CareCloud is a cloud based practice management and ehr system that is widely recognized as being one of the best available. This program is changing the landscape of healthcare one practice at a time. Carecloud employs advanced, intuitive technologies that solve the problems other systems have thought to be too small to deal with. CareCloud not only solves the major headaches of systems but also looks at the small things that make a practice run more efficiently and in the end be more profitable.

Schedule a Quick Demo of Carecloud and Find out our love affair is all about.

The heart of the CareCloud Central system is the Dashboard which puts everything at your fingertips. The medical billing and practice management module allows the user to track and manage key practice metrics from their dashboard. This software has all the features and tools needed to manage any size or type of medical practice.

Features

CareCloud Central has a variety of modules to handle many tasks including a Patient Dashboard. Here is where you can view a clinical summary on any patient. You can view demographic information, scan documents and attach notations quickly and easily. The Medical Billing Collections feature allows the user to do payment posting automatically. It has a robust reporting system that can create all types of customized reports.  It is cloud based which means uptime and scalability are easily satisfied.

System Requirements

The only requirement for accessing CareCloud Central is a web browser. It is web based with a user friendly interface with lots of emphasis put on the graphic design of the software. The output is done in Adobe Flash so the interface is very fluid and responsive.  It is built using ruby on rails which is the gold standard right now for web based programs.

Implementation and Deployment

This cloud based software allows patient records to be accessed from anywhere using a web browser. There is no additional software or hardware to purchase. This software can be accessed from all types of mobile devices such as an iPhone or iPad.

Recap

CareCloud is very intuitive and designed to eliminate reduntant time comsuming tasks. It is a monthly subscription solution that is webbased and can be accessed from anywhere through a web browser. The system is fully integrated so the practice workflow runs smoothly and effeciently. All practice and patient documentation can be accessed from the customizable Practice Management Dashboard.

Pros

VERY User Friendly

Web based

Fully Integrated

Innovative Features

90%+ First Time Claim Submission Success

Cloud Based

Cons

Cannot see any at this time except that there is not a ghost program available that would run locally in the event of an internet outage.

My Opinion

CareCloud Central is a powerful cloud based software that has innovative features including an unique electronic reminders system. I was very impressed with all innovate and high tech features this software had to offer. It can used by any type or size medical practice with very little implementation time needed. I would recommend this effective, straightforward medical practice management solution.

athenaClinicals EHR from athenaHealth

athenaClinicals EHR from athenaHealth (http://www.athenahealth.com ) is web based so all information is available to the entire staff. This means the workflow can be measured and monitored by the entire network. This is an integrated solution that allows patient information to be seen at the point of care; plus many other capabilities such as online record keeping.

Features

The athenaClinicals EHR has an innovative five stage patient encounter feature that gives multiple charting options and collects clinical data. AthenaHealth is constantly integrating government mandates and provisions into their software. This is done automatically and with no cost to you. This system allows the entire staff to be able to access patient information and clinical data quickly and efficiently.  The software seamlessly integrates with their billing software which is one of the best in the industry.

System Requirements

athenaClinicals EHR is a hosted web based system that doesn’t require additional hardware. This software is compatible with Windows XP Professional, Vista and Windows 7. It is recommended that Internet Explorer 8 or higher is used. Dragon Naturally Speaking version 9 or higher is also compatible with this software.

Implementation and Deployment

The technical experts at athenaClinicals will assist your practice in implementing and deploying your system. They will assist you with all aspects of setting of the application and training your staff to use it. There are many online resources available for support and training issues.

Recap

The cloud based architecture of athenaClinicals means there is no need for additional servers or maintaining servers. AthenaHealth hosts all data and software in their very secure data centers. All information is contained in a centralized single database including clinical guidelines, payer requirements and government incentive programs. The five stage patient encounter feature optimizes time to make the workflow run smoothly and efficiently.

Pros

Customizable

Innovative features and tools

User Friendly

Excellent billing platform

Integrated EHR/PM

Cons

The EHR is used in conjunction with their billing service which can be costly.  The implementation fees are a little high and billing percentage is not always competitive depending on your practice size.

My Opinion

athenaClinicals is a robust system that is very user friendly. It has drop down menus that are easy to understand and use. I liked the fact that most things were automatically inputted into the chart such as lab results. This is a web hosted product that can be used my any type or size of medical practice or clinic.

NextGen Ambulatory EHR is a complete system that meets the ARRA Meaningful Use criteria. This software has many innovative features and tools, including prebuilt clinical templates for over twenty six specialties. It also has disease management templates that captures patient data at the point of care.

Features

NextGen Ambulatory EHR has multiple integrated modules that assist in documenting patient information. It features an E&M coding calculator to help prevent lost charges and helps to maximize reimbursements. The ePrescribing & Medications module helps to prevent interactions and errors. It automatically checks a patient’s current medications and allergies before it electronically transmits the prescription to the pharmacy. There are a variety of other management features for health maintenance, images and referrals.

System Requirements

System requirements vary depending on the size of your medical practice. The technical experts will assist you in deciding what type of hardware and software is needed for your specific medical practice.

Implementation and Deployment

The experts at NextGen will assist you in planning and preparing for implementation and deployment of your software. They assist you in setting up a system that is designed specifically for your medical practice. NextGen offers many training options and will assign you a customer care specialist. The specialist will assist with support, training and licenses.

Recap

NextGen Ambulatory EHR can be used in hospitals & health systems, group practices and in small practices. The software uses scalable enterprise architecture so hospitals and large multiple location health systems can connect though the system and share patient documentation. NextGen EHR is designed to work in group practices. It allows each physician to have their own workflow and the patient information is stored in a central location. Small practices can also use this software to run their practice efficiently.

Pros

Innovative tools & features

Customizable

Multiple Modules

User Friendly

Cons

Additional licenses and add-ons may increase the cost of the solution.  The overall cost of this EHR solution may be cost prohibitive to smaller practices.  Majority of NextGen clients are using server side hosting as the web based side of this program is not there just yet.

My Opinion

NextGen Ambulatory EHR is a robust system that can be used in hospitals, group practices and in small practices. The interface allows the user to quickly navigate through the entire system. I was impressed will all of the timesaving tools and features. This product is well suited for any type or size of medical practice.

eClinicalWorks EMR (http://www.eclinicalworks.com ) has innovative features and tools to improve efficiency and allow the physician to deliver the best patient care possible. Patient documentation is faster by using the templates, drop down lists and other built-in tools. This software is customizable to accommodate a practice’s workflow.

Features

The design of the eClinicalWorks makes all data and patient information available anytime including test results and medications. This system makes it simple to send and receive information. This software has tools and features for more than forty specialties and sub-specialties. This is a complete EMR system that any type or size of medical practice can benefit from.

System Requirements

The eClinicalWorks is a web-based product. The system requirements will depend which type of software you purchase. You can either have a client server in-house or by SaaS. The application server works with Windows and Linux. It supports both MySQL and SQL server options.

Implementation and Deployment

Since eClinicalWorks is a web based application with state of the art technology, deployment is fast and easy for any size medical practice. There are two implementation models to choose from. It can be deployed via SaaS or on premises using a client server.

Recap

eClinicalWorks uses a single database to hold all patient demographics, billing and claims data. This solution is designed to improve the workflow and can be customized to fit your specific needs. The design and interface makes it easy to navigate through the entire system. The user can mange medications, access labs, and find patient education materials quickly and efficiently.

There are two options when you purchase eClinicalWorks EMR. The first option is the upfront model with annual support and maintenance. The upfront pricing is $7,500 for the first provider and $4,500 for additional full time providers. The second option is a monthly subscription.  This option is $250 per month per provider and includes maintenance and support. You can also have it hosted by eClinicalWorks for an additional fee of $100 per month per provider.

Pros

Customizable

Innovative tools and features

Multiple modules

Cons

The purchase of additional services and software can boost the cost of the solution.  Support is overseas and some providers state feel that there are too many clicks involved in seeing patients.  You also will need infrastructure investment to insure the integrity of the system.

My Opinion

The design and interface of eClinicalWorks is excellent. You can easily navigate through the different modules. It has many innovative tool and features that makes the workflow of a medical practice run efficiently. eClinicalWorks software can be used by any type or size of medical practice. This EMR is user friendly and I would recommend it for anyone looking for an all-in-one solution.

ADP AdvancedMD (www.advancedmd.com ) is an integrated EHR and practice management system that is web based. It is designed to improve revenue capture, reduce errors and to simplify the entire process of managing a medical practice. This software allows all practice and patient information to be seen in a user friendly interface and is compatible with a variety of specialties.

Features

ADP AdvancedMD has many innovative features including a physician dashboard that gives you a customized view of all aspects of your medical practice. It gives the provider easy access to staff and patient scheduling, test results and patient charts. This system includes hundreds of customizable templates that can be used by physician in a variety of specialties. This system makes it easy to navigate through the various features and puts all information at your fingertips.

System Requirements

This software runs best on Microsoft Windows, Internet Explorer and Office. It is recommended that each work station have a Pentium 4 or better processor. Windows 7 and Windows XP business version are supported. Windows Vista is supported but not recommended. You will also need a broadband Internet connection and Internet Explorer is the recommended browser.

This system can also be used with a Tablet PC. For the reports feature you will need Microsoft Word 2007 or 2010 for HCFA claim forms, letters and statements. For exporting reports Microsoft Excel 2007 or 2010 is required and Microsoft Access is needed for the data export feature.

Implementation and Deployment

The experts at AdvancedMD will work closely with you in every step of the implementation process with only a minimal disruption to your medical practice. Each medical practice is assigned a training professional to guide them through the deployment process. They will implement and deploy the system, including electronic data interchange, customizing paperwork and integrating outside suppliers.

Recap

ADP AdvancedMD has an array of innovative tools and features. It has a built in unified messaging system that allows all staff members to communicate easily. The Patient Portal is a secure web based communication system that can be used by the medical staff and patients. It has a robust document and image management system that stores documents, audio, video and images. The pricing varies depending on the size of the practice. This is a complete system that can be used by any type or size of medical practice.

Pros

Excellent design and layout

Innovative technology

Customizable

Cons

Additional add-ons and services may boost the initial cost of the software

My Opinion

ADP AdvancedMD is a complete system that will handle all aspects of patient documentation and practice management. I was impressed with the design of the interface and how easy it was to navigate throughout the different modules. The Physician Dashboard is a great feature that allows the user to have all information at their fingertips. I would recommend this software for any type of specialty and any size of medical practice.

The confidential personal health data of about 1.7 million New York City patients, hospital staffers and others were stolen in December, the city’s Health and Hospitals Corp. reported Friday.

The medical files, which were stored on magnetic data tapes and extend back as long as 20 years were stolen on Dec. 23 from an unlocked vehicle belonging to GRM Information Management Services, the city’s medical-records vendor based in ..

This article proves just how critical it is to know where and how your data is being secured. This also speaks to the point of having a feature like the IPAD has which can wipe data remotely.  I would also argue that many of the ASP hosted EMRs could use this as possible leverage in showing how easy data can be stolen from an office.  All it takes is someone breaking into your office once and stealing your server.  It happens every year all across the country in Medical offices but you just don’t hear about it as much.

Full article link below. Wall Street Journal Article

Request information on Greenway: Free Demo – Free Price Quote

Positive Review of Greenway Review:

Kris says:

I just happened to come by this site and was surprised by the negative comments regarding Greenway. We implemented Greenway in January of this year and have had a very good experience so far.

Ours is a 15 provider practice in South Carolina. We implemented the Practice Management first and the EMR next. I agree with the comments that a user made in one of the earlier posts, there is no software out there that is going to be a perfect fit. Having said that, Greenway was the closest to a fit that we could find. Below are some of my experiences with our Greenway install and life since:

- Integrated seamless integration of the EMR and PM components with single login (I don’t recall seeing it in any of the other products we demoed – Allscripts and Nextgen included)
- Intuitive use
- Extremely knowledgeable salesperson in Nick. His knowledge of the product made it so much a easier sell for us as we knew we had an added resource to go to once we went live. I don’t think he ever mad a promise or sold a feature that the product did not have. Now there are features that were supposed to come in a future release that are not out yet and we might have had some expectations that they would have been out sooner.
- We were at 100% of our volume on day 3 of implementation
- A 10% increase in revenue due to better tools in tracking patient visits, insurance verification, insurance claims, and patient balances
- Training expenses and training billing could have been managed a little better from Greenway’s end.
- Knowledgeable help desk on both chart and pm side. Rarely have I called the help desk and not got someone on the line that did not know the answer to my question or could not get it resolved within a few hours.

My belief is that any successful software implementation has 6 components to it
- Good Software
- Good Training
- Good Processes
- Able employees
- Good Data during transition
- and most important of all a strong leader who can manage the project and control the demands and manage the expectations placed on the implementation. This perhaps is the number one reason implementations go sour.

As long as a practice keeps its side of the bargain, I don’t think they would have an issue implementing Greenway. I would recommend Greenway to any practice but make sure you have your ducks in a row and don’t expect a plain software switch to solve all your problems.

Having said all this, is Greenway perfect? They are a fast growing company and have had their fair share of growing pains that at times have been a frustration to us but at the same time has been insignificant when compared to the gains in patient care, productivity, and revenue.

Now I will post one of the negative comments left on our original review.  You should always do your own analysis of the programs to ensure that they will work for what you need.  References of similar practices are also very important.

Erik says:

Would have to fall into the camp of those who have been thoroughly disgusted by our choice of Greenway for our gastroenterology practice. I am young and new to my group, with experience of having used 3 other office EMR platforms prior to moving to my present location. The group (none of whom had EMR experience) purchased it both for clinic and ASC, totally based on a few brief demonstrations and a BUNCH of promises as to what could be put into place for our practice. I can tell you that unlike any other company I have EVER dealt with for Endowriters, EMR, or other computer projects – I have never had some many promises made where the company’s promise was based on the sole expectation that YOU as the practice would have to build/create/write in all up in computer language yourself. It’s been kind of like buying a car, where Greenway has many beautiful models on the lot, says “yes we do/yes it can” to anything you might inquire about what the car can do, only then find you have no spark plugs, battery cables, transmission fluid, belts, or gas line with which to be able to make the car get off the lot. As docs we are as human as the next guy, and there is truth in terms of us having realistic expectations about how life with an EMR is to be very different. Having used several EMR’s before, there may be a few weeks to get one customized to my style, but I have always been able to jump in from day one using it. We are still 3 months out and can’t make it work for our office or endo.

The company now admits that they have absolutely no endoscopy programs at all, in their library or otherwise (contrary to what was said in initial discussions). What groups use it for ASC’s have apparently had to hire an IT person on the side to come in and try and write them for the groups. We were told on front in that having Greenway in the office and in ASC would make everything seamless — YET Greenway is one of the few EMR’s that is still lacking in the ability to interface with anyone except just a few lab organizations…..they don’t even interface within themselves!!! All the regristration data that our staff have to enter on our practice side have to turn around and be re-entered into the ASC portion of Greenway because the two parts don’t talk to one another. If we stick with Provation or go with GMed then that takes care of endo programs as we are currently doing but requires continuation of having to scan the reports into both the ASC Greenway and the also into Greenway PM.

These are just the major and financially painfuly headaches. While practice mgmt part of Greenway seems to be OK, it has been awful in the clinic. Everything takes an overly complicated amount of mouseclicks to get to where you need to be, with buttons in what are not obvious places to be found and with cryptic symbols that you have to remember (little to no right-button functions). I cannot tell you the number of minutes and clicks it takes just to print off a paper copy of my daily schedule!

For some specialties, where scope of practice is very refined and repetitive, a template-driven EMR makes sense and should work fine. I would imagine that for OB, where most visits are checklists of things anyway, template notes would work great and do little to drain a docs efficiency. For any practice where there is considerable variety in the types of patients that are being evaluated, you will never be able to create enough templates to run smoothly (and if you do you will waste huge amounts of time sorting through the hundre or so trying to find the “perfect template” for that patient. Face it, folks–medicine is part science and part art. Patients are not like an automobile, and they don’t lay out their stories in the same sequential fashion for each disease. You can forget trying to do a note in the actual exam room–unless you demand that a patient keep quiet and answer only the pre-determined set of questions that you are fed on your template as the boxes scroll across the screen. I think most of us as providers would be sadly disappointed to see medicine reduced to such a level.

I agree with prior comments about anyone out there exploring options for EMR. GET ALL YOUR WANTS IN EXPLICIT WRITING before signing contract. Be very leery of Greenway right now until they listen to their customers and get their act together. If you have an EMR that is not delivering what would be a reasonably expected thing to deliver — give ‘em hell about and continue to press them hard – even legally if need be. I wish a few practices would start banding together in taking on Greenway, in particular, as I am afraid that is what it is going to take before they come back down to reality.

Brian Blake says:

I am an IT Admin; MCP, A+, Net+ and Linux+ certified. I’ve been working on computers since the early ’80′s and networking since the early ’90′s. I’m currently the MIS Director for a non-profit organization in central Florida. Many of my side consulting jobs are with doctors – one of which uses eClinical – and it’s the biggest mess I have ever encountered.

For starters, his original server is a 6 year old Gateway that was running out of space on it’s RAID 5 array. I was able to add another drive to the array, extending the server’s life for a while longer. The problem was, he was adding 150MB of data every week, so it was a temp fix. We recently installed a new server for eCW and requested info regarding migrating the database and application to the new server. What a mess this turned out to be.

At first, eCW demanded a fee of $1,000 for them to do the migration – which is completely asinine. The doctor was finally able to get them to talk to me about it; during the conversation all they would say was they have a certification program for IT Professionals to become eCW certified – but would not discuss with me how to go about doing this. When I asked them what would be different with this migration than any other database migration he stated there should be a backup done before hand and it was quite involved…

At this point, I explained to him that I really didn’t appreciate being talked to like I was clueless. I’ve moved many databases and their applications, and the process is usually quite similar. I also discussed my opinion that there was fine line between running a business to make a profit and outright greed. Charging someone $1,000 to migrate a database, when they are already paying $500 per month for the software and maintenance fee was crossing that line.

By the time I was done, the doctor got the migration for free. The process took two days – why? When they began working, they copied almost 90GB of data from the old server to the new one – all of the contents of the data drive. That was day one. After installing eCW and Tomcat on the new server, they went back and removed much of what they had previously copied. What they did not do was point the doctor’s laptops to the new server – which I had to call them and ask them for info on what to do. Simple process, but, a little documentation goes a long way.

And since he’s used eCW for several years, he’s not looking to change right now. However, they are giving him the run around regarding ‘Meaningful Use’. Several other local practices are inquiring about eCW, but, eCW is telling them they cannot use eCW for Meaningful Use. All of that’s beyond my desire to understand, but, why would a practice pay the money for eCW to manage their practice if it couldn’t provide the necessary services?

Today, I still am no closer to getting the certification info from eCW than I was on that day of my initial conversation with eCW. And knowing what I know now, I’m not sure I’d want to pursue that anyway.

CMS AND ONC FINAL REGULATIONS DEFINE MEANINGFUL USE AND SET STANDARDS FOR ELECTRONIC HEALTH RECORD INCENTIVE PROGRAM

The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) today announced two complementary final rules to implement the electronic health records (EHR) incentive program under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009, the HITECH Act supports the adoption of electronic health records by providing financial incentives under Medicare and Medicaid to hospitals and eligible professionals who implement and demonstrate “meaningful use” certified EHR technology.  The CMS regulations announced today specify the objectives that providers must achieve in payment years 2011 and 2012 to qualify for incentive payments; the ONC regulations specify the technical capabilities that EHR technology must have to be certified and to support providers in achieving the “meaningful use” objectives.

The final CMS rule:

• Specifies initial criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet to demonstrate meaningful use and qualify for incentive payments.
• Includes both “core” criteria that all providers must meet to qualify for payments, while also allowing provider choice among a “menu set” of additional criteria.
• Outlines a phased approach to implement the requirements for demonstrating meaningful use. This approach initially establishes criteria for meaningful use based on currently available technological capabilities and providers’ practice experience. CMS will establish graduated criteria for demonstrating meaningful use through future rulemaking, consistent with anticipated developments in technology and providers’ capabilities.

The CMS rule finalizes a Notice of Proposed Rulemaking published on Jan 13, 2010.

The final ONC rule:

• Sets initial standards, implementation specifications, and certification criteria for EHR technology under the incentive program.
• Coordinates the standards required of EHR systems with the meaningful use requirements for eligible professionals and hospitals
• With these standards in place, providers can be assured that the certified EHR technology they adopt is capable of performing the required functions to comply with CMS’ meaningful use requirements and other administrative requirements of the Medicare and Medicaid EHR incentive programs.

ONC’s standards and certification criteria final rule completes the adoption of an initial set of standards, implementation specifications and certification criteria that was begun with publication of ONC’s on Jan. 13, 2010.

Timetable for Implementation

The HITECH Act states that payments for Medicare providers may begin no sooner than October 2010 for eligible hospitals and January 2011 for EPs. The final rule aligns the Medicare and Medicaid program start dates.   Key steps in the implementation timeline include:

• ONC began accepting applications from entities that seek approval as an ONC-Authorized Testing and Certification Body (ONC-ATCB) on July 1, 2010.

• ONC projects that certified EHR software will be available for purchase by hospitals and eligible professionals by fall, 2010

• Registration by both EPs and eligible hospitals with CMS for the EHR incentive program will begin in January 2011.  Registration for both the Medicare and Medicaid incentive programs will occur at one virtual location, managed by CMS.

• For the Medicare program, attestations may be made starting in April 2011 for both EPs and eligible hospitals.

• Medicare EHR incentive payments will begin in mid May 2011.

• States will be initiating their incentive programs on a rolling basis, subject to CMS approval of the State Medicaid HIT plan, which details how each State will implement and oversee its incentive program.

The “Meaningful Use” Model

By focusing on the effective use of EHRs with certain capabilities, the HITECH Act makes clear that the adoption of records is not a goal in itself:   it is the use of EHRs to achieve health and efficiency goals that matters.  HITECH’s incentives and assistance programs seek to improve the health of Americans and the performance of their health care system through “meaningful use” of EHRs to achieve five health care goals:

• To improve the quality, safety, and efficiency of care while reducing disparities;
• To engage patients and families in their care;
• To promote public and population health;
• To improve care coordination; and
• To promote the privacy and security of EHRs.

In the context of the EHR incentive programs, “demonstrating meaningful use” is the key to receiving the incentive payments. It means meeting a series of objectives that make use of EHRs’ potential and related to the improvement of quality, efficiency and patient safety in the healthcare system through the use of certified EHR technology.

Coordinated Approach to Support EHR Adoption

CMS’ and ONC’s final rules complement two other rules that were recently issued.  On June 24, 2010, ONC published a final rule to establish a temporary certification program for health information technology.   And on July 8, 2010, the Office for Civil Rights announced a proposed rule that would strengthen and expand privacy, security, and enforcement protections under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Together the four rules are key components of the regulatory structure needed to administer the EHR incentive program and to meet the goals of the HITECH Act:

• The assurance of privacy protections is fundamental to the success of EHR adoption.  The refinements and expansions of HIPAA provisions announced July 8 form an important base for EHR acceptance and use.
• The temporary certification process published June 24 establishes a process through which organizations can be approved as certifying entities to which vendors may submit their EHR systems for review and certification.
• The ONC rule announced today identifies the technical standards which must be met in the certification process, and coordinates those requirements with the meaningful use objectives.
• Finally, the CMS rule announced today establishes guidelines and requirements on achieving meaningful use in clinical settings and qualifying for incentive payments based on this meaningful use.

Key Provisions of the Final Rule

CMS’s final meaningful use rule incorporates changes from the proposed rule on meaningful use that are designed to make the requirements more readily achievable while meeting the goals of the HITECH Act.  For Stage 1, which begins in 2011, the criteria for meaningful use focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information.

The final rule reflects significant changes to the proposed rule while retaining the intent and structure of the incentive programs.  Key provisions in the final rule include:

• For Stage 1, CMS’s proposed rule called on physicians and other eligible professionals to meet 25 objectives (23 for hospitals) in reporting their meaningful use of EHRs. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers can choose.  This “two track” approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing latitude in other areas to reflect providers’ varying needs and their individual paths to full EHR use.

• In line with recommendations of the Health Information Technology Policy Committee, the final rule includes the objective of providing patient-specific educational resources for both EPs and eligible hospitals and the objective of recording advance directives for eligible hospitals.

• With respect to defining hospital-based physicians, the final rule conforms to the Continuing Extension Act of 2010. That law addressed provider concerns about hospital-based providers in ambulatory settings being unable to qualify for incentive payments by defining a hospital-based EP as performing substantially all of his or her services in an inpatient hospital setting or emergency room only.

• The rule makes final a proposed rule definition that would make individual payments to eligible hospitals identified by their individual CMS Certification Number.  The final rule retains the proposed definition of an eligible hospital because that is most consistent with policy precedents in how Medicare has historically applied the statutory definition of a ”subsection (d)” hospital under other hospital payment regulations.

• Under Medicaid, the final rule includes critical access hospitals (CAHs) in the definition of acute care hospital for the purpose of incentive program eligibility.

• The final rule’s economic analysis estimates that incentive payments under Medicare and Medicaid EHR programs for 2011 through 2019 will range from $9.7 billion to $27.4 billion.

Development of the Rules

CMS and ONC worked closely to develop the two rules and received input from hundreds of technical subject matters experts, health care providers, consumers, and other key stakeholders. Numerous public meetings to solicit public comment were held by three Federal advisory committees: the National Committee on Vital and Health Statistics (NCVHS), the HIT Policy Committee (HITPC), and the HIT Standards Committee (HITSC). HITSC presented its final recommendations to the National Coordinator in August 2009.

CMS published its proposed rule on Jan. 13, 2010.  The agency actively solicited comments on its proposal and received more than 2,000 submissions by the close of the 60-day comment period.  These comments, along with the input from advisory groups and outreach activities, were given careful consideration in developing the regulations announced today.