ICEHS member Lee Annest provides us this update on Health Care Reform activities relevant to our work in injury surveillance and prevention.

DHHS and CMS have issued their final rulings regarding Electronic Health Records (EHRs) Meaningful Use Criteria for reimbursement for Medicare and Medicaid claims by hospitals and physicians offices. This is part of implementation of the Health Information Technology for Economic and Clinical Health Act (HITECH). Below is a link to a brief NEJM article which summarizes the "meaningful use" regulation by Dr. Blumenthal. In order for hospitals and physicians to receive full reimbursement, they need to comply with these meaningful use criteria. There will be some financial incentives available to help hospitals get set up to comply. I think these regulations apply to what is expected in 2011 and 2012.

As some of you may know, there is a public health reporting component. We submitted a recommendation to include external-cause-of-injury coding as a required data element in the EHR system. It didn’t get attention in this regulation, but I still think we will be okay because ICD-9-CM/ICD-10-CM coding is included in the EHR. There are a couple of more stages of implementation of the Act, so I will be following those activities to look for other opportunities to express our recommendations and needs.

I think coming up with some good quality of care assessment indicators for injuries that rely on external cause of injury (e.g., falls among older persons) would be the next avenue to explore — as mentioned in our action plan published last December. See http://www.cdc.gov/injury/data/ecode_report.html.

The EHR system will make allowance for implementation of ICD-10-CM so there will be lots of changes associated with the introduction of this new and more extensive morbidity coding system. There are many more codes and some different orientations of external-cause-of-injury coding. We will need to come up with new external-cause-of-injury and diagnosis code matrices for reporting injury data in federal and state-based emergency department and hospital discharge data systems.

Relevant New England Journal of Medicine articles include:

The "Meaningful Use" Regulation for Electronic Health Records (Blumenthal) http://content.nejm.org/cgi/content/full/NEJMp1006114/

Finding My Way to Electronic Health Records http://content.nejm.org/cgi/content/full/NEJMp1007785/