Category Archives: Digital Physicians

Teachable Moment — EHR Implementation Video

Posted on by
Reply

Pittsburgh Regional Health Initiative (PRHI) Presents 
EHR Implementation in A Teachable Moment Video  PHRI EHR-A Teachable Moment
Frank Civitarese, DO, President of Preferred Primary Care (PPC) and a Board Member of Pittsburgh Regional Health Initiative (PRHI) is featured in a brief video about his practice’s EHR implemenation, along with comments by Rick   Schaeffer, VP & CIO, ST. Clair Hospital, and Charity Dean, Office Manager in Dr. Civitarese’s practice. 

PRHI is a Pittsburgh, PA area “regional  consortium of medical, business and civic leaders to address healthcare safety and quality improvement as a social and business imperative” using its commmunity as a “demonstration lab.” PHRI “is a nonprofit operating arm of the Jewish Healthcare Foundation.”

“Preferred Primary Care Physicians consists of 34 board-certified physicians specializing in internal medicine and family practice. PPCP has 15 practice locations in the South Hills and two locations in Uniontown in Fayette County. In addition, PPCP offers state-of-the-art outpatient centers for cardiac testing, sleep disorders, and physical therapy.”

PRHI: EHR Implementation: A Teachable Moment Video
PRHI Teachable Moments Videos
PRHI Champions of Work Redesign
http://prhi.org

Usability in Health IT: Strategy, Research, and Implementation Workshop

Posted on by
Reply

Usability in Health IT: Strategy, Research, and Implementation
NIST/AHRQ/ONC Workshop July 13, 2010
National Institute of Standards and Technology
Gaithersburg, MD

This follows in pattern of previous workshops conducted by ONC, eg., Workforce Initiative, when ONC is in early brainstorning stages of developing a systematic program to meet particular needs.

The remainder of this post is excerpted from NIST site.

Purpose:
To promote collaboration in health IT usability among Federal agencies, industry, academia, and others.

Goal: Bring together industry, academia, government, and others to prioritize, align and coordinate short, medium, and long term strategies and tactics to improve the usability of EHRs. 

Objectives:

  • Establish an immediate term set of actions to inform the national initiative to drive EHR adoption and meaningful use.
  • Develop a strategic approach to measure and assess use of EHRs, and impact of usability on their adoption and innovation.
  • Develop strategies to drive best practices and innovation to vendor products.
  • Inspire follow-on activities in the public and private sectors.

NIST ”will be updating workshop information. Please check the website again soon.”
Contains pdf of Prelimimary Agenda (in html below), Roundtable Discussion Participants, and Acronyms.

Agenda
8:00 – 9:00 Registration / Coffee
9:00 – 9:30 Greetings / Introduction / Opening Remarks – (ONC)
Moderator – Janice (Ginny) Redish, PhD
9:30 – 10:30 Current State and Need for Action
–HITECH (ONC)
–Current State of EHRs (AHRQ)
–Current Federal and Private EHR Usability Initiatives Government (ONC, NIST, AHRQ, FDA); Private (HIMSS, EHRA, Miscrosoft); Academia
–Meaningful use (AHRQ, FDA, Academia) – Standard Formats, PSO program, etc.
–Adoption (ONC, HIMSS, EHRA, Industry)
–Innovation (Industry, Academia)
–Q&A
10:30 – 10:45 Coffee Break
10:45 – 11:45 “Points of Pain” – Prevention of Cognitive Overload
–Current research (Academia
–Prevention of Cognitive Overhead During Initial Adoption / Transition from Paper
–Prevention of Cognitive Overhead During Transition from systems in multiple settings (One User / Many Systems Issue)
–Insufficient System Feedback (Critical Issue on Alert Overload)
–Dense Displays of Data (Prevention of Excessive Complexity of System)
–Q&A
11:45 – 1:00 Lunch (NIST Cafeteria)
1:00 – 1:30 “Points of Pain” – Addressing EHR User Disparities
–Clinical Workforce characteristics and limitations (NIST, Access Board, Academia)
–Accessibility Issues – Low/Poor Vision; Mobility/Dexterity; Cognitive Disabilities
–English Proficiency
–Lower socioeconomic demographics – digital divide
–Q&A
1:30 – 1:45 Coffee Break
1:45 – 2:45 Usability Framework (NIST, AHRQ, Academia)
–Best practices and gaps based on experience from other industries / sectors
–Usability Standards Development (NIST)
–Measurement domains
–Objective measures of human performance
–Effectiveness
–Efficiency
–Additional measures
–User satisfaction
–User acceptance
–Ongoing Projects and Research Initiatives (AHRQ Toolkit, SHARP, NIST grants, Common Formats, etc.
–Usability framework for product lifecycle
–Q&A
2:45 – 3:00 Coffee Break
3:00 – 4:00 Recommendations to support HITECH / Certification
–Accreditation Program, Certification
–Test Methods for Products and Users (Pass / Fail Criteria for Usability Standards)
4:00 – 4:45 Recommendations and Next Steps
Moderator: Janice (Ginny) Redish, PhD
–Research and Implementation
–Recommendations for Usability and Adoption
–Recommendations for Innovation
–Next steps

McClellan at Brookings: Making ‘Enhanced Use’ of Health Information Webcast

Posted on by
Reply

McClellan, Health IT Leaders Discuss More Effective Use of Health IT
in Half-Day Session with Far-Reaching Look Ahead
at Promotion, Models, and Policy Implications
Webcast, Podcast, Transcripts Available
In an excellent half-day session on May 14, 2010, Mark McClelland, MD, PhD,  Director, Engleberg Center for Health  Care Reform at Brookings, led a series of discussions among leaders of Health IT focusing on how to use the same data that is being collected, and will increasingly be collected, in patient care to help improve the health care system beyond the individual patient.

Brookings Events Page: “Making ‘Enhanced Use’ of Health Information”
Includes: Archived Webcast
Three Audio Sections
Issues Brief pdf (under Event Materials)
Transcripts

Summary
Starting off the discussion on promoting use of Electronic Health Records, Farzad Mostshari, Deputy Director, Policy and Programs, Office of National Coordinator (ONC) for Health IT,  said the ONC always started from the end goal, as he laid out key principles including keeping data as close to the source as possible and data “collected once and used many times.” When asked how meaningful use was going, he answered with one word “Fantastic” and a broad smile, and then pointed out that focus on quality was the core of “meaningful use.” (See John Halamka’s blog for a list of the principles Mostashari laid out.)

When it comes to promoting the use of Electronic Health Records, John Halamka, CIO, Harvard Medical School and Beth Israel Deaconess Medical Center, and Amanda Parsons, who oversees New York City’s Primary Care Information Project (PCIP), agreed “it’s about the workflow:” don’t be disruptive to the physician’s delivery of care to the patient, while at the same time changing the way they work/think to take best advantage of the data and  the wisdom that electronic health records and information exchange can offer. As Parons stressed “don’t let the perfect get in the way of the good,” one of the constant refrains of EHR and Health IT evangelists.

The next panel titled “Compelling Models of Enhanced Use of Health Information,” shared such models including those conducted by Geisinger Health System in Pennsylvania described by James Walker, chief health information officer of Geisinger; the multi-state metro Cincinnati HealthBridge described by Robert Steffel, president and CEO of HealthBridge; South Carolina HIE described by David Patterson who oversees the HIE along with the state’s Medicaid Director; Wisonsin Health Exchange described by Michael Raymer of Microsoft; and Kaiser Permanante’s Institute for Health Research described by its senior director John Steiner. Geisinger recently won a Beacon Community award from the ONC to extend the kind of Health IT structure it uses to support patients within its IDN to patients and physicians outside its delivery system.

“Implications for Policy” looked ahead with views from White Office of Science and Technology; Carol Diamond of Markle Foundation; Landen Bain of Clinical Data Interchange Standards Consortium Healthlink Program, and Andrew Weber, National Business Coalition on Health.

In answer to a question about what can be done on a policy end to help physicians  think and work with their patients differently for enhanced use of Health IT tools, Diamond said “The key from my perspective in terms of giving them the capacity to use these tools in a way that provides value to them is to not make quality and research a compliance exercise, but to make it part of the way care is delivered. And the only way I know how to do that is to give them the tools at the point of care while they’re with the patient and give them the flexibility to use those tools towards common goals.” Parsons agreed with another panelist when she added “Frankly, it just has to be an alignment of health reform and reimbursement rate.”

Bain may have summed up the impact of the day’s discusssions when he added he was glad that the conversation at Brookings had focused on workflow and business processes: ”I really am encouraged that we’ve moved off of what I call data blindness, where all you can think about is just data and this abstract quality that you want to get a hold of.”

McClelland’s Issue Brief “Using Information Technology to Support Better Health Care: One Infrastructure with Many Uses” (link to Brookings event page) provides an insightful perspective on Health IT and its impact on healthcare and health reform, as well as a good summary of what he described in his opening remarks.

ONC Launches “Health IT: Stories from the road”

Posted on by
Reply

ONC Launches “Health IT: Stories from the road”

Health IT: Stories from the road

Health IT: Stories from the road

Looking to share success stories on Health IT implementation, the Office of the National Coordinator (ONC) for Health IT launched a new section on its Web site called “Health IT Journey: Stories from the road” on April 13, 2010. The following excerpt was selected on April 14, 2010. Please see the ONC site to keep up-to-date with the latest stories. Two of the three stories posted already require a paid subscription, so only the abstracts may be available. And ONC has posted a disclaimer about posted stories on the page.

Share. Inspire. Learn.
“Have you, your practice, or your organization been through a health IT implementation? We’d like you to share your story with us. After internal review, your story may be published to inspire other providers and organizations to become meaningful users of Electronic Health Records (EHRs). Let’s learn together.Email us your story at onc.request@hhs.gov. If the story has been published, be sure to include the name of the publication, the date of publication and a link to the article. Read our disclaimer (below).”

Thanks for sharing your story!

Journey Stories
What’s Keeping Us So Busy in Primary Care?  A Snapshot from One Practice
A small practice uses health IT to streamline delivery of care.
Richard J. Baron, M.D., F.A.C.P.
New England Journal of Medicine, 362: 1632-1636
April 29, 2010

Lessons Premier Hospitals Learned About Implementing Electronic Health Records  [Paid subscription required]
Hospitals implement health IT and develop an electronic health-record best-practices library to support “meaningingful use.”
Susan D. DeVore and Keith Figlioli
Health Affairs, 29: 664-667
April 2010

Health IT and Solo Practice: A Love-Hate Relationship  [Paid subscription required]
A solo practitioner finds efficiencies and challenges in adoption of health IT.
Joseph Heyman
Journal of Law, Medicine & Ethics, 38: 14-16
March 2010

Disclaimer
Posting of the articles on (ONC) Web site does not necessarily constitute HHS or ONC endorsement of the procedures followed; vendors, products and services named; or overall performance of the facility’s delivery of care. We do hope you find these narratives insightful and useful in your efforts to adopt health information technology and improve patient care.

ONC Blog: Beacon Communities Lead Charge to Improve Health Outcomes

Posted on by
Reply

Blumenthal Blogs on Health IT Buzz Blog plus add’l Links
Beacon Communities Lead the Charge to Improve Health Outcomes
Wednesday, May 5th, 2010 | Posted orginally by Dr. David Blumenthal on Health IT Buzz Blog.
Excerpted directly from ONC Health IT Buzz Blog.
Across the nation, in communities large and small, health information technology (health IT) innovators are boldly leading the way toward the adoption and meaningful use of electronic health records (EHRs). Yesterday, we awarded $220 million in Beacon Community cooperative agreements to 15 trailblazing community consortiums that will demonstrate how the meaningful use of electronic health records can serve as a critical foundation for achieving measurable improvement in the quality and efficiency of health care in the United States.

Health care providers often suggest that health IT is challenging to implement, and that certain types of communities are better prepared (and funded) to reap its benefits.

The 15 Beacon Communities named today, however, demonstrate the significant diversity among those who have been successful in implementing and using health IT. The areas of diversity represented in the consortiums receiving grants include:

  • Geographic – Beacon Communities are located from coast to coast and beyond to Hawaii
  • Population Density – Beacon  Communities serve both urban and rural populations
  • Populations – Beacon programs address health disparities among minority populations, including Native American, African American, and Hispanic, among others

Equally important, these communities are committed to demonstrating tangible outcomes:

  • Individual Health Outcomes – Beacon Communities’ outcomes encompass a variety of disease states and treatment approaches, including diabetes, cardiovascular disease, asthma, and chronic obstructive pulmonary disease
  • Population Health outcomes – Beacon Communities target varying dimensions of population and public health, from improved immunization and cancer screening rates, to innovations for public health surveillance

Additionally, the Beacon Community Program demonstrates robust collaboration among Federal agencies.   Two of the grantees seek to improve Veterans’ care by leveraging the Department of Defense’s and Department of Veteran Affairs’ Virtual Lifetime Electronic Record (VLER) program for active duty, Guard and Reserve, retired military personnel, and eligible separated Veterans.

These diverse partners will provide unique insights into best practices that can be applied to similar communities nationwide, as they strive to build a health IT infrastructure as a critical foundation for health system improvement. In doing so, the Beacon Community program will support the nationwide adoption of health IT by 2015.

I congratulate the Beacon Community awardees and am confident the Beacon Communities will succeed in demonstrating the promise of health IT and facilitating other communities’ adoption and meaningful use of technology.

–David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology
For the original post, comments and the complete Health IT Buzz Blog.
                                       #              #               #

White House Video of VP Biden and Sec’y HHS Sebelius Announcement

Additional e-Healthcare Marketing posts with info on Beacon Communities
–Blumenthal Letter #14 on Beacon Communities
–White House Announcement on $220 Million Awards with Communities Listed
–ONC Named for Beacon Communities Program
–ONC Roles and Posts–Includes Overall Director, Ofc of State and Community Programs

Blumenthal Letter #14: Beacon Communities Lead the Charge to Improve Health Outcomes

Posted on by
Reply

Establishing Beacons for Nationwide Advances in Health IT
Emailed May 5, 2010 

Dr. David Blumenthal

Dr. David Blumenthal

A Message from Dr. David Blumenthal,
National Coordinator for Health IT  

Healthcare professionals appreciate opportunities to learn from innovative colleagues and communities – to see what really works, to get “boots-on-the-ground” perspectives, to learn best practices, and to use the experience of other leaders to inform how to improve performance more broadly.    

The Beacon Community Cooperative Agreement Program, by its very design, was intended to shine a spotlight on health information technology (health IT) innovators, so that we all might learn from them. Today, Secretary Sebelius awarded $220 million to establish 15 Beacon Communities throughout America. These community consortia – selected from 130 applicants – have demonstrated leadership in developing advanced health IT solutions to help improve specific health outcomes. They also share a strong conviction in the benefits of health IT as a critical pillar to advance broad and sustainable health system improvement. The average award amount is $15 million over 36 months.    

The Beacon Community awards recognize collaborative community efforts operating at the cutting edge of health IT and health care delivery system innovation. Beacon Communities will implement a range of care delivery innovations building on existing infrastructure of interoperable health IT and standards-based information exchange, in coordination with the Regional Extension Center Program and State Health Information Exchange Program.  

In addition, the program will help Beacon Communities plan and develop new initiatives that can ensure the longer-term sustainability of health IT-enabled improvements in health care quality, safety, efficiency, and population health. This includes preparing for future policy changes resulting from enactment of health care reform legislation that will permit providers, states, and regional health care organizations to test new payment methods emphasizing improvements in quality and value.  

Like so many other providers who effectively implement health IT, Beacon Communities will leverage other existing federal programs and resources to promote health information exchange at the community level. These resources include:  

  • Department of Defense and the Department of Veterans Affairs Virtual Lifetime Electronic Record (VLER)  program, which aims to develop a longitudinal electronic health record for all active duty, Guard and Reserve, retired military personnel, and eligible separated Veterans
  • Health Resources and Services Administration (HRSA) programs at federally qualified health centers (FQHCs) and Health Center Controlled Networks (HCCNs) to advance the adoption of certified electronic health records and exchange of health information
  • Department of Agriculture and Department of Commerce efforts to extend broadband infrastructure

The partnership with applicable VLER, FQHC, and HCCN sites is particularly important to ensure we realize measurable and tangible results in federally funded, military, and private sector health care settings alike.
 
I am particularly pleased by the diversity among Beacon awardees:  geographically, they span the continental United States and reach as far as Hawaii; both urban and rural communities are well represented; and targeted program outcomes span some of America’s most pressing health concerns, from reducing medication errors and improving the care of individuals with cardiovascular disease to reducing disparities in access and outcomes for patients with diabetes. Additionally, the programs bring health IT innovation to a variety of underserved populations to address health disparities and improve patient care. The Beacon Communities demonstrate that health IT can bring meaningful change to health care for all Americans — not just the healthiest, wealthiest, or best insured.  

I extend my sincere congratulations to our 15 Beacon Communities. Your work inspires me, and I believe that in the coming months, it will inspire and inform America’s medical and health IT communities.  

Sincerely,
David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services  

“The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.”
#          #         #
See post on e-Healthcare Marketing with full statement from White House listing recipients and the focus of the award for each.

Boston Health IT/HIE Conferences meets goals center stage and off stage

Posted on by
Reply

Blumenthal, governor put health IT center stage in Boston;
Off stage state HIE, Medicaid and other officials network
Guided by the deft hand of Massacussetts Secretary of Health and Human  Services JudyAnn Bigby through a series

Blumenthal: Live, Projected, Streaming

Blumenthal: Live, Projected, Streaming

 of scheduling shifts, the Boston-based national conference on Health IT with 600 participants from 30 states on April 29-30, 2010, included inspirational keynotes from National Coordinator for Health IT David Blumenthal and Surgeon General Regina Benjamin, as well as an enthusiastic welcome from host Governor Deval Patrick who moderated a panel as well.

Off stage state HIE and Medicaid directors and leaders took the opportunity to network and compare notes, as well as take advantage of the smaller workshops where session leaders focused on encouraging discussion and bringing up issues that needed to be addressed in the accelerating Health IT federal-state initiative.

Bernie Monegain reported for Healthcare IT on April 30, 2010, “The government will announce ‘soon – it should be very, very soon’ which 15 communities of the 130 that applied will be awarded Beacon Community grants, National Coordinator for Health IT David Blumenthal, MD, said.” In addition to supporting improved electronic health record implementation and information exchange in communities that have already demonstrated great strengths in those capabilities, these Beacon communities will share lessons learned and best practices in achieving measurable outcomes in  health care quality, safety, efficiency, and population health with communities across the country, according to the Office of the National Coordinator site. 

CMIO.net story by  Jeff Byers  on April 29, 2010 was headlined “CMIO Blumenthal gets personal, calls for teamwork among health IT pros.” Seeing younger colleagues using electronic health records, Blumenthal noted, per Byers reporting, “I was not going to be the only one in my physician group of ten not using it.”  Blumenthal’s message is increasingly appealing to physicians’ sense of professionalism and focus on delivering the best patient care.

Byers futher reported April 29, 2010 in CMIO.net on a discussion of the role of consumers and patients in Health IT by a  ”Panel: How do HIEs, EMRs affect patient-physician experience?,” and provides the viewpoint of each of the panelists. 

ComputerWorld’s article by Lucas Mearian on April 30, 2010 reported “Health IT funding to create 50,000 jobs; Sixty regional IT help centers will help health care facilities implement electronic medical records.”

In addition to regional collaboration meetings among state officials grouped according to CMS regions, Workshops included “Achieving Sustainable Success,” Making a Difference–Health IT and Clinical Quality Improvement,” “State Initiatives in Healthcare Reform,” “Successful HIEs–How They Did It and How Ii Helps,” “Jobs, Jobs, Jobs–Health IT and State Economic Development Policy,” Creating Effective Public/Private Partnerships,” “EHR Early Adopters–How They Did It and How It Helps,” and “Health IT, HIE, and Public Health.”

One key panel, providing a sweeping overview of Health IT policies and standards, was moderated by Internet publisher pioneer Tim O’Reilly of O”Reilly Communications.

State HIE Directors are reportedly meeting with the ONC next week, and this conference acted as a bit of a warmup, with relatively new officials getting to connect, and others catch up.

See previous post on conference on e-Healthcare Marketing.

NOTE: As Jackie Slivko pointed out on LinkedIn on May 3, 2010, “Local and regional healthcare leaders as well as key vendors were also present and had an unprecedented opportunity to connect, learn from each other and network. Kudos to Mass Health Data Consortium http://www.mahealthdata.org/ , and the eHealth Initiative at the Mass Technology Collaborative http://www.maehi.org/ , both of whom continue to provide related forums and seminars. For live video and more from the conference, see http://mahit.us/ .”

Blumenthal blogs “Promoting Use of Health IT: Why Be a Meaningful User”

Posted on by
Reply

Promoting Use of Health IT: Why Be a Meaningful User
Tuesday, April 27th, 2010 | Posted by: Dr. David Blumenthal 
on ONC’s Health IT Buzz Blog. Excerpted from ONC site. 

“As I write, physicians throughout the United States are deciding whether to become meaningful users of electronic health records by 2011 when Medicare and Medicaid start making extra payments to meaningful users.  For some the decision may be pretty simple.  Almost 200,000 doctors already have adopted EHRs and are using them at a basic or sophisticated level.  For these physicians, the journey to meaningful use, and its financial and clinical rewards, may be comparatively short. Many other doctors, however, remain undecided.

“I don’t want to minimize the obstacles.  When I started using an  EHR, I found it challenging.  I often longed for a dose of my old prescription pad (confession – I cheated once in a while). I chafed at reconciling medication lists, updating problem lists, scanning through seemingly endless consultant notes. (In the past, many wouldn’t have been available – lost somewhere in the paper world.) It was much easier to use the triplicate x-ray requisition I had used for 30 years than the radiology order entry software required  by my EHR.  My visits were longer and more complicated.  Every time I turned on the computer, it seemed, I had to learn something new.

“But I am glad I did it, as are 90 percent of all physicians who adopt an EHR, according to a scientific survey published in the New England Journal of Medicine. My EHR made me a better doctor.  I really knew what was going on with my patients.  I could answer their questions better and more accurately.  I made better decisions.  I felt more in control.

“Physicians don’t go into medicine because it’s easy.  They go through grueling training – spending endless days and nights at the bedside or in the OR.  They face tough personal and clinical decisions throughout their professional lives. They constantly have to grow and learn to keep up with the science and practice of medicine. That’s what makes them the professionals they are.  That’s what earns their patients’ and colleagues’ respect and admiration.  That’s what gets them up in the morning knowing there’s nothing else they would rather be doing.

“The EHR is just another of the transitions that physicians are constantly called upon to make in the interest of their patients, their professional competence, and their professional self-esteem.  Its advent is inevitable – no more avoidable than the arrival of the stethoscope in the early 1800s or anti-sepsis in the mid 1800s ( both of which some physicians furiously resisted) or the ICU in the mid-1900s.  Positive change is often disruptive, but it is irresistible nevertheless. In 10 years, paper records will be the exception.  Lagging physicians will be seen as quaint throwbacks, no longer at the top of their game,  nostalgic reminders of a bygone age when offices brimmed with manila folders and piles of forms, or when nurses and doctors searched endlessly on hospital rounds for that one essential patient chart that always seemed missing from the nursing station.  (How many millions of hours have clinicians spent wandering hospital floors looking for those elusive missing paper records?).

“Still, some physicians may be tempted to put off the inevitable, trying to postpone the disruption and expense.  Why not wait five or six years?  Maybe it will get easier?  Less expensive?

“For several reasons.  First, the sooner physicians start using an EHR, the sooner they and their patients will realize its benefits – the ability to share patient data with colleagues and patients, the ability to retrieve old data effortlessly, the ability to access patient records remotely, so they answer patient questions intelligently from home, or even from a medical meeting.

“Second, right now, the federal government is making a once in a lifetime, never to be repeated, offer: it will help physicians pay for the transition with up to $44,000 in extra fees from Medicare, or $63,750 from Medicaid.  Physicians can take the leap now with financial and technical help from the government.  Or they can do it on their own (or facing a financial penalty) in five years.

“Third, anyone who is building a practice, and wanting to recruit young, talented physicians needs to confront the reality that the next generation will expect and demand that their own medical home have a modern information system. I know this from personal experience.  With two children in medical school, and a daughter in law who is an intern, I know young physicians will never settle for paper records.  Wait, and the cream of the recruiting crop will pass you by.

“To me the choice is clear.  Physicians’ professional, clinical and financial interests all point in the same direction.  Become part of the future.  Become a meaningful user of an electronic health record.”

–David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology

See ONC Health IT Buzz Blog to make direct comments.

Beyond Meaningful Use: Learning Health System, a Theme of Listening Session

Posted on by
Reply

Beyond Meaningful Use: Listening Session Looks Ahead to The Learning Health System
The April 6, 2010 listening session (audio link below) for the draft framework for the Health IT Strategic Plan pointed to a concept more far reaching than meaningful use: the Learning Health System. One of the four themes proposed by the Health IT Committee Strategic Plan Workgroup, the  Learning Health System, is based on the charter of  the Institute of Medicine’s Roundtable on Evidence-Based Medicine, since renamed the Roundtable on Value & Science-Driven Health Care.

One of the transformational concepts underlying the learning system moves the physician beyond reliance on their solo expertise toward working in collaboration with the patient, other clinicians, and continuously updated  data resources and scientific evidence to improve patient care.

“A learning health system” according to a slide from the listening session citing the Institute of Medicine, ”is a system that is designed to generate and apply the best evidence for the collaborative health care choices of each patient and provider; to drive the process of new discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care.”

The prior week, the Roundtable sponsored its latest Workshop,  April 1-2, 2010, in Washington, DC, which was  titled “The Learning Healthcare System in 2010 and Beyond: Understanding, engaging, and communicating the possibilities.” The Roundtable, in describing its work, says it develops meetings and projects with leaders from a range of healthcare sectors to achieve “its goal that by 2020, ninety percent of clinical decisions will be supported by accurate timely, and up-to-date clinical information, and will reflect the best available evidence.”

ONC’s Health IT Strategic Framework:
The Learning Health System 
The following section on the Learning Health System, one of four themes, is excerpted from the pre-decisional draft of the ONC’s Health IT Strategic Framework that was discussed at the April 6 listening session of the HIT Policy Committee Strategic Plan Workgroup.
PDF version of draft Framework

Theme 4: Learning Health System 

a. Goal:
Transform the current health care delivery system into a high performance learning system by leveraging health information and technology. 

 b. Principles |
          1. Health information should be used to facilitate rapid learning and innovation in diagnosis, treatment, and decision making to improve health outcomes and to enhance health system value. 

          2. HIT should help engage patients and providers to take active roles in creation and application of evidence-based care.  

c. Objectives 
          1. Use HIT methodologies, policies and standards to foster creation of knowledge across a large network of distributed data sources, while protecting privacy and confidentiality. 

          2. Engage public and private sectors stakeholders at the national, regional, and local levels to effectively leverage data and human resources to advance care delivery, alignment of payment with outcomes, research (e.g., clinical research, comparative effectiveness research), public health (e.g., drug safety monitoring, outbreak surveillance), education (e.g., K-12, colleges, professional schools, professional lifelong learning) and social services to promote and maintain community health. 

           3. Support individuals decision on making their data be used for society (e.g., research and public health), while protecting their privacy. 

          4. Leverage data from populations to expand knowledge and promote scientific discoveries that advance the understanding of health, disease, and treatments. 

d. Strategies 
          1. Continuously evaluate successes and lessons learned through HIT adoption, and actively incorporate best practices into the HIT programs and services. 

                              Provide mechanisms to assess and continuously improve EHR safety. Explore and develop EHR safety measures and reporting mechanisms as learning processes to improve the safety of EHRs. 

           2. Reward, showcase, and leverage industry best practices and innovative uses of HIT to create an active community learning system that supports advances in health promotion and treatment of diseases in the US. Make knowledge and technology accessible to health care professionals and consumers. 

          3. Engage all levels of the public and private sectors, along with the international community, in coordinated activities to advance population health (public health, biomedical research, quality improvement, and emergency preparedness) by using common policies, standards, protocols, legal agreements, specifications, and services for data sharing and building knowledge. 

          4. Stimulate and support innovations in care delivery, performance measurements, genomics, and comparative effectiveness through HIT. 

                             Support research and development activities to overcome obstacles that impede creation of learning systems.  

           5. Incorporate the global health dimension into the interoperability requirements of the learning system infrastructure.  

           6. Harmonize the meaningful-use requirements with the dual needs of population health (clinical research, comparative effectiveness, public health) and a learning system. 

          7. Through a comprehensive education and communications campaign, promote a shared vision of a learning health system and the role of HIT in helping to create it. 

                         Develop and implement educational material and tools to improve consumers’ health and HIT literacy and to promote self management and self efficacy using HIT. 

                        Communicate with professional societies and boards to identify opportunities for meaningful use activities to contribute to professional education programs. 
END OF EXCERPT

Additional Resources:
See earlier post from e-Healthcare Marketing on Listening Session on Strategic Framework.

Materials and audio from April 6, 2010 Listening Session.

Meeting Materials
Meeting
Audio

IOM April 1-2, 2010 Roundtable: “The Learning Healthcare System in 2010 and Beyond: Understanding, engaging, and communicating the possibilities”

Use the tool below to view free online published version of 2006 IOM Workshop on the Learning Health System.
 

Q&A: Electronic Prescriptions for Controlled Substances

Posted on by
Reply

Q&A: Electronic Prescriptions for Controlled Substances
Drug Enforcement Administration (DEA), U.S. Department of Justice
Per Office of National Coordinator (ONC) for Health IT Regulations & Guidance page, “DEA’s rule, “Electronic Prescriptions for Controlled Substances” revises DEA’s regulation to provide practitioners with the option of writing prescriptions for controlled substances electronically.  The regulations will also permit pharmacies to receive, dispense, and archive these electronic prescriptions.  DEA’s discussions with the Office of the National Coordinator for Health Information Technology (ONC), Centers for Medicare and Medicaid Services (CMS), and Agency for Healthcare Research and Quality (AHRQ) were instrumental in the development of this rule.  DEA also worked closely with the National Institute of Standards and Technology (NIST) and the General Services Administration (GSA).”  

General Questions and Answers
[As of 03/31/2010]
DEA Office of Diversion Control

These Questions and Answers were excerpted from DEA’s Office of Diversion Control Web site on April  8, 2010.
The questions and answers below are intended to summarize and provide general information regarding the Drug Enforcement Administration (DEA) Interim Final Rule with Request for Comment “Electronic Prescriptions for Controlled Substances” (75 FR 16236, March 31, 2010) [Docket No. DEA-218, RIN 1117-AA61].  The information provided is not intended to provide specific information about every aspect of the rule, nor is it a substitute for the regulations themselves.  

 GENERAL
Q.  What is DEA’s rule “Electronic Prescriptions for Controlled Substances?”

A.  DEA’s rule, “Electronic Prescriptions for Controlled Substances” revises DEA’s regulations to provide practitioners with the option of writing prescriptions for controlled substances electronically.  The regulations will also permit pharmacies to receive, dispense, and archive these electronic prescriptions.  The rule was published in the Federal Register Wednesday, March 31, 2010 and becomes effective on June 1, 2010. 

Q.  Is the use of electronic prescriptions for controlled substances mandatory?    

A.  No, the new regulations do not mandate that practitioners prescribe controlled substances using only electronic prescriptions.  Nor do they require pharmacies to accept electronic prescriptions for controlled substances for dispensing.  Whether a practitioner or pharmacy uses electronic prescriptions for controlled substances is voluntary from DEA’s perspective.  Prescribing practitioners are still able to write, and manually sign, prescriptions for schedule II, III, IV, and V controlled substances and pharmacies are still able to dispense controlled substances based on those written prescriptions.  Oral prescriptions remain valid for schedule III, IV, and V controlled substances.   

Q.  Did DEA consider public comment in the development of this rule?    

A.  DEA considered almost two hundred separate comments received from the public to the “Electronic Prescriptions for Controlled Substances” Notice of Proposed Rulemaking (73 FR 36722, June 27, 2008) in the development of this rule.   

Q.  Did DEA work with other Federal agencies in the development of this rule?   

A.  DEA worked closely with a number of components within the Department of Health and Human Services.  DEA’s discussions with the Office of the National Coordinator for Health Information Technology (ONC), Centers for Medicare and Medicaid Services (CMS), and Agency for Healthcare Research and Quality (AHRQ) were instrumental in the development of this rule.  DEA also worked closely with the National Institute of Standards and Technology and the General Services Administration.   

IMPLEMENTATION OF RULE
Q.  When can a practitioner start issuing electronic prescriptions for controlled substances?

A.  A practitioner will be able to issue electronic controlled substance prescriptions only when the electronic prescription or electronic health record (EHR) application the practitioner is using complies with the requirements in the interim final rule.    

Q.  When can a pharmacy start processing electronic prescriptions for controlled substances?   

A.  A pharmacy will be able to process electronic controlled substance prescriptions only when the pharmacy application the pharmacy is using complies with the requirements in the interim final rule.    

Q.  How will a practitioner or pharmacy be able to determine that an application complies with DEA’s rule?    

A.  The application provider must either hire a qualified third party to audit the application or have the application reviewed and certified by an approved certification body.  The auditor or certification body will issue a report that states whether the application complies with DEA’s requirements and whether there are any limitations on its use for controlled substance prescriptions.  (A limited set of prescriptions require information that may need revision of the basic prescription standard before they can be reliably accommodated.)  The application provider must provide a copy of the report to practitioners or pharmacies to allow them to determine whether the application is compliant.   

Q.  As a practitioner, until I have received an audit/certification report from my application provider indicating that the application meets DEA’s requirements, how can I use my electronic prescription application or EHR application to write controlled substances prescriptions?   

A.  Nothing in this rule prevents a practitioner or a practitioner’s agent from using an existing electronic prescription or EHR application that does not comply with the interim final rule to prepare and print a controlled substance prescription, so that EHR and other electronic prescribing functionality may be used.  Until the application is compliant with the final rule, however, the practitioner will have to print the prescription for manual signature.  Such prescriptions are paper prescriptions and subject to the existing requirements for paper prescriptions.   

Q.  As a pharmacy, until I have received an audit/certification report from my application provider indicating that the application meets DEA’s requirements, how can I use my pharmacy application to process controlled substances prescriptions?   

A.  A pharmacy cannot process electronic prescriptions for controlled substances until its pharmacy application provider obtains a third party audit or certification review that determines that the application complies with DEA’s requirements and the application provider provides the audit/certification report to the pharmacy.  The pharmacy may continue to use its pharmacy application to store and process information from paper or oral controlled substances prescriptions it receives, but the paper records must be retained.   

Q.  Is identity proofing of individual prescribing practitioners still required and who will conduct it?    

A.  Identity proofing is still required.  It is critical to the security of electronic prescribing of controlled substances that authentication credentials used to sign controlled substances prescriptions are issued only to individuals whose identity has been confirmed.  Individual practitioners will be required to apply to certain Federally approved credential service providers (CSPs) or certification authorities (CAs) to obtain their two-factor authentication credential or digital certificates.  The CSP or CA will be required to conduct identity proofing that meets National Institute of Standards and Technology Special Publication 800-63-1 Assurance Level 3.  Both in person and remote identity proofing will be acceptable.  Institutional practitioners will have the option to conduct in-person identity proofing in-house as part of their routine credentialing process.   

Q.  What two-factor credentials will be acceptable?    

A.  Under the interim final rule, DEA is allowing the use of two of the following – something you know (a knowledge factor), something you have (a hard token stored separately from the computer being accessed), and something you are (biometric information).  The hard token, if used, must be a cryptographic device or a one-time-password device that meets Federal Information Processing Standard 140-2 Security Level 1.   

Q.  How will the two-factor credential be used?    

A.  The practitioner will use the two-factor credential to sign the prescription; that is, using the two-factor credential will constitute the legal signature of the DEA-registered prescribing practitioner.  When the credential is used, the application must digitally sign and archive at least the DEA-required information contained in the prescription.  Because the record will be digitally signed and archived at that point, the proposed requirement for a lock-out period is not needed and is not part of the interim final rule.   

Q.  May a practitioner use his own digital certificate to sign an electronic controlled substance prescription?    

A.  Yes, the interim final rule allows any practitioner to use his own digital certificate to sign electronic prescriptions for controlled substances.  If the practitioner and his application provider wish to do so, the two-factor authentication credential can be a digital certificate specific to the practitioner that the practitioner obtains from a Certification Authority that is cross-certified with the Federal Bridge Certification Authority at the basic assurance level.   

Q.  Must a practitioner separately attest to each prescription?    

A.  No, the application must include, on the prescription review screen, a statement that the use of the two-factor credential is the legal equivalent of a signature, but no keystroke is required to acknowledge the statement.   

Q.  Is it permissible to have a staff person in the practitioner’s office complete all of the required information for a controlled substance prescription and then have the practitioner sign and authorize the transmission of the prescription?    

A.  Yes, however, if an agent of the practitioner enters information at the practitioner’s direction prior to the practitioner reviewing and approving the information, the practitioner is responsible in the event the prescription does not conform in all essential respects to the law and regulations.   

Q.  Can a practitioner print a copy of any electronic prescriptions for controlled substances?   

A.  Yes, the electronic prescription application may print copies of the transmitted prescription(s) if they are clearly labeled: “Copy only – not valid for dispensing.”  Data on the prescription may be electronically transferred to medical records, and a list of prescriptions transmitted may be printed for patients if the list indicates that it is for informational purposes only and not for dispensing.  The copies must be printed after transmission.  If an electronic prescription is printed prior to attempted transmission, the electronic prescription application must not allow it to be transmitted.    

Q.  Will a practitioner be allowed to simultaneously issue multiple prescriptions for multiple patients with a single signature?    

A.  A practitioner is not permitted to issue prescriptions for multiple patients with a single signature.  However, a practitioner is allowed to sign multiple prescriptions for a single patient at one time.  Each controlled substance prescription will have to be indicated as ready for signing, but a single execution of the two-factor authentication protocol can then sign all prescriptions for a given patient that the practitioner has indicated as being ready to be signed.   

Q.  Once an electronic controlled substance prescription is signed, must it be transmitted to the pharmacy immediately?    

A.  No, signing and transmitting an electronic controlled substance prescription are two distinct actions.  Electronic prescriptions for controlled substances should be transmitted as soon as possible after signing, however, it is understood that practitioners may prefer to sign prescriptions before office staff add pharmacy or insurance information, therefore, DEA is not requiring that transmission of the prescription occur simultaneously with signing the prescription.   

Q.  If transmission of an electronic prescription fails, may the intermediary convert the electronic prescription to another form (e.g. facsimile) for transmission?   

A.  No, an electronic prescription must be transmitted from the practitioner to the pharmacy in its electronic form.  If an intermediary cannot complete a transmission of a controlled substance prescription, the intermediary must notify the practitioner.  Under such circumstances, if the prescription is for a schedule III, IV, or V controlled substance, the practitioner can print the prescription, manually sign it, and fax the prescription directly to the pharmacy.  This prescription must indicate that it was originally transmitted to, and provide the name of, a specific pharmacy, the date and time of transmission, and the fact that the electronic transmission failed.   

Q.  What are the restrictions regarding alteration of a prescription during transmission?    

A.  The (DEA-required) contents of a prescription shall not be altered during transmission between the practitioner and pharmacy.  However, this requirement only applies to the content (not the electronic format used to transmit the prescription).  This requirement applies to actions by intermediaries.  It does not apply to changes that occur after receipt at the pharmacy.  Changes made by the pharmacy are governed by the same laws and regulations that apply to paper prescriptions.   

Q.  Are electronic prescription records required to be backed-up, and if so, how often.   

A.  Yes, pharmacy application service providers must back up files daily.  Also, although it is not required, DEA recommends as a best practice that pharmacies store their back-up copies at another location to prevent the loss of the records in the event of natural disasters, fires, or system failures.   

Q.  What should a pharmacist do if he receives a paper or oral prescription that was originally transmitted electronically to the pharmacy?    

A.  The pharmacist must check the pharmacy records to ensure that the electronic version was not received and the prescription dispensed.  If both prescriptions were received, the pharmacist must mark one as void.   

Q.  What should a pharmacist do if he receives a paper or oral prescription that indicates that it was originally transmitted electronically to another pharmacy?    

A.  The pharmacist must check with the other pharmacy to determine whether the prescription was received and dispensed.  If the pharmacy that received the original electronic prescription had not dispensed the prescription, that pharmacy must mark the electronic version as void or canceled.  If the pharmacy that received the original electronic prescription dispensed the prescription, the pharmacy with the paper version must not dispense the paper prescription and must mark the prescription as void.   

Q.  What are the DEA requirements regarding the storage of electronic prescription records?    

A.  Once a prescription is created electronically, all records of the prescription must be retained electronically.  As is the case with paper prescription records, electronic controlled substance prescription records must be kept for a minimum period of two years.    

AUDITS AND CERTIFICATION OF APPLICATIONS
Q.  Who can conduct an audit or certify an application?

A.  Application providers must obtain a third-party audit or certification to certify that each electronic prescription and pharmacy application to be used to sign, transmit, or process controlled substances prescriptions is in compliance with DEA regulations pertaining to electronic prescriptions for controlled substances.  The application may undergo a WebTrust, SysTrust, or SAS 70 audit conducted by a person qualified to conduct such an audit. The application may undergo an audit conducted by a Certified Information System Auditor who performs compliance audits as a regular ongoing business activity. The application may have a certification organization whose certification has been approved by DEA verify and certify that the application meets DEA’s requirements.   

Q.  When must a third-party audit or certification be conducted?    

A.  The third-party audit or certification must be conducted before the electronic prescription application is used to sign or transmit electronic prescriptions for controlled substances, or before the pharmacy application is used to process electronic prescriptions for controlled substances, respectively.  Thereafter, a third-party audit or certification must be conducted whenever a functionality related to controlled substance prescription requirements is altered or every two years, whichever occurs first.   

Q.  To whom does the third-party audit/certification requirement apply?   

A.  The requirement for a third-party audit applies to the application provider, not to the individual practitioner, institutional practitioner, or pharmacy that uses the application.  Unless an individual practitioner, institutional practitioner, or pharmacy has developed its own application, the practitioner or pharmacy is not subject to the requirement.   

See related post on March 25, 2010 on e-Healthcare Marketing.