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 HIT updates What’s happening August 30, 2010 • Sens. Mark Pryor (D-Ark) and Jay Rockefeller (D-W.Va.) Introduce Legislation to Protect Personal Health Information On August 5th, Senators Mark Pryor of Arkansas and Jay Rockefeller of West Virginia introduced legislation that would add additional requirements to HIPAA and HITECH privacy and security provisions by creating standards to restrict and safeguard personal health information. Under the proposed Data Security and Breach Notification Act of 2010, business and non- profit healthcare organizations that handle sensitive information would be required, under the watchful eye of the Federal Trade Commission, to establish comprehensive data compliance plans and following strict breach-notification requirements. Affected consumers would be entitled to receive consumer credit reports or monitoring services for two years under the legislation. Click here to read Senator Pryor's announcement. • FCC Seeks Public Comment on Rural Health Care Infrastructure Program The FCC's Notice of Proposed Rulemaking (NPRM) to expand the Rural Health Care (RHC) Program was published in the Federal Register on August 9th. Program stakeholders are encouraged to review the NPRM and submit their comments to the FCC. Public comments are due September 8, 2010 and “Reply Comments” due September 23, 2010. The NPRM would establish a permanent telehealth infrastructure fund, cover more of the recurring cost for broadband connectivity, and expand the types of services and health care providers that are eligible to receive funding. The reforms are consistent with the recommendations set forth in the National Broadband Plan. Among other things, the Rural Health NPRM proposes: - Support of up to 85% of new broadband infrastructure costs; - Reimbursement for 50% of recurring monthly broadband costs (currently 25% for Internet Access only); - Funding for eligible skilled nursing facilities, dialysis centers, and off-site administrative offices and data centers ; - Clarification of the FCC’s existing recordkeeping requirements to enhance its ability to protect against waste, fraud and abuse ; - Elimination of the current rule that requires that funding offset universal service contributions owed by participating service providers, direct distribution by Universal Service Administrative Company (USAC) of funds to service providers participating in the health broadband services program, telecommunications program, and health infrastructure program. In related rulemaking, the FCC sought public comment on a petition to permanently grandfather rural health care providers that would otherwise not be eligible for universal service support after June 30, 2011, absent Commission action. Comments were due August 30 and reply comments are due September 13. • CMS Helps State Medicaid Directors Further Understand HITECH Requirements The Centers for Medicare and Medicaid Services (CMS) recently distributed a detailed letter to State Medicaid Directors providing guidance for implementing the ARRA provisions to promote the adoption and meaningful use of certified electronic health (EHR) technology and qualifying for incentives under the HITECH Act. ARRA provides 100 percent Federal financial participation (FFP) to States for incentive payments to eligible Medicaid providers to adopt, implement, upgrade, and meaningfully use certified EHR technology, and 90 percent FFP for State administrative expenses related to the program. The August 17 CMS letter discusses qualifying administrative expenses, requirements for matching funds, and appropriate use of the funds. • Agriculture and Commerce Departments Announce $1.8 Billion in Broadband Projects On August 18th, Vice President Biden announced 94 Recovery Act projects across 37 states totaling $1.8 billion as part of a $7 billion effort to invest in broadband high-speed Internet in rural and urban areas. A joint effort of the US Departments of Agriculture’ Rural Utilities Service (RUS) and Department of Commerce’s National Telecommunications and Information Administration (NTIA), it includes projects geared toward education, public safety/ emergency response, social services and healthcare. A recent analysis by the National Economic Council had concluded that Recovery Act investments in broadband are expected to create tens of thousands of jobs in the near term, and expand economic development and jobs. Telehealth and HIT advocates have stressed the importance of coordinating Recovery Act broadband programs with the Medicare and Medicaid IT incentive funding initiatives toward a more complete solution to achieving an e-enabled healthcare environment. Click here for a list of the projects. • DHHS Announces $32 Million to Support Rural Health / Telehealth On August 23rd, Secretary Sebelius announced $32 million in FY 2010 funding to increase access to healthcare in rural areas. Among other elements, the initiative includes the Medicare Rural Hospital Flexibility Program, and Rural Health Workforce Development Program, as well as $2 million for Telehealth Network grants to build capacity to develop sustainable telehealth programs and networks, and $1 million for a Telehealth Resource Centers grant program to support technical assistance to help health care organizations, networks and providers implement cost-effective telehealth programs serving rural and medically underserved areas and populations. Read the HHS press release here. • White House Report Highlights Recovery Act Provisions on Health IT On August 24th, Vice President Biden released a new White House Report entitled: “The Recovery Act: Transforming the American Economy Through Innovation” which discusses, among other initiatives, provisions related to incentives for health IT and broadband. Summarizing the effort related to building HIT capacity, the report states that: “The Recovery Act is investing approximately $20 billion in health information technology to boost significantly advancements in electronic health records, e-prescribing, e-care, and community health initiatives. Through the $250 million Beacon Communities program, communities will demonstrate the use of new technologies aimed at sustainable improvements in health outcomes, health care quality, safety, and efficiency. These efforts will not only cut certain medical costs, but also improve care. Finally, the rise in e-care technologies or telemedicine will allow medical personnel to treat patients remotely, while being able to monitor conditions and prescribe or administer medications from miles away.” • Secretary Sebelius Outlines Collaborative Efforts Behind the Nationwide Push to Electronic Health Records In a Kaiser Health News guest column, DHHS Secretary Kathleen Sebelius discusses collaborative industry efforts toward eHealth Care, citing public/private sector leveraging efforts. Secretary Sebelius comments on the the Brandeis University/Health Affairs Industry Forum at the National Press Club (see what’s happening August 16, 2010) noting that: “Health care providers may agree with the benefits of electronic health records. But they’ve also believed that adopting them was too difficult and expensive. As the event earlier this month demonstrated, that’s changing – in large part due to an ambitious investment we made in the Recovery Act to reduce many of the obstacles that limited the spread of electronic health records in the past”. • EHR Adoption and Meaningful Use A recent article in Health Affairs by Ashish K. Jha, Catherine M. DesRoches and colleagues titled, “A Progress Report On Electronic Health Records In U.S. Hospitals” reports on a survey of E H R adoption in hospitals in the U.S. The survey found that although adoption increased from 8.7% in 2008 to 11.9% in 2009, only 2% of hospitals reported that their EHRs would allow them to meet Stage 1 meaningful use requirements. The two largest impediments to adoption were cost, often much more than the projected increase in CMS reimbursement, and the changes to clinical workflows that require modifications to existing procedures. The survey found that these impediments were stronger in small, public and rural hospitals which were less likely to qualify for meaningful use. The survey findings suggest important considerations for CHCs. • Shortage of Healthcare Workers to Install and Operate EHRs The Office of the National Coordinator (ONC) estimates that an additional 50,000 workers will be needed to install and operate the EHRs required for meaningful use qualification. A new report by Walt Zywiak explores the implications of this new demand. Aside from the staffing and training considerations, Zywiak recommends exploring new ways to leverage IT resources such as remote hosting or vendor outsourcing of both deployment and operation/maintenance, shared HIT teams (as, for example, through Health Center Controlled Networks or ,Primary Care Associations) and use of pre-packaged or preconfigured systems to help minimize complexity of deployment and maintenance. Meaningful use will make HIT staff and HIT resources a more important focus for CHCs. • ONC Announces the First Two ATCBs The Office of the National Coordinator today announced the first two organizations, CCHIT and the Drummond Group, to be approved as ONC Approved Testing and Certification Bodies, or ATCBs, under the temporary EHR certification program. Since 2006, CCHIT has held responsibility for certifying EHR technology. The Drummond Group is a testing and certification company in Austin, TX that has concentrated on software interoperability, compliance and standards testing. It has been in business since 1999. • ONC Announces New HIT Policy Committee Workgroup Stage 2 Meaningful Use Quality Measures Quality measures and the quality measure convergence process will be an important part of the Stage 2 Meaningful Use criteria. ONC has convened a Quality Measures Workgroup of the HIT Policy Committee to produce initial recommendations on prioritizing quality measures. The Committee must prepare a set of recommendations for quality measures for inclusion in the Stage 2 Proposed Rule, to be issues some time in 2012. Measures were also discussed at the June 30 HIT Standards committee. (see 2010-06-30-standards-transcript.pdf) What’s happening August 16, 2010 • 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, see http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20100805/NEWS/100809976/1029 • 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, http://www.govhealthit.com/newsitem.aspx?nid=74416 • 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: http://www.ehealthinitiative.org/uploads/file/MU%20Workgroup% 20Meeting%20080510%20FINAL.pdf • 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. http://healthaffairs.org/blog/2010/08/05/advancing-electronic-health-record-adoption-and-meaningful-use/ • 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: http://huffpostfund.org/stories/2010/08/fda-obama-digital-medical-records-team-odds-over-safety-oversight • 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. For the text of the bill, see: http://frwebgate.access.gpo.gov/cgibin/getdoc.cgi?dbname=111_cong_bills&docid=f:s3708is.txt.pdf • 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. http://whitehouse.senate.gov/newsroom/press/release/?id=34784783-be3e-49fe-8c56-2dc8862cf2ad • 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. (http://www.cms.gov/EHRIncentivePrograms/) What’s happening August 2, 2010 • On July 7, the Office of the National Coordinator for HIT (ONC) announced an additional funding opportunity limited to applicants that are either currently funded as a Regional Extension Center (REC) or new applicants not currently funded in specific regions in the nation not yet covered by an REC, specifically: Orange County, California; the State of New Hampshire and select counties in the State of Florida. Applications must be submitted by August 6th. (see Grant.gov 7/7/2010 http://www.grants.gov/, Search per Catalogue of Federal Assistance (CFDA) number 93.718 or funding number EP-HIT-09-003-W3) • On July 19th, the eHealth Initiative released a new report entitled: “The State of Health Information Exchange in 2010: Connecting the Nation to Achieve Meaningful Use”, which details findings from its Seventh Annual National Survey on Health Information Exchange. The survey compiles information from a survey of 234 active health information exchange initiatives (HIEs) in the country, of which 56 are State designated entities. The report found that among the 199 respondents, there are 79 initiatives considered “operational” or currently exchanging health data - up from 57 in 2009 - and that while more exchange-oriented organizations appear to be self sustaining than last year, sustainability remains an issue. The primary improvements reported from participation are: reducing clinical administrative time, reducing time processing laboratory andradiology results and reducing cost by (partially) eliminating redundant testing The complete report may be found at: http://www.ehealthinitiative.org/ • Congress is already weighing back in, providing oversight with regard to HITECH implementation. On July 20th, the House Ways and Means Subcommittee on Health held a hearing, introduced by Chairman Pete Stark, on promoting the adoption of and meaningful use of HIT. The somewhat contentious discussion focused on DHHS efforts to move forward with regard to the new proposed certification and final “meaningful use” rules for Stage 1 of the Medicare and Medicaid incentives. Members questioned David Blumenthal, MD of ONC and Tony Trenkle of the CMS Office of E-Health Standards and Services about likely effectiveness of the final rules. Some Republicans questioned whether the final rules went too far in favor of providers, setting the bar too low at the onset. Other Members inquired about privacy and security, the impact on rural and underserved communities, and the effect on multi-campus providers who can otherwise only get support as if they were a single entity. Additional information including witness testimony may be found at: http://waysandmeans.house.gov/hearings/hearingDetails.aspx?NewsID=11261 • On July 22nd the Centers for Medicare & Medicaid Services (CMS) together with The Office of the National Coordinator for Health Information Technology (ONC) held a webinar entitled: “Audio Training on the Final Rules for ONC Certification and Medicare and Medicaid EHR Incentive Programs.” The presentation slides are available at: http://www.cms.gov/EHRIncentivePrograms/downloads /TempCert-SCC-Slides-072210.pdf An audio recording will be available on the CMS site at a later date. Additional webinars offering guidance are being planned by the Office of the National Coordinator and will be announced in Technology in Focus “What’s Happening”. • On Tuesday, July 27th, the House Energy and Commerce, Subcommittee on Health held its own hearing on: “Implementation of the Health Information Technology for Economic and Clinical (HITECH) Act” also featuring Drs. Blumenthal and Tony Trenkle of CMS. Among other issues, Committee Members discussed the manner in which multi-facility hospital providers would receive incentives, and whether the new certification process for electronic health records could be implemented fast enough to meet HITECH incentive timetables. The Committee staff briefing memo, a link to the witness testimony, and video of the hearing may be found at: http://energycommerce.house.gov/index.php?option=com_content&view=article&id=2090:hearing-on -implementation-of-the-health-information-technology -for-economic-and-clinical-health-hitech- act&catid=132:subcommittee-on-health&Itemid=72 • The Federal Communications Commission (FCC) and Food and Drug Administration (FDA) convened a joint public meeting on July 26th and 27th on Wireless Medical Technologies. The two-day meeting was prompted by recommendations of the FCC’s National Broadband Plan to unleash the power of broadband to improve health while cutting costs. Panels of more than 30 experts, led by FCC Chairman Julius Genachowscki and White House Chief Technology Officer Aneesh Chopra were scheduled to kick-off the program. Following the joint public meeting, the FCC and FDA signed a memorandum of understanding (MOU) that the agencies would work together to create an efficient regulatory structure for wireless-enabled medical devices and services. The agreement contains a five-year sunset provision. Considerable additional information including a link to the FCC/FDA Memorandum of Understanding may be found at: http://reboot.fcc.gov/workshops/fcc-fda-joint-meeting-on-life-saving-wireless-medical-technology • Government Health IT reports that 30 organizations requested applications to become a temporary EMR certification body and that six completed applications have been received by the ONC. This would mean beginning this fall, there may be several certification bodies rather than just one as in the past. Dr David Blumenthal, National Coordinator for HIT, stated that having several temporary certification bodies would allow “more opportunity, a broader pipeline for certification, hopefully more price competition and shorter waiting times…”. CCHIT, the only existing certification body, was not grandfathered by ONC and has to go through the evaluation process like all other applicants. EMR certifications should be announced starting in the fall after the certification bodies have been approved and testing completed. http://www.govhealthit.com/newsitem.aspx?tid=65&nid=74280 • Tony Trenkle of CMS, speaking at this month’s HIT Policy Committee Meeting, gave some insight into the Stage 2 meaningful use requirements. He reported that the 10 optional elements in the modified Stage 1 requirements would become mandatory in Stage 2. He also stated that many of the thresholds that were relaxed for Stage 1 would be enforced at the original levels in Stage 2. For instance the threshold of 40% for eprescribing would be raised back to 70% in Stage 2. The Stage 2 requirements are expected to be published later this year and go into effect in 2013. (http://www.informationweek.com/news/healthcare/policy/ showArticle.jhtml?articleID=226100125&queryText= stage%202%20meaningful%20use). What’s happening July 19, 2010 • CMS/ ONC Release Final Meaningful Use Rules On July 13th the Centers for Medicare & Medicaid Services (CMS), issued a final rule defining the minimum requirements that providers must meet through their use of certified EHR technologies in order to qualify for incentive payments. This Final Rule is the first step of an incremental approach to adopting standards, implementation specifications, and certification criteria to enhance the interoperability, functionality, utility, and security of health IT and to support its meaningful use. The certification criteria adopted in this initial set establish the required capabilities and related standards and implementation specifications that certified electronic health record (EHR) technology will need to include in order to, at a minimum, support (beginning in 2011) the attainment of Stage 1 meaningful use requirements by eligible professionals and eligible hospitals under the Medicare and Medicaid EHR incentive programs. The final rule includes modifications that address stakeholder concerns while retaining the intent and structure of the incentive programs. The final rules are thought by industry experts to be a significant improvement from the earlier drafts, The CMS fact sheet can be found at: http://healthit.hhs.gov/portal/server.pt?CommunityID=3002&spaceID=48&parentname=& control=SetCommunity&parentid=& in_hi_userid=11673&PageID=0&space=CommunityPage • Program Information Notice on State HIE The Office of the National Coordinator for Health IT (ONC) issued a Program Information Notice (PIN) on July 6th 2010 addressed to award recipients in the State HIE Cooperative Agreement Program. This PIN http://statehieresources.org/wp-content/uploads/2010/07/Program-Information-Notice-to-States-for-HTML_7-6_1028AM.htm) provides guidance on key deliverables and responsibilities for states and recipients for FY2011. The key functional deliverables are aimed at specific meaningful use criteria and include: E-prescribing, receipt of structured lab results, and sharing patient care summaries across unaffiliated organizations. Of the six key policy goals defined for 2011, the key ones include: - Ensure the privacy and security framework for state HIE is consistent with Federal guidelines and standards found at (http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS _0_10731_848088_0_0_18/NationwidePS_Framework-5.pdf) - Implement a strategy to fill in the meaningful use gaps for state HIE, and - Coordinate with Medicaid and public health programs to create an integrated approach This guidance is important for CHCs as it clearly states the functional areas that State HIE should focus on in 2011 and also directs state HIE to try to fill in the gaps in meaningful use and to coordinate with Medicaid programs. This aligns state HIE efforts more closely with CHC initiatives and provides some guidance for participation. • New Privacy and Security Changes Under HITECH On July 8, 2010, Secretary Kathleen Sebelius and the DHHS Office for Civil Rights (OCR) announced that the 1996 HIPAA Privacy and Security Rules will be modified to add new protections. The proposed new regulations pursuant to HITECH are intended to improve patient privacy and security in health information exchange by extending OCR’s enforcement, giving patients the right to receive their medical information electronically, and setting new limits on the use of protected health information. Among other things, the new regulations will extend OCR’s enforcement to business associates, and set new limits on the sale of individuals’ information. In addition, the rule partially clarifies the privacy status of Personal Health Records (PHRs) by clarifying that PHRs maintained on behalf of covered entities acting in partnership are considered business associates for purposes of the law. However the status of some other types of PHR is still vague – including entities that are software manufactures, health websites, and search engines. DHHS guidance can be found at: http://healthit.hhs.gov/portal/server.pt?open= 512&objID=1147&parentname= CommunityPage&parentid=32&mode= 2&in_hi_userid=11113&cached=true • Using Online Communication to Enhance Primary Care A paper by Dr. Ronald F. Dixon in the current issue of Health Affairs 29, no. 7 (2010): 1364-1369), Enhancing Primary Care Through Online Communication, describes three modes of online communication that can be used in the delivery of healthcare & discusses the impediments and benefits of each. These modes are asynchronous (or non-simultaneous) consultation through the use of secure messaging, real-time consultation via videoconferencing or chat , and remote physiological monitoring using in-home or mobile devices. Studies are cited that show each of these modes can be effective in improving outcomes. The author, a practicing physician, believes that the main impediments to the broader dissemination of these tools include non-alignment with the payment system and lack of integration of communication applications with currently used systems (EHR, PM etc.), but suggests that the provider-patient relationship, especially in the management of chronic diseases, would be greatly improved by their use. Abstract available at: http://content.healthaffairs.org/cgi/content/abstract/29/7/1364 Another paper in the same issue by Yi Yvonne Zhou and colleagues titled, Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients reports on a study of just over 35,000 patients at Kaiser-Permanente with diabetes, hypertension or both. Use of email to interact with patients over a two month period resulted in a significant (2%-6.5%) improvement in quality measures for HbA1c, cholesterol and blood pressure screening and control. http://content.healthaffairs.org/cgi/content/abstract/29/7/1370 • National Progress Report on eHealth The eHealth Initiative (eHI) has released its 2010 National Progress on eHealth. The report includes “a review of progress relative to strategies and actions to utilize health information technology (HIT) and health information exchange (HIE) to improve healthcare quality, safety and efficiency”. The report, the result of an online survey and committee process that included unput form and participation by over 100 experts in HIT, shows significant activity and progress, but also indicates that many stakeholders have reservations about current programs. Several of the key findings are as follows: - 61% of respondents believe that significant progress has been made in the adoption and use of HIT since 2007; - 55% believe that the value of HIE is not clearly understood, and 67% believe that the outreach efforts to consumers about the value of EHRs and HIE have been ineffective; - 56% believe that EHR use and HIE have improved care delivery - A large number of providers are concerned that “the processes and metrics for accelerating adoption and use of HIT and HIE may deter provider participation and delay the transformation to a patient-centered system”; - Similarly, there is concern that current programs driving payment reform and coding updates could discourage adoption of HIT; - Finally, clear, effective and understandable policies for privacy and security of protected health information are the keys to building consumer trust for HIT and HIE. The executive summary can be found here: http://www.ehealthinitiative.org/sites/default/files/file/ NPRexecsummary.pdf. • FCC Plan Expands Broadband for Healthcare Pursuant to the Federal Communications Commission (FCC) Broadband Plan issued in March as part of federal recovery efforts, (http://www.broadband.gov/plan/) the Commission voted unanimously on July 15th to consider a plan for expanding on the 15 year old Universal Service Access effort which provides up to $400 million per year in phone bill surcharges to help level the costs of broadband for rural healthcare facilities. The original program has been widely regarded as a failure given its limitations. The new plan would increase the subsidies to providers, cover the constructions costs of new and upgraded broadband networks, and for the first time allow a rbroader range or providers including skilled nursing facilities, acute care facilities, administrative offices, data centers and renal dialysis centers to qualify for payments. The Notice of Proposed Rule Making provides for 30 days of public comment before the order may be finalized. See: http://www.fcc.gov/ Already, groups including the American Telemedicine Association have suggested that the plan doesn’t go nearly far enough to fix long-standing program deficiencies. In a related development, Congressional leaders including Senator Max Baucus (D-MT), Senate Finance Committee Chair have reportedly discussed the possibility of reallocating a portion of ARRA Recovery Act funds made available for broadband programs in various industries to help pay for continuation of jobless benefits. See http://thehill.com/blogs/hillicon-valley/technology/107361 --baucus-proposes-cutting-broadband-stimulus-funds What’s happening June 30, 2010: • The Electronic Health Record (EHR) Incentive Program Website is now available on CMS.gov. The Centers for Medicare & Medicaid Services (CMS) has launched the official website for the Medicare & Medicaid EHR Incentive Programs. This website provides detailed information about the EHR incentive programs, which will provide incentive payments to eligible professionals and hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. Go to: http://www.cms.gov/EHRIncentivePrograms/ • MS/ ONC Issue Final Rule on Temporary Certification Program on June 18th Eligible professionals and eligible hospitals seeking to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs are required by statute to use Certified EHR Technology. Certification of Health IT is intended to provide assurance to purchasers and other users that an EHR system, or other relevant technology, offers the necessary capability, functionality, and security to help them meet the established meaningful use criteria. Certification is also intended to ensure a level of confidence in the security, confidentiality and interoperability of the application. The final Rule on Temporary Certification is dated June 18, 2010, 45 CFR Part 170 - The Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology and establishes certification programs for purposes of testing and certifying health information technology. The temporary rule will be in effect until December 31, 2011 or until the permanent rule supersedes it. The ONC will post a list of EHRs and EHR modules certified under the temporary program on their website as soon as it is available. Under the temporary rule, organizations may apply to become certifying agencies (ONC-Authorized Testing and Certification Bodies or ONC-ATCBs) only if they have the capability to both test and certify both complete EHRs and/or EHR modules. ONC-ATCBs will use tests and test procedures approved by the National Coordinator. More information is available through at these links: Fact Sheet and Frequently Asked Questions. The rule is at: http://edocket.access.gpo.gov/2010/2010-14999.htm • Alice Lipowicz , writing in Federal Computer Week, reports on a new joint effort announced by the Federal Communications Commission and the Food and Drug Administration to address the regulation of wireless telemedicine and telehealth systems.: http://fcw.com/articles/2010/06/15/fcc-fda-taking-teamwork-approach-to-telemedicine.aspx Joint public hearings are scheduled to take place in the FCC Commission Room, 445 12th St. SW, Washington, D.C, from 8 a.m. to 5:30 p.m. on July 26 and 27. • The House Committee on Veterans Affairs, Subcommittee on Health, Chaired by Rep. Michael H. Michaud (D-ME) held a hearing on Thursday, June 24th addressing the topic “Overcoming Rural Health Care Barriers: Use of Innovative Wireless Health Technology Solutions.” A dozen witnesses from the private sector and federal agencies including the Department of Defense, Federal Communications Commission, and the Veterans Health Administration highlighted the problems facing returning rural veterans, and the promise of innovative mobile technologies for improving veteran care through remote patient care monitoring, specialist consultations,, and social networking among rural patients facing difficult illnesses. In his opening statement, Rep. Michaud outlined the challenge. “Of the nearly 8 million veterans who are enrolled in the VA health care system, about 3 million are from rural areas. This means that rural veterans make up about 40 percent of all enrolled veterans”, Michaud said. “This is where I see the great potential of innovative wireless health technologies. VA certainly is a recognized leader in using electronic health records, telehealth, and telemedicine. However, wireless health technologies also include mobile health, which truly is the new frontier in health innovations”. Several witnesses, including David Cattell-Gordon of the University of Virginia, stressed the importance of VHA collaboration with community providers including community health centers. For more information visit http://veterans.house.gov/hearings/hearing.aspx?NewsID=592. • On May 5th, the Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics” held a Senate-side lunch briefing with Senators Tom Udall (D-N.M.) and Ron Wyden (D-OR) entitled: “Policy, Technology and Research Developments in Mobile Health” www.e-healthpolicy.org • Official Website for CMS EHR Incentive Programs - The Centers for Medicare and Medicaid Services (CMS) unveiled a new website last week dedicated the EHR ‘meaningful use’ incentive programs. Content includes explanatory material on the rule-making process that defines the programs and fact sheets on a variety of topics including the definition of meaningful use, the Medicaid incentive program and a FAQ sheet. CMS intends to continuously update this website http://www.cms.gov/EHRIncentivePrograms • HITECH, One Year Later – A new report titled “HiTech Revisted” written by Manatt Health Solutions, and supported by the California HealthCare Foundation, The Colorado Health Foundation United Hospital Fund, analyzes the effectiveness of the federal Health Information Technology for Economic and Clinical Health (HITECH Act), a key component of the ARRA investments of 2009. http://www.chcf.org/publications/2010/06/hitech-revisited. Among the report’s conclusions: - It is difficult for healthcare providers to develop effective strategies for achieving meaningful use, including determining what HIT products are most appropriate to buy, because only the standards for stage one have been released. - Some key eligible providers, especially small and rural practices and certain community health centers, may have difficulty meeting the proposed "meaningful use" criteria. - The current approach to interoperability (including NHIN and NHIN Direct) is “unlikely to yield quality improvement and cost efficiency gains.” - Additional policies (and associated legislation) are needed, targeted toward to Medicaid and the commercial health insurance markets, to encourage the organization of systems oriented toward high performance. • Writing in Healthcare IT news, senior editor Diana Manos reports that the HIT Policy Committee, in a meeting held last week, approved recommendations by the Privacy and Security Tiger Team that would establish health information exchange credentials and help to protect personal health information. Members of the Tiger Team include HIT Policy Committee members, HIT Standards Committee members, as well as members of the National Committee on Vital and Health Statistics. www.healthcareitnews.com/news/federal-advisory-panel -approves-privacy-and-security-recommendations What’s happening June 16, 2010 • National Health IT Week - This week, June 14- June 18, 2010 marks the 5th annual National HIT week, a collaborative forum of key healthcare constituents - including vendors, provider organizations, payers, pharmaceutical/biotech companies, government agencies, industry/professional associations, research foundations, and consumer protection groups - working together to elevate national attention to the necessity of advancing health IT. More at http://www.healthitweek.org/index.asp • Community Health Data Initiative (http://www.hhs.gov/open/plan/opengovernmentplan/initiatives /initiative.html) -The Department of Health & Human Services, as part of the Open Government Plan, is starting a major program with three goals: “ (1) raise awareness of community health performance, (2) increase pressure on decision makers to improve performance, and (3) help facilitate and inform action to improve performance” (see cited URL). The program will have two parts: first, HHS will make publically available a Community Health Data Set consisting of data aggregated from multiple source sources within the Department including: measures of health care quality, cost, access and public health (e.g., obesity rates, smoking rates, etc.), as well as never before available CMS data and health people 2020 data. It will also include a separate data warehouse and web portal for data access, now under development at the National Center for Health Statistics. Second, HHS will work with a broad variety of public and private organizations and individuals to determine uses for this data that will promote awareness of public health issues. This second effort will also consist of analyses of this data that provide examples for continued and further data use focused on quality improvement. DHHS has committed to a participatory and transparent approach to the data and analytic tools analysis methods, including sharing with other Federal agencies, to encourage broad us e and collaboration. National Demonstration Project for PCMH In a special supplement to the journal Annals of Family Medicine, (http://www.annfammed.org/content/vol8/Suppl_1/), The American Academy of Family Practice and its subsidiary TransforMED reported on their two-year study of the feasibility of Patient-Centered Medical Home ). Reporting on the AAFP site, (http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20100607tmedndpfindings.html) Sheri Porter summarizes the study and findings. Of an initial group of thirty six practices, thirty one family practices participated in and completed the study. Conclusions were developed in four areas as follows: 1) it is possible for ‘highly motivated practices’ to implement the PCMH model, but it is possible to create a system that negatively affects the patient’s experience., 2) it took more than the two year study period for many practices implement the PCMH model even with intense facilitation,3) it is too early to determine the effect on quality of care and patient outcomes, and 4) dissemination of the model requires real work. The overall conclusion was "most primary care practices in the United States will need external resources to successfully undertake the magnitude of redesign envisioned in the PCMH," • Landscape Shifting for CHCs - A new joint project of the Hirsh Health Law and Policy Program of the George Washington University School of Public Health and Health Services and the Robert Wood Johnson Foundation Services, Health Reform GPS, addresses many aspects of the new health reform legislation and associated implementation challenges. Addressing the issues facing community health centers, Feygele Jacobs, EVP of the RCHN Community Healthcare Foundation, posted this commentary: (http://www.healthreformgps.org/resources/feygele-jacobs-rchn-community-health-foundation). In the new, reformed healthcare world, CHCs will be expected to double their capacity in the next five years. This will entail all aspects of the health center including staff, training, facilities and both conventional and technology infrastructure. Health Centers will have to operate at a much faster pace as they deal with expanding primary care, qualify for meaningful use and develop medical home processes. Ms Jacobs concludes “Now comes the hard work of identifying and implementing systems that support health center operations and facilitate the collection and analysis of real information, and that will help take CHCs forward.” • ONC IT Policy Committee Makes Recommendation for EHR Oversight (http://www.ihealthbeat.org/?setday=6/9/2010) - The California Healthcare Foundation, through its iHealthBeat website (June 9, 2010) reports that the IT Policy Committee of the Office of the National Coordinator for HIT has recommended that a national program for monitoring patient safety issues in health IT systems be developed. The Committee did not recommend that any specific agency, such as the FDA, be responsible for this program. Recently there has been considerable speculation that the FDA would require that EHRs be regulated as medical devices. It now appears that the ONC’s IT Policy Committee does not think that is necessary, but does think a monitoring program will be required. • Community Collaboration to Improve Care and Reduce Disparities - The Durham Community Health Network (DCHN) is a public-private partnership which includes Duke University, Durham County HSS and several area hospitals and community health centers (Lincoln Community Health Center, Lyon Park Clinic and Walltown Clinic). A recent article in Health Affairs (Cook et al., http://content.healthaffairs.org/cgi/content/extract/29/5/956) describes DCHN’s participation in the Community Care of North Carolina (CCNC) program. CCNC provides care managers for Medicaid and CHIP enrollees and families with chronic illnesses. The program utilizes electronic alerts and community-based kiosks to help improve patient care and compliance. Previous programs have included an asthma pilot that standardized data collection and patient interaction, an EMR monitoring program that provided over 12,000 notices to care managers on such issues as emergency room visits and unfilled prescriptions, and a program that provided home visits to patients requesting home health assistance that made recommendations for inexpensive home healthcare devices that allowed independent living. The strength of the program is that care managers determine what programs and innovations are needed in the local community instead of a ‘one size fits all’ approach’. • HHS Releases More ARRA Funding for HIT - As part of the funds allocated to HHS and HRSA through the 2009 American Recovery and Reinvestment Act of 2009 (ARRA), HHS Secretary Sibelius announced last week grant awards totaling $83.9 million to 45 health center controlled networks to support the adoption of electronic health records (EHR) and other health information technology. http://www.hhs.gov/news/press/2010pres/06/20100603a.html What’s happening: June 9, 2010 • On May 10th InformationWeek detailed a new report by the Commission on U.S. Federal Leadership in Health and Medicine (http://www.cspresidency.org/Programs/health_and_medicine.php) entitled: "A 21st Century Roadmap for Advancing America's Health: the Path from Peril to Progress.” The May 5th report highlights the role HIT will play in re-engineering healthcare through the adoption of electronic health records, providing better analytics, and driving greater efficiency as the country builds a more comprehensive framework that strengthens the public health infrastructure. Additionally, new systems can create cost savings. "If used in innovative ways, the estimated savings from HIT expansion could reach $261 billion over 10 years," the report said. However, the goal of widespread implementation of EHRs is still in the nascent stages of development, with only 20.5% of physicians and 8-10% of hospitals using basic EHRs. Fewer still are meaningfully applying HIT to advance care coordination, aide clinical decision-making, or report health outcomes, among other practice. To gain appreciable benefits from HIT, a comprehensive approach must be adopted. • On May 4th, Vice President Biden together with DHHS Secretary Kathleen Sebelius announced that 15 communities will serve as health IT models under the $220 million Beacon Community program. Sebelius said the selected communities will offer insight into how health IT can improve health care delivery. The Office of the National Coordinator for Health IT received 130 applications for the grants. Some additional Beacon Community awards may be announced shortly. http://healthit.hhs.gov/portal/server.pt?open=512&objID=1422&mode=2 • Mary Mosquera writes in the April 16th issue of Government Health IT that: President Obama signed into law legislation that allows physicians who treat patients in hospital-based outpatient clinics to be eligible for incentive payments under the HITECH Act. By modifying the definition of hospital-based physician, the administration will enable many more physicians to become meaningful users of electronic health records. http://govhealthit.com/newsitem.aspx?nid=73538 • On April 15th, Representatives Patrick Kennedy (D-R.I.) and Tim Murphy (R-PA), Co-Chairs of the House 21st Century Healthcare Caucus, introduced the Health Information Technology Extension for Behavioral Health Services Act of 2010. This legislation would extend the incentives for the “meaningful use” of electronic health records established through the American Recovery and Reinvestment Act by ensuring the eligibility of many behavioral and mental health professionals, psychiatric hospitals, behavioral and mental health treatment facilities, and substance abuse treatment facilities. • Computer Sciences Corporation, one of the contractors that HHS used to develop the National Health Information Network, has issued a report on the top 10 challenges facing healthcare providers qualifying for meaningful use incentives. These challenges include: establishing effective workflows, using computer-based order entry systems, configuring EHRs to do ePrescribing and implementing health information exchange capabilities. The Foundation believes that meeting the consumer-based criteria will also be challenging. The report can be found at: http://www.csc.com/health_services/insights/44165-meaningful_use_for_eligible_professionals_the_top_ten_challenges • On April 6th U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced that more than $267 million has been awarded to 28 additional non-profit organizations to establish Health Information Technology Regional Extension Centers (RECs). This investment, funded by the American Recovery and Reinvestment Act of 2009, will help grow the emerging health information technology (health IT) industry which is expected to support tens of thousands of jobs ranging from nurses and pharmacy techs to IT technicians and trainers. RECs enable health care practitioners to reach out to a local resource for technical assistance, guidance, and information on best practices. RECs are designed to address unique community requirements and to support and accelerate provider efforts to become meaningful users of electronic health records. • The HIT Policy Committee of the Office of the National Coordinator has recently made a series of recommendations regarding meaningful use qualification, certification of EHRs and privacy and security. The primary recommendations include relaxing the ‘all-or-none’ requirement for qualification so that there would be some mandatory criteria & some flexibility in meeting many of the others. Both the Certification and the Privacy/Security Workgroups made recommendations regarding EHR modules. These are important primarily because HHS is taking seriously the idea that meaningful use qualification could be done without using a single EHR application that covered all of the potential required function. Qualification can also be done using a series of EHR modules, software that provides only one or a few of the required functions. This combined with any relaxing of the ‘all-or-none’ rule could be very significant for health centers. The foundation will provide more commentary on this in the coming months. The Policy Committee’s recommendations can be found by clicking here. • Early in April (2010), the Food and Drug Association’s Center for Devices and Radiological Health (http://www.fda.gov/AboutFDA/CentersOffices/CDRH/default.htm) established a working group to determine if and how the FDA should regulate EHRs. There have been several recent reports and published papers indicating that EHRs, and particularly computer-based provider order entry (CPOE) may have negatively affected both operational effectiveness and clinical outcomes. For recent articles, see Metzger et al. in Health Affairs 29(4) 655-663. http://content.healthaffairs.org/cgi/content/abstract/29/4/655) and a piece by Fred Schulte and Emma Schwartz featured in the Huffington Post Investigative Fund. • The FDA could regulate EHRs in a number of ways; the most onerous would be as a medical device, in which case they would have to undergo clinical trials. The ONC’s HIT Policy Committee recently recommended that the ONC work with the FDA and other stakeholders to determine what role the FDA should play in EHR certification and regulation. More information can be found at: http://govhealthit.com/newsitem.aspx?nid=73573 And More News: • The April 2010 issue of Health Affairs has two articles on the use of EHR technology in the patient-centered medical home. Both articles show that current EHRs leave much to be desired as technology to provide aspects of the medical home. Bates and Britton provide a roadmap for how EHRs need to evolve to increase their effectiveness in the medical home (http://content.healthaffairs.org/cgi/content/abstract/29/4/614). • Fernandopulle and Patel show that the use of a specific (though widely used and typical commercial) EHR in a large, not-for-profit health system in southern New Jersey do not facilitate medical home capabilities, especially in the treatment of patients with chronic diseases (http://content.healthaffairs.org/cgi/content/abstract/29/4/622). The relationship of EHR technology to both the meaningful use and medical home standards is critical for health centers, as FQHCs will be required to adopt certified EHRs in order for providers to qualify for Medicaid incentive payments. Adopting health centers and other organizations will face real challenges if this technology does not adequately support the medical home requirements. • In addition, in an article in the same issue of Health Affairs titled “Easing The Adoption And Use Of Electronic Health Records In Small Practices” (http://content.healthaffairs.org/cgi/content/abstract/29/4/668 )authors Torda, Han and Scholle note that in excess of $640 million over four years has been made available to establish a national program of Regional Health Information Technology Extension Centers. These centers are intended to help small practices adopt and become meaningful users of health information technology by providing technical assistance and guidance to practices. The authors conclude that the centers will need to provide more than just assistance with technical problems and further, will require additional funding after 2011. This article, based on a study of existing support programs, was published a few days before the Department of Health and Human Services released $267 million in funds from the Health Information Technology for Economic and Clinical Health Act for 28 regional centers, bringing the total number of centers to 60. • The spring issue of the Journal of Healthcare Information Management (jhim Spring 2010 volume 24 / Number 2) has an article on the implementation of an ambulatory care EHR in a Health Center Controlled Network (HCCN) in New York City. The network consists of four FQHCs and 18 sites in the greater New York metropolitan area. The lessons learned in this implementation are important including: the need for clinicians to participate and lead in all phases of implementation, the need for early adopter organizations to mentor late adopting ones, the need to prepare and plan (and prepare and plan), the need to customize function for specific practices and workflows, the need to have lab interfaces planned as an early part of the deployment, the need to have an open communication policy for all participants, the need to present a common front to vendors and finally the need to collaborate in all aspects of the effort. A PDF of the article titled, A Health Center Controlled Network’s Experience in Ambulatory Care E H R Implementation: Lessons Learned From Four Community Health Centers by Nick Egelson et.al is available here. • HRSA’s Office of Rural Health Policy released a new publication in April, titled “A Manual on Effective Collaboration Between Critical Access Hospitals and Federally Qualified Health Centers”. The intent of the manual is to illustrate how CAHs and FQHCs in close proximity to each other and serving similar communities, can coordinate to better meet community need. This timely and important manual is available at http://www.hrsa.gov/ruralhealth/pdf/qhcmanual042010.pdf |
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