ONC Privacy Tiger Team Recommendations:

• The privacy and security tiger team, a workgroup of the federally chartered HIT policy committee, has been meeting regularly to develop recommendations related to “meaningful use’ information exchange and determine under which patient consent would be required in order to electronically exchange data for treatment purposes . The group’s preliminary recommendation was that direct patient consent was not needed for “directed exchange,” or HIE-based data sharing related to the direct treatment of a given patient, although they listed six ‘triggers’ that might change this requirement. One of the triggers was the presence of sensitive information such as behavioral health or substance abuse information. The group has now recommended that, “Unless otherwise required by law, with respect to direct exchange for treatment, the presence of sensitive data in the information being exchanged does not trigger a requirement to obtain the patient’s consent in the course of treating a patient.” Relevant Federal and State laws would still need to be followed, and the group also pointed out that the provider should be sensitive to and compliant with a patient’s wishes. This would imply having a dialog with the patient on information exchange and possibly taking some action on restricting the contents of the medical records being exchanged. For Joseph Conn’s recent article on this issue, click here.

Governance Rules for NHIN Exchange:

• The HITECH Act specified not only that meaningful use of healthcare (EMR) technology would require electronic exchange of healthcare data, but that a governance mechanism would be required for this exchange and specifically for the National Health Information Network. The Office of the national Coordinator (ONC) announced this week that it is planning undertake a formal rule-making process for the NHIN Exchange that would provide a framework for participation in and governance of the NHIN. The current informal process, including the support of the Data Use and Reciprocal Support Agreement (DURSA) and the various technical committee and working group guidelines, will be reviewed and codified through the process and a participation, support, security and privacy framework will be defined. The ONC stated that it expects to release a proposed rule early in 2011 and go through a public review process to have a final rule by mid-year. Mary Mosquera addresses this in a recent article.

HIT Policy Committee Working Group on Meaningful Use reviews Care Coordination:

• The Meaningful Use Work Group of the HHS HIT Policy Committee met on August 5th to hear recommendations by expert panelists on achieving and supporting care coordination. Care coordination is one of the Stage 1 meaningful use criteria, and is expected to be more prominent in Stages 2 and 3. After expert testimony, the three panels concluded that the current healthcare payment and incentive structure does not support the data sharing needed to make care coordination successful, but that both vendors and providers could play a role in improving coordination. Specific recommendations included: having EHRs provide a single, easy to understand dashboard view of patient data that is aligned with clinical workflow, and using proactive notifications to alert providers of patient follow-through on time- and condition sensitive issues. The panelists also recommended many concrete elements for Stages 2 and 3 of meaningful use and HER certification, including: listing the providers on the care team, capturing more of the context of medication and treatment orders, allowing multiple providers to access and modify records simultaneously and many others. The eHealth Initiative’s summary is available here.

Briefing: Advancing Electronic Health Records Adoption and Meaningful Use:

• On August 5th, National HIT Coordinator Dr. David Blumenthal and CMS Deputy Administrator Marilyn Tavenner participated in a major briefing at the National Press Club in Washington focused on achieving the HITECH goals of meaningful use of EHRs. The program, sponsored by The Health Industry Forum and HealthAffairs, featured panels of expert industry leaders examining payer, provider, and consumer issues. Two major insurers – WellPoint and United Health Group – announced major efforts to help rural and underserved healthcare organizations in their efforts to become adopters. WellPoint announced that it will make significant capital available to providers through no-interest loans to bridge the gap to incentive funding under HITECH. Meanwhile, UnitedHealth Group said that its Ingenix business subsidiary has introduced “CareTracker” for Federally Qualified Health Centers. The cloud-based EHR system integrates fully with a specially-designed suite of administrative management services tailored to the specific challenges of CHCs. Click here.

Washington Insiders Turn Attention to EHR Safety Issues and Potential for FDA Oversight:

• On August 5t. the Washington-based “HIT Now Coalition” held a lunch briefing on a quickly evolving issue concerning safety and the degree to which the US Food and Drug Administration will become involved in regulating EHRs. Ronda A. Balham, O.D. Vice President of the Marwood Group – and former long time FDA staffer – presented an “Introduction to Medical Device Regulation EHRs and HIT”. Interest in the issue has been growing in part due to investigated reports detailing glitches in some systems which have led to the potential for serious medical errors. Link here to the Huffington Post Investigative Fund article.

Bills Seek to Address HITECH Shortcomings:

• Eight Senators have joined Sen. Charles Schumer (D-NY) in introducing the Electronic Health Record Incentives for Multi-Campus Hospitals Act (S.3708) — a companion to H.R. 6072 by Rep. Jack Spence (D-OH) and 31 co-sponsors — that would “clarify the application of EHR payment incentives in cases of multi-campus hospitals”. The bill would rectify an oversight in HITECH which prevents Medicare and Medicaid incentive payments to each qualified campus of a multi-hospital system. 

Introducing: S.3709

• Sen. Sheldon Whitehouse (D-RI) and six senate co-sponsors have introduced S.3709, which would extend HITECH incentive provisions for mental health providers, permitting Medicare funding for inpatient psychiatric hospitals as well as Medicaid meaningful use incentive funding for community mental health centers, mental health treatment facilities, psychiatric hospitals and substance abuse treatment facilities, and would also clarify eligibility of these mental health service providers for purposes of receiving technical assistance through the Regional Extension Centers. Rep. Patrick Kennedy (D-RI) has introduced similar legislation in the House of Representatives. Sen. Whitehouse and Rep. Kennedy are national leaders in matters related to both health information technologies and improved mental health care.

ONC Technical Assistance Calls on Certification:

• The Office of the National Coordinator for Health Information Technology (ONC) within the U.S. Department of Health and Human Services is hosting a series of informational calls the purpose of which is to provide an overview of, and answer questions related to, the temporary certification program for electronic health record (EHR) technology. Participants will hear an overview of the program and be able to ask questions. Two calls are scheduled for August 2010.
  1. Wednesday, August 18, 2010, 1:00 – 2:00 p.m. EDT; Call-in Information: Phone Number: 888-324-9617; Participant Passcode: 4584230
  2. Wednesday, August 25, 2010, 1:00 – 2:00 p.m. EDT; Call-in Information: Phone Number: 888-324-9617; Participant Passcode: 4584230
• Recordings and transcripts for each call will be made available on the ONC web site, http://healthit.hhs.gov/certification.

CMS Website on Medicare and Medicaid EHR Incentive Programs:

• The Centers for Medicare and Medicaid Services (CMS) has launched a web site to provide up-to-date, detailed information about the federal EHR incentive programs, which should help guide providers through the various regulations, requirements, and available assistance efforts. Related links both within and outside of CMS are provided.