|
September 21, 2009
Advisory panel considers privacy proposals
By Alice Lipowicz A federal advisory panel today heard several proposals about how to best protect patient privacy while creating and sharing electronic health records (EHRs).
The Health Information Technology Policy Committee convened to prepare recommendations to the Health and Human Services Department on distributing $19 billion in economic stimulus funding for incentive payments for EHRs and health information exchanges. The bulk of the money will go to doctors and hospitals that buy certified record systems and participate in the exchanges. HHS is expected to issue a rule by year’s end.
Dr. Deborah Peel, founder of the Coalition for Patient Privacy, said the core of privacy is patient control of the information in EHRs.
“The right to privacy and control is the national consensus,” Peel said, “It reflects centuries of medical ethics. We are asking you to set a high bar for privacy to meet with patients’ expectations.”
She suggested patients should be allowed to consent, or not consent, to each disclosure of the information, and for the information to be segmented to maintain different levels of disclosure for different pieces of information. Industry does not want to change its practices, so it is best if regulations are created to enforce patient consent management rules, she added.
However, patient consent, by itself, has not proven to be effective tool, asserted Deven McGraw, a member of the advisory panel and director of the health privacy project at the Center for Democracy and Technology.
“Although the concept of patient control is very appealing, consent does not work the way we want it to,” McGraw said. “Consent does not provide protection.”
That is because health insurers often require blanket consent forms in which patients authorize a very broad variety of uses and disclosures that are not well understood by patient, she said. Patients don’t really have a choice, because if they don’t sign the consent form, the insurer will deny coverage, McGraw said.
The solution is to include patient consent in a comprehensive framework of technical and legal standards for IT systems, networks, practices and training, along with other features, she said.
The committee also heard discussions about the use, disclosure, secondary use and stewardship of the personal health data. It also is considering audits and accountability for the EHR systems and models for data exchange, data storage, data de-identification and re-identification.
In July, a separate advisory committee to HHS, the Health IT Standards Committee, considered specific recommendations for patient privacy that included encryption, strong access controls and audits.
Above article published on
September 17, 2009
Filed Under (EHR, EMR, Electronic Health Records, Electronic Medical Records, Health, Health IT, Hospital) by admin
By Don A. Solberg, MD, Kathryn L Houck and Jim Roberts
Successful electronic health record (EHR) adoption not only improves quality of care by making patient information easily accessible, it also provides valuable clinical decision support. In addition, organizations benefit from streamlined operations — enabling physicians to spend less time on charting and documentation, and more time engaging in face-to-face interactions with patients.
Despite these obvious advantages, however, many physicians are resistant to adopting EHR systems.
A number of factors account for this resistance. First and foremost, organizations are leery of the cost and disruption that can sometimes accompany the conversion from manual to automated processes. Second, a portion of older physicians — who often serve as the leaders in an organization — are typically less comfortable with new technologies than their younger counterparts. And finally, some physicians believe that taking the time to electronically document patient visits will negatively impact patient interaction because it means spending time in front of a computer screen rather than with the patient.
Kittitas Valley Community Health Information Network is an electronic information-sharing partnership linking 30 providers — about 90 percent of all primary care providers in the county — from seven locations. When we implemented our EHR system in 2007, we utilized several strategies that proved instrumental in overcoming anticipated obstacles and ensuring successful adoption:
1) Locate a physician champion. When identifying champions, we looked for those physicians who had a track record of adopting new technologies, were able to maintain positive attitudes despite occasional setbacks and, most importantly, were well-respected by their peers. These champions could clearly articulate the goals and enthusiastically promote the benefits of a fully functioning EHR system to other physicians — helping to encourage even initially skeptical providers to get onboard.
2) Set honest, realistic expectations for physicians and their staffs. The more complex and sophisticated an EHR system, the more challenges a practice might experience in the early stages of implementation. However, we found the potential productivity gains and cost savings ultimately outweighed any inconveniences. By ensuring that everyone understands that there will be a learning curve and that they will experience some growing pains on the front end, you can alleviate frustration and set a positive tone post-implementation.
3) Ask each location to designate a physician, nurse and administrative user to participate in several days of training with the EHR vendor. These “super users” were then available to help others navigate the EHR system, reducing the need for support while building staff camaraderie.
4) Prepare for the transition. In our case, each location went to an abbreviated schedule for two weeks — scaling back patient volume so that physicians and administrative staff would have adequate time to train on the new system. In hindsight, we would recommend that organizations allow a full month for staff to get comfortable and then gradually add back patient visits each week. For example, a practice might take four patient slots out of both the morning and afternoon schedules during the first week, three slots during the second week, two during the third week, and so on. Providing staff members with the opportunity to use the system while performing their daily routines enables them to learn at a comfortable pace.
5) Use a staged rollout. We did not do this during our initial implementation, but have used it several times with processes and changes adopted since. Within each location, two to three physicians, who were committed to the EHR system and willing to work through any stumbling blocks, were selected for initial implementation. Working with fewer physicians at the onset enabled the implementation staff to provide a strong support system, and helped ensure that any issues or concerns were resolved early in the deployment process. Once the first few physicians went live in each location, other providers were added two at a time. That way, each successive group of physicians could seek guidance from colleagues who were already using the system and could witness firsthand the successful utilization of an EHR system.
As an increasing number of health care organizations take advantage of the dollars offered by the American Recovery and Reinvestment Act to deploy EHR systems, it will become even more important to ensure timely and successful adoption of these systems. By setting realistic expectations among key stakeholders, identifying hurdles early and putting plans in place to proactively deal with any challenges that may occur, the likelihood of a smooth transition is significantly increased.
Above article published on http://health-care-it.advanceweb.com/editorial/content/editorial.aspx?cc=202207&CP=2
September 15, 2009
Bernie Monegain, Editor
The Certification Commission for healthcare information technology has announced that it will launch new certification programs on Oct. 7.
CCHIT officials announced Tuesday they will offer an updated comprehensive electronic health record certification program, called CCHIT Certified 2011, as well as a modular certification program – called Preliminary ARRA 2011 – that is limited to the standards for qualifying EHR technology under the American Recovery and Reinvestment Act (ARRA).
“There is a high risk that providers would not achieve meaningful use to qualify for the ARRA incentives in 2011 and 2012 if they wait until late 2010 to implement certified EHR systems and technologies,” said Mark Leavitt, MD, chairman of the commission. “On our town call Sept. 3, which drew over 700 attendees, we received valuable feedback on our proposed programs and a strong indication of interest from health IT companies and developers in applying for timely certification under these programs.”
Leavitt said the commission has followed the recommendations of the health information technology advisory committees to the Office of the National Coordinator (ONC) and believes there is sufficient information to offer preliminary ARRA certification.
HHS criteria and standards are slated for publication by the end of 2009. Final rules on meaningful use are expected in the spring of 2010.
If that process results in the introduction of new requirements, the commission will offer vendors with preliminary certifications an incremental inspection at no additional fee to bring their certifications into alignment with the final rules.
The commission’s certification materials, including criteria, test scripts and certification policies for both programs, will be published Sept. 24 on the CCHIT Web site. Applications for certification will open online on Oct. 7.
To help HIT companies and developers to make 2011-certified EHR technology available to providers, the commission is offering a workshop in the Chicago area on Oct. 1. The workshop, Get Certified 2011, is designed to orient companies and developers to the new certification process and help them use the new certification program tools effectively.
Above article published on http://www.healthcareitnews.com/news/cchit-poised-begin-new-certification-programs
September 15, 2009
Diana Manos, Senior Editor
The Department of Health and Human Services issued new regulations Wednesday requiring healthcare providers, health plans and other entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify patients if their electronic health information has been breached.
The regulations are mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of American Recovery and Reinvestment Act of 2009 (ARRA) last February.
Developed by the HHS Office for Civil Rights, they require healthcare providers and other HIPAA “covered entities” to promptly notify people whose health records have been breached, as well as the HHS Secretary and the media in cases where a breach affects more than 500.
Covered entities include doctors, clinics, psychologists, dentists, chiropractors, nursing homes and pharmacies – if they transmit any information in an electronic form using a standard that HHS has adopted.
According to the OCR, the rule also applies to health insurance companies, HMOs, company health plans and government programs that pay for healthcare, such as Medicare, Medicaid and the military and veterans’ health care programs. It includes healthcare clearinghouses that process non-standard health information received from another entity into a standard electronic format or data content, or vice versa.
“This new federal law ensures that covered entities and business associates are accountable to the department and to individuals for proper safeguarding of the private information entrusted to their care,” said Robinsue Frohboese, acting director and principal deputy director of the OCR. “These protections will be a cornerstone of maintaining consumer trust as we move forward with meaningful use of electronic health records and electronic exchange of health information.”
HHS officials said they developed the regulations after taking public comment last April and under “close consultation” with the Federal Trade Commission). The FTC has issued its own breach notification regulations that apply to vendors of personal health records and certain others not covered by HIPAA.
To help providers to determine when information is “unsecured” and notification is required by the HHS and FTC rules, HHS is also issuing an update to its guidance on encryption and destruction of technologies that are no longer usable. Providers that are subject to the HHS and FTC regulations that secure electronic health records according to HHS guidance through encryption or destruction are relieved from having to notify in the event of a breach. This guidance will be updated annually.
The HHS interim final regulations on breach notification will be effective 30 days after they are published in the Federal Register and will include a 60-day public comment period.
Above article published on http://www.healthcareitnews.com/news/hhs-issues-rule-ehr-breach-notification
September 10, 2009
Diana Manos, Senior Editor
The Certification Commission for Health Information Technology is expected to release more details on its “modular” certification on Sept. 24, and it is also tentatively planning training sessions in Chicago on Sept. 29 and Oct. 1, to orient vendors and developers to new programs, including updated application processes, certification criteria and test scripts.
The modular approach to certification would tell providers that a healthcare IT product is capable of performing to provide meaningful use, a requirement under the federal stimulus law under which providers could receive bonus payments beginning in 2011.
The certification would be provided in advance of the definition of meaningful use, which is expected out by the end of the year.
Federal officials have said providers would have to make “a business decision” as to whether to go forward in faith with the modular certification ahead of the final rulemaking.
The Certification Commission for Health Information Technology held a “town call” Web conference Thursday to gather input from the vendor and developer communities on the commission’s planned new paths to certification for electronic health record technologies.
CCHIT Chairman Mark Leavitt, MD, said the goal is to achieve more rapid, widespread adoption and meaningful use under the American Recovery and Reinvestment Act of 2009 (ARRA).
“We are concerned that providers could not achieve meaningful EHR use in 2011 if they wait until spring 2010 - the expected date of (the Department of Health and Human Services’)’ final approval of requirements - to begin adopting this technology,” said Leavitt, “CCHIT has analyzed the recommendations of the federal HIT advisory committees and is preparing to offer new paths to certification beginning this October.”
Besides updating and enhancing its certification program for comprehensive EHRs in ambulatory, inpatient and emergency department settings, the commission plans to launch a more limited, modular inspection program for EHR technology, focusing solely on compliance with ARRA-required standards.
In an Aug. 14 meeting, the federal government’s Health IT Policy Committee adopted additional recommendations on meaningful use and proposed expansion of EHR certification to include 10 to 12 certification panels in addition to the existing Certification Commission for Health Information Technology. Physicians, activists, vendors and others warned the committee at a meeting that it was moving too fast.
Above article published on http://www.healthcareitnews.com/news/cchit-maps-out-path-certification-meaningful-use-focus
September 09, 2009
Experts say success hinges on the outcomes of these decisions
By Alice Lipowicz Former President George W. Bush urged doctors and hospitals to go digital on their own, with a few booster shots of federal help. Consequently, progress was slow. But the pace of change has been increasing since President Barack Obama has made health IT a priority and Congress put some real money on the table. Under the economic stimulus law passed earlier this year, as much as $45 billion will be distributed to health care providers who buy and use approved electronic health record systems.
The road ahead is still bumpy for EHRs, but experts say success hinges on the outcomes of five major decisions.
1. Strong standards or wiggle room? Officials at the Health and Human Services Department have the daunting task of creating a framework for certifying EHR systems that are capable of collecting and sharing patient data in ways that satisfy the broader goals of the stimulus law. A critical question is whether HHS can strike the right balance between strong rules and flexibility.
“There is always a trade-off between innovation and any kind of a certification process,” said Wes Rishel, a vice president and distinguished analyst at Gartner’s health care provider research practice.
2. Broaden the meaning of “meaningful use?” In the stimulus law, Congress said only doctors and hospitals that show meaningful use of EHRs can receive incentive payments. That language was meant to prevent the buying of systems that sit idle or are not used as intended. Key decisions for HHS are how broadly and stringently to apply the meaningful-use framework to meet major goals, such as cost savings, improved care and better public health.
3. Take baby steps or giant leaps forward? To help HHS meet its fast-approaching deadlines, an advisory committee urged the agency to immediately set up a temporary program that would allow an existing organization to certify vendors’ EHR systems until more permanent arrangements could be made.
Dr. Carol Diamond, managing director of the Markle Foundation’s Health Program, said HHS should allow the same sort of flexibility for providers to meet EHR-use goals. Some are already using EHRs, but others lag far behind, she added. “We still live in the real world,” she said. “You cannot get up to speed all at once.”
4. Let the states lead the way on data exchange? The ultimate goal of health information technology is the automatic sharing of patient data. The reasoning goes that if providers exchange patient data with government agencies and one another, analysts can identify trends and send the results back to doctors and hospitals to help them provide better care and reduce costs.
For now, a little sugar is making the medicine go down easier — such as the $564 million in state grants for health information exchanges that HHS announced in August. But the agency still has a key decision to make on the federal government’s role in creating that data network.
“You have to either grow the state exchanges that will be connected or try to seed from the top,” said Deven McGraw, director of the Center for Democracy and Technology’s Health Privacy Project.
5. Wait for broader health reforms or forge ahead? Dr. David Blumenthal, HHS’s national coordinator for health IT, said he hopes to strike a balance between incentives and penalties for EHR use. The rules must foster competitiveness, innovation, privacy and security, among other often-conflicting goals. But decisions are also looming about how hard HHS should push for health IT in advance of more comprehensive reforms that will affect health care access and payments.
“If we do not do the work on payment reforms, we will not really reap all the value of health IT,” McGraw said.
Above article published on http://fcw.com/Articles/2009/09/07/FEDLIST-5-steps-to-EHR-success.aspx?Page=1
September 09, 2009
ScienceDaily — A new framework of recommendations created by health informatics researchers may help doctors and hospitals prepare for a federal initiative to expand the use of electronic health records (EHRs).
The recommendations from faculty at The University of Texas Health Science Center at Houston, the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine appear in a commentary in the Sept. 9 edition of JAMA, the Journal of the American Medical Association.
“With high-quality, well-designed, and carefully implemented systems, highly-reliable, safe health care will be achieved,” said Dean Sittig, Ph.D., commentary author, associate professor at The University of Texas School of Health Information Sciences at Houston and member of The University of Texas - Memorial Hermann Center for Healthcare Quality and Safety.
The American Recovery and Reinvestment Act of 2009 created approximately $20 billion in incentives for individuals and organizations to “meaningfully” use electronic health records beginning next year. Previous studies report that 4 percent of physicians in the outpatient setting and 1.5 percent of U.S. hospitals have a comprehensive electronic health record system.
“This framework can help make sure that electronic health records are used safely and effectively as doctors continue to adopt them,” said Hardeep Singh, M.D., M.P.H. co-author and assistant professor of medicine and health services research at the VA Health Services Research and Development Center of Excellence and Baylor in Houston.
This framework of recommendations proposed by Sittig and Singh provides guidance for key stakeholders who are either currently involved or who will soon be involved with electronic health records.
“While using electronic health records, we not only have to consider issues related to technology, but also issues related to people who use them, how they interact with technology and how the electronic health record fits with the work flow of the clinic or organization that adopts it,” said Singh, who noted that if the Computerized Patient Record System developed by the Department of Veterans Affairs was included in the EHR-use study, the percentage of U.S. hospitals with a comprehensive electronic health record system would nearly double to 2.9 percent.
VA’s electronic health record system covers many aspects of patient care, including reminders for preventive health care, electronic entry of orders, display of laboratory test results, consultation requests, and pathology and imaging studies.
“The American Recovery and Reinvestment Act stipulates that clinicians and healthcare organizations can receive incentive payments for ‘meaningful use’ of EHRs. Depending on the definition and timeline for ‘meaningful use,’ this legislation could result in a rush to implement sub-optimal systems,” said Sittig, co-author of a new book that addresses EHR issues and is titled “Clinical Information Systems: Overcoming Adverse Consequences.”
For Americans to realize the full potential of electronic health records, which include reduced cost, less duplication and greater quality, Sittig and Singh believe all eight essentials, which are based on a systems engineering model for patient safety, should be followed.
“These issues are essential to maximize patient care benefits and minimize unintended errors from technology,” Singh said.
The commentary is titled “Eight rights of safe electronic health record use.” The authors received support from the National Library of Medicine, the VA National Center of Patient Safety, the Houston VA Health Services Research and Development Center of Excellence and the Agency for Health Care Research and Quality.
Above article published on http://www.sciencedaily.com/releases/2009/09/090908193440.htm
September 07, 2009
By Mary Mosquera
The Centers for Medicare and Medicaid Services (CMS) plans to test its ability to accept selected clinical quality data directly from hospital electronic health record systems as early as July 2010.
CMS said it would seek volunteer hospitals to report stroke, blood clot and emergency department measures of care via EHR systems as part of the Reporting Hospital Quality Data for Annual Payment Update program, which provides higher Medicare payments to hospitals that report quality measures to the agency.
The agency detailed the plans in the Aug. 27 Federal Register in announcing changes to its rule for the Reporting Hospital Quality Data for Annual Payments Update. The program, a provision of 2003’s Medicare prescription drug legislation, required hospitals by 2010 to report on 42 quality measures to receive additional incentive payments.
Reporting to CMS is generally paper-based or through a mix of manual and automated systems.
Participating hospitals and their vendors will have to be able to transmit clinical EHR data that adhere to interoperability standards, such as cross document sharing, cross community access, clinical data architecture and Health Level 7 version 3, CMS said.
CMS has encouraged hospitals to adopt EHRs that can report quality data directly to a CMS data repository. Ideally, the use of EHR systems would improve the quality of care by providing physicians with pertinent clinical data as they were treating patients.
“The testing of EHR submission is an important and necessary step to establish the ability of EHRs to report clinical quality measures and the capacity of CMS to receive such data,” the agency said in the published interim rule.
The reporting of selected quality measures is also a key provision of the stimulus law. The Health IT Policy Committee, led by Dr. David Blumenthal, the national coordinator for health IT, has recommended that quality reporting be a part of the criteria providers must meet to demonstrate meaningful use of electronic health record systems, CMS said.
The stimulus law authorized Medicare and Medicaid incentive payments to providers who prove they are meaningful users of health IT starting in 2011.
Above article published on http://www.govhealthit.com/newsitem.aspx?nid=72031
September 01, 2009
By Ken Terry While the debate over “meaningful use” of electronic health records rages on, it has been easy to forget the other half of the requirement for getting government health IT subsidies: Physicians and hospitals must use “qualified” EHRs.
Since the passage of the HITECH Act, part of last spring’s stimulus package, there has been speculation that a qualified EHR would have to be certified by the Certification Commission for Health Information Technology (CCHIT), which so far has been the only game in town. But the Health IT Advisory Committee, which advises the Department of Health and Human Services on information technology matters, has decided that there should be multiple certification bodies. All of them would have to certify EHRs under criteria developed by HHS.
According to the work group that made the recommendations approved by the whole committee, CCHIT’s criteria for certification are too detailed and the organization is too close to the industry to be the only certifying entity. Other observers have pointed out that CCHIT is very close to the Healthcare Information and Management Systems Society (HIMSS), a trade association for health IT professionals that include many software vendors among its members. In addition, Mark Leavitt, MD, chair of CCHIT, used to be a HIMSS executive and, before that, led an EHR company. However, there is no evidence that CCHIT’s ties with HIMSS have influenced its approach to certification, which has been implemented by workgroups that include a wide range of industry professionals.
In any case, CCHIT plans to certify EHRs under the criteria that will be established by HHS. Meanwhile, the advisory committee has asked CCHIT to submit a proposal for developing a “Preliminary HHS Certification” process that would allow it to provide preliminary certification to EHR vendors so that providers can begin purchasing qualified products, perhaps as early as October. In addition, the committee approved a plan to grandfather in vendors that have 2008 CCHIT certification, with the proviso that they upgrade their products later.
In a signifier of what this debate is really about, the committee has approved the certification of “open-source” EHRs, which contain non-proprietary code that is available to anyone who wants to use it. The best-known example in the healthcare arena is the VA system’s Vista EHR, which has been available to software developers for a number of years. In addition, the comment about CCHIT’s criteria being too detailed suggests that the committee wants to use looser criteria under which less advanced (and less expensive) EHRs could qualify for government aid.
I applaud this decision on a couple of grounds: First, continuing to tighten criteria for “qualified” EHRs would help a dozen or so vendors consolidate their hold on the market as providers sought EHRs that could garner government aid. Second, physicians don’t need all of the bells and whistles in current EHRs to improve health care. Relaxing the criteria in certain respects would help the development of nontraditional community EHRs, including those linked to disease registries, that might serve the purpose better. But as HHS develops its criteria, it should bear in mind that the EHRs that are qualified for government subsidies must also help doctors demonstrate meaningful use.
Above article published on http://industry.bnet.com/healthcare/10001008/hhs-will-choose-criteria-for-ehr-certification/
September 01, 2009
The Certification Commission for Health IT is moving forward on plans to launch a less comprehensive certification program that will focus solely on compliance with the “meaningful use” requirements of the federal economic stimulus package, Health Data Management reports.
Under the stimulus package, hospitals and physicians who demonstrate meaningful use of electronic health records will qualify for Medicare and Medicaid incentive payments.
Although the federal government is not expected to issue a final definition for meaningful use until next spring, CCHIT aims to launch its new certification program in October.
CCHIT Chair Mark Leavitt said the commission will base its new program on preliminary recommendations from federal health IT advisory committees. He said this will allow health care organizations to purchase and implement EHR systems in time to receive the maximum incentive payments.
Leavitt added that CCHIT also plans to update and expand its current comprehensive EHR certification system for ambulatory, emergency department and inpatient settings (Anderson, Health Data Management, 8/25).
Recent Certification Changes
Earlier this month, the Health IT Policy Committee adopted recommendations that called for multiple entities to certify EHR systems. The certification and adoption work group said it envisions the establishment of 10 to 12 different EHR certification groups, in addition to CCHIT.
The Policy Committee also proposed a transition plan to help health IT vendors develop products that meet the 2011 meaningful use requirements.
Under the “Preliminary HHS Certification” process, CCHIT likely would provide interim certification for EHR vendors. The plan would invite CCHIT to submit a proposal for developing the preliminary certification process (iHealthBeat, 8/17).
Above article published on |
|
