The guide — titled “A Clinician’s Guide to Electronic Prescribing” — was first published in 2008 (Commins, HealthLeaders Media, 4/28).

The organizations that collaborated on the update are the:

• American Academy of Family Physicians;
• American College of Physicians;
• American Medical Association;
• Center for Improving Medication Management;
• e-Health Initiative; and
• Medical Group Management Association (Robeznieks, Modern Physician, 4/26).

Details of the Guide

The updated guide incorporates changes brought about by the federal health reform law, the HITECH Act and a Drug Enforcement Agency rule to allow E Prescription of controlled substances (Goedert, Health Data Management, 4/27).

The guide provides information on:

• E-prescribing requirements that physicians will face in 2011; and
• How the meaningful use program relates to e-prescribing.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments (HealthLeaders Media, 4/28).

Source  :  http://www.eprescriptionservices.com/health-care-groups-update-electronic-prescribing-guide/

According to MGMA, eligible professionals could be unfairly penalized by the programs’ inconsistent requirements (Goedert, Health Data Management, 3/17).

Details of Incentive Programs

Under 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for incentive payments through Medicaid and Medicare (CMIO, 3/18).

The e-prescribing program started paying out incentives in 2009 and will continue to do so through 2013. Medicare providers who do not e-prescribe would face penalties beginning in 2012 (iHealthBeat, 2/22).

Letter Details

In its letter to HHS Secretary Kathleen Sebelius, MGMA said that e-prescribing incentive program rules conflict with similar rules within the meaningful use program.

Eligible professionals participating in the e-prescribing program must report successful transmission on claims for at least 10 e-prescriptions in the first six months of 2011 to avoid a 1% Medicare payment cut next year. They also must submit 25 e-prescriptions by the end of 2011 to avoid another payment adjustment in 2013 (Health Data Management, 3/17). However, eligible professionals must attest to meeting less stringent requirements under Stage 1 of the meaningful use program (CMIO, 3/18).

The letter states, “This makes it possible for an [eligible professional] to earn incentives through the EHR incentive program but still be penalized through the e-prescribing program for submitting the same number of e-prescriptions” (Health Data Management, 3/17).

Recommendations

Some of MGMA’s recommendations include:

• Allowing more health care providers to be exempt from possible e-prescribing payment reductions in 2012 and 2013; and
• Allowing eligible professionals who attest to meeting Stage 1 meaningful use criteria, during any 90-day window this year, to avoid any e-prescribing payment penalties in 2012 and 2013 (CMIO, 3/18).

Source  :  http://www.eprescriptionservices.com/mgma-align-rules-that-govern-e-prescribing-meaningful-use/

The federal government, which strongly supports EMRs, has touted bonuses to physicians who go electronic. A new survey shows just how interested the health care community is in such financial motivation. Forty-one percent of office-based physicians and four in five hospitals plan to take advantage of federal incentive payments for adoption and meaningful use of full-featured, certified EMRs, according to the survey, issued Jan. 13 by the Office of the National Coordinator for Health Information Technology.

Another inducement is from the Medicare electronic prescription incentive program, created by the Medicare Improvements for Patients and Providers Act of 2008 and started Jan. 1, 2009. The five-year program provided a payment to eligible physicians equal to 2% of their total Medicare payments for the year in 2010. The amount is 1% in 2011 and 2012, then will dip to 0.5% in 2013.

While that is a positive step, there also are penalties for those who do not adopt E Prescription systems. A new regulation, which took effect Jan. 1, says eligible practices should meet e-prescribing criteria in at least 10 Medicare office visits between Jan. 1 and June 30. If they don’t, they will pay the government a penalty equal to 1% of their Part B earnings in 2012. The entire 2011 calendar year will determine punishment for 2013.

The American Medical Association and 103 state and specialty medical societies have raised concerns about the penalty and are fighting to revise the policy. In a Dec. 9, 2010, letter to Dept. of Health and Human Services Secretary Kathleen Sebelius, they take issue with the timing. They say the Centers for Medicare & Medicaid Services had indicated that eligible physicians would not be able to get incentives from both the Medicare e-prescribing and Medicare EMR incentive programs simultaneously. Therefore, doctors should choose to take part in only one of these programs, the letter says.

Many doctors who have not yet purchased an e-prescribing or a limited EMR system have decided to forgo the e-prescribing incentives and invest in a comprehensive EMR, the organizations say. But CMS changed its policy at the eleventh hour with the November 2010 publication of its 2011 final fee schedule rule, the letter states. The sudden change doesn’t allow enough time to educate doctors on the need to take part in the 2011 e-prescribing incentive program to avoid penalties in 2012 and 2013.

The major last-minute policy change will compel doctors to spend additional time and money to implement and use e-prescribing software and applications that most will discard when they move to a complete EMR.

The AMA and the organizations strongly oppose basing the 2012 and 2013 e-prescribing penalties on activity that occurs during 2011. At the very least, they say, CMS should extend the reporting period from June 30 to Oct. 31 — an extra four months — to avoid penalties. In addition, the agency should add more exception categories for health professionals, allowing physicians who meet meaningful use criteria in 2011 or 2012 to be exempt from e-prescribing penalties.

The decision to move forward with an EMR can be complicated and costly. Physicians who took the time to make a prudent choice should not be penalized or forced into a wasteful, short-term solution.

Source  :  http://www.eprescriptionservices.com/revise-unfair-e-prescribing-penalty/

Details of Meaningful Use, E-Prescribing Incentives

Both the meaningful use program and the E Prescription program will provide incentive payments to encourage the adoption of health IT. Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments (Mosquera, Government Health IT, 2/18).

According to the GAO report, the meaningful use program allocates incentive payments from 2011 to 2016 and starts penalizing health care providers in 2015 for failing to meaningfully use health IT.

Meanwhile, the e-prescribing program started paying out incentives in 2009 and will continue to do so through 2013. Health care providers who do not e-prescribe would face penalties beginning in 2012 (Zigmond, Modern Healthcare, 2/18).

Inconsistencies in Incentive Programs

According to the report, both programs encourage health care providers to adopt health IT that can perform similar activities related to e-prescribing. However, the meaningful use program requires adoption of health IT systems certified to meet specific criteria, while the e-prescribing program has no such certification requirement (Government Health IT, 2/18).

The report noted, “As a result, providers have no assurance that the systems they invest in will meet the electronic prescribing program’s requirements” (Modern Healthcare, 2/18).

The two programs also set up separate reporting benchmarks for e-prescribing. The meaningful use program contains five e-prescribing reporting requirements, compared with one in the e-prescribing program.

Linda Kohn — director of health care issues at GAO — said these inconsistencies could lead to uncertainty among health care providers as to what type of health IT to acquire (Government Health IT, 2/18).

Recommendations

GAO recommended that the CMS administrator:

• Advise health care providers to adopt certified EHR systems;
• Eliminate any overlapping e-prescribing reporting requirements in the two programs;
• Review whether health care providers who receive e-prescribing incentive payments are meeting the program’s requirements (Modern Healthcare, 2/18).

Source  :   http://www.eprescriptionservices.com/gao-advises-cms-to-resolve-incentive-program-disparities/

The Electronic Prescription network will use a representation of the Direct Project standards and services for simple health information exchanges, according to an announcement Feb. 15 by AAFP and Surescripts.

AAFP Physicians Direct will be available to 75,000 primary care providers across the U.S., and will be offered as a monthly subscription service for $15 per physician user.

The Direct Project is an effort of the Office of the National Coordinator for Health IT to extend health information exchange to individual physicians and small practices who have limited resources and technology assets, so they can meet meaningful use requirements for simple exchanges of referrals, patient summaries and lab results with other providers.

“AAFP Physicians Direct is a health IT innovation that will help providers achieve meaningful use and support continuity of care, which will reduce costs and medical errors,” said Dr. Farzad Mostashari, ONC’s deputy national coordinator for programs and policies.

The Direct Project is a streamlined version of the standards and services of the nationwide health information network (NHIN) that enables providers to exchange patient data securely through the Internet. With Direct, providers send data through secure messaging.

AAFP physicians will be able to connect to the Surescripts network and share information securely through the new AAFP Physicians Direct Web portal or a choice of electronic health record systems.

AAFP’s new service, which is available to physicians and other health care providers serving large and small communities, will help “ensure that everyone can take part and benefit from the digital transformation of the nation’s health care system,” Totonis said.

The Surescripts network will enable providers to exchange clinical data with each other by eliminating communication barriers due to incompatible technology and a lack of interoperability standards.

Dr. David Blumenthal, national coordinator for health IT, has said that health information exchange and clinical interoperability are critical to improving patient outcomes and coordinating care. The next stage of meaningful use measures will require more comprehensive health information exchange, he has said.

“AAFP Physicians Direct will make slow, fragmented and cumbersome patient referrals and follow-up care a thing of the past,” said Dr. Steven Waldren, director of the AAFP Center for Health IT.

Subscribers to AAFP Physicians Direct will be able to securely exchange messages with any other provider on the Surescripts network. Message recipients will retrieve messages from a secure web page within the Physicians Direct portal and reply to messages for free.

It will support federal and state policies and standards for health information exchange, including privacy and security standards as well as standards and technology for exchange, such as Continuity of Care Record (CCR) developed by ASTM International and the Continuity of Care Document (CCD) standard from Health Level 7 to communicate patient summaries.

Source   :    http://www.eprescriptionservices.com/surescripts-aafp-will-provide-physicians-direct-information-exchange/

DEA’s interim final rule, “Electronic Prescriptions for Controlled Substances,” could make things easier for many physicians who are already electronically prescribing noncontrolled drugs, according to Steven Waldren, MD, director of the Center for Health Information Technology at the American Academy of Family Physicians.

“There are advantages from a quality, safety, and efficiency standpoint” that have already been shown with electronic prescribing, Waldren told MedPage Today. “The same thing needs to be applied to controlled substances. There is also one workflow that can [now] be applied to writing scripts electronically,” instead of needing to have a separate procedure for controlled substances.

Although some people have expressed concern that E Prescription of controlled substances may not be as secure as paper prescriptions, “my personal opinion is that it’s more secure,” Waldren said.

Kevin Nicholson, vice president and pharmacy adviser at the National Association of Chain Drug Stores (NACDS) in Alexandria, Va., agreed that electronic prescribing was actually safer. “Right now, most controlled substances can be called in by telephone, and only certain ones have to be written in on a prescription blank,” he said in an interview. “We feel it’s easier to forge a prescription on paper or fake being a doctor over the phone, than to forge one electronically.”

To make electronic prescribing of controlled substances extra secure, the new DEA rule requires that prescribers provide two of the following: something the person knows (such as a password), something the person has (such as a “hard token” device that generates a random number to be typed into the computer), and something the person “is” (such as a retina scan or fingerprint).

Using two of these factors “will constitute the legal signature of the DEA-registered prescribing practitioner,” according to the agency. Once the two factors have been completed, the computer must “digitally sign” the prescription and archive the DEA-required prescription information.

Although the rule went into effect this week, it could be a long time before physicians will actually be able to put it to use, even if they are already prescribing electronically, Waldren said.

That’s because vendors need to get up to speed with the programming needed to manage hard tokens and biometrics, “and a typical software development cycle is about 18 months,” according to Waldren.

In addition, CMS will need to issue its own new electronic prescribing standard under Medicare or grant a waiver to its current standards in order to allow physicians to meet the DEA requirements.

On the pharmacy side, it will probably be at least six months before pharmacies are ready for e-prescribing of controlled substances, said Nicholson.

Pharmacies “will have to reprogram their systems, and the system has to be certified by an entity approved by the DEA,” he told MedPage Today.

The rule from the DEA has been a long time in coming — 15 years, to be exact, according to Nicholson. One apparent reason for DEA’s foot-dragging was that the agency felt that paper forgeries would be easier to prosecute than electronic ones.

“That was one reason they gave us,” Nicholson said. “If you’re prosecuting a case, it’s much easier using paper as evidence than to have to subpoena an electronic record.” But pressure from the Department of Health and Human Services (HHS) helped to move things along.

“The HHS Office of the National Coordinator has a mission for widespread adoption of electronic health records by 2015,” said Nicholson. “Physicians are going to be much more willing to adopt electronic health records if they are prescribing electronically.”

The new rule will also allow physicians to take fuller advantage of the CMS bonus offered to physicians who prescribe electronically.

Now that the federal government has issued its rule, the NACDS will be working with state pharmacy boards and other state agencies to modify any state regulations that are barriers to electronic prescribing of controlled substances, Nicholson said.

“There are a number of state laws and regulations that might still have some prohibitions. States aren’t putting up barriers in response to the DEA’s rule, but there may be laws and regulations that have been on the books for a while that no one’s ever changed.”

Source    :     http://www.eprescriptionservices.com/e-rx-now-an-option-for-controlled-drugs/

Surescripts, based in Arlington, Va., will verify that EHR modules for e-prescribing and privacy and security meet meaningful use standards and certification criteria, ONC said in a Dec. 23 announcement.

In October, Surescripts began to expand its E Prescription network to offer health information exchange services for all types of clinical information. The Surescripts network will let EHRs, health system networks and smaller exchanges connect to its national backbone, which in turn can connect them with any other network.

The e-prescriber already connects healthcare providers with retail pharmacies and pharmacy benefit managers.

As an ONC-Authorized Temporary Certification Body (ATCB), Surescripts joins the Certification Commission for Health IT (CCHIT), the Drummond Group, InfoGard Labs, ICSA Labs and SLI Global Solutions. All but Surescripts may certify both complete EHRs and EHR modules, ONC said.

The temporary program, which expires in December 2011, is designed to ensure health IT vendors have their products and services certified in time for providers to meet 2011 deadlines for qualifying for first stage meaningful use requirements.

ONC’s Certified Health IT Product List includes more than 150 EHRs and modules that the authorized groups have certified to date since September, as well as the criteria they cover.

Certification assures healthcare providers that the EHR technology they acquire can perform the functions they need to participate in the Medicare and Medicaid EHR incentive program. Physicians and hospitals that become meaningful users of certified EHRs and modules are eligible for incentive payments under the HITECH Act.

ONC is developing a permanent certification program, in which separate organizations will perform testing and certification activities, for subsequent years of the incentive program.

Source  :  http://www.eprescriptionservices.com/onc-names-surescripts-to-certify-ehr-modules/

The letter, sent by the AMA to HHS Secretary Sebelius on Dec. 10, stated that the groups believe the e-Rx penalty policy will hurt efforts to implement widespread health IT adoption among physician practices and cause them to take on needless financial and administrative burdens.

“The last minute decision to require E Prescription in 2011 will force physicians to spend additional financial and administrative resources to purchase e-prescribing software that most of them will end up discarding when they transition to a complete EHR system,” said AMA Board Secretary Steven J. Stack, MD.

According to the Centers for Medicare and Medicaid Services (CMS) physicians cannot receive incentives from both the Medicare e-prescribing incentive program and the Medicare EHR incentive program simultaneously. However, if physicians choose not to participate in the 2011 e-prescribing program, they will face penalties in 2012 and 2013. Officials said that not aligning these programs will ultimately delay physicians’ efforts to adopt a complete EHR.

“This unreasonable policy leaves many physicians with little choice but to purchase and use a stand-alone e-prescribing program during the initial months of 2011 just to avoid penalties,” said Stack. “HHS must take action now to align the e-prescribing and EHR incentive programs in order to alleviate confusion and reduce financial and administrative burdens on physician practices working to adopt health IT.”

Source    :     http://www.eprescriptionservices.com/ama-to-hhs-medicare-e-rx-penalty-policy-unreasonable/

Under the policy, physicians who do not e-prescribe in the first six months of 2011 would face penalties starting in 2012.

AMA said the penalties could negatively affect efforts to promote widespread health IT adoption. The group also said the policy would create unnecessary administrative and financial burdens for physician practices.

In addition, AMA said HHS should take action to align the Medicare E Prescription program with the meaningful use incentive program for electronic health record adoption. Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for incentive payments through Medicare and Medicaid.

AMA said a failure to connect the e-prescribing and EHR incentive programs could delay health care providers’ efforts to adopt comprehensive EHRs (Merrill, Healthcare IT News, 12/13).

Source    :     http://www.eprescriptionservices.com/medical-groups-call-for-hhs-to-revise-policy-on-e-prescribing-penalties/

January 5, 2011 – Integrated Systems Management Inc announced today that OmniMD™ EHR, Version 11.0 is 2011/2012 compliant and was certified as a Complete EHR on January 4, 2011 by the Certification Commission for Health Information Technology (CCHIT®), an ONC-ATCB, in accordance with the applicable (eligible provider) certification criteria adopted by the Secretary of Health and Human Services. The 2011/2012 criteria support the Stage 1 meaningful use measures required to qualify eligible providers and hospitals for funding under the American Recovery and Reinvestment Act (ARRA).

According to Divan Dave, CEO, of OmniMD™ “This certification is another step in our commitment to provide providers with intuitive, easy-to-use, affordable technologies that help them improve patient care, reduce their costs and qualify for government incentives”.

The ONC-ATCB 2011/2012 certification program tests and certifies that Complete EHRs meet all of the 2011/2012 criteria and EHR Modules meet one or more – but not all – of the criteria approved by the Secretary of Health and Human Services (HHS) for either eligible provider or hospital technology.

“CCHIT is pleased to be testing and certifying products so that companies are now able to offer these products to providers who wish to purchase and implement certified EHR technology and achieve meaningful use in time for the 2011-2012 incentives,” said Karen M. Bell, M.D., M.S.S., Chair, CCHIT.

OmniMD™ EHR, Version 11.0 certification number is CC-1112-484340-1. ONC-ATCB 2011/2012 certification conferred by CCHIT does not represent an endorsement of the certified EHR technology by the U.S. Department of Health and Human Services nor does it guarantee the receipt of incentive payments.

The clinical quality measures to which OmniMD™ has been certified include:

NQF 0421 – Adult Weight Screening & Follow-Up
NQF 0013 – Hypertension: Blood Pressure Measurement
NQF 0028 – Tobacco Use Assessment and Cessation
NQF 0041 – Influenza Immunization
NQF 0024 – Weight Assessment and Counseling
NQF 0038 – Childhood Immunization Status
NQF 0034 – Colorectal Cancer Screening
NQF 0043 – Pneumonia Vaccination Status
NQF 0067 – CAD: Oral Antiplatelet Therapy
NQF 0084 – Heart Failure: Warfarin Therapy

OmniMD™ EHR Version 11.0 is also certified in CCHIT’s separate and independently developed certification program. OmniMD™ Version 11.0 is a pre-market CCHIT Certified® 2011, Ambulatory EHR. Integrated Systems Management Inc. has certified its EHR technology in both programs to provide greater assurance to its customers.

About Integrated Systems Management, Inc

Founded in 2000, OmniMD™ integrated Electronic Health Records and Practice Management (PMS) products and services, offers unparalleled reliability, ease-of-use, efficiency and customizability. OmniMD™ Ambulatory EHR has also earned a designation as a pre-market CCHIT 2011 Certification with the highest 5 Star Usability Rating ensuring OmniMD™ commitment to have a comprehensive, secure, scalable, intuitive and interoperable EHR system. OmniMD™ Ambulatory EHR Version 11.0 is CCHIT 2011 Pre-Market Certified, web-enabled and support devices ranging from Tablet PCs to Smart phones. OmniMD™ offers a comprehensive set of services such as Health Transcriptions, Document Management, Patient Portal, Patient Reminder and Eligibility Verification as part of an integrated solution under one roof helping practices to effectively addressing their financial, administrative, clinical, and regulatory needs. OmniMD™ Ambulatory EHR Version 11.0 is built as a true Software as a Service solution.  It can be deployed as an Enterprise or a Subscription based Service as per the practice requirements.  OmniMD™ is designed to exceed the present and future needs of the healthcare industry. OmniMD™ is robust, scalable, interoperable, secure, intuitive and customizable with rapid deployment model. OmniMD™ EHR has also achieved Surescripts® Gold Solution Provider status, which allows for interoperability with the nation’s community pharmacies – improving the safety, efficiency and quality of the prescribing process. Gold Solution Provider status is granted to vendors whose software products have surpassed Surescripts’ baseline product certification, by demonstrating a higher level of commitment to e-prescribing, enhanced security, excellent customer support and service. OmniMD™ is a division of Integrated Systems Management, Inc. – ISM Inc. – (www.ismnet.com) a leader in Software Development and Information Technology Consulting since 1989.

About CCHIT

The Certification Commission for Health Information Technology (CCHIT®) is an independent, 501(c)3 nonprofit organization with the public mission of accelerating the adoption of robust, interoperable health information technology.  The Commission has been certifying electronic health record technology since 2006 and is approved by the Office of the National Coordinator for Health Information Technology (ONC) of the U.S. Department of Health and Human Services (HHS) as an Authorized Testing and Certification Body (ONC-ATCB).  More information on CCHIT, CCHIT Certified® products and ONC-ATCB certified electronic health record technology is available at http://cchit.org.

About ONC-ATCB 2011/2012 certification

The ONC-ATCB 2011/2012 certification program tests and certifies that EHR technology is capable of meeting the 2011/2012 criteria approved by the Secretary of Health and Human Services (HHS). The certifications include Complete EHRs, which meet all of the 2011/2012 criteria for either eligible provider or hospital technology and EHR Modules, which meet one or more – but not all – of the criteria. ONC-ATCB certification aligns with Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology published in the Federal Register in July 2010 and strictly adheres to the test procedures published by the National Institute of Standards and Technology (NIST) at the time of testing.   ONC-ATCB 2011/2012 certification conferred by the Certification Commission for Health Information Technology (CCHIT®) does not represent an endorsement of the certified EHR technology by the U.S. Department of Health and Human Services nor does it guarantee the receipt of incentive payments.

“CCHIT®” and “CCHIT Certified®” are registered trademarks of the Certification Commission for Health Information Technology.