EHR Technology – Highlights And Reaction To The Final Rule For Stage 2 Meaningful Use

The Centers for Medicare and Medicaid (CMS) and the Office of the National Coordinator for Health IT (ONC) released the final rule for Stage 2 Meaningful Use on Thursday, August 23, 2012. The final rule for Stage 2 Meaningful Use defines the requirements that both hospitals and eligible healthcare providers must meet in order to continue to qualify and receive payments under the Medicare and Medicaid electronic health records (EHR) incentive programs.

The Medicare and Medicaid EHR Incentive Programs are in place to promote and expand the meaningful use of certified EHR technology which is one important component of a broader national strategy to deploy health information technology infrastructures throughout the entire ambulatory and hospital healthcare system of the United States. This aggressive health IT strategy is critical to successfully reforming our healthcare system which will eventually lead to improving operational efficiency of medical organizations and patient care quality, safety, and outcomes.

Prior to the release of the final rule for Stage 2 Meaningful Use, CMS first posted its proposed rule for Stage 2 in the Federal Register on March 7, 2012. This action opened the sixty day public commentary period that allowed interested parties and individuals to submit comments, challenges, or concerns regarding any portion of the proposed rule. According to the Stage 2 final rule, approximately six thousand one hundred items of timely correspondence was received prior to the May 6, 2012 submission deadline. CMS and the ONC have included summaries of the timely public comments that were within scope of the Stage 2 proposed rule throughout the final rule document.

Key highlights of the final rule for Stage 2 Meaningful Use:

1. Stage 2 attestations start in 2014 – The meaningful use final rule for Stage 1 established an original timeline that would have required eligible providers enrolled in the Medicare EHR Incentive Program who attested to meeting meaningful use in 2011 to meet Stage 2 requirements in 2013. Now under the final rule for Stage 2, any eligible provider that attested to Stage 1 of meaningful use in 2011 will now attest to Stage 2 requirements starting in 2014. This significant change provides more flexibility and allows both eligible providers and certified EHR vendors more time to upgrade EHR systems to the 2014 edition. CMS and the ONC have also published the criteria in the final rule that EHR systems must meet in order to achieve or maintain their ONC-ATCB certification for Stage 2.

2. Changes to Stage 1 and introduction of new objectives and measures in Stage 2 – In the final rule for Stage 2, CMS and the ONC has maintained the same core-menu structure found in Stage 1. In Stage 2, there are a total of twenty measures that eligible providers must meet or qualify for exclusion to seventeen core objectives and three of six menu objectives. For eligible hospitals and critical access hospitals (CAHs), there are a total of nineteen measures they must meet or qualify for exclusion to sixteen core objectives and three of six menu objectives. The final rule has added the “outpatient lab reporting” to the menu for hospitals and CAHs and “recording clinical notes” as a menu item for both hospitals and eligible providers.

Also, the “exchange of key clinical information” core objective from Stage 1 has been replaced with the more robust “transitions of care” core objective in Stage 2, and the “provide patients with an electronic copy of their health information” objective from Stage 1 was eliminated in favor of the new “online, download, and transmit” core objective in Stage 2.

The final rule for Stage 2 also introduces two new core objectives. For eligible providers, the new core objective is “use secure electronic messaging to communicate with patients on relevant health information” and for hospitals and CAH’s, the new core objective is “automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).”

One significant policy change to Stage 1 effective as of 2014 is eligible providers, hospitals, and CAHs that meet an exclusion for a menu set objective does not count towards the number of menu set objectives that must be satisfied to meet meaningful use.

3. Streamlined Group Practice Reporting – The final rule will now allow group practices to batch and submit meaningful use attestation data, for all of their individual eligible providers, in one file.

4. Process for Medicare Payment Adjustments – The final rule has defined the process that will determine whether an eligible provider, hospital, or CAH will experience a Medicare payment adjustment. All future imposed Medicare payment adjustments will be determined by an EHR reporting period prior to the required statute taking effect in 2015. The final rule states that any Medicare eligible or hospital that demonstrates meaningful use in 2013 will not be imposed a payment adjustment in 2015. Furthermore, a Medicare provider that first demonstrates meaningful use in 2014 will not be imposed a payment reduction penalty as long as they successfully register for the EHR Incentive Program and attest to meaningful use by July 1, 2014 for eligible hospitals or October 1, 2014 for eligible providers.

In the final rule, CMS defines four specific categories of hardship exceptions for eligible providers to avoid a Medicare payment adjustment penalty and they are: New Eligible Providers, Infrastructure Barriers, Unforeseen Circumstances, and Specific Specialist/Provider Type that includes radiology, anesthesiology, and pathology.

For the most part, initial reactions by several healthcare associations regarding the final rule for Stage 2 Meaningful Use were quite favorable.

The Medical Group Management Association (MGMA) expressed that they were overall pleased with final rule specifically noting the change that allows groups to report batch information for certain measures that now removes the administrative burden on eligible professionals. They also expressed satisfaction with the threshold decrease of providing online access for the patient to get a hold of their medical records from the proposed ten percent down to five percent in the final rule. While the MGMA welcomed the decrease, they went on to express that this requirement continues to present a number of challenges to providers including the cost to integrate an online portal and the reliance on patients to use it.

The American Health Information Management Association (AHIMA) expressed that they were happy to see CMS acknowledge and continue to make efforts to align meaningful use quality reporting requirements with other quality reporting systems in order to reduce duplication and reporting challenges. The AHIMA also shared that this reporting alignment will drive efficiency and reduce cost over time. Both the MGMA and AHIMA were also glad to see that the Stage 2 Meaningful Use requirements will begin in 2014, as opposed to the proposed starting date of 2013.

On the other hand, the American Hospital Association (AHA) expressed concern about the timeline providers have to meet the Stage 2 requirements. The AHA believes that the final rule sets an unrealistic date by which hospitals must attest to initial meaningful use requirements to avoid financial penalties. They also went on record to say that the final rule makes the reporting of clinical quality measures more complicated and the addition of new meaningful use objectives has created new burdens for hospitals.

In conclusion, the journey to digitize the healthcare system of the U.S. requires all stakeholders to effectively managing change while navigating a very long and winding road. The fact is EHR adoption along with meeting all of the requirements for Stage 2 Meaningful Use is not going to be easy and not everyone will be in agreement with the final rule. However, the time will come when the efforts of today will lead to a more robust coordination of patient care, eliminate redundant screenings and tests, reduce medical errors, reduce healthcare costs, and foster improved patient engagement and outcomes in the near future.

Finding Real Health in a World of Artificial Food

Remember the days when we shopped in food markets no bigger than a convenience store? They were full of locally grown fresh fruits and vegetables, meat, nuts, beans, and grains. Markets back then had only a couple shelves that were stocked with non-perishable foods.

Today, it’s the opposite. We now have supermarkets that are predominantly stocked with non-perishable food items that can sit on a shelf for years. They are called “processed foods.” There are many reasons why this shift has taken place, but the real concern is, how do we now maneuver through a world full of artificial food? That’s a valid concern, so hopefully the following information will help you sift through this confusing world of food sources

Processed Food

Most processed foods are actually not real food at all. Real food is alive, and will spoil. Processed foods may include a few “real food” ingredients; however those items have been processed in order to give it a profitable shelf life – which ultimately reduces it from a living food, to a dead food. Dead food can sit on a shelf for a long time.

Addictive Food

Many manufacturers add addictive chemicals to their processed foods in order to cause cravings and hook us into consuming their product more frequently; therefore driving up their profits. I read years ago about MSG’s hallucinogenic effects that cause us to crave the food that is laced with MSG. These chemicals get lost in the huge list of ingredients. Many times people will eat the food and ignore the dangers. Usually they just don’t want to, or don’t have the time to investigate every ingredient. They are driven by their appetite and cravings because the last time they ate the food it gave them great enjoyment. But as we know, just because something was enjoyable, does not mean that it was safe.

Fortified and Enriched Food

Fortified and enriched foods typically originate as real food, however with the healthiest part removed; either purposely removed, or destroyed during the processing stage. This is done to give the product a long and profitable shelf-life. Unfortunately, the part that spoils is the part that contains the greatest health benefits. Adding synthetic vitamins, minerals, and fiber back into the product does not make up for the lost natural nutrition. It simply makes the product look better. Again, this reduces the real food to artificial food – dead food.

Here’s an interesting fact about fortified foods. If the manufacturer does not complete step 2, by injecting artificial nutrition back into the item, then it cannot be sold in a grocery store. A pharmacist told me years ago that it’s illegal to sell this kind of product in a grocery store because it’s not really food! Without being “fortified” with artificial nutrients it could only be sold in a drug store. Remember, our bodies are alive, and they require food that’s alive – in order to remain alive!

Real Food

Real food is grown from the earth. Fruits, vegetables, grains, lentils, seeds, and nuts are loaded with vitamins and minerals, natural medicine (phytochemicals), and energy; and are alive and full of remarkable components that keep us alive and healthy. You can never go wrong with living food choices. Living food has the right amount of fiber, as well as vitamins and minerals perfectly combined to work synergistically together. Living food has protein, carbohydrates, and fats balanced to compliment your body’s needs, and phytochemical medicines that fight the daily bugs and chemicals of life. With living food, there is no need to count carbs, omit fats, or double up on protein. The work has already been done for us. It’s been created to perfectly match our body’s needs. Eating real food is like inserting a square peg, into a square hole. It fits.

Furthermore, living food tastes great! If you remove artificial food sources from your diet, your taste buds will begin to detox and return to normal sensitivity. When that happens, you will find that artificial food tastes artificial and real food tastes marvelous!

What about animal protein? Animal protein is considered real food, but not living food. The purpose of animal protein is for our protein needs. Animal protein does not supply us with vitamins, minerals, or natural medicine. However, lean animal proteins can be very helpful for those who require more protein. Be aware though that animal fat and any chemicals or hormones that the animal is fed can be harmful to you. Choose animal proteins carefully and limit your intake.

So how do we maneuver in this world of artificial food? We’ve been conditioned to believe that we can solve this problem by simply reading the ingredient list and being aware of what we are eating. I don’t agree with this method. We can spend countless hours in our life reading words we don’t know, then Googling them to decide whether they are good or bad. Even then, we cannot be sure that what we are reading on the internet is true. The internet is full of opinions, sales pitches, and tainted studies. A person can go mad trying to follow all the internet health rules!

Why do we need to know all of the technical verbiage on an ingredient list anyway? After all, when a manufacturer sees that the public is catching on to their unhealthy ingredients and processing techniques, they simply change the names, which can send us back into the Google trap again or frustrate us to the point where we give up. So how do we get out of this bondage?

There are two ways to deal with this confusing issue. We can throw our hands up and say “Whatever, it’s too hard; I’m just going to eat what I want.” Or we can take what I think is an easier route and a healthier route, not only for ourselves but also for our families.

I learned long ago that the best way to identify a counterfeit is NOT to study the counterfeit, but to study the real thing. When you know what real food is, you know when it’s NOT on an ingredient list. So I tell my clients not to READ the ingredient list, but instead, sift through it. Look for the words you know, like “chicken,” “black beans,” “carrots,” etc. Then choose foods with ingredient lists that are clearly identified as 90 to 100% real food – preferably 100%. Keep in mind that 100% food may not even have an ingredient list, and if it did there would be only 1 ingredient!

Every day we are faced with tempting and unhealthy choices. Choose today to become proactive for your health and the health of your family. Here are a few tips to propel you in the right direction:

1. Use your valuable time to study real food, not the counterfeit.

2. Sift through ingredient lists to find real food.

3. Choose food items that are 90% to 100% real food.

4. Put dead food back on the shelf. Don’t spend your hard-earned money on something dead.

5. Plan ahead and prepare your meals.

6. Investing a little time now saves a tremendous amount of time, money, and pain later.

7. Don’t expect to get it right all the time. Simply aim for getting it right more times than wrong.

8. It’s not about perfection, it’s about perseverance!

Just my 2 cents! Bon appétit!

Five Penis Health Rules for a Better Appearance and Improved Sensation

As most men will agree, their penis is one of their most important assets, and caring for this essential equipment is a top priority. The bad news is that, aside from the need to wear a raincoat for each and every one of those steamy encounters, most men aren’t fully aware of all the important steps required to maintain optimum penis health and performance, but these guidelines for penis care can help.

1) Choose a healthy diet. Yes, may be boring to listen to yet another sermon about the need to follow a healthy, nutritious diet, but in truth, we really are what we eat, and what a man puts into his body has a huge effect on his energy levels, his overall health, and his mental and emotional state – and of course, on his ability to perform. A diet that is high in unhealthy fats, salt, and processed/fast foods just does not provide the nutrients that are needed for the body to function at its prime, and it can leave a man feeling bloated, fatigued and generally un-ready for any potential bedroom action. Over the long term, the cardiovascular effects of a poor diet can damage his ability to perform at all.

It is not necessary (and in fact it may be harmful) to follow the latest fad diet craze, but following the FDA guidelines for nutrition is always a good place to start. Men should work with their doctors to determine their daily calorie requirements and then focus on fresh, whole, unprocessed foods like fruits, vegetables, whole grains, lean protein, dairy products and heart-healthy fats.

2) Quit smoking. Few lifestyle choices are as damaging to the human body as use of tobacco products, especially those that are smoked. Smoking damages the heart, lungs, circulatory tissue, and nerves. It reduces a man’s energy levels and stamina, it gives him bad breath, and it can even shrink the penis. Quitting can improve essentially every aspect of a man’s life, including his sex life, so there really is no down side here.

3) Use a sunscreen. Yes, a sunscreen, even down there. The UV rays from the sun don’t just age the face and other exposed areas of the body. Clothing provides something of a cover, but it does not block all of the damaging rays from the sun. Applying a sunscreen to the area when spending any length of time outdoors, especially at the beach or another open area, is a good idea; it can reduce the risk of skin cancer later on, and it can also diminish the aging effects that can cause wrinkled, dry-looking skin.

4) Hydrate, hydrate, hydrate. All of the cells of the body need enough water to carry out their specialized functions, including those of the penis. In addition, consuming enough water can prevent the skin from appearing dry, brittle or saggy. Make sure to drink at least the full 8 glasses of day that are recommended.

5) Use a penis health cream. The average male may be puzzled by the amount of money that a woman is willing to shell out on skin care products. On the other hand, if he takes the time to think about how much he enjoys her soft, radiant skin, it might become clear that she’s actually onto something here. The good news for men is that these products aren’t all made for women, and they are not all intended for use on the face, neck, and hands.

In fact, regular use of a top-drawer penis health crème (health professionals recommend Man1 Man Oil) can visibly improve the tone and texture of the penile skin; and this softer skin is often more responsive to sensual stimulation. Adding a cream like this to his daily personal care routine is an excellent way to support healthier, more youthful penile skin.

Rule of Universal Harmony

Andrea Bocelli’s CD, Romanza, was playing on my car stereo. But, I wasn’t following the rule to listen. Because I was driving in hectic traffic, I was concentrating on following the rules of the road. Sure enough, the traffic light ahead turned yellow, I slowed down and followed the rule to stop. The light turned red. I waited. Traffic passed in front of me until the traffic light again turned green. However, instead of following the rule to go, an intuition told me to pause. I looked to my left in time to see a car speed by in front of me. Whether the driver was oblivious to the rules of the road, or in a BIG hurry, didn’t really matter to me. I was glad my car didn’t get side swept. It was another example of the rule of universal harmony in effect.

I learned about universal harmony from Science and Health, written by Mary Baker Eddy in the 19th century. From the revision 21st Century Science and Health, we read, “Let us prepare for the supremacy of Spirit, the kingdom of heaven-the government and law of universal harmony, which cannot be lost or remain forever unseen.” Universal harmony is a rule we can be aware of.

As it is, the plethora of human rules, to listen, to stop, to go, to wait, to put the toilet seat down, are capricious. Human rules contradict one another quite often. One rule could be good in situation A, but the same rule could cause problems in situation B. It is all very tiring. However, instead of being robots, following rules, rules, rules, humanity is experiencing the law of universal harmony through knowledge, or awareness of Spirit and spirituality.

It is being acknowledged that we don’t have to insist on having our own mind, or our own troublesome ego. We can loosen up and see ourselves as antennas, so to speak. This framework allows us the ability to tap into divine Spirit and its rule of universal harmony on earth. It also might explain why our sophisticated technology can’t detect mind, or ego, in the brain.

Antennas pick up on signals, frequencies, or even smells. However, if we are only tuned into human rules and signals, alas, smashing melodrama is the norm. On the other hand, if we consciously pick up on the guidance of divine Spirit, the human rules of chaos, accidents, and confusion are defied.

I’ve also noticed to be true concerning physical health. Universal harmony has a rule of secure health that defies the human rule of vulnerable health. For example, years ago, I was in the house and felt the flu come on full force. Nausea and fever hit me so quick I was on the floor sweating and miserable. After a few moments I called a Christian Science Practitioner to pray for me and then made my way into bed. Within 24 minutes I felt all the symptoms of illness palpably release from my body. I called it the 24 minute flu, but in reality, our affirmation of universal harmony, which includes secure health, presented a healthy mind/body/spirit.

Human rules are necessary, however, it is our right to increase our spiritual knowledge and take a stand for the fact that those human rules conform to divine rules. Rules of universal harmony can be manifest. I can pause patiently at a green light. I can forgive the oblivious driver. I can accept other people’s forgiveness of me when I am in a hurry. Also, health can be contagious. Spiritual healing can be the norm. Universal harmony is ours.