The graph shows most of the effort in large system development goes into removing defects. Defects can occur in the feasibility, requirements, analysis, design, and coding phases of a project. The sooner a defect is detected in the development life cycle the less expensive it is to correct. So, defects detected in requirements are relatively inexpensive to correct whereas a defect in code is significantly more expensive to correct. Once a system is in operation defects are very expensive to correct. Think about it: not only do you have to fix the code but potentially you fix documentation, retrain users, etc.

So this all begs the question – where do you put your effort and resources during the development of a large system like an MMIS? Focus on quality early (rather than waiting for the testing phase of a project) saves money.  A modest investment in quality assurance or independent validation and verification up front results in real dollar savings down the road.

To access the SHIE Toolkit, visit: http://statehieresources.org/

If you would like some help learning how to use the toolkit please contact us at info@pubknow.com.

CMS’s proposed rule would phase in more comprehensive criteria for demonstrating meaningful use in three stages.  Stage 1 would begin 2011 and focus on electronically capturing health information and using that information to track major clinical conditions, increasing communication between care providers, and initiating the reporting of clinical quality measures and public health information.  Clinical quality measures would need to be directly submitted to CMS starting 2012.

CMS will build upon findings in Stage 1 to propose two additional Stages of meaningful use.  Stage 2 will likely add criteria in the areas of disease management, clinical decision support, medication management, patient access to their health information, transitions in care, quality measurement and research, and increased communication with public health agencies.  Stage 3 may further expand on Stage 1 and 2 to focus on achieving improvements in health care quality, safety and efficiency, decision support for national high-priority conditions, providing patient access to self-management online tools, and improving overall population health outcomes.

In addition, an interim final regulation (IFR) issued by the Office of the National Coordinator for Health Information Technology (ONC) proposes an incremental approach to adopting initial standards, implementation specifications, and certification criteria for EHR technology to support meaningful use.  Subsequent rules will contain standards with greater detail to achieving interoperability.

Both CMS and ONC encourage public comment on each regulation.

For more information on the proposed rule, visit:

CMS: http://www.cms.hhs.gov/Recovery/11_HealthIT.asp

ONC: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1153&mode=2

• State, local, tribal, or territorial government entity with a public health focus
• Integrated delivery network or health system with broad community partnerships
• Independent physician association or consortium of medical groups
• Public/Private partnership aimed at health system improvement and/or community health improvement
• ONC-funded regional extension center with the capacity to expand its services

Eligible applicants are expected to demonstrate an existing infrastructure for health IT and exchange, or previous success in either a community-level practice redesign and care coordination or community-level evaluation that advances health IT and exchange infrastructure.  Applicants are required to provide a detailed approach describing how they plan to advance current health IT and exchange capabilities to achieve a more cost-effective and higher-quality patient care.

An additional $15 million will be provided for technical assistance to the communities to evaluate the success of the program.

An electronic Letter of Intent is required to be submitted by January 8, 2010. Final applications for the grants are due on February 1, 2010.  Award decisions are anticipated in March 2010.  The grants will last for a 36-months.

For more information, visit the HITECH website.