News & Events
Events
May 18-19, 2012: TexMed 2012 Conference - Dallas, Texas
June 13-15, 2012: PMI National Conference for Medical Office Professionals - San Antonio, Texas
News
Chicken Scratches vs. Electronic Prescriptions
NEW YORK TIMES – (April 28, 2012) – As e-mail and texting have become our favored means of written communication, handwriting has almost disappeared. Penmanship is becoming a modern form of hieroglyphics, intelligible only to literary scholars.
But one place where handwriting persists is on medical prescriptions, and that’s unfortunate. Sloppy writing or inappropriate directions can lead to what doctors delicately refer to as preventable A.D.E.’s, or adverse drug events. These can encompass minor but still avoidable problems, like rashes or diarrhea, and much more serious events like, well, death.
Studies show that errors are much less likely if a doctor clicks to select medications from an onscreen list and sends the prescription data via computer to the pharmacy. Rainu Kaushal, a professor of medical informatics at Weill Cornell Medical College, led a study published in 2010 in which she and four colleagues followed prescriptions issued by a sample of providers in outpatient settings in New York. (Providers included physicians, physician assistants and nurse practitioners.) Some were prescribing electronically for the first time, and some continued to use paper.
The researchers found an astonishing 37 errors for every 100 paper prescriptions, versus around 7 per 100 for those who used e-prescribing software.
These errors didn’t even include legibility issues, when the pharmacist couldn’t read the handwriting with confidence and called the provider to clarify.
Earlier, when the participants who would switch to e-prescribing were still using paper, they had almost 88 legibility errors per 100 prescriptions. (Some prescriptions had more than one error.) An illegible prescription requires time to sort out with the provider. “In the case of an urgent medication,” Dr. Kaushal says, “the delay can result in patient harm.”
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Cloud-based EHRs raise unique HIPAA challenges
FIERCE EMR – (March 29, 2012) – Cloud-based electronic health record systems have become increasingly popular. But they raise security issues that providers need to address, according to attorney Howard Burde, speaking at the 20th National HIPAA Summit in Washington, D.C. this week.
"The healthcare information is stored, used, and analyzed remotely from the users, and accessed through the Internet," Burde said. "It's going somewhere you don't know."
Some security issues that are particularly acute in cloud computing, according to Burde, include:
- Access to data, back-up plans, and business continuity in the event of a disaster
- What security incident procedures are in place in the cloud
- How physical access to the server in the cloud is limited
Burde recommended that providers need to conduct security management analysis of the cloud--which includes the ability to audit the cloud provider--to ask if its workforce is adequately trained in HIPAA, and a way to evaluate how the data is kept secure.
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Stage 2 Meaningful Use Rules Released
TEXAS MEDICAL ASSOCIATION – (March 1, 2012) – The Department of Health and Human Services has proposed new rules for Stage 2 of the Medicare and Medicaid electronic health record (EHR) incentive programs that detail proposed expectations for physicians. This is the second of three stages of meaningful use that physicians are required to meet to earn EHR incentives through the Medicare or Medicaid programs.
The three stages are:
Stage 1 (which began in 2011 and remains the starting point for all physicians): "meaningful use" consists of transferring data to EHRs and being able to share information, including electronic copies and visit summaries for patients.
Stage 2 (to be implemented in 2014 under the proposed rule): "meaningful use" includes standards such as online access for patients to their health information and electronic health information exchange between physicians and other providers.
Stage 3 (expected to be implemented in 2016): "meaningful use" includes demonstrating that the quality of health care has been improved.
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HIEs Active in Texas
TEXAS MEDICAL ASSOCIATION – (March 1, 2012) – Health information exchanges (HIE) in Texas are being established with $28 million in federal funds Texas received as a result of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The Texas Health Services Authority (THSA), a public-private partnership whose board includes physicians, oversees distribution of the money.
THSA has prepared a six-page overview, Supporting Meaningful Use – Health Information Exchange Options for Texas Hospitals and Physicians [PDF], that summarizes HIEs in Texas and services available to Texas physicians.
THSA also announced that the Texas Rural White Space Strategy began Jan. 1. It establishes qualified health information service providers to provide health information exchange connectivity to health care professionals in rural counties, known as the Texas "White Space," that do not have local HIEs.
Read more about HIEs in Texas Medicine's February 2010 article, "The Gift of Sharing." Physicians needing help with information technology also may turn to the Texas regional extension centers, which provide on-site consulting at subsidized and below-market rates. Visit the TMA website for more information. For questions related to HIEs, regional extension centers, and health information technology, call TMA at (880) 880-5720 or email HIT.
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For HIT, Innovation, Not ROI, is the Benchmark
HEALTH LEADERS – (February 28, 2012) – Healthcare IT is expensive. Just for starters, consider that the per-bed cost to implement EHRs and CPOE runs between $14,000 and $65,000 in the US, according to the federal Office of Management and Budget. Even at the low end of the estimate, that's an astonishing amount of money, and it doesn't include higher-order IT systems such as clinical decision support.
The high cost of IT creates a catch-22 for healthcare leaders already strapped for cash and forecasting declining revenues in years to come. IT systems offer a way—perhaps the only way—to lower healthcare system cost in a sustainable manner. But where do you find the money to invest in IT?
A useful perspective comes from a US–European Union comparison. Jean-Pierre Thierry, MD, MPH, points out that the comparable cost for implementing EHR and CPOE is a magnitude lower in western European countries—under $6,000 per bed, on average, and as low as $3,000 per bed in Germany. Part of the discrepancy comes from higher administrative costs in the US due to the multiplicity of payer approaches and billing systems.
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New health care law helps expand primary care physician workforce
HHS.GOV – (February 13, 2012) – National Health Service Corps awards $9.1 million to place physicians in medically underserved communities.
The National Health Service Corps (NHSC) awarded $9.1 million in funding to medical students in 30 States and the District of Columbia who will serve as primary care doctors and help strengthen the health care workforce, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced today at the Eisner Pediatric and Family Medical Center, a community health center in Los Angeles, Calif.
Made possible by the Affordable Care Act (the new health care law), the National Health Service Corps’ Students to Service Loan Repayment Program provides financial support to fourth year medical students who are committed to a career in primary care in exchange for their service in communities with limited access to care.
“This new program is an innovative approach to encouraging more medical students to work as primary care doctors,” said Secretary Sebelius. “This is an important part of the Administration’s commitment to building the future health care workforce.”
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Meaningful Use Deadline Coming
TEXAS MEDICAL ASSOCIATION – (January 17, 2012) – Physician have until Feb. 29 to register and attest to meeting meaningful use requirements to receive payments for 2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System.
Feb. 29 also is the deadline to submit any pending Medicare Part B claims from 2011, as the Centers for Medicare & Medicaid Services (CMS) allows 60 days after Dec. 31, 2011, for all pending claims to be processed.
Medicare EHR incentive payments to eligible professionals are based on 75 percent of the Part B allowed charges for covered professional services during the entire payment year.
If you did not meet the $24,000 threshold in Part B allowed charges by the end of calendar year 2011, CMS expects to issue an incentive payment in April 2012 for 75 percent of the Part B charges from 2011.
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Health IT Lowers Blood Pressure
NEXTGOV – (January 16, 2012) – Health IT appears effective in helping medical practices to keep their patients' high-blood pressure under control, according to a study published in the Archives of Internal Medicine.
The combination of electronic health records and clinical decision support (CDS) systems showed the best results, according to researchers from Boston's Brigham and Women's Hospital and the University of Massachusetts Medical System in Worcester. Practices using health IT reported greater success in keeping patients' blood pressure under control and fewer disparities in outcomes among racial and ethnic groups, according to an article by CMIO.net, a health-care online news site.
According to CMIO, the researchers found: (1) Providers using both an EHR and CDS managed to control the blood pressure of 78 percent of non-Hispanic whites and 85 percent of Hispanics. (2) Providers using neither health IT system had blood-pressure control rates of 75 percent of non-Hispanic whites and 69 percent of non-Hispanic blacks. A comparable rate for Hispanics was not included in the CMIO article.
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Dr. David Blumenthal: Success of HITECH Act "Inevitable"
BECKER'S ORTHOPEDIC, SPINE & PAIN MANAGEMENT REVIEW – (December 27, 2011) – David Blumenthal, MD, former head of the Office of the National Coordinator for Health Information Technology, recently wrote in the New England Journal of Medicine that the success of the HITECH Act and other health IT initiatives seem "inevitable, in part because its failure is unimaginable."
The HITECH Act encompasses several components, including meaningful use of electronic health records, EHR certification, Regional Extension Centers for health IT, health information exchange implementation and more.
Dr. Blumenthal said the federal government still faces several challenges — such as interoperability within HIEs, privacy concerns around electronic health information and EHR usability — but the age of electronic information offers a wealth of improved and more efficient patient care.
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Texas RECs Offer HIT Webinar Series
TEXAS MEDICAL ASSOCIATION – Texas regional extension centers (RECs) are hosting a free webinar series on current health information technology (HIT) topics for interested physicians and their staff. Physicians across Texas are turning to the technical experts at the RECs for on-site help implementing new or updated technology.
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EHR Workflow Analysis, Redesign Critical
TEXAS MEDICAL ASSOCIATION – (November 15, 2011) – A successful electronic health record (EHR) implementation begins with a practice workflow analysis and redesign. If you are an existing EHR user, use workflow analysis for continual quality improvement. While this process is often challenging, an effective workflow redesign is a key component in improving care coordination using EHRs. If your office lacks an efficient workflow, you might be experiencing lost productivity and extended workdays. A workflow analysis and redesign can help you identify and overcome variation that often leads to inefficiency.
If you need assistance with a workflow redesign in your office, turn to the Texas regional extension centers (RECs). RECs provide on-site support to Texas physicians to help with workflow analysis, EHR selection and implementation, EHR incentives, and meaningful use. Primary care physicians and specialists who can attest to providing primary care services are eligible for a reduced $300 rate (valued at $5,000) on consulting services. Visit TMA's Texas REC Resource Center for more information. Some of the Texas RECs are close to achieving their grant-allotted enrollment goals. Once that happens, the reduced rate will no longer be available for primary care physicians. Act soon to get the reduced rate!
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CMS Announces Version 5010, D.O and 3.0 Standard Enforcement Discretion Period
CMS.GOV – The Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services (OESS), has announced that it would not initiate enforcement action with respect to any HIPAA covered entity non-compliant with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards until 90 days after their January 1, 2012 compliance date, or until March 31, 2012. The compliance date for implementation of these updated standards remains January 1, 2012. More information, view the complete statement and enforcement FAQs.
New ICD-10 Implementation Handbooks Now Available.
CMS has developed four Implementation Handbooks as additional resources to assist the health care industry with the transition from ICD-9 to ICD-10 codes. Each guide provides detailed information for planning and executing the ICD-10 transition process. Use the guides as a reference whether you're in the midst of the transition or just beginning the process.
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TMA Persuades AMA to Block ICD-10 Switch
TEXAS MEDICAL ASSOCIATION – (November 15, 2011) – Spurred by its Texas members, the American Medical Association House of Delegates voted to oppose a federal mandate that physicians switch to the ICD-10 claims-coding system in 2013. At its interim meeting in New Orleans, the AMA house adopted a Texas Medical Association resolution asking AMA to "immediately petition the Centers for Medicare & Medicaid Services to stop implementation and development of all new coding and billing standards including ICD-10."
AMA delegates voted to direct AMA to "vigorously work to stop the implementation of ICD-10 and to reduce its unnecessary and significant burdens on the practice of medicine," and to "work with other national and state medical and informatics associations to assess an appropriate replacement for ICD-9."
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Medicare, Medicaid Incentives Reach $30M
TEXAS MEDICAL ASSOCIATION – (October 17, 2011) – The Centers for Medicare and Medicaid Services has paid $30 million in electronic health record (EHR) incentive dollars to Texas physicians in 2011, according to a federal official.
The funds received by Texas physicians and hospitals comprise 20 percent of the $870 million already distributed throughout the country. Hospitals in Texas have received $158 million in incentives since the incentive program started Jan. 1, 2011. A total of 11,000 Texas physicians have registered to participate, while only 1,400 have completed the steps necessary to earn the incentive dollars.
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NC Doctors Move Peers Toward Health IT
HHS.GOV – Getting Technical with Dr. John Torontow. When Dr. John Torontow began practicing medicine, he was one of the first physicians who found it helpful to use a handheld device to record patient notes. As an early adopter of health information technology (health IT), Dr. Torontow has always turned to new technologies to help him find efficiencies and re-imagine the way he practices medicine. Now that he is using electronic health records (EHR), Dr. Torontow is beginning to see health IT help his patients, too.
Dr. Torontow is a practicing physician at Piedmont Health, a federally qualified community health center in North Carolina. Piedmont has employed an EHR system for the past three years, eliminating paper charts in favor of a computerized system linking records from nearly 50 providers.
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CMS Sets New E-Prescribing Exemptions
TEXAS MEDICAL ASSOCIATION – (September 1, 2011) – Physicians who did not successfully e-prescribe 10 prescriptions (and report it on a claim form with G-code G8553) by June 30, 2011, are subject to a 1-percent Medicare penalty on Jan. 1, 2012. Thanks to advocacy from TMA and others, the Centers for Medicare & Medicaid Services (CMS) announced on Aug. 31 four new hardship exemptions that physicians can claim to prevent the penalty:
1. Eligible professionals who register to participate in the Medicare or Medicaid electronic health record (EHR) incentive programs and adopt certified EHR technology; 2. Inability to prescribe electronically due to local, state, or federal law or regulation; 3. Limited prescribing activity; or 4. Insufficient opportunities to report the electronic prescribing measure.
Physicians have until Nov. 1 to request the exemption. This deadline also applies to the two previously announced hardship exemptions: eligible practices in a rural area without sufficient high-speed Internet access and eligible practices in an area without sufficient available pharmacies for electronic prescribing.
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For the Record…Why we need Electronic Health Records
UTHEALTH LEADER – (August 12, 2011) – Cynthia Johnson sat in the emergency room on a Saturday morning, frustrated. Instructed by the doctor taking her physician’s calls to seek emergency care, she knew all she needed was one “emergency” pill to lower her high blood pressure, which soared from time to time since her ruptured brain aneurysm eight years earlier. Just a few weeks before, at a regular checkup, her doctor had run an extensive battery of tests. Now, the staff in the emergency room reran them all—wasting her time and racking up a hefty bill for Johnson.
“I received no treatment except rest in the nearly 10 hours I spent in the ER while I guess they ruled out other problems. I was about 1000 feet from where my records were stored, with no way for anyone to access those records,” says Johnson, manager of editorial services in the Office of Advancement at The University of Texas at Houston Health Science Center (UTHealth). She left the ER that evening without the pill and saddled with an enormous medical bill, which she had to pay out of pocket.
“It was an expensive day in the hospital that did nothing for me,” she says.
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Report offers telehealth as a solution to rural healthcare challenges
HEALTHCARE IT NEWS – (July 27, 2011) – A new report indicates rural Americans face an increasing need for quality healthcare at a time when access is proving difficult – and points to telemedicine and telehealth as a possible solution.
The report, issued July 27 by the UnitedHealth Center for Health Reform & Modernization, finds that people living in rural locations face greater difficulty accessing healthcare than their urban and suburban neighbors. In addition, the report indicated rural Americans experience more chronic conditions – such as diabetes and heart disease – and will be more likely to participate in Medicaid and other government-subsidized insurance programs by 2014.
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Meaningful Use: Clinical Summaries
HEALTHCARE IT NEWS – (July 22, 2011) – One of the most misunderstood Meaningful Use core measures for EPs is the objective: "Provide clinical summaries for patients for each visit." The required measure threshold for this objective is that: "Clinical summaries provided to patients for more than 50 percent of all office visits within 3 business days." EPs have the option to exclude this core measure if they "have no office visits during the EHR reporting period."
So let’s define a few terms. What is a clinical summary and what data must it contain? CMS provides very specific clarification and for this measure defines a clinical summary as:
“An after-visit summary that provides a patient with relevant and actionable information and instructions containing the patient name, provider’s office contact information, date and location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other instructions based on clinical discussions that took place during the office visit, any updates to a problem list, immunizations or medications administered during visit, summary of topics covered/considered during visit, time and location of next appointment/testing if scheduled, or a recommended appointment time if not scheduled, list of other appointments and tests that the patient needs to schedule with contact information, recommended patient decision aids, laboratory and other diagnostic test orders, test/laboratory results (if received before 24 hours after visit), and symptoms.”
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Seeing Promise and Peril in Digital Records
NEW YORK TIMES – (July 16, 2011) – Technical standards may seem arcane, but they are often powerful tools of economic development and social welfare. They can be essential building blocks for innovation and new industries. The basic software standards for the Web are striking proof.
Safety is also a potent argument for standards. History abounds with telling examples, like the Baltimore fire of 1904. That inferno blazed for 30 hours, destroying more than 1,500 buildings across 70 city blocks. Fire engines from other cities came to help, but could not. Their hose couplings — each a different size — did not fit the Baltimore fire hydrants. Until then, cities saw little reason to adopt a standard size coupling, and local equipment manufacturers did not want competition. So competing interests undermined the usefulness of, and investment in, the technology of the day.
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E-health records should play bigger role in patient safety initiatives, researchers advocate
HOUSTON – (July 5, 2011) – Patient safety researchers are calling for the expanded use of electronic health records (EHRs) to address the disquieting number of medical errors in the healthcare system that can lead to readmissions and even death. Their commentary is in the July 6 issue of JAMA, The Journal of the American Medical Association.
“Leading healthcare organizations are using electronic health records to address patient safety issues,” said Dean Sittig, Ph.D., co-author and professor at The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics. “But, the use of EHRs to address patient safety issues hasn’t hit the mainstream yet and we think everyone should be doing this.”
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