By Neil Versel

Acknowledging that the body of scientific evidence on the efficacy of health IT still is rather scant, national health IT coordinator Dr. David Blumenthal is anticipating a flood of new research as a result of the federal stimulus that encourages wide adoption of electronic health records. To date, most of the research has focused on health IT in specific environments, such as a single hospital, physician office or integrated delivery network, but the stimulus will help put EHRs in new settings that haven’t been studied.

“We are going to be hungry for how to implement health information technology the most efficiently to gain the greatest value for the health IT investment,” Blumenthal told a gathering convened by the Agency for Healthcare Research and Quality last week. “We’re at that transition that we see every time a new technology is moved out from the laboratory.”

Blumenthal advocated clinical decision support technology that encourages continuous quality improvement by delivering research data and new treatment information to the point of care, easily accessible by clinicians. “One thing we haven’t done is apply the scientific method in the practice of healthcare and medicine,” he said.

But he and other health IT experts at the same AHRQ conference cautioned that the road to achieving “meaningful use” of EHRs will be long and fraught with all sorts of danger.

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Diana Manos, Senior Editor

Social Security administrators have set aside $24 million for contracts to provide electronic medical records to improve the efficiency of its disability programs.

Michael Astrue, Commissioner of Social Security, said the agency is looking for healthcare providers, provider networks and health information exchanges to participate in its Medical Evidence Gathering and Analysis through Health Information Technology program.

Astrue said health IT will improve the efficiency of a process which is largely paper-bound. For nearly a year, he said, Social Security has been testing health IT to obtain electronic medical records. Disability applications processed with electronic medical records from test sites in Massachusetts and Virginia have significantly reduced processing times, he said.

“With these competitive contracts, Social Security continues to be a leader in the use of health IT to improve service to the American public,” Astrue said. “This technology will greatly improve the speed and consistency of our disability decisions.”

The contract opportunities announced Friday are funded through the American Recovery and Reinvestment Act. They will require awardees, with a patient’s authorization, to send Social Security electronic medical records through the Nationwide Health Information Network. The NHIN, considered by the federal government to be a safe and secure method for receiving instantaneous access to electronic medical records, is an initiative of the Department of Health and Human Services and is supported by multiple government agencies and private sector entities.

Social Security reports a significant increase in disability applications as a result of the current recession. The agency expects to receive more than 3.3 million applications in fiscal year 2010, a 27 percent increase over FY 2008. To process these applications, the agency sends more than 15 million requests for medical records to healthcare providers.

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The requirements for how healthcare providers would demonstrate meaningful use of health information technology have gotten a little clearer.

The HIT Policy Committee, led by national health IT coordinator David Blumenthal, adopted July 16 a list of health IT objectives and measures for 2011, 2013 and 2015. It also agreed to give providers more time to adopt electronic health records.

The committee’s meaningful use work group revised some of the health IT objectives for 2011 that were presented at its June meeting, separating out goals by hospital and physician, essentially by inpatient and outpatient environments.

Under the American Recovery and Reinvestment Act, providers will be eligible for increased Medicare and Medicaid payments beginning in 2011 if they demonstrate meaningful use of their health IT.

The committee’s recommendations allow providers who need more time to get started to accomplish the health IT objectives based on “adoption year” instead of specifically in either 2011 or 2012.

In effect, said Paul Tang, chair of the Palo Alto Medical Foundation and co-chair of the meaningful use work group, it lets providers push out to 2013 or 2014 the 2011 foundation criteria.

Providers who do that will be eligible for less incentive money, but will at least have the opportunity to participate in the program. But the first adoption year will be still be considered as 2011, no matter when the provider comes in to the program through 2014.

“We thought there was a kind of double jeopardy in that, if a provider couldn’t make the 2011 or 2012 criteria, and coming into 2013 the bar would be raised higher, it’s almost like you can’t get into the game at all” Tang said. “We’re trying to find a way for people to participate even if it’s a little bit delayed.”

CMS will need to consider the recommendation and its implications for the development of future regulations, Blumenthal said.

The goals for meaningful use are for providers to electronically capture data, report quality measures and use the data to track patients’ medical conditions. Providers must steadily meet more stringent goals with increasing health IT functions, and link them with outcome measures for quality and efficiency improvement in 2013 and 2015.

The work group added measures for 2011, such as providers reporting quality measures to CMS, checking insurance eligibility electronically and submitting claims electronically.

It revised some of the health IT objectives introduced in the June meeting, including implementing drug reaction checks and alerts, problem diagnoses lists based on standards, electronic prescribing and computerized physician order entry (CPOE) for all orders, though interfaces for CPOE are not necessary. Hospitals would have to generate 10 percent of their orders through CPOE.

The committee also endorsed the use of disease registries, which could be used for many purposes, but specifically as a way for specialists to report quality data and demonstrate meaningful use.

Blumenthal will publish an interim final rule by the end of December for the meaningful use of health IT. CMS will also issue a rule by December on provider incentives.

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When the government’s Health IT Policy Committee met a couple of weeks ago, some committee members suggested that a workgroup’s preliminary definition of “meaningful use” of electronic health records had gone too far. Now the official comments are in, and it’s clear that most of the healthcare industry agrees that the requirements in the workgroup’s first draft are overly aggressive. It will interesting to see what the committee comes up with when it reconvenes on July 16.

The “meaningful use” definition is of vital importance to the industry, because physicians and hospitals will have to show that they are using EHRs meaningfully in order to qualify for billions of dollars in government financial incentives. The committee wants to use its power to define the requirements to achieve certain policy objectives. But healthcare providers are concerned that they will be asked to do too much too soon. If the criteria to qualify for incentives in 2011, the first year of the reward program, are too stiff, not many providers will receive the maximum amount of government incentives.

In a letter to the Office of the National Coordinator For Health IT, Mark Leavitt, MD, and Alisa Ray, respectively chair and executive director of the Certification Commission for Health IT, succinctly summed up the problem:

“The lag between a decision to invest in EHR technology and its full, meaningful use in a provider organization is 1 to 2 years at best, and more typically, 3 to 5 years. For this reason, we believe most of the measures proposed for 2011 would be difficult to achieve by providers who have not already begun EHR implementations. Given current adoption levels, the incentives would only be available to a small percentage of providers, potentially provoking disillusionment and frustration with the ARRA incentive program.”

An AMA-led group of 81 medical specialty societies and state medical associations expressed a similar concern, noting that the committee’s timeline “is too aggressive, given that we continue to lack the necessary infrastructure, standards and systems.”

On the hospital side, both the AHA and the Federation of American Hospitals (FAH) opposed the timetable. The AHA noted that according to a recent study, only 1.5 percent of hospitals have a comprehensive EHR and 8-12 percent have a basic system. Consequently, the AHA said, the workgroup’s schedule for EHR implementation is “not achievable in the time frames proposed.” The FAH pointed out that computerized physician order entry (CPOE), which would also be required at an early point, is being used in only a tiny fraction of hospitals today.

Similar points were made by associations of health IT professionals. Bill Bria, MD, the president of the Association of Medical Directors of Information Systems (AMDIS), noted that it takes considerable time and effort to get physicians to use CPOE, even after it’s installed.

All of this noise is not about healthcare providers digging in their heels and refusing to play along with President Obama’s health IT initiative. Rather, it is a frank admission that implementing this technology will be a gargantuan undertaking that will require tremendous amounts of time and money. As AMDIS put it, there must be a “crawl-walk-jog-run” progression to EHR adoption. “These cycles cannot be skipped or condensed … without risking failure to ‘go the distance’ in the marathon that is HIT-powered healthcare transformation,” the association said.

Above article published on http://industry.bnet.com/healthcare/1000879/industry-pushes-back-on-ehr-meaningful-use-definition

Privacy becomes an issue with electronic health records

The Obama administration’s drive to implement electronic health records (EHRs) should have strong identity management tools to ensure privacy and security of the records, members of a panel of providers, vendors and policy experts said today.

The coming health information technology policies and standards are to include protections for patient privacy and security and safeguards against medical identity theft. Achieving those goals could be advanced by identity management tools, such as strong authentication standards and smart cards, according to panelists at an event in Washington today organized by the Smart Card Alliance and the Secure ID Coalition. Both groups represent vendors of identity management programs.

For example, patients checking in to Mount Sinai Medical Center in New York City are assigned a smart card that contains their photograph and a digital summary of recent clinical information. By delivering the information to doctors providing care, the card helps improve care and reduce medical errors. The card also has proven to be critical in reducing fraud and identity theft, which in turn decreases errors in payments and in patient care, said Paul Contino, vice president of IT at Mount Sinai.

“If you don’t catch the errors at the registration desk, you will see dramatic effects downstream,” Contino said. “If you are going to spend money on health IT, you need the right identification standards.” Without strong ID management, care records are likely to have errors because of false identities, misspelled names, duplicative names and other problems. Even a single error, such as a wrong blood type listed on a patient’s record due to a mix-up with another person’s identity, can lead to catastrophic consequences for a patient, he said.

Congress approved spending $17 billion in incentives for doctors and hospitals that install and use health IT systems as part of the economic stimulus law. The Health and Human Services Department is drawing up standards and policies to distribute payments to providers who can show meaningful use of health IT. HHS also is setting up a framework for secure exchange of the health data and the department’s national coordinator for health IT on May 15 released a road map for creating the standards and policies under the stimulus law.

One standards will involve controls on access to patient records. The leakage of private medical information can affect a patient’s employment, housing and insurance status, and because of that extreme sensitivity, medical information requires more than a password for secure handling, said Michael Magrath, director of business development for North America for Gemalto Inc.

“Health information exchanges and regional information exchanges will be targeted by hackers,” Magrath said. “I have strong concerns about the prospect of minimum standards,” such as passwords alone. Identity authentication standards for receiving medical care and handling medical data should require a password and also use of some type of identity token or certificate issued by a third party, he said.

Ideally, patients would be in charge of — and would have complete access to — all of their health records, said William Yasnoff, managing partner of the National Health Information Infrastructure Advisors consulting firm.

“Who has your complete medical records? For most people, it’s no one,” Yasnoff said.

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http://fcw.com/articles/2009/05/19/obama-health-it-initiative-needs-strong-id-management-vendors-say.aspx

Former Gov. Mark Warner said sharing medical records among providers will improve care and reduce costs.

By Sarah Bruyn Jones
With nearly $20 billion in federal funds about to hit the world of health care information technology, Virginia’s health sector and political leadership are trying to prepare to capture their share of the money.

The money is part of the federal stimulus bill signed by President Obama in February and is intended as a financial incentive to get the health care industry to embrace using electronic medical records. Still, the timeline and details of how the money will be distributed have not been finalized.

“This represents a big leap forward for health technology, so we are excited about it,” said Virginia Secretary of Health and Human Resources Marilyn Tavenner. “We just want to be positioned to take maximum advantage of it.”

Some monies will likely go directly to the states to be distributed, while other funds will be allocated through a competitive grant process.

Tavenner said a significant amount of money coming to Virginia could boost job growth for information technology specialists as more health providers implement electronic record-keeping systems.

To help ready Virginia for coming funding, U.S. Sen. Mark Warner has arranged for a health IT summit Monday in Richmond. The national coordinator for health information technology, recently appointed by Obama, will be at the summit.

“This is going to be one of the areas that is going to drive health care reform,” Warner said.

The state will form an advisory group to help Virginia providers access the federal money and implement effective electronic medical record systems.

Between 15 and 20 people will be named to the group, including four people already named to the newly created Health Information Technology Standards Advisory Committee, which was established by the 2009 General Assembly, Tavenner said.

Warner said establishing electronic medical records in hospitals, nursing homes and physicians’ offices throughout the state will improve care and reduce costs.

“There is no reason why health care can’t get some of the efficiencies that every other field has,” he said, pointing to manufacturing and telecommunications as examples.

While the guidelines for exactly how the money will be distributed are still being worked out, Warner said he believes that cooperation between different health care providers will be the key to attracting government dollars. That includes requirements that different hospital systems and physicians’ offices be able to share information.

Warner, who has a background in telecommunications, said the system should be similar to the way cellphone companies operate: There are different providers, but a call from a Verizon phone can be received by a Sprint phone. Financial incentives will be needed to push a working system into operation, he said.

Questions remain about the security of such a system. And some medical providers don’t want to share all their data with another business due to competition in the industry.

Carilion Clinic’s chief information officer, Daniel Barchi, said it is important for system administrators to talk to each other as electronic records become the standard. Carilion began rolling out its new multi-million-dollar record system last year and has been in discussions with some other hospital systems in the state to share experiences, he said.

“The more that health IT leaders get together, the better off we are going to be,” Barchi said.

He is one of the four people already appointed to the advisory committee.

“By cooperating and choosing a common data record, there is a way we can share — with patient permission — information across all these health systems,” Barchi said. “And I think the government is doing an admirable job of putting incentives out there for the providers to make their systems more interoperable.”

The state-led efforts also focus on helping providers who don’t already have electronic medical records systems establish one. That’s because much of the federal funding will be tied to providers who already have an electronic record in use.

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