Again there has been just a heap of stuff arrive this week.
First we have:
SNOMED CT will be required by 2015 for bonuses under economic recovery law
August 20, 2009 | Diana Manos, Senior Editor
WASHINGTON – The federal advisory panel on health IT standards has approved refined recommendations on how providers may electronically record a physician's observations to qualify for federal recovery bonuses.
The HIT Standards Committee endorsed recommendations to call for SNOMED CT for physician's clinical observations by 2015. In 2010, providers must use ICD-9 or SNOMED CT to qualify, and in 2013 they must use ICD-10 or SNOMED CT.
According to John Halamka, co-chairman of the Clinical Operation Workgroup, ICD-9 and ICD-10 were created for billing purposes and are not suitable in the long term for denoting physician observations in an electronic health record.
Halamka said he is pleased with the progress made since July, when the recommendations were initially approved.
Much more here:
This is a major strategic thrust – will be a big call given the time it is seeming to take the US to move to ICD-10.
Second we have:
Obama's big idea for saving $100 billion
Experts say electronic health records will slash health care costs, but hospitals wonder when -- and how -- they'll be able to realize those savings.
By David Goldman, CNNMoney.com staff writer
Last Updated: August 21, 2009: 9:00 AM ET
NEW YORK (CNNMoney.com) -- The health care industry is poised to realize huge savings by implementing electronic health records systems, but who really benefits is up for debate.
Digitizing health records is a big part of the Obama administration's health reform agenda, with the president arguing that EHR will save taxpayers from wasteful spending by making health care more efficient.
The first $1.2 billion of $48.8 billion in health tech spending from the Recovery Act went out Thursday to help health care providers implement digital health systems. Starting next fall, $20 billion of Medicare and Medicaid incentives from the stimulus package will be doled out to providers that meaningfully use EHR.
But huge upfront costs and a questionable return on investment for hospitals have some screaming for broader reforms.
A recent Congressional Budget Office report said the health reform bills wouldn't sufficiently rein in costs nor would they trickle down savings to the average American with employee-sponsored insurance.
But a separate report from the CBO said the Recovery Act program would save the government more than $12 billion in Medicare and Medicaid costs over the next 10 years.
Though that doesn't sound like much, considering American consumers, businesses and governments spent approximately $2 trillion on health care last year, other studies show the savings are potentially ten times that amount for the entire health care industry.
More here:
This is really the billion dollar question – having introduced e-Health how to harvest the benefits. This requires careful planning and lots more besides. Australia take note!
Third we have:
Latest Meaningful Use Matrix Reinforces HIPAA Compliance, CPOE
Lisa Eramo, for HealthLeaders Media, August 20, 2009
Is the third time a charm? That's the burning question on everyone's minds as the Office of the National Coordinator (ONC) begins to review the third set of recommendations set forth by the HIT Policy Committee's meaningful use work group.
The work group proposed its newest version of the meaningful use matrix during the August 14 day-long meeting to discuss a definition and future plans.
Although the newest matrix closely follows the July version, the work group did add the following new footnotes:
- While all process measures (e.g., computerized physician order entry [CPOE] adoption) apply to all eligible providers, applicability of quality or outcome measures to specialists will be defined in the rule-making process. In 2013, disease- and/or specialty-specific registries are included as objectives. Specific measures will be included in refinements to the 2013 recommendations.
- Additional efficiency measures to consider for 2013 recommendations include: generic therapeutic substitutions for medications.
- National Quality Forum is working with measure developers to refine existing administratively defined quality measures referenced in the matrix to be redefined using clinical and administrative data from EHRs.
Of note is that both the July and current versions of the matrix recommend that in 2011, hospitals must be able to prove they are using CPOE for at least 10% of orders (any type). According to the matrix, orders must be entered directly by the authorizing provider, such as an MD, DO, RN, PA, or NP. By 2013, that percentage would jump to 100%. By 2015, hospitals must be able to achieve certain levels of performance as dictated by yet-to-be-determined clinical outcomes standards.
On the physician practice side, providers must use CPOE for 100% of all order types beginning in 2011.
Reporting continues here (with links):
This is important stuff. Defining and agreeing just what ‘meaningful use’ is and means is the first step to having EMR users be able to show they conform and unlock the huge pool (10s of Billions) of incentive funding available under the ARRA.
Fourth we have:
Obama's e-health agenda receives cash infusion
By Aliya Sternstein 08/21/2009
The White House's unveiling on Thursday of $1.2 billion in grants for programs to expand the use of electronic health records represents the first major investment in President Obama's health information technology agenda. Administration officials this past week have publicly tied the benefits of health IT to the president's larger, more controversial health care reform effort.
The grant money is aimed at laying the foundation for so-called meaningful use of electronic health records -- a standard for quality and efficiency of care that will determine which medical professionals and technologies are eligible for forthcoming stimulus funds.
The money will "prepare the groundwork for Medicare and Medicaid incentives" that take effect in 2011 under the Recovery Act, David Blumenthal, national coordinator for health IT, said during a Thursday conference call with reporters. Doctors and hospitals that make meaningful use of e-records by 2011 or 2012 will be eligible for up to $44,000 in Medicare payments over five years.
"Expanding the use of electronic health records is fundamental to reforming our health care system," Health and Human Services Secretary Kathleen Sebelius said on Thursday. "Electronic health records can help reduce medical errors, make health care more efficient and improve the quality of medical care for all Americans."
About half the grants will go toward creating 70 regional centers that will offer hospitals and clinicians hands-on experience in meaningful use of e-health records systems. "These modern health IT centers could be considered as somewhat akin to the agricultural extension centers Congress set up early in the 20th century, which helped to support vast improvements in the efficiency, quality and productivity of the agricultural sector," Blumenthal wrote in an e-mail to the public on Thursday, marking the second in a new series of health
The other half of the funding will go to states to help them roll out policies and networks for exchanging information electronically within and across state lines.
More here:
http://www.nextgov.com/nextgov/ng_20090821_1094.php?oref=topstory
This is the start of the really serious spending the Obama Administration is planning over the next five years – despite the GFC.
Fifth we have:
Why Standards Matter: The True Meaning of Interoperability
By
Americans are generally skeptical of words that otherwise intelligent and articulate people can't pronounce. "Interoperability," like nu-cu-lar, is one of these. After a while, these words can take on a mystique all their own.
But interoperability is a hugely important word in the context of today's ongoing debate about the use of EHR technology by physicians, hospitals, and patients too. The federal government is going to provide billions of dollars to encourage today's fragmented health care providers to convert from mostly paper to mostly computerized information systems. It is critically important for these systems to talk with one another. We want health data to flow between and among these systems and to be, well, interoperable. And it isn't now.
So how can this word be so difficult to put into action? Here's a clue: a lot of people are confused about its meaning.
At the August 14, 2009 meeting of the Health Information Technology (HIT) Policy Committee, one of the two health IT expert committees advising the Office of the National Coordinator (ONC) and the Department of Health and Human Services (HHS) on the definition of "meaningful use of certified EHR technology," no fewer than four different committee members and at least one ONC staff member acknowledged they "didn't really know" what interoperability means.
Is it about transferring data, or sharing it, or both? Is interoperability a quality of the data, or of the computer systems? Can familiar digital file formats such PDF offer a kind of interoperability if exchanged more readily?
Is it hard for computer systems to be interoperable, or is there some "low hanging fruit." For example, can some current software systems talk with each other about health data and information?
And here's a good one: why are even CCHIT-certified EHR products, ones that have been certified for "interoperability," unable to exchange data consistently or reliably?
We're going to try to get to the true meaning of interoperability in this blog post, answering these questions along the way. Let's start with the concept of data (or "content"). The sentence that you're reading now is content, whether its on your computer or in printed form. In either case, the data are the words you're reading and that your brain is interpreting, at least if you can read and you speak English. (Purists may dispute that words can be data, but the word derives from Latin, dare, to give. So, we're giving you our words as data.)
Much more here (registration required):
A must read post with some very good comments indeed. The problem is clear but I would suggest the answer might be a bit harder!
Sixth we have:
Frost & Sullivan: Medico Legal Implications Related to the Usage of Electronic Health Record
Posted : Fri, 21 Aug 2009 05:11:56 GMT
Author : Frost & Sullivan
Category : Press Release
KUALA LUMPUR, Malaysia, Aug. 21
KUALA LUMPUR, Malaysia, Aug. 21 /PRNewswire/ -- The adoption of Information and Communication Technologies (ICT) is essential for modern healthcare delivery systems if they are to gain greater efficiency, reduce overall healthcare costs and improve patient safety.
In recent years, the acquisition of computer technologies by healthcare organizations has increased substantially with the spending, showing an upward tendency placing the industry as one to the major consumers of ICT products and services.
According to Frost & Sullivan estimates, the Health Information Technology (HIT) market (by revenue) in 2008, in APAC (Southeast Asia, China, Japan and Australia) was close to USD5.04 billion with an annual growth rate (CAGR) of 11.8 percent from 2005-2008. Although the APAC HIT market represents currently only 2.1 percent of the total healthcare market, it is very likely that the figure could double if not triple that in the next 10 years.
Frost & Sullivan Senior Consultant, Dr. Pawel Suwinski says, "The HIT is here to stay with even more ubiquitous presence in all aspects of healthcare delivery systems. Moreover, it will be the main factor and driver in the transformation of healthcare industry towards translation care by providing common collaboration platform for information processing and exchange between related sciences and industries."
The aim of healthcare organization is to decrease the uncertainty of care delivery by providing controls to meet acceptable standards of care. This is due to the fact that medical practice environment has many variables (external & internal) that can affect the quality of care.
More here:
http://www.earthtimes.org/articles/show/frost--sullivan-medico-legal,933569.shtml
This brief makes some very good points that are worth bearing in mind. The growth estimates for the Asia Pacific Area are interesting.
Seventh we have:
Blumenthal open letter seeks support for ONC's health IT plans
August 20, 2009 | Healthcare IT News Staff
WASHINGTON – Healthcare IT chief David Blumenthal has joined the White House e-mail campaign for healthcare reform with a public letter sent via e-mail expounding the virtues of electronic health record systems as a critical piece of transformation.
Blumenthal’s e-mail Wednesday follows one sent last week by senior White House adviser David Axelrod aimed at countering what he called “the viral e-mails that fly unchecked and under the radar, spreading all sorts of lies and distortions.”
This initiative will lower costs, improve the practice of medicine and result in more reliable, efficient care, the letter says. It will also be "daunting" and "hard for some clinicians and hospitals," Blumenthal concedes.
"The goal of assuring an electronic health record for every American is daunting," he says. "We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration."
Much more here with full letter text:
http://www.healthcareitnews.com/news/blumenthal-open-letter-seeks-support-oncs-health-it-plans
The letter puts in context and makes clear just what is being attempted – and it isn’t small!
This sentence says it all:
“The goal of assuring an electronic health record for every American is daunting. We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration. “
Eighth we have:
Friday, August 21, 2009
Inside Baseball: The Great Debate About Government-Run Health Care
by Thomas H. Lee M.D.
Summer is fast upon us again. And as we move past the MLB All-Star break, the dialogue on health care reform is only getting hotter. Should government be subsidizing the adoption of health IT? Does it make sense for policymakers to define what "meaningful use" of IT is? Most contentious is the issue of a public health insurance option. Should a government-run health plan be allowed to compete with the private sector for non-Medicare beneficiaries?
Proponents argue that competition by a Medicare-like system, where there is reasonable patient satisfaction and lower administrative costs, would be beneficial for driving out waste and unethical practices by private insurers. Opponents counter that Medicare is structurally destined for insolvency and that competition by a large public entity would only drive down fair competition, ultimately leading to a single-payer system that is financially untenable.
The rhetoric on both sides has been strong. As President Obama has said, "If private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business?" Sen. John McCain (R-Ariz.) has countered, "I have not seen a public option that, in my view, meets the test of what would really not eventually lead to a government takeover."
Unfortunately, that leaves the general spectator and citizen a bit in the dark as to what to support. As noted by Paul Krugman, one such citizen recently attended a town hall on health care and to his congressional representative, he righteously declared, "Keep your government hands off my Medicare." Hmmm.
Full article here:
Noting the Medicare in the US – and here – is run by Government – some are confused. This is a good article I believe.
Ninth we have:
The greatest EHR myths — and the truth behind them
By Steven J. Kraus, DC, DIBCN, CCSP, FASA
The American Recovery and Reinvestment Act (ARRA) of 2009, casually known as the economic stimulus package, has generated a lot of buzz across the chiropractic profession.
A section of the ARRA, known as the HITECH Act, deals specifically with health information technology; however, there has been substantial misinformation and rampant rumors about the package and its relationship to you.
This article will help dispel some of the myths swirling around and simplify some of the complexities.
Much more here:
Nothing like a lot of money to bring all sorts out! I wonder is there a specialist chiropractic EMR and how it would interoperate with standard EMR data sets?
Tenth we have:
Cerner Overhauls America: Under the Radar
08/21/09 - 05:00 AM EDT
"Under the Radar" uncovers little-known companies worthy of investors' consideration. Check in at 5 every Monday, Wednesday and Friday morning to find out about stocks that tend to beat their bigger brethren.
BOSTON (TheStreet) -- Despite impressive second-quarter results, Kansas City-based Cerner(CERN Quote) has fallen about 3% since its earnings release at the end of July. A reduced revenue forecast prompted a flurry of selling.
Cerner was founded in 1979 as "PGI" and its first products, Health Network Architecture and Pathnet Laboratory Information Systems, were designed to simplify the process of health-care record-keeping. Initially, the company was dependent on venture-capital funds. Then management elected to go public in 1986. If you had purchased 1,000 shares following the initial offering (at a split-adjusted price of $1 a share), today you would have $63,000.
More here:
Certainly seems there is some long term money in Health IT! The trick is to find a good small one to invest in and then live long enough!
Eleventh for the week we have:
Extension named exclusive AHA smart-card provider
By Joe Carlson / HITS staff writer
Posted: August 21, 2009 - 5:59 am EDT
The American Hospital Association, though its subsidiary AHA Solutions, issued an exclusive endorsement of a smart-card portable medical-record technology produced by Extension, Fort Wayne, Ind.
The product, HealthID, consists of a secure card that can hold individual patient data that hospital officials can run through a scanner to access medical and demographic information in an individual facility or across a network or system, an AHA news release said. Association officials said they chose the Extension program from among the various similar products they reviewed because it offered the best security and the most comprehensive and versatile applications.
More here (registration required):
http://www.modernhealthcare.com/article/20090821/REG/308219972
I hope they are a properly standardised card if they are to hold clinical information.
Twelfth we have:
Lorenzo launched in shadow of UK NHS debate
DHBs question integration and interoperability with existing systems
By Randal Jackson and Rob O'Neill, Auckland | Thursday, 20 August, 2009
ISoft has introduced its next-generation e-health solution to the New Zealand market, claiming that it is the answer to the problems of integration and interoperability.
The Australian-listed health information technology company has a presence at all 21 district health boards, mainly though providing patient management systems.
Lorenzo was developed as a key component of the UK National Health Service’s National Programme for IT (NPfIT) to connect patient records on a national scale. At £12.7 billion, NPfIT is the biggest civilian IT project in the world and has been heavily criticised.
iSoft chief executive Gary Cohen says the many problems of the project that have been written about have been exaggerated. “We’re light years ahead of where they were five years ago. Over the next one to two years, we will see a major transformation,” he says.
“It’s a very political process. It’s not true that it hasn’t delivered.”
More here:
http://computerworld.co.nz/news.nsf/news/210D787A1ACCE2F2CC2576170018278B
Just turning up all over!
Thirteenth we have:
FDA rules say e-report adverse drug, device events
By Andis Robeznieks / HITS staff writer
Posted: August 20, 2009 - 11:00 am EDT
The Food and Drug Administration today proposed new rules that would require adverse events reports related to approved devices, drugs and biologic products to be submitted electronically.
Currently, reports are received both electronically and on paper, with the paper reports requiring a manual input of the information into FDA databases.
More here (registration required):
http://www.modernhealthcare.com/article/20090820/REG/308209917
We could do with serious progress in this area too!
Fourteenth we have:
HHS issues interim rule on patient privacy breaches
By Joseph Conn / HITS staff writer
Posted: August 20, 2009 - 11:00 am EDT
HHS has issued an interim final rule, which takes effect in 30 days, regulating when and how patients must be notified if their healthcare information has been exposed in a security breach by hospitals, physician offices and other healthcare organizations.
The new rule is part of heightened privacy and security protections under the American Recovery and Reinvestment Act of 2009, or stimulus law. It is a companion to regulations released Monday by the Federal Trade Commission covering breaches involving vendors of personal health-record systems and certain other associated businesses not covered by the privacy and security provisions of the Health Insurance Portability and Accountability Act of 1996.
The new HHS rule was published in the Federal Register Wednesday, starting the 30-day clock toward its effective data. Simultaneously, HHS also opened a 60-day public comment period on the rule.
Both HHS and the FTC issued drafts of their proposed rules and opened those up for public comment in April.
More here (registration required):
http://www.modernhealthcare.com/article/20090820/REG/308209956
This is certainly part of what has to be in our legislation as well.
Fifth last we have:
Fletcher Allen digital record system fails
By Dan McLean, Free Press Staff Writer
Fletcher Allen Health Care's new $57 million electronic health record system failed Tuesday after a morning power failure. It took the bulk of the day to get the system restored, hospital spokesman Mike Noble said.
The Burlington hospital will conduct a "root cause analysis" to determine why the system's back-up power failed to keep the record system from shutting down. This is the first time the system failed in such a manner, he said. The state-of-the-art record system was installed in early June.
The system failure forced the "unplanned downtime plan" to go into effect, Noble said. "And the staff implemented that very well." The downed system caused an elective surgery to be rescheduled and returned hospital staff to transcribing medical notes by hand.
More here:
http://www.burlingtonfreepress.com/article/20090819/NEWS02/908190311
Sounds like no-one bothered to really test the impact of a power outage – but at least they had fall back manual systems in place!
Fourth last we have:
NHS project on critical list
By Nicholas Timmins
Published: August 19 2009 22:44 | Last updated: August 19 2009 22:44
“If you live in Birmingham,” declared Tony Blair when he was UK prime minister, “and you have an accident while you are, for example, in Bradford, it should be possible for your records to be instantly available to the doctors treating you.”
Not any more. Or not, at least, if the Conservatives win the next general election. For the Tories have pledged to scrap the country-wide version of the National Health Service’s electronic patient record.
Back in 2002, the idea of a full patient record, available anywhere in an emergency, was the principal political selling point for what was billed as “the biggest civilian computer project in the world”: the drive to give all 50m or so patients in England (the rest of the UK has its own arrangements) an all-singing, all-dancing electronic record. Roll-out was meant to start in 2005 and be completed by 2010.
Under a Conservative government, development of the local record – exchangeable between primary care physicians and their local hospitals – would continue. Nationally, clinicians would still be able to seek access to it when needed from the doctors who would hold it locally. But the idea of a national database of patients’ records, instantly available in an emergency from anywhere in the country, would disappear.
This may or may not matter, depending on your point of view. For many clinicians, the idea of an instantly available national record was always something of a diversion. It is access to a comprehensive record locally that is crucial for day-to-day care.
Nonetheless, the Conservatives’ decision to scrap the central database is a symbolic moment for a £12bn ($20bn, €14bn) programme that has struggled to deliver from day one. It is currently running at least four years late – and there looks to be no chance in the foreseeable future of its delivering quite what was promised.
More here (subscription required):
http://www.ft.com/cms/s/0/6b74e4c8-8cdd-11de-a540-00144feabdc0.html?nclick_check=1
The second last paragraph says it all. It is true! – NEHTA are you listening?
Third last we have:
PHRs: Worth the Effort
Carrie Vaughan, for HealthLeaders Magazine, August 12, 2009
Will personal health records be a temporary fix or are they here for the long haul? No one knows, but some providers say the benefits for patients are worth the effort.
Personal health records alone are not going to fix healthcare. But failing to incorporate them in your organization's strategy is shortsighted, especially in light of the Health Information Technology Policy Committee's recommendations for "meaningful use" that include patient access to PHRs by 2013. Still there are a host of questions surrounding the effectiveness of PHRs, their adoption rate, and their position in healthcare reform. But industry experts agree that offering patients some sort of tool to manage their healthcare is quantifiably better than the mishmash of records they have right now.
Ernie Hood, vice president and chief information officer at Group Health Cooperative in Seattle, does not believe that personal health records offer the optimal situation for caregivers to share data, but he does concede that providing a PHR is an improvement over the current system. "It's better to give a patient a PHR tool to share their [health] information than to leave them with nothing but incomplete paper records," he says.
And now may be the perfect time for healthcare organizations to jump into the PHR game. For an organization like Group Health, which has 600,000 members who can receive care from 900 physicians and 1,600 nurses in medical centers from Washington to Idaho, to build the interfaces for a PHR, it would have to be fairly certain that patients will use it for the investment to be worthwhile.
Much more here:
http://www.healthleadersmedia.com/content/237383/topic/WS_HLM2_MAG/PHRs-Worth-the-Effort.html
Sort of makes the same point at the previous article from the other side of the Atlantic.
Second last we have:
Should EHRs be able to create legal paper records?
By Joseph Conn / HITS staff writer
Posted: August 19, 2009 - 11:00 am EDT
The tricky and intertwined issues of legal record reproduction and the privacy requirements under new and old federal laws were frequent topics of discussion through day two of a conference on the legal e-health record hosted by the American Health Information Management Association, or AHIMA.
The two-day conference in Chicago wrapped up Tuesday.
Peggy King, the vice president of risk management and legal affairs at NorthShore University HealthSystem, Evanston, Ill., described the ad hoc adaptation of the hospital system's record release procedures and, eventually, the modification of its clinical electronic health-record system—from Epic Systems Corp., Verona, Wis.—to accommodate a legal discovery request.
At the core of the lawsuit behind the request is the plaintiff's allegation that NorthShore emergency room personnel failed in 2004 to diagnose and treat in a timely manner a patient with sepsis and septic shock, according to King. The records request for the patient's subsequent 63-day stay consumed about eight reams of copy paper and filled multiple bankers' boxes, she said.
“Epic is not in the business of producing a paper record,” King said. As a result, she said, the printouts the EHR generated were absent page headers, page numbers and some records contained only a single line of print on an otherwise blank sheet of paper.
Donald Mon, vice president of practice leadership at AHIMA, led a group discussion on AHIMA policy going forward, including whether the association should lobby the industry on including certification of the ability of EHRs to produce legal records as part of the “meaningful use” requirements now being defined under federal rulemaking pursuant to the American Recovery and Reinvestment Act of 2009.
Mon said that the EHR system, when it was first developed, “was positioned as a physician's tool. There was never any intention that the EMR should stand as the legal record.” Should we say strongly to the industry the EMR has to be more than a physician's tool, it has to be a legal record?
Much more here (registration required):
http://www.modernhealthcare.com/article/20090819/REG/308199951
Now here is a real biggie. Needs some careful thought!
Last, and very usefully, we have:
Blumenthal: I.T. Made Me a Better Doctor
HDM Breaking News, August 20, 2009
David Blumenthal, M.D., national coordinator for health information technology, has released a letter updating the industry on the government's activities to accelerate the use of I.T. He also makes a personal pitch to physicians, telling them I.T. made him a better doctor. What follows is the full text of the letter:
"In my role as National Coordinator for Health IT, I have the privilege to be part of a transformative change in health care that will help to extend the benefits of health information technology (HIT) to all Americans. With the passage earlier this year of the Health Information Technology for Economic and Clinical Health (HITECH) Act, we have the tools to begin a major transformation in American health care made possible through the creation of a secure, interoperable nationwide health information network.
"Of course, this system is not an end in itself. Rather, it will enable countless other improvements in the quality and efficiency of health care that will make Americans healthier and their economy stronger.
Much more here:
That is actually why we need to do this stuff – to make better and safer doctors!
There is an amazing amount happening. Enjoy!
David.
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