April, 2010

More health IT standards development work on the way for HITSC

Just when stakeholders and policymakers thought they were busy enough developing health IT standards for meaningful use, more work is on the way.

Ruefully remarking that “no good deed goes unpunished,” David Blumenthal, the physician who heads the Office of the National Coordinator for Health IT (ONC), told the Health IT Standards Committee (HITSC) it soon will be working on standards around electronic insurance enrollment, as well.

The latest assignment stems from the health reform law. Under Sec. 1561 of Title I of the law, the HIT policy and standards committees must work with ONC on developing “interoperable and secure standards and protocols that facilitate enrollment of individuals in federal and state health and human services programs.”

There was a round of chuckles from committee members reacting to Blumenthal’s announcement, but little more on what’s coming was described during the April 28 meeting.

The majority of federal IT initiatives were spelled out in the HITECH Act of the stimulus law last year, and not in this year’s health reform bill. Both the policy and standards committees have been developing the rules for launching those initiatives over the last 12 months.

ONC told the committee it continues to analyze comments received on the standards interim final rule that accompanied the meaningful use proposed rule released by the Centers for Medicare & Medicaid Services. Both ONC and the CMS hope to have final rules released around the same time later in the spring.

The HITSC also heard updates from its workgroups, which have been focused on standards that will allow IT to meet meaningful use requirements. Patient engagement — a topic of interest for the policy committee lately, as well — was addressed by the privacy and security workgroup.

The committee should focus on standards for activities that bring doctors and physicians into closer electronic communication for stages 2 and 3, said HITSC member Dixie Baker, senior vice president of Science Applications International Corp. and chief technology officer of its health solutions business unit. While things like e-messaging, clinical summaries and delivering real-time information to personal health records are components of meaningful use, “it’s very, very clear” that there aren’t any standards in those areas yet, she said.

The committee needs to ask how developers can capture patient consents, privacy, define “real-time” data and consider how home devices and patient-generated data fit into electronic health records, Baker said.

But others believe the issue isn’t a lack of standards, say other committee members. Despite the absence of standardization, “we and other organizations in the country are doing practically all of these,” said James Walker, physician and chief health information officer for Geisinger Health System. He added the committee should start to think about which patient engagement standards are needed and how to incorporate them simply with other IT standards development.

Sankaran steps down from Federal Health Architecture program

Health IT interoperability leader Vish Sankaran announced yesterday that he is stepping down from his role as director of the Federal Health Architecture  (FHA) program. The FHA, which is managed by the Office of the National Coordinator for Health Information Technology, is charged with establishing health IT interoperability among federal agencies. Sankaran was appointed director of the FHA program in March 2007.

Sankaran noted in his email, “This was not an easy decision, but it comes at an ideal time for FHA and for me, when FHA is reshaping to fit in with the overarching federal health IT body being formed.” He reflected on the program’s accomplishments thus far, noting that 20 federal agencies came together to develop tools and solutions for health IT interoperability. He pointed to CONNECT, an open source solution that supports both local and national exchange of health information, as one of the program’s significant achievements.

Sankaran did not provide any details as to the reason for his departure from the Federal Health Architecture program, stating only that he is seeking new opportunities. He hopes to remain involved in national health IT efforts.

Will no Flash for iPad hurt its chances in health care?

Last week, Adobe Systems — which owns Flash — abandoned its plans to support Flash on the Apple iPhone and iPad. The former is a smash-hit smartphone among doctors, nurses and other providers, while the latter could potentially supplant at least some of the laptops those same providers tote from patient to patient. No Flash for iPad changes the tablet’s outlook.

Flash’s market strength is video. A PracticeFusion blog entry written in February around the introduction of the iPad mentioned that 70% of games and 75% of video on the Web are written in Flash, which at first blush wouldn’t seem to affect health care providers much.

Except it does. Many of us connect with Flash on the Web via sites featuring mostly unintelligent content, dumb greeting cards and juvenile games, and that’s the impression we get of its utility. Flash, however, has a very serious side, too. Adobe is known for excellent imaging and document technologies; Adobe Reader, its PDF viewer, and Flash are on a majority of the world’s computers.

Those games could just as easily be electronic health record apps, or forms that feed into EHR apps. The video could be a live stream of a medical procedure, or a remote reading of an imaging study such as an ultrasound. Just because developers haven’t written it yet doesn’t mean it’s not on the drawing board. In fact, it’s likely that some vendors have been waiting for Apple and Adobe to kiss and make up so health care providers don’t have to jailbreak their iPhones to see Flash files.

For now, that’s not going to happen. The PracticeFusion blogger probably is on to something, suggesting it’s all about Apple wanting to capture as much revenue as possible at its App Store by restricting the platforms upon which developers can build. But if that eventually leads to other smartphones and other tablets taking over the health care market, we’ll look back on this week as the exact point Apple cut off its nose to spite its face, and Adobe just decided to quit trying to develop Flash for iPad.

Choosing the right EHR vendor, and other SearchHealthIT.com news

Of all the EHR vendors out there — especially a cadre of new ones catering to solo docs and small group practices — how do you pick one that will be around for the long haul? Providers who look at only the obvious factors of price and usability could be making a costly mistake if the vendor goes out of business.

Yesterday’s article on picking an EHR vendor offers some important advice on choosing the right vendor for the long haul.

Check out the rest of last week’s SearchHealthIT.com coverage:

Patient engagement in IT use leads to richer health experiences — Policymakers and IT developers should consider ways to ensure that patient engagement is at the forefront of technology adoption, advocates tell a federal advisory committee.

Health IT regulation: FDA is weighing deeper involvement — Health IT regulations could be affected by a 2-year-old Food and Drug Administration proposed rule that’s back in the spotlight. Some fear the rule may slow technology adoption.

Tips for running clinical applications in a virtual environment –  Uncertain about how to run clinical applications in a virtual environment? Check out these tips from an experienced health care IT professional.

Top 10 meaningful use challenges for eligible professionals — What are the most significant challenges that providers face in meeting the requirements for Stage 1 of meaningful use? A recent report describes the top 10.

Not there yet: CMS still toiling away on final meaningful use regulations — The Centers for Medicare & Medicaid Services has finished cataloging all the comments it received on the proposed meaningful use rule and is preparing the draft to go through a clearance process.

Tread carefully when choosing an EHR vendor –  Keep the cluttered landscape of the dot-com boom in mind when deciding on an EHR vendor, lest you end up barking up the wrong tree with the next Pets.com.

Issue of patient engagement taken up by advocacy groups

Two advocacy organizations are offering patients and families the chance to report medical errors in an effort to paint a broad picture of patient safety.

The Empowered Patient Coalition and the Consumers Union Safe Patient Project have teamed up to offer an online survey designed to capture information about medical errors from the patient perspective. Patients can fill out the confidential, nonscientific survey, and the organizations hope to use the information in their efforts to create awareness of errors and identify sources of medical harm for the future.

Patient engagement is a big topic in the ongoing rollout of health information technology. Including patients in health care decisions is a key element of meaningful use requirements being established by the Centers for Medicare & Medicaid Services. It’s also been an issue for policymakers seeking ways to include patient-generated medical information in electronic health records.

The organizations see their survey as playing a role in fostering patient engagement. “This survey is designed to answer questions that are important to patients,” the coalition wrote on its website. “We want the public to know that they can and must be the cornerstone to improving health care quality and safety and that their experiences are being counted.”

Upcoming HealthVault offering from Microsoft to get clinical data flowing

A new version of HealthVault, expected to be released by Microsoft in the third quarter, aims to let personal health records (PHR) flow from patients to providers to hospitals and back again.

Dubbed HealthVault Community Connect and built atop SharePoint, the product establishes the following workflow, according to David Cerino, general manager for Microsoft’s Health Solutions Group.

• A patient preregisters at home for an appointment, using a process that’s similar to checking in online for an airline flight.
• When the patient arrives at the medical facility, the admissions staff calls up the patient’s HealthVault account, which includes the demographic and medical information that typically is written down on a paper form on a clipboard.
• During the appointment, the doctor adds notes to the patient’s HealthVault account as needed.
• After the appointment, discharge information and instructions appear in the patient’s HealthVault account and can be forwarded to his or her primary physician.

“This is a roundtrip of data that does not happen today,” Cerino said. “We are now closing the loop electronically to all that clinical information flowing.”

Brooks Rehabilitation Hospital, a physical rehabilitation facility in Jacksonville, Fla., that’s an early adopter of HealthVault Community Connect, is starting with the product’s core features, including preregistration, discharge instructions and access for external providers.

But the hospital’s CIO Karen Green sees a lot of potential in HealthVault, particularly for patients who need significant rehabilitation or follow-up care. These patients, for example, can track diet and exercise regimens and use HealthVault to share that information with physicians. Going one step further, certain USB- or Bluetooth-enabled medical devices, such as blood pressure monitors, post data directly to HealthVault, Cerino noted.

(It’s worth pointing out that HealthVault is a consumer-controlled application, meaning that the PHRs belong to the patient. Physicians can add information but cannot modify info that patients or devices have added, Cerino said.)

The challenge with the application, as with almost every brand of health technology, is user education. Green’s approach is to introduce physicians and clinicians to HealthVault and the vision behind it before she dives into the HealthVault Community Connect portal. (It helps that Brooks Rehabilitation rolled out SharePoint two years ago.) “That vision is not out there yet,” she said. “You have to present that vision to them.”

Patient engagement matters as well, not just for HealthVault but for all PHR services. As Green pointed out, most hospital discharge papers are “summarily lost within a day or two,” making it all too easy to neglect the doctor’s recommendations. Removing paper from the equation — and giving patients a system that charts their progress and prompts physicians to provide feedback — boosts the odds that patients will actively work to get and stay healthy.

Top 10 meaningful use challenges for eligible professionals

With so many requirements to satisfy in achieving Stage 1 of meaningful use, health care providers face a considerable number of challenges to becoming fully compliant. A recently published report from Computer Sciences Corp., a technology software and services company based in Falls Church, Va., includes a list of meaningful use challenges. Here are the top ten, according to the report’s authors:

1. Capture the data.
2. Establish effective workflows to reinforce data entry (Including medication reconciliation).
3. Drive provider involvement in adopting the electronic health record (EHR).
4. Computer-based provider order entry.
5. Start e-prescribing — as soon as possible.
6. Develop a process for managing clinical decision support.
7. Implement patient health information exchange (HIE) workflows.
8. Formulate a provider HIE strategy.
9. Ensure privacy and security compliance.
10. Initiate EHR-based quality performance measurement support.

In its conclusion, the report notes that the criteria for meaningful use have had two major effects. First, despite many challenges, EHR adoption has been gaining a momentum in the U.S. “that has been overdue for decades.” Second, eligible professionals should keep an eye on the future when they implement EHR technology, and not succumb to shortsighted solutions.

View the full report: Meaningful Use for Eligible Professionals: The Top Ten Challenges.

Not there yet: CMS still toiling away on final meaningful use regulations

The Centers for Medicare & Medicaid Services (CMS) continues to shape a couple thousand comments into a final rule governing the meaningful use of health IT — but it’s not finished yet.

The agency has finished cataloging all the comments it received on the proposed rule, and is preparing the draft to go through a clearance process, according to Tony Trenkle, director of CMS’ Office of e-Health Standards and Services. He provided a progress update to the Health Information Technology Policy Committee during its April 21 meeting.

The major issues revealed in the comments have been categorized so that officials can address them and determine what, if any changes need to be made to the language of the proposed rule. The center will be working “over the next several months” to complete the draft, with the hope of releasing the final rule in late spring, Trenkle said.

Among some of the key issues the CMS has categorized are concerns about stages 2 and 3 of the rollout of meaningful use, and the presence of administrative and billing transactions in the regulation. Many in their comments considered it inappropriate that the regulation include those types of transactions, according to Trenkle.

In addition, Congress officials have signaled their dissatisfaction with the proposed rule and have asked for meaningful use criteria to be pared back. The CMS is meeting with several members of Congress in the next week to discuss the proposed rule.

Tread carefully when choosing an EHR vendor

This is a crazy time for electronic health record (EHR) software vendors. It smacks of the Web boom of 1998-2000, where sites like Pets.com, grocery home-delivery site Webvan and eToys rose to prominence and quickly flamed out, despite hundreds of millions of dollars in venture backing. Those of us who can even remember Pets.com — and its funny sock-puppet mascot — laugh at the absurdity of the excesses of those times. Our household contributed to Pets.com’s demise, ordering 35-pound bag after bag of dog food, which the site happily shipped for free. Free to us, that is; it turned out the site was kind of a Ponzi scheme, with the stockholders left holding the bag. Similar stories repeated themselves all over the Web, including Value America, well chronicled in David Kuo’s book dot.bomb.

Ten years from now, what will we think of this period in regards to EHRs, as the health care system builds out its IT infrastructure? There are so many choices, from roll-your-own open source software packages to full-boat installations from vendors like Epic, that many EHR vendors are guaranteeing meaningful use certification in hopes of gaining a competitive advantage.

That sounds like a plausible thing to do, except that meaningful use has not been officially defined yet, and depending on how the rules evolve throughout the rest of this year, software vendors might need an awful lot of programming and testing firepower to make good on those guarantees. That will cost money, and something’s got to give: My crystal ball is saying that some smaller vendors will be covering some of their customers’ incentive payments.

That’s the part vaguely reminiscent of the Web boom, although as of this date, no EHR vendor is using a sock puppet for a mascot.

The tough part for physicians still marooned in paper record-keeping processes is choosing an EHR vendor. It probably feels a little like speculating on dot-com stocks felt like a decade ago: How does one settle upon a company that not only feels your pain of implementation and can support that process, but will also still be in business to usher you into full meaningful use compliance by 2015? For some software startups, five years may as well be a millennium.

In our formal interviews and informal conversations with experts — consultants, analysts, economists and IT leaders for health care providers — a few pieces of advice keep getting repeated: One, check out what your area’s regional extension center will be recommending, as it builds relationships with vendors. Two, try and choose a vendor that has a customer base of providers like you in size and practice. Three, talk to your friendly local health care information exchange, and ask what EHR works best with its system. And four, consider a company that has solid financials.

Last month at HIMSS10, Dell announced a partnership with the American Medical Association to provide EHR implementation services. While our mention of it shouldn’t be construed as an endorsement, it’s arrangements like these that have more financial backing than the typical startup. An established company like eClinicalWorks also has an edge over startups, because it’s been around for 10 years and has made inroads into the small-practice market. Epocrates built a great reputation for serving the solo doc with its drug-interaction database over the last decade-plus. Salesforce is hosting PracticeFusion’s EHR system on its Force.com cloud platform, and that company also has a proven track record.

We’re not pretending to know the future, and this isn’t to say that some innovative startup won’t rise up and take over the market with an elegantly designed, perfectly priced EHR package that will blow away the competition. But when choosing an EHR vendor, don’t forget to take into account the long-term prospects of your potential choices. Because even if a candidate has what looks to be an ideal software application, if that company flames out like Pets.com and you have to start from scratch with a new EHR a couple years from now, that could be much more painful than picking the runner-up, even though that EHR system has a few warts.

Creating a health IT business plan, and other SearchHealthIT.com news

Health care IT managers have a lot on their plates these days. The Health Information Technology for Economic and Clinical Health (HITECH) Act and other federal proposals will have a significant impact on both compliance and health IT infrastructure, and IT managers need to stay on top of it all.

At the recent New England HIMSS 5th Annual Public Policy Forum, a local CIO discussed some of the most important policies and issues that will impact the industry, and encouraged health IT managers to build an IT business plan with health care policy in mind.

Catch the rest of last week’s SearchHealthIT.com coverage:

Regional extension centers face challenges in boosting EHR adoption rates — Federal regional extension centers help providers adopt electronic health record (EHR) systems and reach meaningful use requirements. But physician reluctance and uncertainty about meaningful use stand in the way.

Timing for EHR certification, adoption remains a sticky issue — The time crunch on developing and adopting certified electronic health record systems concerns health IT professionals, who have tight meaningful use deadlines to meet.

For health record storage, SAN technology offers speed, flexibility — As health care data proliferates, providers are turning to storage area network technology, which they find easy to expand without compromising performance or breaking the bank.

Health care data security now defined by encryption, thin clients — Data encryption is central to HITECH Act compliance and data breach notification laws, but health care IT departments find that thin client technology improves data security as well.

NQF leader on using EHR technology to report health quality measures — Dr. Floyd Eisenberg of the National Quality Forum discusses some of the challenges in using EHR technology to report health quality measures, and what the NQF is doing to help.

EHR implementation and meaningful use, step-by-step project management — If your facility is still fairly paper-intensive and you’re wondering how to peel back the onion layers of your processes to figure out where to start implementing your electronic health record system, we’ve found one doc’s way of crossing the Rubicon: Organize the transition with project management software.

National survey finds PHR usage is still low, but growing — A recent survey shows PHR usage is growing, but Americans won’t trust just anyone with their health information.

Office for Civil Rights updates systems for breach notifications — Under the HITECH Act, organizations covered by HIPAA provisions must provide the Office for Civil Rights with information about privacy and security breaches affecting more than 500 people.

More hospital-based docs now eligible for HITECH Act reimbursement – The HITECH Act has been amended by a new federal law that makes more hospital-based physicians eligible for meaningful use reimbursements.