Edition Twenty-One (6/23/09)

Meaningful Use: All Stick and No Carrot
HealthLeaders, 6/23/09
The initial reaction to the HIT Policy Committee's recommendations for the definition of "meaningful use" of electronic health records was shock and concern. I overheard phrases like, "It's more of a stimulus stick." Chief information officers were overwhelmed by the list of objectives for EHRs by 2011. These objectives were centered around five desired health outcomes: Improving quality, safety, efficiency, and reducing health disparities; engaging patients and families; improving care coordination; improving population and public health; and ensuring privacy and security for personal health information.

House Dems Unveil Reform Bill
Health Data Management, 6/22/09
House Democrats have released a discussion draft of their proposed health reform legislation. The 850-page bill is light on health information technology provisions compared to the Senate reform bill now being considered in committee.

A Push for the Wired Patient’s Bill of Rights
New York Times, 6/22/09
Starting with a few dozen supporters, including health bloggers, individual physicians, startups and Microsoft, a group is seeking to firmly inject the rights of patients into the Obama administration’s multibillion-dollar drive to computerize medical records. The group’s effort begins with a Web site, HealthDataRights.org, which goes live on Monday night. And it is a bottom-up endeavor to harness the power of social media to influence policy and practice as personal medical information begins a years-long journey from paper records into the Internet age.

Federal Group Suggests Tough I.T. Funding Standards
Modern Healthcare, subscription needed 6/22/09
A federal advisory panel sought to strike a balance between too much of a stretch and too little when it released a first draft of its so-called “meaningful use” recommendations last week. Their work was an early attempt at setting the bar for office-based physicians and hospitals by defining the criteria they must meet to qualify for an estimated $34 billion in Medicare and Medicaid payments to subsidize the purchase of electronic health-record systems under the American Recovery and Reinvestment Act of 2009.

Under The Scope: Preparing For The Electronic Health Record Infusion
The Processor, 6/19/09
Recent years have witnessed a sustained push for EHRs, but the movement enjoyed a massive surge recently, thanks to the economic stimulus package. In a recent study sponsored by Imprivata, 73% of surveyed health care I.T. decision makers and executives identified EHRs as their top I.T. budget investment priority in 2009. However, the study also found that there’s plenty of work ahead, as only 33% of respondents stated that 75 to 100% of their medical records are in EHR format, while another 22% are in the 51 to 75 percentage range.

Safety Net Hospitals Need Help Installing HIE: Report
Modern Healthcare, subscription needed 6/19/09
Safety net providers need support to implement health information exchanges, but with that support, they can improve the care of the patients they serve through better technology, according to a new report. In October 2007, Mathematica Policy Research convened a 13-member panel on the role of safety net providers in HIEs—the exchange of health information electronically across providers—as part of a project funded by the Agency for Healthcare Research and Quality. The panel concluded that safety net providers may have difficulties implementing HIEs because of lack of funding, expertise, time or knowledge to sustain such an effort.

Study: PHRs Give Docs New Insights
Health Data Management, 6/19/09
Collecting data about observations of daily living through personal health records can give physicians and patients insights unattainable from information captured only from clinical encounters, according to a new study. The Robert Wood Johnson Foundation and California HealthCare Foundation in 2006 launched Project HealthDesign, an effort help consumers better use information within PHRs. The initial report can be viewed here: "Project HealthDesign: Rethinking the Power and Potential of Personal Health Records."

CAHPS Survey May Expand to I.T.
Health Data Management, 6/19/09
The Agency for Healthcare Research and Quality is proposing to expand its Consumer Assessment of Healthcare Providers and Systems surveys to include consumer perspectives on health care information technology use by their providers. The surveys, called CAHPS, measure consumer satisfaction with providers and health insurers.

URAC Seeks Comment on Updated Standards
Health Data Management, 6/19/09
Health care accreditation firm URAC has updated its privacy and security criteria following enacted amendments to the HIPAA rules in the American Recovery and Reinvestment Act. The Washington-based firm will accept public comment through Aug. 3. The Act requires business associates to comply with the rules as if they were covered entities. It imposes new notification requirements following breaches of personal health records data.

Nationwide Health I.T. Expansion Could Create Jobs
Kaiser Health News, 6/19/09
As unemployment rises, the medical world prepares to create thousands of jobs as part of an industry-wide effort to transfer paper health records to electronic medical record systems. "With the initiative of electronic health records, we expect that there will be new types of jobs," a spokeswoman for the American Health Information Management Association, an industry group that predicts the initiative will create 75,000 jobs. People with two year associate degrees will be eligible for many of the jobs, which can carry a starting pay of $25,000 to $45,000.

Public Supports More Funding for Emergency Departments
HealthLeaders, 6/18/09
More than two-thirds of respondents say the government should provide more funding to expand services for emergency departments so they can hire additional physicians and other staff, according to a new poll commissioned by the American College of Emergency Physicians. The Harris Interactive poll also found that 81% say emergency care benefits should be included as part of any government sponsored health insurance plan being designed by Congress and the Obama Administration.

e-Health Records Planned Despite Stimulus Uncertainty
InformationWeek, 6/18/09
More than 50% of health care providers surveyed by IVANS do not believe the federal stimulus package will successfully encourage health I.T. adoption. Although a majority of health care providers remain skeptical about how they'll benefit by the federal government's $20 billion stimulus program, many plan to forge ahead anyway, according to the report.

HIMSS Predicts $14.4B in Hospital I.T. Spending
Government Health IT, 6/17/09
A health care industry association projects that hospitals will spend more than $14 billion on information technology systems during the next five years, but it said capital outlays will remain relatively flat until stimulus-related funding kicks in. HIMSS discussed hospital spending trends, based on the group’s tracking of more than 5,000 U.S. hospitals. HIMSS pegged hospital outlays, impacted by the American Recovery and Reinvestment Act, at $14.4 billion through 2014. Expenditures on systems such as electronic medical records, computerized practitioner order entry, and clinical decision support is expected to hit $1.7 billion this year.

Government Debating 'Meaningful Use' Of e-Health Records
InformationWeek, 6/17/09
E-health records have become a rallying point for I.T. and health care professionals, but pinpointing what constitutes "meaningful" information still eludes most agencies. Under the American Recovery and Reinvestment Act of 2009, the federal government is waving nearly $20 billion in stimulus money at health care providers who, starting in 2011, will be rewarded for using health I.T. in "meaningful" ways. Problem so far is that no one is quite sure what "meaningful use" will mean.

The Meaning of Meaningful Use
ADVANCE, 6/17/09
Advance interviews Beth Just, AHIMA board member and president/CEO of Just Associates, who points out that "meaningful use" goes far beyond implementing software.

New Group Seeks Incentives for Electronic Ordering
Modern Healthcare, subscription needed 6/17/09
A newly established lobbying group called the Imaging e-Ordering Coalition is pushing for lawmakers to broaden their efforts to create incentives for providers to adopt electronic prescribing technology for medication to also include electronic ordering systems for diagnostic imaging procedures. Such incentives would help address efforts by health care reform advocates to eliminate inappropriate and costly use of diagnostic imaging procedures, coalition members said.

EHR Adopters Could Face Series of Tighter Standards
Modern Healthcare, subscription needed 6/17/09
There may soon be one more incentive for hospitals and physician offices to buy and install electronic health record systems on or before 2011. The added push could come from the prospect of increasingly higher thresholds of initial federal eligibility requirements for EHR subsidies under the American Recovery and Reinvestment Act of 2009, according to discussions at the Health Information Technology Policy Committee meeting.

AMA Approves Policies on Security Breaches, EHRs
Modern Healthcare, subscription needed 6/17/09
Policies on security breaches, open source code, and government subsidies of electronic health record systems have been adopted by the American Medical Association's House of Delegates. The policies concern physicians' responsibilities in case of computer security breaches and support of electronic health record systems based on open source code. Another policy calls for the removal of penalties that are scheduled to affect physicians who are not using electronic prescribing by 2015, and another says that the AMA wants government subsidies for the implementation and maintenance of EHR systems to be adjusted for inflation.

HITSP Moves on Research Standards
Health Data Management, 6/17/09
More than 30 organizations have pledged financial support for an initiative to harmonize standards for the use of electronic health records in clinical research. The Healthcare Information Technology Standards Panel has taken on the task. The goal is to produce a streamlined electronic standards implementation guide that outlines pertinent standards, how they support clinical research, and how they fit with existing HITSP interoperability specifications already available in the clinical care environment.

Meaningful Use First Draft Could Guide Final Definition
HealthLeaders, 6/17/09
The Health Information Technology Policy Committee stressed on Tuesday that the meaningful use definitions recommended by a study committee this week are merely a non-binding "first step" in a complex winnowing process. The final product could change a great deal when CMS issues a proposed rule change for a 60-day public comment period at the end of 2009.

Health I.T. 'Meaningful Use' Framework Proposed
Federal Computer Week, 6/16/09
A national vision of "meaningful use" of health information technology should be linked to outcomes such as reducing by half the number of preventable hospitalizations and medical errors by 2015, according to a framework presented to a federal advisory panel. That definition will help decide how billions in federal funds for health I.T. will be distributed. The federal Health IT Policy Committee began considering a three-tiered structure for defining and setting benchmarks for meaningful use of health I.T. that was presented by a workgroup of the panel.

ONC Goes Back to the Drawing Board on Meaningful Use
Healthcare IT News, 6/16/09
The federal advisory policy committee on health I.T. sent its workgroup back to the drawing board with recommendations the workgroup had made earlier in the day to outline the criteria. The HIT policy committee's workgroup, composed of members of the private sector, government and nonprofit organizations, have been pulling together criteria for a meaningful use definition over the past month. The criteria were presented at a Tuesday meeting of the full policy committee for a vote of approval, with a public comment period open for the next 10 days.

Group Tackles Definition of 'Meaningful Use' for e-Health Records
NextGov, 6/16/09
The United States can develop an electronic health record system that could, within the next five years, help prevent a million heart attacks annually and reduce the number of medication errors by 50 percent, a top health official in New York City said. Farzad Mostashari, assistant commissioner of the New York City Health Department, told a meeting of the Health Information Technology policy committee that electronic health record systems also can reduce hospital re-admissions by half, and provide patients with access to their own medical information as well as health departments nationwide.

ONC Offers Insight into Incentives
Health Data Management, 6/16/09
To verify "meaningful use" of electronic health records, the federal government will rely on the presence of electronic transactions, not conduct an office-by-office assessment. That was insight from a Department of Health and Human Services official speaking June 15 at the American Medical Association's annual meeting in Chicago.

Comment Sought on 'Meaningful Use'
Health Data Management, 6/16/09
The HIT Policy Committee will accept public comment through June 26 on the just-released draft description of "meaningful use" of electronic health records. The committee's meaningful use workgroup issued its initial recommendations, which will be refined this summer before the policy committee makes final recommendations to federal officials.

Meaningful Use: Defined by HIT Policy Committee
HealthLeaders, 6/16/09
The I.T. community is one step closer to a definition of "meaningful use" of electronic health records since the HIT Policy Committee made its recommendations to the Office of the National Coordinator for Health Information Technology. I spoke with a number of executives to get their predictions and strategies regarding "The Meaning of Meaningful Use" for the June issue of HealthLeaders magazine.

Obama Names Health I.T. as First Step in Reform
Healthcare IT News, 6/16/09
At a keynote speech at the annual conference of the American Medical Association Monday, President Obama said health care I.T. is the first step to reforming care in the U.S. He said there is already "widespread agreement" on steps necessary to improve the health care system, including the use of health I.T. "First, we need to upgrade our medical records by switching from a paper to an electronic system of record keeping. And we've already begun to do this with an investment we made as part of our Recovery Act," he said.

First Look at 'Meaningful Use'
Health Data Management, 6/16/09
The meaningful use workgroup of the HIT Policy Committee has released its initial recommendations for a definition of "meaningful use" of electronic health records. The definition is important because under the economic stimulus law, providers must "meaningfully use" EHRs to receive financial incentives from Medicare and Medicaid. These initial recommendations do not include a formal definition of meaningful use. But they are the initial recommendation of the functionalities that will be required by 2011 when incentives start.

Obama's Reform Plan to Start with EHRs
Modern Physician, subscription needed 6/16/09
Fixing the nation's health care system will begin with implementing electronic health records, President Barack Obama told the American Medical Association's House of Delegates. "How do we permanently bring down costs and make quality affordable health care available to every single American?" Obama asked. "First, we need to upgrade our medical records by switching from a paper to an electronic system of record-keeping. We've already begun to do this with an investment we made as part of our recovery act."

Health Care Records Should be User-Friendly, Patients Say
Federal Computer Week, 6/15/09
Dave deBronkart has a rather unique perspective on the health information technology debate: He's a cancer survivor, “e-Patient Dave” blogger, and a believer in the power of technology to improve health care for patients, providers, and the government. DeBronkart is one of the founders of a movement to put patients and consumers in the center of health care reform and health I.T.

Overhaul Health Care While We Have the Chance
Modern Healthcare, subscription needed 6/15/09
To the best of my knowledge all the people talking about revamping health care seem to be more interested in cost-shifting than fixing the problem. In my opinion, the payers should require providers to implement a good management system based on Baldrige National Quality Award criteria or ISO 9001 or a system that combines the two. If we don't fix the broken processes for providing care, we can dump tons of money into the system and get the same results we have been getting for years.

Four HIPAA and HITECH Topics to Tackle Now
HealthLeaders, 6/15/09
HHS hasn't released any significant news around HIPAA regulations since its draft guidance on unsecure protected health information April 17, but that does not mean it is time to sit idle. Major regulations surrounding breach notifications on PHRs by the Federal Trade Commission and unsecure PHI by the Department of Health and Human Services are due in August. However, now is the time to start thinking about a few things when it comes to HIPAA and the new laws in the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Study Shows 90 Percent of Doctors Cite Usability as Critical to EHR Adoption
Business Wire, 6/15/09
The health care industry has been awaiting a formal definition of electronic health record meaningful use ever since the language of the HITECH Act within the American Recovery and Reinvestment Act of 2009 was made public. According to the HIMSS Electronic Health Record Association, the federal government is expected to publish criteria pertaining to the definition of meaningful use as early as this week. In anticipation of definitive criteria, Nuance Communications, Inc., a leading supplier of speech solutions that help clinicians with the transition to and utilization of EHRs, engaged physicians via survey to better understand how “meaningful use” should, from their point of view, ultimately be defined.

Prepare to Meet "Meaningful Use" EMR Requirement
AMNews, 6/15/09
True or false? The American Recovery and Reinvestment Act will provide physician practices incentives for the purchase of an electronic medical record system. False. The ARRA is, indeed, meant to foster health I.T. adoption. But the incentive money will directly address the use of EMRs, not the purchase of the systems.

Obama: Current Costs Unsustainable
Health Data Management, 6/15/09
Labeling the current health care system a "ticking time bomb," President Barack Obama assured some 4000 physicians and their staff attending the American Medical Association's annual meeting in Chicago that he would not let it explode in their faces. When it comes to EHRs, Obama struck a pragmatic tone. He spoke almost with a tone of disbelief while describing how Americans doctors still relied on outmoded documentation systems. And with the precision of a surgeon, he analyzed how the resulting lack of information sharing results in needless duplication of services.



S.C. Seeks ‘Road Map’ to Move Toward Electronic Medical Records
The State, 6/17/09
The federal government will spend billions over the next few years to push the country toward electronic health records. Today, those who will help make that happen in South Carolina are gathering for the state’s first health care information technology summit. Their goal is to develop a plan for applying for the stimulus money, said Emma Forkner, director of the S.C. Department of Health and Human Services.

New Jersey Bill Would Outlaw Health I.T. Not Certified by CCHIT
iHealthBeat, 6/16/09
New Jersey lawmakers are considering a bill that would prohibit the use of health I.T. products that are not certified by the Certification Commission for Healthcare I.T. Under the bill, anyone caught selling or distributing such a product could be fined up to $5,000 per violation. The New Jersey bill would affect all health care providers in the state.

Kaine Unveils On-line Health Exchange in Virginia
IFA Web News, 6/16/09
Gov. Tim Kaine has announced a new, secure web portal to connect Virginia health plans, health systems, and state agencies in a move he says will standardize and streamline health care administrative transactions. Kaine, a Democrat, unveiled the Virginia Health Exchange Network June 12, an initiative he expects to lower costs and improve overall service quality for all state residents.



Boston Coders Help Keep Users Fit and Healthy
Journal of New England Technology, 6/16/09
Boston is becoming a hub for information technology and games that help people achieve fitness goals. AWare Technologies Inc., FitnessKeeper Inc., and Molecular Inc. all track fitness data via cellular phones and Web applications, for example.

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