Help Inform the Department of Health and Human Services’ (HHS) Measurement of Interoperability

The ONC asking for your input on ways to measure the progress toward a future where health information is flowing between providers and patients to supports a health system that provides better care, smarter spending, and healthier people. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) declares it a national objective to achieve the widespread exchange of health information through the use of interoperable certified electronic health records and directs HHS to establish metrics in consultation with you – the health IT community – to see if that objective has been met.

The Federal Health IT Strategic Plan is a collaboration with over 35 federal partners and the public which focuses federal offices that use or influence the use of health information technology on person-centered care, advancement of science, and overall health. The central theme of the Strategic Plan is ensuring health data flows seamlessly and securely to create a learning-based, person-centered health system.

Similarly, the Nationwide Interoperability Roadmap was an effort by the Office of the National Coordinator for Health Information Technology (ONC) in collaboration with the private sector, states, and federal partners to identify near-term actions to advance an interoperable health system.

Combined with the recent announcements of private sector market leaders to make EHR information flow more efficiently, these efforts all help to support the flow of health information when and where it is needed for patient care. (See our 3/1/16 post “Health Groups Aim to Make Medical Records Easier to Access” here.)

The ONC is issuing a request for information for your thoughts on how to measure interoperability and ensure HHS is keeping pace with the objectives laid out in the Roadmap and the Federal Health IT Strategic plan to measure the broad health information ecosystem, including individuals and non-health settings. Specifically, the ONC is asking for input on:

1.       What populations and elements of information flow should we measure?

2.      How can we use current data sources and associated metrics to address the MACRA requirements?

3.      What other data sources and metrics should HHS consider to measure interoperability more broadly?

The public comment period closes on June 3, 2016. View and download the request for information here and view the original posting here. 

Health IT Interoperability Remains Elusive

To assess the state of HIT, Modern Healthcare conducted a survey in 2015, known as the 25^th annual Modern Healthcare Survey of Executive Opinions on Key Health Information Technology Issues. The results on interoperability of EHRs were disappointing. Only 11% of respondents to the survey said their organizations were able to routinely exchange electronic patient information with other providers across the country.

That meager showing comes 11 years after President George W. Bush created the Office of the National Coordinator for Health In-formation Technology with a mandate to implement a “nationwide interoperable health information technology infrastructure.

Only 17% of respondents to the 2015 survey indicated their hospitals and physician offices can move patient records around their home states. Just 21% reported they can exchange records within their regions. In contrast, 21% of respondents said they aren't exchanging electronic information at all, either within or outside of their organizations.

Still, an overwhelming majority of respondents (71%) were optimistic they'll be able to exchange a “core data set” of patient information nationally by the end of 2017 in keeping with a goal set in the ONC's “interoperability road map” released in January 2015. And 72% of those taking our survey opined that achieving nationwide interoperability would be of either high value (23%) or moderate value (49%) to their organizations. The road map signaled a shift in emphasis by federal health IT policymakers away from EHR adoption and toward health information exchange.

The original article by Joseph Conn can be found at the following address: http://www.modernhealthcare.com/article/20150411/MAGAZINE/304119986

Trends in Consumer Access and Use of Electronic Health Information

In ONC Data Brief 30, trends in consumer access and use of electronic health information are examined. Over the past few years, a number of policy changes have been put in place to increase individuals' access to their personal electronic health information. HIPAA was modified to clarify that if an individual's health information is available electronically, individuals have a right to obtain that information electronically. In Stage 2 Meaningful Use, CMS requires eligible providers and hospitals participating in the Medicare and Medicaid EHR Incentive Program to use certified EHR technology with the capability for patients to electronically view, download and transmit (VDT) their health information electronically. From 2011 to 2014, participation in the Blue Button Initiative, a public-private partnership to increase consumer access and use of their health data grew from 30 organizations to more than 650. This brief provides national estimates of consumers' access and use of their electronic health information based upon nationally representative surveys conducted from 2012 to 2014.

The data reveal 9 major trends:

1.       Individuals' electronic access to their medical records increased significantly in 2014. In 2014, nearly 4 in 10 Americans were offered electronic access to their medical record. The proportion of Americans offered online access to their medical records rose by more than a third between 2013 and 2014.

2.      In 2014, over half of individuals who were offered access viewed their record at least once within the last year. About one-third of individuals accessed their medical record one to two times in 2014 whereas about one-fifth of individuals accessed their online record once or twice in 2013. In both 2013 and 2014, about one in ten individuals accessed their online medical record more than 6 times over a one-year period.

3.      Almost all individuals report having access to laboratory results within their online medical record. Among individuals using online medical records, more than 90% report having laboratory test results in their record. Among individuals who have used an online medical record, almost 8 in 10 report having a list of health and medical problems in their online medical record. Approximately three-quarters of individuals report having access to a current list of medications within their online medical record.

4.      Individuals most commonly use online medical records for monitoring health. In both 2013 and 2014, about seven in ten individuals who accessed their online medical record, used it to monitor their health. Approximately one-third of individuals downloaded information from their online medical record in 2014; rates of downloading were similar in 2013. Rates of sharing information with at least one other individual or party decreased between 2013 and 2014; however, these decreases were not significant. In both 2013 and 2014, about one in ten individuals used their online medical records to correct medical records. In both 2013 and 2014 about one in ten individuals used their online medical records to transmit their data to somewhere else, such as a PHR or app.

5.      In 2014, 8 in 10 individuals who accessed their medical record online considered the information useful. In 2014, fewer than 5% of individuals who had used an online medical record within the last year considered it 'not useful.' Between 2013 and 2014, there was a significant increase in the proportion of individuals who were neutral about the usefulness of their online medical record. The proportion of individuals who considered their online medical records as 'not useful' and as 'useful' significantly declined between 2013 and 2014.

6.      Lack of need remains the top reason for not accessing an online medical record. In both 2013 and 2014, about three-quarters of individuals who did not access their online medical record indicated they didn't access it because that they did not have a need to use it. About one in ten individuals who did not access their online medical record indicated it was because they had more than one online record. Although not a statistically significant difference, fewer individuals noted privacy or security concerns in 2014 as a reason for not accessing their online medical record compared to 2013.

7.      Over one-quarter of individuals either didn't believe they had a right or were unaware of their right to an electronic copy of their medical record. Almost three-quarters of individuals of individuals were aware of their right to access their medical record electronically. Individuals who were aware of their right to access their medical record electronically were offered online access to their medical record by their health insurer or health care provider at significantly higher rates compared to individuals who were not aware or did not believe they had a right to an electronic copy of their medical record were offered online access.

8.     In 2014, almost one-in-five individuals whose health care provider had an EHR requested their health care provider electronically exchange their medical record. Over two-thirds of individuals report their health care provider has an EHR. Across all individuals nationwide, regardless of whether their provider has an EHR or not, over one-in-ten individuals (12%) requested their health care provider electronically send their medical record to another health care provider.

9.      Among individuals who visited a health care provider within the past year, over one-third experienced at least one gap in information exchange in 2014. Although there was a decline in the proportion of individuals who experienced at least one gap in information exchange between 2012 and 2014, these do not represent significant changes. Having to recount one's medical history because the health care provider did not receive records from another health care provider is consistently the most common gap in information exchange experienced by individuals between 2012 and 2014. Other common gaps in information exchange that remain issues in 2014 relate to test results; this includes having to bring test results with you to an appointment (15%) and having to wait for test results longer than you thought reasonable (11%).

In short, there is a significant opportunity for consumer outreach to increase individuals' awareness regarding electronic access and use of online medical records. Individuals' who were aware of their right to a copy of their electronic medical record had significantly higher rates of being offered online access compared to those who were unaware or incorrectly believed they didn't have this right. A lack of need remains the most frequently cited reason for not accessing an online medical record. Illustrating the value of using an online medical record to manage one's health and address information gaps among providers could increase usage among those individuals who cited a lack of need as a reason for not accessing an online medical record.

What do you make of the results? Has your organization promoted electronic access and use of online medical records by patients? Do you think there are any potential problems with allowing patients open online access? Let us know in the comments below.

Disparities in Individuals' Access and Use of Health Information Technology

ONC Data Brief 34, published last month, examined the disparities in individuals’ access and use of health information technology in 2014. Findings from nationally representative surveys show that individuals' use of information technology (IT) for health needs increased significantly between 2013 and 2014. Prior analysis revealed that disparities in online access of medical records and use of IT for health-related needs existed by certain socio-demographic characteristics and geographic settings in 2013.

The data reveal 5 major trends:

1.       Individuals whose provider had an EHR were offered online access to their medical record at three times the rate of those whose provider does not. In 2014, individuals whose provider had an EHR had significantly higher rates of using IT for health needs compared to individuals whose provider did not have an EHR. The percent of individuals offered access to online medical records, emailing providers, and looking up test results online increased between 2013 and 2014; however, the rate of increase was greater among those whose provider had an EHR.

2.      Individuals with lower incomes and less education had significantly lower rates of being offered online access to their health information. While about half of individuals with incomes of $100,000 or more were offered online access to their health information, only about one-quarter of individuals with less than a $25,000 annual income were offered online access. Individuals with more than a four year college degree were offered online access at about twice the rate as individuals who had a high school degree or less.

3.      Individuals who had difficulty speaking English were offered online access to their medical records at significantly lower rates. While 39% of individuals who spoke English very well or well were offered online access to their medical record, only 15% of individuals who didn't speak English well and only 5% of those who didn't speak English at all were offered online access to their medical record. Almost twice as many white, non-Hispanic individuals were offered online access to their medical record as compared to Hispanic individuals.

4.      Among individuals offered online access to their medical record, those with higher incomes and more education were more likely to view their record. Individuals with annual incomes of at least $50,000 had significantly higher rates of viewing their online medical record compared to individuals with incomes less than $25,000. While almost two-thirds of individuals with annual incomes higher than $100,000 viewed their online medical record at least once within the past year, only about one-third of individuals with incomes less than $25,000 viewed their record within the past year. Individuals with a high school degree or less had significantly lower rates of viewing their online medical record compared to individuals with more than a four-year college degree. Individuals with a four-year college degree or more education were over twice as likely to view their online medical record compared to those without a high school degree.

5.      Individuals with more education and higher income use certain types of IT for health-related needs at significantly higher rates. Individuals 50-59 years of age had significantly higher rates of text-messaging and emailing their provider, looking up online test results, and using a mobile health application compared to individuals 70 years or older. Individuals with no disabilities had significantly higher rates of emailing their provider and using a mobile health application than individuals with a disability. Individuals residing in rural areas have significantly lower rates of emailing their provider, looking up test results online and using a smart phone health application compared to individuals residing in suburban settings.

What do you make of the results? Do your experiences with patients reflect the data above? Let us know in the comments below.

Trends in Consumer Concerns Regarding Privacy and Security of Health Records

The ONC’s newest data brief examines trends in individuals’ perceptions regarding privacy and security of medical records and exchange of health information. Using data from a nationwide survey administered from 2012-2014, the ONC now summarizes the trends in consumers’ attitudes toward privacy and security concerns and preferences regarding electronic health records (EHR) and health information exchange (HIE).

The data reveal 6 major trends:

1.       Individuals' concerns about the privacy and security of both paper and electronic medical records declined significantly between 2013 and 2014 from 75% very or somewhat concerned to 58% very or somewhat concerned. This is a statistically significant difference (p < .05).

2.      In 2014, a similar number of individuals - about one in five - expressed lack of concern about both the privacy and the security of their medical records. The proportion of individuals who were "very concerned" about the privacy of their medical records decreased by about fifteen percentage points between 2013 and 2014. This is a statistically significant difference (p < 0.05).

3.      Individuals' concerns regarding the privacy and security of their medical record do not significantly differ by whether they have an electronic versus paper medical record. There were no statistically significant differences between paper versus electronic health records.

4.      Between 2012 and 2014, at least three-quarters of individuals supported their health care providers' use of EHRs despite any potential privacy or security concerns.

5.      Individuals' concerns regarding unauthorized viewing of medical records when sent by fax or electronic means declined significantly between 2013 and 2014. Between 2013 and 2014, concerns regarding having medical records sent by fax declined by 20% and concerns regarding medical records sent by electronic means declined by 16%. This is a statistically significant difference (p < 0.05).

6.      Between 2012 and 2014, at least 7 in 10 individuals have supported electronically exchanging their health records despite potential privacy or security concerns. There are no significant differences between years (p < 0.05).

In summary, as EHR adoption and HIE increased among hospitals and physicians, consumers' concerns regarding HIE and the privacy and security of medical records declined. However, it is important to note that these perceptions reflect individuals' points of view prior to announcement in 2015 of several large health care information breaches. Additionally, it is unclear as to whether the significant decreases in concerns between 2013 and 2014 are an anomaly or whether this represents the beginning of a trend towards decreasing privacy and security concerns.

What do you make of the results? Has your organization faced any consumer concerns over using one medical record-keeping format over another? Let us know in the comments below.

CMS State Innovation Models Grants Awarded

The HHS announced Tuesday that a significant portion of the $665 million in available grants was awarded to health IT programs.The District of Columbia, 28 states, and three territories received grant money to fund local experiments in improving health care. The money is the second round of grants coming from CMS's State Innovation Models initiative. A breakdown of the awarded grants can be found at the initiative website. 

Politico reports that the selected health IT projects largely focus on improving data in electronic health records and systems. Part of the $100 million New York will receive will go toward better health IT, "including greatly enhanced capacities to exchange clinical data and an all-payer database." Overall, the state is looking to create a stronger, more integrated primary care workforce and delivery system. Colorado will receive up to $65 million over four years to integrate physical and behavioral health care in primary care and community mental health center. Part of the money will expand IT efforts including telehealth. The money will also assist in integrating public health, behavioral health and primary care sectors. Data analytics is a factor in the plans for Michigan and Iowa.

CMS Boosts Coverage for Telehealth

The Centers for Medicare & Medicaid Services released new rules that significantly broaden coverage for chronic care telehealth services.The rulemaking changes are inside the 1,185-page document detailing Medicare payments to physicians and other providers. The new rules also include seven new covered procedure codes for telehealth, including annual wellness visits, psychotherapy services, and prolonged services at physicians' offices.

Health Leaders Media reports, "The American Telemedicine Association, which had sought the expanded coverage for five years, notes that among the rules are provisions that will pay for remote chronic care management using the new current procedural terminology (CPT) code 99490, with a monthly unadjusted, non-facility fee of $42.60.

"For us, it was more important to begin to specifically address chronic care," says Gary Capistrant, senior director of public policy at ATA. "The combination of the chronic care management code and being able to use it in conjunction with monitoring of those chronic conditions is a big step forward and a very substantial change for Medicare." Capistrant says the new rules also represent an acknowledgement by CMS that reimbursing for chronic care could prove to be cost effective.

"It's an important policy move. Whether it is sufficient, time will tell, but it is certainly a step in the right direction and an important initiative," he says. "There has been a lot of focus on primary care, even with the Medicare population. That may be the 80% of the people but it is only 20% of the problem. There's an increasing emphasis on looking at the 80% of the problem that is 20% of the people, and that is chronic and specialty care. They understand that the government is spending a huge amount for chronic care conditions and that there is a value managing those to reduce the overall expenditures."

CMS Names Niall Brennan First Chief Data Officer

The Centers for Medicare & Medicaid Services (CMS) today announced the formation of the Office of Enterprise Data and Analytics (OEDA) which will be led by Niall Brennan, the agency’s first Chief Data Officer (CDO), and tasked with overseeing improvements in data collection and dissemination as the agency strives to be more transparent. OEDA will help CMS better harness its vast data resources to guide decision-making and develop frameworks promoting appropriate external access to and use of data to drive higher quality, patient-centered care at a lower cost.

CMS collects a wealth of data that is critical to decision making for the agency and other stakeholders in the nation’s health care system. CMS generates data administering the Medicare, Medicaid and CHIP programs. In addition, new responsibilities, including stewardship of the EHR Incentive Programs, more expansive quality measurement programs, and the establishment of the Health Insurance Marketplaces, have expanded the scope of data that CMS collects. As CMS works to shift the focus from volume of services to better health outcomes for patients, coordinating care, and spending dollars more wisely, the need for CMS to analyze data across its multiple programs and provide greater access to this data, whether in granular or aggregate form, will only intensify.

“It’s clear how much data transparency will help the country improve outcomes, control costs and aid consumer decision making,” said CMS Principal Deputy Administrator Andy Slavitt. “This appointment signals to the industry that there is no turning back from the health care data agenda. Niall Brennan will help make sure CMS leads the way.”

The creation of this new post and the data and analytics office  builds on the steps CMS has taken in recent years to better harness its data resources both internally and externally. CMS is now routinely analyzing claims data in real time and applying predictive analytics to proactively identify fraud and abuse and track key metrics such as hospital readmissions. Accountable Care Organizations and State Medicaid agencies receive monthly near real-time feeds of Medicare data to support care coordination. CMS has launched the Virtual Research Data Center to facilitate lower cost access to CMS data for researchers and federal grantees. CMS has also released numerous public use datasets; the most notable releases to date include the release of data on hospital charges and physician utilization in 2013 and 2014.

“Our commitment to transparency is matched by our commitment to keeping personal information safeguarded. We can't expect to advance health outcomes unless we also ensure that our policies and practices around data privacy are leading the way,” said Slavitt. “We look forward to building on the success of recent releases, providing a clearer picture of the health care delivery system.”

IATRIC SYSTEMS ANNOUNCES "EHR-NEUTRAL" SOLUTION FOR APPLE HEALTH

Politico reports that health IT company Iatric Systems, Inc. has announced its integration with Apple Health to pull patient data into HealthKit and present it from inpatient, ambulatory and patient-generated sources. The "EHR-neutral" approach will link data from records, physician practices and other health IT software, according to an announcement from Iatric. Iatric envisions that patients will help hospitals with meaningful use requirements--especially view, download and transmit.

Two hospitals are currently using Iatric for integration with Apple Health - Michigan's Memorial Healthcare and King's Daughters Medical Center in Mississippi. "We envision our patients using Apple Health easily because for many, the iPhone is already a main part of their lives, said Frank Fear, CIO at Memorial Healthcare, in the announcement. "We could have integrated Apple Health within a portal from our EHR vendor or ambulatory system vendor, but data from disparate systems sits in silos. Iatric Systems was a natural fit because their portal integrates across all of our systems, giving us one tool for capturing and sending data to patients, and eventually, receiving data back from them."

For more information visit Politico here. 

ICD-10 Transition Date Finalized for October 2015

The Centers for Medicare and Medicaid Services announced last week that the final deadline to comply with the ICD-10 implementation requirement is October 1, 2015. The tenth edition of the International Classification of Diseases is widely viewed as a significant change in the way claims that are submitted to Medicare and private insurance payers are classified. 

These changes enable providers to coordinate patients care over distance and time, improve the accuracy of patient records with more detailed patient history coding, and reduce fraudulent claims. CMS also believes that the ICD-10's granular classifications will improve the data and analytics related to public health research, surveillance, and reporting. The more specific classifications found in ICD-10 represent, in part, the evolution of diagnosis and the modern developments in medicine and medical technology used to treat patients. 

CMS released an online resource designed to help providers in small practices make a timely transition to ICD-10. The "Road to 10" is an online resource available here. The  Road to 10 breaks allows providers to select a profile based on their expertise that is specifically tailored to each speciality's common codes, clinical documentation procedures, and clinical scenarios. Additionally, the Road to 10 gives users the opportunity to create an ICD implementation action plan specifically suited to the needs of their small practices. 

Can't Miss NAHAM Webinar on Improvements to Patient Access Departments Through Automation, June 26th

NAHAM presents the "Building a More Efficient Patient Access Department Through Automation" webinar, free to NAHAM members on June 26, 2014, from 2:00-3:00 p.m. This webinar will be presented by Patrick Kelley, Dedicated Advisor at The Advisory Board Company, and Alexander Guambana, Senior Director at The Advisory Board Company.

In partnership with The Advisory Board Company and Lowell General Hospital, we will be walking through a health system’s response to new industry demands by leveraging automation and efficiency gains. The Advisory Board Company will present its research on new Patient Access trends across the industry, how patient estimation is becoming a major player in healthcare, and how hospital Revenue Cycle departments are responding to new legislation in the ACA. Join us as Lowell General Hospital and The Advisory Board present their experience of implementing a culture of point-of-service estimation and the utilization of technology.


Information
Building a More Efficient Patient Access Department Through Automation
Thursday, June 26, 2014
2:00 pm - 3:00 p.m. ET



This webinar is worth 1 contact hour.




Click here to register for the webinar. There is no cost for members!


Upon purchase, you will receive information via email about accessing the live webinar.

Can't Miss Event May 13th at NAHAM 40th Annual Conference: NAHAM University Session

NAHAM University

 Hot Topics Discussion & Networking Opportunity

The National Association of Health Access Management 40th Annual Educational Conference & Exposition will be held May 13-16th in Hollywood, Florida. The conference theme this year is "From Admitting to Patient Access: 40 Years of Leadership." Conference attendees will enjoy outstanding educational sessions and invaluable networking opportunities. 

One of the most interactive and informative sessions is held before the conference officially begins on Tuesday, May 13th at noon. Peter Kraus, Business Analyst at Emory Healthcare, will moderate a NAHAM University session that is a popular venue for attendees to meet and discuss hot topics in the industry. 

The event is open to patient access manager participants from both academic and non-academic healthcare facilities. The topics for the 2-hour interactive session are determined by conference registrants. Kraus expects this year's discussion to cover the ICD-10 transition, Meaningful Use implementation, electronic health records, and issues that arise in the admission process. Participants found past discussions very helpful as colleagues offered road-tested solutions to the issues facing participants' individual hospitals.

What Hot Topics are you interested in? What issues is your hospital facing in 2014? 

Let NAHAM hear your topic suggestions for the the NAHAM University 

session in the comments section!

EVENT DETAILS

NAHAM University

Tuesday, May 13
12:00 p.m. – 2:30 p.m.

REGISTER HERE: http://www.naham.org/?page=Conference_Reg

Separate registration fee applies. Lunch is included and will be provided starting at 11:30 a.m. 

More than 10,000 Electronic Health Records at Risk in Data Breach

Service Coordination notified nearly 14,000 Maryland residents this month that their personal medical information may have been compromised. Service Coordination is a state-licensed nonprofit organization based in Frederick, Maryland, that works with Maryland residents with intellectual and developmental disabilities. Service Coordination is one of five organizations licensed to provide services by Maryland's Developmental Disabilities Administration. To date there have been no reports of breaches from the other four licensed organizations. 

The organization learned of the security breach in October of 2013, but delayed notifying affected individuals at the request of the U.S. Justice Department. The Justice Department requested the delay to allow time for an unhindered federal investigation. The investigation resulted in the identification of the alleged hacker and the seizure of the hacker's equipment and accounts. 

To date there is no evidence that the data has been released or used for nefarious purposes. Service Coordination spokesman, Michael Baisey, explained that the breach involved a single document that contained personal information for nearly 70% of the group's 13,900 clients. Service Coordination will assist clients and families with credit report checks and identity theft protection. 

CMS Issues Guidance on Stage 2 Meaningful Use Hardship Exceptions

The Centers for Medicare and Medicaid Services (CMS) issued guidance on qualifying for the hardship exception from Stage 2 meaningful use requirements under the federal electronic health record incentive payment program. CMS has been under pressure by stakeholders and lawmakers alike to provide clarification about how to apply and what conditions qualified hospitals and eligible professionals for a hardship exemption

The guidance explains that CMS may grant hospitals and eligible professionals the hardship exception and grant an extension for meeting the Stage 2 meaningful use requirements if their electronic health record (EHR) vendor is at fault for their failure to meet the deadline. This expands on previous statements by CMS Administrator Marilyn Tavenner that the applications for exceptions would be evaluated on a case-by-case basis. 

The guidance specifically states that providers may apply for hardship exceptions if the "EHR vendor was unable to obtain 2014 certification" or the hospital or eligible professional "was unable to implement meaningful use due to 2014 EHR certification delays." If approved, the hardship exception is valid for a single payment year. In the event the application for exception is denied hospitals and eligible professionals may not appeal the decision and any denial is considered final.

The hardship exception application for hospitals is available here.

The hardship exception application for eligible professionals is available here. 

Patient Identification and Matching Report Released by ONC

The Office of the National Coordinator for Health Information Technology (ONC) released the final version of the Patient Identification and Matching Report. The report evaluated best practices and current trends in using electronic health record systems to accurately identify patients and exchange information between providers, patients, and caregivers. Mistakes in properly identifying patient health records put patient safety at risk and has resulted in too many patient deaths. 

The drafting process for the report included an industry environmental scan with input from stakeholders at meetings, on calls, and requests for submitted comments and recommendations. NAHAM was an active participant throughout the drafting process and provided recommendations focused on improving patient safety that are featured in the report. NAHAM's recommendations can be found on page 76 of the report. 

The report resulted in 10 findings that ONC will use as they move forward with the process of improving electronic health record systems and patient matching to improve patient safety.The findings are below.

Findings

1. Standardized patient identifying attributes should be required in the relevant exchange transactions. 

2. Any changes to patient data attributes in exchange transactions should be coordinated with organizations working on parallel efforts to standardize healthcare transactions. 

3. Certification criteria should be introduced that require certified EHR technology (CEHRT) to capture the data attributes that would be required in the standardized patient identifying attributes.

4. The ability of additional, non-traditional data attributes to improve patient matching should be studied. 

5. Certification criteria should not be created for patient matching algorithms or require organizations to utilize a specific type of algorithm. 

6. Certification criteria that requires CEHRT that performs patient matching to demonstrate the ability to generate and provide to end users reports that detail potential duplicate patient records should be considered. 

7. Build on the initial best practices that emerged during the environmental scan by convening industry stakeholders to consider a more formal structure for establishing best practices for the matching process and data governance. 

8. Work with the industry to develop best practices and policies to encourage consumers to keep their information current and accurate. 

9. Work with healthcare professional associations and the Safety Assurance Factors for EHR Resilience (SAFER) Guide initiative to develop and disseminate education and training materials detail best practices for accurately capturing and consistently verifying patient data attributes. 

10. Continue collaborating with federal agencies and the industry on improving patient identification and matching processes. 

No Extension for ICD-10 Implementation

Marilyn Tavenner, Administrator for the Centers of Medicare & Medicaid Services, announced today that there will be no extension of the October 1, compliance deadline for the nationwide conversion to the ICD-10 diagnostic and procedural codes. Speaking at the Healthcare Information and Management Systems Society convention in Orlando, Florida, Tavenner also explained that CMS was not changing compliance requirements for Stage 2 despite extensive pressure on the agency. 

Stage 2 of the electronic health record incentive payment program requires providers to electronically exchange healthcare records with each other to improve the interoperability of CMS' value-based payment programs. Eligible hospitals must commence 90 consecutive days of meeting the meaningful-use criteria on schedule. The starting date for most hospitals was October 1, 2013. However eligible professionals and physicians which operate on a fiscal year must begin compliance on April 1 or July 1, 2014. 

CMS will consider extensions on a case-by-case basis for providers and health IT vendors to obtain a "hardship exemption" that will extend the deadline for that facility. Tavenner does not expect the exemptions to delay full Stage 2 implementation by 2015. 

CCHIT Will No Longer Test or Certify Electronic Health Record Systems

After almost a decade of testing and certifying electronic health record systems (EHR) the Certification Commission for Health Information Technology (CCHIT) will no longer provide these services. CCHIT was the first provider of testing and certification services, and is still the most commonly used provider in the nation. Nearly half of the health IT systems on the Office of the National Coordinator for Health Information Technology at HHS'  Certified Health IT Product List have been certified by CCHIT.

CCHIT stopped taking applications from vendors in January. Executive Director Alisa Ray stated that they would wind down the remaining 70 systems scheduled for tests by April or May of this year. Ray explained that the delay for implementing meaningful use requirements lead to the decision to move away from certification and testing. 

The company will also stop private-label certification programs for other health IT systems. CCHIT is phasing these programs down as the organization shifts to a global focus. 

Consumers will have eight certification bodies to choose from with the withdrawal of CCHIT from the marketplace. Five of the companies are recognized by the ONC as Accredited Testing Laboratories. Three other companies are ONC Authorized Certification Bodies. All eight companies test and certify EHRs to qualify them for participation in the EHR incentive payment program established by the American Recovery and Reinvestment Act of 2009.

Hidden Costs of Duplicate Patient Records

A recent article by Patricia Consolver, Minimizing Duplicate Patient Records to Maximize Cash Flow, highlighted the relationship between a reduction in duplicate patient records and increases in revenue cycle efficiency. A 2008 RAND Corporation study found that the average duplicate patient record is 8 percent. In addition to the inherent risks to patient safety, duplicate and incorrect patient identifications have the potential to impair downstream financial activities such as delayed payments, appeals, and denials. 

The costs associated with duplicate records also include instances of repetitious lab and diagnostic tests that were performed, but documented in a duplicate record. Insurance companies often deny claims for repetitive tests. This results in care that the hospital will not be reimbursed for and cannot collect. 

Texas Health Resources, a 13-hospital system that serves over 1 million patients per year, implemented a four-step process during the transition to EHRs that resulted in a duplicate patient record rate of 0.36 percent. 

The Four-Step Process

1. Scrubbing the existing MPI
2. Identifying and selecting the correct patient records
3. Educating key stakeholders on avoiding duplicate creation
4. Monitoring performance

Education was necessary to ensure the EHR did not devolve to the state of MPI's duplicate records. Texas Health Resources education efforts were focused on both registration and medical record department employees. These courses emphasized the importance of using a full, legal name and the ways that duplicate records affect downstream activities in several areas of the hospital's operations. Data integrity teams were created to monitor the records and focus new education efforts on common mistakes that needed to be corrected. 

The implementation of similar systems is being evaluated at hospitals across the country as Meaningful Use requirements become effective.