Since the U.S. Government passed the Economic Stimulus Act, the Healthcare Industry has been bombarded with information about new mandates, regulations and reform. Keeping up with the changes and getting the facts straight can seem daunting. In response, Health o meter® Professional Scales is dedicating our Facebook page and a section of our website to be an EMR/EHR Compliance Resource Center for Healthcare Professionals. This resource center includes an FAQ section and provides helpful articles and links. Additionally, when you “Like” our Facebook page you will receive our status updates with important links, articles and news regarding EMR/EHR compliance. Also visit our Blog to read more about EMR compliance and Healthcare IT topics. Our goal is to be your go-to source regarding EMR/EHR compliance.

FAQ

What is the difference between EMR and EHR? EMR is Provider-Centric as in, owned, managed and controlled by the provider such as a private practice physician. EHR is a more comprehensive record that spans time, multiple providers, and institutions.

Why do I keep hearing about the importance of using EMR/EHR systems? As part of the 2009 Stimulus Act, the National Coordinator for Health Information Technology (HIT) was mandated to update regulations to require utilization of an electronic health record for each person in the U.S. by 2014. In other words, under this new HITECH Act, by 2014 it will be mandatory for physicians and hospitals to use EMR/EHR for all patients.

What is the HITECH Act? The HITECH (Health Information Technology for Economic and Clinical Health) Act is part of the American Recovery and Reinvestment Act of 2009 (ARRA). The Act outlines many new initiatives for the use of technology in the healthcare industry, including the mandatory implementation of an EMR/EHR system i.e. EMR/EHR compliant.

How does the HITECH Act affect doctors and hospitals? The HITECH Act mandates that by 2014 doctors and hospitals must be using a certified EMR/EHR system, otherwise known as EMR/EHR compliant. But they must also adhere to established criteria of “meaningful use”, that includes up to 30 measures and objectives. For example, one of these criteria is to have automatic transmission and measurement of weight, height and calculation of BMI within their EMR/EHR system. For a complete list of these meaningful use criteria visit http://www.cms.gov/ EHRIncentivePrograms/Downloads/MU_Stage1_ReqSummary.pdf

What does it mean to be EMR/EHR compliant? In the simplest terms it means that a doctor or hospital is using a certified EMR/EHR system in their practice/hospital and using it to meet a series of objectives (a.k.a. meaningful use) as outlined by The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC.)

What is the purpose behind the HITECH Act and meaningful use? The motive behind these new mandates is that it focuses on electronically capturing health information and public health information. Source: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=3794&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keyw ordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

How will meaningful use criteria be enforced? Doctors and hospitals will submit their data to the Department of Health and Human Services. Submitting this data is part of proving meaningful use and then HHS will determine if they are meeting the objectives.

Is the government giving money to doctors and hospitals to cover technology expenses? To help kick-start the adoption of EMR/EHR and encourage providers to become compliant, the government started the EHR Incentive Program which provides eligible hospitals and physicians reimbursement payments for costs incurred while implementing new technology.

What is the EHR Incentive Program? The Medicare and Medicaid EHR incentive programs will provide incentive payments to eligible professionals and eligible hospitals as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. These incentive programs are designed to support providers in this period of Health IT transition and instill the use of EHRs in meaningful ways to help our nation to improve the quality, safety and efficiency of patient health care. Source: http://www.cms.gov/EHRIncentivePrograms/

Who qualifies for these incentive payments?
Medicare
- Doctor of medicine, osteopathy, podiatric medicine
- Doctor of dental surgery or medicine
- Doctor of optometry
- Chiropractor
- Hospitals (paid under inpatient prospective payment system, IPPS; Critical Access Hospitals, CAHs; Medicare Advantage hospitals)

Medicaid
- Physicians
- Dentists
- Certified nurse-midwives
- Nurse practitioners
- Physician assistants, in some settings
- Hospitals with at least 10% Medicaid

What types of medical practices do not qualify for HITECH incentives?
Free clinics that don’t bill Medicare or Medicaid
Physical therapists
Hospital-based physicians such as pathologists, anesthesiologists or emergency physicians
Acupuncturists and other holistic providers
Any practice not eligible for Medicare or Medicaid payments

How do we receive our incentive payments? Eligible hospitals or physicians must successfully demonstrate "meaningful use" of an EHR system for a consecutive 90-day period in their first year of participation and for a full year in each subsequent year to participate in the program and receive incentive payments. The direct link to begin registration for the EHR Incentive Program is https://ehrincentives.cms.gov/hitech/login.action.

What if a physician or hospital does not comply by 2014? Those who are not compliant by 2014 will lose federal subsidies and be penalized with diminished Medicare and Medicaid payments.

What is the benefit of using EMR/EHR systems? There are many benefits to a paperless charting system and automatic transmission of information. EMR/EHR systems allow for consistent documentation, no handwritten legibility issues, and increased patient privacy. New technology can also help with a more efficient workflow and less transcription and prescription errors.

What is the first step to becoming EMR compliant? If you aren’t already using an EMR/EHR system, the first step is to research which certified system works best for your healthcare setting. There are numerous EMR/EHR system vendors so be sure to choose one that has a certified system and a vendor that can help educate you on how to use the system to meet the meaningful use criteria. Once the EMR/EHR system is implemented educate yourself and your staff about the meaningful use criteria and begin making the necessary changes in your workflow to meet these standards. The Centers for Medicare and Medicaid services created training courses for both eligible professionals and eligible hospitals. Click on the links below for their comprehensive resource.

Eligible Professionals - http://www.cms.gov/EHRIncentivePrograms/Downloads/ EHR_Incentive_Program_Agency_Training_081010.pdf
Eligible Hospitals - http://www.cms.gov/EHRIncentivePrograms/Downloads/ EHR_Incentive_Program_Hospital_Training_FINAL.pdf

What are the costs involved in becoming EMR compliant? There is no exact estimate of the costs associated with getting your office or hospital up to date. It can depend on the size of your practice, what and how much equipment is needed, etc. However, if you become compliant and prove meaningful use you can receive your incentive payments which will help offset the costs.

Do small, private practices need to have EMR/EHR technology? In order to qualify for the EHR incentive program and not be penalized with reduced Medicare/Medicaid payments, EMR/EHR technology will be required by all size practices. There is a “Significant Hardship Exception” where “the Secretary may, on a case-by-case basis, exempt an eligible professional from the application of the payment adjustment under subparagraph (A) if the Secretary determines, subject to annual renewal, that compliance with the requirement for being a meaningful EHR user would result in a significant hardship, such as in the case of an eligible professional who practices in a rural area without sufficient Internet access. In no case may an eligible professional be granted an exemption under this subparagraph for more than 5 years.” http://www.hipaasurvivalguide.com/hitech-act-4101.php

We currently use an EMR/EHR system, how do I know if it’s certified? As stated on the CMS Website “All EHR systems and technology must be certified specifically for this program.” The ONC has released an initial list of certified systems and published the list on their website. http://www.cchit.org/. As more systems become certified they will be added to the list.

Will I have to buy other new equipment, besides EMR/EHR software to become compliant? It is very likely that you will also need to update other equipment that is EMR/ EHR connected. For example, you may need a new vital signs monitor that uploads the patient’s temperature or blood pressure directly into their EMR/EHR. As well as a scale that automatically measures and transmits the patient’s weight, height and BMI.

What is Body Mass Index (BMI)? Body Mass Index (BMI) is a ratio between a person’s weight and height and interpreted as a BMI score. This BMI score is then used as a tool to screen for obesity or excessive body fat. While it does not actually measure body fat directly, according to CDC, the BMI scores generally correlate with a person’s body fat percentage. Source: http://cnsnews.com/news/article/69436

What does BMI have to do with the new Healthcare regulations? One of the mandates put forth in the 2009 Stimulus Act requires that all EMR/EHR must now track a patient’s Body Mass Index (BMI) in addition to weight and height. Furthermore, this BMI score must be automatically calculated and displayed, not manually entered or calculated. This BMI calculation is one of the many meaningful use criteria outlined in the general certification criteria for Complete EHR’s.

Why is the government concerned with BMI and why does this measure have to be tracked as part of EMR/EHR compliance? According to the CDC, “BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems.” Providers will have to electronically share their patients’ BMI scores with the CDC and other health agencies, which will streamline data collection and lead to more accurate assessment of public health. These objectives correlate with one of the goals of healthcare reform which is to decrease healthcare costs related to preventable diseases. For example, those with a BMI score in the overweight and obese range are at increased risk for many diseases and health conditions, including the following:

Hypertension
Dyslipidemia (for example, high LDL cholesterol, low HDL cholesterol, or high levels of triglycerides)
Type 2 diabetes
Coronary heart disease
Stroke
Gallbladder disease
Osteoarthritis
Sleep apnea and respiratory problems
Some cancers (endometrial, breast, and colon)

In essence, by measuring BMI and guiding patients to a healthier lifestyle, providers may be able to help decrease healthcare costs related to these illnesses.

For a more detailed list of FAQ regarding new legislation and how it affects your office or hospital visit the Answers page on the CMS website. http://questions.cms.hhs.gov/app/ answers/list/p/21,26,1058

Helpful Articles:

"Obesity Rating for Every American Must Be Included in Stimulus-Mandated Electronic Health Records"
http://cnsnews.com/news/article/69436

Helpful Links:

Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology
http://federalregister.gov/a/2010-17210

The Official Web Site for the Medicare and Medicaid EHR Incentive Programs
http://www.cms.gov/EHRIncentivePrograms/

Health and Human Services Page on Electronic Health Records and Meaningful Use
http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2

Summary of the EHR Incentive Program
http://www.cms.gov/MLNProducts/downloads/EHR_Final_Rule-Medicaid.pdf

Centers for Disease Control and Prevention Page on BMI
http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html