ONC announces launch of "Direct Project" pilots

The Office of the National Coordinator for Health IT (ONC) announced today that providers and public health agencies in Minnesota and Rhode Island began this month exchanging health information using specifications developed by the Direct Project, an 'open government' initiative that calls on cooperative efforts by organizations in the health care and information technology sectors.  Other Direct Project pilot programs will also be launched soon in New York, Connecticut, Tennessee, Texas, Oklahoma and California to demonstrate the effectiveness of the streamlined Direct Project approach, which supports information exchange for core elements of patient care and public health reporting. 

The launch of the pilot demonstrations, less than a year from the inception of the Direct Project, shows the project is on track to give U.S. health care providers early access to an easy-to-use, internet-based tool that can replace mail and fax transmissions of patient data with secure and efficient electronic health information exchange.

"This is an important milestone in our journey to achieve secure health information exchange, and it means that health care providers large and small will have an early option for electronic exchange of information supporting their most basic and frequently-needed uses," said Dr. David Blumenthal, national coordinator for health information technology.  "Other efforts are also going forward at full-throttle to build a comprehensive structure of health information exchange.  But by bringing together health care and IT companies, including competitors, to rapidly produce a system that supports basic clinical delivery and public health needs, we will be able to more quickly start building electronic information exchange into our health care system."

Designed as part of President Obama's 'open government' initiative to drive rapid innovation, the Direct Project last year brought together some 200 participants from more than 60 companies and other organizations.  The volunteers worked together to assemble consensus standards that support secure exchange of basic clinical information and public health data.  Now, pilot testing of information exchange based on Direct Project specifications is being carried out on schedule this year, aiming toward formal adoption of the standards and wide availability for providers by 2012.

"This is a new approach to public sector leadership, and it works," said Aneesh Chopra, the United States Chief Technology Officer.  "Instead of depending on a traditional top-down approach, stakeholders worked together to develop an open, standardized platform that dramatically lowers costs and barriers to secure health information exchange. The Direct Project is a great example of how government can work as a convener to catalyze new ideas and business models through collaboration."

The two pilot programs that have already begun using Direct Project-based information exchange are in Minnesota and Rhode Island:

Since mid-January, Hennepin County Medical Center (HCMC), Minnesota's premier Level 1 Adult and Pediatric Trauma Center, has been successfully sending immunization records to the Minnesota Department of Health (MDH). "This demonstrates the success that is possible through public-private collaborations," said James Golden, PhD, Minnesota's state HIT coordinator. "This is an important milestone for Minnesota and a key step toward the seamless electronic movement of information to improve care and public health." 

Recognizing Minnesota's leadership in delivering high-quality, cost-effective healthcare, U.S. Senator Amy Klobuchar (D-MN) said, "this is the type of innovation that can help strengthen our health care system by reducing waste and improving quality. We need to continue to improve our health care system by continuing to integrate information technology to better serve patients and providers."
The second pilot implementation site, The Rhode Island Quality Institute (RIQI), has delivered a pilot project with two primary goals. First, RIQI is improving patient care when patients are referred to specialists by demonstrating simple, direct provider-to-provider data. Second, RIQI is leveraging Direct Project messaging as a means to securely feed clinical information, with patient consent from practice-based EHRs to the state-wide HIE, currentcare, to improve quality by detecting gaps in care and making sure the full record is available to all care providers.

Discussing RIQI's collaborative approach to health IT, Laura Adams, president and CEO of RIQI said, "All too often, providers do not have the data they need to take the best care of patients they serve. Direct Project allows the Quality Institute to be on the cutting edge - providing health information exchange via currentcare, delivering the efficient rollout of technology through the Regional Extension Center, and enabling and measuring real patient outcome improvements in our Beacon Community. The ability to bring together and drive consensus among a diverse set of stakeholders has been critical in the successful rollout of these innovative programs."

"Rhode Island continues to be a nationwide leader in improving health care with better information technology," said Senator Sheldon Whitehouse (D-RI). "Health care providers communicating with each other in a secure and cost-efficient way helps patients get better sooner with less hassle and confusion."

Other pilot projects to be launched this year include a Tennessee effort with the Veteran's Administration, local hospitals and CareSpark to provide care to veterans and their families; a New York effort including clinicians in hospital and ambulatory care settings with MedAllies and EHR vendors; a Connecticut effort involving patients, hospitals, ambulatory care settings and a Federally Qualified Health Center with Medical Professional Services, a PHR, and a major reference laboratory; an expansion of the VisionShare immunization data pilot to Oklahoma; a California rural care effort involving patients, hospitals and ambulatory care settings with Redwood MedNet; and an effort in South Texas with a collaboration of hospitals, ambulatory care settings, public health, and community health organizations to improve care to mothers with gestational diabetes and their newborns.

The Direct Project was launched in March 2010 as a part of the Nationwide Health Information Network, to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet in support of Stage 1 Meaningful Use requirements.  Participants include EHR and PHR vendors, medical organizations, systems integrators, integrated delivery networks, federal organizations, state and regional health information organizations, organizations that provide health information exchange capabilities, and health information technology consultants.

Information transfers supported by Direct Project specifications address core needs, including standardized exchange of laboratory results; physician-to-physician transfers of summary patient records; transmission of data from physicians to hospitals for patient admission; transmission of hospital discharge data back to physicians; and transmission of information to public health agencies.  In addition to representing most-needed information transfers for clinicians and hospitals, these information exchange capabilities will also support providers in meeting "meaningful use" objectives established last year by HHS, and will thus support providers in qualifying for Medicare and Medicaid incentive payments in their use of electronic health records.  The Direct Project specifications can also support physician-to-patient information transfers, and Microsoft Corp. today announced an application for that purpose based on Direct Project standards. For more information about the Direct Project, please visit http://directproject.org.

Other ongoing efforts supported by ONC are underway to bring about a comprehensive health information structure in the U.S.  These include technical and governance issues that are being addressed under the Nationwide Health Information Network, which embodies the standards, services and policies that enable health information exchange over the internet.  The Nationwide Health Information Network Exchange is already supporting some health information exchange between federal agencies and the private sector.  In addition, ONC provides grants to states to develop locally-appropriate policies and standards for health information exchange that are consonant with broader national standards.

For more information about the Office of the National Coordinator for Health Information Technology, please visit http://healthit.hhs.gov.


###



Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.

The End Of Internal Medicine As We Know It – Health Affairs Blog

by Caroline Poplin

Physicians have doubtless been issuing jeremiads since before Jeremiah. We are overworked, underpaid, and underappreciated.

But today, general internists have a real problem. And it is our leaders who do this to us. As summarized in the Annals of Internal Medicine:

To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change. The economic forces put in motion by the Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups. The most successful physicians will be those who collaborate with other providers to improve outcomes, care productivity and patient experience.

In the future envisioned by the health policy community, including the leadership of the Amercian College of Physicians and the American Medical Association, patients who want a personal physician, someone they know and trust, who understands and cares about them as individuals will have to pay extra for “concierge” care. Everyone else will migrate to team care from large “Accountable Care Oranizations” (accountable to whom, one may ask—certainly not the patients). These teams may well improve patients’ blood pressures, glucose control, lipid panels, maybe even weight, and indeed improve the outcomes of patients whose outcomes can be improved. Their care will be efficient: providers (yes, providers) who do not see enough patients, whose patients do not improve adequately, who order too many tests, do not meet the fifteen criteria for meaningful use of EHRs, or do not continuously pursue quality improvement projects, will see their incomes fall.

Perhaps the new organizations will provide better care for some patients and some conditions. Will other patients — those with poor prognoses, bad attitudes, complex or ill-defined diagnoses, multiple complications, cognitive limitations, even just morbid obesity — be lost in the shuffle.

And whether this radical overhaul of the health care delivery system will reduce health care costs overall, ostensibly the point of the exercise, is unknown. The cost of multiple layers of highly paid managers (including multi-million dollar executives) and the extensive information technology infrastructure on which these elaborate systems depend, is not trivial. Indeed, modern industry abandoned command-and-control style vertical integration decades ago in favor of flatter, more nimble institutions that pay serious attention to suggestions from production workers and those who deal directly with customers. What little evidence we have on cost savings from ACOs is largely anecdotal and equivocal.
Continue Reading

Electronic Medical Record vs. Electronic Health Record: Clarifying the EHR/EMR Difference « Health IT Buzz

Posted by: Peter Garrett ONC Office of Communications and Joshua J. Seidman PhD Director Meaningful Use

What’s in a word? Or, even one letter of an acronym?

Some people use the terms “electronic medical record” and “electronic health record” (or “EMR” and “EHR”) interchangeably. But here at the Office of the National Coordinator for Health Information Technology (ONC), you’ll notice we use electronic health record or EHR almost exclusively. While it may seem a little picky at first, the difference between the two terms is actually quite significant.The EMR term came along first, and indeed, early EMRs were “medical.” They were for use by clinicians mostly for diagnosis and treatment.

In contrast, “health” relates to “The condition of being sound in body, mind, or spirit; especially…freedom from physical disease or pain…the general condition of the body.” The word “health” covers a lot more territory than the word “medical.” And EHRs go a lot further than EMRs.

What’s the Difference?   Continue Reading

ONC Issues Final Rule for Permanent Certification Program for Health Information Technology

ONC Issues Final Rule for Permanent Certification Program for Health Information Technology

Steps to create permanent health IT certification program underway

The Office of the National Coordinator for Health Information Technology (ONC) today issued a final rule to establish the permanent certification program for health information technology.  The permanent certification program provides new features that will enhance the certification of health information technology, including increasing the comprehensiveness, transparency, reliability, and efficiency of the current processes used for the certification of electronic health record (EHR) technology.  Meaningful use of "Certified EHR Technology" is a core requirement for eligible health care providers who seek to qualify to receive incentive payments under the Medicare and Medicaid Electronic Health Record Incentive Programs as authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act.

"This final rule completes the two-phased approach ONC began with the proposed rule issued in Spring 2010 and includes several important improvements to our certification processes," said David Blumenthal, M.D., M.P.P., national coordinator for health information technology.  "Our goal is to make the transition to the permanent certification program as seamless as possible."

The temporary certification program, established through a final rule published on June 24, 2010, will continue to be in effect until it sunsets on December 31, 2011, or at a later date when the processes necessary for the permanent certification program to operate are completed.  ONC expects to stand-up the programmatic activities necessary to implement the permanent certification program throughout 2011. 

Features of the permanent certification program include:
Organizations must first be accredited in order to test and/or certify health information technology;
Certification bodies authorized by the National Coordinator (ONC-Authorized Certification Bodies or ONC-ACBs) are required to conduct post-certification surveillance; and
ONC-ACBs are permitted to perform "gap certification." 

As proposed, ONC will request that the National Institute of Standards and Technology (NIST) through its National Voluntary Laboratory Accreditation Program (NVLAP) develop a laboratory accreditation program for organizations to be accredited to test health information technology for purposes of the permanent certification program.  Based on NIST's technical expertise and the strong relationship formed between ONC and NIST during the successful implementation of the temporary certification program, the use of NVLAP is expected to enhance testing under the permanent certification program and its objectivity overall.     

This final rule is issued under the authority provided to the National Coordinator for Health Information Technology in section 3001(c)(5) of the Public Health Service Act, as added by the Health Information Technology for Economic and Clinical Health Act.

For more information about the permanent certification program and the final rule, please visit http://healthit.hhs.gov/certification.

For more information about the Office of the National Coordinator for Health Information Technology, please visit http://healthit.hhs.gov.

eNews from AoA - October 2010

Table of Contents
Top Story

October Is Domestic Violence Awareness Month

 AoA News

Population Data on Older Hispanic Adults Featured in AoA’s October Widget

Other HHS News

CMS Awards Grants to Six States to Combat Abuse and Neglect in Long Term Care Facilities

Information on Peripheral Arterial Disease Added to NIHSeniorHealth Website

HHS Announces the Launch of HealthCare.gov on Facebook

HHS Releases $101 Million in Emergency Funding to States for Energy Assistance

Nationwide System to Assist Doctors and Hospitals in Switching to Electronic Health Records Is Completed

HHS Awards $68 million in Grants to Support Community Living for Seniors and Individuals with Disabilities

Federal Funding Opportunities

Rural Health Network Development Grant Program

Second Opportunity for National Background Check Program Funding

More News

NCOA to Fund Benefits Enrollment Centers

October Is Crime Prevention Month: Learn About Go Direct

October 16 Is World Food Day

USDA Awards Grants to Expand Nutrition Aid for Low-Income Seniors

UN Report on “Current Status of the Social Situation, Wellbeing, Participation in
Development and Rights of Older Persons Worldwide”

Additional National Observances in October
Submit a Story! 
Conferences
Full Newsletter

The “Meaningful Use” Regulation for Electronic Health Records | Health Care Reform Center

by David Blumenthal, M.D., M.P.P., and Marilyn Tavenner, R.N., M.H.A.

The widespread use of electronic health records (EHRs) in the United States is inevitable. EHRs will improve caregivers’ decisions and patients’ outcomes. Once patients experience the benefits of this technology, they will demand nothing less from their providers. Hundreds of thousands of physicians have already seen these benefits in their clinical practice.


But inevitability does not mean easy transition. We have years of professional agreement and bipartisan consensus regarding the potential value of EHRs. Yet we have not moved significantly to extend the availability of EHRs from a few large institutions to the smaller clinics and practices where most Americans receive their health care.


Last year, Congress and the Obama administration provided the health care community with a transformational opportunity to break through the barriers to progress. The Health Information Technology for Economic and Clinical Health Act (HITECH) authorized incentive payments through Medicare and Medicaid to clinicians and hospitals when they use EHRs privately and securely to achieve specified improvements in care delivery.

Continue Reading

National Progress Report on eHealth - The Commonwealth Fund

A new report from eHealth Initiative—an organization that seeks to help health care industry stakeholders better understand and use health information technology (IT)—tracks developments over the past three years in promoting the adoption and use of health IT. Supported by The Commonwealth Fund, the National Progress Report on eHealth finds that:

• Significant advances have been made as a result of public and private sector initiatives. The 2009 American Recovery and Reinvestment Act, which allocated $30 billion to promote health IT, has been a key driver of progress.
• Many providers are concerned about the lack of coordination across government health and health information technology initiatives.
• More education and outreach to consumers about health IT and health information exchange are needed.
• Knowledge and transparency of privacy and security policies will be key to building consumer trust.

More than a hundred experts helped assess progress in the following five areas: aligning incentives, engaging consumers, improving population health, managing privacy, security and confidentiality, and transforming care delivery. Stakeholders’ perceptions of progress were also gauged. Sixty-one percent agreed or strongly agreed that significant progress has been made in the successful adoption and use of health IT since 2007, but most (67%) felt that outreach to educate consumers about the value of electronic health records and health information exchanges is not effective.

To realize the goal of using health IT adoption to improve quality in care delivery, the report recommends implementing policies and programs that take into consideration all sectors of the health care community, including consumers, and promoting further education on the new privacy and security laws and regulations.

Read complete report

HHS Seeks Comments on “Meaningful Use” Regulation Involving Accessibility of Electronic Health Records

Image via Wikipedia

Electronic health records (EHR) are at the cutting edge of health information technology and a tool which has the potential to improve the quality and delivery of health care for all Americans. The HHS Office on Disability writes to advise you of an opportunity for disability community stakeholders to weigh in, as EHR policies and standards are being developed and implemented.

In late December, the Centers for Medicaid and Medicare Services (CMS) released a notice of proposed rulemaking that defined how health care providers can demonstrate “meaningful use” of electronic health records that would qualify themselves for Federal incentive payments made available under the American Recovery and Reinvestment Act of 2009 (ARRA) (Pub. L. 111–5.). At the same time, the Office of the National Coordinator (ONC) for Health Information Technology released an interim final rule describing certification standards for Electronic Health Records (EHR) technology.

On January 13, 2010, both the CMS notice of proposed rulemaking and the ONC interim final rule were published in the Federal Register, launching a 60-day public comment period. ONC states that with regard to EHR, the “accessibility requirements of the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 still apply to entities covered by these Federal civil rights laws.”

Furthermore the interim final rule specifically requests feedback on the following item which may be of interest to you and your constituents:

We are interested in public comments to inform future deliberations on whether specific certification criteria could be adopted to further promote the capabilities Certified EHR Technology should provide with respect to meeting the accessibility needs of individuals with disabilities. Federal Register, Vol. 75, No. 8, Wednesday, January 13, 2010, Proposed Rules (p. 2005)

You have the opportunity to share your insights and suggestions about the accessibility of electronic health records and the above question with the Office of the National Coordinator. To be assured consideration written or electronic comments for both the ONC interim final rule and the CMS Notice of Proposed Rulemaking must be received at one of the below addresses no later than 5 p.m. on March 15, 2010.

1. Instructions For Submitting Comments On The Interim Final Rule (from the Federal Register) - Office of the National Coordinator

Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You may submit comments, identified by RIN 0991– AB58, by any of the following methods (please do not submit duplicate comments).

• Federal eRulemaking Portal: Follow the instructions for submitting comments. Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word. http://www.regulations.gov.

• Regular, Express, or Overnight Mail: Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology, Attention: HITECH Initial Set Interim Final Rule, Hubert H. Humphrey Building, Suite 729D, 200 Independence Ave., SW., Washington, DC 20201. Please submit one original and two copies.

• Hand Delivery or Courier: Office of the National Coordinator for Health Information Technology, Attention: HITECH Initial Set Interim Final Rule, Hubert H. Humphrey Building, Suite 729D, 200 Independence Ave., SW., Washington, DC 20201. Please submit one original and two copies.

(Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without federal government identification, commenters are encouraged to leave their comments in the mail drop slots located in the main lobby of the building.)

FOR FURTHER INFORMATION CONTACT: Steven Posnack, Policy Analyst, 202– 690–7151.

2. Instructions For Submitting Comments On The CMS Notice Of Proposed Rulemaking - Centers for Medicare and Medicaid Services

ADDRESSES: In commenting, please refer to file code CMS–0033–P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You may submit comments in one of four ways (please choose only one of the ways listed):

1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the instructions on the home page.
2. By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–0033–P, P.O. Box 8013, Baltimore, MD 21244–8013. Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By express or overnight mail. You may send written comments to the following address only: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–0033–P, Mail Stop C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850.

4. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments before the close of the comment period to either of the following addresses:

a) For delivery in Washington, DC—Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445–G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201.

(Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)

b. For delivery in Baltimore, MD— Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244–1850. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786– 9994 in advance to schedule your arrival with one of our staff members.

Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.

FOR FURTHER INFORMATION CONTACT:
Elizabeth Holland, (410) 786–1309, EHR incentive program issues.
Edward Gendron, (410) 786–1064, Medicaid incentive payment issues.
Jim Hart, (410) 786–9520, Medicare fee for service payment issues.
Terry Kay, (410) 786– 4493, Medicare fee for service payment issues.

Related articles by Zemanta

• CMS and ONC Issue Rules on Proposing a Definition of Meaningful Use and Setting Standards for EHR Incentive Program (healthcarebloglaw.blogspot.com)
• CMS Proposes Meaningful Use Definition and Standards for Electronic Health Record Incentive Program (medicareupdate.typepad.com)
• Leading Consumer, Business Experts Laud Two Key Federal Agencies for Hitting the Right Note on Meaningful Use of Health Information Technology (HIT) (medicineandtechnology.com)