Edition Thirteen (4/28/09)

Senate Set to Confirm Sebelius as Health Secretary
Miami Herald, 4/28/09
The Senate was set to approve President Obama's nominee for health and human services secretary Tuesday, giving the agency a leader in the midst of the swine flu outbreak. Morning debate and an afternoon vote were scheduled to confirm Kathleen Sebelius, the two-term Democratic governor of Kansas. She was expected to get the 60 votes needed in the Democratic-led Senate, though perhaps with little margin to spare.

Bipartisan Bill Would Increase Access to Telemedicine
The Times-Standard, 4/28/09
The Medicare Telehealth Enhancement Act, House Resolution 2068, would expand Medicare reimbursement to telemedicine facilities in urban and suburban areas. The bill would also provide $30 million in grant funding for healthcare organizations.

Making the Business Case for HIT
HealthLeaders, 4/28/09
Chief information officers are not always a member of the CEO's inner circle. In fact, only a quarter (25.23%) of CEOs listed a CIO as members of their senior executive team, according to the 2009 HealthLeaders Media Industry Survey. But the passage of the American Recovery and Reinvestment Act of 2009 may have just elevated their position. The federal government's $36 billion incentive package to install electronic health records means that more CIOs will report directly to the CEO and help set the strategy of the organization.

Reform Means Leaner Hospitals
HealthLeaders, 4/28/09
Attendees at the 40th annual membership meeting of the American Hospital Association in Washington were assured that health care reform is on track on Capitol Hill. But the message underlying that prediction is somewhat bittersweet: Hospitals are likely facing a future with a new definition of success that entails "doing less but producing greater results for patients," said AHA President and CEO Rich Umbdenstock at the opening session.

HIMSS Defines 'Meaningful Use' of EHRs
Health Data Management, 4/28/09
The Healthcare Information Management and Systems Society has released two definitions for "meaningful use" of certified electronic health records technology under the American Recovery and Reinvestment Act. The definitions cover meaningful use in hospitals and physician practices. HIMSS has sent its definitions to the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology for consideration as the government develops the formal definitions.

Senator: EHR Grants to Safety-Net Providers
Health Data Management, 4/27/09
Sen. Jay Rockefeller (D-W.Va.) has introduced legislation to make federal electronic health records software available to safety-net providers, particularly those in small, rural facilities. The Institute of Medicine defines safety-net providers as those delivering a significant level of health care and other health-related services to the uninsured, Medicaid, and other vulnerable patients.

Commentary: Five Myths on Health Care's Electronic Fix-it
The Washington Post, 4/26/09
Tevi Troy, deputy secretary of the Department of Health and Human Services from 2007-2009, provides his thoughts on what he says are common health I.T. myths. Troy questions whether the $20 billion for EHRs in the stimulus package is worth the risk.

AHRQ Readies E-Prescribing Tool
Health Data Management, 4/24/09
The Agency for Healthcare Research and Quality has contracted with the Rand Corporation, Santa Monica, Calif., to develop a toolset for implementing electronic prescribing systems. The toolset will be a "how to" guide for implementing e-prescribing across various provider settings, according to a notice AHRQ published April 24 in the Federal Register.

Here’s a “Meaningful Use” Tip
Health Data Management, 4/24/09
Hospitals that want to make an educated guess on how the federal government will define “meaningful use” of electronic health records under the economic stimulus package can use an existing benchmark, one expert says. They can refer to the qualifications for earning Stage 4 on the seven-level rating system of hospital EHR functionality from HIMSS Analytics, a Chicago-based research firm.

Hearing on “Meaningful Use” Slated
Health Data Management, 4/24/09
The National Committee on Vital and Health Statistics will hold a public meeting April 28 and 29 in Washington to discuss a definition for “meaningful use” of electronic health records under the economic stimulus program. The two-day meeting of the NCVHC executive subcommittee will feature 10 panel discussions with a variety of speakers.

Report: Change EHR Priorities
Health Data Management, 4/24/09
Hospitals should consider changing their priorities when implementing electronic health records, automating documentation of physicians’ notes earlier in the game, a new report suggests. The change in priorities would help hospitals provide adequate data for “core measures” that many payers demand, according to a new white paper from Computer Sciences Corp., a Falls Church, Va.-based consulting firm. The report also says hospitals should speed their efforts to document medication reconciliation to provide complete information on medications for use in core measure reporting.

PHI Security: Move Backward, Look Forward
HealthLeaders, 4/24/09
Thanks to HHS, we now know what "unsecured protected health information" means. So where do we go from here? If you're leading an organization that handles protected health information (PHI), you may be asking that question today. HHS issued a proposal for security breach notification in a 20-page report that defines acceptable conditions for covered entities and business associates to encrypt or destroy their private patient data to secure PHI and prevent a breach.

U.S. Launching $1.1 Billion Study of Which Medical Therapies Work
Chicago Tribune, 4/24/09
Gaps in medical knowledge are getting new attention as the federal government prepares to invest $1.1 billion in "comparative effectiveness" research and evaluate potential therapies head-to-head. The Institute of Medicine is reviewing priorities for this type of research and preparing to issue recommendations this summer. A new 15-member panel overseeing the government's initiative has been asking for public input. The hope is that by identifying which treatments are most effective, doctors and patients will make better-informed decisions and avoid therapies that don't measure up.

Lifetime EHR Could Mean Better Health Care for Veterans
HealthLeaders, 4/23/09
When Deb Howard, 42, of Kingwood, TX was discharged from the military in 1992, she was given eight years' worth of her paper medical records in two tattered and worn out folders. And although the records include valuable health information, including every illness with which she had been diagnosed and every drug for which she had been prescribed during her military career, she says she has no idea where those records are now.

The Change Health Care Needs
Health Management Technology, 4/09
As a new administration settles into the White House armed with conviction, experience, and technological know-how, there’s an air of doing well and doing right. At the forefront of priorities, along with the current economic downturn at hand, is the need to streamline the health care system and make quality, affordable health care a reality. As part of President Obama’s economic stimulus package, he’s pledged to have all medical records electronic within five years. That’s not a lot of time when you consider the fact that only 25 to 35 percent of the nation’s 5,000 hospitals use computerized order entry and medical record systems.

GOP Puts Brakes on Sebelius Confirmation
Modern Healthcare, subscription needed 4/23/09
Republican lawmakers in the Senate have blocked a move to confirm Kansas Gov. Kathleen Sebelius as HHS secretary. In a brief exchange on the Senate floor, Majority Leader Harry Reid (D-Nev.) pushed for a vote on the governor’s nomination today, but was rebuked by his Republican counterpart Mitch McConnell (R-Ky.). McConnell said that members of his party needed more time to consider her nomination.

NCVHS to Hold Two-day Meeting on ‘Meaningful Use’
Modern Healthcare, subscription needed 4/23/09
The National Committee on Vital and Health Statistics will hold a hearing on “meaningful use” for health care information technology next week. The April 28-29 executive subcommittee meeting to be held in Washington will focus on use as it relates to the capacity and functionality of electronic health records, quality reporting, health information exchange, and population/public health. Sessions also will discuss meaningful use in health I.T. product certification, and panelists will talk about ways to help vendors, providers and other health care stakeholders reach health I.T. goals by 2011.

Where, More or Less, is "The Frontier"?
HealthLeaders, 4/22/09
Health check on the farm. They are lands of great expanse, of tumbleweed, grand canyons and parks, and yes, national treasures. But for health program funding and definition purposes, just what is a "Frontier"? How many people must live there to qualify, or sustain a program for funding, licensing, or support? Starting this Friday in Albuquerque, federal officials are holding the first of three meetings to help resolve these questions, followed by meetings May 18 in Seattle and June 26 in Omaha. The task—to better distinguish what is merely "rural" from what is really "out there yonder"—is advocated in part by a patient, but persistent nonprofit group, the National Center for Frontier Communities.

Survey: Americans Want EHRs
Health Data Management, 4/22/09
Three out of four Americans think it’s important that their health care provider use electronic health records. But nearly 60% say they are not confident these records, which can be shared on-line, will remain confidential, a new national consumer survey shows. The survey found that 67% of Americans think it’s likely that electronic records would improve the overall quality of U.S. medical care, and 62% say the automated records would improve the quality of care their family receives.

Consumers Confused by EHR, PHR Differences
Modern Healthcare, subscription needed 4/22/09
The purpose of a personal health record is to help a consumer or patient empower themselves by keeping track of their own personal medical data for three main reasons: to help reduce the number of deaths caused by medical errors; to help a person in case of emergency and to help that patient keep track of their medications and insurance claims; and to attach X-rays, test results and to carry emergency contact information for portability. The purpose of an electronic health record is completely different, and many patients believe that a PHR is an EHR.

AMA Plans One-stop Electronic Shopping for Docs
Kansas City.com, 4/22/09
The American Medical Association is developing a Web-based service offering doctors electronic prescribing, up-to-date reference material and other resources. The idea is to make it easier for physicians to adopt technology President Obama is promoting for health care reform, to streamline their workload, and improve patient care.

Health Nominee Kathleen Sebelius Clears Hurdle
LA Times, 4/22/09
Kansas Gov. Kathleen Sebelius won the endorsement of a divided Senate Finance Committee on Tuesday, probably clearing the way for her confirmation as President Obama's secretary of Health and Human Services. But eight of the 10 Republicans on the panel voted against her, underscoring the increasingly partisan nature of the emerging health care debate on Capitol Hill.

Senator Explains His Vote Against Sebelius
Wall Street Journal, 4/21/09
Sen. Jon Kyl said he voted against Kansas Gov. Kathleen Sebelius to be secretary of Health and Human Services because of her support for research comparing the effectiveness of different medical treatments for a specific disease. "She left me with no assurance that HHS, federal health care programs, or any new entity—such as the Federal Coordinating Council—will not use comparative effectiveness research as a tool to deny care. And this should be a matter of concern to all of us," the Arizona Republican said in a statement.

Winners and Losers of HIT Stimulus Funds
HealthLeaders, 4/21/09
The federal government's $36 billion incentive package to install electronic health records has created a lot of excitement in the industry. It has also generated a call to action. Health care CIOs and industry experts all seem to agree that if providers want to collect the maximum reimbursement available to them, they had better start (if they haven't already) forming an I.T. strategy, choosing vendors, and ensuring they have the I.T. expertise required to meet the 2011 deadline. No one wants to leave one penny of this money on the table.

Big Challenges Await Health-Records Transition
Wall Street Journal, 4/21/09
The physician in charge of the federal government's massive push to move health care to electronic records from paper files faces "huge challenges" as he starts his new job in Washington this week. That phrase comes from a paper David Blumenthal himself published recently in the New England Journal of Medicine. He cited low adoption rates, high costs, technical complexities, and physician and patient concerns about privacy. Some other experts have warned that systems that are poorly designed or badly run can jeopardize patient safety. They are calling for more regulation or stricter standards for certification, arguing that the risks are heightened by limited public oversight of the systems.

Partners' Glaser Joining ONC as Advisor
Health Data Management, 4/21/09
John Glaser, vice president and CIO at Partners HealthCare System Inc. in Boston, soon will join the office of the National Coordinator for Health Information Technology in a temporary advisory role. Starting May 4, Glaser says he’ll work four days a week for six months advising the national coordinator within the U.S. Department of Health and Human Services. He’ll focus on the issue of carrying out the health care information technology provisions of the American Recovery and Reinvestment Act.

EHNAC Develops Application Service Provider Accreditation Program for EHRs
Healthcare IT News, 4/21/09
The Electronic Healthcare Network Accreditation Commission, a non-profit standards development organization and accrediting body, has developed a new accreditation program for application service providers for electronic health records. The Application Service Provider Accreditation Program for Electronic Health Records (ASPAP-EHR) evaluates companies providing ASP-format EHRs against specific criteria covering privacy and confidentiality, technical performance, business processes, resources, and security.

Senators Ready for Major Health Reform
Health Data Management, 4/20/09
U.S. Senators Edward Kennedy (D-Mass.) and Max Baucus (D-Mont.) have announced their committees will move in a coordinated manner in early June on major health care reform legislation. Kennedy chairs the Health, Education, Labor and Pensions Committee; Baucus chairs the Finance Committee. The American Recovery and Reinvestment Act contained substantial funding and policy provisions to promote health care information technology to support comprehensive reform.

Blumenthal Starts as National Coordinator
Health Data Management, 4/20/09
David Blumenthal M.D., has begun serving as the National Coordinator for Health Information Technology within the U.S. Department of Health and Human Services. He succeeds Robert Kolodner, M.D., who is returning to the Department of Veterans Affairs. Blumenthal is a practicing physician. He most recently served as director of the Institute for Health Policy at Massachusetts General Hospital in Boston and as a professor of medicine at Harvard Medical School. He was a senior health policy advisor to President Obama during the presidential campaign.

HHS Issues Guidance on Health I.T. Security
Healthcare IT News, 4/20/09
The Department of Health and Human Services has issued guidance on how to comply with the security specifications found in the economic recovery package. The Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of American Recovery and Reinvestment Act of 2009 (ARRA), requires providers to use certain technologies and methodologies to keep protected health information unusable, unreadable, or indecipherable to unauthorized individuals. The guidance was developed through a joint effort by the HHS Office for Civil Rights, the Office of the National Coordinator for Health Information Technology, and the Centers for Medicare and Medicaid Services.



Vermont Ban on Marketing Use of Rx Data Remains Intact
Modern Healthcare, subscription needed 4/27/09
A federal judge in Vermont rejected a challenge to a state law that blocks the use of prescriber-identifiable data for marketing. U.S. District Judge J. Garvan Murtha wrote that the prescribing information represents protected speech under the First Amendment but can be appropriately limited to advance a substantial government interest, granting deference to the Vermont Legislature’s conclusion that it has one.

GAO: States Worried about Tracking Funds
The Philadelphia Inquirer, 4/24/09
Despite President Obama's pledge that the $787 billion in stimulus money will be subject to "unprecedented accountability," many state officials worry that they lack the resources to properly oversee how their share of the money is being spent, Congress' watchdog agency said in a report yesterday. With states slated to receive about $49 billion in this budget year—mostly for health, transportation and education programs—the Government Accountability Office found that the biggest concern was keeping track of the money.

Rural California RHIO Gets Tax Exempt Status
Health Data Management, 4/23/09
The Internal Revenue Service has approved federal tax exemption status for the East Kern County Integrated Technology Association, a Tehachapi, Calif.-based regional health information organization. The IRS, after years of inaction, recently started awarding tax-exempt status to health information exchanges and regional health information organizations.

Vermont Lawmaker: State Can Take Lead in Medical Cards
Boston Globe, 4/22/09
State lawmakers are hoping to have Vermont become the nation's first state to employ medical card technology, sort of a health care debit card. The proposal is part of the Senate Appropriations Bill. Part of the proposal establishes a task force of lawmakers, health care providers, technology representatives, and licensed health insurers. They would review the prospects of using health information technology to revamp payment processes.

Whose eRecords Will They Will Be?
New Haven Independent, 4/21/09
Electronic medical records could potentially cut Connecticut’s health care costs, experts told a state panel, but thorny ethical and technical questions must first be addressed. That’s where you come in. The Connecticut Health Policy Project, which is taking the first steps toward establishing electronic medical records here, wants consumers to pose as many queries as possible, members of the organization’s board of directors told a group largely composed of state health officials Monday.

Report Tracks State Health I.T. Efforts
Health Data Management, 4/21/09
The National Association of State Chief Information Officers has published "Profiles of Progress 3: State Health I.T. Initiatives." It is an updated summary of where each state stands with government led or designated efforts to implement health I.T. and interoperable health information exchanges. The report, which also covers the role, if any, that state CIOs play in the efforts, was first published in November 2006. The latest version chronicles the "expeditious growth and adoption of health I.T. in just a few years as government leaders increasingly tout this as a means to improve patient care and reduce costs," according to the Lexington, Ky.-based association.

More Prescribers Go Electronic
Health Data Management, 4/22/09
Some 100,000 U.S. prescribers are now routing prescriptions electronically over the Surescripts network, up from just 19,000 two years ago and 74,000 at the end of 2008, the company says. Of the clinicians using e-prescribing in the first quarter of this year, 85% were physicians and the remainder were nurse practitioners and physician assistants, Surescripts says.

How Far Can Interactive Digital Medicine Go?
The Economist, 4/21/09
Let's explore the potential impact interactive digital medicine that flows in multiple directions—peer-to-peer, doc-to-patient, physician-to-physician, and on-line groups—can have on the industry. For example, a Web site called, "PatientsLikeMe," enables members from around the world to share stories about their ailments and treatment plans.

Hospitals Mine Data to Identify Those Likely to Pay
Atlanta Journal-Constitution, 4/20/09
Services such as credit scoring help nonprofit hospitals identify patients who qualify for charity or free care, those eligible for discounts and those who should pay the whole bill. "It's a sign of the times in health care," said Kevin Bloye, a Georgia Hospital Association vice president. "Hospitals can use this as a tool to determine who can pay and who can't." But the use of credit scores in analyzing patients' finances has triggered criticism for nonprofit hospitals. Many are trying to tamp down a reputation as aggressive bill collectors while their tax-exempt status gets heightened scrutiny from lawmakers and regulators.

CMS Validation Surveys: On the Rise?
HealthLeaders, 4/20/09
Reports from the field indicate that validation surveys by state surveyors on behalf of the CMS are happening with greater frequency in 2009. Validation surveys are unannounced surveys used to validate an organization's accreditation process. These surveys are conducted on a representative sample basis, or in response to substantial allegations of noncompliance. Unlike in the case of a for-cause survey, hospitals are selected at random for validation surveys. It could be that CMS is requesting more validation surveys to be ready to review the Joint Commission's soon-to-be-submitted applications for continued deeming authority.

NEHI Offers Ideas on Comparative-Effectiveness
Modern Healthcare, subscription needed 4/20/09
The New England Healthcare Institute, a quality-research and policy group based in Cambridge, Mass., has issued a set of recommendations that it urges the Institute of Medicine to include in its forthcoming guidance to Congress on developing a national comparative-effectiveness research program. The recommendations, included in the white paper “Balancing Act: Comparative Effectiveness Research and Innovation in U.S. Health Care,” would help design a national comparative-effectiveness program that identifies the best clinical interventions while not discouraging innovation, said NEHI President Wendy Everett.

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