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Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs

CMS EHR Incentive Programs Website Updated for Medicare and Medicaid

Get up-to-date and accurate information about the Medicare and Medicaid EHR incentive programs from CMS at http://www.cms.gov/EHRIncentiveprograms/. Visit the website to get specifics about the program and download our new tip sheets.

Tip Sheets for Eligible Professionals:

  • Medicare EHR Incentive Payments for Eligible Professionals

This tip sheet describes which types of individual practitioners can participate in the Medicare EHR incentive program. It provides user friendly information about incentive payment amounts and describes how they are calculated for fee for service and Medicare advantage providers. It also describes payment adjustments beginning in 2015 for EPs who are not meaningful users of certified EHR technology.

  • Medicare EHR Incentive Program, PQRI and E-Prescribing Comparison

Learn what opportunities are available to Medicare Eligible Professionals to receive incentive payments for participating in important Medicare initiatives. This fact sheet provides information on eligibility, timeframes, and maximum payments for each program.

Now available on the CMS EHR Incentive Programs website http://www.cms.gov/EHRIncentivePrograms.  Select the Medicare Eligible Professional tab on the left, and then scroll to “Downloads.”

Tip Sheets for Hospitals:

  • EHR Incentive Program for Medicare Hospitals

Learn which Medicare hospitals are eligible for incentive payments. (See the separate tip sheet for Critical Access Hospitals below.) This sheet provides user friendly information about the factors which impact incentive payment amounts and provides sample payment calculations.

  • EHR Incentive Program for Critical Access Hospitals

How are Medicare incentive payments calculated for CAHs? When can they be earned? Learn more in this informative discussion of the calculation of incentive payments. Sample calculations are provided. This sheet also provides information on how reimbursement will be reduced for CAHs which have not demonstrated meaningful use of certified EHR technology by 2015.

Now available on the CMS EHR Incentive Programs website http://www.cms.gov/EHRIncentivePrograms.  Select the Hospitals tab on the left, and then scroll to “Downloads.”

Federal Health Care Overhaul Will Cause Shortages

U.S. Physician Shortage May Worsen Following Healthcare Overhaul

The same theme is being seen across many states, with more than 30 million patients becoming eligible for medical insurance.  Tom Davis, the head of Coventry Healthcare of Georgia, said the combination of a shortage of doctors along with a flood of new patients could cause “a bottleneck to primary care.”  Maine, meanwhile, is the oldest state in the nation, with about 14 percent of the population over the age of 65. In about a decade, one of every five Mainers is expected to be a senior citizen. There are about 100 unfilled openings for primary care physicians in the state right now,” said Marc Hahn, dean of UNE’s College of Osteopathic Medicine. The state also is in short supply of other medical professionals, including nurses, therapists and pharmacists.

Health care reform will not succeed without an adequate supply of primary care physicians, making it incumbent upon Congress to enact policies that increase the nation’s primary care physician workforce. That’s what AAFP President-elect Lori Heim, M.D., of Vass, N.C., said during testimony before the House Small Business Committee here on July 8.

AAFP President-elect Lori Heim, M.D., testifies before the House Small Business Committee on the importance of increasing the primary care workforce. American Osteopathic Association President Carlo DiMarco, D.O., shown here at right, echoed Heim’s concerns about shortcomings in graduate medical education funding and physician payment in his testimony.

Heim told the committee that the current supply of primary care physicians is “far from adequate,” and future projections about upcoming shortages are “truly alarming.”

Dr. Joe Thompson told a legislative panel that between 80 and 90 percent of the state’s 500,000 uninsured will become covered under the health care law. Thompson said most of those will come from an expansion of the Medicaid program. Arkansas’ surgeon general told lawmakers Wednesday that he’s worried the state won’t have enough medicalproviders to care for the thousands of newly insured covered under the federal health care overhaul.

Increasingly many are looking toward healthcare information technology to help alleviate some these future bottlenecks. Hawaii County’s 2010 health care conference, “Building a Healthier Future Together,” will convene on Friday, Aug. 13, at the Waikoloa Beach Marriott. Mayor Billy Kenoi also will introduce the Hawaii County Beacon Community Grant, a $16 million federally funded initiative to accelerate the use of health information and technology in an effort to reduce costs and improve the quality of health care and overall health on Hawaii Island.

For more information and a registration flyer click here

Privacy of Individually Identifiable Health Information (Privacy Rule)

Applying the Substance Abuse Confidentiality Regulations to the Health Information Exchange (HIE)

The Substance Abuse & Mental Health Services Administration (SAMHSA) and the Office of the National Coordinator (ONC) for Health Information Technology announced yesterday the release of the Frequently Asked Questions (FAQs) for Applying the Substance Abuse Confidentiality Regulations to the Health Information Exchange (HIE).

The Substance Abuse Confidentiality Regulations, 42 CFR Part 2, govern the use and disclosure of alcohol and drug abuse patient records that are maintained at federally funded substance abuse programs. Both SAMHSA and ONC want to ensure that our constituents receive every tool and resource possible to allow a more complete understanding of these Federal regulations, which were enacted in 1972 and 1975. The FAQs outline the general provisions of 42 CFR Part 2, provide guidance on its application to electronic health records, and identify methods for including substance abuse patient record information into health information exchange that is consistent with the Federal statute.

The FAQs will serve as a valuable resource to a variety of individuals, including specialty and medical providers, as well as HIE technical developers and policymakers. The FAQs are not meant to provide legal advice.

Both SAMHSA and ONC are committed to adhering to the Federal protections of 42 CFR Part 2 and recognize the importance of promoting behavioral health in electronic health records. A meeting is being planned for August 4, from 8:30 a.m. to 12:30 p.m. to provide those interested an opportunity to provide input on the utility of the FAQs.

Substance Abuse Confidentiality Regulations

Frequently Asked Questions: Applying the Substance Abuse Confidentiality Regulations to Health Information Exchange (HIE) (pdf file | 81 kbytes) | Cover Page (26 kbytes) | Posted on 06/16/2010

Privacy and e-Consent in Three Countries (pdf file | 731 kbytes)

The Confidentiality of Alcohol and Drug Abuse Patient Records Regulation and the HIPAA Privacy Rule: Implications for Alcohol and Substance Abuse Programs (pdf file | 192 kbytes)

Confidentiality of Alcohol and Substance Abuse Patient Records regulation (42 CFR Part 2)

HHS, Office for Civil Rights – HIPAA

HHS, Office of National Coordinator (ONC)

Health Information Exchange in Primary Care

Health Information Exchange in Minnesota and Arkansas

In the Archives of Internal Medicine, a bi-monthly professional medical journal published by the American Medical Association, an article was published April 12th, titled “Health information exchange: participation by Minnesota primary care practices.” Here is the abstract:


BACKGROUND: The American Recovery and Reinvestment Act of 2009 will provide $36 billion to promote electronic health records and the formation of regional centers that foster community-wide electronic health information exchange (HIE) with the ultimate goal of a nationwide health information network. Minnesota’s e-Health Law, passed in 2007, mandates electronic health record and HIE participation by all clinics and hospitals. To achieve these goals, small primary care practices must participate. Factors that motivate or prevent them from doing so are examined. METHODS: From November 10, 2008, through February 20, 2009, we gathered data (through questionnaires and interviews) from 9 primary care practices in Minnesota with fewer than 20 physicians and with varying degrees of electronic health records and HIE involvement. RESULTS: No practice was fully involved in a regional HIE, and HIE was not part of most practices’ short-term strategic plans. External motivators for HIE included state and federal mandates, payer incentives, and increasing expectations for quality reporting. Internal motivators were anticipated cost savings, quality, patient safety, and efficiency. The most frequently cited barriers were lack of interoperability, cost, lack of buy-in for a shared HIE vision, security and privacy, and limited technical infrastructure and support. CONCLUSIONS: Currently, small practices do not have the means or motivation to fully participate in regional HIEs, but many are exchanging health data in piecemeal arrangements with stakeholders with whom they are not directly competing for patients. To achieve more comprehensive HIE, regional health information organizations must provide leadership and financial incentives for community-wide meaningful use of interoperable electronic health records.


The Arkansas State Health Alliance for Records Exchange (SHARE) is seeking informational responses (PDF) regarding creation and implementation of an interoperable health information exchange structure for the State of Arkansas. The Arkansas Coordinator for Health Information Technology is seeking this information on authorization from the Arkansas Department of Finance and Administration, the state-designated entity for Arkansas’s Health Information Exchange (HIE).

HIE Design Principles and Requirements

1. The HIE will be “vendor neutral,” i.e., vendor products must be non-proprietary and interoperable with others.
2. The HIE will rely upon a network, or infrastructure, to provide service functionality.
3. The HIE will be a “hybrid” architecture; not completely federated nor centralized. In the development of a phased implementation, it may be practical to start with a centralized architecture and evolve to a “hybrid” architecture.
4. The HIE will be focused on facilitating exchange of information, rather than the end user application functionality.
5. The HIE will support construction and aggregation of the longitudinal patient record for secure sharing among authorized users across the network.
6. The HIE will comply with current interoperability standards available in the market today.
7. The HIE will interoperate with existing community and private health information exchanges as well as the NHIN infrastructure.
8. The HIE technical architecture will be scalable and expandable.
9. The HIE will utilize standard security protocols supporting user authorization, authentication, non-repudiation, encryption, and administration. It also should support security auditing functions.
10. The HIE will utilize standard data storage and management protocols normally associated with large information technology solutions and available in the market today.
11. The HIE will be supported by industry standard business continuity and disaster recovery infrastructure and processes.
12. The HIE must be compliant with the accessibility requirements as defined in Arkansas Act 1227 of 1999.

Descriptive  Information About the Arkansas HIE

The technical infrastructure of the Arkansas HIE will support recognized data standards, code sets, and exchange standards for each component architectural layer. Those layers include technical, privacy and security, administrative context, clinical context, and the Nationwide Health Information Network (NHIN). The HIE will be designed to permit participants (clinical and administrative) to incrementally migrate from a basic exchange to full integration as national, state, and user-based standards and associated technologies evolve. The role of the HIE will be to incorporate data from many sources and formats as standards and technologies evolve to facilitate exchange and to meet national standards.
The HIE will seek to capitalize on existing community, private, and public, health information exchange capabilities to build a statewide HIE. The HIE will participate with other participants in the NHIN to facilitate and promote care coordination with local Veterans Administration, Indian Health Services, public health, and Department of Defense (DOD) military health systems. (There are no Indian Health Services entities within the State of Arkansas.) As previously mentioned, the HIE will coordinate with Medicare and Medicaid in support of information exchange and interoperability.

Expanding Health Information Technology Education

ARRA Funds Advance Health Information Technology (HIT) by Educating Professionals

EurekAlert! reports that Oregon Health & Science University has been awarded $5.8 million in American Recovery and Reinvestment Act (ARRA) funds to advance the widespread adoption and meaningful use of health information technology (HIT) by educating professionals to work in this rapidly growing field.

Through this recovery act funding, OHSU will provide financial aid for nearly 140 new students to enroll in and complete the university’s online Graduate Certificate Program in Biomedical Informatics. The funding also will allow at least 12 students to enroll in and complete OHSU’s on-campus master’s degree program. All financial aid under this grant is for students in graduate-level programs requiring a minimum of a bachelor’s degree for admission.

Students receiving financial aid will be required to choose among six career paths:

  • Clinician/public health leader
  • Health information management and exchange specialist
  • Health information privacy and security specialist
  • Research and development scientist
  • Programmers and software engineer
  • Health IT sub-specialist

Awards totaling $84 million to 16 universities and junior colleges will support training and development of more than 50,000 new health IT professionals.

Additionally Strategic Health IT Advanced Research Projects (SHARP) awards totaling $60 million were provided to four advanced research institutions ($15 million each) to focus on solving current and future challenges that represent barriers to adoption and meaningful use of health IT.

Los Rios Community College District is one of five community college districts in the nation selected to participate in a U.S. Department of Health and Human Services grant to establish computerized health information training programs.

Los Rios received a grant of $5.4 million for the project, Rep. Doris Matsui said in a news release Tuesday. The district will act as the lead institution for a consortium of 14 colleges in California, Nevada, Arizona and Hawaii.

State Health Information Exchanges Ramping Up

State Health Information Technology Centers Organizing

In Maine, the Governor announced that federal support through the Recovery Act funding will allow the expansion of Maine’s health information exchange, HealthInfoNet, to eventually reach all healthcare providers in the State. “This is an important step in reaching our goal to increase quality and efficiency in health care delivery,” said Governor Baldacci. “With our public and private partners, we have been working hard to improve care that all Maine people receive. All together, the additional funds and the creation of the State infrastructure to support and plan for collaborative efforts to advance health information technology will help Maine meet the goals of the State and the federal government.”

In Illinois, Governor Pat Quinn named State Representative Julie Hamos as Director of the Illinois Department of Healthcare and Family Services (HFS). As agency director, Hamos will focus on expanding access to healthcare while improving patient safety. In 2005, Hamos sponsored legislation that created the Electronic Health Records Taskforce, and this year she is sponsoring the Illinois Health Information Exchange and Technology Act.  That Act will establish a public-private Health Information Exchange Authority to work in conjunction with the Governor’s Office of Health Information Technology to enable providers throughout Illinois to securely share patient health information, and it is a step toward the adoption of statewide electronic health records.

In New York, Great Rochester RHIO, the regional health information organization connecting medical providers across nine counties in New York, today announced that six emergency departments are using Rochester RHIO to view critical patient information from data providers across the region. Rochester RHIO Executive Director, Ted Kremer, said that implementing the health information exchange in emergency departments has been a priority for the organization. “We are happy that six EDs are using Rochester RHIO, and we’re working with other hospitals to bring this valuable tool to their emergency staffs,” Kremer said.

In California the San Francisco Business Times reported that Governor Arnold Schwarzenegger and California Health and Human Services Agency Secretary Kim Belshé said the state is naming a new nonprofit entity called Cal eConnect to oversee the development of Health Information Exchange services in the Golden State. Some of the organizations in Northern California include the California Regional Health Information Organization (CalRHIO), San Francisco and Northern California Regional Extension Center. Some of the organizations in Southern California include the Southern California Regional Extension Center and L.A. Care Health Plan, Los Angeles.

Nationwide Health Data Exchange

Terminology and Processes for Nationwide Health Data Exchange

The Health and Human Services Department is collaborating with the Justice Department on a terminology and process for nationwide health data exchange. In a related announcement, ONC has issued an Interim Final Rule (IFR) [PDF – 247 KB] that specifies the Secretary’s adoption of an initial set of standards, implementation specifications, and certification criteria for electronic health record (EHR) technology.

On March 2nd, the Secretary of the Department of Health and Human Services (HHS) released a notice of proposed rulemaking (NPRM) outlining the proposed approach for establishing a certification program to test and certify electronic health records (EHRs). The HITECH Act mandates the development of a certification program which will give purchasers and users of EHR technology assurances that the technology and products have the necessary functionality and security to help meet meaningful use criteria. Dr. David Blumenthal stated “while we are making significant strides toward modernizing our health care system, these efforts will only succeed if providers and patients are confident that their health information systems are safe and functional.”

The Office of the National Coordinator for Health Information Technology (ONC) is responsible for putting forward a vision for nationwide, interoperable health IT. Last week, the ONC posted a draft of the HIT Policy Committee Strategic Plan Workgroup’s Health IT Strategic Framework for public review. Comments can be provided via the FACA Blog and via a public listening session, scheduled for April 6, 2010. Registration is required and complete details are available at http://healthit.hhs.gov/StrategicPlanWG.

Meanwhile throughout the country, the VA is seeking proposals to establish health information exchanges, such as the one with the VA in Utah. This is the Notice of Intent. The U.S. Department of Veterans Affairs intends to acquire services to initiate a Health Information Exchange (HIE) pilot in rural Utah. Currently there is only one firm, Utah Health Information Network (UHIN), which contains the necessary membership of healthcare practitioners in Utah that is vital to the development of the HIE, as well as the authorization from the State of Utah to act as the duly appointed statewide HIE for this project.

HITECH’s State Health Information Program

HITECH’s State Health Information Exchange (HIE) Cooperative Agreement Program

Early 2010 marked the first announcement of awards to 40 states and State Designated Entities (SDE) under HITECH’s State Health Information Exchange Cooperative Agreement Program. This Program funds states’ efforts to rapidly build capacity for exchanging health information across the health care system both within and across states. Awardees are responsible for increasing connectivity and enabling patient-centric information flow to improve the quality and efficiency of care. Key to this is the continual evolution and advancement of necessary governance, policies, technical services, business operations, and financing mechanisms for HIE over each State and SDE’s four-year performance period. This Program is building on existing efforts to advance regional and state level health information exchange while moving toward nationwide interoperability.

Over the next several weeks the remaining cooperative agreements will be awarded to approved applicants; these awardees will join the 40 awardees announced today in advancing mechanisms for health information sharing in their states and across the country.

State grantees in the first series of awards:

Information & Resources

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