March, 2010

Why the ONC can’t endorse a particular EHR vendor

After Dr. David Blumenthal, national coordinator for health information technology, delivered the Tuesday keynote at last week’s IEEE-AMA conference on personalized medicine in Washington, D.C., an audience member representing the Mayo Clinic asked him whether his office (the ONC) might endorse an electronic health record (EHR) vendor — that, or at least influence vendors to standardize their products in the name of lessening the burden on providers charged with the task of making them interoperable.

The questioner detailed his experiences coordinating EHR systems at multiple facilities across five states for Mayo. Software from more than 440 vendors in the system must work together for the health care system to create its meaningful-use-ready EHR system that will plug into the National Health Information Network.

“It’s just like the United States, except smaller,” the audience member said, calling each installation a “little fiefdom” of data.

The United Kingdom’s government, he concluded, limits vendors in the EHR space, so that health care providers do not have to bear such an enormous cost of interoperability. Why can’t ONC do that for the United States?

“I guess I could come back to you and say, ‘And why didn’t Mayo succeed in overcoming all those independent fiefdoms?’ and then ask you to put yourself in the position of someone sitting in the Hubert Humphrey Building in Washington, trying to make that happen across a population of 300 million in 50 states,” Blumenthal said. “If it were the right thing to do — and I don’t think we know yet whether that exactly is the right thing to do, the British experiment is a very astute one [but] it’s not been without its problems — the right of people to choose what they do in their own office with respect to electronic health systems is a right that your colleagues in the medical profession would staunchly defend.

“We have a culture of autonomy and independence, valuing liberty and innovation in the United States. Our health [care] reform debate has shown the power of that cultural norm, in spades, and I think we are at the right place for where our country needs to be right now with respect to the level of central control and local control in implementing electronic health systems,” Blumenthal added.

Translated: Run this up your flagpole — there won’t be an ONC-approved EHR system coming to a doctor’s office near you, at least anytime soon.

Stage 2 meaningful use criteria already in the crosshairs

Stage 1 meaningful use requirements aren’t yet finalized, but policymakers and industry stakeholders are already turning their eyes to what might be coming down the pike for Stage 2.

By 2012, providers will have to begin implementing Stage 2 requirements, whatever they might be. The Centers for Medicare and Medicaid Services, tasked with rolling out meaningful use under the HITECH Act, is now at work on crafting a final rule for Stage 1 criteria - set to go in effect in 2011 - and plans to publish two more proposed rules governing stages 2 and 3.

Recommendations being drafted now by a federal work group would ensure providers and vendors focus more on patient safety reporting in the Stage 2 meaningful use requirements. The certification and adoption work group of the Health IT Policy Committee met this week to discuss its suggestions, which it plans to present to the full policy committee at an April 21 meeting.

One idea the work group is floating is to create a national patient information reporting system that could collect and analyze data on errors, adverse events and “near misses” - a situation in which a patient might have been harmed, but the error was caught - during medical care. By analyzing that information, researchers can see where systems break down and help providers make improvements to their operations and deliver safer care, officials say.

Such patient information systems already exist, in the form of Patient Safety Organizations (PSOs). The creation of PSOs was mandated through the Patient Safety and Quality Improvement Act of 2005, and the first PSOs were designated in 2008. The Agency for Healthcare Research and Quality (AHRQ) oversees the program, which is not mandatory for hospitals and doctors to participate in. Doctors and hospitals also already have been accustomed to reporting some information about errors and other population health issues to state agencies and organizations like the Joint Commission, but all the systems largely collect information in different ways.

The AHRQ is developing common formats to make reporting information more seamless for providers, according to William Munier, a physician who is director of the agency’s Center for Quality Improvement and Patient Safety. PSOs are currently designed to accept submissions in paper form, but eventually reporting systems will have to be populated by electronic health records so that data analysis can be accomplished easily.

The certification and adoption work group initially considered suggesting that the PSO program become the national reporting system. But in its final recommendations it will likely instead say that the Office of the National Coordinator for Health IT should conduct a formal study regarding the relationship between patient safety and technology, and develop actions from that analysis.

What the health reform bill means for health IT

Last week’s signing into law of the historic health reform bill is expected to affect all hospital departments — and IT is no exception. In the days since its signing, many bloggers have pontificated on what the health reform bill means for health IT. Here we offer a small sample.

For starters, Margalit Gur-Arie succinctly points out the four objectives of the health reform bill “that will require massive HIT support — administrative streamlining, quality measurement, patient involvement and innovative care models.” Brian Ahier expands on this idea, noting that transparency, interoperability and standards are among the keys to the health reform bill. Taken together, the concepts offer “some interesting possibilities for mashups with existing data sources.”

And there will plenty of data. As Cheryl McEvoy points out, with health care coverage extended to more than 32 million Americans, there will be more appointments to schedule, more cases to log and more bills to file. That, combined with a more vigorous focus on preventing Medicare and Medicaid fraud, will only heighten the need for accelerated electronic health record (EHR) adoption, she writes.

Speaking at a conference in Washington, D.C., last week, Dr. David Blumenthal, the national coordinator for health IT, noted that grants have been made available to state organizations to help individual providers offset the costs of the health reform bill. It is in the states’ best interest to assist providers with EHR adoption, Blumenthal said, because this will allow them to plug into health information exchanges and then, “a nationwide, interoperable health system.”

Whether such a system will be realized remains to be seen. A lot of it depends on the fortitude — and creativity — of health IT professionals.

NHIN Direct to help providers exchange health information

As the deadlines to receive American Recovery and Reinvestment Act incentive payments draw ever closer, the Office of the National Coordinator for Health Information Technology is eager to jump-start its NHIN Direct project for exchanging health information securely over the Internet. (NHIN stands for Nationwide Health Information Network.) In the next two months the ONC plans to publish a set of draft standards for NHIN Direct’s specifications.

The NHIN Direct team hopes to begin testing the specifications in a real-world environment by October, so that tools and services can be ready for providers to achieve Stage 1 of meaningful use, which begins in 2011.

Although NHIN and NHIN Direct include standards, services and policies, NHIN Direct, considered an extension of NHIN, will support a different set of use cases. For example, NHIN Direct might be used by a primary care provider who refers a patient to a specialist and wishes to send the specialist the patient’s summary care record. The specialist in turn could use NHIN Direct to send an updated summary care record back to the primary care provider.

Arien Malec, a member of the Health IT Policy Committee’s NHIN workgroup, is the coordinator for NHIN Direct. For individuals and organizations wishing to become involved, there are two paths to participation: an implementation group, consisting of members who have committed to active involvement in deploying the standards and specifications; and an expanded group, consisting of individuals who will provide feedback, expertise and suggestions along the way.

EHR implementation a foregone conclusion, ONC says

In addition to addressing health care reform, Dr. David Blumenthal, the national coordinator for health IT, took some time during his keynote at the First AMA-IEEE Medical Technology Conference on Personalized Healthcare yesterday to address an equally critical issue for physicians — electronic health record (EHR) implementation.

Blumenthal mentioned that his Office of the National Coordinator for Health Information Technology received more than 2,000 comments on proposed meaningful use rules for EHR technology. Many of the comments were substantive, he said, and the ONC is considering some of their suggestions for changes to the final rule. Next up for the office are the temporary and final EHR certification rules under development.

No matter how the rules shake out, EHR implementation in the United States is a foregone conclusion, Blumenthal said. He sees the skills of collecting, using, searching and sharing health data electronically becoming part of the assumed professional skill set for health care providers, just as using a stethoscope is now.

In the next five to 10 years, hospitals will use their robust EHR systems to recruit physicians; solo physicians who succeed in implementing EHR will sell their practices more easily when the time comes, but solo physicians still using paper will not be able to sell their practices at all.

“Physicians and others will stop asking for the federal government to buy electronic health systems for them, because they are simply baked into the definition of being a professional,” Blumenthal said. “We don’t ask the federal government to buy our blood pressure cuffs, our stethoscopes, our EKG machines.”

CCHIT certification revamp announced — but you already knew that

Today, the Certification Commission for Health Information Technology issued a press release announcing the April 7 reopening of the CCHIT certification process and the formal separation of the organization’s comprehensive certification from its Preliminary ARRA program. (ARRA, of course, stands for the American Recovery and Reinvestment Act of 2009.)

Now, we know a certain other health care topic has dominated headlines, but we can’t help but notice a couple of things — one, our own story on CCHIT certification changes came out yesterday, and two, no one else, save for a few attentive folks on Twitter, seems to have covered the issue.

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Learning what it takes to undergo an EHR implementation

Like the path to true love, the course to true electronic health records (EHR) never does run smooth: This is the realization that dawns on providers some time after they begin the implementation process. At least, this could be a conclusion one reaches after hearing several tales from hospitals and doctors explaining the implementation projects they’ve undertaken.

The American College of Healthcare Executives is gathering in Chicago this week for its 2010 Congress on Healthcare Leadership. On the first day attendees listened to presentations from hospitals and doctors, who explained what they’re going through to implement EHR technology and comply with the meaningful use criteria in the proposed rule coming soon from the Centers for Medicare & Medicaid Services (CMS).

The keys to a good information system are strong communication among all involved, transferable technology, data integration and improved decision-making support, according to officials from the Lifespan health system in Rhode Island. “Information needs to be patient-centric in order for us to accomplish those goals,” said Nancy Barrett, vice president of information services for the five-hospital system.

Lifespan is implementing a strategic plan to move its hospitals from their status as Stage 6 facilities on HIMSS Analytics’ Electronic Medical Records Adoption Model to Stage 7 status. To Lifespan, there is little difference between the upper levels on the adoption model and the requirements of the meaningful use proposed rule. The funding incentives under the stimulus law only accelerate the work, they don’t change it, Barrett said.

Baptist Healthcare System attributes its success with EHRs to partnerships and to timely access to data. In 1998 the Louisville, Ky.-based system gave up its best-of-breed approach to implementing IT systems. Instead, it signed a $100 million contract with one vendor to provide applications for all hospital functions, and standardized systems across all its facilities.

Teams consisting of vendor employees, in-house IT staff, clinicians and hospital personnel, and health system executives are involved in making decisions about the system’s IT plan, according to Jackie Lucas, vice president and chief information officer of Baptist Healthcare. “They’ve become very comfortable in these partnerships.”

Will meaningful use rules leave rural doctors vulnerable?

On the final day of the comment period for federal meaningful use rules regarding electronic health record (EHR) technology, a group of more than 90 federal and state medical societies wrote to the Center for Medicare & Medicaid Services (CMS), asking for relaxed meaningful use rules.

Such a request is not necessarily surprising, and we’ve written about the desire for “partial credit” meaningful use before. But this particular plea suggests that doctors in small, rural practices, bereft of resources, will be especially vulnerable to the “aggressive timeline” established by CMS.

In their letter, the societies ask CMS to consider awarding financial incentives once five meaningful use criteria have been awarded; that, they surmise, would give small practices a better chance of achieving meaningful use. The group also wants a reduction in the number of clinical quality measures on which practices are expected to report.

All in all, CMS received more than 2,000 comments about meaningful use and expects to issue a final set of rules later this spring. The agency says most folks accept and understand the approach that CMS is taking but think the timeline needs an extension. We’ll have to wait and see if that makes it into the final rule.

Of sports cars and meaningful use

What do Ferraris and health information technology have in common?

Both need a good support network if they’re going to provide any meaningful use, according to Marc Probst, vice president and chief information officer of Salt Lake City-based Intermountain Healthcare.

Probst provided the analogy during a presentation at the latest meeting of the Health IT Policy Committee. Recounting his days as a missionary in South America, he told a story about living in one village where there were no traffic lights, street lighting or road signs; and the mud roads virtually disappeared during rainstorms.

While the townsfolk might have enjoyed the chance to drive fancy sports cars, they would have been useless in such conditions, Probst recalled thinking at the time.

Much like people need a strong infrastructure for their cars to function, providers need a strong infrastructure for their health IT, Probst said. Policymakers and health IT end users must think about coming up with ways to discuss IT safety, engage patients and train providers.

Otherwise, it’s like having a bunch of red Ferraris stuck in the mud, clogging the streets, Probst said. And then, “not even the horse and carts could get through.”

House members seek revision of meaningful use requirements

Earlier this week, more than 200 members of Congress submitted a letter to the Centers for Medicare & Medicaid Services (CMS) urging them to modify the meaningful use requirements proposed late last year by the Office of the National Coordinator for Health Information Technology Policy.

The letter expresses concern that the requirements for achieving meaningful use will be “too much, too soon” for most hospitals, and goes on to suggest that “[t]he rule should be altered to recognize a practical, staged approach to EHR [electronic health record] adoption that rewards the efforts already under way in America’s hospitals.”

This idea of giving “partial credit” to providers who meet a certain percentage of the requirements, while encouraging a phased approach to implementation, is echoed in the commentary provided by a number of health organizations, including the Health Information and Management Systems Society, the American Hospital Association and the College of Healthcare Information Management Executives.

The members of Congress also suggest that CMS revise its definition of an “eligible provider,” which they say is currently too broad and will preclude a number of providers and individual hospital campuses from being eligible to receive EHR incentive funds.