MEANINGFUL USE

First EHR & EHR Modules Certified

• The Office of the National Coordinator has selected three organizations as ONC – Authorized Testing and Certification Bodies (ATCBs) to certify and test EHRs as capable of meeting Stage 1 meaningful use criteria. These are: Certification Commission for Health Information Technology (CCHIT), The Drummond Group and InfoGard Laboratories..The Drummond Group has certified two complete EHRs and two EHR Modules. InforGard Laboratories has yet to announce any certifications. More on CCHIT certifications appears below; the list of CCHIT certifications can be found at CCHIT Certifications List.
• The ONC has an official website with a posted Certified HIT Product List, but as of today it only has the Drummond certified EHR products listed

CCHIT Announces First Round of Certifications
The Certification Commission for Health Information Technology (CCHIT) announced on October 1st  that it has tested and certified 33 Electronic Health Record (EHR) products under the Commission’s ONC-ATCB program, which certifies that the EHRs are capable of meeting the 2011/2012 criteria supporting Stage 1 meaningful use as approved by the Secretary of Health and Human Services (HHS).  The certifications include 19 Complete EHRs, which meet all of the 2011/2012 criteria for either eligible provider or hospital technology, and 14 EHR Modules, which meet one or more – but not all – of the criteria.

CMS Incentive Payments may be subject to  taxation
The American Academy of Family Physicians (AAFP), after consultation with both the ONC and tax experts, has concluded that CMS incentive payments will be viewed as taxable income by the IRS. Mark Estroff, C.P.A., a principal at the Atlanta, GA. health care consultancy and accounting firm Gates Moore and Co., is of the opinion that the meaningful use incentives would be taxable income, but that healthcare organizations and individual providers could take advantage of tax credits for technology investments, staff training etc. For more on this see AAFP’s piece by Sherry Porter.

ONC HIT Information Exchange Work Group Meeting (9/30/2010)
TTwo panels at a recent meeting of the Information Exchange Workgroup of the ONC HIT Policy Committee disagreed over high-level concepts for provider directories to be used in regional and nationwide HIE. The Health Plans, Public Health and Others panel agreed that a single nationwide directory should exist and that it should also be able to point queries to more detailed regional directories. The Technical Requirements Panel specified that there are many existing large-scale provider registries and that there was no need for a single registry, but for interconnectivity standards so that regional and government agency registries (CMS, VA etc.) could reference each other. There were many other disagreements among and within Panels. It appears that this is not yet a mature topic. The issues are summarized in a meeting summary prepared by the eHealth Initiative.

Meaningful Use Penalty
A recent survey on EHR implementation had some surprising results, as reported in Healthcare IT News. The survey, done by Physicians’ Reciprocal Insurers (Roslyn, NY) found that while the majority (85%) of the physicians polled  knew about CMS incentives for EHR adoption, a large number (35%) were not aware of noncompliance penalties starting in 2015. Of those physicians who were not aware, a majority (65%) said that the penalties, which equate to 1% of CMS reimbursement a year up to 5%,  would not influence their decision to acquire & use an EHR. The survey also found that 85% of physicians were concerned about the cost of EHR adoption and 79% were concerned that training would take considerable time and so also be a cost. On the positive side, 58% of the physicians surveyed thought that EHR use would improve patient care and outcomes.

NEW REPORTS

Web-based Tool Improves Care for Chronic Diseases When Used in Conjunction with EHR
Two recent studies, one in the American Journal of Managed Care (AJMC) and the other in Population Health Management (PHM), have shown that the use of a web-based care management application in conjunction with an EHR can improve care for patients with diabetes or heart disease. The application was the Panel Support Tool (PST) developed at Kaiser Permanente and used by care panels in Kaiser facilities. The AJMC study followed 204 primary care teams providing care to 48,344 patients with diabetes and/or heart disease. After a year of using the application, the percentage of care recommendations met per month rose 5% for diabetes patients and 7% for heart disease patients. The larger PHM study, of 207 teams, following 263,509 patients, found that after 20 months of use the percentage of care recommendations met per month also went up 7%. Patients in this study ranged from relatively healthy to quite ill. The application is tightly integrated with Kaiser’s EHR, and this integration was seen as key in getting providers to use the tool. The results in summarized in this October 4 article from Healthcare IT News.

Future Physicians: EHR & Smartphone Use
An August 2010 survey of medical students by epocrates, provider of online and mobile drug and disease information, showed that 96% own a mobile device capable of displaying web or mobile browser based information and that 78% of them used their mobile device to access medical information at least once a day. They were also more than twice as likely to consult their mobile device first before an attending physician. 94% of medical students believed that it was ‘important’ to ‘very important’ to have an EHR at the first place they practiced after medical school, up from 90% in 2009). Reported in CMIO, September 30.

CIO Survey Says Staff Shortages Could Severely Impact EHR Adoption
A newly released survey by the College of Healthcare Information Management Executives (CHIME) predicts that IT staffing shortages will put projects at risk and negatively impact their chances to implement electronic health records successfully. More than 60 percent of responding CIOs reported that IT staffing deficiencies will possibly (51 percent) or definitely (10 percent) affect their chances to implement an EHR and receive stimulus funding. Other surveys by provider groups and industry have reached similar conclusions. See the Executive summary of the CHIME Survey.

Physicians Slow to Use E-mail With Their Patients
According to a new study (Issue brief #134) by the Center for Studying Health System Change, only 6.7 percent of office-based physicians routinely e-mail their patients. Even among the highest users – physicians in group /staff-model HMOs – only 50.6 percent reported routine e-mail use. A total of 4,200 M.D.s were surveyed in 2008. Physician adoption and use of e-mail remains low for a variety of reasons including: lack of financial incentives; increased workload without reimbursement; and, security and privacy concerns.

Comparative Effectiveness Research
The journal HealthAffairs has dedicated its October issue (and a major Washington Briefing on October 5th) to Comparative Effectiveness research. Read more in the HEALTH AFFAIRS Blog. An excellent summary of the October 5th briefing, “New Era of Comparative Effectiveness Research” is available at Federal Telemedicine Reports.

INFRASTRUCTURE

FCC Announces Availability of New “Unlicensed” Spectrum
On September 23rd the Federal Communications Commission took steps to free up vacant airwaves between TV channels — called “white spaces” — to unleash a host of new technologies, such as “super Wi-Fi,” and myriad other diverse applications. This is the first significant block of spectrum made available for unlicensed use in more than 20 years. Consistent with the goals (see Chapter 10 on Healthcare) of the National Broadband Plan, the announcement is thought to be important to many industries. High-bandwidth applications for Telemedicine and disease monitoring may especially benefit. Read the FCC September 23 release.

GRANTS AND PROGRAMS

DHHS Announces $727 Million in Health Reform Awards to Community Health Centers
On October 8th, DHHS Secretary Kathleen Sebelius announced awards of $727 million to 143 community health centers across the country to address pressing construction and renovation needs and expand access to quality health care. The funding, made under the Affordable Care Act, will be used to help serve an additional 745,000 persons. The funding builds upon more than $2 billion in capital improvement and HIT investments made through the American Recovery and Reinvestment Act (ARRA).

ONC Rounds Out Coverage of Regional Extension Centers – Including Additional Coverage by Community Health Centers Alliance in Florida
The Office of the National Coordinator for HIT announced selection of the final two awardees for the Regional Extension Center program: CalOptima Foundation in Orange County, and the Massachusetts eHealth Collaborative in New Hampshire. ONC also announced expanded coverage for two existing RECs in Florida including Community Health Centers Alliances for additional areas in Glades and Hendry Counties. See the List of regional extension centers on the ONC site.

ONC Funds IOM Study on Patient Safety and HIT
The Institute of Medicine (IOM) has been awarded $989,000 in funds under a grant from the Office of the National Coordinator (ONC) to conduct a 1-year study aimed at ensuring that health information technology (HIT) will achieve its full potential for improving patient safety in health care. The study is expected to:

• Summarize existing knowledge of the effects of HIT on patient safety
• Identify approaches to promote the safety-enhancing features of HIT while protecting patients from any safety problems associated with HIT
• Identify approaches for preventing HIT-related patient safety problems before they occur
• Identify approaches for surveillance and reporting activities to bring about rapid detection and correction of patient safety problems
• Address the potential roles of private sector entities such as accrediting and certification bodies as well as patient safety organizations and professional and trade associations
• Discuss existing authorities and potential roles for key federal agencies, including the Food and Drug Administration (FDA), the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Medicare & Medicaid Services (CMS).

DHHS Announces Grants for Competitive Health Insurance Planning Including HIT Provisions
On September 30th, DHHS awarded nearly $49 million to help 48 states and the District of Columbia plan for the establishment of health insurance exchanges. . Starting in 2014, health insurance exchanges – new, competitive, consumer-centered private health insurance marketplaces that are a key part of the Affordable care act – will put greater control and greater choice in the hands of individuals and small businesses. The grants to states require assessing current information technology (IT) systems and infrastructure, and determining new requirements for HIT. Read more in the HHS news release.

Comparative Effectiveness Research Ramps Up
Also On September 30th, the DHHS Agency for Healthcare Research and Quality (AHRQ) announced the award of grants and contracts totaling $473 million to support evidence – based health care decision making. The funding announced covers all of AHRQ’s allocation and $173 million administered for the HHS Secretary by AHRQ. The funded projects include patient-centered outcomes research, also known as comparative effectiveness research, including health care interventions in real world settings, advanced use of the research findings by diverse populations, development of effective patient registries and training and career development for the next generation of researchers.

MEETINGS / CONFERENCES / HEARINGS

House Science and Technology Committee Holds Hearing on Health IT Standards
Just as the House of Representatives was adjourning to prepare for the November elections on September 30th , the House Science and Technology Subcommittee on Technology and Innovation, Chaired by Oregon Congressman David Wu, managed to squeeze in one last hearing – this one focused on: “Standards for Health IT: Meaningful Use and Beyond”. Witnesses included: ONC Director Dr. David Blumenthal: National Institute of Standards Information and Technology Laboratory representative Ms. Kathleen Roberts; and Dr. Dick Gibson of the Oregon Health Network. Read more in the Committee on Science and Technology release.

Capitol Hill Steering Committee on Telehealth / NHIT Collaborative for the Underserved Briefing Regarding HIT and Communities of Color

• While the House Science and Tech Committee was meeting on HIT Standards, the Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics” – supported by the RCHN Community Health Foundation and also co-led by Rep. David Wu (D-OR) – was right next door in another House Science and Technology hearing room convening a briefing session regarding: “The Impact of Federal and State Health Investments in Underserved and Communities of Color: Successes, Challenges, Next Steps.
• The briefing featured leading experts regarding the status of HIT efforts for underserved and minority communities including Garth Graham, M.D., M.P.H., Deputy Assistant Secretary for Minority Health, U.S. Department of Health and Human Services who served as moderator, as well as: Andrea Anderson, M.D., Deputy Medical Director, Upper Cardozo Health Center in Washington; Ann Lefebvre, Associate Director, NC AHEC Program, University of North Carolina at Chapel Hill; and Philip Magistro, Deputy Director and State HIT Coordinator, Pennsylvania. 

Healthcare Transformation Not Fast Enough (?)

• Paul Tang, MD, is Chief Medical Information Officer at the Palo Alto (CA) Medical Foundation and a member of the ONC’s HIT Policy Committee. He spoke recently at the American Health Information Management Association (AHIMA) and was very clear that despite many public comments about how fast healthcare reform and particularly the adoption of HIT was going, he feels it is not going fast enough. He said that public policy was needed because private markets had not been successful at reducing healthcare costs. He felt that EHR functionality has to be increased, especially in the areas of privacy and patient participation. His goal is to evolve EHRs into a tool for both providers and patients so that they become a not a personal health record but a ‘personalized health record’. See: “All of a Sudden we have the Docs‘ Attention”