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Health IT Pulse


October 29, 2014  11:54 AM

DeSalvo still running ONC



Posted by: ShaunSutner
AMA, DeSalvo, Interoperability, Meaningful use, ONC

Karen DeSalvo, M.D., is still in charge.

That unambiguous message was embedded in a low-profile post on ONC’s blog, “Health IT Buzz,” a few days after the agency blasted out news to the world that the sort-of former ONC coordinator was gone, promoted to acting assistant secretary for health (ASH) at HHS.

While DeSalvo’s portfolio at HHS is important (it includes supervising the federal government’s Ebola response and overseeing the surgeon general’s office), we’ve learned she will also continue to oversee ONC.

“Dr. DeSalvo will serve as Acting ASH while maintaining her leadership of ONC.  Importantly, she will continue to work on high level policy issues at ONC, and ONC will follow the policy direction that she has set,” the un-bylined blog post says. “She will remain the chair of the Health IT Policy Committee; she will continue to lead on the development and finalization of the Interoperability Roadmap; and she will remain involved in meaningful use policymaking.”

It’s unclear whether ONC insiders knew DeSalvo was never really leaving the agency, which she has headed since December 2013 after the departure of ONC’s former leader, the charismatic Farzad Mostashari, M.D., or if the decision to keep her in control was made some time after the news first leaked out Oct. 23.

The health IT community has been, indeed, buzzing over DeSalvo’s pseudo-exit. Some observers, such as, John Halamka, M.D., CIO at Beth Israel Deaconess Medical Center, thought it wasn’t such a big deal and constituted normal turnover, and perhaps the much-clamored-for movement toward interoperability and standards would now shift decisively to the private sector.

But let’s also not underestimate the anxiety over DeSalvo’s purported departure and leadership vacuum at the top of an agency that was already seen as floundering because of the real and impending exits of other top officials such as DeSalvo’s number two, Jacob Reider, M.D., and ONC chief scientist Doug Fridsma, M.D.

A lot of people were worried.

Now, it looks like DeSalvo’s “return” is meant to allay those fears.

Witness the American Medical Association’s (AMA) response, for one. The AMA has been worried that the meaningful use program is too tough on doctors and what docs really need is more interoperability between EHRs and other health IT systems.

“The American Medical Association is pleased to learn that Karen DeSalvo will remain involved in the Office of the National Coordinator for Health Information Technology,” the AMA’s President-Elect, Steven Stack, M.D., said in a release. ”We look forward to continuing to work with her to fix the meaningful use program and achieve an interoperable technology infrastructure.”

Insiders have been told DeSalvo will continue to be the boss of Lisa Lewis, ONC’s former COO and acting deputy national coordinator.

Lewis’s title now is acting national coordinator.

Lewis may be running the shop day to day, but DeSalvo remains at the top.

October 28, 2014  3:15 PM

$840 million HHS initiative targets better patient care



Posted by: adelvecchio
clinical quality measures, hhs, Sylvia Burwell

U.S. healthcare providers tempted to treat as many patients in as little time as possible to benefit their bottom lines have a new reason to reconsider that approach. The Department of Health and Human Services announced an $840 million initiative that will fund organizations that work directly with providers to drive better patient care and more coordinated healthcare systems.

The program, dubbed the Transforming Clinical Practice Initiative, aims to invest in approximately 150,000 clinicians over the next four years. Providing physicians with more complete patient information — such as the medications they take — and facilitating communication between patients and their caretakers are two of the ways the initiative aims to improve care quality, while keeping costs down.

“The administration is partnering with clinicians to find better ways to deliver care, pay providers and distribute information to improve the quality of care we receive,” said Sylvia Burwell, HHS secretary, in an HHS release.

Two network systems, Practice Transformation Networks and Support and Alignment Networks, will be awarded funding by CMS under the Transforming Clinical Practice Initiative. Practice Transformation Networks are peer-based networks designed to help educate clinicians to improve their practices. Support and Alignment Networks will offer a system of workforce development by relying on regional and national professional associations and public-private business partnerships that are already focused on improving care methods. Applications to receive funding for participation in either of these networks must be received by Jan. 6, 2015.

Healthcare systems, group practices and medical provider associations are among the groups that can qualify to receive funds from the initiative. The HHS release specifies daily EHR use as one method applicants could use to improve and track the quality and efficiency of their patient encounters. The likelihood of providers using EHRs to track patient care has increased, because the number of EHRs in use has risen. According to a progress report the ONC submitted to Congress, 78% of office-based physicians used an EHR in 2013, an increase of 60% since 2001.


October 27, 2014  8:40 AM

CDC, ONC collaborate to improve use of EHRs for Ebola screening



Posted by: MonicaVallejo
CDC, Ebola, EHR, EHR systems, ONC

The Public Health-EHR Vendors Collaboration Initiative, composed of public health practitioners and EHR vendors, convened earlier this month to discuss Ebola electronic screening tools and protocols. The PH-EHR Vendors Collaboration Initiative was established by the CDC the ONC in August 2013 to help providers meet public health reporting criteria for meaningful use stages 1 and 2.

The group, however, has put meaningful use topics on hold and is focused on leading discussions about improving EHRs to screen possible cases of Ebola.

The initiative replaced its monthly meeting with two special session webinars focused on the response to Ebola in the United States. The group convened for the first session on October 16, to explore the inclusion of travel history and the assessment of relevant clinical signs and symptoms into an electronic format to alert clinicians to consider the diagnosis of Ebola, and also to discuss ways in which existing EHRs can be configured to support Ebola screening.

The CDC Ebola team reviewed the clinical algorithm and guidelines created by CDC before any cases of the disease were present in the United States. Dana Meany-Delman, epidemiologist and deputy lead of CDC’s Medical Care Task Force for Ebola response, talked about ways to translate existing algorithms and guidelines into the EHR.

“There are a lot of things the EHR is capable of doing and we want to make sure that we have the mechanisms to rapidly identify the Ebola cases,” Meany-Delman said.

ONC’s Chief Medical Officer, Jon White explained that the majority of hospitals have EHRs that are able to provide the decision support with clinical knowledge to determine whether or not a person has been exposed to a patient with Ebola. He also talked about the ONC’s efforts in configuring existing EHRs to support standards development and Ebola screening protocols. The ONC is working with health IT developers and listening to suggestions from the Electronic Health Records Association to explore the capabilities that EHRs have to support screening procedures.

After the presentation from members of the ONC and CDC, the group opened the dialogue to answer questions and hear comments from the 596 webinar attendees. Information about the second part of the special sessions webinar on Ebola can be found on the PH-EHR Vendors Collaboration Initiative website.


October 22, 2014  3:31 PM

Healthcare groups call on CMS and ONC for meaningful use slowdown



Posted by: ShaunSutner
American Academy of Family Physicians, CMS, Meaningful use, ONC

Eight influential healthcare groups have joined the campaign to persuade federal health IT officials to ease up on the meaningful use program’s requirements and timelines.

Rather than focusing on demanding easier attestation requirements for meaningful use stage 2, the tack taken by a broad coalition of health IT organizations, the more recent effort is centered on adjusting ONC’s certification requirements for vendors.

In a 2-page letter to Sylvia Burwell, secretary of the U.S. Dept. of Health and Human Services, the groups, led by the American Academy of Family Physicians (AAFP), called on the government to orient meaningful use more toward EHR usability and require fewer “strict MU requirements and deadlines that do not provide sufficient time to focus on achieving interoperability.”

The letter signatories argued that too-strict EHR certification measures have forced vendors, providers and other healthcare players to meet arbitrary goals that stifle interoperability and technological innovation.

(However, while the groups are asking ONC to slow down on meaningful use, ONC itself has backed away somewhat from the program to concentrate more on interoperability and standards.)

The AAFP-led coalition is asking for these broad changes:

“• Streamline and focus the ONC certification requirements on interoperability, quality measure reporting, and privacy/security. Removing a heavy handed set of certification mandates and allowing instead for a flexible and scalable standard based on open system architectural features like application program interfaces (APIs) will promote the delivery of more innovative and usable solutions. This in turn will allow data to move more freely across the health care system, reducing data lock-in and promoting more usable systems.

• Foster collaboration among stakeholders to promote the development of new HIT that is focused on meeting clinical care needs.

• Remove restrictive MU policies that stifle HIT innovation.

• Recognize vendors and providers need adequate time to develop, implement, and use newly deployed technology and systems before continuing on with subsequent stages of the MU program. Testing and achievement of specific performance benchmarks should occur before providers are held accountable for any new MU requirements.”

The other groups are: the American Medical Association; Medical Group Management Association; National Rural Health Association; Memorial Healthcare System; Mountain States Health Alliance; Premier healthcare alliance; and Summa Health System.


October 22, 2014  1:05 PM

Nurses bemoan system deficiencies in EHR survey



Posted by: adelvecchio
EHR cost, EHR implementation, ehr purchasing, nurses

Nurses — a group of employees often left out of hospital technology purchasing decisions — were recently asked for their opinions on the EHRs they work with. Their disapproval was nearly universal. Nearly all of them (98%) said they weren’t part of the purchase or configuration processes for their EHRs, and 88% blame their CIOs for cutting corners at the expense of quality of care by buying their EHR based on its price and ability to qualify their facility for government incentives.

Nearly 14,000 nurses from 40 states responded to the Q3 2014 Black Book EHR Loyalty survey.  Nine out of ten respondents agreed that their EHR systems negatively affected communications between patients and nurses, and 94% think their EHR hasn’t improved communications between nurses and other care teams. Only 26% agreed that with a statement in the EHR survey that said “the current EHR at my organization improves the quality of patient information.”

Executives aren’t the only internal group nurses are blaming for the difficulties they’ve experienced working with EHRs. Nearly seven out of ten (69%) nurses at for-profit inpatient providers labeled their IT departments as “incompetent” in regards to their knowledge and support of their in-house EHR. Nurses were nearly unanimous in their unhappiness with the amount of time they spend working with EHRs and how it has limited their face-to-face patient interactions, a notion 98% of respondents backed.

Nurses working in the 22 largest metropolitan locations surveyed responded that the EHRs of NextGen Healthcare Information Systems Inc., Epic Systems Corp., Cerner Corp. and McKesson Corp. are the easiest to use, while systems from hCare, Allscripts Healthcare Solutions Inc., Meditech Inc. and eClinicalWorks LLC received the lowest satisfaction scores.  Post-implementation issues seen in these and other systems are sometimes left uncorrected, they indicated. Slightly fewer than 90% of nurses say they’ve developed workarounds to avoid system deficiencies that went unfixed after they were reported to their superiors or the IT department.


October 20, 2014  1:49 PM

AMA proposes changes to meaningful use program



Posted by: MonicaVallejo
AMA, CMS, EHR adoption, Meaningful use, meaningful use attestation

The American Medical Association (AMA) lobbied the Centers of Medicare and Medicaid Services (CMS) to implement its version of a revamped meaningful use program in a 30-page letter. The AMA, which has been a long thorn in CMS’ side regarding EHR adoption, meaningful use and ICD-10 implementation, outlined its vision for the meaningful use program urging for a full assessment to improve the program before moving on to stage 3.

The AMA’s recommended changes include adopting a more flexible approach for meeting meaningful use to make it easier for providers to avoid reimbursement penalties, expanding hardship exemptions for all stages, improving quality reporting and addressing physician EHR usability challenges.

In terms of adopting a more flexible approach for meeting meaningful use measures, the AMA suggested that rather than expanding the reporting requirement, the list of measures should be refined and focused on the primary goals of the program. Another recommendation made was to expand hardship criteria to relieve physicians who struggle to meet reporting mandates from paying penalty fees. Recommended additions to hardship categories include providing an exemption to hospitals, physicians who successfully participated in the PQRS program and physicians who are close to retirement.

The AMA also included possible changes to present quality reporting timelines by choosing not to expand reporting measures until IT infrastructure challenges are resolved, more flexibility is instituted and existing quality measures are updated to comply with changes in practice guidelines.

In the letter, the AMA explains that despite the increase in EHR adoption, there has been a growing level of physician dissatisfaction with EHRs and the meaningful use program. Some of the issues listed include poor usability, time consuming data, interference with face-to-face patient care and regulatory requirements. The growing dissatisfaction affecting physicians’ workflow as they spend much time on documentation and administrative duties related to EHR. To best address usability issues, the AMA recommended that in addition to physicians, licensed professionals and medical assistants should be able to enter orders for patients, too.


October 15, 2014  1:59 PM

ONC health data privacy watchdog Lucia Savage arrives as interop czar Doug Fridsma leaves



Posted by: ShaunSutner
Fridsma, informatics, ONC, privacy

Another lawyer will soon guide ONC’s privacy office.

Lucia Savage, a New York University Law School grad, will later this month succeed Joy Pritts, the Case Western Reserve-trained lawyer who left the post in mid-July after serving as ONC’s first chief privacy officer since 2011.

It certainly makes sense to have expert legal direction at the core of the government’s efforts to nudge, and push strict health data privacy protections and preserve the sanctity of patients’ health information.

For her part, Savage has more than just a legal background. She also has extensive experience in the healthcare private sector.

Most recently, she has been working in the insurance industry as senior associate general counsel at UnitedHealthcare Services, Inc., supervising a team that works in large data transactions in health information exchanges (HIEs) and other healthcare projects, ONC coordinator Karen DeSalvo, M.D., told staff in a letter.

Savage also spent 2011 to 2013 on the governance board of CMS’ multi-payer claims database project, working with HIE and state agencies in planning with players.

Before UnitedHealthcare, Savage was general counsel at the Pacific Business Group on Health (PBGH), one of the nation’s oldest employer healthcare purchasing coalitions.

At that San Francisco-based nonprofit, Savage used her 15 years of experience as an employee benefit lawyer in both compliance and litigation, and in healthcare regulation and reform, data transactions, and HIPAA implementation. Before joining PBGH, was Stanford University’s benefits compliance officer.

*  *  *

While Savage is on her way in, another ONC-associated policy expert is on his way out.

Doug Fridsma, M.D., the agency’s chief scientist and an informatics specialist, is leaving soon to run the American Medical Informatics Association.

At the recent AHIMA (American Health Information Management Association) conference in San Diego, Fridsma spoke at length with SearchHealthIT about a broad range of issues, about which you can read in an upcoming question-and-answer series on SearchHealthIT.

In the meantime, Fridsma, who claims informatics as his true intellectual passion, is naturally sanguine about this burgeoning field’s role in health IT and healthcare delivery. He says informatics people are critical to making interoperability among disparate EHRs and other  health IT systems work effectively.

Fridsma also said that vendors in the data mining and text mining space will have leading roles in the future of health IT, a future that ONC and other players perceive as focused on interoperability.

Fridsma notes that big organizations and undertakings such as the Mayo Clinic and IBM’s Watson natural language-based artificial intelligence system already are applying informatics in a big way in the health field.

“Those who will be most successful in this will be informatics professionals who understand how medical information is related,” Fridsma told SearchHealthIT. “So the kind of associations and the kinds of insights they get have some relevance in the medical domain and diagnoses.”


October 14, 2014  2:38 PM

Optional 2014 EHR certification criteria up for review



Posted by: adelvecchio
2014 EHR Certification, CPOE, EHR certification, EHR standards, ONC

Alterations to the draft version of ONC’s 2014 Edition Release 2 EHR Certification Criteria is now open to a public comment period, during which users can offer reviews and feedback on changes to criteria that governs computerized physician order entry and how patients electronically view, download and share their health data.

The certification criteria for CPOE are broken down into three categories: medications, laboratory and diagnostic imaging. The draft provides examples of how ONC-certified testers electronically record, change and access each of these order types. In general, the draft offers regulatory flexibilities for organizations aiming to certify products they use or create up to 2014 Edition EHR certification criteria standards.

How data is transmitted is the focus of the change to the viewing, downloading and sharing of patient data section of the 2014 certification update. There is now an additional alternative approach “for demonstrating ‘transmit’ capabilities that follow the Implementation Guide for [the Direct Project's] Direct Edge Protocols” — a fix that is shown in the ONC’s test procedure document. The Direct Edge Protocols were designed to protect how health information service providers communicate electronically with their clients.

All of the criteria contained within the 2014 release 2 are optional, meaning developers and providers don’t have to test their products against its standards. The 2014 release 2 document contains a subset of rules originally proposed as 2015 Edition EHR certification criteria. To stick to their desired timeline for EHR certification to be a yearly occurrence, ONC decided to combine a selection of 2015 rules with their 2014 revisions and package them as one update.  Though not mandatory, ONC suggests that EHR vendors and providers consider if any of the criteria are something worth pursuing.

The public comment period will remain open for 30 days, prior to the rule being finalized and approved by the ONC’s national coordinator.


October 9, 2014  1:53 PM

CMS reopens meaningful use hardship exceptions



Posted by: MonicaVallejo
EHR, hardship exceptions, Meaningful use, meaningful use attestation

The Centers for Medicare and Medicaid Services (CMS) reopened the submission period for meaningful use hardship exception applications for eligible providers. CMS extended the period for hardship exception applications to November 30, allowing doctors and hospitals who have not yet attested to avoid penalties in 2015.

The original hardship exception application deadline to avoid payment adjustments was April 1 for eligible hospitals and July 1 for eligible professionals. The penalty fees may be avoidable for some providers, because of a technical glitch in the meaningful use attestation portal that could inappropriately penalize physicians who recently adopted EHRs.

According to reports, CMS will not be able to register whether or not providers with new EHR systems can meet meaningful use requirements until mid-October. These delays mean providers who adopted EHR systems for the first time late this year would not have been able to ready their reports by the October 1 deadline if their vendors were late receiving ONC certification for 2014 Certified EHR Technology (CEHRT).

“Giving physicians more time to file for a hardship exception provides necessary relief as many physicians are struggling to meet a number of reporting mandates to avoid multiple penalties,” said Robert Wah, M.D., President of the American Medical Association.

Medicare physicians can apply for the exceptions and their eligibility will be considered for the new deadline if they meet all of the following requirements:

  • They must be eligible professionals who were unable to fully implement 2014 Edition CEHRT due to vendor certification delays.
  • They must be eligible professionals who were unable to attest by Oct. 1, 2014 or eligible hospitals that were unable to attest by July 1, 2014 using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule.


October 8, 2014  2:35 PM

Motley Fool bullish on health IT stocks



Posted by: ShaunSutner
CIOs, EHRs, investment, Motley Fool

Investors who want to make money with sometimes unorthodox, and sometimes amusingly presented, approaches, often follow advice from the Motley Fool family of media market gurus. Amid the ballyhoo of their latest picks of health IT stocks, however, is a salient point to comfort healthcare provider CIOs. It’s a growth sector, worth investing in, and it’s not going away anytime soon.

Of course, it’s no surprise to savvy health IT investors that some stocks in the category are hotter than others, nor that “Foolishness” about health IT has taken hold in the Motley world of this Washington, D.C. –based group of investment honchos.

A recent column by Motley Fool contributor Seth Robey enumerates “10 problems electronic health records can help solve.”

Among the list of problems EHRs can help solve is a panoply of health IT and EHR vendor royalty and other companies. These names of these publicly traded health IT and other tech companies won’t surprise anyone, especially those who already know they possess the capacity to make owners of their stock wealthier. The picks also inform health IT insiders and startup wannabes what technologies look to have staying power in the eyes of these analysts.

  1. Cost. EHRs can drive down healthcare costs, Robey asserts. The market plays here: Epic Systems Corp., Cerner Corp. and athenahealth, Inc.
  2. Healthy living: Robey says savvy investors can profit here from stock in Apple, Inc. with the megacompany’s frontal assault on the wellness-wearable-mHealth market by way of smart watches, health apps and huger smartphones.
  3. Personalized care: Gene sequencing and customized care make an appearance here, but the Fool doesn’t pinpoint any specific companies, but rather the EHR sector as a whole.
  4. Empowering patients: Ditto as to investment advice, but patient access to their own health records via cool EHRs gives them more information to make better choices among providers.
  5. Empowering doctors: Robey gives athenahealth a big nod here, saying the company’s cloud-based EHR systems help smaller physician practices meet federal meaningful use and Medicare standards and exploit opportunities for profit without hospital-sized economies of scale.
  6. Crowdsourcing care: IBM’s Watson supercomputer project in collaboration with Memorial Sloan Kettering Cancer Center is trying to outsource diagnostic care by learning to treat cancer with evidence-based medical data from EHRs, Robey points out.
  7. Population health: Robey singles out Cerner Corp’s cloud-based Healthe Intent platform for providers to track regional population health trends and enable better, cheaper care.
  8. Epidemiology: Twitter is mentioned as a key tool that first tracked Haiti’s 2010 cholera epidemic. The Foolish columnist says a great EHR could provide the same real time data for early warning epidemic systems in the First World.
  9. Drug development: Medidata Solutions’ Rave lets clinicians easily input relevant trial data to detect safety problems, among other things. As a result, Robey reports, the firm’s subscription sales have spiked sharply.
  10. Innovation: No single pick here, but Robey writes: “The broad acceptance of EHRs will bring the benefits listed above, but will also open the doors to untold innovation built on the flexibility of an interconnected health care industry.”


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