This post is authored by James Tcheng, MD, FACC, co-chair of the ACC’s Informatics Committee

As we kick off the 7th Annual National Health IT Week, I’m reminded of just how far discussions around health IT have evolved in a relatively short time. Only a few years ago, the conversation was focused on how to choose an electronic health record (EHR) system. Today, we have moved beyond basic implementation to discussing how best to leverage systems to provide meaningful and timely clinical decision support, improve patient communications, reduce errors, and improve delivery of high quality care.

A recent ACC survey of cardiovascular practices found that 74 percent of practices are using, or are in the process of implementing, an EHR system. In addition, most practices are either already participating or plan to participate in the federal EHR Incentive Program. This is great news on a number of fronts. Not only does more structured and interoperable data enable increase quantitative decision making and improve clinical decision support, the availability of data will ultimately enable a learning health care environment that continuously returns information useful to improving health care delivery, quality, and outcomes. (Important note: Oct. 3 is the last day for eligible professionals to begin their 90-day reporting period for the 2012 EHR Incentive Program. To get the maximum incentive payment, Medicare eligible professionals must begin participation by 2012).

That’s not to say we don’t still have challenges. In fact, one of the biggest challenges is how to best optimize the potential of health IT now that so many providers are on board.  Health technology solutions are inherently complex, requiring substantial resources to maintain and optimize. But there are severe constraints on available resources, and funding is not distributed equally. Changes in the IT portfolios will need to occur without compromising care during transition periods.  Also given the fast-moving nature of health IT, maintaining the security and privacy of information is a challenge. (This will definitely need to be a focus as we move forward with exciting opportunities around mobile technologies).

We also need to move beyond the current emphasis on financial levers to push Meaningful Use compliance.  The real drivers ultimately will be increases in usability, efficiency, and productivity.  Until a true return on investment can be achieved, health IT will remain on the wrong side of the ledger, and thus will be subject to compromise.  A plan for long term assistance with the costs of Health IT should be considered.

When it comes to health IT, my best advice is to never be afraid to tear down what was previously built. Technology evolves rapidly and what was once a good plan/design/technology may not be optimal in the future. We need to be flexible and forward thinking – as do governments, consumers and health care systems. To borrow the National Health IT Week theme, we need to come together with “one voice, one vision [to] transform health and care.”

Be a part of Health IT Week:

• Take part in the “Health IT is…” Twitter Chat on Friday, Sept. 14. at noon ET moderated by @HIMSS and @HealthStandards. Use the hashtag #HITsm and follow ACC's @Cardiology account.
• Visit the ACC’s Health IT Resource Center for information on e-prescribing, the EHR Incentive Program, and choosing and using an EHR.
• Share your thoughts on Health IT on this blog, or on the ACC’s Facebook page.
• For additional information about National Health IT Week, visit healthitweek.org
  

This post was authored by ACC Past President W. Douglas Weaver, MD, MACC.

Wednesday was an exciting day in Washington, DC, where I testified on behalf of the ACC before the Senate Finance Committee hearing regarding Medicare physician payments. The hearing addressed problems plaguing the current Medicare physician payment system and sought to identify new payment models and quality initiatives that incentivize high-quality and high-value care at reduced costs.

Following recent discussions with former Centers for Medicare and Medicaid (CMS) administrators and insurers, the ACC, along with the American Medical Association, American Academy of Family Physicians, American College of Surgeons and American Society of Clinical Oncology, was invited to share lessons learned on effective physician payment approaches. This was a vital opportunity to reiterate our long-term dedication to exploring innovative payment models in Medicare and share how our many quality programs and evidence-based measures are working to improve the delivery of high quality, affordable care.

I cannot stress enough how critical the discussion on Medicare physician payment is to the sustainability of our health care system. Congress must avert scheduled reimbursement cuts just released in the proposed 2013 Medicare Physician Fee Schedule, repeal the SGR, and provide stable payments for several years to allow the development of new delivery and payment models. They know this, but just don’t know how to do it. Although I was prepared to provide suggestions to improving value over the next several years; I was surprised to be asked about what we can do this year which will dramatically reduce Medicare costs beginning in January.

The SGR has been a problem for years and a key issue I faced during my tenure as ACC President in 2008. The current uncertainty in the future stifle both our practices and our hospitals in making real investments aimed at improving integration and reducing the current fragmentation of care and reducing waste. It is discouraging that Congress has yet to come up with a solution, but I am hopeful that we can develop a system that aligns compensation with performance of evidence-based medicine and higher value, appropriate health care.

During my testimony, I had the opportunity to discuss several of the College's exciting innovations currently underway, such as our clinical registries which can be used to increase quality far beyond the PQRS quality measures of CMS. We also have appropriate use criteria embedded into Cath PCI-which has begun to lower the number of patients getting unneeded revascularization.  I asked them to incent doctors to use these tools and incent EMR venders to incorporate them into their products which also need to be made interoperable among all of the suppliers.

I also told them they need to support care management in the out-patient setting, which is paying primary care docs and specialties such has ours in which the vast majority of our patients are billed under primary care diagnoses (eg, heart failure, coronary disease, hypertension). These extra dollars allow us to fund the needed physician infrastructure to keep these patients on a care plan, and to reduce emergency visits and hospitalization.

The bottom line is that ACC knows how to improve quality and efficiency use our registries and other specialty specific tools. If Medicare promotes these activities by incentivizing their use and helping pay for the efforts, I believe the current improvements that we are witnessing will accelerate.

Read more about the ACC's involvement in the Senate Finance Committee roundtable on Medicare Physician Payments on CardioSource.org including the submitted testimony. Also read a statement from ACC President William Zoghbi, MD, FACC on the hearing.

(pictured top: Dr. Weaver testifying before the Senate Finance Committee; pictured bottom: Senator Max Baucus (D-Mont.) and Dr. Weaver)

This post was authored by Dino Damalas, chief information officer of the ACC.

It’s no secret that technology is playing an ever increasing role in our daily life.  A study conducted by manhattanResearch in 2011 indicated smartphone penetration has reached 81 percent in the physician community and the reliance on these devices to connect with colleagues, search for treatment options, and stay informed is skyrocketing.  Cardiovascular professionals have always been on the leading edge of technology adoption, but is the College effectively leveraging technology to better deliver tools, services, and knowledge assets to help our members deliver better care?

This was the question at hand during a recent workshop that brought together College leaders, a representative group of members from around the country, patients and ACC executive staff. As part of a larger digital strategy discussion taking place across the College, the focus of the workshop was to develop a true understanding of the issues, challenges, and needs faced by cardiovascular professionals.

Workshop participants were presented with data from more than 70 individual interviews, shadowing exercises conducted at member practices, and a wealth of secondary research and were able to get an inside look at the behaviors, needs, and challenges related to use of digital technologies. This data was then used to develop a comprehensive user needs model based on several member segments that was then used to facilitate discussions around the many ways the ACC could leverage technology to deliver tools and services.

The workshop was eye-opening and the exercises enriched a collective understanding of how to better serve the cardiovascular community.  Moving forward there is still much more to do in order to move the concepts identified at the meeting from ideas to reality. The next step is to develop a comprehensive digital strategy and outline a roadmap that will help us move forward in meeting member needs in the digital future. What was also clear during this event – envisioning the future through technology is not a singular event.  Technology changes rapidly and so must the College. Leveraging the latest technology to bring the best possible science and education to our members, when they need it, where they need it is as core to our mission as developing practice guidelines.

This post was authored by Thad Waites, MD, FACC, past chair of the Board of Governors.

The ACC is launching a vigorous digital transition. In fact, the world is launching this transition. The House of Medicine and the health system in general has been said to be late going digital. But now with the Centers for Medicare and Medicaid Services’ (CMS’) Meaningful Use criteria, the federal government's encouragement, and the broad global rollout of new clinical technologies, we can’t afford not to move forward. Unfortunately, even the computer world is learning how difficult it is for Medicine to go digital.

In the microcosm of my clinic in Hattiesburg, MS, we have transitioned to a new electronic medical record (EMR) system, and there are certainly some lessons learned. My clinic consists of 250 multispecialty doctors with satellite clinics and a close connection to a single hospital system. Before we transitioned, we already had a very acceptable web-based software program that was modular, served our needs fairly well, but was outpatient. We needed to evolve into a larger program and would that also could be seamless with the hospital's system.

The decision to buy a new EMR from one of the major software vendors was not an easy decision. The cost was high, and the work required to transition was immense, it pulled professionals away from their jobs in the clinic. At some point personnel and physicians from every area had to train at the software vendor's campus. Additional costs were also involved, not to mention it was difficult to convince 250 physicians that this was the right thing to do.

The project was painstakingly done. It took two years to fully transition and involved carefully established timelines. It was important to have a physician champion as the leader of the project and it also helped that this physician was on the clinic governance board.

The clinic transitioned on a single launch date. Expecting the unexpected certainly applied to the first several days after the launch. Our servers malfunctioned, users were being shut down throughout the day for several days, and doctors, who had already reduced their workload for the transition, were greatly affected. Needless to say, there was a great deal of consternation. Fortunately the problem proved to be software glitches and not hardware problems. Since we had major brand servers and one of the leading software vendors, it was a surprise that these glitches had not been encountered before in other launches. Once the initial problems worked out, it has been relatively smooth sailing ever since. However, since doctors were seeing fewer patients, the entire system experienced a decrease in the bottom line during that time.

There were several lessons to be learned in our launch. Transitioning from regular dictation to voice recognition dictation or template notes has been a vital but difficult part of the transition. In addition, going from check-off order sheets to a computerized physician order entry (CPOE) has been critical but difficult as having to find the right name for a procedure, the associated diagnoses, and even where to sign the order takes time. Whether it is better to launch in one fell swoop rather than unit by unit is definitely open to debate. It is important that all issues post launch are handled by a helpdesk that is specific to EMR issues and that has adequate personnel to handle the load. It has also been vitally important for the end users to help each other.

We are now approximately 9 months into the transition and from what I hear our production is within 5 percent of what it was prior to the launch. This may or may not be a permanent decrease in production, but based on conversation with other health systems, this may just be a permanent effect of “going digital.” As for the hospital, we are now gearing up for the transition to the same EMR software.

There is no doubt that if we could transport ourselves into the future, all of American medicine will be digital. This will be beneficial to patients, the system, and even the providers. It is the going over, however, that can be quite bumpy. I therefore will end with a quote from William Shakespeare: "I am in blood steeped in so far that should I go no more, returning were as tedious as the going o’er."

This post was authored by James Fasules, MD, FACC, Senior Vice President of Advocacy.

E-prescribing has been shown to improve safety and convenience for patients and clinicians, while also saving clinicians and pharmacists time and money. In an effort to encourage e-prescribing use, the Centers for Medicare and Medicaid Services in 2009 launched the E-Prescribing Incentive Program. As part of the program, providers that met the program criteria are able to earn an incentive payment on top of their Medicare Part B earnings.

Three years later, the program is still moving forward. Providers who e-prescribe 25 times between Jan. 1 and Dec. 31, 2012 will receive a one percent bonus – a definite incentive in this time of declining reimbursement. (Other restrictions apply and can be found here.) The newest addition, however, is that all eligible providers not participating in the program are subject to gradually increasing penalties. While it’s too late to avoid the 2012 penalty, there is still time to avoid the 1.5 percent penalty for 2013 … although the June 30 deadline is fast approaching.

According to CMS, individual eligible professionals and group practices can avoid the penalty by meeting the following six-month reporting requirements between now and the end of June:

• Individual eligible professionals: 10 e-prescribing events via claims
• Small e-prescribing group using the group practice reporting option (GPRO): 625 e-prescribing events via claims
• Large e-prescribing group using the GPRO: 2,500 e-prescribing events via claims

More information is also available here.

In addition, individual eligible professionals and group practices can also avoid the penalty by filing for a significant hardship exemption. Hardships exemptions are available to providers who are unable to electronically prescribe due to local, state, or federal law or regulation; have or will prescribe fewer than 100 prescriptions during a six-month reporting period (Jan. 1 – June 30); practice in a rural area without sufficient high-speed Internet access; or practice in an area without sufficient available pharmacies for e-prescribing. Hardship exemptions must be submitted through the Quality Reporting Communication Support Page no later than June 30. These requests are granted on a case-by-case basis and all decisions are final. Given the issues experienced last year by providers trying to request exemptions via the website, CMS has developed two documents outlining how to navigate the support page (Quality Reporting Communication Support Page User Guide and Tips for Using the Quality Reporting Communication Support Page). The College urges members not to wait until the deadline to file for an exemption!

For more information on health IT visit CardioSource.org/HealthIT.

That great, growling engine of change – technology – Alvin Toffler, Future Shock, 1970. (Harper, S&S)

The ACC this week submitted its comments to the Centers for Medicare and Medicaid Services (CMS) on its proposal for the second stage of the Electronic Health Record (EHR) Incentive Program. EHR adoption and meaningful use of these technologies is not an easy feat given the constant development of new technologies and the many challenges associated with true interoperability across different platforms. CMS and the Office of the National Coordinator (ONC) for Health IT have definitely undertaken a herculean task. The College’s comments outline the concerns with moving forward with Stage 2 without a careful analysis of Stage 1 – including the challenges associated with participation, as well as the positive results. To quote our comment letter: “We are concerned that the sum total of the requirements contained within this proposal seek to change behavior too rapidly without enough appreciation for the potential consequences.” We will be continuing to work closely with both CMS and ONC to refine requirements in a way that helps, rather than hinders, participation by cardiovascular specialists. (Read the ACC’s summary of Stage 2 requirements).

Meanwhile we are still in the first stage of the EHR Incentive Program, which is good news. However, this year marks the last year for physicians interested in participating to receive the maximum benefit of program participation. Physicians can earn up to $44,000 over five years if they meet the program requirements and begin participating in 2011 or 2012. First-year participants must only comply with the program’s requirements for 90 days, which means interested parties (not already participating) have until Oct. 1 to comply. (Check out this helpful guide from CMS).

We have also partnered with the Managed Care Advisory Group (MCAG) to help members receive incentive payments under program. MCAG uses a dashboard to track physician progress in meeting the Meaningful Use requirements and help identify problem areas. Once requirements are met, MCAG completes and sends the application for the incentive bonus to CMS. MCAG will be hosting a free webinar for ACC members from 1-2 p.m. on May 24, so stay tuned for more information on how to register. CMS also offers a number of resources, accessible via the College’s Health IT page, to help providers through the process themselves. The College is working with CMS to co-host a webinar later in June.

This post was authored by William J Oetgen, MD, MBA, FACC, ACC's senior vice president of Science and Quality.

The implementation and use of health information technology (IT) is a crucial component to the systematic practice of quality cardiovascular medicine. Not only is health IT at the crux of ensuring appropriate and continuous patient care across different care settings, it also is vital to practice and hospital quality improvement efforts. Health IT also allows for improved data collection and reporting that can aide in identifying gaps in care and/or areas for further research. At the end of the day, health IT adoption and meaningful use also provides opportunities for increased reimbursement through several federal programs, including the E-Prescribing Incentive Program, the Electronic Health Record (EHR) Incentive Program and the Physician Quality Reporting System. Meanwhile, those not currently participating in these efforts are at risk of penalties.

Over the last several years the growth in health IT has been unprecedented. Speaking at ACC.12 in Chicago this past March, Farzad Mostashari, MD, SCM, deputy national coordinator for programs and policy at the Office of the National Coordinator for Health IT, noted that 34 percent of all physicians and 35 percent of all hospitals have adopted EHRs. In terms of cardiovascular professionals, a recent survey of the ACC’s CardioSurve panel indicates that 43 percent of cardiologists and 50 percent of practice administrators participated in the federal EHR Incentive Program in 2011. The latest numbers released by the Centers for Medicare and Medicaid Services (CMS) in February 2012 indicate that 2,538 physicians identified as cardiologists successfully participated in the program.  Fifty-eight percent of cardiologists responding to the 2012 survey indicated that they are participating or plan to participate in 2012.

Given the integral role of health IT in patient care, quality improvement and now physician reimbursement, it’s important that cardiovascular professionals understand how best to use health IT; the pros and cons of using health IT vs. waiting; and the fundamentals of the federal incentive programs in order to gauge eligibility and avoid looming financial penalties. Over the course of the next month, the ACC in Touch Blog will feature a series of blog posts on Thursdays detailing the federal incentive programs; providing overviews of ACC health IT resources and tools; and highlighting cases studies/lessons learned from members “in the trenches.” Webinars are also being planned with the Centers for Medicare and Medicaid Services, as well as some of our partners involved in providing health IT services to members.

We also invite you to share your own questions, challenges, lessons learned and EHR tips below. These will be compiled and featured in the July/August issue of Cardiology, as well as help guide us in the development of future tools and communications to aide in the ongoing transition to a digital world.

As we wrap up ACC.12 after soaking in all the new and best cardiovascular science and education, I’m continuously amazed at how much progress is made from these meetings. Over the past few days I’ve both presented with and had the honor to learn from some of the most astounding cardiovascular health care innovators in the field. Now the challenge lies in taking what we’ve learned and implementing it – and, as Immediate Past President David Holmes, MD, noted in his ACC.12 Opening Session address, using it to transform how we provide care to patients and work in partnership with others.

With the recent two year anniversary of the Affordable Care Act (ACA) and the start of the Supreme Court hearings of the constitutionality of it all, I’d be remiss not to also mention the timely discussions that took place throughout ACC.12 on health care reform and its impacts on everything from health IT, to imaging, to academia, to the future.

Yesterday I gave the presentation, “ACA for Dummies,” giving a play-by-play of the ACA’s nine separate independent titles, as part of a session that looked at where cardiology will be as a profession in 2015. The bottom line is even if the decision is to rid of the ACA we will still be faced with immense access, cost and quality problems. Our goal at the College is to ensure that we’re poised to help ensure these changes put patients first and reward physicians and other medical professionals for their commitment to quality and evidence-based care.  Congress’ traditional cost reduction strategies of price controls and caps on spending -- as in the broken SGR (or sgrrrr, expressed as a growl) Medicare payment formula -- just won’t work. Instead we need to systematically improve care.

Also yesterday, I was on a progressive panel discussion about the Future of Cardiovascular Diseases: Where Are We Going (and Where Do We Want to Go?) with ACC’s new President Bill Zoghbi, MD, President-Elect John Harold, MD, Million Hearts Director Janet Wright, MD, and others, which discussed the recent UN Summit on NCDs, and others initiatives to combat the growing epidemic of cardiovascular disease. I think Huon Gray, MD, said it best: “Since CV disease knows no boundaries with regards to the patients it affects, nor should the organization and cardiologists whose job it is to help them.”

Professionalism has to be a part of our changing future and the patient must be the center. We have to change the physician/patient relationship and move toward patient centered care, something that Zoghbi is focusing on during his presidential year. We’re not just embracing change, we need to lead change!

Overall it was a great meeting, folks and thanks to everyone who made the journey to the Windy City. Save the Date for ACC.13, March 9-12 in San Francisco!

PS the fun never stops here on Hollywood on the Potomac, check out my testimony before a House Appropriations subcommittee here where I was able to discuss the need for more funding for cardiovascular disease research (just like what was presented at ACC.12), prevention and treatment.

This post was authored by Farzad Mostashari, MD, ScM, deputy national coordinator for programs and policy within the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.

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When I talk to people about why the Obama Administration is investing billions of dollars in health information technology (IT) I tell them it’s not about technology, it’s about helping improve care and outcomes through better information.  To be sure, a first step in that process is increasing adoption of electronic health record systems (EHRs), which has more than doubled over the past two years to 34% among all office-based physicians and 35% at acute care hospitals.

But just as important is the need for providers who have EHRs to use them in meaningful ways, which is what the HITECH Act is really trying to achieve.  Just like a piano is not much use if no one ever plays it, EHR are worthwhile only if providers use them to help deliver high quality care and improve health outcomes.  Meaningful use means using EHRs to help clinical information follow patients through the care process, coordinate care among providers, and better manage chronic diseases, as well as enabling patients to become more engaged in their own care.  Meaningful use of certified EHRs also provides information tools that cardiologists and other providers need in order to succeed in a delivery system that is increasingly rewarding high quality care rather than high quantity care.

Given the prevalence of cardiovascular disease in the United States, it is particularly important that cardiologists embrace advanced information technology.  So far more than 2,500 cardiologists have successfully attested to Meaningful Use, collecting nearly $45 million in Medicare incentive payments.  Congratulations to those who have achieved Meaningful Use – I’m greatly encouraged by your success!  But I also know there’s plenty of room for these numbers to grow.  The ACC has committed to getting 8,000 of its members to Meaningful Use by the end of the year.  It’s an ambitious goal, but it’s also achievable and I look forward to reaching (or even surpassing) it in the months ahead.

The proposed rules for Stage 2 for the Medicare and Medicaid EHR Incentive programs, and accompanying EHR certification, aim to move the Incentive programs forward in a balanced, impactful way.  Among the proposed changes, providers will have more ways of reporting quality measures, including registries, and there will be greater alignment among quality reporting measures among HHS programs.  The standard for exchanging clinical information will be more robust than Stage 1 and more emphasis will be placed on making information available to patients.  Providers will also no longer be required to purchase certified EHR systems that perform functions which they don’t need in order to achieve Meaningful Use – that means EHRs can be more geared to specific specialties and still qualify for incentive payments.  We’d love to get your input on these rules, so I would strongly encourage members of ACC to submit comments on the two proposed rules through May 7.

I am also pleased to recognize the winners of the Investing in Innovation initiative’s (i2) One in a Million Hearts Challenge, which asked multi-disciplinary teams of innovators to create technology applications that activate and empower patients to pursue healthy lifestyles and improve their heart health. The i2 initiative utilizes prizes and challenges to facilitate innovation and obtain solutions to intractable health IT problems.  The winner of the One in a Million Hearts Challenge is Team THUMPr, which will be awarded $50,000. The second and third place teams, mHealthCoach and Wellframe, will be awarded $20,000 and $5,000, respectively.

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Please note that statements or opinions expressed herein reflect the views of the contributor, and do not reflect the official views of the ACCF, unless otherwise noted.

For more information about Health IT visit CardioSource.org.

Today the Bipartisan Policy Center’s Task Force on Delivery System Reform and Health Information Technology (IT) released an important report, Transforming Health Care: The Role of Health IT, which outlines recommendations for the most effective use of health IT to achieve the triple aim through new models of care delivery and payment reform. I am a member of the task force – we’ve been working on this plan for over a year.

Following the authorization of up to $30 billion to support health IT under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the report was created to identify real-world examples and best practices that facilitate coordinated, accountable and patient-centered care; and to make recommendations for ensuring that current health IT efforts support delivery system and payment models shown to improve quality and reduce costs in health care, in ways that best utilize scarce public and private resources.

I joined the Bipartisan Policy Center’s co-chairs, former Senators Tom Daschle (D-S.D.) and Bill Frist, MD (R-Tenn.), and former Governors Ted Strickland and John Engler, at a policy briefing featuring prominent leaders in the field to release the report and discuss how to make it happen.

The report identifies key gaps and barriers to achieving widespread adoption of health IT, including: misaligned incentives; a lack of health information exchange; limited level of consumer engagement using electronic tools; limited levels of Electronic Health Record (EHR) adoption; privacy and security concerns; and multiple federal priorities that all require focus and attention.

The task force also identified several goals and recommendations to overcome these barriers including: aligning incentives and payment with higher quality, more cost-effective health care, accelerating health information exchange efforts, accelerating and supporting engagement of consumers using electronic tools, expanding education and implementation assistance, addressing concerns about privacy and security, and further aligning federal health care and health IT programs. Incidentally, the task force has had a kind of brilliant idea on how to get beyond the unique patient identifier controversy – which is politically stalled. We suggest developing “patient tracking” systems to manage patients securely over the continuum.

After the press event was over I had lunch with Daschle, Frist, Strickland, and Engler to talk further about implementation ideas and how the ACC can help move this. The good news is most of the field of cardiology and the ACC with its quality tools and programs are already working to implement most of these recommendations, but as the health care landscape changes and the cost of health care increases, it is important now more than ever to adopt new models of care delivery.

For more information, visit www.CardioSource.org/HealthIT.