Source: Diana Manos Date: Oct 23, 2013
“It has been a slow start,” said Alisa Ray, executive director and CEO of the Certification Commission for Health Information Technology, of EHR vendors’ readiness for Stage 2 meaningful use. “They’re working hard. They’re struggling a little bit.”
That stands to reason, considering that, when comparing Stage 1 to Stage 2 certification, technology developers are “navigating a higher bar and increased complexity,” she said.
As the end of 2013 closes in, most federal certification bodies are noticing an uptick in the number of vendors who are applying to become certified under the 2014 criteria — the same criteria that will be required for the EHR products providers must use to attest to meaningful use Stage 2.
But not all of them are finding the process to be a cakewalk. Ray said there are three areas of Stage 2 that are proving the most challenging for certification: clinical quality measures, interoperability, and automated measure calculation for reporting metrics.
Automated measure calculation “requires almost a whole day of testing,” she said. “There are just a lot fewer products than were there with the Stage 1 or 2011 criteria.”
CCHIT has close to 40 companies with products listed. “Of the 2011 products we certified, we’ve seen 21 or 22 percent having been completely certified to date,” Ray continued. “It’s a testament to how much harder it is.”
Amit Trivedi, healthcare program manager at ICSA Labs, added that many vendors might also be going through certification fatigue, and explained that in stage 1 there were close to 3,000 listings, and many vendors had multiple entries (Cerner had 800) but for Stage 2, so far there are fewer than 300 on ONC’s Certified Health IT Products List.
And without naming names, Ray said that “almost everyone has struggled and been surprised by the complexities,” and a number of them have had to go through several certification trials, after not meeting certain criteria. “There are companies that have been testing every year since 2006 with the CCHIT programs; it’s not like they’re novices. And when they get into it, there’s a new wrinkle or something they may not have anticipated or configured correctly.”
Published Online: October 23, 2013 Vaishali Patel, PhD, MPH; Matthew J. Swain, MPH; Jennifer King, PhD; and Michael F. Furukawa, PhD
Objectives: To provide national estimates of physician capability to electronically share clinical information with other providers and to describe variation in exchange capability across states and electronic health record (EHR) vendors using the 2011 National Ambulatory Medical Care Survey Electronic Medical Record Supplement.
Study Design: Survey of a nationally representative sample of nonfederal office–based physicians who provide direct patient care.
Methods: The survey was administered by mail with telephone follow-up and had a 61% weighted response rate. The overall sample consisted of 4326 respondents. We calculated estimates of electronic exchange capability at the national and state levels, and applied multivariate analyses to examine the association between the capability to exchange different types of clinical information and physician and practice characteristics.
Results: In 2011, 55% of physicians had computerized capability to send prescriptions electronically; 67% had the capability to view lab results electronically; 42% were able to incorporate lab results into their EHR; 35% were able to send lab orders electronically; and, 31% exchanged patient clinical summaries with other providers. The strongest predictor of exchange capability is adoption of an EHR. However, substantial variation exists across geography and EHR vendors in exchange capability, especially electronic exchange of clinical summaries.
Conclusions: In 2011, a majority of office-based physicians could exchange lab and medication data, and approximately one-third could exchange clinical summaries with patients or other providers. EHRs serve as a key mechanism by which physicians can exchange clinical data, though physicians’ capability to exchange varies by vendor and by state.
Am J Manag Care. 2013;19(10):835-843 – See more at: http://www.ajmc.com/publications/issue/2013/2013-1-vol19-n10/Physician-Capability-to-Electronically-Exchange-Clinical-Information-2011#sthash.wM7YRTll.dpuf
The capability to electronically share and view clinical data has the potential to enable clinical information to follow patients wherever they go to seek care and thereby improve the safety, quality, and efficiency of healthcare.1 Despite promising benefits, historically physicians have not exchanged clinical information electronically due to the high costs associated with implementation and limited incentives for data sharing.2 Exchange activity has largely been confined to regions of the country where there are operational health information organizations that support clinical data exchange within their community.3 Furthermore, physicians have typically had to use stand-alone e-prescribing systems or proprietary portals that support the exchange of specific types of clinical data (eg, viewing lab data), which can be costly, difficult to incorporate into their clinical work flow, and possess limited capability to support integrated data as with an electronic health record (EHR).4-7
A number of federal programs and other initiatives are under way to help address some of these barriers. The Health Information echnology for Economic and Clinical Health (HITECH) Act of 2009 includes up to $22.5 billion in financial incentives for eligible professionals who demonstrate “meaningful use” of interoperable EHRs capable of electronic exchange. HITECH also awarded more than $540 million to the Office of the National Coordinator for Health Information Technology (ONC) State Health Information Exchange (HIE) Program, which provides support for state-designated entities to ensure mechanisms are in place to enable providers to exchange clinical information.8 Furthermore, ONC’s Health Information Technology Certification Program seeks to ensure that EHR products include functionality that enables electronic exchange.9 In addition to the HITECH incentives and programs, a public-private initiative provides relatively simple technical solutions to enable directed exchange between 2 known providers.10 A community of participants from the public and private sector focus on providing tools, services, and guidance to promote functional interoperability.11
In the first stage of meaningful use, it was sufficient for providers to perform a test to demonstrate their EHR’s capacity to electronically exchange information.12,13 Stage 2 meaningful use requirements related to HIE have evolved to become more advanced. Physicians must go beyond demonstrating capability to exchange; they must actually electronically exchange key clinical data among providers and patient-authorized entities. Additionally, physicians must demonstrate the capability to send summary-of-care documents electronically to recipients with a different EHR vendor.14
Yet little is known about current physician capability to electronically exchange clinical information at a national or state level, both of which are relevant in implementing ONC’s strategy and in assessing its potential for success. We used a nationally representative survey of office-based physicians conducted in 2011 to provide a snapshot of physicians’ capability to electronically exchange clinical information associated with key national priorities: pharmacy exchange(e-prescribing), laboratory exchange (including receipt of results and lab orders), and clinical summary exchange with patients and providers.15 This assessment provides both a portrait of exchange capability as of stage 1 meaningful use and a baseline for monitoring progress going forward as new policies and initiatives to accelerate HIE are implemented—in particular, stage 2 meaningful use. Future trends in physicians’ HIE capability could help assess the effectiveness of these policies. We describe physician exchange capability geographically across states and by EHR vendor. Finally, we examined the association between physician and practice characteristics, including adoption of EHRs, with physician capability to exchange different types of clinical information. – See more at: http://www.ajmc.com/publications/issue/2013/2013-1-vol19-n10/physician-capability-to-electronically-exchange-clinical-information-2011/1#sthash.H3s71xpQ.dpuf
POSTED IN: Electronic Health Records, Mobile/Wireless, Quality and Safety
Since 2001, the Nation has embarked on several Health Information Exchange initiatives, yet to date, a Business Case has not yet been developed that addresses integrated Electronic Health Records (iEHRs) and Health Information Exchange (HIE) from the Patient perspective.
The following examines:
What is the Business Case for iEHRs and Health Information Exchange?
What is the long term approach that’s going to make sure that there is not only the technology in place but also the willingness to exchange/integrate information?
How did we get to where we are today with HIE?
Is where we are today where we should be with HIE?
Is HIE viable a path forward?
If so, what form of HIE will scale to a population of 300 million and beyond?
If not, what, if any, alternatives are there?