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Archive for the ‘Electronic Health Records’ Category

HHS Secretary Announces Delay of ICD-10 until October 1, 2014

In a new press release from the Centers for Medicare & Medicaid Services (CMS), HHS Secretary Kathleen Sebelius announced a proposed rule that would delay the compliance date for ICD-10 from October 1, 2013 to October 1, 2014. The ICD-10 compliance date change and proposed rule would adopt a standard for a unique health plan identifier (HPID), adopt a data element that would serve as an “other entity” identifier (OEID), and add a National Provider Identifier (NPI) requirement. The proposed rule was developed by the Office of E-Health Standards and Services (OESS) as part of its ongoing role, delegated by HHS, to establish standards for electronic health care transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Additional details about the proposed rule may be found on the CMS ICD-10 fact sheet.

The proposed changes would save the health care industry up to $4.6 billion over ten years by enabling greater automation of electronic health care transactions, in turn helping physicians spend less time interacting with health plans, and more time with patients. The proposed rule would implement several administrative simplification provisions of the Affordable Care Act. The proposed rule also would delay by one year, until Oct. 1, 2014, the date by which covered entities must comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10). Covered entities are defined in HIPAA as (1) health plans, (2) health care clearinghouses, and (3) health care providers who electronically transmit any health information in connection with a transaction for which HHS has adopted a standard.

Some provider groups have expressed serious concerns about their ability to meet the October 1, 2013 compliance date. CMS and HHS believe the change in the compliance date for ICD-10, as proposed in this rule, would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition among all industry segments. Please visit the ICD-10 web site for the latest news and resources to help you prepare for a smooth transition!

Proposed Rule for Stage 2 Meaningful Use Posted to the Federal Register

The Notice of Proposed Rulemaking (NPRM) for Stage 2 meaningful use was posted to the Office of the Federal Register today. The proposed rule outlines the next stage of meaningful use for the Electronic Health Record (EHR) Incentive Programs, administered by the Centers for Medicare & Medicaid Services (CMS). CMS has developed a fact sheet to give providers an overview of the rule and how Stage 2 expands upon Stage 1 of meaningful use. Additional information about meaningful use is available on the CMS EHR Meaningful Use Overview web page.

NLM’s 175th Anniversary: Reflections from the Director

U.S. Medicine is a publication serving healthcare professionals working in the Department of Veterans Affairs, Department of Defense and U.S. Public Health Service. It provides a mix of news, medical updates, interviews, reports on special government topics and monthly columns. In the recently published special issue, This Year in Federal Medicine – Outlook 2012, National Library of Medicine Director Dr. Donald A.B. Lindberg, MD, took the opportunity to acknowledge and celebrate NLM’s 175 years of public service, and to look ahead to 2012 and beyond. He began by reviewing the enormous amount of electronic information generated through resources such as PubMed and MedlinePlus. He also acknowledged the role of the National Network of Libraries of Medicine in promoting access to health information throughout the U.S., and the support and training that NLM provides in the areas of biomedical informatics and health information technology. Dr. Lindberg also addressed the emerging opportunities to link NLM’s health information resources with electronic health records. Even though Dr. Lindberg expects budgetary challenges for NLM in 2012 and beyond, his outlook for the future remains very positive, as he envisions that NLM’s range of services will continue to expand into new areas of biomedical research and health care.

Specific themes mentioned by Dr. Lindberg in his future outlook include the continuing growth of NLM resources, such as PubMed/MEDLINE, PubMed Central, and ClinicalTrials.gov. In addition, several new NLM resources will be released in 2012, including a Genetic Testing Registry and a database of clinical significant human genetic variants. Dr. Lindberg also expects the continued development of NLM resources related to disaster preparedness, and he noted the recent deployment of these resources in events such as the Gulf Oil Spill, and the earthquake and tsunami in Japan. Dr. Lindberg also expects that NLM will continue to utilize and expand the range of social media tools, mobile applications, and mobile versions of its resources to reach new and diverse audiences with high quality health information. He mentioned the impressive array of social media currently used by NLM, including 13 Twitter feeds, notably @medlineplus and the Spanish-language version @medlineplusesp, six Facebook pages and a new YouTube channel. The full text of Dr. Lindberg’s remarks is available on the U.S. Medicine web site.

New Health Information Technology (HIT) Resource Targets Rural Health Providers

A new Health Information Technology Toolkit will serve as a pilot program for providing health information technology (HIT) resources to rural health care providers. The toolkit, developed by the Rural Assistance Center (RAC) and the National Rural Health Resource Center (The Center) is designed to help rural providers find resources for HIT, electronic health records (EHR), meaningful use and related topics. Funding for the toolkit is provided by the federal Office of Rural Health Policy (ORHP). This toolkit was developed as a result of the President’s Rural Health Initiative, which identifies HIT as a priority. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius established the Rural HIT Taskforce to address challenges rural communities face in adopting HIT and achieving meaningful use. The taskforce offers ways to meet those challenges and show rural communities how to coordinate federal resources. The taskforce is co-chaired by HRSA Administrator Dr. Mary Wakefield and National Coordinator for HIT Dr. Farzad Mostashari.

Using the toolkit, rural communities will be able to address challenges in finding capital funding; provide support to community colleges to enhance training programs; stay informed about legislation affecting EHRs; and leverage multiple federal resources for project development. Toolkit resources provide guidance in the planning, setup, implementation, and operation of an HIT infrastructure. Additional resources provide information about locating training programs, funding support, management expertise, and the meaningful use program. Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Privacy and Security Mobile Device Good Practices Project Launched

The Office of the National Coordinator for Health Information Technology (ONC), Office of the Chief Privacy Officer (OCPO), recently launched a Privacy & Security Mobile Device project, in conjunction with the HHS Office for Civil Rights (OCR). The project goal is to develop an effective and practical way to bring awareness and understanding to those in the clinical sector to help them better secure and protect health information while using mobile devices (e.g., laptops, tablets, and smartphones). Building on the existing HHS HIPAA Security Rule – Remote Use Guidance, the project is designed to identify privacy and security good practices for mobile devices. Identified good practices and use cases will be communicated in plain, practical, and easy to understand language for health care providers, professionals, and other entities.

HHS will be looking for input. There will be a public roundtable event in Spring 2012. Information about other HHS mHealth activities is available on the mHealth Initiative web site.

HHS Announces Changes to Timeline for Meaningful Use

On November 30, 2011, US Department of Health and Human Services Secretary Kathleen Sebelius announced policy changes designed to make it easier for health care providers and hospitals to qualify for meaningful use incentive payments, Modern Healthcare reports. Secretary Sebelius announced the changes during an event at Cuyahoga Community College in Cleveland, Ohio. Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments. Under current regulations, eligible health care providers that attest to Stage 1 of the Medicare EHR incentive program this year would need to meet Stage 2 requirements in 2013. However, health care providers who attest to Stage 1 in 2012 would not need to meet Stage 2 requirements until 2014, but they still would be eligible for the same total incentive payment amount.

To encourage greater participation in the meaningful use program, Secretary Sebelius said that health care providers who meet Stage 1 requirements this year would not need to meet the Stage 2 standards until 2014. According to an HHS statement, “Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.” HHS will launch outreach efforts to inform health care providers and health IT vendors about the policy changes. The agency said it will target outreach, education and training to eligible health care providers that have registered for the Medicare EHR incentive program but have not yet met the meaningful use requirements.

Secretary Sebelius also announced the release of a new Centers for Disease Control survey showing that the percentage of U.S. physicians who have adopted basic EHRs has doubled from 17% in 2008 to 34% in 2011. During the same time period, the percentage of primary care doctors using basic EHRs nearly doubled from 20% to 39%. The survey also found that 52% of office-based U.S. physicians now plan to participate in the meaningful use incentive program.

NLM Announces Enhancement of Drug Naming Standard for Electronic Health Records

The RxNorm standard clinical drug vocabulary produced by the National Library of Medicine (NLM) now contains more accurate and complete connections between National Drug Codes (NDCs) and standard nonproprietary names of medications recommended for use in electronic health records (EHRs). NLM is the world’s largest medical library and a component of the National Institutes of Health. It also includes, for the first time, the complete set of NDCs from Thomson Reuters’ Red Book, a drug database widely used in the health care industry.

NDCs are product identifiers assigned by manufacturers and packagers of drugs in the United States. They are published on medication labels and packages and are often used in pharmacy inventory control and in dispensing and billing for drugs. If a single manufacturer issues the same medication in packages of different sizes (25 tablets, 50 tablets, etc.), each size has a different NDC. If more than one manufacturer produces the same medication, each assigns different NDCs. In contrast, the RxNorm vocabulary creates standard names and identifiers for the combinations of ingredients, strengths, and dose forms (such as Aspirin 325 MG Oral Tablet) that exist in drugs marketed in the United States. This is the information doctors typically include when they write a prescription because they often can’t know the specific product that will be used to fill it. All medication products that contain the same active ingredients, the same strengths, and the same dose forms have the same RxNorm standard name. This standard name is connected to other information in RxNorm that can be used within EHR systems to improve patient safety.

Accurate and complete connections between NDC product codes and RxNorm standard names and identifiers have many potential uses within an individual patient’s EHR. These include the use of an NDC on a medicine bottle to speed standard data entry or to trigger an alert written in the RxNorm standard that could prevent a medication error. At present, there is no single source that contains the NDCs for all medications currently marketed in the United States. RxNorm has included NDCs provided by the Food and Drug Administration, the Department of Veterans Affairs, and the Multum and Gold Standard drug information sources for a number of years. Starting with the Feb. 7, 2011 release, RxNorm included a revised, filtered version of the NDC data that segregates obsolete NDCs from those currently in the marketplace. It also included First DataBank’s set of NDCs. Since August of 2011, it has included the NDCs from Red Book. Other useful data that Red Book is providing to RxNorm includes better linkages between branded drugs and their NDCs, information about whether or not drugs are still on the market, and Drug Enforcement Agency Class for controlled drugs. This additional information is instrumental in the production of the Current Prescribable Subset of RxNorm.

In a recently published study sponsored by the Centers for Medicare & Medicaid Services and performed by the RAND Corporation and others, RxNorm was found to have entries for essentially all of the drugs in a sample of 19,743 ambulatory e-prescriptions (electronic prescriptions for patients seen in clinics or physician offices). Some e-prescriptions in the study sample failed to match automatically to an NDC in RxNorm, however. A more complete set of NDCs is likely to eliminate this gap.

For more information about RxNorm, visit the NLM News Release and the NLM UMLS website.

NLM and Department of Veterans Affairs Launch Online Registry of Biomedical Informatics Tools (ORBIT)

The widespread adoption of electronic medical records makes it possible to more effectively learn from and improve clinical care. A significant challenge is the development and wide spread diffusion of tools that make it possible to aggregate, structure, and analyze medical record data.

The National Library of Medicine (NLM), a significant producer of such tools and a component of the National Institutes of Health, has partnered with the Department of Veterans Affairs Office of Research and Development and the American Medical Informatics Association’s Natural Language Processing Working Group to launch the Online Registry of Biomedical Informatics Tools Project.

This online catalog was designed to facilitate easier location of available software tools and related resources that can be used to turn medical data into valuable information. Examples of these resources include natural language processing software, knowledge bases, ontologies, and controlled vocabularies, machine learning and data mining software, and visualization tools.

Users of ORBIT can:

  • Contribute information about resources;
  • Add comments, questions, & ratings about resources;
  • Follow resources of interest, receiving notification when any changes are made to resource pages;
  • Search by any number of fields including institution, resource type, programming languages, etc.;
  • Link to code repositories hosting resources, home institutions of resources, etc.; and
  • Share discovered resources with others easily through email or any one of dozens of social networking sites.

To learn more, please visit the Online Registry of Biomedical Informatics Tools (ORBIT) website and the ORBIT About Us webpage.

MedlinePlus Connect Responds to More Problem Codes

MedlinePlus Connect now delivers targeted consumer health information in response to even more problem codes! MedlinePlus Connect coverage has expanded to include the descendants of the SNOMED CT CORE Problem List Subset. Previously, the focus was on the CORE Problem Subset codes only. This expanded coverage has doubled MedlinePlus Connect’s coverage of SNOMED CT codes. Coverage of ICD-9-CM continues to grow, and MedlinePlus Connect will support ICD-10-CM in the future.

MedlinePlus Connect is a free service of the National Library of Medicine (NLM), National Institutes of Health (NIH), and the Department of Health and Human Services (HHS). This service allows health organizations and health IT providers to link patient portals and electronic health record (EHR) systems to MedlinePlus, an authoritative up-to-date health information resource for patients, families, and health care providers. MedlinePlus Connect accepts requests for information on diagnoses (problem codes), medications, and lab tests, and returns related MedlinePlus information.

Don’t hesitate to let the MedlinePlus Connect team or the PSRML know if you have any questions about MedlinePlus Connect. Also, please let MedlinePlus Connect team know if you’d like your company or organization to be added to the MedlinePlus Connect sample users list.

Enhanced MedlinePlus Connect Web Service Response

Today the National Library of Medicine (NLM) enhanced the MedlinePlus Connect Web service for problem/diagnosis codes by adding selected links to related information for patients to the XML response. Here’s an example of how these links appear for ICD-9-CM code 493.22 in the Web service response XML. The links appear beneath the topic summary, in bulleted list format. You can see responses for other problem/diagnosis codes by visiting the MedlinePlus Connect Web service demonstration page.

Prior to this release, MedlinePlus Connect returned these selected links via the Web application response but not in the Web service response. This change applies to both English and Spanish responses for ICD-9-CM and SNOMED CT requests.

Special Instructions for Current Users of the MedlinePlus Connect Web Service:

In the Web service response XML, the new links appear in the <summary> node within a new unordered list having the class “NLMrelatedLinks”. The impact on applications that utilize the MedlinePlus Connect Web service is that the block of text beneath the summary and summary attribution grows vertically to accommodate the new links in bulleted list format. Users that would like to display this new content do not need to modify their requests to the service in any way. The links are now available in the XML response.

The range of related links associated with health topics in the MedlinePlus Connect Web service response varies from zero to dozens, depending on the health topic. On average, health topics have four to five related links assigned to them. Users may choose to display all of the links or code their applications to only display a certain number of links. As an example, the MedlinePlus Connect Web application response page only displays a maximum of five related links and gives users the option to “see all” to view the entire list. You can see an example of this expandable/collapsible menu formatting on the Web application response page for ICD-9-CM code 493.22.

Users that prefer not to display this new content should consider suppressing the links in the new “NLMrelatedLinks” class through the use of style sheets.

This enhancement only affects the Web service response for problem/diagnosis codes (ICD-9-CM, SNOMED-CT). There are no changes to the Web application response and no changes to the Web service response for lab tests or medications.

If you have questions about this enhancement, please contact the MedlinePlus Connect team.