Michael McBride

Now that the Centers for Medicaid and Medicare Services (CMS) has announced the "final rule" for attestation of meaningful use (MU) stage 2, what does it mean to you? 

Primary care physicians (PCPs) and other eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) now can review the upcoming MU stage 2 requirements. 

The final rule revises certain MU stage 1 criteria as well as establishes criteria for stage 2 of MU attestation. Additionally, it specifies the payment adjustments (read: reductions) to Medicare reimbursements that EPs, eligible hospitals, and CAHs can expect should they fail to demonstrate MU of certified electronic health record (EHR) technology. 

Elizabeth Holland, director, Health Information Technology (HIT) Initiatives Group, and Robert Anthony, policy analyst, are both with the Office of E-Health Standards and Services (OESS). They spoke with 

 after a National eHealth Collaborative live Web seminar in which Anthony outlined the most significant new revisions in the MU final rule. OESS is a division of CMS. 

"Providers have to have successfully attested to MU use no later than October 1, 2014, to avoid payment adjustments, so our goal is to assist as many people as we possibly can," Holland says. "We have resource centers and lots of information on our Web site. We're here to help." 

"It's critical for providers to ask their EHR vendors detailed questions and to be informed about the products they're buying," Anthony says. "There are a lot of EHR products out there. Knowing that an EHR can meet MU is great, and that's the knowledge that certification provides. But whether the EHR specifically fits your practice's needs-whether it has the ability to integrate with your other systems- only your vendor can answers those questions." 

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Whether the electronic health record (EHR) system you use is Web-based, software-as-a-service (SaaS), or a client/server arrangement, your EHR vendor will take responsibility for most of the EHR connectivity issues you'll face. That does not mean, however, that none of an EHR's connectivity needs are your responsibility and are out of your direct control. Some aspects of EHR connectivity always will be yours to establish and maintain. 

EHR connectivity refers to the internal EHR system connections within your practice or the external connections between your practice's EHR and other organizations. It is the physical wiring between your EHR servers, external hard drives, and broadband Internet connection, and it refers to the network connections between your registration/check-in desk, exam rooms, and billing department. EHR connectivity also can refer to the wireless systems in your practice and the remote terminal you use at home, as well as the mobile devices you use when on the move.  

The most critical element of connectivity for practicing physicians, however, is access to patients' records. 

"It touches a little bit on interoperability between disparate systems and also on making sure the hardware is up and works in a safe and secure fashion," says Robert Rowley, MD, a practicing family physician and healthcare information technology consultant who blogs at 

Rowley also was an early creator of electronic medical record technology for his own practice that eventually became the Practice Fusion EHR.  

"Keep in mind, there are two types of EHR connectivity," he says. "There's technical connectivity, like making sure your Internet connection doesn't go down and everybody can access the patients' records-especially during natural disasters like hurricanes. And then there's the connectivity of getting all the departments in a practice communicating and exchanging data between disparate system, which is more difficult." 

According to Rowley, Web-based EHR systems don't experience as many issues with lost connectivity as do practice EHRs that are hobbled together piecemeal from different vendors.  

Even external billing companies that receive electronic super bills from practices are interconnected to the practice EHR and generally fall under the responsibility of the vendor for maintaining connectivity. 

"A physician-consumer [with that type of EHR] doesn't have as much to worry about," Rowley says. "Those are unified EHR systems. They work well, and there are plenty of them in the market place, so internal system connectivity really isn't an issue for them." 

External connectivity, however, is another matter. The Centers for Medicare and Medicaid Services meaningful use EHR incentive programs established the Internet as essential to practicing medicine electronically and to receiving Medicare and Medicaid reimbursement payments. A practice's broadband connection, therefore, is of utmost importance to EHR connectivity. 

"We have an electronic healthcare system now," Rowley says. "And because it's Internet-based, we can work from home, from mobile devices, from wherever." 			

Your Internet connection, therefore, must be strong and reliable to ensure that your practice's EHR connectivity remains accessible. 

In addition to learning how to use your EHR, you will also need to work on connectivity and remote access. Here's what you need to know.

How to work with your vendor to work out connectivity and remote access

Want to know whether you and the other healthcare professionals and pharmacies in your area are at the forefront or lagging when it comes to adoption of electronic health records and e-prescribing? Now you can, thanks to a new tool from the federal government’s 

Office of the National Coordinator for Health Information Technology

The office, part of the U.S. Department of Health and Human Services, has released a new 

 that adds national-, state-, and local-level health information exchange (HIE) and EHR adoption data into its existing Web site.

The new content includes initial results from the ONC’s research and monitoring into patterns of healthcare provider adoption and use of EHRs to treat patients and exchange health data with other providers.

Among the key data you’ll find on the ONC Health IT Dashboard:

What percent of office-based healthcare providers have adopted EHRs in your state.

How many health information technology (HIT) implementation-support professionals have been trained by community colleges (ONC grantees) in your state.

The percentage of pharmacies that are enabled and actively using electronic prescribing (e-prescribing) technologies in your county or state.

How many providers (all or primary care only) are in your county or state.

The Health IT Dashboard includes six unique views that draw on more than 250 state, ONC program, and grantees dashboards.

“Our ONC stakeholders and the interested public now have a more comprehensive picture of the ways in which ONC programs and research are contributing to the widespread adoption and meaningful use of HIT,” said 

, ONC’s director for the Health IT Dashboards projects.

These capabilities join existing ones that let you (among other things):

generate maps of ONC’s planned obligations by state and program;

learn how ONC's Health Information Technology for Economic and Clinical Health (HITECH) Act programs work together to create momentum in EHR adoption and HIE activity; and

download a full list of ONC HITECH program grantees.

You can access the Health IT Dashboard at 

Want to know whether you and the other healthcare professionals and pharmacies in your area are at the forefront or lagging when it comes to adoption of electronic health records and e-prescribing? Now you can, thanks to a new tool from the federal governmentâ€™s Office of the National Coordinator for Health Information Technology (ONC).

ONC adds EHR/HIE adoption information to Web tool

When the U.S. Supreme Court ruled on the constitutionality of the Affordable Care Act (ACA), it also ruled that the federal government could not coerce states into expanding their Medicaid programs. Consequently, many states likely will opt out of Medicaid expansion. 

In addition to being a practicing emergency physician as well as a professor at Harvard Medical School, Halamka is chairman of the New England Healthcare Exchange Network and co-chairman of the Health Information Technology Standards Committee. 

Massachusetts realized Medicaid's desire to increase the quantity and quality of outcomes for its beneficiaries aligned with CMS' mandate to expand HIE nationwide, he says.  

The state presented CMS with a three-phase model and was awarded $16.9 million to help implement phase 1 of its plan. Massachusetts estimates the total cost of the plan at approximately $50 million, to be partially funded by Medicaid, partially by the state, and partially from private industry stakeholders. 

If Massachusetts can do this, then every other state also might be able to implement statewide HIE by engaging in a similar Medicaid expansion program. Cash-strapped states that opt out of Medicaid expansion, however, might find it difficult to implement such a plan.  

Halamka acknowledges that other states also can use this plan to expand HIE, but payers, providers, and government must work together. It's a compelling argument, and one every state should consider, because use of the resulting HIE infrastructure won't be restricted to only Medicaid-related activities. 

"If you build a backbone that connects hospitals and healthcare providers in the state in order to support the care coordination Medicaid wants," he says, "you can reuse that backbone for all kinds of purposes. By using state funds with Medicaid matching funds and private contributions, we created a sustainable business model." 

The Massachusetts HIE will connect every healthcare provider in the commonwealth through a common set of federal standards, which, not so coincidentally, are the same standards found in the meaningful use stage 2 proposed rule (see more information on the final stage 2 meaningful use rule at 

									http://www.MedicalEconomics.com/finalMU2

). Using similar plans, every state in America could effectively build a statewide HIE. States would have to consider expanding Medicaid in their state. 

ACA wants to build health information exchanges to connect Medicaid providers. Learn what you need to know about them.

Author | Michael McBride

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