I recently presented for AuntMinnie.com’s RadExpo 2012 on the Centers for Medicare and Medicaid Services (CMS) and HHS Office of the National Coordinator for HIT (ONC) proposed rules to update the user and technology requirements of the EHR Incentive Program (“meaningful use”). I have received several questions about that presentation and subsequent Q&A session.
Q: You stated that ONC’s proposed redefinition of “certified EHR technology” was the most significant thing for radiologists and radiology HIT vendors. Why is that, and why not the imaging related items in CMS’ proposed rule?
A: ONC’s proposal to remove the comprehensiveness requirement for combinations of certified EHR Modules to meet the regulatory definition of “CEHRT” is beyond huge for users and vendors of “non-EHR” EHR technology. If finalized and improved, specialized HIT products with EHR Module certification can by themselves, or with minimal added functionality, meet the “CEHRT” regulatory definition. It also would mean that radiologists would not be forced to implement unused functionalities (like eRx, etc) just to meet a regulatory requirement of limited utility. ACR has been pushing for such a change in ONC’s regulations since our comment letter on the original ONC Interim Final Rule back in early 2010 when the problem was easily foreseeable.
On the other hand, while the imaging data-related menu set objective in CMS’ proposed rule is important from a policy perspective (and a long, hard-fought advocacy victory for ACR and patients regardless of whether or not that item makes it into the final rule), it would have no impact on the ability of radiologists to comply with the various requirements of the program. In fact, that proposed objective as written appears to be meant for ordering/referring physicians and not diagnostic radiologists.
Also note that the CMS Stage 2 proposals are fundamentally more of the same. There are no specialty-specific pathways to compliance or any revolutionary changes that would change existing perceptions. On the other hand, the ONC’s proposed redefinition of “CEHRT” and perhaps even the removal of the General, Inpatient, and Ambulatory criteria categorization scheme are quite revolutionary and potentially helpful to specialists.
Q: In the slide about avoiding penalties, you mentioned a July 3 deadline for eligible professionals (EPs) to begin complying if they have not complied already. Isn’t the EP deadline for compliance to avoid penalties in early October?
A: I should have been more clear in the verbal explanation of that particular slide. July 3 is proposed by CMS to be the last date when EPs would need to begin their 90-day EHR Reporting Period to complete attestation by October to avoid penalties in the following calendar year. This is different than the current (incentive year) paradigm in which EPs’ first 90-day EHR Reporting Period simply needs to fall within the calendar year and attestation could be completed as late as two months into the following calendar year. The three month difference between the attestation deadlines for incentive years versus penalty years is the result of CMS needing some time to determine who should receive reduced rates before billing actually begins.
While we are discussing this, I should also note that on the same slide I made a verbal error explaining the first bullet. EPs who are already participating in the program would avoid 2015 penalties by virtue of their “2013″ compliance, not “2011.” Clearly, 2011 is not 2 years before 2015.
Q: You barely touched on Stage 1 requirements and certain aspects of the proposed rules, such as eligible hospital and Medicaid requirements in CMS’ proposed rule, and concepts such as gap certification in ONC’s proposed rule. Why?
A: I only minimally covered main concepts from the existing CMS and ONC regulations because the presentation was intended to focus primarily on the March 7, 2012 Notices of Proposed Rulemaking from CMS and ONC. To do that, however, I needed to do a quick refresher of the way things are currently for comparative purposes.
I did not cover everything in CMS’ proposed rules for two reasons: 1) ACR’s focus is exclusively on the Medicare EP version of the program because most ACR members will not meet the Medicaid version’s patient volume threshold eligibility requirement; and 2) the hospital version of the program does not incentivize, penalize, or otherwise impact physicians in a direct fashion.
I did not cover everything in ONC’s proposed rule because of time limitations and relevance to end-users and their patients. Even though I chose not to cover it, key stakeholders like HIT vendors should explore the ONC proposed rule in depth and note important concepts like “gap certification.” My personal hope is that radiology HIT vendors also submitted detailed comments to ONC on that particular proposed rule.
On May 15, the HHS Office of the National Coordinator for HIT (ONC) published its request for information (RFI) on “Nationwide Health Information Network: Conditions for Trusted Exchange” in the Federal Register for a 30-day public comment period ending June 14. Following collection of stakeholder responses to the RFI, ONC plans to address HIE governance issues via a future rulemaking, perhaps beginning later this year.
The RFI presents numerous concepts and asks 66 associated questions. Stakeholders planning to submit comments should focus on specific questions of interest.
The American College of Radiology’s IT and Informatics Committee-Government Relations Subcommittee is currently reviewing the RFI. If you are a member of the radiology community and are interested in providing feedback for potential inclusion in ACR’s future comments, please contact Michael Peters (Director of Legislative and Regulatory Affairs, ACR Government Relations Department) at 202-223-1670.
ACR to Present on Meaningful Use Stage 2 Proposed Rules During AuntMinnie.com’s RadExpo 2012 on May 15
During tomorrow’s AuntMinnie.com RadExpo 2012, I will present an overview of the CMS’ and Office of the National Coordinator for HIT’s proposed rules to update the user and technology requirements of the EHR Incentive Program (“meaningful use”). I will also discuss expectations and ACR advocacy efforts associated with those rulemakings. The presentation will be followed by a live Q&A moderated by Bryan Casey, AuntMinnie.com’s Editor-in-Chief.
On May 14, the U.S. Department of Health and Human Services (HHS) published a Federal Register notice to announce the latest in a series of “America Creating Opportunities to Meaningfully Promote Excellence in Technology, Education, and Science (COMPETES) Act” prize competitions (or “challenges”), this one on the topic of ocular imaging. While ophthalmology specific, this challenge may be of interest to a few in the radiology IT community.
For the challenge, participants are asked to create an application that improves interoperability among ophthalmic imaging devices, measurement devices, and EHRs. Specifically, HHS wants the application to:
- Convert output from legacy ophthalmic imaging and measurement devices from proprietary formats to vendor-neutral standard formats (e.g. using freeware DICOM tools).
- Archive data from multiple imaging and measurement devices.
- Display images and data for clinicians, and permit basic functionalities such as optimizing viewing parameters (e.g. brightness, contrast, color, zoom, pan).
- Integrate with existing EHRs (e.g. single sign-on).
- Where applicable, leverage and extend NwHIN standards and services including, but not limited to, transport (Direct, web services), content (Transitions of Care, CCD/CCR), and standardized vocabularies.
As with all America COMPETES Act challenges, the prize money is relatively limited ($100k for 1st place, $35k for 2nd place, and $15k for 3rd place), but could certainly pique the interest of individual software developers, IT students, start ups, etc.
On May 11, the HHS Office of the National Coordinator for HIT (ONC) released on the Office of the Federal Register’s Public Inspection Desk its Request for Information (RFI) on health information exchange (HIE) governance topics, “National HIE Network: Conditions of Trusted Exchange.” The RFI will be published in the Federal Register on May 16, 2012 for a 30-day comment period.
The ACR IT and Informatics Committee-Government Relations Subcommittee is currently reviewing the document.
On May 8, the HHS Office of the National Coordinator for HIT (ONC) announced the release of its “Guide to Privacy and Security of Health Information” written for various healthcare professional audiences.
Certain Health Insurance Portability and Accountability Act and “meaningful use” items are discussed, but the guide is intended to be more of an educational resource about general privacy/security issues than a regulatory guidance. In other words, the information goes far beyond what is required and speaks to the broader concept of a privacy/security culture in the workplace.
This guide is a product of the Office of the Chief Privacy Officer of the ONC. This office is essentially charged with engaging the very active and involved patient privacy/security advocacy community.
On May 4, 2012, the American College of Radiology (ACR) submitted official comments to the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for HIT (ONC) regarding the agencies’ March 7, 2012, proposed rules to revise and update the professional and technology requirements of the EHR Incentive Program (“meaningful use”). The ACR IT and Informatics Committee (ITIC) – Government Relations Subcommittee compiled the comments with feedback from ACR members, allied organizations, and other stakeholders.
The latest formal comments and related resources are available on the ACR Government Relations website: