Nextgov/FCW - Authors - John Pulley

CMS Seeks to Broaden Use of Health IT Reports

John Pulley — Mon, 31 Dec 2012 14:50:14 -0500

The Centers for Medicare and Medicaid Services is asking hospitals and electronic health record vendors for advice on how hospitals can use EHRs to electronically submit required reports measuring the quality of clinical services.

In a request for information filed Friday in the Federal Register, CMS says it wants hospitals to be able to use the same certified EHR technology now required for reporting under the EHR incentive program to automatically report patient-level data under its Hospital Inpatient Quality Reporting program.

The information is to be reported by hospitals for calendar year 2014 using the Quality Reporting Document Architecture category 1, CMS notes.

CMS says its goals include streamlining quality reporting, reducing the administrative burden on hospitals and developing a single set of electronic specifications for clinical quality measures adopted under multiple quality reporting programs.

Among questions CMS asks:

How well are EHR-based reporting and hospital quality reporting programs aligned?
If hospitals and vendors foresee problems meeting criteria for reporting clinical quality measures electronically for the EHR incentive program, what challenges stand in the way?
When are hospitals planning to adopt EHR technology meeting 2014 Edition certification criteria?
Are hospitals planning to electronically report data on venous thromboembolism, stroke and emergency department measures under the Medicare EHR incentive program in fiscal 2014?
Do hospitals plan to report data using any state health information exchange initiative, or the Nationwide Health Information Network (NwHIN) Exchange, now known as the eHealth Exchange?
Are there operational challenges to electronically reporting quality data, and if so, how do hospitals plan to overcome the challenges?
What are the top three operational challenges facing EHR vendors over the next three years?
How are vendors planning to assess the accuracy and reliability of clinical process of care quality data using QRDA category 1 standards?

Comments are due by Jan. 22.

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Health IT investigation finds ‘gaping security holes’

John Pulley — Fri, 28 Dec 2012 14:21:45 -0500

The health-care industry’s headlong rush into information technology and wireless services has significantly increased its vulnerability to hacking, partly because the industry is slow to address known risks, the Washington Post reported after a year-long investigation.

“I have never seen an industry with more gaping security holes,” Avi Rubin, technical director of the Information Security Institute at Johns Hopkins University, told the Post. “If our financial industry regarded security the way the health-care sector does, I would stuff my cash in a mattress under my bed.”

According to the newspaper, Rubin found that health IT specialists often fail to correct flawed software and health-care workers routinely bypass security safeguards.

Another problem is that many health IT vendors mistakenly believe they cannot update systems approved by the Food and Drug Administration, the paper said. Such updates are actually encouraged by the FDA.

Electronic health records are at risk from “basic, basic, Security 101 vulnerabilities,” N.C. State University computer scientist Laurie Williams told the paper. “I’m concerned that at some point the hackers are really going to begin exploiting them. And that’s going to be a scary day.”

Most of the known health IT data breaches have been by hackers looking for personal patient information for identity-theft purposes. Lost laptops and other mobile devices have been a major cause of data breaches.

But the Post noted that medical devices such as heart defibrillators and insulin pumps also are vulnerable to hacking, as the General Accountability Office pointed out in a report this summer. The GAO recommended the FDA expand its medical-device focus to include cybersecurity threats.

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Feds resolve to facilitate health data exchange in 2013

John Pulley — Thu, 27 Dec 2012 07:36:43 -0500

Easing the way of a nationwide health information network will be a major priority for the Office of the National Coordinator for Health IT in 2013, with a new funding opportunity announcement issued late last week paving the way.

With the Dec. 20 announcement, ONC declares its intention to collaborate with organizations already involved in governing electronic health information exchanges, writes Dr. Farzad Mostashari, who heads the office, in the Health IT Buzz Blog.

Other initiatives for promoting health information exchange governance in 2013, according to Mostashari, include:

Hosting an open listening session in January on health information exchange governance.
Having the HIT Police Committee and HIT Standards Committee hold a public hearing, on Jan. 29, on providers’ needs under new payment models and opportunities to strengthen health information exchange governance, among other topics.
Supporting the National e-health Collaborative’s first-quarter meeting of governance stakeholders.
Publishing governance guidelines for electronic health information exchanges.
Launching a governance monitoring program.

“The overarching goal for ONC remains that the information follow the patient where and when it is needed, across organizational, vendor, and geographic boundaries,” Mostashari writes.

ONC announced in September that it would not issue federal regulations for nationwide health information exchange governance, but would support existing governance initiatives and work to improve interoperability and trust among exchange participants. ONC also wants to make nationwide exchange of health data less complex and costly, Mostashari notes.

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HHS moves toward safer electronic health records

John Pulley — Wed, 26 Dec 2012 07:08:20 -0500

The U.S. Department of Health and Human Services has released a road map for making electronic health records and other health IT safer for patients.

The Health IT Patient Safety Action and Surveillance Plan was released Friday by the Office of the National Coordinator for Health IT (ONC). The draft plan recommends actions organized under three strategies, according to an HHS news release: increasing the quantity and quality of data about health IT safety; targeting resources and corrective actions to improve safety; and promoting a culture of health IT safety.

Strategies in the document, as outlined in a fact sheet, include:

Continuously improving the safety of health IT by developing a code of conduct for IT developers, supporting providers in reporting adverse events, creating a forum for health IT users to compare their experiences, and leveraging surveillance and live testing opportunities available through ONC authorized accrediting bodies.
Using Agency for Healthcare Research and Quality (AHRQ) Common Formats to facilitate real-time reporting and aggregation of patient safety issues.
Including health IT and patient safety in Centers for Medicare and Medicaid Services’ (CMS) health-care facility safety standards.
Further incorporating safety requirements into CMS’s EHR meaningful-use standards, and ONC’s standards and certification criteria.
Planning an ONC-led public-private effort to identify priorities, measures and targets for health IT safety, and HHS support for developing technology to mitigate health IT safety risks.
Establishing an ONC safety program to analyze reported data and establish a multi-agency HHS health IT safety committee.
ONC, Food and Drug Administration and Federal Communications Commission collaboration for a health IT safety regulatory framework.

“This report will help all of us better use health IT to deliver high quality care and improve patient safety,” said Dr. Farzad Mostashari, national coordinator for health IT.

Comments on the draft are due by Feb. 4.

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Privacy group asks HHS to regulate the cloud

John Pulley — Fri, 21 Dec 2012 14:30:06 -0500

An advocacy group that endorses giving patients control over sensitive health information is asking the Office of Civil Rights for the Department of Health and Human Services to issue guidelines for regulating cloud computing.

“Health providers will benefit from such guidance as they consider moving to cloud services and patients will benefit by knowing which data privacy and security protections should be in place – both will undoubtedly help increase trust and drive adoption,” wrote Dr. Deborah Peel, founder of the Austin, Texas-based Patient Privacy Rights, in a Dec. 19 letter.

The letter cited the case of Phoenix Cardiac Care, which was fined $100,000 by HHS in April for failing to protect the security of Internet-based personal health information.

The privacy group said guidance should include several criteria:

Secure infrastructure with safeguards, including comprehensive risk assessment by external auditors, data encryption, robust access controls, and measures that include intrusion detection and automated server management systems.
Security standards that are consistent with federal medical privacy rules and health IT security breach notification requirements.
Standards establishing the appropriate use, disclosure and safeguarding of protected health information.
Standard privacy-protection requirements for Business Associate Agreements (BAA) between health-care providers and cloud-computing providers.

“To be clear, keeping information confidential and secure needs to be a top priority,” the letter said, “and more specific guidance in the health care ecosystem would help ensure that cloud providers, health care professionals and patients alike are aware of how the privacy and security rules apply to clouds.”

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Outlook for telehealth market: Global warming

John Pulley — Wed, 19 Dec 2012 14:16:54 -0500

Revenue for the global telehealth market is expected to grow by 55 percent in 2013 as hospitals work to reduce readmissions and to cost-effectively manage the care of newly insured patients, according to a new report by the market analysis firm InMedica.

Revenue from telehealth devices grew only 5 percent between 2010 and 2011, and 18 percent between 2011 and 2012, even as remote patient monitoring grew, InMedica says in a news release.

The U.S. health-care market was somewhat paralyzed by uncertainty over reform in 2012, according to the report, “Telehealth – An Analysis of Demand Dynamics – 2012 Edition.” The Centers for Medicare and Medicaid Services (CMS) identifies telehealth as one of 13 possible models for reducing hospital readmissions, the firm notes.

“For telehealth to succeed in reaching a wider audience, it needs to break out of being a niche market and become part of a comprehensive patient-care model,” said senior InMedica analyst Theo Ahadome. “This is even more important in the post-acute care market where health-care providers are more willing to pay for telehealth if it is part of a total post-acute care model.”

The analysis also found that many health-care providers have not yet found the right mix of tools and software applications to start using telehealth to monitor patients.

InMedica is the medical technology research division of UK-based IMS Research.

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Health insurance exchange extension?

John Pulley — Tue, 18 Dec 2012 15:44:47 -0500

States are unlikely to meet the Jan. 1, 2014, deadline for implementing health insurance exchanges, a long-shot scenario that will require the Health and Human Services Department to extend the deadline, predict industry analysts.

“I think we should absolutely expect a delay,” Scott Lundstrom, vice president of the IDC Health Insights market research group, recently told Government Health IT. “As someone that watches large organizations deploy large systems every day, I don’t see any of the telltales that I would look for in a deployment here.”

Lundstrom also casts doubt on the possibility that more state politicians will drop their opposition to state health insurance exchanges now that the election is over.

“I don’t doubt that some states will,” he said. “But if you read the verbiage of the regulations around the exchanges the federal government has said that it will cover the incremental costs for some period of time. They haven’t said that they’ll cover it forever.”

He added: “Many states are concerned that while they will be reimbursed for the Medicaid expansion for some period of time, it’s not going to happen indefinitely. There will be a point at which more and more of this liability is going to get pushed off on the states.”

Moreover, the issue isn’t just one of financing or federal reimbursement, Lundstrom told the magazine.

“These are substantial IT projects,” he said. “They’re not simple. They require staffing, services, significant interaction with suppliers. … They require significant resources.”

A state that hasn’t already started building an exchange can’t complete one by the federal deadline, he said. The deadline for states to declare whether they would build their own exchange or let the feds build it for them, or operate in partnership with them, was Friday. Only 18 states and the District of Columbia said they would take on the task themselves, Kaiser Health News reported.

A challenge for the federal health insurance exchange network will be coordinating with state Medicaid programs and making it easy for people to use the exchange, Ceci Connolly, managing director at consulting firm PricewaterhouseCoopers, told Kaiser Health News.

“It is going to be a sprint for government officials and the industry to be ready by next fall,” Connolly told the news service.

There may be a silver lining to the decision of most states to go with the federal health insurance exchange model, Lundstrom said in his Government Health IT interview.

“Honestly, to have 50 states do their own thing is probably a disaster, too,” he said. “Go talk to a software vendor that has 50 different applications in 50 different states to see how well organized and how well-run they are.”

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GAO analyzes federal health IT incentives

John Pulley — Fri, 14 Dec 2012 13:01:15 -0500

Hospitals that received Medicaid incentive payments in 2011 for achieving meaningful use of electronic health records typically were nonprofit, independent acute-care facilities in Southern cities, according to a report released Thursday by the General Accounting Office.

The Health Information Technology for Economic and Clinical Health (HITECH) Act requires GAO to monitor the impact of its provisions, including whether certain types of providers are more likely to participate in the EHR incentive programs than others.

One finding was that, at least in the early stages of the program, hospitals were more likely to participate in the Medicaid EHR incentive program than the Medicare incentive program. On the other hand, the median payment through Medicaid of $613,512 was less than half as much as the comparable Medicare payment.

In total, 1,964 hospitals received $1.7 billion in Medicaid EHR incentive payments in 2011, ranging from $7,528 to $7.2 million, according to the report. About half of those hospitals received 80 percent of the distributed incentive payments. In addition, 45,962 providers – about one-third of those thought to be eligible -- received Medicaid incentive payments. Hospitals and other providers combined received $2.7 billion in payments for the year.

GAO also found that acute-care hospitals were 1.7 times more likely than critical-access hospitals to have received a Medicaid incentive payment; and children’s hospitals were 1.6 times more likely to have received the payment than a critical-access hospital. Critical-access hospitals are typically in rural areas with few health-care resources, and they provide limited services compared with acute-care hospitals.

Larger hospitals with more beds were twice as likely to have received payments as the smallest hospitals, according to the report.

Other findings:

In the South, 46 percent of hospitals received Medicaid incentive payments, compared with 15 percent in the Northeast.
Of the hospitals receiving Medicaid incentives, 62 percent were in urban areas, 80 percent were acute-care hospitals, 57 percent were nonprofits and 57 percent were not part of a hospital chain.

As for medical professionals, 97 percent received the maximum amount of $21,250. The number of providers participating in the Medicaid incentive program was three times the number participating in the Medicare incentive program. The cumulative amount paid by the two programs was about the same.

Among providers receiving Medicaid incentives, 83 percent were in urban areas, 51 percent were specialty-practice physicians, 23 percent were general-practice physicians and just 1 percent were physician assistants.

Nearly half had signed agreements to receive technical assistance in EHR implementation from a regional extension center.

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New tools secure mobile health data

John Pulley — Wed, 12 Dec 2012 16:05:05 -0500

The U.S. Department of Health and Human Services today released several online tools to help health-care providers use mobile devices such as smartphones, tablet computers and laptops without risking breaches of patient health information.

The tools are part of an HHS education initiative to help providers and other health-care organizations better secure protected health information on mobile devices. The multipronged initiative also includes a variety of videos, fact sheets, FAQs and posters.

In a recent Ponemon Institute survey on patient privacy and data security, 94 percent of health-care organizations reported a data breach in the past two years. The most common security breach was the loss of equipment, primarily mobile devices, reported by 46 percent of respondents.

Larry Ponemon, chairman of the institute, based in Portland, Ore., said many of the breaches can be traced to the use of cloud computing services and the rapid growth of workers using their own mobile devices in the workplace.

“Many organizations admit they are not confident they can make certain these devices are secure and that patient data in the cloud is properly protected,” Ponemon said in a statement. “Overall, most organizations surveyed say they have insufficient resources to prevent and detect data breaches."

The HHS education initiative grew out of a Mobile Device Roundtable held in March. The mobile device security initiative was formally launched today at the annual meeting of the Office of the National Coordinator for Health IT, a division of HHS.

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Health care providers leave patients' data vulnerable

John Pulley — Mon, 10 Dec 2012 15:59:37 -0500

Data breaches plague the vast majority of health care providers, with 94 percent of health organizations reporting at least one breach of patient information in the past two years, a new survey shows.

In addition, 45 percent of 80 organizations that responded to the Ponemon Institute Patient Privacy & Data Security survey reported more than five data breaches during the same two-year period. Slightly more than half of the organizations said the compromised information involved medical identity, with a quarter of those saying the theft affected a patient’s medical treatment.

More than half of the organizations said they have little or no confidence in their ability to detect all breaches, according to a news release. Data breaches cost the U.S. health-care industry an average of $7 billion per year, or $1.2 million per organization, the study finds.

Most of the breaches resulted from lost electronic devices, employees’ mistakes, technology glitches, third-party errors and criminal attacks. The survey also found that 69 percent of surveyed organizations do not secure devices such as insulin pumps that hold protected health information.

The risks will increase with the growing use of mobile and cloud technologies, the study concludes.

For example, 81 percent of the organizations surveyed allow employees to use their own mobile devices, but 54 percent can’t guarantee the security of those devices. And while 91 percent of hospitals in the survey use cloud-based services, 47 percent are unsure that the cloud data are secure.

Nearly three out of four hospitals surveyed said they don’t have the resources to detect or prevent data breaches.

“Clearly, in order for the trend to shift, organizations need to commit to this problem and make significant changes,” said Rick Kam, president and co-founder of Portland, Ore.-based ID Experts, which sponsored the study. “Otherwise, as the data indicates, they will be functioning in continual operational disruption.”

The Ponemon Institute conducts independent research on data privacy and information security.

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Electronic records surge continues

John Pulley — Fri, 07 Dec 2012 15:20:27 -0500

Almost 72 percent of office-based physicians in the United States use an electronic medical record or electronic health record, new government statistics show. Close to 40 percent use digital record systems that meet federal requirements for basic functionality.

The number of doctors with some sort of EMR/EHR is up 26 percent since last year, according to a data brief from the National Center for Health Statistics at the Centers for Disease Control and Prevention.

The number of doctors who use records that qualify as basic systems rose 17 percent over last year, according to “Use and Characteristics of Electronic Health Records Among Office-based Physician Practices: United States, 2001-2012.”

Among other findings:

Two-thirds of office-based physicians say they plan to apply, or already have applied, for incentives that reward using electronic records in ways that meet meaningful use standards.
The percentage of physicians using some type of digital records varied by state, from a low of 54 percent in New Jersey to a high of 89 percent in Massachusetts.
When it came to using certified basic EHRs, the District of Columbia was at the bottom, at 22 percent, followed by Louisiana at 25 percent. Top honors went to Wisconsin, at 71 percent, followed by Minnesota at 67 percent.

The National Ambulatory Medical Care Survey, conducted by mail, is the source of data cited in the brief.

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FDA needs mobile health IT office, lawmaker says

John Pulley — Wed, 05 Dec 2012 17:16:36 -0500

A California congressman introduced a bill this week to promote health IT innovation, in part by creating a Food and Drug Administration office to oversee mobile health technology.

U.S. Rep. Mike Honda, a Democrat, said in a news release that his Healthcare Innovation and Marketplace Technologies Act would foster innovation through marketplace incentives, challenge grants and more workforce retraining opportunities.

“Investments, development and adoption of technologies remain stagnant,” Honda said in a statement. “Why have the principles of Silicon Valley, which I represent – competition, innovation, and entrepreneurship – not fully manifested themselves in the health-care information technology space? This bill gets us closer to that space.”

The measure would establish an Office of Wireless Health at the FDA to “develop and maintain a consistent, reasonable and predictable regulatory framework” for mobile-health technology issues. One of its goals would be to clarify and simplify existing regulations, Honda’s office said.

The bill, H.R. 6626, also would:

· Establish an mHealth developer support program at the Department of Health and Human Services that would help developers of mobile applications to meet privacy regulations. Support services would include a nationalhotline, an educational website, and an annual report “that will help translate the wide array of privacy guidelines into common English.”

· Create a prize program and small innovator challenge grants to attract private investment in three major areas of health IT. A commission comprising private industry, patient safety and privacy advocates, medical professionals and government officials would determine the three areas of greatest need.

· Provide low-interest loans to clinics and physicians for the purchase of health IT products and services.

· Create a tax incentive program that would allow providers to deduct costs related to health IT other than electronic health records.

· Establish two-year grants to help providers retrain employees into new health IT positions.

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Trending: Health IT in 2013

John Pulley — Mon, 03 Dec 2012 15:34:54 -0500

AT&T released predictions Monday for 2013’s biggest health IT trends:

A shift from stand-alone mobile health apps to “sponsored mHealth solutions” from health-insurance companies, health care providers, employers and other stakeholders, resulting in more patients using the apps and participating more fully in their own health care.
The movement of more health data into the cloud, where data analytics will “better manage health care costs by finding and addressing patient needs earlier.”
Large-scale adoption of remote monitoring of patients with chronic conditions.
mHealth applications that can integrate with other devices, apps and data and be safely shared across different vendors’ health IT platforms.
Significant growth in the telehealth market, bringing more access to health care in areas without enough physicians to meet demand.

"Physicians make better treatment decisions and predictions based on better data, so we must have better access to information when patients need it the most," said Dr. Geeta Nayyar, chief medical information officer at AT&T ForHealth, in a statement. "These kinds of technologies have the potential to help people make the shift from being reactive to being proactive with their care."

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Oversight of e-health record incentive program is lax, IG says

John Pulley — Fri, 30 Nov 2012 13:56:07 -0500

Health care providers should do more to prove that their electronic health records meet meaningful-use standards, says the Health and Human Services Department inspector general.

In a report issued Wednesday, HHS IG Daniel Levinson said the information providers submit to the Centers for Medicare and Medicaid Services lacks validation. As such, the Medicare EHR incentive program is “vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements.”

CMS lacks “strong prepayment safeguards, and its ability to safeguard incentive payments post-payment is also limited,” according to the report.

Prepayment verification involves double-checking the numbers in providers’ reports, but not validating whether the core information is true, according to the findings. That’s because there’s no requirement for providers to submit documentation supporting the numbers in their reports. CMS can conduct post-payment audits, but it has not yet done so.

The IG suggested that conducting spot risk analyses by requesting documentation from a subset of providers could give CMS a truer picture of compliance. Using one of the risk analyses CMS has proposed to identify candidates for post-payment audits could have identified 14 percent of professionals and 17 percent of hospitals for possible review, the IG found.

The Office of the National Coordinator for Health Information Technology also came in for criticism. ONC could help CMS with verification by requiring that EHR certification bodies comprehensively test EHR reports for accuracy, and by updating its regulations to include reporting functions, according to the report.

The IG’s office recommended that CMS:

Obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information.
Issue guidance with specific examples of documentation that professionals and hospitals should maintain to support their compliance.

CMS responded by saying that prepayment reviews would “increase the burden on practitioners and hospitals and could delay incentive payment.” CMS agreed that there is a need to issue guidance with examples of documentation.

The report also recommended that ONC:

Require that certified EHR technology be capable of producing reports for yes/no meaningful use measures where possible.
Improve the certification process for EHR technology to ensure accurate EHR reports.

ONC concurred with those recommendations.

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More doctors prefer pixels to prescription pads

John Pulley — Wed, 28 Nov 2012 14:30:11 -0500

E-prescribing has gone mainstream.

According to federal officials, almost half of all physicians prescribe drugs electronically through an electronic health record. That’s a 41 percent increase since December 2008, according to a report released this week by the Office of the National Coordinator for Health IT.

States with the highest rates of increases include New Hampshire, where the rate went from 5 percent in 2008 to 74 percent in June 2012, and Iowa, where e-prescribing rates rose from 7 percent to 73 percent.

States with the lowest e-prescribing rates are Alaska, at 32 percent; Nevada, at 37 percent; and New Jersey and Wyoming, each at 38 percent.

Overall, 23 states had e-prescribing rates above 50 percent, ONC reported. The percentage of community pharmacies that are capable of filling e-prescriptions grew from 76 percent to 94 percent.

The analysis looked at prescriptions sent through EHRs that use the Surescripts network.

In a post on ONC’s Health IT Buzz blog, the report’s authors said the significant increase in e-prescribing could be credited in part to the State Health Information Exchange Cooperative Agreement Program that promotes pharmacies’ participation.

They further cited technical assistance from ONC’s 62 regional extension centers that assist small physician practices that adopt EHRs, as well as the growing number of providers that meet federal guidelines for demonstrating meaningful use of e-records.

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Doctors abroad report mixed results for health IT

John Pulley — Mon, 26 Nov 2012 12:54:03 -0500

Health IT fails to consistently provide primary care physicians with timely information about patients or information on physician performance, a recent survey of doctors in 10 industrialized nations found.

Even so, physicians say they’re seeing more progress in health IT than in some other health care areas, according to the survey, which was published online in the November issue of Health Affairs journal. U.S. doctors in particular said the health care system needs “fundamental change,” with a majority reporting they spend a great deal of time dealing with insurance hassles that force some patients to go without care.

Researchers surveyed primary care physicians in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the United Kingdom and the United States earlier this year for the report, which follows a similar survey conducted in 2009.

The survey found near-universal use of electronic medical records in Australia, the Netherlands, New Zealand, Norway and the U.K. Two-thirds or more of physicians in the U.S., France and Germany report using electronic records, with significant growth reported in the U.S. and Canada in the last three years.

Basic electronic medical records functionality was common across countries, according to the findings, but decision-support functions were rarer, especially in Germany and Norway. Multifunctional capacity was most prevalent in the U.K., where more than two-thirds of doctors have multifunctional capacity. Only 27 percent of U.S. practices had multifunction capacity.

In addition, electronic information exchange “is not yet the norm in any country,” according to the survey, with adoption rates ranging from 55 percent in New Zealand to 14 percent in Canada. In the United States, larger practices and those in integrated health systems were most likely to have information-exchange capabilities.

Doctors in Switzerland, the Netherlands and Germany were most likely to have patients contact them via email. Doctors in Norway and the U.K. were most likely to allow patients to request appointments or referrals online through email or Web portals. Dutch, Norwegian, Swiss and U.K. doctors were most likely to offer online prescription refills, according to the findings.

Canada and Australia lagged in offering electronic access to physicians. On that measure, the United States was in the middle of the pack relative to other countries surveyed for the report.

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Virtual visits to doctors' offices yield good outcomes

John Pulley — Wed, 21 Nov 2012 14:35:17 -0500

Doctors who confer electronically with patients suffering from sinusitis and urinary tract infections correctly diagnose the infections at about the same rate as they do when seeing patients in their offices, yet they are more likely to prescribe antibiotics, according to a research letter published online this week in the Journal of the American Medical Association.

During e-visits, patients log into a doctors’ electronic health record system and answer electronically generated questions about their complaints, according to the letter. A doctor reviews the information, makes a diagnosis, orders appropriate care and responds to the patient via the portal within a few hours.

Doctors were less likely to order a test for a UTI during an e-visit than an office visit, but there was no significant difference in sinusitis-related tests for e-visits and office visits, according to the letter. Nor was there any difference in the number of follow-up visits for either type of condition, an indication that doctors had correctly diagnosed and treated patients.

The big difference in e-visits and office visits was in the rate of prescribing antibiotics, particularly for UTIs. “When physicians cannot directly examine the patient, physicians may take a ‘conservative’ approach and order antibiotics,” the researchers concluded. “The high antibiotic prescribing rate for sinusitis for both e-visits and office visits is also a concern given the unclear benefit of antibiotic therapy for sinusitis.”

E-visits were less costly than office visits, the researchers said—$74 versus $93 in the case of a UTI visit.

A JAMA subscription is required to view the entire research letter online.

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Seeing health IT through patients' eyes

John Pulley — Tue, 20 Nov 2012 11:02:46 -0500

The National eHealth Collaborative on Monday released a framework to guide the transition from provider-centered health IT to a system built around patients.

The collaborative’s Patient Engagement Framework outlines five major phases from the perspective of patients: inform me, engage me, empower me, partner with me and support my e-community.

The “inform me” and “engage me” steps align with the first stage of “meaningful use” requirements. Health-care providers must demonstrate that they have achieved “meaningful use” of electronic health records to qualify for incentive payments under Medicare and Medicaid. Most providers either have or are attesting to Stage 1 meaningful use now.

“Empower me” aligns with Stage 2 of meaningful use, in which EHR performance evaluation depends more heavily on patient engagement. Providers must begin meeting Stage 2 in 2014, and Stage 3 in 2016. “Partner with me” aligns with Stage 3 meaningful use.

The fifth stage, “support my e-community,” is a guide for a robust collaborative system that integrates providers, such as dentists and chiropractors, into a patient’s electronic record and lets patients control access to records and privacy, among other enhancements.

“The patient is the point of health information, and a framework for systematically keeping the patient’s interests at the center of health information technology helps us move toward higher-performance, higher-value health care,” said Dr. Jonathan Perlin, chief medical officer and president of clinical services at the Hospital Corporation of America, in a news release. “This is a great way for health care to measure how prepared they are for patient engagement.”

The framework “is organized to build on an organization’s capabilities including information and way-finding, e-tools, forms and patient education, patient access to their information, patient role in generating their information, and patient role in the care team,” the National eHealth Collaborative said in the news release.

The Washington-based collaborative describes itself as a neutral public-private partnership that is working to accelerate progress toward secure, interoperable nationwide health information exchange.

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Health information exchanges face significant financial challenges

John Pulley — Mon, 19 Nov 2012 16:00:00 -0500

Concerns about competition could undercut development and long-term sustainability of health information exchanges, according to preliminary findings of a survey by the eHealth Initiative.

Of 126 exchanges that responded to the group’s 2012 survey, 36 said competition from other HIEs was an important challenge, and 50 worried about competition from health IT vendors with exchange capabilities. More than half said stakeholders’ concerns could potentially have an impact on their participation in exchanges, according to the preliminary findings.

“Given the importance of stakeholder buy-in to sustainability, competition between data exchanges and health IT vendors over smaller stakeholder populations could impact development in the area,” the initiative said. “Similarly, these findings suggest that some stakeholders may not engage in data exchange because of fear of losing revenue . . . It will be important for groups to create secure technical infrastructure and policies that can help allay fears from stakeholders.”

The group also concluded that some federally funded HIEs risk going out of business if they don’t develop sustainable business models after funding from the Health Information Technology for Economic and Clinical Health (HITECH) Act ends.

All exchanges need to look at a variety of revenue-generation methods to improve sustainability, the report preliminarily concludes. “There needs to be more development in other areas of revenue generation, such as transaction fees, assessment fees and membership, for HIEs to truly become sustainable,” the initiative said.

Other preliminary findings include:

Top challenges cited by stakeholders are privacy, developing a sustainable business model, lack of funding, concerns about their competitive position in the marketplace, addressing technical barriers and addressing government policy and mandates.
More than a quarter of the HIEs that don’t already support Accountable Care Organizations or Patient Centered Medical Homes expect to do so in the future.
Primary revenue sources are membership fees and government funding.

A link to a PDF of the preliminary report is available under “News” on the eHealth Initiative home page.

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HHS extends states' health-exchange deadline, again

John Pulley — Mon, 19 Nov 2012 12:38:08 -0500

For the second time in a week, states that have delayed taking action to create federally mandated health insurance exchanges were granted an extension of a key deadline by the Department of Health and Human Services.

As noted last Thursday by The Hill Healthcare, the latest delay extends the deadline for states to file a notice of intent to operate a state-based exchange to Dec. 15. The decision came a week after HHS Secretary Kathleen Sebelius, in a Nov. 9 letter to governors that was posted online by Government Health IT, extended the deadline for applying to operate a state-based exchange to Dec. 15.

In other words, states can submit both a letter of intent and an application to operate their own exchange on the same day, explained Sebelius in a Nov. 15 letter to the Republican Governors Association (RGA). The letter was posted online by Kaiser Health News.

“We appreciate the administration’s acknowledgement that not enough information has been provided to the governors and hope this is a signal that the White House intends to engage directly with the governors on the substantial policy issues that remain unresolved and are open to real reform,” RGA spokesman Mike Schrimpf said in a statement last week, as reported by Kaiser Health News.

States can either set up their own health insurance exchanges, let the federal government handle it, or develop an exchange in partnership with the federal government. States receive federal grant money to help offset the cost.

The deadline for applying to operate an exchange in partnership with the federal government is Feb. 15.

Under the Affordable Care Act, the administration must certify by Jan. 1, 2013 states’ plans to run their own exchange. Exchanges are to be up and running by Jan. 1, 2014.

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Veterans Affairs broadens view of mobile devices

John Pulley — Wed, 14 Nov 2012 15:24:41 -0500

The Department of Veterans Affairs seeks a contractor to develop an application that will view images from the VistA electronic health record on mobile devices.

In a request for information posted earlier this month on FedBizOpps.com, the VA said it wanted to expand mobile viewing of diagnostic images such as X-rays, CT and PET scans, ultrasound and angiography beyond the iPad. The idea is to “expedite diagnosis and treatment planning, facilitating communication among radiologists and referring clinicians.”

The RFI noted that it wants to better connect its geographically dispersed network of 152 hospitals and health-care systems, 974 outpatient clinics and 133 skilled-nursing and extended-care centers “into a meaningful and seamless health-care system in which veterans receive the right care no matter where they are in relation to the system’s resources.”

Technical and workflow considerations include providing a browser and platform for mobile imaging that can integrate with any picture archive and communication system (PACS); providing data security and central management of personal devices; providing a “state-of-the-art imaging platform”; and allowing real-time collaboration among geographically separated users.

Responses are due by Nov. 28.

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Top 10 health IT hazards for 2013

John Pulley — Tue, 13 Nov 2012 09:01:36 -0500

Linking patient data to the wrong electronic health record is one of the top 10 health technology hazards for 2013, the ECRI Institute says in a new report.

EHRs can “multiply the effects of such errors” far more than when similar data mismatches occur in paper records, the report contends. “The result is that such errors can have far-reaching consequences, leading to a host of downstream effects that can be both difficult to identify and difficult to correct once they have been identified.”

Mismatched patient data in EHRs is fourth on the list, followed by interoperability failures between medical devices and health IT systems.

Devices used to gather and record patient data for transfer to an EHR needs to accurately note when switching to a new patient, the report says. Simple events can disrupt the process, such as a patient’s transfer from one hospital room to another, or a network outage.

Incidents of patient-data mismatches “may increase as hospitals in the United States fast-track efforts to implement EHRs,” the report says.

Interoperability issues, highlighted in hazard No. 5, include interfaces between medical devices, incompatible systems, and the ways that problems with one system can have a domino effect with other systems, according to the report.

The other eight health technology hazards identified by ECRI Institute are, in order:

Alarm hazards
Medication administration errors with infusion pumps
Unnecessary exposure and radiation burns from diagnostic radiology procedures.
Air embolism hazards
Inattention to the needs of pediatric patients when using technologies designed for adults
Inadequate reprocessing of endoscopic devices and surgical instruments
Caregivers being distracted by smartphones and other mobile devices
Surgical fires

“The inherent complexity of HIT-related medical technologies, their potential to introduce new failure modes, and the possibility that such failures will affect many patients before being noticed—combined with federal incentives to meet meaningful use requirements—leads us to encourage health-care facilities to pay particular attention to health IT when prioritizing their safety initiatives for 2013,” said James P. Keller Jr., the ECRI’s vice president for health technology evaluation and safety, in a statement.

The nonprofit ECRI Institute, based in Plymouth Meeting, Pa., researches patient care and safety issues.

Discuss the future of Federal IT with experts, innovators and your peers on Dec. 3 in Washington at Nextgov Prime, the defining event in the federal technology landscape. Learn more at nextgov.com/prime.

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Committee releases Stage 3 rules for electronic health records

John Pulley — Fri, 09 Nov 2012 16:02:22 -0500

A federal health information technology committee this week released its proposed rules for Stage 3 meaningful use of electronic health records -- the first step in a long public process of reviewing how the government assesses whether EHRs qualify for incentive payments under Medicare and Medicaid.

Health care providers must demonstrate “meaningful use” of EHRs to qualify for incentives. Meaningful use stages are being phased in over several years, with each stage raising levels of functionality, usability and data exchange required of EHR systems.

The committee’s “vision” for Stage 3 “includes a collaborative model of care with shared responsibility and accountability, building upon the previous [meaningful use] objectives,” according to the document released Wednesday by the Health Information Technology Policy Committee.

“While the committee appreciates and recognizes today’s challenges in setting up data exchanges, it is the committee’s recommendation that Stage 3 is the time to begin to transition from a setting-specific focus to a collaborative, patient- and family- centric approach,” the committee wrote.

With that in mind, the committee said Stage 3 objectives should:

Support new models of care;
Address national health priorities;
Have broad applicability to different medical specialties, patient health needs and regions of the country;
Promote advancement of EHR capabilities; and,
Be achievable and feasible.

The recommendations are broken down into charts comparing them with the final Stage 2 rules and briefly outlining what might be next for future stages. The 44-page document also includes several issues on which the Office of the National Coordinator for Health IT requests comment.

A 45-day comment period is under way, to be followed by the committee’s review in the first three months of 2013. Stage 2 guidance is final, but the deadline for compliance isn’t until 2014. The tentative date for Stage 3 compliance is in 2016.

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Disbursement of federal health IT incentives tops $7 billion

John Pulley — Wed, 07 Nov 2012 11:34:21 -0500

Federal funds continue to benefit health-care providers who demonstrate meaningful use of electronic health records. As of September, incentive programs have distributed more than $3.9 billion through Medicare, $3.5 billion through Medicaid, according to figures provided by the Centers for Medicare and Medicaid Services.

Providers in 16 states had received more than $151 million in incentive payments (as of Aug. 31): California, Florida, Georgia, Illinois, Indiana, Louisiana, Massachusetts, Michigan, Missouri, New York, Ohio, Oregon, Pennsylvania, Tennessee, Texas and Wisconsin.

A number of states had received less than $50 million during that time period: Alaska, Hawaii, Idaho, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, South Dakota, Utah, Vermont and Wyoming.

Florida, which has a large retiree population, led the way in Medicare payments at $307.5 million, as of Sept. 30. Alaska, which ranks 47th out of 50 states in population, was at the bottom, with only $1.99 million in Medicare incentive payments as of Sept. 30.

In terms of combined Medicare and Medicaid payments, California leads all states, with $637.6 million in total payments, according to CMS. Florida is second in the combined total, at $525.8 million – far outpacing No. 3 Illinois, with $258.8 million in payments. Idaho had $15.1 million in combined incentive payments, least among states. Its Medicaid incentive payment has been active since summer.

The first states began running Medicaid EHR incentive programs in January 2011. As of the end of September, 45 states were operating such a program, according to CMS. Medicare EHR incentive programs began in May 2011.

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Electronic filing simplifies review of Medicare payments

John Pulley — Mon, 05 Nov 2012 15:55:08 -0500

Electronic submissions are simplifying the process of providing documentation for Medicare payment reviews.

Participation in the Centers for Medicare and Medicaid Services’ Electronic Submission of Medical Documentation system is growing. In the 12-month period ending Sept. 15, 85,000 medical records were transmitted electronically to review contractors. That equates to 5.5 percent of the total requested for review, CMS says in an announcement.

Almost 1,778 Medicare providers used esMD to respond to medical-record requests issued by contractors hired to identify and correct improper payments from Medicare, CMS says.

“Providers have often complained that [a] paper-based process is costly and time-consuming,” CMS says in the announcement. “Many providers, especially those who use electronic health records, have requested an electronic means to respond to these documentation requests.”

CMS has approved 21 contractors to accept medical records via esMD, which uses CONNECT gateway software developed by the Office of the National Coordinator for Health IT and meets ONC’s Nationwide Health Information Network standards.

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