ARRA/Stimulus Funds

Cultural Change at CMS is Needed to Mend Adversarial Relationship With Physicians

CMS has issued a request for information (RFI) and invited comments on the implementation of the Merit-Based Incentive Payment System (MIPS) as introduced in the MACRA legislation that repealed SGR last April.   The legislated "composite performance score" upon which "adjustments" to physician payments will be made under MIPS consists of four categories:  Quality, Resource Use, Clinical Practice Improvement Activities and Meaningful Use of CEHRT.   Comments are being sought on many topics, including certification of EHRs, technology standards, accountability for data integrity, management of "virtual groups"  and, yes, Meaningful Use (MU).

I have three overarching comments:

1.  Adversarial relationship with physicians:  Right now government programs such as MU and PQRS are generally viewed by physicians as requirements only, not as elements of best practices that lead to quality care.  I think it is vital to change this adversarial perception.  This will involve a cultural change at CMS.  Perhaps the most important tactical change to pursue is moving away from rewarding/penalizing the achievement of specific targets, and moving toward innovative programs that reward practices for making incremental improvements in quality care.

2.   Inhibition of Innovation:  Physicians support technology innovations developing in the consumer marketplace that have the potential to improve quality of care and lower healthcare costs.   While government regulations have the potential to catalyze innovations in the consumer marketplace, they also have the potential to inhibit innovation.    Regulations that strive for high-level outcomes are generally more likely to catalyze innovation, while regulations that impose specific limits or require specific actions, mechanisms and processes are more likely to inhibit inhibition.   I believe the Meaningful Use regulations have inhibited innovation--EHR vendors have been scrambling to meet specific requirements imposed by the regulations with no evidence that these requirements would result in higher quality of care or lower costs.    To change this, we need CMS to mindfully develop government regulations that maintain a high-level focus on the achievement of quality care outcomes while avoiding the development of limitations or specific requirements, methods and processes that discourage innovation. 

3.    Fair and ethical use of quality metrics for reimbursement:   The AMA has published guidelines on the Fair and Ethical Use of Quality Metrics.    The guidelines advocate for rewarding physician practices that make incremental improvements in quality care rather than rewarding/penalizing the achievement of specific levels of performance.   Although my opposition to the use of quality metrics to impose financial penalties is aligned with these guidelines, I concede that it is difficult for a value-based model of reimbursement to completely avoid penalties.    My alternative suggestion is for CMS to incorporate tiered levels of "performance achievement" instead of the "all-or-none" requirements put in place for the MU program.  Tiered levels of achievement, with lower levels of achievement designed to avoid certain penalties and higher levels designed to provide additional rewards, will help avoid the "drop-out" rate that the MU program has experienced after Stage 1 as the levels of expected performance were increased.  Many physicians just gave up.  Even though they could achieve all but one of the requirements, that one requirement eliminated the possibility of receiving any credit.  

I  would be interested in hearing your thoughts on the implementation of MIPS by CMS.


Physicians Must Level the Slippery Slope of Quality Metrics

I am concerned about the slippery slope of quality metrics that ACOs, private payors and CMS are stepping further down into.  My primary concern is that decisions being made by payors on the use of quality metrics are too often resulting in unfair or unethical use of quality metrics.   It is critical for community physicians to engage with these entities now to level the slope and establish a more optimal precedent for the future use of quality metrics.

Several years ago I participated in the Texas Medical Association's (TMA) launch of their Health Care Quality Council.  One of Council’s primary interests has been the issues inherent to pay-for-performance programs and the use of quality metrics by payors.   Some of these issues overlap onto the TMA's ad hoc Health IT Committee that I serve on as well.    Physicians in Texas have reported to these committees about unfair and unethical applications of quality metrics such as failure to consider risk adjustments for severity-of-illness or for important socioeconomic factors.   Many physicians are concerned  that they are getting overwhelmed by requests for different sets of quality metrics from different private payors as well as from CMS.   They are also frustrated by the variable, non-standardized methods by which each payor requires the physician's data to be formatted and/or submitted.

Based on my experience with these TMA committees, I have no confidence in the ability of insurance companies or ACOs to develop and use quality metrics in a fair and ethical manner without intimate involvement of working physicians from the community served by the ACOs/payors.    

There are guiding principles available regarding the fair and ethical use of quality metrics from the TMA and the AMA.     Physicians should actively engage with their ACOs and payors to ensure that these guiding principles are adhered to as quality metrics are developed.

 

 fort worthcook children's, athenahealth, meditech


Health IT-related patient safety risks should inspire Congress to create a national patient safety board

The idea’s time has come. The U.S. healthcare system needs a national, independent entity empowered by Congress to oversee health IT patient safety. Now.

In today's world a health IT-related patient safety issue that is identified by a physician practice or hospital is investigated and managed in a nontransparent manner by the individual provider and the EHR vendor.  

Although the issue may be escalated to a local accountable care organization (ACO) or patient safety organization (PSO) that providers are increasingly becoming associated with, neither the issue nor the results of the investigation are reported to a statewide or national oversight entity. The patient safety data is therefore not collected, aggregated and analyzed at a state or national level. Without such oversight we are missing out on the opportunity to identify known avoidable health IT risks to patient safety and failing to disseminate knowledge on how to manage those risks. For example, if an issue is resolved at the physician practice between the physicians and EHR vendor but is not addressed at other practices that use the same EHR, then patients at those other practices remain at risk. 

I have observed EHR vendors tune in to patient safety issues more keenly in the past decade and sometimes make more visible efforts to ensure identified issues are addressed with all customers and not just the ones who report issues. And let's be clear that a majority of EHR-related patient safety risks are related to how an EHR product is being used or implemented by their clients and not due to inherent technical flaws with the vendor's product. Nevertheless, patient safety should be viewed as a shared responsibility between the physicians, their practices or organizations and the health IT vendors. Identifying and managing patient safety risks is done most effectively when all cooperate in a team effort.

In Texas there had been discussions within the Texas Medical Association about establishing a central, statewide EHR patient safety entity to monitor and manage health IT-related patient safety issues. The data would be rolled up from hospitals, physician practices and patient safety organizations across the state for aggregation and analysis. However, it became evident during those discussions that it would be feasible and much more beneficial to establish governance at a national level.

So why does this need to be a new, independent national agency charged by Congress to oversee health IT patient safety? 

Today there are many government agencies and private entities that I believe could and should contribute to patient safety surveillance and improvements, but none have the expertise, assets and time that are necessary to coordinate a national effort. In addition to the complexity involved with collecting and analyzing data from hundreds of institutions and PSOs, there are hundreds of unrelated EHR vendor products being used. There is not yet any available registry of health IT products, many of which are subdivided into multiple versions that sometimes vary widely in their available functionality. As a result, I strongly agree with the observations and recommendations described in an article by Singh, Classen and Sittig (J Patient Saf, Dec 2011; 7(4): 169-174) calling for a national patient safety board that is an independent government agency structured similarly to the National Transportation Safety Board. This entity would be charged by Congress to oversee HIT patient safety and coordinate with other agencies who can contribute to improvement in patient safety such as the Office of the National Coordinator, the Federal Drug Administration, the National Institute of Standards and Technology, the Agency for Healthcare Research and Quality, the Center for Medicare and Medicaid Services, the National Quality Forum, local patient safety organizations, local healthcare organizations who collect patient safety data, other local EHR patient safety reporting entities and industrial (EHR and HIT) trade associations. All of these entities need to function in a cooperative fashion in order to effectively identify and manage health IT-related patient safety risks.

The recent health IT report from the Food and Drug Administration Safety Innovation Act (FDASIA Health IT Report) proposes a framework to improve health IT-related safety risks including a proposed National Patient Safety Center. 

I am concerned, however, that the proposal does not appear to provide this entity with enough authority to get the job done effectively. A national patient safety entity must have the authority to not only monitor activity and provide learning opportunities for vendors and providers, but also to regulate activities, investigate events, ensure issue resolution and require compliance. I do not see enough "teeth" given to the entity proposed by the FDASIA report. 

The primary focus of a national Health IT Patient Safety Center should be on the dedicated surveillance of HIT-related safety risks and to promote learning from identified issues, potential adverse events (“close calls”) and adverse events. But it must also have the authority to effectively manage identified risks and ensure compliance with best practices for health IT patient safety.


Ask Not What ICD-10 Can Do For Healthcare, Ask What Healthcare Can Do With SNOMED and ICD-11

ICD-10 is so “last century”.    The United States did not adopt ICD-10 twenty years ago when the standard was first developed.    The current version of ICD-10 that the United States is designated to adopt is based primarily on the international version of ICD-10 that the World Health Organization (WHO) published in 1990.    The international version was drafted by committees that began their work over thirty years ago in 1982 (see 2nd Edition of ICD-10 by WHO).    In other words, our version of ICD-10 is based on work done before use of the rich information space called the Internet became common and before the human genome was mapped.

ICD-11 is “this century”.    According to an article in Healthcare Financing News, Christopher Chute who is one of the leading informatics experts and a Chairman of an ICD-11 Revision Steering Group at the World Health Organization stated:

“ICD-11 will be significantly more sophisticated, both from a computer science perspective and from a medical content and description perspective…. Each rubric in ICD-11 will have a fairly rich information space and metadata around it. It will have an English language definition, it will have logical linkages with attributes to SNOMED, it will have applicable genomic information and underpinnings linked to HUGO, human genome standard representations. ICD-10, as a point of contrast, provides a title, a string, a number, inclusion terms and an index. No definitions. No linkages because it was created before the Internet, let alone the semantic web. No rich information space.”

ICD-x codes are used by non-clinicians for important administrative and financial purposes.    SNOMED-CT, on the other hand, is what physicians will actually use to communicate information about patients in their electronic health records (EHRs).    In fact, physicians must use SNOMED vocabulary in their EHRs, not ICD-x codes, for their problem lists in order to achieve Stage 2 Meaningful Use for incentive payments and to avoid Medicare penalties in the future.    Unlike ICD-10, ICD-11 is based on SNOMED.  And SNOMED includes over 311,000 concepts with unique meanings, making it more granular than ICD-10 or ICD-11.  

One way to think about the relationship is that SNOMED is the input and ICD-x is the output.  SNOMED is used by clinicians to input clinical information into the EHR at a high level of detail.  ICD-10 and ICD-11 aggregate that data into less detailed classifications that are more useful for output purposes such as quality reporting.    They really cannot replace each other.   But we could and should require EHRs to map in the background the SNOMED codes used by physicians into the ICD-x codes used by others.    No need to engage physicians in ICD-x debates or to learn new vocabularies each time WHO does their thing with the U.S. traditionally following way behind.

So what the HIT are we thinking?    Do we really believe that healthcare quality will be significantly improved based on ICD-10 that was developed out of work done over 30 years ago before the Internet was commonly used and before human genome coding was completed?    Or do we believe that we need to adopt ICD-11 for output purposes and to use SNOMED–CT in EHRs for input purposes in order to move the quality needle in the right direction?

I for one believe that we need to get to ICD-11 as soon as possible.     And I believe we should cut the umbilical cord to ICD-10 right now because:

  1. There is currently no information showing that a conversion to ICD-10 is required before ICD-11.
  2. It is intuitively obvious that the costs of going to ICD-11 directly from ICD-9 would be less than incurring the remaining costs of implementing ICD-10 in 2015 (or later) and then implementing ICD-11 sometime thereafter.    And that includes the sunken ICD-10 costs.    If you believe that this is an outrageous assumption, then prove it to be untrue.    Show the comparative costs of both pathways.    But don’t just comment or blog that it’s ridiculous without providing some kind of evidence.     Sometimes it’s wisest to go with intuition.
  3. The ICD-10 implementation has been so painful that it is unlikely the industry will have the stomach to move on to ICD-11 within a decade.    This will result in an excessively long delay to ICD-11 and an excessive period of time using a classification system from the previous century.
  4. There is consensus among leading informatics experts that ICD-11 is superior to ICD-10

 

Matt Murray, MD


AMA's Opposition to Bill on SGR Fix and ICD-10 Delay Is a Winning Ploy

Incidental to the AMA's opposition to the SGR fix bill is that they fail to actively support the one-year delay of ICD-10 that is included in that bill.     Interesting ploy--oppose a bill that you could live with.     If their opposition fails to change minds and the bill is passed, they are not blamed by others for the ICD-10 delay and they are not blamed by us physicians for not trying to fix SGR.     They get a delay in ICD-10 and they begin hard work to fix SGR next time.     On the other hand, there is obviously no luxury of a "next time" for an ICD-10 delay once the implementation starts.

And, by the way, the dream of skipping ICD-10 and moving to ICD-11  sooner momentarily flickered in my head last night.     The cost analysis of the two possible pathways to ICD-11 would still be interesting.     However, I recognize that the sunken costs into the current pathway to ICD-11 (through an ICD-10 implementation) have grown exponentially since I wrote that blog.

ICD-11 could be implemented within 7 years if we are determined to do so.     But once we implement ICD-10 I fear the industry will not be able to stomach an ICD-11 implementation within a decade.     And if the ICD-10 implementation is a debacle, then I believe thinking about ICD-11 will cause such nausea that it will be delayed 15-20 years.   For ICD-11's sake, I hope the one-year delay holds up in order to mitigate the chances of an ICD-10 debacle this year.

                                                                                                      .


EHR Interoperability is a Nervous System

For those familiar with using email applications such as Outlook, Gmail or Apple Mail, it might not seem like it should be very hard to send and receive electronic health information.   But as it turns out, maintaining privacy, security, HIPAA compliance and electronic patient consent is very complex when exchanging electronic health data over the Internet.   It is not easy even for physicians and hospitals using fully functional EHRs.

Virtual Scenario:  Imagine that your patients’ electronic medical records are packaged in individual charged impulses that can propagate along the axons of a national health IT nervous system. This neuronal circuit provides the infrastructure needed to send one of those charged impulses containing the right information on the right patient to the right receiving provider whenever and wherever needed. As physicians know, the charged impulses will propagate along the tubular-shaped axon until they reach the terminal end, which does not directly connect with another axon. Instead, there is a gap or synapse which prevents the impulses from proceeding unless an intermediary event occurs. This constraint prevents chaotic, asynchronous transmissions of impulses that would result in unwanted movements or seizures. So, trusted intermediaries (i.e. neurotransmitters, ions) are needed at the gaps or synapses to enable axons to “talk” with one another in a standard and controlled manner. This allows the charged impulses to proceed in a synchronous manner. The axons, gaps, synapses and intermediaries must work together, or be “interoperable”, so that the charged impulses travel in a secure, coordinated manner all the way to their intended destination.

In this scenario the imaginary national health IT nervous system is analogous to the real-life health IT infrastructure being developed at the national and state levels through National Health Information Network (NHIN) Direct project and the State Health Information Exchange (HIE) Cooperative Program.   The charged impulses represent each patient’s electronic health information.  The axons represent each physician’s cable to the Internet.   The gap or synapse represents the present-day constraints on our ability to send and receive electronic health information to one another.   The trusted intermediaries represent local health information exchanges (local HIEs) and health information service providers (HISPs) that allow each physician’s axon to communicate through the Internet with axons from other physicians and hospitals.  The interoperability needed among all parts of the virtual health IT nervous system is analogous to the interoperability needed among all parts of the real-life health IT infrastructure including EHRs, local HIEs and HISPs.

The Nationwide Health Information Network (NHIN), through the NHIN Direct project, defines standards, services and policies at a national level for health IT interoperability.  At the core of NHIN Direct are trusted intermediaries that physicians can connect to in order to allow electronic health information to traverse the synapses between their axons and those from other physicians and hospitals.   These trusted entities are called health information service providers (HISPs). HISPs are able to authenticate the senders and recipients of electronic health information.   This provides verification regarding who really sent information and who really received it while also maintaining privacy and security while the data passes across the axonal synapses.

The Office of National Coordinator for Health IT (ONC) is making an effort to trickle down NHIN Direct standards and protocols to each state.   Through the State HIE Cooperative Program, ONC grants funds to states who submit plans to build statewide health IT infrastructure to support interoperable health information exchange.   In order to be funded the states must adhere to NHIN Direct standards.

For example, the Texas Health Services Authority (THSA) is using the grant funds to serve as a statewide convening entity that has gained consensus from a broad base of healthcare stakeholders on a three-pronged strategic plan for HIE in Texas:

  1. Local HIE Program— Local HIEs are another type of trusted intermediaries, like HISPs, that physicians can connect to in order to allow electronic health information to pass across the synapse to the axons of other physicians, labs, radiology centers, hospitals or others with electronic health information. Twelve local HIEs were launched in 2011-2012 with partial funding through the THSA’s Local HIE Grant Program. Some are currently operational and actively providing HIE connectivity to physicians and hospitals in their area 
  2. State-level IT infrastructure and services—The goal is to develop statewide infrastructure and services that can be used by local HIEs to help them provide HIE services locally as well as to enable exchange of data from one HIE to another (statewide HIE services); also to support a transparent governance structure and develop policies and strategies that guide maturation of statewide health IT infrastructure
  3. “White Space” initiative—The goal is to make available basic health information exchange services to physicians and hospitals in regions of the state without local HIEs (the “white space”) by creating a marketplace of health information service providers (HISPs); physicians can apply for “vouchers” from THSA to offset the initial costs of connecting with the HISP they select.
Physicians should stay abreast of health IT interoperability efforts like these, especially those in their own communities like the local HIE efforts in Texas.  Physician input and involvement in these initiatives helps ensure health IT is spliced into the healthcare industry's genome in way that promotes high quality care.

CMS Decision on ICD-10 Spurns Optional Path to ICD-11 Without Comparing Value

 

"The decision to mandate ICD-10 for covered entities has already been made."  

This response in the ICD-10 final rule published last Friday by the Department of Health and Human Services (HHS) bluntly spurns the option of foregoing ICD-10 to implement ICD-11.   HHS predictably argues that the considerable investments already made by healthcare organizations into ICD-10, the years of rulemaking with previous analyses of ICD-10 value/costs and the "uncertainties" over the timeline and value of ICD-11 all justify a decision to eliminate ICD-11 as an option.  

I am disappointed that HHS made no estimates on the comparative value of ICD-10 to ICD-11.   Instead of comparing the total cost of proceeding with ICD-10 and then implementing ICD-11 to the total cost of foregoing ICD-10 to implement ICD-11, HHS candidly explains that "we do not participate in this debate in this rule, except to say that we are convinced of the benefit of ICD-10 to health care delivery in this country."  There clearly was no intent to revisit a previous decision to implement ICD-10, even though there is an opportunity to gather and analyze new information to assure we make an informed decision on the optimal pathway to an inevitable ICD-11 implementation. 

The final rule dismisses the call from several commenters on the proposed rule for an analysis of the total costs of the two pathways to an ICD-11 implementation.   One argument made against such an analysis is that the "the disruption and costs of transitioning to ICD-11 are highly unlikely to be less those of transitioning to ICD-10."  I agree that each individual implementation may have comparable costs, but that does not compare the cost of the two pathways which are: 

  1. Implement ICD-10, then implement ICD-11 (two complete implementations)
  2. Forego ICD-10 to implement ICD-11 (one implementation + sunken ICD-10 investments)

What is the comparable cost of each pathway? A comparison of the cost and benefits could have a significant impact on the decision.  Let's learn from this for next time. 

By the way, there will soon be a next time.  I fear that this decision locks the U.S. into another cycle of the same-- using a diagnosis coding system that rapidly becomes archaic and leads to another decade of desperate efforts into the 2030s to upgrade after the rest of the world has already transitioned to ICD-11.

I also fear that that the burden will be excessive on healthcare organizations in 2014 to implement ICD-10 and meet the 2014 Stage 2 Meaningful Use requirements which were both announced by CMS this week.   This burden will be greatest on the small, individual physician practices are already throttled by meaningful use, 5010, e-prescribing and healthcare reform.  They are struggling to find the time and resources for the ICD-10 effort. Since the EHR Incentive Program has a specified timeline under ARRA, I believe this excessive burden is likely to trigger another delay of ICD-10, at least for small physician practices.  

Will we be left wondering why we didn't just stop investing in ICD-10 back in 2012?


Keep the data collection cart behind the trailblazing horse

In today's Health IT News there is an article expressing dissappointment with the recently released proposed rules for Stage 2 of the Electronic Health Record (EHR) Incentive Program.   Some alarming viewpoints are evident in this article regarding the collection of data for use by the federal government to improve public health .

The proposed rule for Meaningful Use Stage 2 on page 13702-13703 specifically states that the purpose of Stage 2 Meaningful use is to "“encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible”.    No where in the rule does it state that the primary purpose of Stage 2 Meaningful Use is to collect data for use by the federal government as is suggested by concerns expressed in this article.   Let's keep the data collection cart behind the trailblazing horse so that it does not aimlessly roll down the steepest part of the hill instead of steering toward most beneficial path.   Stage 2 objectives draw a sensible roadmap to the next planned destination where we can finally begin realizing the maximum potential value of health IT and EHRs.   We currently have the horse trotting around potholes toward the widespread adoption and successful use of EHRs, the development of robust HIE networks, the maturation of EHR product functionalities and an improved understanding of safe EHR usage.   If we fail to align Stage 2 activities with Stage 2 goals by taking unplanned shortcuts to collect and use data in hopes of improving care now, I fear the cart will crash and cripple the momentum that Stage 1 has initiated.


Healthcare Industry's Triple Strand of DNA: health IT, payment reform and patient empowerment

Earlier this month I used a genetics anology to describe the amazing progress with electronic health record (EHR) usage by physicians over the past two years (see Progress being made to splice information technology into the healthcare industry's genome in Texas).   Facilitating this progress are the EHR Incentive Program and other federal health IT initiatives that the Office of the National Coordinator for Health IT (ONC) oversees. 

Last Thursday the National Coordinator of ONC, Dr. Farzad Mostashari, took my genetics analogy one step further in his keynote speech at the HIMSS12 Annual  Conference for health IT in Las Vegas.   And I have to admit that he improved upon it.  I guess that's why he's in Washington D.C. and I'm not. 

Dr. Mostashari warned the 36,000  conference attendees that along with this continued progress there are two other societal trends to align health IT with.   He advocated for "twisting health IT to create a triple strand of DNA" with payment reform and patient empowerment. 

Health IT, payment reform and patient empowerment.  The triple strand of DNA to splice into the healthcare industry.  I like that. 

Payment reform is seriously needed to align incentives with the provision of quality care in an efficient manner.   Right now I am basically paid to "encounter" patients and to do procedures.       Although I am personally motivated to provide high quality care, the incentives are oddly there for physicians to "see more" and "do more" rather than to "see it done best".     In addition, my documentation is based on meeting reimbursement rules to make sure I get paid rather than being based on communicating a clear picture of my findings and care plan.   I absorb the extra time it takes to do both.

Consequently it is no surprise that for decades EHR vendors developed products based on episodic care.    Physician's sought out products that would help them document and get paid for patient encounters.  Documentation templates and charge capture functionalities were developed to maximize chances for reimbursement.    

The potential for EHRs to improve quality and chronic disease management is just now starting to be realized.    The ONC's health IT initiatives enacted by CMS under the HITECH portion of the 2009 Recovery Act are providing the push.   But as payment reform proceeds, whether it be value-based purchasing, accountable care or some other program, EHR vendors will be incentivized even more to shift development efforts into chronic disease management and clinical decision support that are a basis for improving patient care. 

And the third strand of DNA to splice into the healthcare industry, patient empowerment, is indeed an active and growing societal influence.  But I will have to blog about that another day...


Progress being made to splice information technology into the healthcare industry's genome in Texas

It's amazing-the progress being made to splice information technology into the health care industry's genome.   When I first dove into health IT a decade ago the use of electronic health records (EHRs) was dismal and healthcare stakeholders rarely sat at the same table with mutually beneficial, collaborative objectives in mind.   Even within the same healthcare organization it was not uncommon for individual department leaders to disrupt an integrated health IT effort in order to protect some of their department's self-interests.   Less than 5% of hospitals had implemented fully functional computerized provider order management (CPOM) systems; less than 1 in 5 physicians were using an ambulatory EHR; and less than 5% of those were fully functional EHRs.    Today the percentage of physicians and hospitals using robust EHRs is rising at a rate that was unthinkable back then.  

This progress parallels the launch of health IT initiatives established through the federal HITECH funds such as the EHR Incentive Program.   In the past two years these funds have been a catalyst here in Texas to engage diverse groups of healthcare stakeholders  to use health IT to improve quality of care.   As a result:  

  • Increasing numbers of Texas physicians are using EHRs (approaching 50%)
  • More and more hospitals are using CPOM
  • Over a dozen of community-wide health information exchanges (HIEs) are up and running
  • New health IT workforce training programs are established
  • Four regional extension centers were formed covering all geographic areas of the state and are doing a phenomenal job assisting thousands of physicians with EHR selection, implementation and meaningful use
  • Texas became the first state to have it’s HIE plan approved by ONC
  • Texas was one of the first states to stand up the Medicaid EHR incentive program making our program a model for other states
  • Texas was one of four to receive a SHARP grant
  • And Texas leads the way with the number of physicians attesting to meaningful use; Texas physicians and hospitals have received over $270 Million in EHR incentives

This rate of progress is only possible when individuals with diverse backgrounds and from different healthcare stakeholder groups are able to collaborate.  In Texas these stakeholders have demonstrated an ability to park their self-interests in order to drive forward with a common vision to improve the quality and delivery of patient care in our communities.