Accelerating Electronic Health Records Adoption and Meaningful Use

Image via Wikipedia

The following joint statement, by the National Coordinator for Health Information Technology, David Blumenthal, M.D.,M.P.P., and the Centers for Medicare & Medicaid Services' Principal Deputy Administrator Marilyn Tavenner, was issued today at a forum,"Accelerating Electronic Health Records Adoption and Meaningful Use."

The forum was sponsored by the Health Industry Forum at Brandeis University and Health Affairs:

"The goal of achieving widespread adoption and meaningful use of electronic health records by 2014 is established in the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH), part of the American recovery and Reinvestment Act of 2009.

The HITECH Act directs the Centers for Medicare & Medicaid Services(CMS) to administer an incentive payments program that will make available significant bonus payments to eligible health care providers who adopt and demonstrate meaningful use of certified electronic health records (EHR).  In addition, the HITECH Act provides for leadership and
support for EHR adoption and use through the Office of the National Coordinator for Health Information Technology (ONC). 

"On July 13, final regulations were announced by CMS and ONC that define the incentive payments program, the meaningful use requirements for Stage 1 of the program, and the standards and certification requirements for certified EHR systems.

"However, the CMS and ONC regulations establish only the parameters of the federal program.  The public and private sectors can and must collaborate in furthering the goal of creating a 21st century electronic health information system in the United States.

"For that reason we are pleased and encouraged by today's announcement of significant initial steps by organizations across the spectrum of health care to support HITECH's goal of furthering the meaningful use of certified EHRs.  These entities include providers, payers and professional licensure bodies.  The individual programs announced today show both an appreciation of the challenges we face as well as initiative and creativity in applying the resources of these organizations toward meeting our goals.  The actions announced today are also built on the meaningful use structure, which provides alignment of our national efforts toward coherent technology adoption and toward improved health and health care goals.

Electronic Personal Health Information Exchange

Image via Wikipedia

Why GAO Did This Study

Health Care Entities' Reported Disclosure Practices and Effects on Quality of Care Highlights of GAO-10-361, a report to congressional committees

To promote the use of information technology for the electronic exchange of personal health information among providers and other health care entities, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act. It provides incentives intended to promote the widespread adoption of technology that supports the electronic sharing of data among hospitals, physicians, and other health care entities. Pursuant to a requirement in the HITECH Act, GAO is reporting on practices implemented by health information exchange organizations, providers, and other health care entities that disclose electronic personal health information.

GAO’s specific objectives were to describe (1) the practices implemented for disclosing personal health information for purposes of treatment, including the use of electronic means for obtaining consent, as reported by selected health information exchange organizations, their participating providers, and other entities; and (2) the effects of the electronic sharing of health information on the quality of care for patients as reported by these organizations.

To address both objectives, GAO conducted case studies of 4 of more than 60 operational health information exchanges and a selection of each of the exchanges’ participating providers.

What GAO Found

The health care entities GAO studied reported that they implement disclosure practices that reflect widely accepted practices for safeguarding personal information–the Fair Information Practices–to help ensure the appropriate use and disclosure of electronic personal health information for treatment purposes. For example, providers in the study described various implementations of practices that require direct interaction with patients, such as informing patients of the use and disclosure of personal health information and providing patients access to their own records. Some of them inform patients that their electronic personal health information may be shared through health information exchanges–entities that were formed to facilitate the electronic sharing of patients’ health information among providers. Both the providers and exchanges in the study described practices that limit disclosure of information, secure electronic information that they store and transmit, and help ensure accountability for safeguarding electronic personal health information.

Although the health information exchanges reported that they have not conducted formal studies or evaluations of the overall effect of electronically sharing personal health information, both the exchanges and providers reported examples of ways that sharing electronic personal health information about patients has had a positive effect on the quality of care that providers deliver to patients.

Full Report

HIPAA enforcement by state attorneys general: The shape of things to come

from David Harlow's Health Care Law Blog

Connecticut Attorney General Richard Blumenthal entered a brave new world yesterday, as the first state AG to file a HIPAA enforcement action under the "Son of HIPAA" amendments found in the HITECH Act.  Among other HIPAA changes made in the new law (all of which should be of concern to health care providers, health care payors, health care clearinghouses  -- "covered entities" or CEs -- and their "business associates" -- vendors who touch electronic protected health information or ePHI), there is a provision that permits state attorneys general to file HIPAA enforcement actions on behalf of the people of their state, in order to protect their interests, and to seek injunctive relief and/or money damages.  See Sec. 13410(e) of ARRA (p. 160 of HR 1 PDF). 

The basic facts of the case are not unfamiliar:  A hard drive gone missing from a health insurance company's offices, this one with unencrypted information about 250,000 plan members.  The insurer, Health Net, failed to promptly notify data subjects that the data had gone missing, taking six months to issue a notice and letters to affected individuals and offer credit monitoring and repair for anyone affected.  Unfortunately, data breaches are all too common.  See, for example, my post on the Virginia health data breach last year, and the recent Chilmark Research post asking, in essence, whether we can reasonably expect a breach-free world.

While asserting a HIPAA claim is new territory for state AGs, the crux of the claim is really a consumer protection claim, one of the state AGs' mainstays.

Continue Reading

'Invisible bracelet' for emergency health alerts? - Boston.com

By Lauran Neergaard, AP Medical Writer

Emergency health alerts for the Facebook generation? The nation's ambulance crews are pushing a virtual medical ID system to rapidly learn a patient's health history during a crisis -- and which can immediately text-message loved ones that the person is headed for a hospital.

The Web-based registry, invisibleBracelet.org, started in Oklahoma and got a boost this fall when the state's government made the program an optional health benefit for its own employees.

Now the Invisible Bracelet attempts to go nationwide as the American Ambulance Association next month begins training its medics, who in turn will urge people in their communities to sign up.
Continue Reading

Delaware: First Statewide Health Information Exchange

Delaware established the first statewide clinical health information exchange (HIE) in 1997. Compared with other states, it has taken more of a public sector approach to HIE governance, though this strategy may be shifting. Its HIE, the Delaware Health Information Network (DHIN), is a public–private partnership that operates under the auspices of the Delaware Health Care Commission, which the state created in 1990 with the goal of moving toward basic, affordable health care for all residents.
Continue Reading

Arizona Medical Information Exchange Outgrows Medicaid - The Commonwealth Fund

This article first appeared in the October/November 2009 issue of the newsletter "States in Action."

The Arizona Medical Information Exchange (AMIE) is a Web-based health information exchange that allows participating practitioners to view hospital discharge and other clinical reports, lab test results, and medication data for many of their patients. AMIE was developed by Arizona's Medicaid agency (the Arizona Health Care Cost Containment System, or AHCCS), went live in September 2008, and is slowly growing in capabilities and utilization. Focused primarily on the Phoenix region, AMIE is the only operational HIE in the state, and will play a key role as it works to build interoperability with other developing exchanges in the region.

Arizona recently submitted a proposal for federal stimulus funds (under the State Health Information Exchange Cooperative Agreement Program) to support a cooperative effort among AMIE, another HIE developing in the southern region in the state, and several smaller HIE efforts under way. The goal is to make these HIEs interoperable, essentially building a statewide system in which the whole will be greater than the sum of its parts. A new state HIT coordinator will oversee this collaborative effort.
Continue Reading

Related articles by Zemanta

• Trust, Sharing and Managing Health Information (thielst.typepad.com)
• WVHIN Releases RFP for West Virginia Health Information Exchange (healthcarebloglaw.blogspot.com)
• Medicare Extends Personal Health Record Pilot Program - Magpie Healthcare Thrives, Where's the Training and Education? (ducknetweb.blogspot.com)
• ARRA HITECH and Health Information Exchange (medicineandtechnology.com)

The Health Care Blog: Health 2.0: Beneath the Hype, There's Cause for Real Hope

By MICHAEL MILLENSON

Health 2.0 is a trend accompanied by both buzz and buzzwords. That worries some advocates for the poor, underserved and just plain old and sick. Will those groups be left behind in the latest information revolution?
Continue Reading

Indiana, Ohio link health exchanges ... American Medical News

As of September, two health information exchanges in Indiana and one in Ohio began exchanging data with each other.

The linkup among Indiana Health Information Exchange of Indianapolis, HealthLINC of Bloomington, Ind., and HealthBridge of Cincinnati marks what the networks say is the first time separate regional health information exchanges are sharing data. Federal officials and others hope to build a national health information network in this way, with regional networks linking up and sharing data.

Continue Reading

HIT Standards Committee Advisory Meeting

This notice announces a forthcoming meeting of a public advisory committee of the Office of the National Coordinator for Health Information Technology (ONC). The meeting will be open to the public. Date and Time: The meeting will be held on August 20, 2009, from 9 a.m. to 3 p.m. Eastern Time. Location: The Holiday Inn Washington Capitol, 550 C Street, SW., Washington, DC. The hotel telephone number is 202–479–9400. Agenda: The Committee will discuss reports and recommendations from its Clinical Quality, Clinical Operations, and Privacy and Security Workgroups. ONC intends to make background material available to the public no later than two (2) business days prior to the meeting. If ONC is unable to post the background material on its Web site prior to the meeting, it will be made publicly available at the location of the advisory committee meeting, and the background material will be posed on ONC’s Web site after the meeting, at http://healthit.hhs.gov.

HIT Policy Committee Meeting

Date and Time: The meeting will be held on August 14, 2009, from 10 a.m. to 3 p.m./Eastern Time. Location: The Holiday Inn Washington Capitol Hotel, 550 C Street,SW., Washington, DC. The hotel telephone number is 202–479–4000. Agenda: The committee will discuss the definition of Meaningful Use, and hear presentations from the Certification/Adoption and Information Exchange Workgroups. The HIT Standards Committee will also update the HIT Policy Committee on its progress to date. ONC intends to make background material available to the public no later than two (2) business days prior to the meeting. If ONC is unable to post the background material on its Web site prior to the meeting, it will be made publicly available at the location of the advisory committee meeting, and the background material will be posed on ONC’s Web site after the meeting, at http://healthit.hhs.gov. Read More

Info Long-Term Care: Exercise and Physical Activity for Older People

The American College of Sports Medicine's updated Position Stand on Exercise and Physical Activity for Older People was released July 20th 2009. The purpose of this Position Stand is to provide an overview of issues critical to understanding the importance of exercise and physical activity in older adult populations. The Position Stand is divided into three sections: * Section 1 briefly reviews the structural and functional changes that characterize normal human aging, * Section 2 considers the extent to which exercise and physical activity can influence the aging process, * Section 3 summarizes the benefits of both long-term exercise and physical activity and shorter-duration exercise programs on health and functional capacity. Read More: Info Long-Term Care: Exercise and Physical Activity for Older People Full Report can be accessed by clicking on link at the bottom of the original post.

Hospital system tries letting patients read physicians' notes

Pamela Lewis Dolan in AMnews -

Tom Delbanco, MD, conducted an experiment in the 1970s in which he asked patients to take their own notes during clinical visits and compare them to their physicians' notes.

The experiment didn't last long, he said, because when patients asked other physicians for notes, "doctors thought the patients were crazy," he said. "They literally said, 'I am calling a psychiatrist.' "

Now, more than 30 years later, Dr. Delbanco, an internist at Beth Israel Deaconess Medical Center in Boston and professor of general medicine and primary care at Harvard Medical School, is trying again. He is one of the leaders of an experiment at Beth Israel that allows patients unfettered access to their doctors' notes made in relation to their visits. The idea is to see how granting real-time access to clinical notes will change the dynamic between physicians and patients.

Read Full Article

HIT Policy Committee's Certification/Adoption Workgroup.

General Function of the Committee: to provide recommendations to
the National Coordinator on a policy framework for the development
and adoption of a nationwide health information technology
infrastructure that permits the electronic exchange and use of
health information as is consistent with the Federal Health IT
Strategic Plan and that includes recommendations on the areas in
which standards, implementation specifications, and certification
criteria are needed. The Certification/Adoption Workgroup is charged
with making recommendations to the HIT Policy Committee on issues
related to the adoption of certified electronic health records, that
support meaningful use, including issues related to certification,
health information extension centers and workforce training.

Date and Time: The meeting will be held on July 14, 2009, from 9
a.m. to 4 p.m./Eastern Time, and July 15, 2009, from 9 a.m. to 10
a.m./Eastern Time.

Agenda: The committee will be hearing testimony from stakeholder
groups, such as purchasers, vendors, and users, on the certification
process. ONC intends to make background material available to the
public no later than two (2) business days prior to the meeting. If
ONC is unable to post the background material on its Web site prior
to the meeting, it will be made publicly available at the location
of the advisory committee meeting, and the background material will
be posted on ONC's Web site after the meeting, at http://
healthit.hhs.gov. The meeting will be available via webcast; visit
http://healthit.hhs.gov for instructions on how to listen via
telephone or Web.

Additional Information

Health Information Technology Policy Committee

Agenda: The committee will discuss the preliminary draft
definition of Meaningful Use. ONC intends to make background
material available to the public no later than two (2) business days
prior to the meeting. If ONC is unable to post the background
material on its Web site prior to the meeting, it will be made
publicly available at the location of the advisory committee
meeting, and the background material will be posted on ONC's Web
site after the meeting, at http://healthit.hhs.gov.

Date and Time of Meeting:July 16, 2009; 10am to 2pm Eastern

Additional Information

CAHPS Field Test of Proposed Health Information Technology Questions and Methodology

This study, funded through cooperative agreements with RAND and Harvard, is being conducted pursuant to AHRQ’s statutory authority to conduct research and evaluations on health care and systems for the delivery of such care, including activities with respect to (1) the quality, effectiveness, efficiency, appropriateness and value of health care services and (2) health care technologies, facilities and equipment. See 42 U.S.C. 299a(a)(1) and (5). This study is a one-time field test to be conducted in calendar year 2009. The field test to be conducted under this request will be done for the following purposes: a. Analysis of revised item wording— Assess candidate wordings for survey items b. Mode Analysis—Evaluate the equivalence of items administered by mail, telephone, and internet; compare the characteristics and responses of respondents who complete the survey by different modes of administration. c. Case mix adjustment analysis— Evaluate variables that need to be considered for case mix adjustment of scores. d. Psychometric Analysis-Provide information for the revision and shortening of questionnaires based on the assessment of the reliability and validity of survey items and composites. The end result will be a data collection related to the assessment of patients’ perspective on how well health information technology is being used by health care professionals. The field testing will ensure that the future data collection yields high quality data and to ensure a minimization of respondent burden, increase agency efficiency, and improve responsiveness to the public. The survey items will be added to currently available CAHPS® surveys and will provide a venue to clinicians and practitioners to verify the quality of their services.

Sentinel Initiative: Structure, Function, and Scope

The Food and Drug Administration (FDA) is announcing a public workshop entitled Sentinel Initiative: Structure, Function, and Scope. The workshop is co-sponsored by the Food and Drug Administration and the eHealth Initiative Foundation, and convened by the Engelberg Center for Health Care Reform at the Brookings Institution. The workshop is intended to bring together academia; government; patient, consumer, and provider groups; health care data owners; industry; and other interested organizations for an update on the current status of the Sentinel Initiative and to allow for comment from all interested stakeholders. Specific topics for discussion include potential governance models and their implications, and approaches for ensuring continued involvement of all stakeholders as the Initiative evolves. Date and Time: The public workshop will be held on December 16, 2008, from 9 a.m. to 3:30 p.m. Location: The public workshop will be held at the Omni Shoreham Hotel, 2500 Calvert Street NW., Washington, DC 20008.

Keeping Track: National Disability Status and Program Performance Indicators

Federal data is used to describe the status of Americans with disabilities and their quality of life. The report measures indicators such as employment, education, health status and health care, financial security, leisure and recreation, personal relationships, and crime and safety. The authors also lay out a road map for the federal government to expand the national disability indicator set, as well as for installing the set into a key national indicator system. Report - PDF Word

Aetna Links Up With Microsoft’s HealthVault

Posted by Sarah Rubenstein in the Wall Street Journal Health blog Aetna is taking a new step toward making patients’ health records portable. The national insurer will begin allowing enrollees in its plans to transfer medical records to Microsoft’s year-old health record site, HealthVault. Starting next month, many Aetna members will be able to move information from their Aetna “personal health record” — an online repository of data that includes claims, diagnoses, test results and prescriptions — to HealthVault, the WSJ reports. This is part of a broad effort among tech companies, insurers and health providers to help patients access all of their health info in one place and transfer it easily to doctors or hospitals, among others. Sites including HealthVault and Google Health, which launched earlier this year, are trying to become central points where patients’ data are available to them, for instance, when they switch from one insurer to another. Meanwhile, Kaiser Permanente next month will start a pilot for its employees to transfer data in Kaiser’s personal-health record to HealthVault. Also next month, Blue Cross Blue Shield of Massachusetts will start allowing members to send their claims information to Google Health. Online health records so far haven’t gained much traction among patients, because many remain unconvinced of the sites’ utility and ease of use and also worry about the security of their private information, Liz Boehm, a principal analyst at Forrester Research told the Health Blog. Aetna says it’s exploring relationships with other online health-record companies, including Google. “We believe that the personal health record needs to be as ubiquitous as it can be in order for us to get the most value from it,” Aetna President Mark Bertolini told us. (Perhaps Aetna CEO Ron Williams has had a change of heart since he referred to Microsoft’s and Google’s efforts as “vaporware.”)

American Health Information Community Meeting

This notice announces the meeting date for the 25th meeting of the American Health Information Community. Meeting Date: November 12, 2008, from 8:30 a.m. to 2:45 p.m. (Eastern) The meeting will include updates on:

• the Healthcare Information Technology Standards Panel,
• the Certification Commission for Healthcare Information Technology, and
• hospital health information technology adoption rates.

Final reports on the Electronic Health Records, Chronic Care, Consumer Empowerment, Quality, and Personalized Healthcare Workgroups will also be presented.

Finally, an update on the AHIC Successor organization will be heard.

A Web cast of the Community meeting will be available on the NIH Web site at: http://www.videocast.nih.gov/.

MEDICARE HOSTS NATIONAL CONFERENCE TO PROMOTE ELECTRONIC PRESCRIBING

WIDESPREAD USE OF E-PRESCRIBING WOULD ELIMINATE THOUSANDS OF ANNUAL MEDICATION ERRORS Boston , MA – October 7, 2008 – More than 1,400 health care professionals and industry leaders convened in Boston today at the National E‑prescribing Conference hosted by the Centers for Medicare & Medicaid Services (CMS) and 34 co-sponsoring organizations. Featuring U.S. Department of Health and Human Services Secretary (HHS) Mike Leavitt, CMS Acting Administrator Kerry Weems, Senator John Kerry (D-MA), Former House Speaker Newt Gingrich, Massachusetts Governor Deval Patrick, Rhode Island Governor Donald Carcieri, and Health Evolution Partners Chairman David Brailer, M.D., Ph.D., the conference addressed the potential of electronic prescribing (e-prescribing) to improve health care in the United States. Topics of discussion included a newly enacted federal e-prescribing incentive payment program; strategies and tools for integrating e-prescribing with current health care delivery practices; and privacy, security, and risk management implications. “Our Nation’s health care system is undergoing a major transformation thanks to health information technology advancements like e-prescribing,” said HHS Secretary Leavitt. “From the smallest rural communities to the largest metropolitan areas, e-prescribing is streamlining the prescription process for patients, providers, health plans, and pharmacies. Today’s National E‑prescribing Conference is a vital step in overcoming e-prescribing barriers and sharing both best practices and insights to accelerate adoption.” Prescribing electronically gives physicians secure electronic access to each patient’s prescription history, helping to avoid prescriptions that may result in drug interactions. E-prescribing also: Eliminates the possibility of medication errors caused by illegible handwriting; Improves quality and efficiency by actively promoting appropriate prescribing patterns; Furnishes information to providers and dispensers about formulary-based drug coverage; Speeds up prescription renewals; and Facilitates communication between physicians’ offices and pharmacies. The Institute of Medicine reported in 1996 that more than 1.5 million Americans, including an estimated 530,000 Medicare beneficiaries, are injured each year by drug errors. Medicare is advancing e-prescribing by bringing together members of the health care community at the National E‑prescribing Conference. Under provisions in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), physicians and other eligible professionals who meet federal requirements as a successful electronic subscriber between 2009 and 2013 will receive incentive payments from Medicare. Under MIPPA, the Secretary of HHS is authorized to identify successful electronic prescribers for a reporting period using one of two possible standards: one based on the reporting of electronic prescribing measures established under Physician Quality Reporting Initiative and one based on the electronic submission of prescriptions under Medicare Part D. Incentive payments, which are available from 2009 through 2013, will be set at 2 percent for 2009 and 2010; 1 percent for 2011 and 2012; and 0.5 percent for 2013. Beginning in 2012, eligible professionals who are not successful electronic prescribers will be subject to a penalty in the form of a percentage reduction in their Medicare physician fee schedule payment. “Medicare is leading the way in implementing innovative technology solutions to deliver optimal health services for beneficiaries,” said CMS Acting Administrator Weems. “Widespread adoption of e-prescribing will mean a significant reduction in annual medication errors, improved efficiency and convenience, and will garner financial savings for both physicians and consumers.” Co-sponsoring organizations of the National E-prescribing Conference were the following: AARP; America ’s Health Insurance Plans; American Academy of Family Physicians; American College of Physicians; American Medical Association; American Medical Group Association; American Optometric Association; American Osteopathic Association; American Osteopathic Association of Medical Informatics; American Pharmacists Association ; American Society of Consultant Pharmacists; Arizona Health-e Connection; Blue Cross Blue Shield Association; Blue Cross Blue Shield of Massachusetts ; California HealthCare Foundation; eHealth Initiative; ePrescribe America ; Florida Agency for Health Care Administration; Health IT Now Coalition; Healthcare Information and Management Sys­tems Society (HIMSS); Lahey Clinic; Massachusetts College of Pharmacy & Health Sciences; Massachusetts Health Data Consortium Inc.; Massachusetts Medical Society; Medical Group Management Association; National Alliance of State Pharmacy Associations; National Association of Chain Drug Stores; National Association of Community Health Centers; National Community Pharmacists Association; National Council for Prescription Drug Programs; New England Healthcare Institute and Massachusetts Technology Collaborative; Pharmaceutical Care Management Association; State of Tennessee ; and SureScripts-RxHub. HIMSS independently sponsored an E-prescribing Solutions Showcase exhibition during the conference. The HIMSS exhibition featured e-prescribing innovations by Allscripts, EHS, Greenway, NextGen, RxNT, Sage Software, and Zix. This e-prescribing initiative is part of HHS’ bold vision for health care reform built on the four cornerstones of value-driven health care. These include: adopting interoperable health information technology; measuring and publishing quality information to enable consumers to make better decisions about their providers and treatment options; measuring and publishing price information to give consumers information they need to make decisions on purchasing health care; and promoting incentives for high-quality, efficient delivery of care. For more information, visit www.hhs.gov/valuedriven or www.cms.hhs.gov/pqri. National E-prescribing Conference presentations can be downloaded at www.e-prescribeconference.com.