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Meaningful Use Stage 2 Electronic Health Records

Meaningful Use Objectives For Stage 2 Electronic Health Records

Sharing electronic health records is always a matter of security. It’s all about making sure someone’s medical history is protected as it’s transferred and stored in the digital space. Christensen Law shares this article of a few things that go into securing your electronic health records.

Written By: S.Sandy Sanbar, MD, PhD, JD, Blake Christensen, DO, D. Wade Christensen, JD, J.Clay Christensen, JD, L. Nazette Zuhdi, JD, LLM, Adam W. Christensen, JD, MBA, Oklahoma City

On Jan 1, 2014, Meaningful Use Stage 2 began for eligible professionals (EPs). Physicians must develop strategies for meeting each of the following five Meaningful Use Objectives, and talk to their vendors about plans and timelines for getting their electronic health record (EHRs) certified and upgraded.

(1) Develop Web Portals for Patients. Physicians should sign up their patients to participate in a web portal linked to EHR’s that give more than 50% of patients seen during the reporting period timely online access (within 4 business days of a visit) to their health records and allows them to message the physician securely. And, more than 5% of patients seen in that party their health information. EPs will also have to demonstrate Meaningful Use for the entire calendar year, not just for the 90-day period required in Stage 1. Secure messaging might be built into the EHR. One may use an external messaging service like RelayHealth, which offers a certified EHR that includes patient-messaging features. Kryptiq is another external messaging service. Patients may also set up their own personal health record (PHR) on an external “platform” such as Microsoft Health Vault, which allows users of some EHRs to upload clinical data to patients’ PHRs with their permission.

(2) Exchanging Clinical Summaries. EHRs should be capable of generating a summary in a specific and mandatory format known as the Consolidated CDA, which can be shared with other physicians who use EHRs when exchanging clinical summaries with other providers during transitions of care, such as referrals and consultations. Some EHRs can currently create a similar summary known as the Continuity of Care Document (CCD). In Stage 2, EPs must provide a summary-of-care record for more than 50% of transitions of care and referrals. In 10% of those transitions, the summary must be transmitted electronically using certified EHRs. EPs have to exchange a summary at least once with a recipient who uses a different EHR from that of the sender, or conduct a successful exchange with one of the Centers for Medicare & Medicaid Services-designed test EHR. Some healthcare organizations and physician groups are acquiring internal health information exchanges (HIEs) that allow providers to send clinical messages and document attachments to one another. Other organizations may allow independent practices to join their HIEs. Alternatively, a private practice could join a community or regional HIE if one is available. Direct Secure Messaging (DSM) protocol, created by a public-private consortium, specifies how a clinical message can be transmitted from one trusted party to another. Companies known as health information service providers (HISP) route the messages, maintain provider directories, and guarantee the authenticity of senders and receivers of information. DSM could provide independent physicians a cost-effective way to exchange summaries.

(3) Laboratory Orders. Physicians should place laboratory orders themselves. More than 30% of laboratory and imaging test orders must be done electronically in Stage 2. Laboratories are expected to offer a two-way interface before 2014 in order to keep its customers. Physician groups should analyze workflow and figure out how best to pace lab orders electronically, e.g. customizing template orders for annual exams that might include a blood panel, ECG, and bone density test.

(4) Medication Reconciliation. More than 60% of medication orders must be done electronically in Stage 2, compared with just 30% or prescription drug orders in Stage 1. When a patient is transferred to the care of an EP, the physician must use his EHR to reconcile the patient’s medications in 50% of these care transitions. Vendors must build in the capability. Staffers will have to ask patients about their medications and capture that data in structured fields, and Surescripts medication histories can help as well.

(5) Preventive Care reminders. An EHR must have some kind of registry function that can identify patients who are due for preventative/follow-up care for more than 10% of patients with two or more office visits in the previous 2 years. The EHR must have a method of automating those alerts to patients; the office staff does not have to call or mail reminders. Third-party solutions do exist that help solve this problem if an EHR cannot do it.

Electronic health records make the transfer of important patient information easier to do between doctors and other health professionals, but its convenience can be abused if not properly secured. Christensen Law hopes that this has been informative for readers and if you have any questions regarding medical law, don’t hesitate to give our professional lawyers in OKC a call!

Accountable Care Organizations- Christensen Law

Accountable Care Organizations

Christensen Law Explains Accountable Care Organizations

Accountable Care Organizations are a part of the Affordable Care Act that’s designed to give doctors incentives to keep people healthy and out of the hospital. Christensen Law explains this new denomination of healthcare in the article below.

Written By: D. Wade Christensen, JD^ , J. Clay Christensen, JD^^ , L. Nazette Zuhdi, JD, LLM^^^, Adam W. Christensen^* , JD, MBA, Blake Christensen, DO, and S. Sandy Sanbar, MD, PhD, JD^**

The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama on March 23, 2010. It created the Medicare Shared Savings (MSS) program*. The MSS program promotes accountability for a patient population, coordinates items and services under part A and B; and encourages investment in infrastructure and redesigned care processes for the purpose of providing high quality and efficient service delivery.

In 2011, the Centers for Medicare & Medicaid Services (CMS), which is one of the HHS agencies, issued the rule that established Accountable Care Organizations (ACOs)** . The ACO initiative is a doctor-hospital partnership which heavily emphasizes integration through technology. The goals or benchmarks of ACOs are the provision of good quality care to Medicare beneficiaries, the reduction of waste when rendering medical services, and ultimately the containment of health care cost.

The doctors and hospitals will jointly be accountable for the health of their patients. They are expected to utilize, meaningfully, the use of electronic medical records and to effectively coordinate care among all providers, and are discouraged from repeating tests on patients. The Accountable Care Organizations providers contractually agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years. They are given strong incentives to cooperate and save money by avoiding unnecessary tests and procedures.

They will get paid more in bonuses for keeping their patients healthy and out of the hospital. On the other hand, the ACOs may have to pay a penalty if they do not meet performance and savings benchmarks. And patients in Accountable Care Organizations would still be free to see doctors of their choice outside the network without paying more. In this regard, ACOs differ from HMOs (Health Maintenance Organizations) where patients do not have that choice. In an attempt to become integrated systems, U.S. hospital systems have been buying up physician practices in hopes of becoming ACOs that directly employ the majority of their physicians.

The novel idea of the ACO doctor-hospital partnership has raised some important legal concerns, including:

(1) anti-trust and anti-fraud laws

(2) novel contracts between doctors and hospitals

(3) direct liability of ACOs for integrated system failure or improper integration of care, failure to properly credential and re-credential physicians, and failure to properly train or oversee personnel, vicarious liability extending to both old and new duties which are based on general corporate and agency law principles

(4) liability for independent contractors under the theory of apparent authority, or ostensible agency

(5) liability of primary care physicians for any system breakdown, even at a third-party level

(6) ACO liability caused by self-insurance which protects physicians as long as the system remains financially stable

(7) malpractice claims resulting from incentivizing physicians to not repeat tests or not to refer patients for needed treatment, delay some admissions or discharge patients prematurely

(8) the standard of care for ACOs may be higher than the prevailing standard because the physician may have to explain why he or she did not follow the ACO application, assessment and individualized care plan

(9) when providing informed consent, physicians should ascertain that the patient comprehends the alternative therapies presented and their risks in order to make an informed choice; patient understanding is pivotal in the informed consent process.

An ACO should put the beneficiary and family at the center of all its activities, honor individual preferences, values, backgrounds, resources, and skills, and should thoroughly engage people in shared decision-making about diagnostic and therapeutic options. This is referred to as patient engagement, which allows the patient to assess the merits of various treatment options in the context of his or her values and convictions. The ACO standards may indeed be stricter than the prevailing informed consent standards. Physicians may be liable for lack of informed choice for failure on the part of the physician to demonstrate that a patient understood all reasonable alternatives and made decisions accordingly.

^ First Gentleman of Oklahoma; Owner, Christensen and Associates; ^^ Owner and Managing Director, Christensen Law Group ^^^ Chair, Health Law Section, Christensen Law Group ^* Attorney, Health Law Section, Christensen Law Group ^** Of Counsel, Health Law Section, Christensen Law Group Address for all: 210 Park Avenue Suite 700, Oklahoma City, OK 73102.

*http://edocket.access.gpo.gov/2011/pdf/2011-7880.pdf

**http://www.cms.gov/sharedsavingsprogram

Don’t forget, the lawyers at Christensen Law can answer any other questions you have on Accountable Care Organizations.

medical Law

Obama Care: A Pyrrhic Victory in Medical Law

Christensen Law Reviews Changes In Medical Law

In this post, Christensen Law reviews how medical law has changed due to how healthcare has evolved overtime. The Obama Care medical law has been the center of controversy ever since its inception. The idea of universal healthcare is an idea many would favor, but its practicality has always been debated.

Compiled by: D. Wade Christensen, JD, J. Clay Christensen, JD, Blake D. Christensen, DO, L. Nazette Zuhdi, JD, LLM, Adam W. Christensen, JD, MBA, and S. Sandy Sanbar, MD, PhD, JD

President Ronald Reagan was deeply opposed to the creation of Medicare, which he viewed as the sun setting on America’s future. In 1965 under the Presidency of Lyndon B. Johnson, Congress had created Medicare under Title XVII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history.

Approximately 19 million people received Medicare in 1966. Before Medicare’s creation, only half of older adults had health insurance, with coverage either unavailable or unaffordable to the other half. Medicare was expanded in 1972 and again in 2001. In 2010, 48 million Americans received healthcare through Medicare. The Affordable Care Act (ACA) of 2010 is the most significant healthcare legislation since the creation of Medicare.

Beginning in 2014, the ACA requires most Americans under age 65 years to have health insurance or face financial penalties. On June 28, 2012, the U.S. Supreme Court declared the ACA in toto as constitutional, including the individual mandate which was permissible under the taxation powers of Congress as defined by the Constitution. President Obama, himself a constitutional scholar, and the Democrats in Congress were relieved, pleased, and gratified by the favorable Supreme Court decision, especially that the majority of the Justices (five) are appointees of Republican Presidents. But the Republicans in Congress have vowed to continue to “fight the battle” to repeal the ACA.

Is the Supreme Court ACA landmark decision a Pyrrhic victory for President Obama’s signature piece of legislation?

One can say that the President’s victory comes “with such a devastating cost that it carries the implication that another such victory will ultimately lead to defeat. Someone who wins a ‘Pyrrhic victory’ has been victorious in some way; however, the heavy toll and/or the detrimental consequences negate any sense of achievement or profit. There is, therefore, no reason to celebrate.” If the President is victorious in one more major and “politically destructive” and “financially costly and debilitating” battle with the Republicans, will he be utterly ruined?

In 280 BC, the army of King Pyrrhus of Epirus, an ancient Greek state, suffered irreplaceable casualties in defeating the Romans in two battles during the Pyrrhic War. Instead of being joyful of his victory, he allegedly stated that one more such victory would utterly undo him or another such victory and I come back to Epirus alone. He had lost a great part of the Greek forces, commanders and friends that he brought with him, with no recruits in sight. In contrast, the Roman camp was quickly and plentifully filled up with fresh men, not at all abating in courage for the loss they sustained, but even from their very anger gaining new force and resolution to go on with the war.

The ACA will, among other things, help over 40 million Americans without health insurance, do away with inequities of pre-existing conditions, and encourage medical students to choose primary care specialties. The ACA will impact physicians who serve uninsured and lower-income patients. It may also calm political and economic anxiety among the broader population of physicians who are unwilling or undecided about undertaking difficult and costly practice transformations to better coordinate care for patients. To some, the ACA is a step toward assuring the availability of health care to all as a universal goal. Health care, to others, is a right and not a privilege. Regardless, it must be provided in a way that is financially responsible. ‰

Select References: http://www.larrydewitt.net/Essays/Reagan.htm The Patient Protection and Affordable Care Act – Public Law 111-148. 124 Stat. 119 through 124 Stat. 1025 (906 pages) http://www.whitehouse.gov/blog/2012/06/28/supreme-court-upholdspresident-obamas-health-care-reform

Reflecting on this article, one may see that medical law is a complicated area of law that’s only getting more complicated with each passing year. If you are in need of assistance with matters pertaining to healthcare law , the lawyers at Christensen Law would be happy to help you. Please click here to contact us.

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State Question 777: A Compelling Reason To Vote YES


Why Vote Yes For SQ 777

There are many reasons to vote in November, including one of the least understood, but most crucial pieces of legislation relating to Oklahoma’s agriculture: State Question 777.  It is important to know that this proposed constitutional amendment was drafted by rural Oklahomans for the benefit of ALL Oklahomans and the land we call home. YOUR elected representatives, both Urban and Rural Senators and Representatives, overwhelming passed this proposal by a vote of 124-13.  This is a non-partisan, non-political proposal where the sole interest is to protect Oklahoma’s agriculture.  It is about making sure that Oklahoma encourages and protects all Oklahoma farmers and ranchers while enabling them to continue to have the ability to provide for their families in their chosen line of work and deliver quality, safe and affordable food to fellow Oklahomans and those around the world. S.Q. 777 is designed to benefit Oklahoma farmers and ranchers, whether full-time, part-time or even gardeners and hobbyists.

The actual amendment in full states, Section 38. “To protect agriculture as a vital sector of Oklahoma’s economy, which provides food, energy, health benefits, and security and is the foundation and stabilizing force of Oklahoma’s economy, the rights of citizens and lawful residents of Oklahoma to engage in farming and ranching practices shall be forever guaranteed in this state. The Legislature shall pass no law which abridges the right of citizens and lawful residents of Oklahoma to employ agricultural technology and livestock production and ranching practices without a compelling state interest. Nothing in this section shall be construed to modify any provision of common law or statutes relating to trespass, eminent domain, dominance of mineral interests, easements, rights of way or any other property rights. Nothing in this section shall be construed to modify or affect any statute or ordinance enacted by the Legislature or any political subdivision prior to December 31, 2014.”

Through the commercials and speeches, there is often much “political spin.”  Casting politics aside, what does this proposal really do and not do?

This proposal:
1. does NOT open the door to foreign ownership of agricultural land. (Constitutionally prohibited)
2. does NOT de-regulate puppy mills.  (Statutorily regulated)
3. does NOT legalize cock fighting.  (Statutorily prohibited)
4. does NOT change a single law currently in effect.
5. does NOT pollute our water or change a single water law.
6. does NOT prohibit additional laws to protect our water.
7. does NOT give agriculture any new freedoms.
8. does NOT affect county or municipal laws in any way. (legislative specific language)
9. does NOT allow for any anti-agriculture regulation without a compelling state interest, similar to the constitutional protections that rodeo, hunting and fishing currently have in Oklahoma.

This proposal:
1. does continue to provide for freedom of food choice.
2. does still provide for Oklahomans to make sure our food is safe and our water is protected; farmers and ranchers are the original Stewards of the Land.
3. does help to protect Oklahoma jobs, which is vital to our economy.
4. does protect Oklahoma farmers and ranchers from future adverse legislation from out of state special interest groups that do not care about Oklahomans or their values.
5. does help to continue to encourage future generations of agriculturists to become involved in agriculture by protecting Oklahoma rural values.
6. does restrict harmful, unscientific legislation that does not promote a compelling state interest from being passed by either political party.

Everything in this state question is intended to be in the best interest for all Oklahomans. However, this State Question is garnering a great amount of adverse, political publicity from several special interest groups. Oklahomans must remember, this is about Oklahoma, our food source and our farmers and ranchers, not political out-of-state special interest groups.

Vote YES, to support your local farmers, ranchers and all Oklahomans who enjoy a healthy meal.


Wade Christensen is a fourth generation farmer and rancher from Thomas, Oklahoma and managing Director of Christensen Law in Oklahoma City.  He has served as Chairman of the National Governors Spouses Leadership Committee.  While serving as Chairman, his National platform was entitled “America’s Farms: Feeding and Strengthening Communities.” Christensen highlighted the important role farming and ranching play in providing a safe and healthy food source in the U.S and throughout the world.  He also highlighted the importance of the agricultural sector to the U.S. economy, national security and public health. Oklahoman and American culture celebrates farming and ranching as an important part of our history, but sometimes we don’t remember how important it is to our economy and our way of life today. Whether it is childhood obesity or global hunger, farmers and ranchers are helping to address some of the great issues of our times.