IN THIS ISSUE:
January 29, 2014
UPDATE
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Electronic Health Records and Meaningful Use
Health Information Exchange
Regional Extension Center
EHR Loan Fund
Telehealth and Broadband
Privacy and Security
WORD ON THE STREET
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ICD-10 Implementation – Less Than 1 Year Away
ICD-10 Webinar: Prepare Now for ICD10: What Health Centers Need to Know
mHealth Regulations: What’s In Store – iHealthBeat Report
iHealthBeat: Study Assesses Providers' Biggest Meaningful Use Challenges
New ONC National Coordinator
ONC Releases Safety Assurance Factors for EHR Resilience (SAFER) Guides
RESOURCES
 ONC
 CMS
 HRSA
 NACHC
 STATE
 CalHIPSO
 CPCA
California Primary Care Association • (916) 440-8170 • w w w .cpca.org
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HOT TOPICS
ELECTRONIC HEALTH RECORDS AND MEANINGFUL USE
Federal:
 CMS Clarification on 1099s for EHR Incentive Payments
Earlier this year, the IRS Chief Counsel drafted an opinion related to the issuance of 1099s for EHR
Incentive Program payments. The opinion and subsequent IRS Bulletin implied that states should issue
1099s for EHR Incentive payments to eligible professionals (EPs), regardless of whether the payment was
voluntarily reassigned. This opinion contradicted direction previously provided by CMS, and as such,
was not implemented in California pending further discussion and clarification. On a CMS All States call
on November 25, DHCS received notice that the IRS had reviewed the situation further. It appears the
review of applicable incentive program laws/regulations, as well as the nature of the relationship between
the EP and Payees, demonstrated that the incentive payments fell under an “exception”, and could thus
be deemed income to the payee. Further clarification is forthcoming, however, states have been advised
that continued 1099 reporting to Payees is appropriate pending further guidance. As such, in California,
1099’s will continue to be issued to the payee’s. In the case of states who issued corrected 1099’s under
the IRS bulleting, further guidance will be forthcoming as well.
 CMS Blog: New Data Shows Rapid Adoption of EHRs; Announcements of 2015 Policies
Between 2009 and 2012, EHR adoption nearly doubled among physicians and more than tripled among
hospitals. Every month, thousands of providers join the ranks of hospitals and professionals that have
adopted or are meaningfully using EHRs. As of October 2013, 85 percent of eligible hospitals and more
than six in 10 eligible professionals had received a Medicare or Medicaid EHR incentive payment.
Moreover, nine in 10 eligible hospitals and eight in 10 eligible professionals had taken the initial step of
registering for the Medicare or Medicaid EHR Incentive Programs as of October 2013.
The Centers for Medicare & Medicaid Services (CMS) today proposed a new timeline for the
implementation of meaningful use for the Medicare and Medicaid EHR Incentive Programs and the Office
of the National Coordinator for Health Information Technology (ONC) proposed a more regular
approach to update ONC’s certification regulations.
Under the revised timeline, Stage 2 will be extended through 2016 and Stage 3 will begin in
2017 for those providers that have completed at least two years in Stage 2. The goal of this change is
two-fold: first, to allow CMS and ONC to focus efforts on the successful implementation of the
enhanced patient engagement, interoperability and health information exchange requirements in Stage 2;
and second, to utilize data from Stage 2 participation to inform policy decisions for Stage 3.
The phased approach to program participation helps providers move from creating information in Stage
1, to exchanging health information in Stage 2, to focusing on improved outcomes in Stage 3. This
approach has allowed us to support an aggressive yet smart transition for providers.
This new proposed timeline tracks ongoing conversations we at CMS and ONC have had with providers,
consumers, health care associations, EHR developers, and other stakeholders in the health care industry.
This timeline allows for enhanced program analysis of Stage 2 data to inform to the improvements in
care delivery outcomes in Stage 3.
Please click here for more information.
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 CMS Tip Sheet on Stage 2 Health Information Exchange Requirements for Eligible Professionals
CMS has prepared a Tip Sheet for Eligible Professionals on several Stage 2 MU objectives that require
information to be shared with another party. Three of these objectives—Clinical Summary, Patient
Electronic Access, and Summary of Care—outline specific data elements needed to meet the objective.
While some of the data elements are common between these three objectives, other data elements are
individual to each objective. Click here to access the Tip Sheet.
 Proposed Legislation to Expand MU Incentives to Behavioral Health Providers
Sen. Rob Portman (R-Ohio) has introduced legislation to encourage behavioral health providers such as
psychiatric hospitals, substance abuse facilities and psychologists to adopt electronic health records by
extending the Meaningful Use incentive program to them.
The Behavioral Health Information Technology Coordination Act of 2013 (S. 1685), introduced in the
Senate Nov. 12, would not only extend the Meaningful Use program to such providers, but also
addresses the reporting of EHR-related adverse events to patient safety organizations, clarifies that EHRs
are not devices subject to the Food, Drug and Cosmetics Act, limits electronic discovery in EHRs and
increases legal protections for providers. Click here for more information.
 CMS EHR Certification: 2014 Criteria Redefine Certified EHR Technology
To participate in the Medicare & Medicaid EHR Incentive Programs, eligible professionals, eligible
hospitals, and critical access hospitals must use an EHR system or module that is certified specifically for
the EHR Incentive Programs. If you select certified EHR technology for your practice, you can know
that your EHR has the necessary capabilities to help you meet meaningful use criteria.
In the previous rule (the 2011 Edition criteria) the standards for certified technology for the EH R
Incentive Programs required that participants have EHR technology capable of meeting all of the
certification criteria for an inpatient or an ambulatory setting. In other words, each provider had to have
a complete EHR with full functionality.
HHS has changed the policy and definition of what constitutes certified EHR technology in the new rule
(the 2014 Edition EHR certification criteria). With the expanded definition of certified EHR technology,
vendors can now offer smaller-scoped, more specific certified EHR modules that will align more closely
to your needs. If you are seeking a product tailored to your practice needs, you can start by looking at
the Certified Health IT Product List, which lists all certified EHR technology. The CMS website also
offers information to help determine what certified EHR will work best for you.
 CMS Security Risk Analysis Tools
Have you reviewed your practice processes to make sure that your patients’ personal health information
is protected and secure?
Even though there are no changes to the HIPAA Security Rule, if you are participating in Stage 1 or Stage
2 of the EHR Incentive Programs, you need to conduct a security risk analysis of your practice to meet
Meaningful Use requirements.
What’s required? CMS has a tipsheet that will help you understand:
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Steps for conducting a security risk analysis
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How to create an action plan
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Security areas to be considered and their corresponding security measures
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Myths and facts about conducting a security risk analysis
Be sure to review the steps and conduct your review for your practice. It is required in both stages of
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meaningful use to receive your incentive payment.
Additional Resources
The CMS EHR Incentive Programs website offers other meaningful use resources.
For a deeper dive, ONC offers a Guide to Privacy and Security of Health Information that includes a tenstep plan for health information privacy and security.
 CMS Resources for Stage 2 Meaningful Use
If you are an eligible professional who has completed at least two years of Stage 1 of meaningful use, you
will begin Stage 2 in 2014. CMS has additional resources available to help you participate in the next stage,
including:
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Stage 2 Beginner’s Guide
Stage 2 PowerPoint and webinar recording, including an overview of audits and payment
adjustments
Specification sheets for Stage 2 criteria
My Participation Timeline widget to help you determine the year you start each stage of
meaningful use
Stage 2 Exchange Requirements for Eligible Professionals Presentation
If you are just beginning meaningful use, or have only completed one year, you must complete two full
years of Stage 1 before moving to Stage 2.
For more resources to help you prepare for Stage 2, visit the Stage 2 webpage on the EHR Incentive
Programs website.
 SAMHSA-HRSA Center for Integrated Health Solutions
The SAMHSA-HRSA Center for Integrated Health Solutions offers a Ten Minutes at a Time HIT Library.
Divided into two series, the library offers 20 concise, voice-narrated PowerPoints, packed with
information about Stage 1 Meaningful Use and Project Management. The presentations are useful for any
behavioral health provider interested in the integration of primary and behavioral health care, project
management, Stage 1 Meaningful Use, and electronic health records for behavioral health.
 CMS eHealth Provider Webinar on Stage 2 Health Information Exchange Requirements for
Eligible Professionals
CMS conducted an eHealth webinar on Stage 2 health information exchange requirements, on Tuesday,
November 5th which was titled, “Exchange Criteria in Stage 2.” Click the links below to access the
presentation and webinar recording:
PowerPoint Presentation
Webinar Recording (Recording ID: MRBF9N; Key: eHealth)
 CMS Stage 1 Meaningful Use Calculator
The Stage 1 Meaningful Use Attestation Calculator can help you prepare to enter your meaningful use
information into the CMS attestation system. Enter your meaningful use data into the calculator to learn
if you have met all of the objectives and the associated measures prior to completing attestation for
Stage 1 of the EHR Incentive Programs.
The updated calculator reflects the latest requirements for participation in Stage 1 of meaningful use.
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Changes include:
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Removal of core measures no longer required for Stage 1
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Updates to measure requirements in accordance with the Stage 2 rule
You can find the Stage 1 Meaningful Use Attestation Calculator and more information about the
attestation process on the Registration & Attestation page of the EHR Incentive Programs website.
In order to better understand the meaningful use criteria, you can also review the Stage 1 Meaningful
Use Specification Sheets for eligible professionals. These specification sheets contain detailed information
on each core and menu meaningful use measure.
 CMS Possible Payment Adjustments for Medicare EHR Program
Eligible professionals (EPs) participating in the Medicare EHR Incentive Program may be subject to
payment adjustments beginning on January 1, 2015. CMS will determine the payment adjustment based
on meaningful use data submitted prior to the 2015 calendar year. EPs must demonstrate meaningful use
prior to 2015 to avoid payment adjustments. Click here for more information.
 ONC: Unveils New Rule To Tweak Dental Meaningful Use Standards
From iHealth Beat: On Monday, November 4, the Office of the National Coordinator for Health
Information Technology published in the Federal Register an interim final rule that would revise dental
meaningful use standards. In the interim final rule, ONC wrote that it would allow "EHR technology that
has been primarily developed to record dental procedures to be tested and certified to CDT alone,
rather than in addition to SNOMED CT or CPT-4/HCPCS".
ONC said the revision was made in response to feedback from stakeholders who explained that
SNOMED CT or CPT-4/HCPCS standards rarely include dental procedure codes. ONC said the change
would make it easier for dentists and their EHR vendors to comply with meaningful use requirements.
ONC emphasized that the change would apply only to EHR technology that is developed primarily to
record dental procedures and that all other EHR vendors would have to continue testing their products
using SNOMED CT or CPT-4/HCPCS codes.
Click here for the article and a link to the interim final rule.
 CMS: New and Updated FAQs
To keep you updated with information on the Medicare and Medicaid Electronic Health Record (EHR)
Incentive Programs, CMS recently posted two new and two updated FAQs to the CMS FAQ system.
New FAQs:
1. Can an eligible professional (EP) or hospital charge patients a fee to have access to the certified
EHR technology (CEHRT) solution that is used to meet the meaningful use objective of
providing patients the ability to view online, download and transmit their health information?
Read the answer here.
2. When meeting the meaningful use measure for “secure messaging” in the EHR Incentive
Programs, which requires that more than 5 percent of unique patients send a secure message
using the electronic messaging function of CEHRT, is it required that the patient only use an
interface that is certified or can any secure message received into the eligible professional’s
CEHRT count for this measure? Read the answer here.
Updated FAQs:
1. If an EP practices at an outpatient location, a location other than an inpatient (place of service
21) or emergency department (place of service 23), and that location is only equipped with
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CEHRT certified to the criteria applicable to an inpatient setting, must the EP include that
location in their meaningful use calculations? Read the answer here.
2. For Stage 1 and 2 meaningful use objectives of the EHR Incentive Programs that require
submission of data to public health agencies, if multiple EPs are using the same CEHRT across
several physical locations, can a single test or onboarding effort serve to meet the measures of
these objectives? Read the answer here.
 CMS: eHealth Provider Webinar Presentations
CMS launched the eHealth webinar series to educate eligible professionals (EPs) about the eHealth
programs and resources available. The PowerPoint presentations and recordings from past webinars can
now be accessed on the Resources page of the eHealth website.
Upcoming Webinars
A listserv message will be sent prior to each webinar with registration information. Sign up f or the
eHealth listserv here.
Past Webinars
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Less Than One Year Until ICD-10: Steps Your Practice Can Take to Prepare (November 19,
2013)
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PowerPoint Presentation
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Webinar Recording (Recording ID GT6Z24; Key eHealth)
Stage 2 Exchange Requirements for Eligible Professionals (November 5, 2013)
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PowerPoint Presentation
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Webinar Recording (Recording ID: MRBF9N; Key: eHealth)
CQMs for 2014 (September 24, 2013)
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PowerPoint Presentation
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Webinar Recording
eHealth Overview (September 19, 2013)
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PowerPoint Presentation
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Webinar Recording
Medicare and Medicaid EHR Incentive Programs: Overview and a Look Ahead (September 17,
2013)
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PowerPoint Presentation
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Webinar Recording
2013 PQRS Program: What Providers Need to Know About Upcoming PQRS Deadlines
(September 11, 2013)
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PowerPoint Presentation
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Webinar Recording
Medicaid EHR Incentive Program: How Eligible Professionals Successfully Participate (August 13,
2013)
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o PowerPoint Presentation
o Webinar Recording
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Administrative Simplification and eHealth (July 30, 2013)
o PowerPoint Presentation
o Webinar Recording
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Quality Measurement 101: What Providers Need to Know about CMS Quality Programs (July 16,
2013)
o PowerPoint Presentation
o Webinar Recording
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Intro to the EHR Incentive Programs for EPs: Basic Eligibility and Payment Information, Review of
Key Deadlines (July 2, 2013)
o PowerPoint Presentation
o Webinar Recording
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EHR Incentive Programs: Stage 2 Overview, Audits, and Payment Adjustments (June 20, 2013)
o PowerPoint Presentation
o Webinar Recording
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Advancing Interoperability through Meaningful Use: A Refresher Course (June 6, 2013)
o PowerPoint Presentation
State:
o Webinar Recording
 State Level Registry (SLR) Not Accepting Program Year 2014 Meaningful Use (MU) Attestations
Providers wishing to attest to MU for Program Year 2014 will not be able to do so until April 1, 2014 and
should not enter any data into the SLR until then. This restriction only applies to 2014 MU attestations.
Providers may submit 2013 AIU and MU attestations until March 31, 2014 and may submit 2014 AIU
attestations beginning January 1, 2014.
 Medi-Cal Eligibility Update
Objective: In order to be eligible for the Medi-Cal EHR Incentive program eligible providers must have at
least 30% and 20% for pediatricians, patient encounters during a 90 -day “representative period”
delivered to Medi-Cal patients or (in the case of FQHC or RHC providers) other “Needy Individuals.”
Update: As of late October the Department of Health Care Services (DHCS) has approved and put into
production rounding up for Medi-Cal Eligibility. Eligible Providers can now round up from 29.5% and
19.5%. Anything above these percents will meet the Medi-Cal EHR Incentive Program’s eligibility
threshold.
 HIE Gateway - Announcement for Cancer Case Reporting Only
The California Department of Public Health (CDPH) is coordinating all cancer reporting requirements
for Meaningful Use. Only physician offices reporting for MU Stage 2 need to register their intent to
send data through the HIE Gateway. To register please go to the HIE Gateway and click on the register
button located at the top of this page, or you can click here to be taken to the site.
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Please Note: Current entities reporting cancer cases to California Cancer Registry (CCR) that are
not part of MU Stage 2 do not need to register intent with the HIE Gateway at this time. Current
entities reporting cancer cases to CCR are to continue to report through the already existing CCR
reporting system.
If you have any more questions specific to Meaningful Use, please send your inquiries to
MeaningfulUse@cdph.ca.gov. For any questions regarding cancer case reporting please send your
inquiries to qasupport@ccr.ca.gov.
 California Department of Public Health Launches Portal
The California Department of Public Health (CDPH) announces the launch of the CDPH Health
Information Exchange (HIE) Gateway to assist eligible healthcare professionals and hospitals in meeting
the requirements for Meaningful Use (MU) Public Health Objectives of the Cen ters for Medicare and
Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program. The CDPH HIE Gateway
will serve as a single point of entry for data submission to many state public health programs, although not
all programs will begin using the CDPH HIE Gateway immediately.
Starting in October 2013, all eligible healthcare professionals and hospitals in California who wish to
register and submit data to the following CDPH systems should do so through the CDPH HIE Gateway,
regardless of whether they are seeking to fulfill MU requirements or not:
1.
Immunization reporting to the California Immunization Registries (CAIR) (7 regions only:
NorCal, Bay, Greater Sacramento, Central Coast, Central Valley, LA-Orange, and Inland Empire) will
need to register and submit data through the CDPH HIE Gateway. Note: The CAIR Immunization
Messaging Portal is now integrated into the CDPH Gateway. If your Site has already registered at the
CAIR Portal and is only interested in immunization reporting, you will not be required to re-register at
the CDPH Gateway.
2.
Electronic lab report submission to the California Reportable Disease Information Exchange
(CalREDIE) system will need to register and submit data through the CDPH HIE Gateway.
In future phases, the CDPH HIE Gateway will be expanded for registration of other CDPH electronic
reporting systems. To access the Gateway and begin the registration process, thereby declaring your
intent to submit data to CDPH, please go to http://hie.cdph.ca.gov.
For questions related to MU, please send an e-mail to MeaningfulUse@cdph.ca.gov.
CPCA:
 CPCA Meaningful Use Webpages
CPCA has recently and will continue to update our Meaningful Use website. If there is any helpful
MU information that you would like to see included, please contact Renee Wright at
rwright@cpca.org. To access the website please click here.
 User Friendly Stage 2 Objectives Table
In Stage 2 Meaningful Use there are 20 core and menu objectives eligible professionals must report
on. EPs must report on 17 core objectives and 3 of 6 menu objectives. To aid in tracking and
notating of each objective EPs chose to report on, CPCA created a user friendly excel spreadsheet
that houses all 20 objectives, measures and information on exclusion rules. This document is
located on the CPCA websites under the Stage 1 and Stage 2 Measures tab:
http://cpca.org/index.cfm/health-center-resources/meaningful-use/stages-1-2-measures/
 Optometrists and Meaningful Use
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Groups – During a call last month, Dr. Dickey from OHIT shared with us that OHIT was planning
on providing written guidance on how to add a provider after a Group has been submitted and 1
or more Providers have been approved for payment.
Email from Dr. Dickey on this: We are planning to change our message on the SLR about
Optometrists to read:
Optometrists may now apply to the Medi-Cal EHR Incentive Program. DHCS hopes that all
optometrists practicing individually or in a group/clinic with 30% or greater Medi-Cal patient
volume will take advantage of the program. Optometrists and other eligible providers will have
until March 31, 2014 to apply for 2013 program year payments. Applications for 2014 program
year payments open on January 1, 2014. If a provider applies for the 2013 program year their
application must be reviewed and approved before an application for the 2014 program year can
be accepted. If an optometrist was not added to a group for the 2013 program year the
optometrist can register in the SLR as an individual provider but enter group encounter volumes
to establish eligibility if: 1) the group representative uploads a letter into the SLR documenting
that the optometrist was a member of the group in 2012 and 2) the optometrist uploads a letter
into the SLR with their application documenting that they were a member of the group in 2012
and have used group encounter volumes to establish eligibility.
 NextGen Users: Meaningful Use and Dentists Fact Sheet and Codes Available
Sean Folweiler with Central Valley Collaborative worked with Next Gen to put together a fact
sheet entitled “Meaningful Use for Eligible Dental Providers – NextGen EDR Version 4.” If you are a
NextGen user and would like a copy of the Fact Sheet, please contact Renee Wright at
rwright@cpca.org.
NextGen has also provided a list of Dental codes for dentists who use their system. To obtain the
code list please contact Renee.
 Patient Electronic Access (e-Portal)
Beginning 2014 Stage 1 meaningful use menu set measure 5, electronic copy of health information,
will be replaced with Stage 2 core measure 7, View, Download, Transmit (VDT), regardless of
whether or not an EP is in Stage 1 or 2.
The following current Stage 1 objectives will be replaced beginning in 2014:
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Provide patients with an electronic copy of their health information (including diagnostics
test results, problem list, medication lists, medication allergies, discharge summary,
procedures) upon request.
New: Stage 2 Core Measure 7 will now be used instead: http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore_7_PatientElectronicAcces
s.pdf
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Provide patients with timely electronic access to their health information (including lab
results, problem list, medication lists, and allergies) within 4 business days of the
information being available to the EP.
For more information on Patient Electronic Access Information please the access the MU
resources page at http://www.cpca.org/index.cfm/policy-advocacy/policy/health-informationtechnology/electronic-health-records/
 90 Day Reporting Period for 2014 Update
Objective: For 2014 only, all providers regardless of their stage of meaningful use are only required to
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demonstrate meaningful use for a 3-month EHR reporting period. CMS is permitting this one-time 3month reporting period in 2014 only so that all providers who must upgrade to 2014 Certified EHR
Technology will have adequate time to implement their new Certified EHR systems.
Additional Information: Eligible Providers (EPs) participating in the Medicaid EHR Incentive Program the
90 day reporting period is not fixed to the calendar quarter. EPs participating in the Medicare EHR
Incentive Program their 90 day reporting period is not fixed to a calendar quarter in the first payment
year, but in the second year and going forward the reporting period is fixed to the calendar quarter year.
*2014 is the last year to start participating in MU for Medicare EPs. EPs will be penalized if they start MU
in 2015.
 DHCS A & I NO LONGER Offsetting PPS Rates with MU Incentives
Update from CPCA: DHCS A&I has stopped offsetting PPS rates with MU incentive payments and they
have submitted a letter to CMS requesting a change in their earlier policy.
For health centers that had a rate approved where the offset was applied, A & I suggests that health
centers file an appeal citing the MU Offset. If the rate is already finalized the health centers may file an
order to show cause. A & I committed to backing out the adjustment.
Any questions on this issue can be directed to Andie Patterson at apatterson@cpca.org.
HEALTH INFORMATION EXCHANGE
Federal:
 HIE Online Interoperability Training Courses
The Office of the National Coordinator (ONC) has developed training modules around the Stage 2
Meaningful Use (MU) Rule to train Eligible Professional (EPs) and Critical Access Hospitals (CAHs) on
how to implement new standards to support
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Transitions of Care
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Lab Exchange
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Patient Engagement
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Public Health Measures.
The web based training courses on each of these four areas are designed to better equip personnel
assisting providers and hospitals in meeting these new objectives. The result is a five part series of web based training courses that provide real-world examples and a story-based approach to highlight the
interoperability of EHR standards in the aforementioned key areas.
The series consists of five self-paced courses that allow learners to access the material as their schedule
permits, providing flexibility to take the entire course at once or over a period of time.
Click here for more information and to access the online courses.
 Emerging HIE Forum
On November 14th, in conjunction with the HIE Stakeholder Summit, CHeQ hosted its third
Emerging HIE Forum - Focus on 2014. Stakeholders from around the state came together to
discuss the current status of their emerging initiatives and their plans for 201 4.
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Significant progress has been achieved since the last Emerging Forum, with many of those in
attendance participating in CHeQ's Rural HIE Incentive Program and making the move from the
planning phase to the implementation phase of development. We look forward to seeing their
continued progress in 2014! Resources for Emerging HIEs can be found here:
http://www.ucdmc.ucdavis.edu/iphi/Programs/cheq/emerginghies.html.
 ONC Launches Meaningful Consent Online Resource
ONC released new online tools to help providers and Health Information Exchange organizations
(HIEs) educate patients about the electronic sharing of their health information.
Meaningful consent occurs when the patient makes an informed decision and the choice is properly
recorded and maintained. ONC’s new Meaningful Consent resources provide strategies and tools
that can be used by health care providers to engage and educate patients so they can make an
informed decision.
As part of the resources, users will find background information about Meaningful Consent,
practical implementation tips, videos, and customizable tools from ONC's eConsent Trial Project.
The educational materials and tools are now available for download and customization at eConsent
Toolkit.
Fostering trust in new technologies is integral to the successful adoption of health information
exchange. Effectively informing patients and providing them with options for how they would like
to participate are important means of fostering this trust. Read more on the new Health Affairs
blog.
State:
 California Healthline: Health Information Exchange Taking Root in Northern California
A California Healthline article discusses the expanding health information exchange work throughout the
state. The article, entitled “Health Information Exchange Taking Root in Northern California” outlines some of
the groundwork, and some of the successes, of HIE in California.
 California eHealth Initiative: Connecting California – Stories from the Field
California eHealth Initiative brings you a story about why the Inland Empire Health Information Exchange
is fast becoming one of the largest, self-sustaining HIEs in the country.
 California Association of HIEs
The California Association of HIEs is working to establish "light-weight self-governance" for trusted
exchange in California based on a single multiparty agreement that enables all organizations to
exchange information with each other and builds on Healtheway and the national eHealth Exchange.
Four voluntary workgroups are working on a range of issues, according to Dave Minch, CAHIE cochair. A joint pilot project by CHeQ and CAHIE is underway to develop the technical and policy on boarding and governance documents and processes. Seven organizations have signed up for the
pilot.
"The DURSA parsing workgroup is about to complete its work on the DURSA decomposition
which we are planning on sending to HealtheWay to help them with their development process,"
Minch said. "The DURSA parsing group's current task is surveying existing bilateral agreements in
the state to find common terms and elements which along with the DURSA decomp will form the
body of the CA DURSA."
 California Health Equality (CHeQ) News – October 2013 Snapshot of Community HIOs
CHeQ presents an October 2013 snapshot of Community Health Information Organizations (HIOs)
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across California. The map depicts both operational and emerging HIOs providing or planning to provide
HIE services to health care delivery organizations in counties across California.
 CHeQ Announces "California Direct" with 1,000 free accounts
California Health eQuality (CHeQ), a program of the UC Davis Health System Institute for Population
Health Improvement, is delighted to announce the formation of California Direct, and the availability of
free Direct accounts for rural providers in California. These Direct accounts will be managed through a
grant issued to Axesson to operate a Health Information Service Provider (HISP) using Direct technology
for an inexpensive, easy-to-use, quick-to-implement method to securely exchange health information in a
manner similar to secure email.
This exchange method improves care coordination by enabling providers with or without an Electronic
Health Record to securely share protected health information with care team members across
organizational boundaries and:
• transmit referrals and care summaries securely, consistently, and electronically
• send alerts to all providers caring for a patient upon hospital admission, discharge, and transfer
• enable patient access to their information electronically
• connect to trusted health information exchanges
• meet Meaningful Use requirements
Through its federally-funded program with the California Health and Human Services Agency (CHHS)
under the HIE Cooperative Agreement with the ONC, CHeQ has worked diligently to steadily build a
stable foundation for HIE expansion. By way of grant programs targeted at improving health care quality,
impacting policy and infrastructure development and lowering over all costs, HIE has expanded in
California.
Recognizing the need for low cost, easily implemented, intuitive HIE options for widely distributed rural
providers, California Direct will enable ambulatory providers, clinics, and hospitals to engage in HIE with
inexpensive Direct accounts – offered free in 2014 to the first 1,000 participating rural providers.
Interested urban providers may subscribe to the service for a small fee.
Axesson will begin accepting enrollment to California Direct in January 2014. for more information on
how to participate please visit www.cadirect.org.
REGIONAL EXTENSION CENTER
CalHIPSO:
 CalHIPSO Audit Information
Providers who participate and receive incentive payments from the Medicare/Medicaid Meaningful Use
programs may potentially be subject to an audit. On November 7, CalHIPSO conducted a very
informational MU auditing eLunch Break training, Click. Capture. Save., to address how to prepare and
succeed during an audit. The following topics were discussed:
•
Audit Process
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Audit Preparation
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Importance of Supporting Documentation (More information from CMS at:
http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/EHR_SupportingDocumentation_Audits.pdf )
•
Appeals
•
Useful Resources
The slides from the training will be posted soon on the CPCA website.
 CalHIPSO Tip Sheets: Changes to Stage 1 – 2014 Tipsheet
CalHIPSO has put together a Tip Sheet entitled “Changes to Stage 1 – 2014.” Meaningful Use Stage 2
includes several changes to Stage 1, some of which were effective in 2013, others effective January 1,
2014. This worksheet will help you prepare for the most significant changes in 2014.
In addition, CalHIPSO has prepared a checklist for Meaningful Use Stage 1 Objectives 2014.
 RECs Meaningful Use and Medical Homes Case Study
Regional Extension Centers (RECs), located in every region of the country, serve as a support and
resource center to assist providers in EHR implementation and their Health IT needs.
Read more about how RECs are helping providers develop medical homes in this Meaningful Use and
Medical Homes Case Study. Meaningful Use of Health IT is a pivotal component of building a medical
home because it helps providers coordinate care, provide more efficient health care, and improve
patient outcomes. In this case study, four RECs – Wisconsin Health Information Technology Extension
Center, Rhode Island REC, Oregon Health Information Technology Extension Cen ter and Tri-State REC
– share their experiences helping providers develop medical homes.
Learn more about REC Support for New Care & Delivery Models.
EHR LOAN FUND
CHFFA:
The California Health Facilities Financing Authority (CHFFA) has been and remains very interested
in supporting clinics and health centers acquire and utilize EHRs. CHFFA encourages clinics and
health centers to start inquiring with them about what type of financing options are available.
CHFFA wants to see how broad the interest is from clinics for financing an EHR so that they can
entertain possibly structuring a program around the need/demand. Loans are currently available at
a 3% fixed interest rate for up to 5 years.
If your organization is looking for financing to purchase an EHR, you are encouraged to contact the
following CHFFA staff about what options are available:
 Ray Artinian, Program Manager, Ray.ARTINIAN@treasurer.ca.gov.
 Rosalind Brewer, Deputy Executive Director, Rosalind.Brewer@treasurer.ca.gov.
CPCA Loan Fund:
The CPCA Ventures Program can be used to finance EHR equipment. The maximum loan amount is
$600,000; the interest rate is 3.175%; and the loan has to be repaid in 5 years. More detailed
information can be found here. The application form is available here. Once complete, the
application should be sent to the attention of Virginie Arnaud Le Pape, Senior Loan Officer. NCB
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typically takes 2 weeks to review and approve a loan.
TELEHEALTH/BROADBAND
Telehealth:
 UC Davis Center for Health and Technology - Two-day Telehealth Education Course
The UC Davis Center for Health and Technology is offering a two-day Telehealth Education Course,
8:00a.m. – 4:30p.m., in Sacramento on February 5 - 6, 2014.
The unique curriculum encompasses a multidisciplinary approach by incorporating discussion, lecture,
and hands-on training. The state-of-the-art facility offers customized classrooms and fully equipped
telemedicine training laboratories
Program Features:
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An executive overview that addresses current topics and issues relevant for the development,
maintenance and expansion of a successful telehealth/telemedicine program.

Focused learning areas on day two advancing the learners area of expertise through a clinical
operational track and a technical track
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A unique curriculum that encompasses a multi-disciplinary approach by incorporating discussion,
didactics, and hands-on learning.
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Highly skilled faculty with extensive experience in the field of telehealth.
Please click here for the information flyer, or visit their website.
The next course is scheduled for March 5 - 6, 2014, in Sacramento (8:00 a.m. - 4:30 p.m.) To register
online for the upcoming course, please go to
http://www.ucdmc.ucdavis.edu/cht/education/telehealth/registration.html
If you would like further information regarding our program please visit our website at
http://www.ucdmc.ucdavis.edu/cht/education/
 Center for Connected Health Policy to Create Telehealth Research Catalog
The nine-month project will be the first ever effort to compile field-wide research on telehealth’s role
within the Triple Aim – better care and better health at lower costs – into a single catalog. Read more
about the full project in CCHP’s press release.
 Telehealth Resource Consortium (TRC)Telehealth Definition Framework
The National Consortium of Telehealth Resource Centers released their first collaborative project, a
Telehealth Definition Framework fact sheet to help decision makers accurately understand “telehealth”
and its key components. The fact sheet covers telehealth status as a service delivery method, its main
applications, and why “telemedicine” is an outdated term.
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 TRC Consortium Update: HIPAA and Telehealth
HIPAA compliance is more complex than simply using technology and products that claim to be “HIPAAcompliant.” The Consortium’s second collaborative fact sheet looks at these issues, focusing on how
telehealth applications – and consumer applications like Skype – fit into HIPAA regulations.
 CCHP Telehealth Training Series
Click here to access the Center for Connected Health Policy’s Telehealth Policy Legal module, part of a
joint series from The National Telehealth Policy Resource Center and South Central Telehealth
Resource Center. Read the full press release here. The second installment , “Medicare and Medicaid
Telehealth Policy Issues,” is set for release on February 4th.
 SAMHSA-HRSA Center for Integrated Health Solutions Online Training Sessions to Establish a
Telebehavioral Health Program
The SAMHSA-HRSA Center for Integrated Health Solutions is offering a new set of online trainings to
establish telehealth services for mental health and substance use. Telehealth allows for increased access
to mental health and substance use services, particularly in rural or underserved areas.
After completing this training and technical assistance series, you will be able to:
• Identify one or more telebehavioral health service models that are clinically appropriate for your
organization
• Engage the stakeholders necessary to successfully establish telebehavioral health services
• Coordinate telebehavioral health activities with pertinent local, state and federal partners
• Understand the important pieces needed to start a telebehavioral health program
Divided into six sessions, the Telebehavioral Health Training and Technical Assistance Series guides
safety net providers through the crucial steps involved to implement a telebehavioral health program.
The sessions include:
Session I: Laying the Groundwork
Session II: Reimbursement and Engagement
Session III: Partnerships and Financing
Session IV: Technology and Logistics
Session V: Implementation
Session VI: Launch and Refinement
Each session is led by subject matter experts and lasts approximately one hour. In addition to the
primary recorded training, each session includes recorded Q&A discussions and additional resources for
further exploration into each subject.
 CTN 2014 Telehealth Summit
The California Telehealth Network, in partnership with the California Telehealth Resource Center,
presents the 2014 Telehealth Summit: “Growing California’s Connections”, which will be held April 2829, 2014 in Newport Beach.
The 2014 Telehealth Summit invites all healthcare professionals, telemedicine personnel, administrators,
physicians, clinic managers, billing managers, healthcare IT specialists and other healthcare leaders to
discover the latest advancements in healthcare technologies and services, best practices, HIEs, EHRs and
Meaningful Use, hands-on telemedicine program training, and the latest innovations and delivery models
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in telemedicine.
This two day event will be kicked off with an intensive three-hour Telehealth Workshop presented by
the California Telehealth Resource Center, followed by educational (classroom, seminar and panel) and
networking opportunities, including the California Telehealth Network’s Excellence in Telehealth
Awards. Click here for more information, and to register.
The California Telehealth Network has secured a discounted room rate of $135 at the Hyatt Regency
Newport Beach. Reserve early as hotel space is limited. In addition, a limited number of summit
scholarships are available. Click here for more information.
 National Telehealth Webinar Series
This webinar will discuss the FCC's Rural Health Care - Healthcare Connect Fund (HCF) and the Indiana
Telehealth Network (ITN). The webinar will cover the history of the program, including its
predecessor, the Rural Health Care Pilot Program, and the new rules for the Healthcare Connect Fund.
They will also cover the ITN's role as a consortium, as well as our current implementation strategy.
FCC Healthcare Connect Fund Overview
Thursday, February 20, 2014
11:00 am - 12:00 pm (PST)
To join this webinar: https://hrsa.connectsolutions.com/sbtelehealth/
Webinars are free of charge to all participants.
 Telemedicine Reimbursement Guide
The California Telehealth Resource Center has updated its Telemedicine Reimbursement Guide to
reflect Medicare, Medi-Cal and private payer changes effective January 2014. The guide also includes the
FQHC billing models, previously published as its own guide. Click here to download.
 Web-Based Video Conferencing
CTN Connect, powered by Arkadin/Vidyo, provides a new generation of Web-Based video
conferencing, accessible from any internet connection. CTN Connect delivers the highest levels of
security, reliability and customer service with advanced video collaboration features that enable you to
conduct virtual telemedicine and distance learning sessions over the internet. Each CTN site will receive
one free CTN Connect, powered by Arkadin/Vidyo, license. Additional licenses are available at a nominal
fee.
 CTN Webinar Series
The UCSF-based Pacific AIDS Education and Training Center presented their HIV telehealth program,
called the HIV Learning Network (HIVLN), which described the purpose and structure of the HIVLN,
and demonstrated the experience of participating in a telehealth session.
Click here for the presentation.
PRIVACY AND SECURITY
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California Healthcare Foundation Report:
There is a new report from the California Healthcare Foundation entitled “Rights and Requirements:
A Guide to Privacy and Security of Health Information in California”. The federal government and the
State of California both have laws and regulations protecting the privacy and security of p ersonal
health information. This report describes the health privacy landscape in California, including the
federal Health Insurance Portability and Accountability Act (HIPAA) and California's own
Confidentiality of Medical Information Act (CMIA). It also examines the impact of the Health
Information Technology for Economic and Clinical Health Act (HITECH) and the Patient
Protection and Affordable Care Act (ACA).
The report explains how these laws work in tandem under the legal doctrine of federal
preemption. Specific topics include:

Sources of legal protection for health information privacy

Who and what types of health information are covered by which privacy laws

Patients' rights to access and amend health information
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Audit trails for health information disclosures
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How entities are permitted to use and disclose health information
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Patient notification in the event of a breach
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Enforcement of health information privacy laws
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Protections for information collected by health insurers and health insurance exchanges
The report also identifies gaps in privacy protection that remain unaddressed.
WORD ON THE STREET
 ICD-10 Implementation – Less Than 1 Year Away
There is less than one year to implement ICD-10 and CMS has put together a variety of resources
to help prepare for the transition. If you are a provider, payer, or other health care entity, you
should prepare for your ICD-10 transition now. A large part of that preparation includes having
conversations and building collaborations with your trading partners and vendors, as well as with
your peers and professional associations. By communicating and working together, we can move
toward a successful transition to ICD-10 that will improve the detail of data captured through
coding and facilitate patient care coordination across clinical settings—a goal that is shared by many
other CMS eHealth initiatives.
As we enter the final year of the ICD-10 transition, CMS is developing additional resources and
increasing outreach to providers, payers, and vendors to help ensure industry readiness by
October 1, 2014.
Based on feedback from medical and trade associations and other stakeholders, we have developed
a variety of ICD-10 resources for Providers, Payers, and Vendors. These resources cover topics
ranging from a basic introduction to ICD-10 to Continuing Medical Education/Continuing Education
courses with a roadmap and guide for small practices. For a more in-depth explanation of how to
guide a practice, hospital, or payer organization through the ICD-10 transition, CMS has created
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the Online ICD-10 Guide, which can be found on the Provider Resources page. The ICD-10
website also offers checklists and timelines, as well as FAQs, guides, and tips geared toward various
audiences. CMS also attends conferences and hosts online events, to educate and encourage
providers to transition to ICD-10.
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the
October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates.
 ICD-10 Webinar: Prepare Now for ICD-10: What Health Centers Need to Know
On Tuesday, October 22, NACHC conducted a webinar entitled: “Prepare Now for ICD-10: What
Health Centers Need to Know.” Follow the instructions below to access a recording of the webinar:
1. Please click on the link below to access the webinar:
https://mylearning.nachc.com/diweb/gateway/init/1/f/catalog*2Fitem*2Feid*2FW102213TTAW
2. Upon clicking of the link you will be prompted to sign in
3. Please use your IMIS id and password to login to My NACHC
4. If this is your first time logging in to My NACHC you will be prompted to choose a role. These roles
are tied to the type of credits you typically earn during NACHC conferences (if available). Below are
descriptions of the roles and the credits associated with them to help guide your selection process.
 Physician - Those who need Continuing Medical Education (CME) credits should select this
role.
 Social Worker - Those who need Continuing Education (CE) credits should select this role.
 Accountant - Those who need Continuing Professional Education (CPE) credits should select
this role.
 Board Members - For all other credit categories, non-credit seekers and for those that are a
part of the NACHC Board Governance program please choose this role.
5. Upon successful login you will see the archived materials from the webinar
6. Click launch to playback materials
 mHealth: What’s In Store
A new article in iHealthBeat entitled mHealth: What’s In Store discusses upcoming guidance on
mobile health technologies.
 iHealthBeat: Study Assesses Providers' Biggest Meaningful Use Challenges
Health care providers' biggest challenges associated with the meaningful use of electronic health
records are clinical summary measurement, the required security risk analysis and the reporting of
patient smoking status, according to a new study, Clinical Innovation & Technology reports. Click
here to read the article.
 New ONC National Coordinator
ONC welcomed its new National Coordinator, Karen DeSalvo, as she formally took the reins of
ONC on Monday, January 13. You may have heard that ONC traded a charismatic epidemiologist
with earned street cred helping providers adopt and meaningfully use health IT in the Big Apple
(and across the country), for a charismatic professor of medicine, NOLA health commish and
National Health Service Corps alum who helped rebuild the delivery system and HIT infrastructure
in the Big Easy literally from the ground up. Read more about the new National Coordinator, Dr.
Karen DeSalvo in our newsroom.
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Hitting the ground running, Dr. DeSalvo will bring some good news going into our Annual Meeting
next week regarding physician adoption of EHRs. She penned her first blog post as the new
National Coordinator reporting new findings in the latest report card on the EHR Incentive
program.
 ONC Releases Safety Assurance Factors for EHR Resilience (SAFER) Guides
ONC has released the Safety Assurance Factors for EHR Resilience (SAFER) Guides. "There are nine
SAFER Guides and each is designed to help care delivery organizations of all shapes and sizes conduct
self-assessments of recommended practices in those areas we know are important to the safety and safe
use of health information technology," Jacob Reider, MD, director of the Office of the Chief Medical
Officer writes on the Buzz blog post.
RESOURCES
GENERAL
 EHR Implementation with Minimal Practice Disruption in Primary Care Settings (WA and ID
Regional Extension Center)
 Issue Brief- Stage 1 Meaningful Use for Eligible Professionals Working in Multiple Locations
ONC
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Health IT Legislation and Regulations
Two new technical resources for Meaningful Use Stage 2 implementers and vendors
Guide to Privacy and Security of Health Information
Assess Your Practice Readiness
Continue Quality Improvement
Change Management for EHR Implementation
Continuous Quality Improvement (CQI) Strategies to Optimize your Practice
CMS
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Stage 2 Beginner’s Guide
Stage 2 PowerPoint and webinar recording, including an overview of audits and payment adjustments
Specification sheets for Stage 2 criteria
My Participation Timeline widget to help you determine the year you start each stage of meaningful
use
Stage 2 Exchange Requirements for Eligible Professionals Presentation
ICD-10 Implementation – Multiple Resources
Stage 1 Meaningful Use Attestation Calculator
An Eligible Professional’s Guide to Stage 2 of the EHR Incentive Programs
Meaningful Use for Pediatricians
The Official Web Site for the Medicare and Medicaid Electronic Health Records (EHR) Incentive
Programs
Guide to the Quality Reporting Data Architecture, QRDA, for 2014 eCQMs.
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CMS National Provider Call on January 16, 2013- Meaningful Use Stage 1 and 2
HealthIT.Gov- Achieving MU- Clinical Quality Measures
Stage 2 Overview- Tipsheet
Stage 1 vs. Stage 2 Comparison Table for Eligible Professionals
Tip Sheet for Specialists- useful for dentists
Educational Resources
HRSA
 Health IT Adoption Toolbox: Meaningful Use
 Oral Health IT Toolbox
NACHC
 Medicaid and Medicare Electronic Health Records Incentives: Reassigning Payments
STATE
 California OHIT Meaningful Use Data Aggregation Tool for Providers that Practice at Multiple
Locations
 CalOHII- Security and Privacy Tools
 State Level Registry
 Provider FAQs
 Changes to Medi-Cal Meaningful Use Program in 2013
CalHIPSO
 Educational Resources
 50% Meaningful User and Reporting from Multiple Locations PPT
CPCA
Electronic Health Records and Meaningful Use
 (NEW) Dentist Tool for Meaningful Use
 Third Party Registration for Medicaid Eligible Providers Step By Step Guide
 August 16, 2011 Meaningful Use Frequently Asked Questions
 Meaningful Use Registration Tool Kit for FQHCs
 Meaningful Use Registration Tool Kit for Non-FQHCs
 UDS/ Meaningful Use Crosswalk
CCHC Organizations/Products
 2012: Electronic Medical Records
 2012: Electronic Dental Records
 2010: Pharmacy Management Systems
 2010: Chronic Disease Management Systems
 2010: Billing and Clearinghouse Systems
 2010: Practice Management Systems
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