMR Market trends sent straight to your email? Join thousands of healthcare pros who subscribe to EMR Thoughts for FREE!

New EHR Attestation Deadline for Eligible Hospitals: December 31, 2014

I just got the following note from CMS about an extension to the EHR Attestation deadline for eligible hospitals. Here’s all the details:

CMS is extending the deadline for eligible hospitals and Critical Access Hospitals (CAHs) to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year from 11:59 pm EST on November 30, 2014 to 11:59 pm EST on December 31, 2014.

This extension will allow more time for hospitals to submit their meaningful use data and receive an incentive payment for the 2014 program year, as well as avoid the 2016 Medicare payment adjustment.

CMS is also extending the deadline for eligible hospitals and CAHs that are electronically submitting clinical quality measures (CQMs) to meet that requirement of meaningful use and the Hospital Inpatient Quality Reporting (IQR) program. Hospitals now have until December 31, 2014 to submit their eCQM data via Quality Net.

Note: This extension does not impact the deadlines for the Medicaid EHR Incentive Program.

November 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Fine Thinking Friday

I just posted a tweet summary of today’s #HITsm chat about meaningful use. It was full of amazing insights on what’s happening with EHR, meaningful use and healthcare IT. There were so many insights that it got really long, but go and read it anyway. It’s still just a bunch of easily digestible tweets.

Since the post was getting too long, I didn’t want to make it longer by including some of the off topic tweets that were sent during the #HITsm chat. I guess that’s where it’s an advantage to have a full network of EHR and Healthcare IT blogs. I decided that I’d share the really interesting off topic tweets from today’s Twitter chat here.


What a great discussion between Keith and Stephanie. I think we’d all like to see a “little less talk…a lot more action!” (sorry to get that song in your head, but I had to do it)


Gregg Masters response to this tweet was spot on: “Bingo! you nailed the problem. ‘complexity’.” It is super complex and Mandi’s right that no doctor is going to go through the trouble. Bernadette also replied to the tweet and said that “Experts like you are precious.” Very true!


This is the challenge that we’ll be dealing with for a while to come. The shift will not be easy.

I love when a Twitter chat goes off topic. These tweets are great examples of why I like it. Definitely worthy of a Fine Thinking Friday post!

October 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Capturing Unstructured Data for Better Patient Care

The following is a guest blog post by Dr. Chris Tackaberry, CEO of Clinithink.
Clinithink_Chris Tackaberry_CEO and Founder
There is a veritable gold mine of high value data locked inside the free text fields of all EHR systems, as well as in the free text of other sources of clinical documentation such as progress notes, discharge summaries, consult requests and diagnostic reports. In all of these sources, rich, actionable patient data is trapped in unstructured text—stored side by side with more easily accessible structured data.

Take echocardiography reports, for example. The data contained within them—specifically ejection fraction, for instance—are crucial to the management of heart failure as outlined within NQMC core measures for this serious chronic condition. Yet seldom is an ejection fraction captured as structured data. Instead, it is usually documented as free text.

Since narrative has been an inherent part of clinical workflow for many years, HIT software vendors have reasonably added free text fields to their applications. While there is clearly value in driving insights from structured data captured in such systems, the unstructured piece in free text fields remains untapped. This represents a source of potentially significant additional value that can be gleaned from EHR and other clinical documentation sources. However, conventional structured data tools do not support the ability to exploit it for use in clinical decision making.

Unlocking the clinical value in unstructured data

In the days of paper charts, highly experienced physicians were able to quickly scan large charts to find information such as allergies, medications, family history, past and current symptoms, social history, and other background detail that provided the context so critically important to any clinical encounter. This information was usually summarized in documents (discharge summaries, referrals, etc.). Ironically, such information is now more difficult to find when stored electronically.

If the existence of unstructured narrative data were known, discoverable, searchable and actionable for every patient—across any EMR or other health IT systems—the currently hidden additional diagnostic and clinical data could further increase the efficiency and quality of care. Clinical Natural Language Processing (CNLP) is a technology that enables access to unstructured narrative data which can be used to unlock this additional value. Using narrative data found in reports, web pages, transcribed output, EMRs, and other electronic sources of free text at the point of care can expand our knowledge of the patient beyond the information obtained from structured data.

Recently, the AMA issued a report in conjunction with the RAND Corporation on the need for EHR vendors to improve the software solutions they are delivering to better meet the needs of physicians. Utilizing CNLP technology to access the clinical value inherent in unstructured EHR data would allow vendors to begin addressing some of the potential improvements.

As we move from a world in which healthcare is delivered on an episodic basis retrospectively to one where care is delivered almost continuously and prospectively, CNLP increases the opportunity to deliver rich, actionable and meaningful clinical content to help improve decision-making for more accurate, evidence-based and effective care.

Dr. Chris Tackaberry is the CEO of Clinithink.

October 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

History of Health Informatics Infographic

Nothing like taking a look back at history to remember how far we’ve come. The crazy thing is that we still have a long way to go.
History of Healthcare Informatics

August 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

New Interactive Hardship Exception Tool for Eligible Professionals

Eligible professionals can now use CMS’ new interactive tool to help determine if they will avoid upcoming 2015 and 2016 Medicare EHR Incentive Program payment adjustments by demonstrating meaningful use, or if they should apply for a hardship exception.

If an eligible professional determines that they need to apply for a hardship exception, the application must be submitted by July 1, 2014CMS will review applications to determine whether or not a hardship exception will be granted. If approved, the exception is valid for one year.

Applying for Hardship Exception
When submitting hardship exception applications, entries must include supporting documentation that proves demonstrating meaningful use presented significant hardship.

CMS has posted hardship exception applications on the EHR website for:

Please read and follow the submission instructions on the application. Note that all required supporting documentation must be included at the time of submission. Completing your application online and submitting it electronically toEHRhardship@provider-resources.com, with all required supporting documentation, will reduce the application processing time. Please do not submit hand-written applications.

Hardship Exception Tipsheets
You can also avoid payment adjustments by successfully demonstrating meaningful use prior to the payment adjustment. Tipsheets are available on the CMS website that outline when eligible professionals must demonstrate meaningful use in order to avoid the payment adjustments.

June 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Healthcare Cloud Infographic

As you know, I always love a good infographic. This one does a decent job showing where we’re at in healthcare’s view of the cloud. Basically, cloud is a part of healthcare and will be forever. Watch for that trend to continue.

???????????????????

June 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

How the Meaningful Use Stage 2 Timeline Affects Your Medical Practice

The following is a guest blog post by Dana Deardorff.
D. Deardorff pic
The year of 2014 will be a year of great transition for most medical practices. You may be in the beginning stages of using EHR/EMR software, or you may be installing Medical Practice (MP) software for the first time. Perhaps you have been using a software program, but you’ve realized you need to upgrade to software that is certified for Meaningful Use. Or, if you’ve purchased certified software, you may need help proving the “meaningful use” of that software, meeting the requirements of Stage 2.

What does Stage 2 Meaningful Use mean for your medical practice? In addition to more recording and reporting measures, Stage 2 of Meaningful Use emphasizes care coordination and HIPAA-compliant engagement with patients.

Meaningful Use Stage Requirements

Stage 1

Beginning in 2011, the focus was on data capturing and sharing. Eligible providers and hospitals were required to show meaningful use of software by meeting a set number of objectives. These objectives were broken down into core objectives and menu set objectives. To be eligible for incentive payments, eligible providers and hospitals needed to prove they met the requirements for a 90-day period in the first year of participation and the entire second year of participation.

In a nutshell, during Stage 1, you are expected to:

  • Capture health information in a standardized electronic format
  • Use EHR/EMR or MP software to track clinical conditions
  • Report clinical quality measures and public health information
  • Begin engaging electronically with patients via HIPAA-compliant software

Your EHR/EMR or MP software vendor should be able to explain the practical applications of these requirements to you, training your staff how to prove and report compliance.

Stage 2

Once you’ve met the requirements for Stage 1 of Meaningful Use, you will need to widen your focus to include clinical processes.

In shorthand, during Stage 2, you will be expected to:

  • Engage in more rigorous health information exchange
  • Engage in e-prescribing
  • Deliver lab results electronically
  • Offer increased patient-controlled data and engagement with patient through electronic means
  • Transmit patient care summaries securely and compliantly through approved electronic methods

On a practical level, this means your office will need to use software that provides the following features, amongst others:

  • Patient engagement portal, including mobile device access to messages and records
  • Electronic recording of and communication of immunization records
  • E-prescribing capabilities and communication

You can begin meeting Meaningful Use Stage 2 requirements now (2014), assuming you have already met Meaningful Use Stage 1 requirements for the minimum time frame. (Ninety consecutive days one year, and an entire year the following year. Be sure to learn more about the possible Meaningful Use Stage 2 delay.) You will need to do the same with Meaningful Use Stage 2 before you can proceed to Stage 3.

Stage 3

Beginning in 2016, eligible providers and hospitals can take on a third set of requirements, focused on improving quality of care, safety and efficiency. The end goal is to provide improved health outcomes.

Meaningful Use Timeline

Eligible hospitals are held to a fiscal-year timeline, but eligible providers are held to the calendar year. This means you will need to ask your EHR/EMR or MP software vendor to help you figure out what your practice’s deadline is and how to meet it for each stage. A good vendor should be able to help you overcome obstacles like:

  • Employee resistance to using new software or processes
  • Software implementation and integration challenges
  • Office procedure modifications and work flow changes

Participation in Stage 1 opened in 2011. Practices that were early participants are now moving into Stage 2 here in 2014. Those who participate soon will be eligible for Stage 3 participation as soon as 2016, taking advantage of years of incentive payments.

Medical Practice Participation

According to the Centers for Medicare and Medicaid Services, more than 355,000 health care providers have received incentive payments for their participation in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (as of February 2014).  Over $13.6 billion has been paid out through the Medicare EHR Incentive Program thus far, and over $7.5 billion has been paid out through the Medicaid EHR Incentive Program.

Incentive payments aren’t the only reason to upgrade your MP software. Medicaid and Medicare eligible providers and hospitals that do not meet Meaningful Use requirements will be subjected to penalties starting in 2015. These penalties will come in the form of payment reductions, starting at one percent, capped at five percent for each year eligible providers don’t demonstrate meaningful use.

If you haven’t tackled this challenge yet, you’ll want to take it on now, before you miss out on the incentive payments and lose out on a percentage of your Medicaid and Medicare payments.With the right guidance, you’ll find that the upgrade and training will result in an improved experience for everyone, staff and patients alike.

About Dana Deardorff of MediPro

MediPro, Inc. is a full-service medical billing software company offering practice management (PM) software, electronic health records (EHR) and electronic medical records (EMR) from IMS and McKesson. As of April 2014, IMS is certified for Meaningful Use Stage 2, and McKesson, which is certified for Stage 1, will soon also be certified for Stage 2. (McKesson is certified for Stage 2 now, they just haven’t made the formal announcement).

May 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Eligible Professionals: Deadline to Submit Hardship Exception Applications Approaching

Here’s the latest email from CMS on the hardship exception deadline:

Are you a Medicare provider who was unable to successfully demonstrate meaningful use for 2013? CMS is accepting applications for hardship exceptions to avoid the upcoming Medicare payment adjustment for the 2015 reporting year.

Payment adjustments for the Medicare EHR Incentive Program will begin on January 1, 2015 for eligible professionals.

However, you can avoid the adjustment by completing a hardship exception application and providing supporting documentation that proves demonstrating meaningful use would be a significant hardship for you. CMS will review applications to determine whether or not you are granted a hardship exception.

CMS has posted hardship exception applications on the EHR website for:

Applications for the 2015 payment adjustments are due July 1, 2014 for eligible professionals.  If approved, the exception is valid for one year.

New Hardship Exception Tipsheets
You can also avoid payment adjustments by successfully demonstrating meaningful use prior to the payment adjustment. Tipsheets are available on the CMS website that outline when eligible professionals must demonstrate meaningful use in order to avoid the payment adjustments.

May 28, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Meaningful Use Stage 2 Delayed Until 2015 (Unless You Don’t Want to Wait)

Big news coming out of HHS today, CMS issued a proposed rule that changes the EHR certification requirements, firms up the meaningful use stage 3 delay that was announced previously, and most importantly delays the meaningful use stage 2 requirement until 2015. I guess one could argue that it’s not a delay since you can still attest to MU stage 2 in 2014 if you’d like (some already have), but for practical purposes this is a delay in the enforcement of meaningful use stage 2 for many organizations.

It looks like CMS and ONC was listening to the backlash against meaningful use stage 2 and the potential fallout. This isn’t quite blowing up meaningful use, but it’s a step in that direction. Here’s the chart that ONC put out that shows the new timelines:
New Meaningful Use and EHR Certification Timelines - Meaningful Use Stage 2 Delay

It’s worth noting that this is just a proposed rule, but there were usually very few drastic changes between proposed rules and final rules in the past. Sure, there could be a few tweaks, but I bet this goes into place essentially as it stands.

This will be a relief to hundreds of EHR vendors that are behind on becoming 2014 Certified. I expect most will continue with their 2014 Certified plans, but many of their users will likely opt to stick with the simpler meaningful use stage 1 objectives and measures. What’s not clear to me is if the attestation process will stay the same (ie. self attestation in MU stage 1) or not. I’ve asked HHS and will update the post (see update at the bottom of the post) once I hear from them.

What do you think of these changes? What impact will this have on you and your organization?

Here’s another email that CMS sent out:

CMS and ONC Release NPRM Allowing CEHRT Flexibility and Extending Stage 2

Today, CMS and ONC released a notice of proposed rulemaking (NPRM) that would allow providers participating in the EHR Incentive Programs to use the 2011 Edition of certified electronic health record technology (CEHRT) for calendar and fiscal year 2014.

The NPRM will grant flexibility to providers who are experiencing difficulties fully implementing 2014 Edition CEHRT to attest this year. The proposed rule would allow providers to use EHRs that have been certified under the 2011 Edition, a combination of the 2011 and 2014 Editions, or the 2014 Edition.

Beginning in 2015, all eligible providers would be required to report using 2014 Edition CEHRT.

2014 Participation Options
Under this proposal, valid only for the 2014 reporting year, providers would be able to use 2011 Edition CEHRT for either Stage 1 or Stage 2, would have the option to attest to the 2013 definition of meaningful use core and menu objectives, and use the 2013 definition CQMs.

Providers currently working on Stage 1 in 2014 would be able to demonstrate:

  • Stage 1 (2013 Definition) using 2011 Edition CEHRT, or using a combination of 2011 and 2014 Edition CEHRT; or
  • Stage 1 (2014+ Definition) using 2014 Edition CEHRT.

Providers currently working on Stage 2 in 2014 would be able to demonstrate:

  • Stage 1 (2013 Definition) using 2011 Edition CEHRT, or using a combination of 2011 and 2014 Edition CEHRT;
  • Stage 1 (2014+ Definition) using 2014 Edition CEHRT; or
  • Stage 2 (2014+ Definition) using 2014 Edition CEHRT.

UPDATE: Here’s the response I got from CMS about the reporting periods:

Reporting periods are not changing.

For 2014 Only
Because all providers must upgrade or adopt newly certified EHRs in 2014, all providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a three-month (or 90-day) EHR reporting period in 2014:

Medicare eligible professionals beyond their first year of meaningful use must select a three-month reporting period fixed to the quarter of the calendar year for eligible professionals. Providers must attest to these reporting periods no later than February 28, 2015 at 12 am ET.

Medicare eligible professionals in their first year of meaningful use may select any 90 day reporting period.

Medicaid eligible professionals can select any 90-day reporting period that falls within the 2014 calendar year.

May 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

National Nurses Week Infographic

It’s National Nurses Week, and so I thought it was appropriate to share this Future of Nursing infographic from Norwich University. I of course was most interested in the nursing technology section.

National Nurses Week

May 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.