Blumenthal Blogs on Future of Healthcare with EHRs and New Rules

Posted on July 14, 2010 by Mike Squires

Advancing the Future of Health Care with Electronic Health Records
Tuesday, July 13th, 2010 | Posted by: Dr. David Blumenthal on Health IT Buzz Blog and reposted here by e-Healthcare Marketing here.

Today, we’ve taken great steps forward in bringing America’s health records into the 21^st century. Widespread and meaningful use of fully functional electronic health record systems combined with a robust infrastructure for broad-based health information exchange can improve the quality, safety, and efficiency of health care for all Americans.

As more organizations adopt electronic health records, physicians will have greater access to patient information, allowing faster and more accurate diagnoses. Complete patient data helps ensure the best possible care.

Patients too will have access to their own information and will have the choice to share it with family members securely, over the Internet, to better coordinate care for themselves and their loved ones.

Digital medical records make it possible to improve quality of patient care in numerous ways. For example, doctors can make better clinical decisions with ready access to full medical histories for their patients—including new patients, returning patients, or patients who see several different providers. Laboratory tests or x-rays downloaded and stored in the patient’s electronic health record make it easier to track results. Automatic alerts built into the systems direct attention to possible drug interactions or warning signs of serious health conditions. E-prescribing lets doctors send prescriptions electronically to the pharmacy, so medications can be ready and waiting for the patient.

And while electronic health records require an initial investment of time and money, clinicians who have implemented them have reported saving money in the long term. With the efficiencies that electronic health records promise, their widespread use has the potential to result in significant cost savings across our health care system.

The future looks bright, but the vision can’t become reality without first laying a firm foundation.

Helping us in this endeavor are the providers, software developers, health care administrators, patients, and others on the frontlines of health care. We talked with them about their experiences and expectations of health IT. We heard their aspirations and their reservations. Our commitment to ensure privacy and security of electronic health records and health information exchange will remain at the forefront of all our efforts. We are confident that what we’ve learned from these ongoing conversations will lead to the development of a structure designed to support and improve health care in this country.

The final rules recently released are the blueprints for that structure. The standards and certification final rule, released on July 13, 2010, helps ensure that certified electronic health records will have the capabilities necessary to achieve our goals. And now, with the release of the final rule for the meaningful use of electronic health records, we have a plan for how those capabilities can lead to better health care.

These rules are not an end in and of themselves, but provide us with a plan for the future.

I recognize the challenges and obstacles before us. Fundamental changes are difficult to undertake but I saw the difference an EHR made in my practice and I can clearly see where meaningful use of health information technology can take us.

Now that we have the foundation in place and the blueprints in hand, I encourage you to continue your electronic health record adoption and implementation efforts so we can transform our vision into reality.

– Dr. David Blumenthal, National Coordinator for Health Information Technology
To comment directly on ONC’s Health IT Buzz Blog, click here.

See previous post on e-Healthcare Marketing for Final Rules PDFs, Press Release, Fact Sheets, and additional info.

Final Rule on Meaningful Use, Certification, Standards Announced

Posted on July 13, 2010 by Mike Squires

SECRETARY SEBELIUS ANNOUNCES FINAL RULES TO SUPPORT MEANINGFUL USE OF ELECTRONIC HEALTH RECORDS
July 13, 2010 Press Release from Centers for Medicare and Medicaid Services
Plus PDFs of Final Rules, Joint ONC/CMS Fact Sheet,
ONC and CMS Fact Sheets and FAQs
Blumenthal article from NEJM with Summary Matrix
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KEY LINKS:
Summary of
The “Meaningful Use” Regulation for Electronic Health Records
By David Blumenthal, MD, MPP, National Coordinator for Health IT
and Marilyn Tavenner, RN, MHA, Principal Deputy Administrator of CMS
New England Journal of Medicine, July 13, 2010
Includes matrix with Summary Overview of Meaningful Use Objectives
HTML Version PDF Version

Finding My Way to Electronic Health Records
By Regina Benjamin, MD, MBA, Surgeonn General, US Public Health Service
New England Journal of Medicine, July 13, 2010
HTML Version PDF Version

FINAL RULES
Medicare and Medicaid Programs;
Electronic Health Record Incentive Program [PDF]
http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf

Health Information Technology:
Initial Set of Standards, Implementation Specifications,
and Certification Criteria
for Electronic Health Record Technology [PDF]
http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf
———————————————————————————————
July 13, 2010 Press Release from CMS:
WASHINGTON – U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced final rules to help improve Americans’ health, increase safety and reduce health care costs through expanded use of electronic health records (EHR).

HHS Secretary Kathleen Sebelius

“For years, health policy leaders on both sides of the aisle have urged adoption of electronic health records throughout our health care system to improve quality of care and ultimately lower costs,” Secretary Sebelius said. “Today, with the leadership of the President and the Congress, we are making that goal a reality.”

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. One of the two regulations announced today defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other regulation identifies the technical capabilities required for certified EHR technology.

Announcement of today’s regulations marks the completion of multiple steps laying the groundwork for the incentive payments program. With “meaningful use” definitions in place, EHR system vendors can ensure that their systems deliver the required capabilities, providers can be assured that the system they acquire will support achievement of “meaningful use” objectives, and a concentrated five-year national initiative to adopt and use electronic records in health care can begin.

“This is a turning point for electronic health records in America , and for improved quality and effectiveness in health care,” said David Blumenthal, M.D., National Coordinator for Health Information Technology. “In delivering on the goals that Congress called for, we have sought to provide the leadership and coordination that are essential for a large, technology-based enterprise. At the same time, we have sought and received extensive input from the health care community, and we have drawn on their experience and wisdom to produce objectives that are both ambitious and achievable.”

Two companion final rules were announced today. One regulation, issued by the Centers for Medicare & Medicaid Services (CMS), defines the minimum requirements that providers must meet through their use of certified EHR technology in order to qualify for the payments. The other rule, issued by the Office of the National Coordinator for Health Information Technology (ONC), identifies the standards and certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.

As much as $27 billion may be expended in incentive payments over ten years. Eligible professionals may receive as much as $44,000 under Medicare and $63,750 under Medicaid, and hospitals may receive millions of dollars for implementation and meaningful use of certified EHRs under both Medicare and Medicaid.

The CMS rule announced today makes final a proposed rule issued on Jan, 13, 2010. The final rule includes modifications that address stakeholder concerns while retaining the intent and structure of the incentive programs. In particular, while the proposed rule called on eligible professionals to meet 25 requirements (23 for hospitals) in their use of EHRs, the final rules divides the requirements into a “core” group of requirements that must be met, plus an additional “menu” of procedures from which providers may choose. This “two track” approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing latitude in other areas to reflect providers’ needs and their individual path to full EHR use.

“CMS received more than 2,000 comments on our proposed rule,” said Marilyn Tavenner, Principal Deputy Administrator of CMS. “Many comments were from those who will be most immediately affected by EHR technology – health care providers and patients. We carefully considered every comment and the final meaningful use rules incorporate changes that are designed to make the requirements achievable while meeting the goals of the HITECH Act.”

Requirements for meaningful use incentive payments will be implemented over a multi-year period, phasing in additional requirements that will raise the bar for performance on IT and quality objectives in later years. The final CMS rule specifies initial criteria that eligible professionals (EPs) and eligible hospitals, including critical access hospitals (CAHs), must meet. The rule also includes the formula for the calculation of the incentive payment amounts; a schedule for payment adjustments under Medicare for covered professional services and inpatient hospital services provided by EPs, eligible hospitals and CAHs that fail to demonstrate meaningful use of certified EHR technology by 2015; and other program participation requirements.

Key changes in the final CMS rule include:

Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012. This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.
An objective of providing condition-specific patient education resources for both EPs and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee.
A definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which conforms to the Continuing Extension Act of 2010
CAHs within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.

CMS’ and ONC’s final rules complement two other recently issued HHS rules. On June 24, 2010, ONC published a final rule establishing a temporary certification program for health information technology. And on July 8, 2010 the Office for Civil Rights announced a proposed rule that would strengthen and expand privacy, security, and enforcement protections under the Health Insurance Portability and Accountability Act of 1996.

As part of this process, HHS is establishing a nationwide network of Regional Extension Centers to assist providers in adopting and using in a meaningful way certified EHR technology.

“Health care is finally making the technology advances that other sectors of our economy began to undertake years ago,” Dr. Blumenthal said. “These changes will be challenging for clinicians and hospitals, but the time has come to act. Adoption and meaningful use of EHRs will help providers deliver better and more effective care, and the benefits for patients and providers alike will grow rapidly over time.”

A CMS/ONC fact sheet on the rules is available at http://www.cms.gov/EHRIncentivePrograms/

Technical fact sheets on CMS’s final rule are available at http://www.cms.gov/EHRIncentivePrograms/

A technical fact sheet on ONC’s standards and certification criteria final rule is available at http://healthit.hhs.gov/standardsandcertification.

RULES:
Medicare and Medicaid Programs; Electronic Health Record Incentive Program [PDF]
http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf

Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology [PDF]http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf

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ONC: Electronic Health Records and Meaningful Use
Information for Providers
Information for Consumers

Information excerpted from ONC pages on July 13, 2010.
Electronic health records can provide many benefits for providers and their patients:

Complete and accurate information. With electronic health records, providers have the information they need to provide the best possible care.Providers will know more about their patients and their health history before they walk into the examination room.

Better access to information. Electronic health records facilitate greater access to the information providers need to diagnose health problems earlier and improve the health outcomes of their patients. Electronic health records also allow information to be shared more easily among doctors’ offices, hospitals, and across health systems, leading to better coordination of care.

Patient empowerment. Electronic health records will help empower patients to take a more active role in their health and in the health of their families. Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families.

Currently, most health care providers still use medical record systems based on paper. New government incentives and programs are helping health care providers across the country make the switch to electronic health records.

Why Electronic Health Records?
Electronic health records can improve care by enabling functions that paper medical records cannot deliver:

EHRs can make a patient’s health information available when and where it is needed – too often care has to wait because the chart is in one place and needed in another. EHRs enable clinicians secure access to information needed to support high quality and efficient care
EHRs can bring a patient’s total health information together to support better health care decisions, and more coordinated care
EHRs can support better follow-up information for patients – for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided; and reminders for other follow-up care can be sent easily or even automatically to the patient.
EHRs can improve patient and provider convenience – patients can have their prescriptions ordered and ready even before they leave the provider’s office, and insurance claims can be filed immediately from the provider’s office.

Background: Legislation and RegulationsThe Health Information Technology for Economic and Clinical Health (HITECH) Act provides HHS with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health information technology (HIT), including electronic health records and private and secure electronic health information exchange.Under HITECH, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. Two regulations have been released, one of which defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other which identifies the technical capabilities required for certified EHR technology.

Incentive Program for Electronic Health Records: Issued by the Centers for Medicare & Medicaid Services (CMS), this final rule defines the minimum requirements that providers must meet through their use of certified EHR technology in order to qualify for the payments.
Standards and Certification Criteria for Electronic Health Records: Issued by the Office of the National Coordinator for Health Information Technology, this rule identifies the standards and certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.

JOINT ONC/CMS FACT SHEET
CMS AND ONC FINAL REGULATIONS DEFINE MEANINGFUL USE AND SET STANDARDS FOR ELECTRONIC HEALTH RECORD INCENTIVE PROGRAM
Excerpted from CMS site on July 13, 2010.
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) today announced two complementary final rules to implement the electronic health records (EHR) incentive program under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009, the HITECH Act supports the adoption of electronic health records by providing financial incentives under Medicare and Medicaid to hospitals and eligible professionals who implement and demonstrate “meaningful use” certified EHR technology. The CMS regulations announced today specify the objectives that providers must achieve in payment years 2011 and 2012 to qualify for incentive payments; the ONC regulations specify the technical capabilities that EHR technology must have to be certified and to support providers in achieving the “meaningful use” objectives.

The final CMS rule:

Specifies initial criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet to demonstrate meaningful use and qualify for incentive payments.
Includes both “core” criteria that all providers must meet to qualify for payments, while also allowing provider choice among a “menu set” of additional criteria.
Outlines a phased approach to implement the requirements for demonstrating meaningful use. This approach initially establishes criteria for meaningful use based on currently available technological capabilities and providers’ practice experience. CMS will establish graduated criteria for demonstrating meaningful use through future rulemaking, consistent with anticipated developments in technology and providers’ capabilities.

The CMS rule finalizes a Notice of Proposed Rulemaking published on Jan 13, 2010.

The final ONC rule:

Sets initial standards, implementation specifications, and certification criteria for EHR technology under the incentive program.
Coordinates the standards required of EHR systems with the meaningful use requirements for eligible professionals and hospitals
With these standards in place, providers can be assured that the certified EHR technology they adopt is capable of performing the required functions to comply with CMS’ meaningful use requirements and other administrative requirements of the Medicare and Medicaid EHR incentive programs.

ONC’s standards and certification criteria final rule completes the adoption of an initial set of standards, implementation specifications and certification criteria that was begun with publication of ONC’s on Jan. 13, 2010.

Timetable for Implementation
The HITECH Act states that payments for Medicare providers may begin no sooner than October 2010 for eligible hospitals and January 2011 for EPs. The final rule aligns the Medicare and Medicaid program start dates. Key steps in the implementation timeline include:

ONC began accepting applications from entities that seek approval as an ONC-Authorized Testing and Certification Body (ONC-ATCB) on July 1, 2010.

ONC projects that certified EHR software will be available for purchase by hospitals and eligible professionals by fall, 2010.

Registration by both EPs and eligible hospitals with CMS for the EHR incentive program will begin in January 2011. Registration for both the Medicare and Medicaid incentive programs will occur at one virtual location, managed by CMS.
For the Medicare program, attestations may be made starting in April 2011 for both EPs and eligible hospitals.
Medicare EHR incentive payments will begin in mid May 2011.
States will be initiating their incentive programs on a rolling basis, subject to CMS approval of the State Medicaid HIT plan, which details how each State will implement and oversee its incentive program.

The “Meaningful Use” Model
By focusing on the effective use of EHRs with certain capabilities, the HITECH Act makes clear that the adoption of records is not a goal in itself: it is the use of EHRs to achieve health and efficiency goals that matters. HITECH’s incentives and assistance programs seek to improve the health of Americans and the performance of their health care system through “meaningful use” of EHRs to achieve five health care goals:

To improve the quality, safety, and efficiency of care while reducing disparities;
To engage patients and families in their care;
To promote public and population health;
To improve care coordination; and
To promote the privacy and security of EHRs.

In the context of the EHR incentive programs, “demonstrating meaningful use” is the key to receiving the incentive payments. It means meeting a series of objectives that make use of EHRs’ potential and related to the improvement of quality, efficiency and patient safety in the healthcare system through the use of certified EHR technology.

Coordinated Approach to Support EHR Adoption
CMS’ and ONC’s final rules complement two other rules that were recently issued. On June 24, 2010, ONC published a final rule to establish a temporary certification program for health information technology. And on July 8, 2010, the Office for Civil Rights announced a proposed rule that would strengthen and expand privacy, security, and enforcement protections under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Together the four rules are key components of the regulatory structure needed to administer the EHR incentive program and to meet the goals of the HITECH Act:

The assurance of privacy protections is fundamental to the success of EHR adoption. The refinements and expansions of HIPAA provisions announced July 8 form an important base for EHR acceptance and use.

The temporary certification process published June 24 establishes a process through which organizations can be approved as certifying entities to which vendors may submit their EHR systems for review and certification.
The ONC rule announced today identifies the technical standards which must be met in the certification process, and coordinates those requirements with the meaningful use objectives.
Finally, the CMS rule announced today establishes guidelines and requirements on achieving meaningful use in clinical settings and qualifying for incentive payments based on this meaningful use.

Key Provisions of the Final Rule
CMS’s final meaningful use rule incorporates changes from the proposed rule on meaningful use that are designed to make the requirements more readily achievable while meeting the goals of the HITECH Act. For Stage 1, which begins in 2011, the criteria for meaningful use focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information.

The final rule reflects significant changes to the proposed rule while retaining the intent and structure of the incentive programs. Key provisions in the final rule include:

For Stage 1, CMS’s proposed rule called on physicians and other eligible professionals to meet 25 objectives (23 for hospitals) in reporting their meaningful use of EHRs. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers can choose. This “two track” approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing latitude in other areas to reflect providers’ varying needs and their individual paths to full EHR use.
In line with recommendations of the Health Information Technology Policy Committee, the final rule includes the objective of providing patient-specific educational resources for both EPs and eligible hospitals and the objective of recording advance directives for eligible hospitals.
With respect to defining hospital-based physicians, the final rule conforms to the Continuing Extension Act of 2010. That law addressed provider concerns about hospital-based providers in ambulatory settings being unable to qualify for incentive payments by defining a hospital-based EP as performing substantially all of his or her services in an inpatient hospital setting or emergency room only.
The rule makes final a proposed rule definition that would make individual payments to eligible hospitals identified by their individual CMS Certification Number. The final rule retains the proposed definition of an eligible hospital because that is most consistent with policy precedents in how Medicare has historically applied the statutory definition of a ”subsection (d)” hospital under other hospital payment regulations.
Under Medicaid, the final rule includes critical access hospitals (CAHs) in the definition of acute care hospital for the purpose of incentive program eligibility.

The final rule’s economic analysis estimates that incentive payments under Medicare and Medicaid EHR programs for 2011 through 2019 will range from $9.7 billion to $27.4 billion.

Development of the Rules
CMS and ONC worked closely to develop the two rules and received input from hundreds of technical subject matters experts, health care providers, consumers, and other key stakeholders. Numerous public meetings to solicit public comment were held by three Federal advisory committees: the National Committee on Vital and Health Statistics (NCVHS), the HIT Policy Committee (HITPC), and the HIT Standards Committee (HITSC). HITSC presented its final recommendations to the National Coordinator in August 2009.

CMS published its proposed rule on Jan. 13, 2010. The agency actively solicited comments on its proposal and received more than 2,000 submissions by the close of the 60-day comment period. These comments, along with the input from advisory groups and outreach activities, were given careful consideration in developing the regulations announced today.
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ELECTRONIC HEALTH RECORDS AT A GLANCE
CMS FACT SHEET With Frequently Asked Questions
Excerpted from CMS site on July 14, 2010.

“Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy and save lives.”
- President Obama, Address to Joint Session of Congress, February 2009

Background
As promised by the President, the American Recovery and Reinvestment Act of 2009 included under which, according to current estimates, as much as $27 billion over ten years will be expended to support adoption of electronic health records (EHRs). While there has been bipartisan support for EHR adoption for at least half a decade, this is the first substantial commitment of federal resources to support adoption and help providers identify the key functions that will support improved care delivery.

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), federal incentive payments will be available to doctors and hospitals when they adopt EHRs and demonstrate use in ways that can improve quality, safety and effectiveness of care. Eligible professionals can receive as much as $44,000 over a five-year period through Medicare. For Medicaid, eligible professionals can receive as much as $63,750 over six years. Medicaid providers can receive their first year’s incentive payment for adopting, implementing and upgrading certified EHR technology but must demonstrate meaningful use in subsequent years in order to qualify for additional payments.

Since enactment of HITECH in February 2009, the Office of the National Coordinator for Health Information Technology (ONC), the Centers for Medicare & Medicaid Services (CMS) and other HHS agencies have been laying the groundwork for the massive national investment in EHRs:

Creation of Regional Extension Centers (RECs) to support providers in adopting EHRs
Developing workforce training programs
Identifying “Beacon Communities” that lead the way in adoption and use of EHRs
Developing capabilities for information exchange, including building toward a Nationwide Health Information Network
Improving privacy and security provisions of federal law, to bolster protection for electronic records
Creating a process to certify EHR technology, so providers can be assured that the EHR technology they acquire will perform as needed
Identifying standards for certification of products, tied to “meaningful use” of EHRs
Identifying the “meaningful use” objectives that providers must demonstrate to qualify for incentive payments.
Supporting State Medicaid Agencies in the planning and development of their Medicaid EHR Incentive programs with 90/10 matching funds.

Why EHRs?
Electronic health records improve care by enabling functions that paper records cannot deliver:

EHRs can make a patient’s health information available when and where it is needed – it is not locked away in one office or another.
EHRs can bring a patient’s total health information together in one place, and always be current – clinicians need not worry about not knowing the drugs or treatments prescribed by another provider, so care is better coordinated.
EHRs can support better follow-up information for patients – for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided; and reminders for other follow-up care can be sent easily or even automatically to the patient.
EHRs can improve patient and provider convenience – patients can have their prescriptions ordered and ready even before they leave the provider’s office, and insurance claims can be filed immediately from the provider’s office.
EHRs can link information with patient computers to point to additional resources – patients can be more informed and involved as EHRs are used to help identify additional web resources.
EHRs don’t just “contain” or transmit information, they also compute with it – for example, a qualified EHR will not merely contain a record of a patient’s medications or allergies, it will also automatically check for problems whenever a new medication is prescribed and alert the clinician to potential conflicts.
EHRs can improve safety through their capacity to bring all of a patient’s information together and automatically identify potential safety issues — providing “decision support” capability to assist clinicians.
EHRs can deliver more information in more directions, while reducing “paperwork” time for providers –for example, EHRs can be programmed for easy or automatic delivery of information that needs to be shared with public health agencies or quality measurement, saving clinician time.
EHRs can improve privacy and security – with proper training and effective policies, electronic records can be more secure than paper.
EHRs can reduce costs through reduced paperwork, improved safety, reduced duplication of testing, and most of all improved health through the delivery of more effective health care.

Why “meaningful use” requirements?
EHRs do not achieve these benefits merely by transferring information from paper form into digital form. EHRs can only deliver their benefits when the information and the EHR are standardized and “structured” in uniform ways, just as ATMs depend on uniformly structured data. Therefore, the “meaningful use” approach requires identification of standards for EHR systems. These are contained in the ONC Standards and Certification regulation announced on July 13, 2010.

Similarly, EHRs cannot achieve their full potential if providers don’t use the functions that deliver the most benefit – for example, exchanging information, and entering orders through the computer so that the “decision support” functions and other automated processes are activated. Therefore, the “meaningful use” approach requires that providers meet specified objectives in the use of EHRs, in order to qualify for the incentive payments. For example: basic information needs to be entered into the qualified EHR so that it exists in the “structured” format; information exchange needs to begin; security checks need to be routinely made; and medical orders need to be made using Computerized Provider Order Entry (CPOE). These requirements begin at lower levels in the first stage of meaningful use, and are expected to be phased in over five years. Some requirements are “core” needs, but providers are also given some choice in meeting additional criteria from a “menu set.”

Identification of the “meaningful use” goals and standards is the keystone to successful national adoption of EHRs. The announcement of final “meaningful use” regulations on July 13, 2010, marks the launch of the Nation’s push for EHR adoption and use.

Looking ahead
What is the timetable for approving the organizations that will certify EHR systems as qualifying for “meaningful use?”

ONC anticipates that the first entities will be authorized as ONC-ATCBs before the end of summer.

How soon can we expect certified EHR systems to be available?

We anticipate that certified EHR systems will be available later in the fall.

How will be the CMS EHR incentive program registration process work?

Medicare: Hospitals and eligible professionals can register for the program starting in January 2011. Once the programs begin, a link on the Registration web page on http://cms.gov/EHRIncentivePrograms/ will be available. Providers can use this central website to get information about the program and link to the programs’ online registration system.
Medicaid: The registration process will be the same for the Medicaid Incentive Program as for Medicare. A link on the Registration web page on http://cms.gov/EHrIncentivePrograms/ will be available when the program begins. Eligible Providers under the Medicaid Incentive Program can register at this site whether or not their state has initiated their program yet and CMS will pass their information on the state once the state initiates their program.

How will providers demonstrate that they have achieved the “meaningful use” objectives required by the regulation?

For 2011, CMS will accept provider attestations for demonstration of all the meaningful use measures, including clinical quality measures. Starting in 2012, CMS will continue attestation for most of the meaningful use objectives but plans to initiate the electronic submission of the clinical quality measures. States will also support attestation initially and then subsequent electronic submission of clinical quality measures for Medicaid providers’ demonstration of meaningful use.

How and when will incentive payments be made?

CMS expects to initiate Medicare incentive payments nine months after the publication of the final rule. For Medicaid, States are determining their own deadlines for launching their Medicaid EHR Incentive programs but are required to make timely payments, per the CMS final rule. CMS expects that the majority of States will have launched their programs by the summer of 2011.

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Standards and Certification Criteria Final Rule:
Fact Sheet
Excerpted from ONC site on July 14, 2010

The Health Information Technology for Economic and Clinical Health (HITECH) Act provides HHS with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health information technology (HIT), including electronic health records (EHRs) and private and secure electronic health information exchange.

The HITECH Act directs the Office of the National Coordinator for Health Information Technology (ONC) to support and promote meaningful use of certified EHR technology nationwide through the adoption of standards, implementation specifications, and certification criteria as well as the establishment of certification programs for HIT.

About the Standards and Certification Criteria Final Rule
Two companion regulations were announced today. ONC’s final rule complements a final rule announced by the Centers for Medicare & Medicaid Services (CMS) that defines the minimum requirements that providers must meet through their use of EHRs in order to qualify for payments under the Medicare and Medicaid EHR incentive programs. The ONC rule establishes the required capabilities and related standards and implementation specifications that Certified EHR Technology will need to include to, at a minimum, support the achievement of meaningful use Stage 1 by eligible health care providers under the Medicare and Medicaid EHR Incentive Program regulations.

What Standards and Certification Criteria Mean for Health Care Providers
Both the Medicare and Medicaid EHR incentive programs include a requirement related to certified EHR technology. Under the Medicare EHR incentive program, eligible health care providers may receive incentive payments if they adopt and meaningfully use certified EHR technology (Complete EHR or EHR Modules that have been certified by an Office of the National Coordinator for Health Information Technology-Authorized Testing and Certification Body (ONC-ATCB)). Under the Medicaid EHR incentive program, eligible health care providers may first adopt, implement, or upgrade to certified EHR technology in their first year of the program and receive an incentive payment before having to meaningfully use certified EHR technology. The standards and certification criteria final rule specifies the necessary technological capabilities EHR technology will need to include, for the EHR technology to be certified by an ONC-ATCB. Additionally, it specifies how eligible health care providers will need to use the certified EHR technology to meet applicable meaningful use requirements.

What Standards and Certification Criteria Mean for Developers of EHR Technology
Developers of EHR technology who design their EHR technology in accordance with this final rule and subsequently get their EHR technology tested and certified by an ONC authorized testing and/or certified entity are assured that their EHR technology can be adopted by eligible health care providers who seek to achieve meaningful use Stage 1.For other questions related to the standards and certification criteria, please email onc.request@hhs.gov

Standards and Certification Criteria, visit http://healthit.hhs.gov/standardsandcertification
Medicare and Medicaid EHR incentive programs, visit http://www.cms.gov/EHRIncentivePrograms/

Standards and Certifications Criteria Final Rule:
Frequently Asked Questions
Excerpted from ONC site on July 14, 2010.

A. Background/GeneralKey Messages

Health Care Providers: Key Points
Both the Medicare and Medicaid electronic health record (EHR) incentive programs include a requirement related to certified EHR technology. Under the Medicare EHR incentive program, eligible health care providers must adopt and meaningfully use certified EHR technology (Complete EHR or EHR Modules that have been certified by an Office of the National Coordinator for Health Information Technology-Authorized Testing and Certification Body (ONC-ATCB)). Under the Medicaid EHR incentive program, eligible health care providers may first adopt, implement, or upgrade to certified EHR technology in their first year of the program and receive an incentive payment before having to meaningfully use certified EHR technology. The standards and certification criteria final rule specifies the necessary technological capabilities EHR technology will need to include in order be certified by an ONC-ATCB and subsequently used by eligible health care providers to meet applicable meaningful use requirements.

Developers of EHR Technology: Key Points
Developers of EHR technology who design their EHR technology in accordance with this final rule and subsequently get their EHR technology tested and certified by an ONC-ATCB are assured that their EHR technology can be adopted by eligible health care providers who seek to achieve meaningful use Stage 1.

B. Standards and Certification

B1. What is the standards and certification criteria final rule?
The final rule establishes the required capabilities and related standards and implementation specifications that Certified EHR Technology will need to include to, at a minimum, support the achievement of meaningful use Stage 1 by eligible health care providers under the Medicare and Medicaid EHR Incentive Programs.

B2. What are the major differences between the standards and certification interim final rule and the final rule?
In large part, the final rule is very similar to the interim final rule. However, in response to public comments, the final rule clarifies or revises certain standards and certification criteria. As noted in the final rule, some of the adopted certification criteria were revised to realign with changes to the Medicare and Medicaid EHR Incentive Programs final rule.

B3. What is the difference between a Complete EHR and an EHR Module?
Complete EHR refers to EHR technology that has been developed to meet, at a minimum, all applicable certification criteria adopted by the Secretary. For Complete EHRs designed for an ambulatory setting this means all of the certification criteria adopted at 45 CFR 170.302 and 45 CFR 170.304. For Complete EHRs designed for an inpatient setting this means all of the certification criteria adopted at 45 CFR 170.302 and 45 CFR 170.306. These certification criteria represent the minimum capabilities EHR technology needs to include and have properly implemented in order to achieve certification. They do not preclude Complete EHR developers from including additional capabilities that are not required for the purposes of certification.

EHR Module refers to any service, component, or combination thereof that meets at least one certification criterion adopted by the Secretary. EHR Modules, by definition, must provide a capability that can be tested and certified in accordance with at least one certification criterion adopted by the Secretary. Therefore, if an EHR Module does not provide a capability that can be tested and certified at the present time, it is not HIT that would meet the definition of EHR Module. We stress “at the present time,” because as new certification criteria are adopted by the Secretary, other HIT could be developed and then tested and certified in accordance with the new certification criteria as EHR Modules. An EHR Module could provide a single capability required by one certification criterion or it could provide all capabilities but one, required by the certification criteria for a Complete EHR. In other words, we would call HIT tested and certified to one certification criterion an “EHR Module” and HIT tested and certified to nine certification criteria an “EHR Module,” where ten certification criteria are required for a Complete EHR.

B4. CMS has specified a number of clinical quality measures for meaningful use. What clinical quality measures must EHR technology include in order to be certified?
In order to be certified, a Complete EHR or EHR Module designed for an ambulatory setting must be tested and certified as including at least nine clinical quality measures specified by CMS – all six of the core (three core and three alternate core) clinical quality measures specified, and at least three of the additional measures. Complete EHR and EHR Module developers may include as many clinical quality measures above that requirement as they see fit.A Complete EHR or EHR Module designed for an inpatient setting must include and will be required to be tested and certified to all of the clinical quality measures specified by CMS.

B5. Does EHR technology need to include administrative transactions capabilities?
No, we have removed these capabilities as conditions of certification for EHR technology in support of meaningful use Stage 1, but intend to revisit their inclusion for Stage 2.

C. Certification Process

C1. Where can I find out about the certification process?
For more information on the temporary certification program and the certification process, visit http://healthit.hhs.gov/tempcert.

D. Comments on the Interim Final Rule

D1. Where can I learn about how my comments on the interim final rule on standards and certification criteria, issued in January, were addressed in the final rule?
ONC staff carefully reviewed and considered each of the approximately 400 timely comments received on the standards and certification criteria interim final rule. Section III of the standards and certification criteria final rule discusses how the comments were addressed and incorporated into the final rule.

E. Related Rules

E1. How is this final rule related to the Medicare and Medicaid EHR Incentive Programs final rule?This final rule completes the adoption of an initial set of standards, implementation specifications, and certification criteria, and more closely aligns such standards, implementation specifications, and certification criteria with final meaningful use Stage 1 objectives and measures. Adopted certification criteria establish the required capabilities and specify the related standards and implementation specifications that certified EHR technology will need to include to, at a minimum, support the achievement of meaningful use Stage 1 by eligible professionals, eligible hospitals, and/or critical access hospitals.

ONC: Building Trust in HIE, Changes to HIPAA Privacy/Security Proposed

Posted on July 8, 2010 by Mike Squires

Blumenthal, ONC; and Verdugo, HHS Office of Civil Rights Release
“Statement on Privacy and Security”
Plus New Web site, FAQs, HHS Press Release, Blog Post

PDF: Notice of Proposed Rule Making (NPRM):
Modifications to the HIPAA Privacy, Security, and Enforcement Rules
under HITECH

Joint ONC/OCR Statement on Privacy and Security
David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (HHS); and
Georgina Verdugo, Director, Office for Civil Rights, HHS

As the Department of Health and Human Services (HHS or The Department) continues its efforts to improve the health and care of all Americans by promoting the advancement of health information technology (IT), one of the Department’s guiding principles is that the benefits of health IT can only be fully realized if patients and providers are confident that electronic health information is kept private and secure. HHS’s goal, as directed by the 2009 Health Information Technology for Clinical and Economic Health (HITECH) Act, is to improve the nation’s health care system by enabling health information to follow the patient wherever and whenever it is needed. The HHS Office of the National Coordinator for Health Information Technology (ONC) and the HHS Office for Civil Rights (OCR) are working jointly on a number of projects to ensure that this electronic exchange of health information is built on a foundation of privacy, and security.

On July 8, 2010, HHS announced proposed regulations under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 that would expand individuals’ rights to access their information and restrict certain disclosures of protected health information to health plans, extend the applicability of certain of the Privacy and Security Rules’ requirements to the business associates of covered entities, establish new limitations on the use and disclosure of protected health information for marketing and fundraising purposes, and prohibit the sale of protected health information without patient authorization. In addition, the proposed rule is designed to strengthen and expand OCR’s ability to enforce HIPAA’s Privacy and Security provisions. This rulemaking will strengthen the privacy and security of health information, and is an integral piece of the Administration’s efforts to broaden the use of health information technology in health care today. We urge consumers, providers, and other stakeholders to read these proposals and offer comments during the 60-day comment period, which will officially open on July 14, 2010. Information about posting comments will be available at http://www.regulations.gov.

Additionally, over the past few months, ONC and OCR have embarked on a number of other initiatives that serve to integrate privacy and security into the nation’s health IT efforts. As directed by HITECH, ONC established a new Chief Privacy Officer (CPO) position to provide critical advice to the National Coordinator in developing and implementing ONC’s privacy and security programs. The new CPO, Joy Pritts, JD, will play a key role in helping ONC design new policies to address privacy and security issues in every phase of health IT development and implementation.

On August 24, 2009, OCR issued an interim final breach notification regulation, which improves transparency and acts as an incentive to the health care industry to improve privacy and security by requiring HIPAA covered entities to promptly notify affected individuals, the HHS Secretary and, in some cases the media, of a breach. This new federal law holds covered entities and business associates accountable to the Department and to individuals for proper safeguarding of the private information entrusted to their care.

ONC is coordinating with the Centers for Medicare & Medicaid Services (CMS) on CMS’s development of a final regulation on the Medicare and Medicaid Electronic Health Record Incentives Programs. The incentives programs promote critical privacy and security measures and business practices. ONC also is developing a final regulation on standards and certification criteria to ensure that electronic health records (EHRs) contain the capabilities to support needed privacy and security requirements.

With respect to security, the Department also embarked on a number of initiatives. OCR coordinated with the National Institute of Standards and Technology to host a conference focused on the HIPAA Security Rule. OCR also issued draft guidance in conducting a HIPAA Security Risk Analysis to assist organizations in identifying and implementing the most effective and appropriate administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of electronic protected health information. Additionally, an advisory committee on HIT standards held hearings to better understand security priorities, the effectiveness of security procedures, and vulnerabilities.

All these activities only serve as a prelude to our ongoing efforts to ensure that electronic health information is private and secure. In addition:

ONC and OCR are working together with representatives of consumer and industry groups to promote the adoption of privacy and security safeguards as essential components of implementing health information technology.
ONC is ensuring that the technical and policy foundations of the nationwide health information network will demonstrate methods for achieving trust among entities exchanging information while integrating best practices for privacy and security. A privacy and security workgroup (known as a “Tiger Team”) of the Health Information Technology Policy Committee (HITPC) was convened with strong consumer representation to hold public deliberations and make recommendations related to patient choice in how health information is exchanged; consumer access to health information; personal health records (PHRs); segmentation of health information; and transparency about information sharing and protections.
ONC staff is working with the President’s cybersecurity initiative and other Federal partners to solicit input from the best security minds in the federal government. Based on these activities, ONC will provide direction on security best practices and standards to technical and policy decision makers for inclusion in health information exchange programs.
Finally, the Department is working to provide the private sector with greater resources for improving privacy and security. Regional Extension Centers will educate providers about necessary privacy and security measures. Curriculum Development Centers Programs will incorporate necessary information into standard curricula for Community College Consortia, where a new cadre of HIT professionals will be trained, and for University-Based Training Programs, where health professionals will learn about HIT. State Health Information Exchange Cooperative Agreements and Beacon Communities grants will provide living examples of how privacy and security are successfully implemented and brought to scale.

Our Nation is poised to harness the power of information technology to improve health care. Transforming our health care system into a 21st century model is a bold agenda. As we enter into a new age of electronic health information exchange, it is more important than ever to ensure consumer trust in the privacy and security of their health information and in the industry’s use of new technology.
# # #

Excerpted from ONC Health IT Buzz Blog on July 8, 2010:
Privacy and Security
Thursday, July 8th, 2010 | Posted by: Joy Pritts, Chief Privacy Officer on Health IT Buzz Blog and republished here by e-Healthcare Marketing.
Privacy and security are the bedrock of building trust in health information exchange. The proposed modifications to the HIPAA Privacy & Security Rules, announced today, are a significant step forward in HHS’s efforts to protect patient privacy rights while encouraging the adoption of electronic health information exchange. The next phase of this process is just as important—obtaining public feedback and suggestions concerning the proposed rules. The comment period will begin once the rule is published in the Federal Register on July 14. You can submit your comments electronically through http://www.regulations.gov/ or via mail (original and 2 copies) to the Office for Civil Rights at: Office for Civil Rights, Attention: HITECH Privacy Rule Modifications, Hubert H. Humphrey Building, Room 509F, 200 Independence Avenue, S.W., Washington, D.C. 20201. HHS is looking forward to receiving your input.
# # #

HHS Press Release on July 8, 2010:
HHS Strengthens Health Information Privacy and Security through New Rules
New health privacy website launched

HHS Secretary Kathleen Sebelius today announced important new rules and resources to strengthen the privacy of health information and to help all Americans understand their rights and the resources available to safeguard their personal health data. Led by the Office of the National Coordinator for Health Information Technology (ONC) and the HHS Office for Civil Rights (OCR), HHS is working with public and private partners to ensure that, as we expand the use of health information technology to drive improvements in the quality and effectiveness of our nation’s health care system, Americans can trust that their health information is protected and secure.

“To improve the health of individuals and communities, health information must be available to those making critical decisions, including individuals and their caregivers,” said HHS Secretary Kathleen Sebelius. “While health information technology will help America move its health care system forward, the privacy and security of personal health data is at the core of all our work.”

Through the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, current health information privacy and security rules will now include broader individual rights and stronger protections when third parties handle individually identifiable health information.

The proposed rule announced today would strengthen and expand enforcement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Enforcement Rules by:

expanding individuals’ rights to access their information and to restrict certain types of disclosures of protected health information to health plans.
requiring business associates of HIPAA-covered entities to be under most of the same rules as the covered entities;
setting new limitations on the use and disclosure of protected health information for marketing and fundraising; and
prohibiting the sale of protected health information without patient authorization.

“The benefits of health IT can only be fully realized if patients and providers are confident that electronic health information is kept private and secure at all times,” said Georgina Verdugo, OCR director at HHS. “This proposed rule strengthens the privacy and security of health information, and is an integral piece of the administration’s efforts to broaden the use of health information technology in health care today.”

HHS is also looking more closely at entities that are not covered by HIPAA rules to understand better how they handle personal health information and to determine whether additional privacy and security protections are needed for these entities.

“Giving more Americans the ability to access their health information wherever, whenever and in whatever form is a critical first step toward improving our health care system,” said HHS’ national coordinator for health information technology, David Blumenthal, M.D., M.P.P. “Empowering Americans with real-time and secure access to the information they need to live healthier lives is paramount.”

HHS also launched today a privacy website at http://www.hhs.gov/healthprivacy/index.html to help visitors easily access information about existing HHS privacy efforts and the policies supporting them. The site emphasizes HHS’ deep commitment to privacy in the collection, use, and exchange of personally identifiable information. This new resource provides Americans with confidence that their personal information is secure and underscores HHS’ goal of greater openness and transparency in government.

The HITECH Act established the position of Chief Privacy Officer in ONC. Joy Pritts recently assumed the new position and is leading HHS efforts to develop and implement privacy and security programs and polices related to electronic health information.

“HHS strongly believes that an individual’s personal information is to be kept private and confidential and used appropriately by the right people, for the right reasons,” said Pritts. “Without such assurances, an individual may be hesitant to share relevant health information.”

For more information about the proposed rule announced today visit http://www.ofr.gov/OFRUpload/OFRData/2010-16718_PI.pdf

For other HHS Recovery Act programs, see
http://www.hhs.gov/recovery/programs/index.html#Health.

# # #

New HHS Web Site:
Health Data Privacy and Security Resources
http://www.hhs.gov/healthprivacy
The contents of the Health Data Privacy and Security Resources section have been excerpted below on July 8, 2010.

HHS respects the privacy of your personal information, and this page will help you find privacy resources throughout HHS.

This page provides key messages and access to resources emphasizing HHS’ commitment to privacy as a fundamental consideration in its collection, use, and exchange of personally identifiable information. This central resource helps visitors easily access information about existing HHS privacy efforts and the policies supporting them.

In support of HHS’ vision for Open Government and Transparency, this resource is to provide further confidence in the expectations Americans have for the privacy of their personal information and is to inspire added trust in HHS’ efforts to improve our nation’s health through safe and secure health information exchanges. HHS strongly believes that an individual’s personal information is to be kept private, confidential and used appropriately by the right people, for the right reasons. Without such assurances, an individual may be hesitant to share relevant health information.

More information about HHS’ commitment to health data privacy can be found in the notice of proposed rulemaking (NPRM) issued July 8, 2010; in the Frequently Asked Questions (FAQs); and the OCR/ ONC Joint statement on the NPRM.

You can access more information on health data privacy through the links provided below.

Privacy Policies

HHS Privacy Impact Assessments

The Privacy Act

Your Right to Federal Records: Questions and answers on the Freedom of Information Act and Privacy Act.

Health Information Portability and Accountability Act

Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules

Electronic Health Information Exchange Privacy and Security

Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information

Department Privacy Resources

Privacy Protection for Research Subjects: Certificates of Confidentiality

National Center for Health Statistics

HHS Privacy Committee

# # #

Privacy and Security: Frequently Asked Questions

The FAQs have been excerpted from the Health Data Privacy and Security Resources section on July 8, 2010 and reproduced below.

1. What is the role of the Chief Privacy Office in the Office of the National Coordinator for Health Information Technology (ONC)?
Section 13101 of the HITECH Act (2009) required that a new Chief Privacy Officer (CPO) position be established in ONC. The CPO will advise the National Coordinator on critical privacy and security policies and will play a key role in the design of new policies to assure that privacy and security is addressed in every phase of health IT development and implementation. The Chief Privacy Officer will also coordinate with other federal agencies, states and regions, and international efforts.

2. What are respective roles of ONC and OCR regarding privacy and security?
The Office for Civil Rights (OCR) within the Department of Health and Human Services has the regulatory authority for the HIPAA Privacy and Security rules. OCR also issues guidance and interpretations on HIPAA Privacy and Security rules, including how these rules apply to electronic health records, personal health records, and health information technology. OCR has enforcement authority to ensure compliance with the HIPAA Privacy and Security Rules through investigation and the ability to impose civil monetary penalties. The HITECH Act of 2009 enhanced many of the Privacy Rule provisions, including extending certain requirement to business associates; limiting uses and disclosure of protected health information for marketing; prohibiting the sale of protected health information (PHI) without patient authorization; expanding individuals’ rights to access their information and restrict certain PHI disclosures to health plans; and providing greater enforcement authority to OCR. The Office of the National Coordinator (ONC) for Health Information Technology is charged with the development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of health information. This includes examining and recommending policy, technology, and practices that protect privacy and promote security. In addition, ONC develops regulations for the certification of electronic medical records, engages public input, and implements grant programs, such as those to initiate state health information exchanges, the Regional Extension Centers that provide technical assistance to provided to reach meaningful use of EHRs, and Beacon Communities grants that will establish and demonstrate best practices for middle and later adopters of HIT.

3. What are the roles of the HITPC and HITSC in privacy and security?
HITECH (Section 13101) required the establishment of a Health Information Technology Policy Committee (HITPC) to make recommendations on the policies needed to enable the electronic exchange and use of health information. The HITPC recently formed a privacy and security work group (called a “Tiger Team”) with strong consumer representation to make recommendations on patient choice in health information exchange; consumer access to their health information; personal health records; segmentation of health information; and transparency about information sharing practices. The Health Information Technology Standards Committee (HITSC) deliberates on the technical HIT standards required for electronic exchange. HITSC held hearings to better understand security priorities, the effectiveness of security procedures, vulnerabilities, and is currently soliciting information related to data segmentation and privacy. The Committees submit their recommendations to the National Coordinator. The National Coordinator evaluates the Committees’ recommendations and advises the Secretary of Health and Human Services.

4. What is ONC doing to promote privacy in health information exchange (HIE)?
ONC is working with the federal Health Information Technology Policy Committee (HITPC) and HIT Standards Committee (HITSC) to explore policy and technical methods for enabling patient choice in health information exchange, including a one-day conference on available technical capabilities to support patient consent. White papers on patient consent models and state consent laws were issued and a paper on data segmentation is underway. A study of the privacy and security practices of entities not subject to HIPAA will support a report to Congress in which ONC will, in consultation with the Federal Trade Commission, make recommendations on the privacy and security requirements for non-covered entities, with an emphasis on personal health records. A Request for Information on the same topic is being released to solicit information from the public. ONC is organizing a series of listening sessions to engage the public in a national dialogue about health information exchange. The Office of the Chief Privacy Officer is working with ONC divisions to assure the integration of privacy into all facets of ONC activities and projects. In addition, ONC is working to ensure that the technical and policy foundations of the nationwide health information network will demonstrate methods for achieving trust among entities exchanging information while integrating best practices for privacy and security.

5. What ONC activities are targeted to assure sufficient security capabilities in HIE?
ONC federal advisory committees have been active in collecting information, deliberating on key issues, and making recommendations to the National Coordinator on measures related to security of health information exchange. In addition to the activities of the Health Information Technology Policy Committee (HITPC), the Health Information Technology Standards Committee held hearings to better understand security priorities, the effectiveness of security procedures, and vulnerabilities. ONC also embarked on a multi-phase cybersecurity program that includes an assessment of HIT risks and threats and the development of a multi-pronged approach to combating them. ONC also is collaborating with the President’s cybersecurity initiative along with other federal partners to solicit input from the best security minds in the government on security best practices and standards. Meaningful use requirements for Medicare and Medicaid incentive payments include measures to protect security and privacy, and ONC’s interim final rule certification standards for EHRs includes the technical capabilities required to assure that information is adequately protected.

AHRQ Presents: Sustainable HIEs, Patient Empowerment, Transitions in Care

Posted on July 5, 2010 by Mike Squires

PDFs of Three Webinars Produced by AHRQ
and Released on Web June 18, 2010
These are all large files and take time to open.

Building and Maintaining a Sustainable Health Information Exchange: Experience from Diverse Care Settings: [PDF-1.49MB]
May 14, 2010

The Vanderbilt HIE Experience in Memphis
Mark Frisse, Vanderbilt University Medical Center

Health Information Exchange in Small Primary Care Practices: Someone Needs Needs to Say “Do It”
Patricia Fontaine, University of Minnesota

Delaware Health Information Network: Better Communicaation for Better Healthcare
Gina Perez, Advances in Management

A National Web Conference on Patient Empowerment: Leveraging Health IT for Patient Empowerment [PDF-3.73MB]
April 8, 2010

Leveraging Health Information Technology for Patient Empowerment
Christine A. Sinsky, Medical Associates Clinic and Health Plans

A Personalized Portal to Promote Patient-Centered Prevntive Care
Alex Krist, Virginia Commonwealth University

e-Coaching: Interactive Voice Response (IVR)-Enhanced Care Transition Support for Complex Patients
Christine S. Ritchie, University of Alabama at Birmington

A National Web Conference on Transitions in Care [PDF-1.07MB]
February 24, 2010

Transitional Care and Rehospitalization: Information Technology
Stephen Jencks, Independent Consultant In Health Care Safety

Project RED: The ReEngineed Discharge
Brian Jack, Boston University School of Medicine

Transitions in Care
Terry Field, University of Massachusetts Medical School

‘National Progress Report on eHealth’ Shows Significant Progress in Last 3 Years

Posted on July 4, 2010 by Mike Squires

eHealth Initiative Survey Identifies Challenges with Consumer Outreach and Understanding of Value
eHealth Initiative (eHI) issued the following press release on July 1, 2010.
WASHINGTON, DC – July 1, 2010 -Today, the eHealth Initiative (eHI) released the “National Progress Report on eHealth,” which tracks the progress of eHealth in the wake of the American Recovery and Reinvestment Act of 2009.

National Progress Report on eHealth 2010

The National Progress Report on eHealth includes a review of progress made over the last three years relative to strategies and actions proposed in a 2007 eHI report. Over one hundred individuals participated on committees charged with assessing progress in five focus areas: Aligning Incentives; Engaging Consumers; Improving Population Health; Managing Privacy, Security & Confidentiality; and, Transforming Care Delivery. The report highlights key trends, actions, and strategies that still need to be addressed.

The report reveals a number of high-level findings including:

Significant progress has been made over the last three years as a result of public and private sector initiatives. The American Recovery and Reinvestment Act (ARRA) was the key driver of progress.
Many providers are concerned about the lack of coordination across the government health and health information technology (HIT) initiatives.
More education and outreach to consumers about HIT and health information exchange (HIE) is required.
Knowledge and transparency of privacy and security policies will be the key to building consumer trust of HIT and HIE.

As part of the assessment process, eHI conducted an informal online survey to gauge perceptions of progress. The survey responses offer a snapshot about the eHealth landscape. Some findings include:

The majority of respondents believe significant progress has been made: 61 percent of respondents agree or strongly agree with the statement that significant progress has been made in the successful adoption and use of HIT since 2007.
The value of HIE is not clearly understood by the majority of respondents: 54.9 percent disagree or strongly disagree with the statement that the value of HIE is clearly understood.
The majority of respondents believe outreach to consumers about the value of EHRs and HIE is not effective: 66.6 percent disagree or strongly disagree with the statement that current outreach to consumers about the value of EHRs and HIE is effective.
The majority believe Regional Extension Centers and the National Health Information Technology Research Center (HITRC) will be vital to educating providers: 66.1 percent of respondents agree or strongly agree with the view that Regional Extension Centers and the HITRC will be vital to educating providers about adoption and meaningful use of HIT.

“Contributors to the report found that, while considerable progress has been made over the past three years, challenges remain,” noted Jennifer Covich Bordenick, eHealth Initiative’s Chief Executive Officer. “Coordinating public and private sector efforts, and communicating the true value of HIT and HIE to consumers will be critical as we move forward.”

As part of its work, the eHealth Initiative collected information on dozens of existing and new HIT initiatives occurring across the country. An online version of the current activities is available in the report and online.

The National Progress Report on eHealth was supported by the Commonwealth Fund, a private foundation supporting independent research on health policy reform and a high performance health system.

The report is available on the eHI website at: http://www.ehealthinitiative.org/

###

About eHealth Initiative
The eHealth Initiative (eHI) is an independent, non-profit, multi-stakeholder organization whose mission is to drive improvements in the quality, safety, and efficiency of healthcare through information and information technology (IT). eHI is the only organization that represents all of the stakeholders in the healthcare industry. eHI advocates for the use of HIT that is practical, sustainable and addresses stakeholder needs, particularly those of patients. For more information, visit http://www.ehealthinitiative.org/
# # #

Jennifer Lubell, HITS staff writer, reported July 2, 2010 in ModernHealthcare.com on National Progress Report,
“Electronic healthcare initiatives have made headway over the last several years, but health information technology remains an undervalued tool, a new report concludes.”

Enrollment for Health Insurance and Human Services Made Easy: HHS Wants Your Ideas

Posted on June 21, 2010 by Mike Squires

FACA Blog: Enrollment Workgroup solicits your help with information
on moving government into the 21st century
Monday, June 21st, 2010 | Originally Posted on FACA Blog by Judy Sparrow and reposted by e-Healthcare Marketing blog below.

In January 2010, at the White House Forum on Modernizing Government, President Obama noted that, “Improving the technology our government uses isn’t about having the fanciest bells and whistles on our websites – it’s about how we use the American people’s hard-earned tax dollars to make government work better for them.” Now, six months later, the newly formed Enrollment Workgroup of the Health IT Policy and Standards Committees has begun the discussion of how to bring eligibility determination and enrollment in health and human services programs into the 21^st century.

What we critically need—and what these standards have the promise to support—is an eligibility and enrollment system that will make applying for health insurance and other human service programs as easy as using the Internet to pay your bills or file your income taxes. It should be possible to apply for programs online, easily obtain the documents and information needed to confirm eligibility, and re-use this information to apply for a variety of programs, and re-certify your eligibility when the time comes. We need your help to uncover the examples, insights and best practices that will make this effort successful.

As background, the Enrollment Workgroup, authorized by the Affordable Care Act (ACA), has been tasked to recommend a set of standards to facilitate enrollment in Federal and state health and human services programs, including standards for:

Electronic matching across state and Federal data
Retrieval and submission of electronic documentation for verification
Re-use of eligibility information
Capability for individuals to maintain eligibility information online
Notification of eligibility

To follow up on the June 14^th Enrollment Workgroup’s first meeting and public hearing and to elicit further public comment, the FACA Blog is open for comments until July 1st. Comments can be submitted online on the blog website or emailed to: judy.sparrow@hhs.gov (use “enrollment workgroup” in header)

Specifically, the Workgroup would like public comment on:

(1) Federal, state, local or tribal government initiatives to simplify and streamline eligibility and enrollment in health and human services programs.

We would appreciate your insights on:

How should this work support health reform goals, including simplified and streamlined eligibility?
What standards are currently being used by state health and human services programs to determine eligibility?
In what areas would additional standards create clear progress towards the goal of a seamless eligibility system for consumers?
What standards or technology principles would enable rapid innovation in this space?

You might also describe your efforts, including use of standards and technology to simplify eligibility and enrollment, for:

Front end check of eligibility/enrollment across multiple programs:
- How do you check eligibility/enrollment across programs at the front end? Which programs are included? Standards used?
Approach and standards for data linking/matching? Is the matching probabilistic? What level of accuracy is required? Collecting information to determine multiple program eligibility
- What interfaces do you use to obtain electronic verification information? What standards used?
- Consumer entry of eligibility information, what data elements? Consumer authentication?
- What standards are used for messaging?

(2) Alternatively, if you are not in the healthcare sector, how have you solved challenges similar to those found in simplifying and streamlining eligibility and enrollment? In other words, how can we move towards 21^st century practices?

For example, share your perspectives on:
- Opportunity to move towards a web-services model
- Viability of a platform-based or enterprise service approach
- Role of consumer in managing own data
- Where we need standards to accelerate progress and consumer participation

Your responses will help form the agenda for the on-going work of the Enrollment Workgroup, and assist us as we work toward a September 30^th deliverable deadline as mandated by ACA.

Thank you for your contribution!
– Aneesh Chopra, Chair, Enrollment Workgroup
– Sam Karp, Co-Chair, Enrollment Workgroup
# # #
To make comments directly on the official FACA blog site, click here.

VA Announces $80 Mil Competition for Health IT and Other Innovations

Posted on June 10, 2010 by Mike Squires

Telehealth Included in at least Two Areas of
VA Innovation Initiative (VAi2)
Mary Mosquera of Government HealthIT reported on June 08, 2010 “The Veterans Affairs Department will make $80 million available to test technology applications developed through a competition to find innovative solutions to VA’s most pressing healthcare challenges, including homelessness, expanding online healthcare and strategies for treating kidney disease on an outpatient basis.”

VA Announces Industry Innovation Competition
$80 Million Available for Private Sector Innovations
June 7, 2010 VA Press Release excerpted:

WASHINGTON – Secretary of Veterans Affairs Eric K. Shinseki announced today the opening of the Industry Innovation Competition by the Department of Veterans Affairs, the most recent effort under the VA Innovation Initiative. With this competition, VA seeks the best ideas from the private sector to address the department’s most important challenges.

“At VA, we are continually looking for new ways to improve the care and services we deliver,” said Secretary Shinseki. “Engaging the private sector to tap its expertise and find ways to leverage private-sector innovations, we can improve the quality, access and transparency in service to our Nation’s Veterans.”

The VA Innovation Initiative (VAi2) is a department-wide program that brings the most promising innovations to VA’s most important challenges by involving employees and the private sector in the creation of visionary solutions in service to Veterans.

Innovation is more than simply a collection of ideas,” said Jared Cohon, president of Carnegie Mellon University. “It requires close collaboration between academia, industry and government to produce solutions that make a meaningful impact on society. VAi2’s programs bring about exactly that kind of fruitful collaboration.”

“Creativity in the private sector generates a wealth of technology capability that can help drive VA forward,” said Dr. Peter Levin, senior advisor to the secretary and VA’s chief technology officer. “By targeting innovations that are nearing commercialization, the Industry Innovation Competition provides a bridge between creative ideas in the private sector and real-world deployments that improve the services we deliver.”

Public and private companies, entrepreneurs, universities and non-profits are encouraged to participate in the competition…
# # #

Department of Veterans Affairs Innovation Initiative (VAi2)
Industry Innovation Competition (Industry-IC)
Solicitation Number: VA118-10-RP-0418
Excerpts from FedBizOpps.Gov VAi2 Solicitation as of June 10, 2010:

This Broad Agency Announcement (BAA), solicitation number VA118-10-RP-0418, sponsored by the Veterans Affairs Innovation Initiative (VAi2) will provide support to the VAi2 Industry Innovation Competition (Industry-IC). The Industry-IC invites private sector companies, entrepreneurs and academic leaders to contribute ideas for innovations that increase Veteran access to VA services, reduce or control costs of delivering those services, enhance the performance of VA operations and improve the quality of service that Veterans and their families receive. Specifically, the proposed effort supports the acquisition of solutions submitted by industry in response to VAi2 solicitations. Note: In order to conduct business with the Government, contractors must be registered in the Central Contractor Registration (CCR) database.

It is anticipated that proposals submitted in response to this BAA shall fit into one or both of the following phases. Offerors shall indicate which phase applies to their submission, or that it is a combination proposal.

Development Proposals: New and untested ideas and technologies or novel customization and application of existing technologies with the potential to provide benefits outweighing all costs and which provide results that significantly exceed currently deployed solutions. Technologies and products submitted as Development Proposals shall achieve a working prototype or test system preferably within one year but preferably within two years.

Field Test Proposals: Products and solutions that have demonstrated significant value in commercial or other production environments but are new to the operating environment within Veterans Affairs. Solutions shall be repeatable and ready for small-scale deployment at the regional or VISN level. Should the results from small-scale deployment prove favorable, the solution shall be scalable to a VA-wide implementation. It is anticipated that this BAA fund the small-scale field testing.

The VA is looking for solutions which can be implemented and impact to the VA realized within a 12-24 months timeframe.

An industry day is scheduled via Webinar on June 16 2010. Information will be provided for each area of interest and questions from industry will be addressed. As it becomes available, additional Webinar information will be posted at http://www.fbo.gov/ and www.va.gov/vai2

Topic Number: 0002
Topic Title: Telehealth
Topic Detail: Broadly defined, Telehealth includes a wide range of technologies and solutions that connect caregivers and patients and improve the ability to prevent, diagnose and monitor health conditions, to manage treatments and to enable communication and intervention when required. Telehealth solutions can provide mobile caregivers with greater flexibility, allowing them to spend more time interacting with patients. Access to healthcare services can be enhanced for rural patients or for patients for whom travel to hospitals is difficult. Frequently, these services can improve the quality of care while lowering costs.

The Department of Veterans Affairs has been a leader in the deployment of Telehealth solutions for some time, and currently reaches thousands of veterans through services such as home health monitoring (see www.carecoordination.va.gov/telehealth for more information).

VA is interested in solutions that significantly extend and improve our ability to provide the right treatment in the right place at the right time, using technologies such as, but not limited to:

Wireless communications
Videoconferencing
Imaging
Remote sensing & monitoring
Portable or wearable sensors
Mobile devices
Web-based services and patient portals
Human factors, ergonomic and usability design
Process and workflow design

Potential applications for Telehealth solutions are broad and varied, and we encourage the submission of proposals that have significant impact on the quality, access, cost and performance of the healthcare delivered to veterans. Example applications include, but are not limited to:

Home Monitoring for Chronic Care: The ability to monitor patient vital statistics from a distance has existed for many years and has improved chronic care and disease management. However, the needs and expectations of both patients and caregivers continue to evolve, and Telehealth technology must evolve beyond the recording and reporting of key statistics. Functions such as real-time, two-way communication between patients and all members of the care team; self-management tools allowing patients to take an active role in their care, continuous, real-time and/or unobtrusive sensing & monitoring; delivery of educational content, integration of wireless mobile devices with Telehealth delivery and more can significantly extend the reach and scope of Telehealth services in the home environment.
Home Monitoring for Severe or Challenging Disabilities: Veterans with severe disabilities may have care that is managed at home, but may further benefit from specialist recommendations for environmental modifications or other quality-of-life improvements based on continual home monitoring. Also, certain injuries (such as Traumatic Brain Injuries) and conditions (such as mental health) are difficult to diagnose and monitor through the measurement and analysis of traditional vital statistics. Long-term monitoring of diverse symptoms such as headaches, fatigue, memory function, depression, irritability, anxiety, etc. may be required. Changes in symptoms based on social environment such as family interaction and community involvement, or based on types & levels of activities such as physical exercise, home management, child rearing, work and recreation may be important to monitor. As a special case of Home Monitoring, solutions that involve creative methods to capture, record and communicate these kinds of difficult-to-capture symptoms are of interest.
Home Monitoring for Acute Care: Acute hospital care may not always be the best solution for many patients. Factors from risk of additional infection to the emotional benefits of being in a familiar environment may make home-based care a preferred option. Home monitoring capabilities are a crucial part of enabling such options. Hospital@Home is an innovative approach that VA has employed for a number of years to provide hospital-like services to patients in their homes for such conditions as acute heart failure, pneumonia, and other conditions that can safely be managed at home with intensive support of a physician, nursing, and home infusion capability. Also, similar capabilities exist to remotely monitor patients in Intensive Care Unit settings. VA is interested innovative approaches that allow for the remote monitoring, in the home environment, of patients’ vital signs and that enable visual interaction between patients and caregivers. Proposed solutions must be capable of storing information in VA electronic medical records.
Mobile Support for VA Preventive Care Coordinators: Preventive Care coordinators can improve care and reduce costs by serving multiple veterans outside of the hospital environment, capturing and reporting relevant data and interacting with patients to monitor overall well-being. However, a substantial amount of caregiver time involves routine data collection and recording, leaving less time for valuable patient interaction. Solutions that provide a capability to capture vital statistics and quickly transfer them to the Care Coordinator can significantly impact the quality of interaction between the Care Coordinator and the patient. As an illustrative example, a vest containing relevant sensors and monitors might capture vital statistics upon or prior to Care Coordinator arrival and transmit data to a mobile device carried by the Coordinator.
VA has offered patients group visits (Doctor Interactive Group Medical Appointments – DIGMA) for almost 10 years. These group interactions with healthcare providers optimize care for patients with similar chronic conditions, such as diabetes, and foster an environment where patients can coach and mutually support each other in the management of their chronic disease. VA would like to explore virtual options to provide a similar environment for patients that cannot or choose not to travel for such care. These solutions may employ social networking tools that would allow patients to drop-in to a virtual group visit in a secure environment. These solutions should allow for the capture of some information into VA’s electronic medical record, such as patient documentation and the collection of health information relevant to the encounter.
Online Care: Veterans currently have access to online services through My HealtheVet (www.myhealth.va.gov ), where they can access trusted, secure and current health and benefits information and may be able to access Personal Health Records and functions such as prescription refill. However, web-based technology offers the opportunity to provide significant new services such as real-time interaction with caregivers via video, text chat and/or telephone. VA wishes to explore options that would allow for either synchronous or asynchronous communication between patients and clinicians or administrative staff, in ways that protect patient confidentiality and privacy. Where possible, integration of new online services with the existing MyHealtheVet should be considered. It should be noted that VA has some experience with providing online services, such as video monitoring, on a small scale. Therefore, proposals that demonstrate point solutions via individual prototypes may not be as valuable as proposals that involve fully integrated solutions and scalable platforms.
Communication Tools that allow Clinician-to-Clinician interaction: VA has an advanced electronic health record, but lacks tools that improve clinician to clinician communication, particularly over significant distances. VA would like to provide the capability to staff to be able to communicate with each other about sensitive patient care information in a secure environment that protects patient confidentiality and privacy. These tools might provide either synchronous or asynchronous capability to request urgent help with patient care issues or to communicate more routine information that might not otherwise specifically be in the medical record. For example, such a tool might be used by a physician in an acute care setting (hospital or emergency room) to communicate with the patient’s primary care team, notifying them of the visit or discharge, with specific concerns or follow up requirements. Ideally, this tool could be used by both VA staff as well as clinicians outside of VA to communicate with VA staff. These tools should ideally fit into the normal work flow of VA staff (possibly from within the VA electronic medical record).

Topic Number: 0003
Topic Title: Expansion of Polytrauma Rehabilitation Services
Topic Detail: Rehabilitation services encompass a broad range of therapies and treatments which provide maximum reduction of physical or mental disability and restoration of a patient to their optimal functional level. Service delivery models vary by range of providers and environments of care, which include but are not limited to provider offices, freestanding outpatient clinics, medical centers, nursing homes, patient homes, and may involve remote/Telehealth interventions. Regardless of provider type or treatment setting, an effective individualized rehabilitation plan, developed following a comprehensive evaluation, can help patients restore function and cope with deficits that have not otherwise been reversed by medical care.

The Department of Veterans Affairs has been a leader in the provision of rehabilitation services across multiple spectrums of care. Rehabilitation services provide the core disciplines in the Polytrauma System of Care (see www.polytrauma.va.gov) which was established to provide specialized comprehensive inter-disciplinary rehabilitation care to veterans and returning service members with polytraumatic injuries.

VA is interested in technological solutions that assist in the provision of evidence based practice through enhanced access to treatment algorithms and the expansion of remote assistive technology monitoring services, regardless of treatment location. This effort will help to bridge geographic distances and improve our ability to provide the right treatment in the right place at the right time. For these efforts, we are interested in using technologies such as, but not limited to:

Portable interfaces to computerized medical records

Real time bi-directional data exchange
Interactive/responsive programming to user entries
Wireless communications
Videoconferencing
Remote sensing & monitoring
Portable or wearable sensors
Mobile devices
Web-based services and patient portals
Human factors, ergonomic and usability design
Process and workflow design

Potential applications for rehabilitation services are broad and varied, and we encourage the submission of proposals that have significant impact on the quality, access, cost and performance of the health care delivered to veterans. Example applications include, but are not limited to:

Dynamic Treatment Algorithms: Collaboration among VA, Department of Defense, and private sector has expanded the availability of evidence-based clinical practice guidelines in rehabilitation focused treatment areas which include but are not limited to mild TBI, low back pain, cerebrovascular accidents, dysphagia, and amputation. Provider utilization of these clinical practice guidelines/decision trees for emerging areas of practice through technology based interfaces is still not maximized. Technology should be sensitive and responsive to the actions of the providers such that treatment recommendations and contraindications are provided, practice patterns are captured and monitored, and outcomes are stored for analysis. The expansion of this monitoring should include not only the immediate clinical setting, but may also extend to the patients home for regular follow up. Consideration should be given to provider collaboration and outreach in dealing with complex cases through technological solutions which permit real time exchange of data between multiple locations working on the same evaluation; interaction between patient (self completed surveys), and multiple providers; and documentation/storage of the results in a central location. Consideration should also be given to self-management tools which would allow patients to take an active role in their care and delivery of appropriate educational content based on patient feedback/status.
Home Monitoring for severe or challenging disabilities: Veterans with severe disabilities may have care that is managed at home, but may further benefit from specialist recommendations for environmental modifications or other quality-of-life improvements based on continual home monitoring. Also, certain injuries (such as Traumatic Brain Injuries) and conditions (such as mental health) are difficult to diagnose and monitor through the measurement and analysis of traditional vital statistics. Long-term monitoring of diverse symptoms such as headaches, fatigue, memory function, depression, irritability, anxiety, etc. may be required. Changes in symptoms based on social environment such as family interaction and community involvement, or based on types & levels of activities such as physical exercise, home management, child rearing, work and recreation may be important to monitor. As a special case of Home Monitoring, solutions that involve creative methods to capture, record and communicate these kinds of difficult-to-capture symptoms are of interest.
Symptom-Based Medication Guidance: The prevalence of patients with symptoms related to TBI has led to increased research and collaboration on developing treatment recommendations for patients who may have experienced a mild, moderate or severe TBI. Medication recommendations based on reported symptoms are available, and technology can enhance the communication of these recommendations and their utilization by providers caring for these patients. This technology should be mobile, dynamic, and reactive based on changes in patient status and provider entries. Solutions should be able to store, analyze and respond to data entered into the system, alerting providers to any potential recommendations or contraindications. Consideration should also be given to provider collaboration and outreach in dealing with complex cases through technological solutions which permit real time exchange of data between multiple locations working on the same evaluation; interaction between patient (self completed surveys), and multiple providers; and documentation/storage of the results in a central location. Expansion of technological solutions in this area will assist in improving care and reducing costs through remote patient interactions and adherence to evidence based practice.
Assistive Technology (AT): Veterans are currently provided with a variety of assistive technology devices, including augmentative communication devices, environmental control units, cognitive devices, specialized mobility devices, etc. Initial evaluation and training occurs at the prescribing clinic. Often training needs change or do not become apparent until this technology is used in the home for a period of time. VA is interested in mechanisms to monitor use, provide ongoing follow-up and training, and further evaluate the AT needs of Veterans remotely in their homes. Consideration should also be given to provider collaboration and outreach in dealing with complex cases through technological solutions which permit real time exchange of data between multiple locations working on the same evaluation; interaction between patient (self completed surveys), and multiple providers; and documentation/storage of the results in a central location.

ADDITIONAL TOPICS
Topic Number: 0001
Topic Title: Addressing Veteran Homelessness via Innovative Housing Technology

Topic Number: 0004
Topic Title: Adverse Drug Event Trigger Tool: Reducing Adverse Drug Events for our Nation’s Veterans

Topic Number: 0005
Topic Title: Integrated Business Accelerator

Topic Number: 0006
Topic Title: Dialysis & Kidney Replacement

Updates on ONC’s SHARP — Strategic Healthcare IT Advanced Research Projects

Posted on June 7, 2010 by Mike Squires

SHARP Awards for Health IT Establish Web Sites
Web sites have been launched for each of the four advanced research projects announced April 2, 2010 by the Office of the National Coordinator (ONC) for Health IT. The program called Strategic Healthcare IT Advanced Research Projects (SHARP), totalling $60 million over four years, taps into four consortia of leading reseach and academic institutions each led by a major research institution. “The research projects supported by the SHARP program will focus on solving current and expected future challenges that represent barriers to adoption and meaningful use of health IT. These projects will focus on areas where ‘breakthrough’ advances are needed to realize the full potential of health IT.” This chart was taken from the Mayo Clinic College of Medicine Wiki site for its project.

: SHARP Organization

1. Security of Health IT
http://sharps.org
University of Illinois at Urbana-Champaign
Strategic Healthcare IT Advanced Research Projects on Security (SHARPS)
SHARPS is accociated with the Center for Health Information Privacy and Security in the Information Trust Institute at the University of Illinois at Urbana-Champaign
In their research overview, SHARPS describes the structure of their project, “SHARPS is organized around three major environments: Electronic Health Records (EHRs), Health Information Exchanges (HIEs), and Telemedicine (TEL), with Personal Health Records (PHRs) included as a major subtopic. SHARPS research projects in these strategic areas are interconnected through three cross-cutting themes: conceptual and policy foundations, service models, and open validation.”
People
Research
Jobs
Publications
Links

2. Patient-Centered Congnitive Support
http://sharpc.org
The University of Texas Health Science Center at Houston
National Center for Cognitive Informatics and Decision Making in Healthcare (NCCD)
Alternative URL: http://www.uthouston.edu/nccd
Mission: “The mission of the NCCD is to bring together a collaborative, interdisciplinary team of researchers from across the nation; with the highest level of expertise in patient-centered cognitive support research from biomedical and health informatics, cognitive science, clinical sciences, industrial and systems engineering, and health services research. Additionally, the NCCD will conduct short-term research that addresses the urgent usability , workflow, and cognitive support issues of Health Information Technology ( HIT) as well as long-term, breakthrough research that can fundamentally remove the key cognitive barriers to HIT adoption and meaningful use. The center will translate research findings to the real world through a cooperative program involving researchers, patients, providers, HIT vendors, and other stakeholders.”

About NCCD
Org Chart
Projects
Key Personnel

Project Advisory Committee
Sharp C Wiki (not up and running as of 6/7/2010)

Projects	Project Title
Project 1	Work-Centered Design of Care Process Improvements in HIT
Project 2A	Cognitive Foundations for Decision Making: Implications for Decision Support
Project 2B	Modeling of Setting-Specific Factors to Enhance Clinical Decision Support Adaptation
Project 3	Automated Model-based Clinical Summarization of Key Patient Data
Project 4	Cognitive Information Design and Visualization: Enhancing Accessibility and Understanding of Patient Data
Project 5	Improving Communication in Distributed Team Environment

3. Health Application and Network Platform Architectures
http://www.smartplatforms.org
Harvard University
Substitutable Medical Apps, reusable technologies

“A platform with substitutable apps constructed around core services is a promising approach to driving down healthcare costs, supporting standards evolution, accommodating differences in care workflow, fostering competition in the market, and accelerating innovation.”

The March 26, 2009 essay by Kenneth D. Mandl, MD, MPH, and Isaac S. Kohane, MD, PhD, in New England Journal of Medicine “No Small Change for the Health Information Economy”. They wrote “A health care system adapting to the effects of an aging population,growing expenditures, and a diminishing primary care workforceneeds the support of a flexible information infrastructure thatfacilitates innovation in wellness, health care, and publichealth.” They reference the flexbility of applications and the stable platform provided by the iPhone.

HTML: http://content.nejm.org/cgi/content/full/360/13/1278
PDF: http://content.nejm.org/cgi/reprint/360/13/1278.pdf

Ten principles were developed at a subsuquent workshop setup on May 13, 2009 by the”Informatics Program at Children’s Hospital Boston (CHIP) “of leading experts in health, innovation and technology to define ten core principles of a platform that would support healthcare information technology.” See “Ten Principles for Fostering Development of an ‘iPhone-like’ Platform for Healthcare Information Technology”

4. Secondary Use of EHR Data
http://sharpn.org
Mayo Clinic College of Medicine
Per Mayo Clinic College of Medicine Wiki: “We propose research that will generate a framework of open-source services that can be dynamically configured to transform EHR data into standards-conforming, comparable information suitable for large-scale analyses, inferencing, and integration of disparate health data. We will apply these services to phenotype recognition (disease, risk factor, eligibility, or adverse event) in medical centers and population-based settings. Finally, we will examine data quality and repair strategies with real-world evaluations of their behavior in Clinical and Translational Science Awards (CTSAs), health information exchanges (HIEs), and National Health Information Network (NHIN) connections.

“We have assembled a federated informatics research community committed to open-source resources that can industrially scale to address barriers to the broad-based, facile, and ethical use of EHR data for secondary purposes. We will collaborate to create, evaluate, and refine informatics artifacts that advance the capacity to efficiently leverage EHR data to improve care, generate new knowledge, and address population needs. Our goal is to make these artifacts available to the community of secondary EHR data users, manifest as open-source tools, services, and scalable software. In addition, we have partnered with industry developers who can make these resources available with commercial deployment. We propose to assemble modular services and agents from existing open-source software to improve the utilization of EHR data for a spectrum of use-cases and focus on three themes: Normalization, Phenotypes, and Data Quality/Evaluation. Our six projects span one or more of these themes, though together constitute a coherent ensemble of related research and development. Finally, these services will have open-source deployments as well as commercially supported implementations.

“There are six strongly intertwined, mutually dependent projects, including: 1) Semantic and Syntactic Normalization; 2) Natural Language Processing (NLP); 3) Phenotype Applications; 4) Performance Optimization; 5) Data Quality Metrics; and 6) Evaluation Frameworks. The first two projects align with our Data Normalization theme, while Phenotype Applications and Performance Optimization span themes 1 and 2 (Normalization and Phenotyping); while the last two projects correspond to our third theme.”

SHARP Program Organization
SHARP Area 4: Themes & Projects
Project Initiation Meeting Slides PDF

For more recent post about SHARP Program on e-Healthcare Marketing, click here.

ONC’s Seidman Blogs on Health IT Disparities Meeting + June 4 Agenda

Posted on June 3, 2010 by Mike Squires

Using Health IT to Eliminate Disparities: A Focus on Solutions
Posted originally on Office of Nat’l Coordinator for Health IT’s
Federal Advisory Committee Blog: Wednesday, June 2nd, 2010
by Joshua Seidman PhD
See June 4, 2010 Meaningul Use Workgroup Agenda Below

The meaningful use (MU) of electronic health records (EHRs) has great potential to improve the quality, efficiency and safety of health care. If we are not careful, however, benefits may disproportionately accrue to those best positioned to implement and use new technologies. That could have the unintended consequence of growing health, health care and health information disparities.

On the other hand, ignoring technological innovation is not a viable option for preventing exacerbation of disparities. Moreover, many innovators have demonstrated that—deployed thoughtfully—health IT solutions can improve access to, and understanding of, important personal health information.

That is the focus of the June 4 public hearing being convened in Washington, DC by the Health IT Policy Committee’s MU Workgroup. Given the great research that already exists on what causes disparities, we are focusing this discussion specifically on solutions—that is, how can meaningful use of health IT solutions help us reduce disparities?

In this context, disparities can refer to differences in health, health care and health information. They may be caused by inadequate health literacy or by cultural or language issues that affect communication. In many cases, disparities can also be caused by access to care, to technology, or to meaningful and useful health information.

Like the Workgroup’s previous hearing on patient and family engagement, we will build on the live public testimony and discussion through this FACA Blog. The April 20 hearing generated more than 50 thoughtful comments that have been incorporated into the public record as we begin the process of building the definition for future stages of meaningful use.

We hope that we have an equally robust online discussion that provides valuable input on this topic. As with the previous hearing, all comments are welcome but we particularly encourage you to consider the following questions that we posed to the panelists.

1. What do you see as the greatest risks posed by the implementation of HIT in relationship to potentially increasing disparities in health processes and outcomes?

2. What are you, or others with whom you work, doing (or planning to do) to reduce the risk of exacerbating disparities as HIT is implemented across the county?

3. What research is being done, or needs to be done, in this area to inform the HIT Policy Committee in trying to establish guidelines that will move providers to implement methods of using HIT to reduce disparities?

4. With patient and family engagement in care at the forefront of our thinking about improving our Nation’s health, what particular strategies would you recommend to us as potential meaningful use requirements in 2013 and 2015 for the vulnerable populations we have asked you to address?

5. How can the meaningful use of HIT specifically reduce a health disparity?

6. What specific HIT applications have been used to address health literacy (panel 1), culture (panel 2), or access (panel 3)?

7. Please share any relevant evidence on your topic.

Additional Questions for the Access Panel:

What tools can be used to improve access for those who face access barriers to healthcare or technology?

What are the most innovative solutions you have seen to overcome these challenges?
# # #
To post comments directly on FACA blog article, click here.

AGENDA (pdf version) excerpted from ONC site
HIT Policy Committee Meaningful Use Workgroup
Friday, June 4, 2010
9 a.m. to 3:30 p.m./Eastern Time
Washington, DC

Hearing on “Using HIT to Eliminate Disparities: A Focus on Solutions”
“As providers across the country begin to meaningfully use health information technology to improve care to vulnerable populations, we acknowledge the need to pay special attention to ensuring that we are improving disparities in healthcare processes and outcomes, not exacerbating them.”

9:00 a.m. Call to Order/Roll Call – Judy Sparrow, Office of the National Coordinator
9:05 a.m. Meeting Objectives and Outcomes:
Using HIT to Eliminate Disparities: A Focus on Solutions
– George Hripcsak, Co-Chair, and Neil Calman, The Institute for Family Health
9:15 a.m. Panel 1: Health Literacy & Data Collection
Moderator: Neil Calman
–Sara Czaja, University of Miami
–Cynthia Solomon, MiVia
–Geniene Wilson, The Institute for Family Health
–Silas Buchanan, The Cave Institute
10:45 a.m. Panel 2: Culture
Moderator: Joshua Seidman
–Russell Davis, National Health IT Collaborative for the Underserved
–M. Chris Gibbons, Johns Hopkins Urban Health Institute
–Dianne Hasselman, Center for Health Care Strategies
–Deeana Jang, Asian/Pacific Islander American Health Forum
12:15 p.m. LUNCH BREAK
1:15 p.m. Panel 3: Access
Moderator: George Hripcsak
–Carolyn Clancy, Agency for Healthcare Research & Quality, HHS
–Howard Hays, MD, Indian Health Service, HHS
–Ian Erlich, Maniilaq Association, Alaska
–R. Scott Hawkins, Boston Healthcare for the Homeless
–Cesar Palacios, Proyecto Salud Clinic
2:45 p.m. Meaningful Use Workgroup Discussion
3:15 p.m. Public Comment
3:30 p.m. Adjourn

To participate:
Webconference or iPhone
Audio
You may listen in via computer or telephone.
US toll free: 1-877-705-2976
International Direct: 1-201-689-8798

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

Posted on May 21, 2010 by Mike Squires

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.

e-Healthcare Marketing

Health Information Exchange, Electronic Health Records and Personal Health Records

Category Archives: Patients

Blumenthal Blogs on Future of Healthcare with EHRs and New Rules

Final Rule on Meaningful Use, Certification, Standards Announced

ONC: Building Trust in HIE, Changes to HIPAA Privacy/Security Proposed

HHS Press Release on July 8, 2010:
HHS Strengthens Health Information Privacy and Security through New Rules
New health privacy website launched

AHRQ Presents: Sustainable HIEs, Patient Empowerment, Transitions in Care

‘National Progress Report on eHealth’ Shows Significant Progress in Last 3 Years

Enrollment for Health Insurance and Human Services Made Easy: HHS Wants Your Ideas

VA Announces $80 Mil Competition for Health IT and Other Innovations

Updates on ONC’s SHARP — Strategic Healthcare IT Advanced Research Projects

Projects

Project Title

ONC’s Seidman Blogs on Health IT Disparities Meeting + June 4 Agenda

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

HHS Press Release on July 8, 2010: HHS Strengthens Health Information Privacy and Security through New Rules New health privacy website launched

Projects

Project Title

HHS Press Release on July 8, 2010:
HHS Strengthens Health Information Privacy and Security through New Rules
New health privacy website launched