In the News: Electronic Health Care Information and Tools

Electronic Health Records Demonstration Project

Several recent Centers for Medicare & Medicaid Services (CMS) initiatives have focused on the use of electronic information management.  In late April, CMS hosted a Special Open Door Forum on the Electronic Health Records Demonstration project.  This demonstration is undertaken by CMS at the direction of the Secretary of the Department of Health and Human Services [DHHS].  The Electronic Health Records Demonstration Project uses the Medicare waiver authority to reward the delivery of high-quality care that is supported by the adoption and use of electronic health records (EHR). [http://www.cms.hhs.gov].  The overall goal of this demonstration initiative is to encourage small to medium-sized primary care physician practices to use electronic health records for the purpose of increasing quality of care, reducing medical errors and transforming care delivery.

This is a five-year demonstration project that involves not only the adoption of Electronic Health Records [EHRs], but also the use of Health Information Technology (HIT) in day to day operations and care delivery.  At this time solicitation of partners working within the care setting is underway, seeking to closely involve community based technology firms, physician practices and partner organizations in the development and management of this demonstration project.  The CMS Office of Research, Development, and Information is charged with presenting the scope and requirements of the project, along with the application process to interested participants.

A key aspect required of all participating physician practices is that they become certified by the Certification Commission for Healthcare Information Technology (CCHIT) by the end of the second year of the demonstration.  Core functions of the EHR system must be those that will positively impact care and specifically must include clinical documentation, ordering and recording lab tests, and ordering prescriptions.

Incentive payments and bonuses will be paid based on practice performance in relationship to established quality measures, with a bonus based on the degree of HIT functionality used to manage care.  These payments are to be revised throughout the five years of the demonstration project.

The Demonstration Fact Sheet, Medicare Waiver Application and Frequently Asked Questions, specific to this demonstration project, can be accessed through the following website: http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp.  Additional information on electronic health records access and demonstration project is available by accessing http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1204776.

E-Prescribing Tools

Another electronic initiative undertaken by CMS is E-Prescribing Tools that are designed to decrease and prevent adverse drug interactions.  These tools will assist physicians to select and offer generic options when prescribing medications.  This initiative is part of the Medicare Part D prescription drug plan’s final rule, which establishes prescribing standards for four types of information: formulary and benefits, medication history, fill status notification, and identification of individual health care providers.  These specific standards indicate:

• Formulary and benefits:  This standard allows doctors and other prescribers to communicate with Part D sponsors regarding drugs covered by a Medicare eligible individual's prescription drug benefit plan.  Prescribers can also identify generic prescription drugs that could offer lower-cost options for the individual.
• Medication history:  This standard allows doctors and other providers, as well as dispensers and Part D sponsors, to communicate regarding the prescribed medications a beneficiary has taken or is taking, including those prescribed by other providers.  This information potentially will reduce the number of adverse drug events that result from drugs negatively interacting with other drugs a beneficiary is already taking, and can ensure that the doctor or other prescriber has the necessary information regarding all the beneficiary’s current prescription medications.
• Fill status notification:  This standard allows doctors and other providers to receive an electronic notice from the pharmacy or other dispenser telling them that a patient’s prescription has been picked up, not picked up, or has been partially filled.  These notifications assist in monitoring patients with chronic conditions, such as diabetes or hypertension, as these factors can provide an indication whether medications are being taken as prescribed.
• Provider identifier:  The final rule requires the National Provider Identifier (NPI) by providers, dispensers, and Part D sponsors to identify individual health care providers in Part D e-prescribing transactions.  The use of the NPI speeds workflow by eliminating pharmacy call-backs for verification of the individual prescriber’s identity. [http://www.cms.hhs.gov/apps/media/press/release.asp]

This final rule, released in April 2008, does not dictate that prescribers, dispensers and other providers are required to implement e- prescribing.  But rather should they choose to do so, they must adhere to the new Medicare standards when using e-prescribing to send prescriptions and prescription-related information for covered drugs prescribed for Part D eligible individuals.  Access of the complete press release is available at CMS’s website, http://www.cms.hhs.gov/apps/media/press/release.asp or for access to the final rule on Part D e- prescribing standards (CMS-0016-F/CMS-0018-F) and the earlier final rule establishing e-prescribing foundation standards (CMS-0011-F) please access:  http://www.cms.hhs.gov/EPrescribing/.

Resources/References/Links:

http://www.cms.hhs.gov/apps/media/press/release.asp

http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp