Physicians in hospital-based outpatient clinics now are eligible for federal EMR incentive payments, as President Obama has signed into law legislation that removes a restriction in the American Recovery and Reinvestment Act.

Meanwhile, two longtime health IT advocates in Congress have introduced legislation that would expand the forthcoming "meaningful use" program to behavioral and mental health professionals.

The proposed Health IT Extension for Behavioral Health Services Act (H.R. 5040), from Reps. Patrick Kennedy (D-R.I.) and Tim Murphy (R-Pa.), would make psychologists, licensed clinical social workers, psychiatric hospitals and substance-abuse treatment professionals and facilities eligible to receive Medicare and Medicaid bonus payments for adopting EMRs. Kennedy and Murphy are founders and co-chairs of the 21st Century Health Care Caucus.

"Electronic medical records ensure that physicians and mental health professionals are working together and delivering the best possible treatments," Murphy, himself a psychologist, said in a statement. "The Health Information Technology Extension for Behavioral Health Services Act keeps the 21st Century Healthcare Caucus's commitment to treating mental illness with the same vigor as physical ailments."

At least one EMR vendor for behavioral health organizations was gratified by the news. "This proposed legislation corrects an oversight that excluded a major component of the healthcare system from critical funding that will help organizations accelerate their adoption of electronic health records," James L. Conway, CEO of Great River, N.Y.-based Netsmart Technologies, said in a press release.

For more information:
- read this Government Health IT article
- see this Healthcare IT News story about the Kennedy-Murphy bill
- check out this Netsmart Technologies page, which includes links to the legislation

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When the employer-centric Leapfrog Group started way back in 2000, it pushed computerized physician order entry as a way to improve the quality of care. (The impetus likely was the landmark 1999 Institute of Medicine report, To Err Is Human.) Few hospitals scored very high on the Leapfrog Group's report cards.

With the advent of the American Recovery and Reinvestment Act, CPOE is again in the spotlight, since it's one of the key components of the proposed requirements for meaningful use of EMRs. For Stage 1 of meaningful use, which runs through 2012, hospitals will have to enter 10 percent of their orders electronically, while the CPOE threshold for physicians is 80 percent, based on the current proposal.

Time may be fairly short, but meeting the CPOE requirement is possible, according to CSC consultants Jane Metzger and Donna Schmidt. "A successful implementation requires the right reason [better, safer care for patients], the right policy [the only way orders are managed in the hospital] and the right understanding of the challenge [transforming the complex order management process]," the two state in the just-published April issue of Hospitals & Health Networks. Pressure from payers, they say, is not the right reason.

"CPOE success stories all share an executive team and corporate culture pushing for more consistent evidence-based care and for safer, more reliable processes; CPOE enables a new, standard process to achieve that vision. Voluntary use of CPOE by physicians or any other professionals is not an option," they add.

Metzger and Schmidt debunk a widely held belief that CPOE implementation in an average hospital takes three to five years. "A growing number of examples prove otherwise," they write. "In one recent case, a smooth implementation was accomplished in 15 months from the beginning of planning to physician entry of 92 percent of orders throughout the hospital." Keys to quick success include understanding of workflow issues and leadership from clinical teams.

For more:
- check out this Hospitals & Health Networks feature

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If nothing else, it should at least be easy to register to receive federal incentive payments for meaningful use of EMRs.

CMS has awarded a $1.6 million contract to CGI Federal, a Fairfax, Va.-based unit of Montreal-based technology consulting firm CGI Group, to revise the existing Provider Enrollment Chain Ownership System (PECOS) so physicians and hospitals can attest to meeting the requirements for meaningful use that will qualify them for Medicare bonuses. PECOS currently manages and verifies enrollment of Medicare providers and vendors.

Build-out of the online system to accommodate EMR incentive enrollment should take about 10 months, CMS says. Hospitals, however, could be eligible for the bonuses as soon as the end of December, since the rules for meaningful use, as currently proposed, only require providers to meet the standards for 90 consecutive days in 2011. Medicare Part A, which applies to inpatient care, follows the federal fiscal year, which begins Oct. 1.

For more information:
- see this Government Health IT story
- read this CMS notice about the contract award

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Just as predicted at the end of 2008, e-prescribing volume nearly tripled in 2009, according to prescription transaction network Surescripts. And the growth has picked up this year.

Surescripts reports that U.S. prescribers wrote 191 million electronic prescriptions in 2009, up from 68 million a year earlier. That accounts for about 12 percent of all 1.63 billion original prescriptions--not refills--of all scripts written last year. For the first three months of 2010, nearly 20 percent of all new scripts have been filed electronically.

To date, about one-quarter of office-based physicians nationwide have e-prescribing technology, even if they aren't all using it, Surescripts adds, about twice the rate at the end of 2008.

The rapid growth could further accelerate as the Drug Enforcement Administration moves to lift a restriction on e-prescribing of controlled substances. Last month's DEA interim final rule "is what we've all been waiting for," Dr. John Halamka tells the Wall Street Journal. "Now we can write prescriptions for Lipitor and Valium on the same program," adds Halamka, CIO of Boston's CareGroup Healthcare System and an emergency physician at Beth Israel Deaconess Medical Center.

For more information:
- read this Wall Street Journal story, which includes a discussion of the safety benefits of e-prescribing

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It won't qualify you for Medicare and Medicaid EMR incentive payments, but a an "ultra-light record" based on standards of the National Cancer Institute's Cancer Biomedical Informatics Grid (caBIG) soon will be available to help physicians capture data related to cancer patients' office visits--and at least satisfy one of the proposed requirements.

NCI is working with Microsoft and federal technology contractor SAIC to release the open-source EMR within 60 days. The product would be capable of recording patient demographics, disease information and treatment results, Ken Buetow, NCI's associate director for bioinformatics and IT, said at a conference last week, Government Health IT reports.

At the heart of the technology is the Continuity of Care Document, a Health Level 7 International specification that facilitates exchange of patient summaries and progress notes. Providers will need to be able to exchange such information to achieve meaningful use, according to proposed CMS standards. "If someone wants their cancer encounter in electronic form, the physician can use the web interface to push it to the individual's care record," Buetow explained.

To learn more:
- read this Government Health IT story

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Last week, we reported about the anemically low usage rate of the Summary Care Record in the UK. Now, we learn that the national Department of Health would suspend uploading of any more patient records until public awareness is higher. The reason? Privacy. Physicians and other care providers must ask patients each time they want to access the records. But, the Daily Telegraph reports, "The British Medical Association (BMA) warned that many people were not even aware of the scheme, let alone the fact that they could 'opt out.' In some cases, letters informing patients of their rights had gone missing," the paper adds. Article

> A new report from IDC says that many big health IT vendors are looking to acquire smaller companies that offer technology for health information exchange. Article

> The American College of Physicians and other specialty societies are teaming with Canadian firm Cientis Technologies to launch AmericanEHR Partners Program, an online resource to help physicians select EHR systems. Article

> A new, all-digital specialty hospital in Botswana could serve as a prototype of a new model of low-cost, high-quality care "without borders." Article

> EDIMS, maker of clinical and management systems for emergency departments, will incorporate Discharge 1-2-3 discharge automation software into its EMR, thanks to a licensing agreement with that product's maker, Schaumburg, Ill.-based Callibra. Press release

And Finally... They've created a monster! Blog