Quovadx Participates in Developing Accenture Nationwide Health Information Network Prototype

Quovadx Participates in Developing Accenture Nationwide Health Information Network Prototype
Accenture-Led Consortium Shows Benefits of Nationwide Network Are within Reach of U.S. Citizens and Healthcare Community
GREENWOOD VILLAGE, Colo.--(BUSINESS WIRE)--Jan. 25, 2007--Quovadx, Inc. (Nasdaq: QVDX), a global software and vertical solution company, today announced its Integration Solution division's (ISD) role in the Accenture-led team that developed a fully integrated health information system prototype.
The Accenture solution, which works with legacy clinical systems, is a significant step toward building an interoperable, standards-based network. Quovadx ISD, as part of the Accenture-led team, provided its clinical interoperability solution, leveraging flagship Cloverleaf(R) Integration Suite technology to support secure interoperability, and its Secure Object Client to facilitate physician office connectivity for the networked community. Quovadx also provided implementation services for each of these technologies.
"We are extremely proud to be working alongside Accenture and the other consortium members to create an integrated health information system prototype as part of the Nationwide Health Information Network (NHIN) program," said Harvey A. Wagner, chief executive officer, Quovadx. "At Quovadx, we feel strongly that clinical data sharing can help improve patient safety and the quality of care while reducing healthcare costs, and we are excited to be part of Office of the National Coordinator for Health Information Technology (ONCHIT) initiative to facilitate interoperability between healthcare organizations and advance this cause."
The Accenture prototype shows that patient data can be extracted from disparate information systems and converted to a common language that enables sharing between physician offices, medical laboratories, hospitals and other clinical settings - offering a "single view" of a patient's medical information. This approach, which allows the industry to build on existing investments in legacy provider systems, allows rapid implementation of a secure infrastructure to facilitate data sharing.
In November 2005, the U.S. Department of Health and Human Services awarded a contract to Accenture to lead the development of a prototype network for secure information sharing among healthcare communities in West Virginia, eastern Kentucky, northeastern Tennessee and southwestern Virginia. This region has a wide variety of clinical systems among different provider organizations, much like the majority of the United States.
About Accenture
Accenture is a global management consulting, technology services and outsourcing company. Committed to delivering innovation, Accenture collaborates with its clients to help them become high-performance businesses and governments. With deep industry and business process expertise, broad global resources and a proven track record, Accenture can mobilize the right people, skills, and technologies to help clients improve their performance. With approximately 146,000 people in 49 countries, the company generated net revenues of US$16.65 billion for the fiscal year ended Aug. 31, 2006. Its home page is www.accenture.com.
About Quovadx, Inc.
Quovadx (Nasdaq: QVDX) offers software and services for system development, extension, integration and analysis to enterprise customers worldwide. Quovadx has three divisions, including the Integration Solutions division (ISD), which offers private and public healthcare organizations software infrastructure to facilitate system interoperability and leverage existing technology, the CareScience division, which provides care management and analytical solutions to hospitals and health systems and pioneered regional healthcare information organization (RHIO) technology, and the Rogue Wave Software division, which provides software and services for enterprise-class application development and high-performance SOA. Quovadx serves companies in the healthcare, financial services, telecommunication and public sectors. For more information, please visit http://www.quovadx.com.
QUOVADX is a trademark of Quovadx, Inc. and Cloverleaf is a registered trademark of Quovadx, Inc. in the United States and other countries. All other company and product names mentioned may be trademarks of the companies with which they are associated.
CONTACT: Quovadx, Inc.Andrea Lashnits, 720-554-1246andrea.lashnits@quovadx.comorAbby Cohen, 212-850-5710abby.cohen@fd.comSOURCE: Quovadx, Inc.

Progress report on federal healthcare IT goals

HHS releases progress report on federal healthcare IT goals

Healthcare IT News

By Bernie Monegain, Editor
01/24/07
WASHINGTON – Since 2004, the United States has made strides toward automating its healthcare system, according to a report released Wednesday by the Department of Health and Human Services. The report details HHS accomplishments toward the goal of healthcare automation that President Bush first called for in his 2004 State of the Union Address, reiterated in his 2005 speech and again in the State of the Union Address Tuesday night.
“In 2006, HHS achieved several major milestones to meet the president’s call for most Americans to have access to electronic health records by 2014,” HHS Secretary Michael Leavitt stated in the report. “These significant accomplishments will provide tangible value to healthcare consumers – helping to reduce costs and medical errors with better information technology.”The report casts 2004 as “laying the foundation,” and 2005 as initial steps and progress.” HHS lists “major accomplishments” in 2006 and spells out some goals for 2007. Among the accomplishments: • Recommendations delivered by the American Health Information Community having to do with consumer empowerment, chronic care, electronic health records and bio-surveillance. • Standards harmonization that form the basis of interoperability• President Bush’s Executive Order on value-driven care• EHR certification developed by the Certification Commission for Healthcare Information Technology• Changes to regulations to allow hospitals or other healthcare organizations to donate healthcare IT to physicians• Healthcare IT adoption measurement – working with George Washington University, HHS conducted a physician survey to establish a baseline for measuring healthcare IT adoption. “These accomplishments will encourage broad, standards-based adoption of health IT that will improve the health and healthcare of all Americans,” according to the HHS report. “Already, the markets are responding to federal leadership.”Looking forward, the report cites the upcoming demonstrations of four prototype architectures for development of a nationwide health information network and work by the American Health Information Community workgroups on matters of privacy and security, quality and personalized healthcare.

Companies poised to take part in EMR shift

Posted on Sun, Jan. 21, 2007

Poised to assist the medical sector in connecting the data

By Jane M. Von BergenInquirer Staff Writer
Imagine cradle-to-grave personalized health information, computerized and centralized.
Scary? Or part of the salvation of America's expensive and unwieldy health system? If it saves lives and improves efficiency, as proponents say, it will mean billions of dollars of business for hardware, software and consulting companies.
No wonder companies are positioning themselves to profit from electronic medical records.
Tens of billions of dollars worth of technology - depending on who's estimating and how - would be needed to bridge existing islands of medical information now stored in files in doctors' offices, pharmacies, insurance companies, hospitals, laboratories and workplaces.
Doctors' offices, now notoriously paper-dependent, would need to go digital. So would hospitals, and they would all need help.
Gone would be those under-the-bed cartons of old X-rays, children's immunization records, and medical bills. The pharmacist could log on to see all a patient's prescriptions, avoiding dispensing pills in harmful combinations.
An electronic medical record, linked to hospitals, doctors and pharmacies, would follow someone from her first day to her last. Under some scenarios, the individual would control the record; in others, control would remain with health-care providers.
Whether payers, such as insurance companies, or academics doing broad-based research would be able to link in remains an open question. So does the amount of access that employers would have.
However it is set up, it will cost billions to implement.
BBC Research & Consulting, a Denver market-research firm, predicts that the market for health-information technology will reach $34.7 billion in sales by 2011 - and that does not include computer systems used by insurers, employers or even individuals to keep track of their care.
"It bodes very well for a company like mine, being in the right place in the right time with the right product," said Dennis Gallagher, a salesman for Vitalize Consulting Solutions Inc. in Kennett Square, a 115-employee firm that helps hospitals and doctors convert from paper to electronic systems.
And it also bodes well for Gallagher's former employer, Siemens Medical Solutions USA - a multibillion-dollar unit of the German company with its U.S. headquarters in Malvern. Siemens is one of the nation's largest providers of clinical software coordinating patient care in hospitals and doctor practices.
Earlier this month, Gallagher and 130 other members of the Delaware Valley Healthcare Information and Management Systems Society went to the Siemens corporate campus for its regular monthly meeting.
The speaker?
Former GOP House Speaker Newt Gingrich, whose Center for Health Transformation think tank in Washington has been a major advocate of using information technology to enable patients to receive better care at lower cost. And Siemens, which helps fund Gingrich's center, is trying to boost its presence in the electronic-medical-record market.
"Our commitment is to educate" doctors and hospitals, said Connie D'Argenio, vice president of health services for Siemens, who introduced Gingrich at the event earlier this month. If doctors and hospitals want to spend money on technology, she said, "then we'll be well-positioned to be their partners."
About half of Siemens Medical's $10.3 billion in annual sales derives from the United States, and a sizable portion of that comes from information-technology systems that Siemens sells to coordinate and computerize clinical care in hospitals and doctors' offices.
For example, Siemens showed Gingrich its bar-code technology that requires a nurse, before dispensing medicine, to scan bar codes on her identification badge, on the medicine package, and on the patient's hospital bracelet. That raises the patient's chart on a computer wheeled into the room and confirms that the right patient is receiving the right dose of the right medicine at the right time, while also pointing out any potential counterindications and generating a care record for the future.
Gingrich said the government should finance an electronic medical network as part of the nation's defense system against, for example, a bioterrorism attack, just as Dwight Eisenhower initially funded the interstate highway as a national defense network during the Cold War.
"It is virtually inevitable that we will move to an electronic health record for every person, and that health record will start with prenatal care and end with analytics after you passed away," Gingrich said in his speech, which was Webcast to 803 Siemens customers and employees around the nation.
Although there has been talk of electronic medical records for at least a decade, several factors have been moving it to the forefront.
The rising cost of health care and its effect on the nation's competitiveness, the health needs of aging baby-boomers, leadership from the Bush administration nationally and the Rendell administration in Pennsylvania, and increased technological proficiency are all driving support for such records.
On Wednesday, Rendell included the idea of electronic health records in his sweeping plan to change how health care has been provided and funded in Pennsylvania.
Around the nation, experiments and projects are cropping up - financed by a variety of sources.
"Philadelphia is one of the most innovative leaders in this respect," said Elliot Menschik, founder of Hx Technologies in Center City.
In the second quarter, Hx Technologies' Philadelphia Health Information Exchange will begin to trade patient data - with patients' approval - among several competing health organizations, including the University of Pennsylvania Health System and Thomas Jefferson University Hospital.
Menschik said the launch would build on results from a 20-month experiment completed last year - an experiment that he said showed how electronic health records could improve patient care and cut costs.
His company analyzed medical imaging done in the two health systems, selecting imaging because CT scans, X-rays and MRIs are already digitized and would be easy to share.
The experiment showed that 20,000 patients sought care in both systems. These patients generated 125,000 imaging examinations. Of those, 10,000 would have been useful to doctors at the other hospital.
For example, a doctor at one hospital might have liked to compare older X-rays taken at the other hospital to improve diagnosis. Of the 10,000, 1,520 were straight duplicates that cost $218,000 - an expense that could have been avoided.
"Our company believes the strongest potential is working with the health plans," Menschik said. So far, funding has come from the National Institutes of Health and the hospital systems. He said he has been talking to local insurers.
Some regions, including Boston and California, have established nonprofit organizations to set up similar exchanges, called Regional Health Information Organizations. Next week in Washington, leaders will be sharing business prototypes at a conference sponsored by the U.S. Department of Health and Human Services.
Last month, five major corporations - among them Intel Corp., Wal-Mart Stores Inc. and Pitney Bowes Inc. - announced they would finance the development of Dossia, a Web-based personal health record available to their 2.5 million employees, dependents and retirees.
Controlled by employees, Dossia would cull information from their doctors, hospitals and pharmacies to create a comprehensive health history that would be portable and private.
"As an employer, we've got 50,000 people," said Colin Evans, director of policy and standards at California-based Intel.
Evans said the company's motivation in financing Dossia was more about concerns it has as one of the nation's largest employers, rather than for potential new business it might garner through electronic medical records.
"We spend half a billion dollars on health care every year," he said. "One could argue that it is out of control. The amount we spend on health care is pricing jobs out of the U.S. to other places."
From Paper to Computer
Here's a glossary of some of the most frequently used terms for digital medical information:
Personal Health Record (PHR): Controlled by individuals, these records could include prescriptions, laboratory results, physicians' reports, lab images. Some think these records should also link to sources of relevant medical information, including, for example, help in controlling diabetes or asthma.
Electronic Medical Record (EMR): Controlled by doctors or hospitals, these records keep track of the care given to patients in a clinical setting. These can also assist with billing.
Computerized Physician Order Entry (CPOE): These systems keep track of physicians' orders, partly to ensure that bad handwriting doesn't contribute to medical errors.
Regional Health Information Organization (RHIO): Typically nonprofits, these organizations orchestrate the electronic exchange of information among area hospitals and other providers, with the consent of the patients. They choose standards and protocols.
Health Information Exchange (HIE): The technology infrastructure that a RHIO would use.
Workplace reporter Jane M. Von Bergen and Elliot Menschik, founder of Hx Technologies, chat online at noon tomorrow about how sharing digital patient information could improve care and cut costs.
Read more at http://go.philly.com/hxfiles.
E-mail your questions to: businessnews@phillynews.com.

WellPoint Launches E-Prescription Pilot

January 23, 2007


Indianapolis-based WellPoint on Monday announced the launch of an electronic-prescription pilot program for 100 physicians in its subsidiary, Anthem Blue Cross and Blue Shield of Ohio, the Indianapolis Star reports.

The program will allow participating physicians to submit patient prescriptions electronically to pharmacies and provide information about the prescriptions, such as possible drug interactions, drugs with similar names and cheaper generic options.

Physicians will be reimbursed $750 for computer hardware and $40 per month for the cost of the e-prescribing service. WellPoint said that other e-prescribing programs have resulted in changes to 2% of prescriptions because of alerts about safety concerns.

General Motors, an Anthem customer in the Ohio area, also is providing funding for the program. WellPoint has not yet decided if the program will be expanded to its other markets (Lee, Indianapolis Star, 1/23).

Free E-prescribing to Every Physician in America

Washington, DC – Jan. 16, 2007 – A coalition of the nation’s most prominent technology
companies and leading healthcare organizations announced today a national initiative to provide
free electronic prescribing for every physician in America. The National ePrescribing Patient
Safety InitiativeSM (NEPSISM) is the first nationwide effort to improve patient safety by offering a
solution to the medication errors that harm millions of people each year.
Preventable medication errors injure at least 1.5 million Americans and claim more than 7,000
lives each year, according to a July 2006 study by the Institute of Medicine (IOM) of the National
Academy of Sciences. In an effort to reduce these errors, the IOM has called on all of the
nation’s physicians to adopt electronic prescribing by 2010.
“While medication errors and adverse drug events can be common and serious, electronic
prescribing is clearly a tool that can dramatically reduce errors and improve patient safety,” said
Nancy W. Dickey, currently President of the Health Science Center and Vice Chancellor for
Health Affairs at the Texas A&M University System and formerly President of the American
Medical Association. “Yet despite the many benefits of electronic prescribing, physician adoption
is still modest. The situation calls for a solution that will overcome the barriers many physicians
face in adopting this life-saving technology.”
The challenge, according to the eHealth Initiative, is that fewer than 1 in 5 of the nation’s
practicing physicians currently process prescriptions electronically. Studies indicate that most
physicians have been reluctant to adopt electronic prescribing largely because of the cost of the
systems, and a perception that the technology requires too much time to learn and install.
NEPSI will help address those barriers by providing physicians simple, safe and secure electronic
prescribing at no cost. NEPSI is led by Allscripts (Nasdaq: MDRX), the leading provider of clinical
software, information and connectivity solutions that physicians use to improve healthcare, and by
national sponsor Dell Computers, Inc. (Nasdaq: DELL), the world’s leading computer company.
Other technology companies sponsoring NEPSI are Cisco Systems Corp., Fujitsu Computers of
America, Inc., Google, Inc. – the coalition’s Search Sponsor – Microsoft, Corp., Sprint Nextel
Corp., SureScripts, Inc., and Wolters Kluwer Health, Inc.
“Medication errors represent a significant challenge for our nation and we know we can and we
must do better by taking action – right now,” said Glen Tullman, Chief Executive Officer of
Allscripts. “The National e-Prescribing Patient Safety Initiative brings together a diverse group of
technology companies, payers and physicians who share a commitment to one remarkable idea –
that providing free electronic prescribing for every physician will ultimately reduce errors and
improve care. This initiative delivers a simple yet comprehensive solution, and represents an onramp
to a complete Electronic Health Record.”
Kevin Rollins, President and Chief Executive Officer of Dell, NEPSI’s national sponsor,
commented, “We are proud to add sponsorship of the NEPSI Coalition to the growing list of
healthcare-related initiatives that Dell is helping to lead. Information technology holds great
promise as a means to help upgrade our nation’s healthcare system, and we look forward to
working with partners such as Allscripts to help demonstrate its potential to improve the quality,
efficiency and productivity of healthcare in the America.”
In addition to Dell, a number of the largest technology companies in the world are sponsoring
NEPSI including Microsoft and Intel.
"Microsoft is proud to support the NEPSI initiative, which we believe is a major step forward in the
effort to arm our nation’s physicians with the technology they need to eliminate paper from the
prescription process and deliver higher quality, safer patient care,” said Steve Shihadeh, General
Manager of Sales, Marketing and Partners for Microsoft’s Health Solutions Group. “We believe
that consumers will be the biggest beneficiaries of this technology adoption by physicians,
enabling real-time access to the most relevant patient information".
Craig Barrett, Intel Chairman, who recently announced an initiative with major employers to
provide a personal health record system for their employees, commented, “Paper prescriptions
are a key cause of cost, errors and inefficiency in U.S. health care. Which other industry could
tell their customers it was OK to have a 15 percent error rate; imagine the airlines landing at the
wrong destination 15 percent of the time. Electronic prescribing should be the rule not the
exception. We look forward to working together with Allscripts and this initiative to lower health
care costs and drive improvements, ultimately providing more timely and accurate information to
our employees through direct feeds to the Dossia lifelong health record.”
A key element of the NEPSI initiative is participation by two of the nation’s largest health benefits
companies, Aetna and WellPoint, as well as influential regional payers such as Horizon Blue
Cross Blue Shield of New Jersey. The coalition’s health benefits sponsors will provide a range of
incentives to physicians in their networks to encourage adoption and use of electronic prescribing
technology. Their view is that electronic prescribing adds quality and efficiency to the patient care
process.
"WellPoint views electronic prescribing as an essential tool in providing high-quality, safe and
cost-effective care to our members,” said Charles Kennedy, M.D., Vice President of Health
Information Technology for WellPoint. “We are excited about the potential of the NEPSI program
to improve care when executed by our network physicians."
To add local presence and expertise, NEPSI also includes more than a dozen of the most
prestigious and leading academic medical centers, integrated delivery networks and physician
groups representing thousands of physicians across the country. These organizations will serve
as regional supporters of NEPSI, leading the delivery and support of electronic prescribing to
physicians in their states and regions by providing education, training, incentives and local
physician support.
Leading healthcare provider organizations acting as regional supporters of the NEPSI rollout of
free electronic prescribing include: Advocate Health Partners, Mount Prospect, IL; Brown &
Toland Medical Group, San Francisco, CA; Delta Health Alliance/University of Mississippi Medical
Center, Stoneville, MS; George Washington University Medical Faculty Associates, Washington,
DC; Healthcare Partners Medical Group, Torrance, CA; Holston Medical Group, Kingsport, TN;
LSU Health Network, New Orleans, LA; MaineGeneral Health, Augusta, ME; Novant Health,
Winston-Salem, NC; Sierra Health Services and Southwest Medical Associates, Las Vegas, NV;
UMass Memorial Healthcare, Worcester, MA; University of South Florida/USF Physicians Group,
Tampa, FL.
The backbone of the NEPSI program is eRx NOW™, web-based software from Allscripts
powered by the same engine used today by more than 20,000 physicians to write millions of
electronic prescriptions each year. Designed to appeal to physicians in solo practice or small
groups, eRx NOW™ is available free to any healthcare provider with legal authority to prescribe
medications, and requires no download, no new hardware, and minimal training.
The product includes the ability to quickly generate secure electronic prescriptions that can be
sent computer-to-computer or via electronic fax to 55,000 retail pharmacies – more than 95
percent of all U.S. pharmacies – via SureScripts. All prescriptions are instantly checked for
potentially harmful interactions with a patient’s other medications using a real-time complete
medication database provided by Wolters Kluwer Health, as well as real-time notification of
insurance formulary status from leading payers, plans and pharmacy benefit managers. The
product also includes the ability for physicians to search and find targeted health-related
information for themselves or patients using a custom search engine from Google. The NEPSI
Custom Search Engine was created for medical professionals and enables those using the eRx
Now™ product to get search results tailored for the medical community.
eRx NOW™ offers physicians and patients the highest levels of security available, with multiple
redundant layers of firewall, deep-packet inspection, SSL encryption, database encryption,
intrusion detection and virus, spyware and malware protection for the program’s remote servers.
To ensure patient privacy, all patient information is stored on remote servers in a secure location,
so information cannot be compromised even if a physician’s computer or phone is stolen.
Interested physicians can visit the NEPSI web site, www.nationaleRx.com to register for the
program. The solution is currently being used by physicians and will begin national deployment
within 30 days.
ABOUT NEPSI
The National ePrescribing Patient Safety Initiative (NEPSI) is a coalition of the nation’s most
prominent technology companies and leading healthcare organizations dedicated to improving
patient safety by providing free access to simple, safe and secure electronic prescribing for every
physician in America. The coalition is led by Allscripts (Nasdaq: MDRX) and national sponsor
Dell, Inc. (Nasdaq: DELL); and includes Aetna, Inc., Cisco Systems, Inc., Fujitsu Computers of
America, Inc., Google, Inc., Microsoft, Corp., Sprint Nextel, Inc., SureScripts, Inc., WellPoint, Inc.,
and Wolters Kluwer Health, Inc.
The NEPSI offering also is supported by a growing number of academic medical centers,
integrated delivery networks and physician groups across the U.S., who are leading the rollout of
the NEPSI electronic prescribing solution, eRx NOW™, within their states and regions. For more
information, visit NEPSI on the web at www.nationaleRx.com.

Contacts:
Tarsis Lopez Dan Michelson Todd Stein
Fleishman Hillard Allscripts Allscripts
847-921-8353 312-506-1217 312-506-1216
tarsis.lopez@fleishman.com dan.michelson@allscripts.com todd.stein@allscripts.com
National Patient Safety Initiative Launched To Provide
Free Electronic Prescribing To Every Physician In America
Leading Healthcare and Technology Companies Join in Support of Initiative:
Aetna, Allscripts, Cisco, Dell, Fujitsu, Google, Intel, Microsoft, Sprint Nextel,
SureScripts, WellPoint, Wolters Kluwer Health

Cause of Death: Sloppy Doctors

Doctors' sloppy handwriting kills more than 7,000 people annually. It's a shocking statistic, and, according to a July 2006 report from the National Academies of Science's Institute of Medicine (IOM), preventable medication mistakes also injure more than 1.5 million Americans annually. Many such errors result from unclear abbreviations and dosage indications and illegible writing on some of the 3.2 billion prescriptions written in the U.S. every year.

To address the problem—and give the push for electronic medical records a shove—a coalition of health care companies and technology firms will launch a program Tuesday to enable all doctors in the U.S. to write electronic prescriptions for free. The National e-prescribing Patient Safety Initiative (NEPSI) will offer doctors access to eRx Now, a Web-based tool that physicians can use to write prescriptions electronically, check for potentially harmful drug interactions and ensure that pharmacies provide appropriate medications and dosages. "Thousands of people are dying, and we've been talking about this problem for ages," says Glen Tullman, CEO of Allscripts, a Chicago-based health care technology company, that initiated the project. "This is crazy. We have the technology today to prevent these errors, so why aren't we doing it?"

One of the reasons is that doctors haven't invested in the needed technology, so it's being provided to them. The $100 million project has drawn support from a variety of partners, including Dell, Google, Aetna and numerous hospitals. "Our goal long-term is to get the prescription pads out of doctors' hands, to get them working on computers," says Scott Wells, a Dell vice-president of marketing. Google is designing a custom search engine with NEPSI to assist doctors looking for health data. Insurance companies such as Aetna have pledged to provide incentives for physicians using e-prescription systems.

Although some doctors have been prescribing electronically for years, many still use pen and paper. This is the first national effort to make a Web-based tool free for all doctors. Tullman says that even though 90% of the country's approximately 550,000 doctors have access to the Internet, fewer than 10% of them have invested the time and money required to begin using electronic medical records or e-prescriptions.

By providing doctors with free tools and support—and perhaps a little prodding from the big insurers who pay the bills—the NEPSI alliance hopes to encourage a quickening in adoption of electronic prescribing. Because the new program is Web-based, no special software or hardware is required, and NEPSI says the new system takes 15 minutes to learn. Sprint plans to give away 1,000 web-enabled phones to be used to transmit e-prescriptions and to demonstrate the technology's ease of use. To keep pharmacies plugged into the new system, SureScripts, which links pharmacies around the country much like the national ATM network connects banks, will handle the e-prescriptions traffic from doctors to the country's 55,000 pharmacies.

Automation should eliminate many of the errors that occur when pharmacists misunderstand or misrecord medication names or dosages conveyed messily on paper or hurriedly by phone. Given that there are more than 17,000 pharmaceutical brands and generics available, a spoken request for Celebrex, for instance, can be mistaken for Celexa, or a notation requesting 150 milligrams of a drug might be read as 1500. In electronic systems, drugs and dosages are selected from menus to prevent input errors, and pharmacists don't need to re-enter information.

SureScripts CEO Kevin Hutchinson says one key to reducing medication errors is to get the most prolific prescribers to transition to electronic processing. "Not a lot of people understand that 15% of physicians in the U.S. write 50% of the prescription volume," Hutchinson says. "And 30% of them write 80%. So it's not about getting 100% of physicians to e-prescribe. It's about getting those key 30% who prescribe the most. Then you've automated the process."

Wider adoption of e-prescribing could lead to further efficiency in medical record keeping, which many believe is vital to both improving health care delivery and lowering costs. "Electronic prescribing could be an on-ramp for physicians beginning to use a full-featured electronic medical records system," Hutchinson says. "That's the holy grail."

nations's Capital Welcomes It's First Electronic Prescription

FOR RELEASE
8:00 A.M. EST
January 17, 2007

Contact:
Jennifer Mead
703-921-5328
jennifer.mead@surescripts.com


New Year Hastens Countdown to 100 Percent, Nationwide E-Prescribing Eligibility:
Two States Remain As Washington, D.C. Joins 48 States
that Allow Safer, More Efficient E-Prescribing

Washington, D.C. – January 17, 2007 – Today, SureScripts®, operators of the Pharmacy Health Information Exchange™, announced that the first prescription has been transmitted electronically from physician to pharmacist in the nation’s capital. Less than one month after the Washington, D.C. Board of Pharmacy adopted new rules making electronic prescribing legal, a D.C.-based Rite Aid pharmacy became the first to receive and process a new prescription electronically from a D.C.-based physician.

“Utilizing e-prescribing is a huge benefit for our patients, our pharmacists and our physician partners,” said Phil Keough, senior vice president of pharmacy operations for Rite Aid.
“E-prescribing improves accuracy, eliminates unnecessary phone calls and faxes to physician offices and, most importantly, allows our pharmacists to spend more time counseling their patients, answering their questions, and ensuring their compliance with medication therapy.”

The announcement follows last July’s release of a report by the Institute of Medicine (IOM) that focused national attention on the 1.5 million preventable medication errors that occur in the United States each year. To prevent these errors and the injuries they cause, the IOM report made a series of recommendations, including one that all prescribers and pharmacies prescribe electronically by 2010.

“These new rules present an opportunity for patients and physicians in the District of Columbia to enter a new era of medication safety, enabled by health information technology,” said
Dr. Peter Basch, a practicing internist and medical director for eHealth at MedStar Health in Washington, D.C. “Electronic prescribing has been shown to reduce medication errors caused by illegible prescriptions, improper dosing, and drug interactions. We see e-prescribing as part of any health system’s approach to make high quality care even better.”

“Many physicians, like myself, practice in or see patients from Maryland, D.C. and Virginia and it has been difficult to deal with different rules for each jurisdiction in recent years,” said
Dr. Alan Zuckerman, a pediatrician practicing in the District of Columbia. “When we use electronic prescribing tools today, prescriptions travel directly to the pharmacy computer system in some locations, but, unfortunately, are turned into a fax in others. The changes to the D.C. electronic prescribing rules to allow direct electronic prescriptions is a most welcome change that will help accelerate adoption of electronic prescribing and help achieve critical benefits in patient safety and quality.”

To capitalize on this new opportunity for safer and more cost efficient prescribing, SureScripts, operators of the Pharmacy Health Information Exchange, is working closely with community pharmacies throughout the nation’s capital to immediately activate previously certified computer systems for electronic prescribing. SureScripts has certified the software solutions being used by more than 95% of the nation's retail pharmacies. As a result, the great majority of the Washington, D.C. area's 113 retail pharmacies can now begin e-prescribing. Once activated, community pharmacies in the District will be able to receive new prescriptions from physicians directly into their pharmacy computer systems – instead of by fax or handwritten prescription. The same applies to prescription refill requests, which can now be sent from pharmacies to physicians electronically – no faxing or phone calls required.

“CARE Pharmacies is pleased that the D.C. Board of Pharmacy has approved the use of e-prescribing for pharmacies,” said Gerry Serody, CEO and chairman, CARE Pharmacies, Inc. “We feel strongly that this technology will be extremely important for the practice of pharmacy in the twenty first century.”

“When the nation’s community pharmacies founded SureScripts in late 2001, we began building the technical capability in our network to support e-prescribing between physicians and pharmacists anywhere in the nation,” said Ken Whittemore, senior vice president of clinical practice integration for SureScripts. ”At that time, however, there were only a dozen states with laws and regulations that would even allow electronic prescribing. A little over five years later, we are proud to announce that Washington D.C. has joined with 48 other states that allow their physicians and pharmacists to electronically exchange life-saving prescription information.”


About SureScriptsFounded by the pharmacy industry in 2001, SureScripts operates the Pharmacy Health Information Exchange™ which facilitates the electronic transmission of prescription information between physicians and pharmacists and provides access to life-saving information about patients during emergencies or routine care. Today, more than 95 percent of all pharmacies and all major physician technology vendors in the United States are certified on the Pharmacy Health Information Exchange. More information about SureScripts is available at www.surescripts.com.

Draft Requirements for EHR

Draft requirements for electronic health records that are intended to detect fraud and claims errors have been posted for public comment, Technology Daily reports (Technology Daily, 1/16).The requirements are based on guiding principles established during an earlier phase of the project contract with the Office of the National Coordinator for Health IT, AHA News reports. Comments, which will be submitted to the Certification Commission for Health IT, are due on Jan. 22 (AHA News, 1/16).HHS publicly announced late Friday afternoon the more than 60 proposed requirements in 16 categories, Modern Healthcare reports (Conn, Modern Healthcare, 1/15). One proposed requirement would enable users to view the method of entry for each piece of data. "Having an audit version of the (records that) indicates which of these tools were used could enable detection of patterns of abuse or fraud," RTI International researchers said (Technology Daily, 1/16).The Web site for RTI International, which created two work groups to prepare the recommendations, states that "the term 'model requirements' used in this project is meant to indicate a product that will be put forth as recommended criteria for future EHR certifications," adding that the criteria "will not become official requirements unless they are adopted as such by entities in the future." Some privacy advocates oppose the draft requirements. Dr. Deborah Peel, founder of the Patient Privacy Rights Foundation, in a response writes, "This draft is yet another instance of ONCHIT/HHS putting corporate interests ahead of the lives and health of the American people." She adds that the requirements "eliminate patients' fundamental rights to control access to their medical records, by claiming that such access is needed to detect fraud" (Modern Healthcare, 1/15).

Democrats to push health IT funding, privacy

By Heather B. Hayes
Published on Jan. 11, 2007


Congress did not pass national health information technology legislation last year, but it remains one of few truly bipartisan issues the new Congress will deal with, advocates say. As Democrats exert their leadership, industry observers also expect a shift in how health IT laws are approached.

“Democrats will certainly re-address the issue, and in fact, there’s already been talk among staffers about putting together a new broad-based [health IT] bill,” said David Merritt, project director for the Center for Health Transformation. “But it is for certain that their priorities will differ somewhat.”

Four themes are likely to emerge among the Democrats’ talking points: funding, privacy, systems interoperability and personal health records. Funding and privacy are potential sticking points.

Democrats will likely target funding to encourage small medical practices in underserved communities to adopt health IT. But Dave Roberts, vice president of government relations at the Healthcare Information and Management Systems Society, said they will have to be creative, because the Democrats have already committed to using a pay-as-you-go budgeting approach.

“They’re going to have to find sources to pay for it or raise taxes,” he said. “That’s going to be a real trick, since there’s going to be a lot of competition for funding among other health care concerns.”

Privacy is another issue that promises to produce a vigorous debate. House Democrats have long been pushing for comprehensive patient privacy protections as part of health IT legislation, including the right to consent to data disclosure, to opt in and out of electronic databases, and to be notified of privacy breaches.

“It’s going to be a different ballgame because the Democrats are at least going to hold extensive hearings on privacy and have a lot more oversight of what’s been going on at the Department of Health and Human Services,” said Deborah Peel, executive director of the Patient Privacy Rights Foundation.

Last year, the Republican-led Congress largely avoided the privacy issue. The Senate bill relied on existing Health Insurance Portability and Accountability Act protections, while the final House bill directed the HHS secretary to study existing privacy law and recommend a single national standard.

Zix Corporation Expands e-Prescribing Contract

Zix Corporation Expands e-Prescribing Contract with Independence Blue Cross

Successful PocketScript® deployment and program results lead to expanded contract for 350 physicians with the Philadelphia region's largest health insurer

DALLAS — January 10, 2007 — Zix Corporation (ZixCorp®), (Nasdaq: ZIXI), the leader in hosted services for email encryption and e-prescribing, today announced that Independence Blue Cross (IBC) has expanded its e-prescribing contract with ZixCorp for an additional 350 physicians based on ZixCorp’s earlier success with IBC's e-prescribing pilot. IBC is the Philadelphia region's leading health insurer with more than 2.6 million members locally and 3.4 million nationwide.
"Since our e-prescribing pilot program began over a year ago, we have seen improvement in generic and formulary prescribing by the participating pioneer physicians," said Dr. Steven Udvarhelyi, Chief Medical Officer for Independence Blue Cross. "With ZixCorp's help, we now have more than 265 physicians writing prescriptions electronically — much faster and easier for physicians and patients, and safer than paper prescriptions with hard-to-read handwriting. We look forward to continuing to improve patient safety and generic usage through e-prescribing with ZixCorp's PocketScript service."
PocketScript enables participating IBC physicians, through a wireless handheld PDA, to write prescriptions and then send them immediately and electronically to pharmacies, improving patient convenience. Prescriptions can also be written and managed through a ZixCorp secure Web site using a common browser. During the prescribing process, the application provides real-time access to formulary information, a drug reference guide, drug-to-drug and drug-to-allergy checking, and patient-specific dispensed-drug lists.
"IBC continues to demonstrate its leadership in this market by fueling the broader adoption of e-prescribing technology in the state of Pennsylvania," said Rick Spurr, chief executive officer for ZixCorp. "We’re proud to have been selected as the vendor for this next phase, which represents yet another expansion of a successful e-prescribing program."
About Independence Blue Cross Independence Blue Cross is the leading health insurer in Southeastern Pennsylvania. Nationwide, IBC and its affiliates provide coverage to nearly 3.4 million people. For nearly 70
2711 N. Haskell Ave. Suite 2300, LB 36 Dallas, TX 75204 phone 214 37 0 2000 fax 214 37 0 207 www.zixcorp.comZix Corporation
years, Independence Blue Cross has offered quality health care products and services tailored to meet the changing needs of members, employers, groups and providers.
Independence Blue Cross recently received the highest ratings from the National Committee for Quality Assurance for its HMO and PPO health care plans. In addition, in 2005, Independence Blue Cross's Personal Choice was rated the No. 1 PPO in the nation and its Keystone HMO was ranked the No. 1 HMO in the region by health care consumers in a leading independent consumer magazine.
About Zix Corporation
Zix Corporation (ZixCorp®) provides easy-to-use-and-deploy email encryption and e-prescribing services that protect, manage, and deliver sensitive information to the healthcare, finance, insurance, and government industries. ZixCorp's email encryption services enable policy-driven email security, content filtering, and send-to-anyone capability. Its e-prescribing service provides point-of-care access and transmission of patient and payor data that improves patient care, reduces costs, and improves efficiency. For more information, visit www.zixcorp.com.

New Congress, Same IT Issues

New Congress, Same I.T. Issues
By Joseph Goedert
(January 2007) With the 110th Congress starting work this month will come a renewed push to get health care information technology legislation through the House and Senate.
Many of the existing I.T. advocates in the two chambers remain, but the power centers have switched with Democrats now in charge.
For instance, Rep. Pete Stark (D-Calif.) will chair the House Ways and Means health subcommittee. Stark has been an ally of the health I.T. industry but not supportive of proposals to broaden the Department of Health and Human Services' rules to permit the donation of I.T. to physicians,
Donald Asmonga, director of government relations at the American Health Information Management Association in Chicago, expects Stark and other Democrats to push for deadlines for implementation of interoperable electronic medical records software, more aggressive enforcement of privacy protections and funding for that task, and more federal grants and other financial incentives to accelerate I.T. adoption.
But increased I.T. funds aren't guaranteed. Democrats have pledged to pay for new spending with budget cuts elsewhere or increased revenue. "You have to be careful about going down the road giving away money when you have to balance everything," explains Ann Berkey, vice president of public affairs at San Francisco-based McKesson Corp.
Watch for Stark to push to make the Veterans Administration's VistA electronic medical records software available for public use, Asmonga says. He also believes Democrats will attempt to require informed patient consent for the release of health information and continue to oppose a uniform privacy standard that preempts stronger state laws. But he cautions that could change with Democrats' new status on Capitol Hill. "When you get in the majority, it changes your outlook on everything."
Democrats may, however, seek to expand the HIPAA privacy rule to cover personal health records, notes Steve Wojcik, vice president of public policy at the National Business Group on Health in Washington.
Of all the health care legislation before Congress in the last session that will come back again, health I.T. is one of the least affected by which party is in control because it has the most bipartisan support, Wojcik says.
Still not easy
But despite support from the Bush administration and major congressional players from both parties in both houses, I.T. legislation didn't get through last year and won't be a cakewalk in 2007, observers say. "I'm not thinking the dynamics will change that much," Berkey says.
One way to remove an obstacle to passing legislation is to keep out language that would amend the new HHS donation rules and wait a year or two to see how the rules work out. "I don't think there will be an appetite to change what HHS has done so far," says Hugh Zettel, director of government and industry relations of the Integrated IT Solutions division at GE Healthcare, Waukesha, Wis.
If the rules are changed, Zettel believes there may be efforts to wave the required 15% physician payment for the value of donated technology if physicians participate in a health information exchange.
Another major sticking point in 2006 legislation-mandated implementation of the ICD-10 code set-won't be going away this year.
The House-passed bill in 2006 included language to mandate ICD-10 by October 2010 and the Senate-passed bill did not address the issue.
However, many physician and payer organizations are pushing for implementation by October 2012, and their influence, particularly the Blue Cross and Blue Shield Association, remains strong. "The Blues won't lose clout because they're so darn big," Asmonga says.
Observers say there will be plenty of members of both parties and in both chambers that likely will take leadership roles in pushing health I.T.
In the Senate, watch for Thomas Carper (D-Del.) to introduce legislation to offer personal health records to all federal employees, and for Sam Brownback (R-Kan.) to push for creation of independent health records banks.
Other Senate I.T. players likely will include Hillary Clinton (D-N.Y.); health committee leaders Edward Kennedy (D-Mass.) and Michael Enzi (R-Wyo.); and finance committee leaders Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa).
House members expected to play roles include Stark, Patrick Kennedy (D-R.I.), Tim Murphy (R-Pa.), John Dingell (D-Mich.), Henry Waxman (D-Calif.), Frank Pallone (D-N.J.) and Jim McCrery (R-La.).

HIT movers and shakers in 2007

Industry leaders identify movers and shakers to watch in 2007
By Bernie Monegain, Editor
01/03/07
Since President Bush mentioned the electronic medical record in his 2004 State of the Union Address, the concept of automating healthcare has become part of everyday talk. A concept that may have seemed abstract to many just three years ago seems complex, but doable today.
It won’t be that simple or quick, of course, to transform a behemoth into a smart, new machine, industry insiders say. But, there are plenty of movers and shakers doing their part.
Healthcare IT News asked a few of these leaders to identify who – besides themselves – would likely influence healthcare IT initiatives in 2007. Who is worth watching?
Some familiar names – and initiatives – emerged.
William F. Jessee, MD, president and CEO of the Medical Group Management Association, predicts there will be a flock of players in the personal health records space. He mentioned the recent launch of Dossia by a coalition of employers led by Intel, followed by a similar announcement from America’s Health Insurance Plans and the Blue Cross Blue Shield Association. Jessee expects ICW, a German company, to make a splash in the U.S. market in 2007 with its LifeSensor PHR, a product he says is already well proven in Europe.
“What is new in all this,” said Jessee, “is the idea of encouraging consumers to create their own PHR as a ‘pull-through’ strategy to get more physicians to use EHRs that can interface with those PHRs. Unfortunately, Dossia is more of a concept than a product at this point, but it demonstrates the kind of large corporate investments that I think we are likely to see more of in 2007.”
Concept or product, the prospect of Dossia was enough to put Intel Chairman Craig Barrett on Jeffrey Hill’s list of potentially top influencers for 2007. Hill is CEO of Anceta, a subsidiary of the American Medical Group Association. Hill admires Barrett for taking the lead on personal health records.
“He’s not going to sit and wait until it all gets fixed,” he said.
The AMGA itself is not sitting still, having charged Anceta with gathering data from its membership of more than 300 large multi-specialty groups for comparison and analysis.
Hill credits Donald W. Fisher, AMGA president and CEO, with the vision to get the comparative data project launched and for creating a direction for other critical initiatives, such as CAPP, the Council of Accountable Physician Practices, which promotes a model of care focused on performance, efficiency, use of electronic clinical systems and results-based reimbursement.
“He’s the one who is tying all these things together,” Hill said,
Hill expects continued accomplishments on the healthcare IT front from Janet Marchibroda, CEO of eHealth Initiative. Marchibroda has been brilliant at pulling together all the different factions that – together – can transform healthcare, he said.
Francois de Brantes, from GE who, as head of Bridges to Excellence, has dedicated himself to effecting change, is on Hill's movers and shakers list, too. de Brantes is developing a model of pay for performance and “trying to get his hands on data in the real world,” Hill said.
Donald Mon, vice president of practice leadership at the American Health Information Management Association will be watching who fills top positions at JCAHO (the Joint Commission on Accreditation of Healthcare Organizations) and Health Level 7, a standards development organization.
Mon is also keeping his eye on Robert Kolodner, MD, the nation’s interim healthcare IT chief. If he stays in the position, he could have broad influence.
Carolyn Clancy is director of the government’s American Healthcare Research and Quality. It will be interesting to see how she leads the AHIC (American Health Information Community) quality work group, Mon said, and what AHRQ does to advance quality reporting across the country.
Mark Leavitt, MD, chairman of the Certification Commission on Healthcare Information Technology, is another leader expected to accomplish great things, Mon indicated. He noted that Leavitt has deftly handled the process of certifying ambulatory EHRs. Now Leavitt faces new challenges as the commission begins certifying network components and specialty areas.
On the project front, Jessee of the MGMA predicts that hospitals are finally about to turn the corner on their IT investments. “Many of them have been in the selection/development mode, and more are going to transition into an operational mode in 2007,” he said. “So the stars will be those organizations and vendors that have done a good job of preparing to throw the switch – and the horror stories will be those that haven’t.
“The number of stories – both successes and failures – will really take an upswing in 2007 as more and more systems come online.”

Hawaii Blues to Docs: We'll Help With EMRs

Hawaii Blues to Docs: We'll Help with EMRs
By Joseph Goedert
A $50 million program from the Hawaii Medical Service Association, under which the Blues plan would give providers substantial financial help to purchase electronic medical records systems, could wire up most physicians in the state.
"I think it will come close to covering the whole market," says Patrick Kennedy, president at PJ Consulting, a Rockville, Md.-based consulting firm serving payers. "Fifty million will go a long way out there."
Honolulu-based HSMA also thinks the program will foster the longer-term goal of establishing regional health information organizations. "We're making this investment to move the community along to wider adoption of I.T. so we can be ready for RHIO activity," says Cliff Cisco, senior vice president. "There's a lot of RHIO talk, but we're a ways off from implementing a network. We want to prepare for that and give motivation."
Under the three-year HMSA Initiative for Innovation and Quality, the plan has committed $20 million to the purchase of EMRs for physician practices. It will contribute up to half the cost of an EMR, capped at $20,000 per physician, for about 1,000 physicians.
The remaining $30 million of the funding, to be given out over three years, is available to state hospitals in Hawaii to finance proposed projects-that could include use of information technologies-to improve patient care and outcomes. Cisco believes a "significant" amount of funds under the hospital program will go toward I.T., but the overall goal is to reduce practice variances and improve safety. Details of the program remain under development. "We've made the commitment and now are talking to hospitals," he adds.
Getting the docs
Hawaii has about 2,200 practicing physicians. About half are closely affiliated with urban hospitals, and many of their practices are using some clinical software.
The program to help pay for EMRs is open to any physician who doesn't have EMR software. But the focus will be on small and rural practices where adoption rates are low. HMSA hopes it will get most of these practices to take up its offer, Cisco says. "This is an effort to bring on slower adopters of the technology."
The Blues plan this fall was developing criteria for EMRs purchased with its financial assistance. "They'd have to be known systems with wide adoption rates," Cisco says. "We're not going to pay $20,000 for a system someone's nephew built in his garage."
The EMRs also will have to be certified by the Certification Commission for Healthcare Information Technology. HMSA expected to have a list of acceptable EMRs available by the end of 2006.
Heavy penetration of EMRs in Hawaii could support more comprehensive pay-for-performance programs. HMSA for five years has had a pay-for-performance program that gives physicians and hospitals "modest" payments for meeting certain quality standards, Cisco says. The new initiative is much larger than existing P4P programs, he notes. "Our board thought we'd ramp this up a bit, put out this $50 million commitment and see what it achieved."
Joining the fray
Several other Blues plans-particularly Highmark Inc. in Pennsylvania, CareFirst in Maryland, and Blue Cross and Blue Shield of Massachusetts-have launched significant initiatives to help defray physician costs for EMRs.
HMSA has an advantage, however, because the Blues plan controls 80% of the private insurance market in Hawaii, says Kennedy, the consultant. That's about three times the market share of most Blues plans.
Consequently, other Blues can't expect to get the same type of return on investment that HMSA should get, he adds.
Nor can other commercial insurers expect the same ROI, even large ones like Aetna Inc., Cigna Corp. and UnitedHealth Group. Despite their size, these national payers don't have a dominant market share in most of their regions, Kennedy says.
But many commercial insurers are talking with Blues plans about cooperating in regional I.T. incentive strategies, he notes.
Payers, however, are not yet convinced that state laws-and the recently changed federal rules governing the Stark Act and anti-kickback laws-are clear enough to allow the insurers to work together, Kennedy adds. "They're not sure they can do this without getting their hands slapped."

Improving Health Care Access: Grantmakers Share Their Experiences

Improving Health Care Access: Grantmakers Share Their Experiences

This report is a collection of profiles that tells the stories of how health funders across the country are working to improve access to health care. With these profiles, we have attempted to capture the priorities, funding strategies, accomplishments, and challenges of a cross section of grantmakers, giving readers a place to look for insights that they can adapt to their own circumstances.

The report profiles the work of 11 foundations: Blue Cross Blue Shield of Massachusetts Foundation, The California Endowment, The Health Foundation of Greater Cincinnati, Robert Wood Johnson Foundation, The Henry J. Kaiser Family Foundation, W.K. Kellogg Foundation, Maine Health Access Foundation, Quantum Foundation (West Palm Beach, Florida), The Rhode Island Foundation, Rose Community Foundation (Denver, Colorado), and Universal Health Care Foundation of Connecticut.

Related Information

	Improving Access to Health Care (1386K) [download]
	Improving Access Executive Summary (77K) [download]

Ahead for 2007: Open-source software for RHIOs?

BY Nancy Ferris

Related Links

The California HealthCare Foundation is considering turning the software developed for the Santa Barbara County Care Data Exchange into an open-source software product that other regional health information organizations (RHIOs) could use.

Foundation officials revealed their tentative plan at a Washington, D.C., forum where people from many organizations discussed the potential of open-source software for health information exchanges. A Forrester Research executive said at the forum that the use of open-source software could result in a 20 percent increase in nationwide RHIO expansion by 2014.

Forrester Vice President Eric Brown said open-source software would not solve all the problems that RHIOs are encountering as they try to establish information exchanges. But he said a survey Forrester undertook for the foundation suggested that if open-source systems were available, 60 percent of the country might have access to a RHIO by 2014, compared with 48 percent without open-source software.

President Bush set 2014 as a target for all Americans to have e-health records. Health care providers could share those records via RHIOs.

In Santa Barbara, the foundation and other organizations spent nearly $20 million on the software that underlies one of the country’s first RHIOs. To increase the return on that investment, the foundation might submit the software to a consortium or other nonprofit that could license it to other users, said Sam Karp, the foundation’s vice president of programs. As a result, RHIOs could acquire less expensive software and easily modify or enhance the system to meet their needs, forum speakers said.

The Forrester study suggested that the software from Santa Barbara could be converted to an open-source product for about $695,000. Even if less than 10 percent of RHIOs used it, Brown said, its existence in the marketplace would influence other software vendors, holding prices down and tending to make products more open and standards-compliant, he said.

Lori Hack, director of government relations and policy at California RHIO, endorsed open-source software for health information exchanges.

“We have to find a sustainable model,” she said, “and what’s out there today just isn’t working.”

With open-source software, users can see the source code and modify it to meet their needs. They are expected to share enhancements with other users. As is the case with the open-source Linux operating system, for-profit companies can make money on open-source software by providing custom implementations and support.

About 75 people attended the forum, and many expressed interest in joining an open-source community for clinical systems. The foundation will hold a similar meeting in California this week.

Tradeshows and Speaking Engagements

IHE Connectathon & Educational Conference
January 15-19, 2007
Hyatt Regency, Chicago, IL

Building Community Health Information Exchange
January 26-27, 2007
Hilton Garden Inn, Bloomington, Indiana
Speakers: Keith Hepp, CFO, HealthBridge
Alan Snell, M.D., CEO of Michiana Health Information Network

2007 EHR & E-Prescribing Summit
January 29-31, 2007
Hyatt Regency Orange County, Anaheim, CA
Speaker: Robert Keet, MD

HIMSS RHIO/ HIE Symposium
Sunday, February 25, 2007
Ernest N. Morial Convention Center, New Orleans, LA
Sponsor

2007 Annual HIMSS Conference and Exhibition
Sunday-Thursday, February 25-March 1, 2007
Ernest N. Morial Convention Center, New Orleans, LA
Booth #5127
Real RHIO's Achieving Real Results, 2/27/2007 from 3:15 - 4:00 PM
Speakers: Keith Hepp, CFO, HealthBridge, Cincinnati and Robert Keet, MD, President, Western Medical Associates, Santa Cruz

4th Annual Health Information Technology Policy Summit / 14th HIPAA Summit
March 28-30, 2007
Hyatt Regency on Capitol Hill
Washington, DC

Illinois and Missouri Health Information Management Association
Wednesday - Friday, April 18-20, 2007
Saint Charles Convention Center, St. Charles, Missouri

Connecting Communities Regional Forum
May 3, 2007
Rosen Shingle Creek, Orlando, FL
Sponsor

Connecting Communities Regional Forum
May 10, 2007
Boston, MA
Sponsor

Michigan Health Information Management Association
Monday-Wednesday, May 21-23, 2007
Kalamazoo, MI

Florida Health Information Association Convention and Exhibit
Monday-Thursday, July 25-28, 2007
Rosen Shingle Creek Resort, Orlando, Florida

California Health Information Association Convention and Exhibit
Sunday - Wednesday, June 10-13, 2007
La Quinta Resort & Club in La Quinta, California
Booth 29

Group prescribes changes

Posted on Tue, Jan. 02, 2007 Group prescribes changes By Cheryl Powell Beacon Journal medical writer The days of walking out of the doctor's office with a prescription in hand could be numbered. Rather than handing over a prescription scrawled on a piece of paper, doctors are starting to send their medication orders over secure computer connections directly to the pharmacy of the patient's choice. Electronic prescribing -- known as ``e-prescribing'' for short -- is being heralded as a way to cut down on medication errors while reducing costs and improving patient compliance with their doctor's orders. In fact, the National Institute of Medicine recently issued a recommendation that all prescriptions be written electronically by 2010 to help cut down on medication errors. This month, a group representing many of the region's largest employers is launching a program to encourage more doctors in the Akron-Canton area to adopt e-prescribing. The Employers Health Purchasing Corp. of Ohio wants to find 25 area doctors who are willing to be the first physicians in the region to use an e-prescribing tool called ``iScribe.'' The Canton-based group is made up of area employers that pay medical bills for their employees. Participating businesses -- including FirstEnergy, Diebold, the cities of Akron and Canton, Summit County, numerous school districts and others -- employ about 430,000 people. The employer group is offering the program in partnership with Caremark Rx Inc., the Nashville-based company that manages the employee pharmacy benefits for the coalition's member companies. The Canton-based group and Caremark will share the cost -- estimated at $8,000 per participating doctor -- to provide training and purchase the software, personal digital assistants and other hardware needed for iScribe. Doctors won't face any out-of-pocket costs to participate, said Christopher Goff, president and chief executive of Employers Health Purchasing. The goal is to have the system operational in the region by the end of June, he said. ``We feel it will bring a lot of convenience to our employers' employees, retirees and dependents,'' Goff said. Records computerized Caremark's iScribe program gives doctors computerized access to their patients' medication history, allergies and potential drug interactions, said Dr. Jan Berger, senior vice president and chief clinical officer with Caremark. ``We see this first and foremost as a patient safety issue,'' Goff said. Doctors also can get access to more than 4,000 formularies. Those are lists indicating which prescription drugs insurance companies will cover, as well as which medicines carry higher co-payments for patients. Armed with that information, Goff said, doctors hopefully will be more likely to order generic medicines and preferred brand-name drugs that cost the patients -- and their employers -- substantially less money. ``We think it will have a positive financial impact to employees, dependents and retirees in that if a physician writes a brand script and a generic equivalent or substitute is available, the system should prompt the physician to write that alternative,'' Goff said. ``... It will also generate that consumer discussion about what more cost-effective options are available.'' Indeed, there is some evidence that e-prescribing can drive down drug costs. Costs could drop Preliminary results from a study of four Dayton doctors who used e-prescribing found those physicians were more likely to order generics or cheaper brand-name drugs, said Marc Sweeney, past president of the Ohio Pharmacists Association and chair of pharmacy practice at the University of Findlay School of Pharmacy. ``It definitely changed prescribing patterns,'' Sweeney said. Another study by Caremark found that doctors who used the iScribe system were three times more likely to prescribe a generic treatment for an acid-related gastrointestinal problem. Practice already here A few practices throughout Northeast Ohio already have adopted e-prescribing. Last year, for example, physicians at the Cleveland Clinic wrote almost 3 million prescriptions electronically from computers in their examining rooms, according to Dr. C. Martin Harris, chief information officer. The e-prescribing tool is part of an extensive electronic medical record system the Clinic has installed to provide computerized access to personal health information for doctors and their patients. Cleveland Clinic patients who sign up for online access to their medical records can use the computer system to send medication refill requests directly to their doctor rather than having to call the office or come in for a visit, Harris said. ``It really had a dramatic impact on phone calls,'' he said. ``What it's done is allowed the telephone calls that are really needed to get through.'' Doctors at Falls Family Practice in Cuyahoga Falls also launched e-prescribing as part of a $750,000 investment in electronic medical records. ``You get legible writing, clear concise instructions and checks for drug interactions,'' said Dr. Hugh McLaughlin, a family physician with the practice who's been using e-prescribing for eight months. ``It's foolproof.'' Not necessarily, Sweeney said. Doctors still can point and click to the wrong drug or dose, creating ``a nice, legible error.'' Getting doctors to abandon their pen and prescription pad can be challenging. Initially, Sweeney said, some doctors find it more time-consuming to switch to e-prescribing. ``One of the challenges is getting physicians to adopt it,'' he said. ``The reality is, in a time-pressured environment, there's nothing faster than just writing it down on a piece of paper. ``However,'' he added, ``once they're up and running, the nice thing is that it ultimately will save time because they don't have to re-enter information.'' Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.

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© 2007 Beacon Journal and wire service sources. All Rights Reserved.
http://www.ohio.com

Expanding the reach and Impact of Consumer E- Health Tools

Expanding the Reach and Impact of Consumer E-HEALTH TOOLS (HHS, June 2006)
Report (230 p.)

http://www.health.gov/communication/ehealth/ehealthTools/pdf/ehealthreport.pdf

Summary & related documents:
http://www.health.gov/communication/ehealth/ehealthTools/default.htm This report summarizes a study undertaken by the Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, on the potential utility and value of consumer e-health tools for populations that experience health disparities.

National Office for Health IT Awards State E-Health Alliance Contract

National Office for Health IT Awards State E-Health Alliance Contract

October 19, 2006

The Office of the National Coordinator for Health IT has awarded a contract to the National Governor's Association to form a State E-Health Alliance in 2007, reports.

NGA's Center for Best Practices will develop a steering panel composed of governors and state legislators working to form health information networks, according to Jodi Daniel, director of ONCHIT's Office of Policy and Research.

Daniel said that three task forces will work on issues, including:

• Health information exchanges;
  
• Licenses and other legal issues;
  
• Privacy; and
  
• Security.
  

The one-year contract, which is the third awarded by ONCHIT to promote health IT at state and regional levels, is worth nearly $2 million, according to ONCHIT spokesperson Nancy Szemraj (Ferris, Government Health IT, 10/18).

Cost called largest obstacle for EMR adoption

DENVER – The price tag remains the single most significant barrier to electronic medical record system adoption by physicians today, two leaders of prominent physician organizations said Tuesday.

William F. Jessee, MD, president and CEO of the Medical Group Management Association, and Douglas Henley, MD, executive vice president of the American Academy of Family Physicians, were part of a panel speaking to the members of the American Health Information Management Association at their annual meeting here

With doctors facing an average 5 percent cut in Medicare reimbursement in 2007, the $32,600 estimated cost per physician to adopt an EMR, plus additional annual costs for maintenance, is off-putting, said Jessee. It’s not that physicians are “technological Luddites,” he said.

Jessee noted that vendors’ quoted prices typically run 20 percent higher than estimated. A hard-to-perceive ROI - or return on investment, an almost certain change in workflow, and a still fragmented market add to the resistance, he said.

Henley’s remarks closely mirrored Jessee’s. The AAFP, which has more than 50,000 members, had a goal of having 50 percent of its members adopt electronic medical record systems by 2005. It achieved 30 percent adoption.

“We are now focused on the next 30 percent,” Henley said. “Half of them say they are ready to write the check in the next 12 months”

A recent MGMA study estimated that 75 percent of medical practices are paper-based. Fourteen percent have what Jessee called a true electronic record with a relational database. The rest employ a combination of paper and automation in their offices,

Both organizations are working to boost IT adoption rate among their members, and despite the stated roadblocks, they offered reasons for optimism.

“Forces are converging to accelerate change,” said Jessee, who pointed to federal initiatives from Congress (both parties), the Centers for Medicare and Medicaid; the Office of the National Health Information Coordinator; and the American Health Information Community.

Jessee also mentioned certification of products by the Certification Commission for Healthcare Information Technology as helping to reassure physicians regarding the functionality of products on the market today.

Among Jessee’s laundry list of pros for EMR adoption:
- Safety improves
- Workflow improves
- Productivity improves (after about six months)
- Charge capture improves
- Transcription costs go down
- Records are easily accessed (not so likely to be in the trunk of a physician’s car)
- Rx management is streamlined
- Patient satisfaction is enhanced

Jessee and Henley agreed that insurers could encourage physicians to adopt electronic medical records by creating incentives for those groups that do “take the plunge.”

“We’ve got to adopt health information technology, and get on with it,” Henley said.

Drug Reactions Send 700,000 Yearly to ER

By LINDSEY TANNER

The Associated Press
Tuesday, October 17, 2006; 7:00 PM

CHICAGO -- Harmful reactions to some of the most widely used medicines _ from insulin to a common antibiotic _ sent more than 700,000 Americans to emergency rooms each year, landmark government research shows.

Accidental overdoses and allergic reactions to prescription drugs were the most frequent cause of serious illnesses, according to the study, the first to reveal the nationwide scope of the problem. People over 65 faced the greatest risks.

"This is an important study because it reinforces the really substantial risks that there are in everyday use of drugs," said patient safety specialist Bruce Lambert, a professor at the University of Illinois at Chicago's college of pharmacy.

Even so, the study authors and other experts agreed that the 700,000 estimate was conservative because bad drug reactions are likely often misdiagnosed.

The study found that a small group of pharmaceutical warhorses were most commonly implicated, including insulin for diabetes; warfarin for clotting problems; and amoxicillin, a penicillin-like antibiotic used for all kinds of infections.

"These are old drugs which are known to be extremely effective. We could not and would not want to live without them. But you've got to get the dose exactly right. Variations, especially on the high side, are really dangerous," Lambert said. He was not involved in the research.

Those aged 65 and older faced more than double the risk of requiring emergency room treatment and were nearly seven times more likely to be admitted to the hospital than younger patients.

The results, from 2004-05, represent the first two years of data from a national surveillance project on outpatient drug safety. The project was developed by the federal Centers for Disease Control and Prevention, the Food and Drug Administration and the U.S. Consumer Product Safety Commission. The study was published in Wednesday's Journal of the American Medical Association.

The database included 63 nationally representative hospitals that reported 21,298 bad drug reactions among U.S. adults and children treated in emergency rooms during the two-year period. The tally is based on what emergency room doctors said were complications from using prescription drugs, over-the-counter medicines, dietary supplements or herbal treatments.

The researchers said it translates to 701,547 complications nationwide each year.

"Experts had thought that severe outpatient drug events were common, but no one really had good numbers" until now, said lead author Dr. Daniel Budnitz, a CDC researcher.

Complications included diabetics on insulin passing out from low-blood sugar, excessive bleeding in patients on warfarin, and severe skin rashes in patients taking amoxicillin. Drug reactions were severe enough to require hospitalization in about 17 percent of patients. The study did not include information on whether any of the reactions were fatal.

"The numbers are quite troubling," said Jim Conway, senior vice president at the Institute for Healthcare Improvement. The tally underscores that "there is a tremendous number of consumers in the United States taking medication."

The CDC has estimated that about 130 million Americans use prescribed medication every month. U.S. consumers buy far more medicine per person than anywhere else in the world.

Yet a recent study found that doctors' conversations with patients when prescribing new drugs aren't very thorough and that side effects often aren't mentioned. Many of the drugs implicated in the new study require frequent physician monitoring to make sure the dose is correct.

The new findings highlight the need for better doctor-patient communication about use of medicines, Conway said.

The number likely underestimates the number of people who have bad drug reactions outside a hospital setting because many don't get ER treatment, while others who do may have symptoms that are mistakenly attributed to something else, said patient safety expert Dr. David Bates, a professor at Harvard Medical School.

Still, Bates called the effort a significant contribution since previous reports on the problem have not been national in scope.

Developing a national HIT network

WASHINGTON – The marketplace is still defining PHRs and whether they should include claims data, National healthcare IT interim chief Robert Kolodner, MD, told an audience at the 2nd Nationwide Health Information Network Forum held earlier this week in the nation's capital. Kolodner and John Loonsk, director of the Office of Interoperability and Standards, responded Monday to several questions from some of the hundreds of stakeholders at the forum.

Patient health records
Question: Are there any plans to establish small portions of patient health records as an initial effort?
Kolodner: Yes. There are plans to develop an “e-clipboard” where patients can electronically record the basic information usually collected in the waiting room at a first visit with a doctor. A second idea is to create a way for patients to access a simple list of their prescriptions.

Volunteer burnout
Question: What does HHS plan to do about the limited pool of private entities available to build the National Health Information Network? (Glen Marshall, standards and regulations manager, Siemens Medical Solutions)
Loonsk: Volunteer burnout is a concern and one possible solution could be to bring in organizations that can participate on a smaller scale.

Property rights for PHRs and EHRs
Question: Who has property rights over PHRs and EHRs?
Loonsk: This is a complicated issue that should be addressed by states, with federal support.

PHRs vs. EHRs
Question: How do you differentiate between electronic health records and patient health records? Also, will PHRs include patient claims data, and is that needed in both PHRs and EHRs? (Ann Will, vice president, CGI Federal)
Kolodner: The marketplace is still defining PHRs and whether they should include claims data. For now, the development of EHRs–the electronic record of a patient’s healthcare to be exchanged through IT networks–takes higher priority than personal records retained by patients themselves.

International data exchange
Question: Are there plans for including international data exchange in a federal healthcare IT network? (Amy Verstappen, Adult Congenital Heart Association)
Loonsk: There have been a number of discussions over the issues, concerns and approaches for international data exchange. There is a desire to exchange data between nations.

Creating networks
Question: Standards for the financial world were not sufficient enough to create a network; how will this be addressed in developing a successful healthcare information network? (an Environmental Protection Agency representative)
Loonsk: There has been a lot of discussion about interoperability, and constraint testing will be an important part of it. There is tension between what can actually be adopted and the broader vision. “Because of the complexity, we might have to settle for less [than the broader vision].”

State AHICs
Question: What states will participate in ONC’s upcoming plans to launch several state versions of the American Health Information Community? (Donald Mon, American Health Information Management Association)
Kolodner: That information is not readily available because the project is in the initial stages.

Are We Close to Real Data Integration

Are We Close to Real Data Integration 'Redefining Healthcare'?
By Matthew Holt

Michael Porter and Elizabeth Teisberg in their book Redefining Healthcare tout the concept of hospitals competing over excellence in treating specific medical conditions nationally. The Cleveland Clinic, among others, is marketing its online second opinion service. Technology vendors such as Sun ("services-oriented architecture"), Cisco ("application-oriented networks"), and Microsoft -- which just acquired interface technology company Azyxxi -- are all narrowing in on the problem of information exchange between existing clinical and operational systems. The PACS market is growing fast, and the amount spent on medical imaging is growing faster. Meanwhile, physician shortages in rural areas mean that hospitals are outsourcing radiology to larger regional, national, and even international players.

This all sounds like the perfect environment to share information regionally. There's just one tiny problem. The average CIO is already minding more than a hundred interfaces between systems, and the concept of having to extend that management beyond the bounds of the institution is frightening -- and a major stumbling block in front of the RHIOs.

What's needed is an easy way of extracting and exchanging clinical data in its context. Companies such as TeraMedica and Philips (via its acquisition of Stentor) are all working with brand-name clients to achieve this, but some of the boldest claims being made come from a small company called CMTC. CEO Shimon Schurr says, "The concepts that RHIOs are in policy discussions about for the future, our technology can do today." For example, CMTC can take clinical data from a variety of system, allow it to be put on a secure Web site and have it uploaded into a completely different system (e.g., PACS and EMR), including keeping the surrounding workflow information and patient context. Adding videoconferencing and this creates an online workspace for consults.

Schurr says that at the core of CMTC's .NET-based technology is a concept called Semantic Interoperability, which essentially allows data to be automatically normalized and exchanged between systems. Thus far, it's been used for remote consultation between New York Presbyterian Hospital and medical centers in Turkey and Israel. In conjunction with Kodak and Accenture, University of Virginia Medical Center will soon start testing the system with community oncologists and regional hospitals.

If the Porter/Teisberg concept is to succeed, for technology to bring the expertise of centers of excellence virtually to patients in any setting requires an easy, secure method of combining patient records, workflow information, images, and conferencing technologies online. Then remote physicians or teams of clinicians can view it at one time (or asynchronously) without new interfaces or expensive infrastructure. The promise is a real "dislocation" of the workflow for how diagnoses are currently managed. Possibly using technology like CMTC's, that promise could become reality sooner rather than in some pie-in-the-sky futures.

Rural Assistance Center Announces New State Information Resource

Aug 15, 2006

GRAND FORKS, N.D. -- The Rural Assistance Center (RAC), a national resource for rural health and human services information, has launched State Resources on its Web site allowing easy access to continuously updated demographics and statistics, documents and resources, contacts and success stories for all 50 states.

“People using our services are often looking for state-level contacts, resources or information that can help them to maintain and improve services in their local communities,” said Kristine Sande, RAC’s director. “The new part of the RAC Web site has been developed in response to these information needs.”

The new State Recourses, located at http://www.raconline.org/states, feature an overview of each state and its rural health and human services environment. In addition, the pages include:

• State-level contacts and organizations relevant to rural health and human services;
• Tools, such as web sites with demographic and statistical information for the state;
• Possible funding sources for rural health and human service projects;
• Documents, articles and journals written about the state;
• Success stories from the state that can serve as model projects in rural communities; and
• News and upcoming events from the rural community.

“The new State Resources help rural communities find information and resources that can assist them in important activities such as locating and competing for funding opportunities and networking within their state,” said Sande. “We are working with state-level partners, such as the State Offices of Rural Health, to ensure that these pages remain current and feature the best information available for each state.”

“In small towns, health care providers and human services representatives juggle many responsibilities,” explained Mary Wakefield, director of the Center for Rural Health which houses the Rural Assistance Center. “The federally-funded Rural Assistance Center’s State Resources is a one stop shop to help these individuals quickly find local resources and information. It’s about helping them to do their jobs more efficiently and serve their rural communities even better.”

About RAC
The Rural Assistance Center (RAC) serves as a rural health and human services information portal which helps rural communities access the full range of available programs, funding, and research that can enable them to provide quality health and human services. RAC is a collaboration of the University of North Dakota Center for Rural Health and the Rural Policy Research Institute (RUPRI). It is funded through HRSA's Office of Rural Health Policy.

Since its launch in December 2002, RAC’s web site has received over 680,000 visits, with over 335,000 of those visits coming in the last year. In addition, RAC has responded to nearly 3,600 customized assistance requests from people in all 50 states, Puerto Rico, and several foreign countries.

RAC's other web-based services, available at www.raconline.org, include an online clearinghouse of news, documents, maps, and success stories; a calendar of events; a directory of rural contacts and organizations; and a searchable database of funding opportunities. Also available on the web site are Information Guides, which provide in-depth information focusing on rural aspects of an issue or topic. RAC’s electronic updates on rural health and human services keep subscribers abreast of new happenings and resources available. RAC also provides free customized assistance on topics related to rural health or human services. Contact RAC at 1-800-270-1898 or info@raconline.org to request customized assistance from RAC's information specialists.

Legislative jam-up

More than 50 bills related to health information technology and personal medical records were introduced during the 109th Congress, but it now looks as if only one piece of legislation — the result of two still-evolving companion bills in the House and Senate — stands any chance of becoming law, according to health IT industry observers.

With the session winding down even as midterm election battles heat up, many advocacy groups are wondering whether lawmakers have the political commitment and goodwill to push any health IT legislation through this year, especially after a partisan divide unexpectedly flared up in early June over the issues of privacy and funding.

“People are getting awful nervous at this point,” said Dave Roberts, vice president of government relations at the Healthcare Information and Management Systems Society (HIMSS).

The legislation with the most potential involves two bills: The Wired for Health Care Quality Act (S. 1418), sponsored by Sens. Hillary Rodham Clinton (D-N.Y.) and Bill Frist (R-Tenn.) and passed by the Senate in November 2005; and the Health IT Promotion Act of 2006 (H.R. 4157), sponsored by Reps. Nancy Johnson (R-Conn.) and Nathan Deal (R-Ga.), which House leaders are still working to get to the floor for a vote.

Both bills would begin the process of setting national standards for medical records storage and interoperability and codify the Office of the National Coordinator for Health IT within the Department of Health and Human Services.

However, the bills also have their differences. H.R. 4157 directs the secretary of HHS to recommend to Congress a single privacy standard that consolidates existing state and federal privacy laws, while S. 1418 defers to the confidentiality requirements laid out in the Health Insurance Portability and Accountability Act (HIPAA).

The Senate also provides some public funding, while the House does not. And Johnson’s bill would create exceptions to conflict-of-interest laws that prohibit health entities from sharing technology with physicians. The Senate bill does not address the issue.

Most health IT advocates believe that compromises would be easy to agree on in a conference committee and that the bill could pass both houses. “If members are really committed to getting this thing done, it is doable,” said Bruce Fried, a partner and co-chairman of the Health Care Group at Sonnenschein Nath & Rosenthal.

Election-year roadblocks
However, that commitment came into question in June, when several political hurdles popped up that could eventually kill any legislation this year, according to Scott Wallace, president of the National Alliance for Health IT.

First, Johnson’s bill was marked up by the House Ways and Means and Energy and Commerce committees. Not surprisingly, the two panels ended up with different versions of the bill. What surprised analysts was that votes came down completely along party lines, even though health IT has so far been largely a nonpartisan issue.

Questions over privacy and funding caused the gap. “Overall, we think it’s more an issue of general political climate raining down on health care IT rather than a fundamental change in attitude toward health care IT,” Wallace said.

Despite the political coloring of the bills, most analysts believed lawmakers could work out their differences in a June conference. But legislators and health IT advocates alike were taken by surprise when the Congressional Budget Office weighed in and projected that the bill would increase federal spending and decrease revenues.

“The CBO really threw sand in the gears,” Fried said. “It’s unclear at this point whether anything will go forward.”

At first it seemed as if Republicans would do whatever it took to push a health IT bill through so they could campaign on an accomplishment to which most constituents can relate. But health IT advocates said that the issue of patient privacy is becoming a larger concern among conservatives, who are now trying to stall the legislation.

“We’ve definitely noticed a real shift in people’s attitudes toward health technology on the Hill,” Roberts said. “People have been hearing a lot of things regarding possible abuses and issues with health records, and they’ve gotten very concerned and taken those concerns to Capitol Hill.”

Privacy advocates pleased
Privacy advocates were more than happy with the development.

“We think that the privacy issue is causing consternation on this whole health IT push, and we think that’s exactly correct,” said Dr. Deborah Peel, executive director of the Patient Privacy Rights Foundation.

“It should cause incredible consternation,” she said, “and we’ve heard from key insiders on the Hill who don’t think the legislation is going anywhere this year because privacy has become so controversial.”

Peel and others think that both the Clinton/Frist and Johnson/Deal bills put patient privacy at risk. Peel said she believes the Johnson bill in particular could ultimately dismantle a set of strong state privacy laws.

“We think it’s a bad bill, and while we think that technology can be a wonderful thing for health care, it has to be the right technology with the right protections,” she said. “We’d rather see Congress pass nothing than to pass a bad bill.”

Despite the challenges, health IT advocates still hold out hope that the issues will be resolved and that Congress will pass a bill. But they worry that the legislation could end up getting stripped of any real substance.

“If all they do is pass a bill that codifies the office of the national coordinator, why bother?” Fried asked.

Already, members of the House Ways and Means Committee have deleted a 2009 deadline for health care providers to convert to ICD-10 billing codes.

That version also appropriates no federal money for providers to adopt new health IT tools.

Extra innings
Wallace continues to hope for a bill that sets up a structure for creating national interoperability standards, codifies the office of the national coordinator, provides some funding to rural safety-net organizations to help them close the IT adoption gap, addresses privacy and includes some type of requirement for ICD-10 conversion.

“It’s hard for me to find words that don’t involve baseball analogies and grand slams to describe the magnitude of that kind of success,” Wallace said. “But I still wouldn’t describe it as a silver bullet. We will not have an interconnected health information system by dint of passage of this bill. There are a number of other major issues that still have to be crossed, not the least of which is the confidentiality debate.”

If the Johnson bill is passed, advocates believe it will move through conference with the Senate bill fairly quickly and go to President Bush. Though he hasn’t spoken publicly about any pending health IT measure, Roberts said, the president is likely to sign the bill given the vision for the use of electronic health records for all Americans by 2014, which he laid out in his State of the Union address earlier this year.

If no legislation is passed this year, health IT is likely to be taken up quickly in 2007 regardless of who controls the House and Senate. Health IT watchers say that the issue has such broad bipartisan support that it will move ahead.

Even though the legislative process would have to start all over, health IT advocates think they’ve made progress in the current Congress. “In terms of getting congressional committee staff educated, getting some members educated and beginning to define what the issues are and what some of the challenges are, I think we’re well under way,” Fried said. “So while we’d be starting from square one, we would be starting from an informed advantage.”

An e-prescription for Medicaid

An e-prescription for Medicaid Information technology could help save Medicaid, but complexity and a lack of standard practices continue to hobble the program

BY Nancy Ferris
Published on Aug. 14, 2006

Related Links

States are beginning to incorporate clinical information technology into their Medicaid systems, but the nation’s broadest health care program is by no means at the forefront of the movement to digitize medical information.

That’s the consensus of health industry observers, some of whom say the program is missing opportunities. Medicaid could help lead the nation toward a 21st-century health information environment, they say, while making a dent in two major national problems: the high cost of and lack of consistent care for uninsured Americans.

Despite much talk about the potential of electronic health records (EHRs), few examples of their use in Medicaid programs are available for study and even less is known about their impact on costs. And for every advocate who says EHRs will improve the quality of care, there is another who says the states can’t afford the care they provide now.

In a study conducted in late 2005 for the Agency for Healthcare Research and Quality (AHRQ), Avalere Health found that of 101 health information exchanges under way in 35 states, only 19 mentioned Medicaid as a stakeholder. Meanwhile, the University of Massachusetts is conducting another AHRQ-funded investigation into how Medicaid can help advance health IT.

Mike Leavitt, secretary of the Department of Health and Human Services, said he wants to reform Medicaid and the other major federal health insurance program, Medicare, so that they “are viewed as leaders in the collaborative development and use of health information technology, quality measurement and pay for performance.”

But Medicare, which insures about 42.5 million senior citizens, has gained most of the high-level attention at HHS. Medicaid insures about 55 million low-income citizens and is widely viewed as the stepchild of the Centers for Medicare and Medicaid Services (CMS), the HHS agency that operates both programs. In Leavitt’s statement in May outlining the HHS budget for the coming fiscal year for a Senate subcommittee, Medicare got five paragraphs and Medicaid only one.

Even with HHS picking up the most of the tab, escalating Medicaid costs are making headlines in most states. Total expenditures increased 7.6 percent in 2004 after an increase of 6.9 percent in 2003, according to a May report from the Kaiser Commission on Medicaid and the Uninsured. Health care now is the single largest expenditure for state governments, and some could face bankruptcy if such trends continue.

As a result, states and the federal government have been bickering over cost controls, which distracts them from making long-term improvements to the program. But even without the financial difficulties, cooperation on health IT could be difficult because of the split responsibility for Medicaid.

Advocates of more Medicaid leadership on health IT, such as former Speaker of the House Newt Gingrich, say the program is a prime candidate for expanded use of health IT because of the difficulty of coordinating care for low-income individuals. With primary care physicians increasingly in short supply in parts of the nation, Medicaid recipients often turn to hospital emergency rooms, free-standing clinics and other sources of care, especially in emergencies.

They often receive duplicate diagnostic tests and treatments, and providers have difficulty finding out what care they have received elsewhere. “There’s a fair amount of overutilization of services,” said Rick Friedman, director of state systems for CMS’ Medicaid division.

The various providers may also unknowingly prescribe medicines that interact and harm the patient. Having an EHR available to each doctor who sees a patient could improve the quality of care, health IT proponents say.

In addition, Medicaid fraud and abuse are a constant concern among legislators and auditors. “There’s at least 10 percent fraud in Medicaid,” said Sen. Tom Coburn (R-Okla.) at a recent hearing. “That’s $4 billion we don’t have.”

Coburn, who is a physician, added that he would like to see more physicians and providers go to jail for such abuses.

Another common problem involves patients who receive multiple prescriptions for painkillers and other drugs, then abuse or resell the medicines. More comprehensive recordkeeping systems would make it easier to spot such abuses. But policy experts say health IT is not a priority for Medicaid decision-makers for a variety of reasons.

First of all, Medicaid is administered by the states. They split the costs with the federal government according to a complex formula that results in the federal government paying one-half to three-quarters of the costs, depending on the state.

Each state’s program is different, said JoAnn Lamphere, state health policy manager at the Lewin Group, a Virginia consulting firm. However, most states face the same challenges of dealing with strict and arcane Medicaid rules and providing the necessary health services to the low-income people the program serves, Lamphere said.

Bruce Greenstein, vice president of health care at technology company CNSI, said that “on the state side, all too often the technology and the policy leadership are bifurcated” and reside in different government divisions. Some states also operate Medicaid systems separately from their other health programs.

In addition, most states have opted for managed care delivery systems that operate under contract to the governments. That adds another layer of complexity because those governments do not deal directly with some of the doctors and hospitals that might use health IT.

However, because the federal government pays 90 percent of the cost of buying the computer systems that process Medicaid claims, CMS has some leverage when a state applies for funds to upgrade its systems.

CMS is beginning to push the states toward a standards-based, modern IT architecture that can link data from a variety of sources, including Medicaid claims, to provide a more comprehensive picture of each patient’s health. It is called the Medicaid IT Architecture (MITA).

Like the rest of the nation’s health IT infrastructure, MITA is less than 100 percent complete. “It will take a fair amount of time,” maybe a decade, to flesh out the architecture and deploy it nationwide, said Friedman, who is responsible for MITA.

The new architecture provides ways for Medicaid to link up with a larger health IT system and incorporate clinical information, thereby giving providers a holistic view of each patient’s case, Friedman said. Systems will be modular, flexible and responsive to program changes.

Part of Friedman’s vision for MITA includes connecting to regional health information organizations (RHIOs) or other data repositories. He described state Medicaid systems as future nodes on a nationwide health information network.

Medicaid currently relies on an infrastructure in which little interoperability exists among state systems. For example, New York’s system cannot connect with Florida’s, even though a substantial number of people get services in both states. And information from systems supporting other health-related services, such as mental health and substance abuse, is usually not available to those caring for Medicaid patients.

Although some people abuse the system, lack of good information means that even well-intentioned people sometimes get unnecessary tests and treatment, Friedman said. The key to reducing such duplication is to create a complete picture of a patient’s interactions with health care providers and services such as pharmacies, he said. Such a networked clinical architecture would include doctor and nurse interactions with the patient, prescriptions, diagnoses, laboratory test results and medical procedures performed, no matter where the patient received care.

However, Lamphere is not convinced that the states will be eager to participate. Despite the hype about savings and benefits from systems that support better program management, she said, the states might not spend the money needed to provide EHRs for their Medicaid patients.

The return on investment is likely to be slow to materialize, Lamphere said, and states have become wary of the unanticipated costs that seem to pop up every time a new system is built. “The goal is a worthy one,” she said, but “it’s not the highest agenda item for state Medicaid policy.”

Friedman agreed that state Medicaid managers are skeptical about health IT. They are often preoccupied with the crisis du jour, which at midyear was the new federal requirement that Medicaid recipients prove they are U.S. citizens.

Another barrier to Medicaid involvement in health information exchanges is cultural. Program managers have a deep-seated belief that data about their clients must be kept confidential at all times. New York officials have requested a letter from CMS confirming that participation in clinical data exchanges is appropriate and legal.

Despite those barriers, some Medicaid officials are taking a longer-term view. In North Carolina, for example, more than a dozen community groups coordinate care for Medicaid patients. Although they are organizations rather than data networks, they could become the foundation for RHIOs, said Dr. Allen Dobson, assistant secretary for health policy and medical assistance at North Carolina’s Division of Medical Assistance.

One group has developed a Web-based system for managing the care of patients with chronic diseases such as asthma and hypertension and is sharing it with other communities, Dobson said. He envisions similar community-based development of other health IT systems, perhaps with financial support from the state.

“We’ll use Medicaid as a lever to try to get into the communities” and encourage them to build systems that share information for the benefit of the entire population, Dobson said. The whole point of health IT, he added, is to improve people’s health.

The Utah Health Information Network (UHIN) has operated for more than a decade, sharing claims information among doctors, hospitals, insurers such as Medicaid, laboratories, local health departments and other providers. Now the network is adding clinical information to help reduce paperwork and speed the movement of records to providers involved in coordinating patient care. The state’s Medicaid program is a founding member of UHIN.

“Right now, we’re in a transition phase” with several pilot projects under way, said Dr. David Sundwall, executive director of the Utah Department of Health.

Like their federal counterpart, state governments have been reluctant to force doctors to adopt health IT as a condition of receiving Medicaid reimbursements. In some parts of the nation, doctors are reluctant to accept Medicaid patients, and a health IT mandate could cause more of them to drop out of the program.

Yet some kind of mandate might be necessary before patients can benefit from health IT. At a federal Medicaid Commission meeting in July, members discussed recommending a Medicaid EHR mandate in their report, which is due in December.

It’s more likely, however, that policy-makers will opt for some kind of incentive program, such as paying doctors a small sum each time they use health IT in a Medicaid-funded encounter with a patient. That could help doctors justify the cost of acquiring EHR systems, but it would also drive up the program’s already high costs.

Another option is for CMS to require that state Medicaid programs participate in health information exchanges such as RHIOs as a condition of receiving federal funds. Such a requirement would demonstrate that the federal government is committed to advancing health IT.

But in the end the states are responsible for the Medicaid program, and they must take the lead, Greenstein said. As the largest single payer of health claims in every state, he said, Medicaid “ought to be in the forefront and in the driver’s seat.”

Physicians' Foundations Invest $2.6 Million to Support Doctors' Use of Technology

August 9, 2006

Physicians' Foundations Invest $2.6 Million to Support Doctors' Use of Technology

Boston-based Physicians' Foundations has announced a $2.6 million program-related investment to help physicians use health information technology (HIT) to improve patient safety.

The organization is partnering with DocSite LLC in Cary, North Carolina, which will develop front-end tools that allow small or solo practices to use HIT through company's Internet-based technology, Web-enabled training modules, and an array of bundled products. According to DocSite CEO and medical officer John Haughton, the product suite will be designed to integrate into systems easily and intuitively, even into paper-based offices that might not consider themselves "IT-ready."

According to Physicians' Foundations president Jack Lewin, even though the spread of HIT has become a national priority, the cost, difficulty, and disruption of deploying electronic medical record systems have been significant barriers to entry for the practicing physician. "With this program, we are [creating] a model that will help fulfill the promise of HIT as a means to improve patient care and safety in a practical fashion for physicians," he said.

“Physicians' Foundations Invest $2.6 Million to Support Physicians' Use of Technology.” Physicians' Foundations Press Release 8/02/06.

Report: Health Care IT Programs To Reach $12 Billion In 2011

By W. David Gardner, TechWeb Technology News

State and local health care and welfare IT programs are expected to grow from $7.6 billion in fiscal year 2006 to surpass $12.2 billion by fiscal year 2011, government research firm Input said Wednesday.

Input cited recently government actions that will contribute to the growth including the Health Information Technology Promotion Act of 2006.

The market research firm also pointed to new efforts by the National Coordinator Office for Health Information Technology (ONCHIT) and the Certification Commission for Healthcare Information Technology (CCHIT) as measures that will drive health care and welfare IT growth.

"Both the amount of action and the type of action we are seeing are indicative of forward momentum for health IT," said James Krouse in a statement. "We are seeing notable health IT projects from numerous states essentially serving as laboratories for the national efforts." Krouse is acting director of Input's public sector market analysis.

Projecting that state and local IT spending for health and welfare will be driven by an increasing need for program efficiencies, the Input report observed that fraud and abuse reduction will lead to consolidation of current IT systems.

Report: Health Care IT Programs To Reach $12 Billion In 2011

	August 02, 2006 (4:55 PM EDT)
	By W. David Gardner, TechWeb Technology News State and local health care and welfare IT programs are expected to grow from $7.6 billion in fiscal year 2006 to surpass $12.2 billion by fiscal year 2011, government research firm Input said Wednesday. Input cited recently government actions that will contribute to the growth including the Health Information Technology Promotion Act of 2006. The market research firm also pointed to new efforts by the National Coordinator Office for Health Information Technology (ONCHIT) and the Certification Commission for Healthcare Information Technology (CCHIT) as measures that will drive health care and welfare IT growth. "Both the amount of action and the type of action we are seeing are indicative of forward momentum for health IT," said James Krouse in a statement. "We are seeing notable health IT projects from numerous states essentially serving as laboratories for the national efforts." Krouse is acting director of Input's public sector market analysis. Projecting that state and local IT spending for health and welfare will be driven by an increasing need for program efficiencies, the Input report observed that fraud and abuse reduction will lead to consolidation of current IT systems.

CMS Awards First of 15 Contracts to Process and Pay Medicare Part A and Part B Claims

Aug 1, 2006

The Centers for Medicare & Medicaid Services (CMS) have announced the award of the first of 15 contracts for the combined handling in six states of both Part A and Part B Medicare claims. The winning contractor is Noridian Administrative Services, LLC, (NAS), headquartered in Fargo, N.D.

As the new Part A/Part B Medicare Administrative Contractor (A/B MAC), NAS will serve as the first point-of-contact for processing and paying fee-for-service claims from hospitals and other institutional providers, physicians, and other practitioners in Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming .

“The contract award is a major step to improved Medicare service for beneficiaries and providers, and significant cost savings from greater efficiency in managing the original fee-for-service Medicare program,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “Noridian Administrative Services was selected through a full and open performance-based competition to administer the program as effectively and efficiently as possible.”

The A/B MAC contract, which has a value of $28.9 million for the first year of performance, is the first of 15 to be awarded by 2011 to fulfill requirements of the contracting reform provisions of the Medicare Modernization Act of 2003. NAS will immediately begin implementation activities and will assume full responsibilities for the claims processing work in its six-state jurisdiction no later than March 2007.

Under the current system, fiscal intermediaries process claims for Medicare Part A providers, including hospitals and skilled nursing facilities. Part B contractors, known as carriers, handle claims for doctors, laboratories and other practitioners. When contracting reform is fully implemented, the fiscal intermediaries and carriers will be replaced by MACs that will be responsible for both Part A and B claims.

“For beneficiaries and providers, the new structure will mean that they each have a single point of contact with the Medicare program,” Dr. McClellan said. “The MACs will serve as the point of contact for all Medicare providers and physicians in their respective jurisdictions, while beneficiaries will pose any questions about their claims to a Beneficiary Contact Center.”

CMS awarded the A/B/MAC contract to NAS which offered the best overall value to the federal government, when both cost and technical qualifications were considered. The contract, which includes a base period and four one-year options, will provide NAS with an opportunity to earn award fees based on its ability to meet or exceed the performance requirements set by CMS.

These requirements, based on CMS’ key objectives for MACs, are enhanced provider customer service, increased payment accuracy, improved provider education and training leading to correct claims submissions, and cost savings resulting from efficiencies and innovation. In accordance with the Medicare Modernization Act, MAC contracts must be put up for competitive bidding at least every five years.

For more information, see: http://www.cms.hhs.gov/MedicareContractingReform/

Source: CMS Press Release

Tommy Thomson briefs Congressional caucus on healthcare IT

Healthcare IT News

By Bernie Monegain, Managing Editor

07/31/06

WASHINGTON – Former Health and Human Services Secretary Tommy Thompson told a congressional caucus last week that the decision physicians face today about implementing healthcare information technology is not about whether to go electronic, but how soon. Thompson and other panelists called for federal incentives to boost healthcare IT adoption by physicians.

More than 36 members of Congress attended the session on July 26. They represented the medical and dental doctors in Congress and the 21st Century Health Care Caucuses.

"Health Information Technology adoption is vital to the future of our Nation's health system," Thompson said. "We need interoperable solutions that provide physician incentives and give them options to choose which technology is right for them."

Thompson led a panel that briefed the lawmakers on the barriers physicians face in implementing electronic health record systems and other healthcare information technology.

A 2004 national survey of physicians conducted by the Commonwealth Fund showed that 56 percent of physicians viewed start-up costs as a major barrier to implementing healthcare IT. A more recent survey by the Centers for Disease Control indicates that one-quarter of office-based physicians report using fully or partially electronic medical record systems in 2005, a 31 percent increase from the 18.2 percent reported in the CDC’s 2001 survey.

For Dr. Michael A. Poss, a physician at Professional Park Medical Services in Carrollton, Ga., converting to an electronic record system seemed the only choice, though cost was always a factor, Poss said, particularly in the face of declining reimbursement rates for physicians.

"Professional Park Medical Services knew that we could not maintain the status quo and that our patients deserved the best in patient care, "Poss told lawmakers. "I am here today before Congress advocating for support and increased incentives for physician practices to adopt HIT. Our practice would have implemented an integrated EHR solution much sooner had financial incentives been aligned more properly."

"Hopefully, after today, members of Congress and their staff will better understand the pressures that physician practices are under from decreasing reimbursement rates to increasng costs to malpractice hikes," Poss said. "All affect the bottom line of critically important businesses like ours that are dedicated to supporting and caring for communities across America."

More Physicians Using Electrical Medical Records

Jul 24, 2006

CDC's National Center for Health Statistics is issuing a new Health E-Stat today entitled "Electronic Medical Record use by Office-based Physicians: United States, 2005."

The E-Stat is the latest look at the growing trend towards electronic record-keeping in the medical community. Some of the key findings in the report include:

Nearly one in four (23.9 percent) of physicians reported using full or partial electronic medical records (EMRs) in their office-based practice in 2005 - a 31 percent increase from the 18.2 percent reported in 2001.

Physicians in the Midwest (26.9 percent) and West (33.4 percent) were more likely to use EMRs than those in the Northeast (14.4 percent).

Physicians in metropolitan statistical areas (nearly 24.8 percent) were more likely to use EMRs than were those in non-metropolitan areas (16.9).

Only one in ten (9.3 percent) physicians, however, used EMRs with all four of the basic functions (computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes) considered necessary for a complete EMR system.

The entire E-Stat can be accessed at the CDC/NCHS web site at www.cdc.gov/nchs.

Source: CDC Press Release

Medication Errors

Read Full Report Date: July 20, 2006 Contacts: Christine Stencel, Media Relations Officer Chris Dobbins, Media Relations Assistant Office of News and Public Information 202-334-2138; e-mail <news@nas.edu> FOR IMMEDIATE RELEASE Medication Errors Injure 1.5 Million People and Cost Billions of Dollars Annually; Report Offers Comprehensive Strategies for Reducing Drug-Related Mistakes WASHINGTON -- Medication errors are among the most common medical errors, harming at least 1.5 million people every year, says a new report from the Institute of Medicine of the National Academies. The extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and productivity or additional health care costs, the report says. The committee that wrote the report recommended a series of actions for patients, health care organizations, government agencies, and pharmaceutical companies. The recommendations include steps to increase communication and improve interactions between health care professionals and patients, as well as steps patients should take to protect themselves. The report also recommends the creation of new, consumer-friendly information resources through which patients can obtain objective, easy-to-understand drug information. In addition, it calls for all prescriptions to be written electronically by 2010 and suggests ways to improve the naming, labeling, and packaging of drugs to reduce confusion and prevent errors. "The frequency of medication errors and preventable adverse drug events is cause for serious concern," said committee co-chair Linda R. Cronenwett, dean and professor, School of Nursing, University of North Carolina, Chapel Hill. "We need a comprehensive approach to reducing these errors that involves not just health care organizations and federal agencies, but the industry and consumers as well," she said. Co-chair J. Lyle Bootman, dean and professor, College of Pharmacy, University of Arizona, Tucson, added, "Our recommendations boil down to ensuring that consumers are fully informed about how to take medications safely and achieve the desired results, and that health care providers have the tools and data necessary to prescribe, dispense, and administer drugs as safely as possible and to monitor for problems. The ultimate goal is to achieve the best care and outcomes for patients each time they take a medication." Estimates of Rates and Costs Medication errors encompass all mistakes involving prescription drugs, over-the-counter products, vitamins, minerals, or herbal supplements. Errors are common at every stage, from prescription and administration of a drug to monitoring of the patient's response, the committee found. It estimated that on average, there is at least one medication error per hospital patient per day, although error rates vary widely across facilities. Not all errors lead to injury or death, but the number of preventable injuries that do occur -- the committee estimated at least 1.5 million each year -- is sobering, the report says. Studies indicate that 400,000 preventable drug-related injuries occur each year in hospitals. Another 800,000 occur in long-term care settings, and roughly 530,000 occur just among Medicare recipients in outpatient clinics. The committee noted that these are likely underestimates. There is insufficient data to determine accurately all the costs associated with medication errors. The conservative estimate of 400,000 preventable drug-related injuries in hospitals will result in at least $3.5 billion in extra medical costs this year, the committee calculated. A study of outpatient clinics found that medication-related injuries there resulted in roughly $887 million in extra medical costs in 2000 -- and the study looked only at injuries experienced by Medicare recipients, a subset of clinic visitors. None of these figures take into account lost wages and productivity or other costs. Improving the Patient-Provider Partnership Establishing and maintaining strong partnerships between health care providers and patients is crucial to reducing medication errors, the report says. The committee called on consumers to be active partners in their medication care and on physicians, nurses, and pharmacists to know and act on patients' medical care rights. The report recommends specific steps that physicians, nurses, pharmacists, and other health professionals should take to ensure that their patients are fully informed about their drug regimens and to minimize opportunities for mistakes to occur. Health care organizations also should make it a standard procedure to inform patients about clinically significant medication errors made in their care, whether the mistakes lead to harm or not. Currently, health care providers typically do not inform the patient or the patient's guardians about errors unless injury or death results. The report also provides consumers with a list of specific questions to ask health care providers, such as how to take their medications properly and what to do if side effects occur. Also included are actions consumers should take, such as requesting that their providers give them a printed record of the drugs they have been prescribed. Patients should maintain an up-to-date list of all medications they use -- including over-the-counter products and dietary supplements -- and share it with all their health care providers. This list should also note the reasons they are taking each product and any drug and food allergies they have. New and Improved Drug Information Resources Although consumers can find helpful drug information online or in the printed materials provided by pharmacies, this information often is too difficult for many people to understand, too scattered, or otherwise not consumer-friendly. The quality of the drug information leaflets that accompany prescriptions varies widely, and these printouts are typically written at a college reading level. The U.S. Food and Drug Administration (FDA) should work with other appropriate groups to standardize the text and design of medication leaflets to ensure that they are comprehensible and useful to all consumers. The committee called on the National Library of Medicine (NLM) to be the chief agency responsible for online health resources for consumers; it should create a Web site to serve as a centralized source of comprehensive, objective, and easy-to-understand information about drugs for consumers. In addition, NLM should work with other groups to evaluate online health information and designate Web sites that provide reliable information. The committee also recommended that NLM, FDA, and the Centers for Medicare and Medicaid Services evaluate ways to build and fund a national network of telephone helplines to assist people who may not be able to access or understand printed medication information because of illiteracy, language barriers, or other obstacles. This telephone network should also enable consumers to report medication-related mistakes or problems. Electronic Prescribing and Other IT Solutions New computerized systems for prescribing drugs and other applications of information technology show promise for reducing the number of drug-related mistakes, the report says. Studies indicate that paper-based prescribing is associated with high error rates. Electronic prescribing is safer because it eliminates problems with handwriting legibility and, when combined with decision-support tools, automatically alerts prescribers to possible interactions, allergies, and other potential problems, the committee found. While it acknowledged that significant regulatory issues and problems with automated alerts still need to be worked out, the committee said that by 2008 all health care providers should have plans in place to write prescriptions electronically. By 2010 all providers should be using e-prescribing systems and all pharmacies should be able to receive prescriptions electronically. The Agency for Healthcare Research and Quality (AHRQ) should take the lead in fostering improvements in IT systems used in ordering, administering, and monitoring drugs. All health care provider groups should be actively monitoring their progress in improving medication safety, the committee recommended. Monitoring efforts might include computer systems that detect medication-related problems and periodic audits of prescriptions filled in community pharmacies. Drug Naming, Labeling, and Packaging Confusion caused by similar drug names accounts for up to 25 percent of all errors reported to the Medication Error Reporting Program operated cooperatively by U.S. Pharmacopeia (USP) and the Institute for Safe Medication Practices (ISMP). In addition, labeling and packaging issues were cited as the cause of 33 percent of errors, including 30 percent of fatalities, reported to the program. Drug naming terms should be standardized as much as possible, and all companies should be required to use the standardized terms, the report urges. FDA, AHRQ, and the pharmaceutical industry should collaborate with USP, ISMP, and other appropriate organizations to develop a plan to address the problems associated with drug naming, labeling, and packaging by the end of 2007. The report also recommends studies to evaluate the impact of free drug samples on overall medication safety. In general, there has been growing unease among health care providers and others about the way free samples are distributed and the resulting lack of documentation of medication use, as well as the bypassing of drug-interaction checks and counseling that are integral parts of the standard prescription process. The study was sponsored by the U.S. Department of Health and Human Services and Centers for Medicare and Medicaid Services. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. A committee roster follows. Pre-publication copies of Preventing Medication Errors are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above). # # # [ This news release and report are available at http://national-academies.org ] INSTITUTE OF MEDICINE Board on Health Care Services Committee on Identifying and Preventing Medication Errors J. Lyle Bootman, Ph.D., Sc.D., (co-chair) Dean and Professor University of Arizona College of Pharmacy, and Founding and Executive Director University of Arizona Center for Health Outcomes and PharmacoEconomic Research Tucson Linda R. Cronenwett, R.N., Ph.D. (co-chair) Professor and Dean School of Nursing University of North Carolina Chapel Hill David W. Bates, M.D., M.Sc. Chief Division of General Medicine Brigham and Women’s Hospital; Medical Director of Clinical and Quality Analysis Partners Healthcare System; and Professor of Medicine Harvard Medical School Boston Robert M. Califf, M.D. Associate Vice Chancellor for Clinical Research; Director Duke Clinical Research Institute; and Professor of Medicine Division of Cardiology Duke University Medical Center Durham, N.C. H. Eric Cannon, Pharm.D. Director of Pharmacy Services and Health and Wellness IHC Health Plans Intermountain Health Care Salt Lake City Rebecca W. Chater, M.P.H. Director of Clinical Services Kerr Drug Inc. Asheville, N.C. Michael R. Cohen, Sc.D. President Institute for Safe Medication Practices Huntington Valley, Pa. James B. Conway, M.S. Senior Fellow Institute for Healthcare Improvement, and Senior Consultant Dana-Farber Cancer Institute Boston R. Scott Evans, Ph.D. Senior Medical Informaticist Department of Medical Informatics LDS Hospital and Intermountain Health Care, and Professor Department of Medical Informatics University of Utah Salt Lake City Elizabeth A. Flynn, Ph.D., R.Ph. Associate Research Professor Department of Pharmacy Care Systems Harrison School of Pharmacy Auburn University Auburn, Ala. Jerry H. Gurwitz, M.D. Chief Division of Geriatric Medicine; Dr. John Meyers Professor of Primary Care Medicine; and Executive Director Meyers Primary Care Institute University of Massachusetts Medical School Worcester Charles B. Inlander President People’s Medical Society Allentown, Pa. Kevin B. Johnson, M.D., M.S. Associate Professor and Vice Chair Department of Biomedical Informatics, and Associate Professor Department of Pediatrics Vanderbilt University Medical School Nashville, Tenn. Wilson D. Pace, M.D. Professor of Family Medicine and Green-Edelman Chair for Practice-based Research University of Colorado, and Director National Research Network American Academy of Family Physicians Aurora, Colo. Kathleen R. Stevens, Ed.D., R.N. Professor and Director Academic Center for Evidence-Based Practice University of Texas Health Science Center San Antonio Edward Westrick, M.D., Ph.D. Vice President of Medical Management University of Massachusetts Memorial Health Care Worcester Albert W. Wu, M.D. Professor of Health Policy and Management and Internal Medicine Johns Hopkins University Baltimore INSTITUTE STAFF Philip Aspden, Ph.D. Study Director

Announcement to Help Speed Adoption of Electronic Health Records

Jul 19, 2006

The first round of ambulatory electronic health record products (EHRs) have been certified by the Certification Commission for Healthcare Information Technology (CCHIT), HHS Secretary Mike Leavitt announced today. HHS awarded CCHIT a contract in fall 2005 to develop certification criteria and a certification process.

“This seal of certification removes a significant barrier to wide-spread adoption of electronic health records. It gives health care providers peace of mind to know they are purchasing a product that is functional, and interoperable and will bring higher quality, safer care to patients,” Secretary Leavitt said.

CCHIT certification indicates that EHR products meet base-line levels of functionality, interoperability and security in compliance with CCHIT’s published criteria. This impartial seal of approval paves the way for adoption of health IT products by limiting the risk associated with investing in health IT. CCHIT is continuing to evaluate products, and additional results will be announced at the end of the month and quarterly thereafter.

“Volunteers from across the health care spectrum developed CCHIT’s criteria and inspection process, ensuring fairness and balance between the interests of diverse stakeholders,” said Dr. Mark Leavitt, CCHIT Chair.

In September 2005, HHS awarded a $2.7 million contract to CCHIT, a private, non-profit organization, to develop an efficient, credible, and sustainable mechanism for certifying health care information technology products. The CCHIT will certify health IT products in three initial phases:

• First, outpatient or ambulatory EHRs;
• Second, inpatient, or hospital EHRs; and
• Third, architectures, or systems that enable the exchange of information between and among health care providers and institutions.

The announcement of the first round of vendors to earn certification for electronic health record products from the CCHIT came at the George Washington University’s Medical Faculty Associates, who adopted an EHR system last year. That system achieved certified status today.

“George Washington Medical Faculty Associates was an early adopter of the electronic health record system which has transformed our practice, enabling us to be proactive instead of reactive,” said Stephen Badger, CEO of the George Washington University Medical Faculty Associates. “It has enhanced the overall patient care, significantly reduced our administrative costs and led to happier physicians and patients, because of this transformation.”

Additionally, Secretary Leavitt noted that HHS will soon publish rules creating Anti-Kickback statute safe harbors and Physician Self-Referral law exceptions. These changes will allow certain donations of health information technology that may not have been permitted before, allowing hospitals and other health care providers and suppliers to take a more active role in contributing to health IT adoption. The regulations will finalize proposals made by the Office of Inspector General and the Centers for Medicare & Medicaid Services on Oct. 11, 2005.

To learn more about the CCHIT, and for a list of certified products, visit www.cchit.org.

Source: HHS Press Release

Health Information Technology: A Rural Provider's Roadmap to Quality

Health Information Technology: A Rural Provider's Roadmap to Quality

Plan now to attend the HRSA's Office of Rural Health Policy (ORHP) national meeting on health information technology (HIT) to be held September 21-23, 2006 in Kansas City, MO.

REGISTRATION:

Registration will start Thursday, April 20th, 2006 and will be on a first come, first served basis. Space is limited, register today! REGISTER HERE

WHO:

This conference is specifically designed for the rural provider who is considering making an HIT investment to meet quality aims, but is not sure where to start. The ideal attendee is closely tied to the decision-making process in their facility, has not thoroughly explored their HIT options, and who is excited about learning how to improve quality outcomes through the use of health information technology.

The meeting seeks to attract rural health care providers and vendors, including: small and solo physician practices, Critical Access and other small rural hospitals, rural health clinics, Federal Qualified Health Centers, and vendors interested in serving rural health care providers.

WHAT:

In an effort to to explore the benefits of health information technology adoption and its link to quality improvement, this conference will provide an opportunity for rural providers to:

• Learn about the basic components of HIT
• Focus on the initial steps of strategic planning for HIT investments
• Understand how to find appropriate technology to meet individual quality aims
• Share best practices and lessons learned about HIT implementation.

WHEN & WHERE:

September 21-23, 2006 at the Kansas City Downtown Marriot, Kansas City, MO.

For Further Information Contact:
Carrie Cochran
HRSA's Office of Rural Health Policy
Phone: 301-443-0835
ORHP@hrsa.gov
http://ruralhealth.hrsa.gov

For Further Information Regarding Conference Logistics Contact:
Sandy Barnes

McKing Consulting Corporation

Phone: (301) 468-0172, x261

Fax: (240) 221-0771

Email: sbarnes@mcking.com

WyHIO Update

WyHIO Update

Posted to Christina's Considerations by thielst on Fri, 05/26/2006 ? 9:18am Health IT

My friends in Wyoming continue to move forward with their creation of a RHIO to support a statewide EHR system. WyHIO received an initial grant earlier this year and has just entered a subcontract with RTI International, Inc. (RTI) to address privacy and security policy questions affecting interoperable health information exchange (HIE).

The formal WyHIO board is preparing for their first meeting and they will soon start interviewing for the executive director position. I anticipate new proposed legislation will be next!

Hold on to your hats, Wyoming, its going to be a wild ride!

House HIT legislation faces obstacles

Healthcare IT News

By Caroline Broder, Senior Editor

06/23/06

(WASHINGTON) Healthcare IT legislation in the U.S. House of Representatives is stalled and unlikely to move before the July 4th congressional recess.

Two key committees – House Ways and Means and Energy and Commerce – have passed different versions of H.R. 4157, a bill from Reps. Nancy Johnson, R-Conn., and Nathan Deal, R-Ga. The bills would codify the Office of the National Coordinator for Health Information Technology, provide safe harbors in Stark and anti-kickback laws to allow hospitals and other healthcare groups to share IT tools with doctors and examine variations in state privacy laws. A provision that called for a transition by Oct. 1, 2009 to ICD-10 billing codes was dropped. The transition by 2009 was opposed by insurance companies, which wanted a longer time to prepare for the new coding system. The Energy and Commerce version of the bill calls for a demonstration program that would provide grants to small physician practices.

Lawmakers must now work out difference in both versions of this legislation before a bill can move to the House floor. However, the bill faces some roadblocks. First, the Congressional Budget Office forecast that the bill could increase spending and reduce revenues over the 2007-2011 and 2007-2016 periods. The CBO said the increase in direct spending would result from “safe harbors” that allow for donations of health information technology and that such donations by entities other than hospitals, group practices, Medicare Advantage plans, and prescription drug plans would lead to an increase in the volume of services that Medicare and state Medicaid programs pay for, thus increasing costs.

The CBO also said the move from ICD-9 to ICD-10 codes would carry a substantial cost to providers and claims processors. The CBO argued that a transition before 2012 would result in higher premiums for health insurance in those years.

David Merritt, a project director for the Center for Health Transformation, a group led by Former House Speaker Newt Gingrich, called the CBO’s estimate disappointing but not surprising.

“What they failed to understand and failed to look at is the effects of the technology,” he said. “At the same time they do not look at the impact on costs and quality.”

Gingrich has been a long-time critic of the CBO, which scores legislation for Congress. Merritt called CBO’s estimate a minor setback for healthcare IT legislation in the House.

“It’s a speed bump,” he said.

House Democrats have also opposed both versions of the bill, saying it does not go far enough to protect patient privacy or provide adequate incentives to spur healthcare IT adoption.

“There is substantial democratic concern about the content of these bill,” said Michael Zamore, a policy advisor for Rep. Patrick J. Kennedy (D-R.I.). Kennedy introduced his own healthcare IT bill last year.

“I think they’re going to push through a bad health IT bill. They don’t need Democrats and they don’t want Democrats’ input,” he said.

Once differences in the bills are resolved, the bill would move to the House floor for a vote. The bill will then need to be reconciled with a similar Senate bill (S.1418), which passed last year with bi-partisan support. The bills would need to pass both Houses again before moving to the President’s desk for a signature.

House Committees Approve Health IT Bil

House Committees Approve Health IT Bill June 16, 2006
The House Energy and Commerce and Ways and Means committees on Thursday each approved separate versions of a bill (HR 4157) that would promote the use of health care IT, CQ Today reports. The bill passed the Energy and Commerce Committee by a vote of 28-14, while Ways and Means approved its version 23-17 (Schuler, CQ Today, 6/15). The legislation, sponsored by Reps. Nancy Johnson (R-Conn.) and Nathan Deal (R-Ga.), would codify the Office of the National Coordinator for Health IT within HHS and would establish a committee to make recommendations on national standards for medical data storage and develop a permanent structure to govern national interoperability standards. The Senate passed health IT legislation (S 1418) in November 2005. Many Democratic lawmakers contend that funding sources are needed to help providers adopt the technology. Neither of the House committees' versions includes grant provisions for providers, while the Senate's version does. In addition, the House Ways and Means version includes a provision that would increase the number of procedure and billing codes from 24,000 to more than 200,000 by 2009. The Energy and Commerce version does not include that provision. Opponents maintain that the deadline is too soon to adapt to a new system, CQ Today reports. The two House versions will have to be reconciled before the legislation is considered by the full chamber, possibly next week (CQ Today, 6/15). Meanwhile, CMS Administrator Mark McCellan said that the current billing and coding systems is "bursting at the seams" and needs to be updated (Carey, CQ HealthBeat, 6/15).

EHRs Offer Benefits, but Privacy Risks Remain

EHRs Offer Benefits, but Privacy Risks Remain June 12, 2006
There are many benefits associated with electronic health record adoption, but centralizing patient information also poses privacy risks that must be addressed, according to a column in Monday's Boston Globe. EHRs would ensure that prescriptions are more legible and filled accurately, and they would reduce repetitive medical tests and help public health officials identify disease outbreaks and track their spread. In addition, EHRs would minimize adverse drug interactions and other errors and give scientists "access to a gold mine of data about diseases," according to the Globe. However, Dr. Deborah Peel, a psychoanalyst and founder of the Patient Privacy Rights Foundation, said, "If privacy is not fully protected, we won't be building anything except the most valuable motherlode of information for data mining on earth." She added, "If the Veterans Administration can't prevent the theft of 26 million names and Social Security numbers from an electronic file, why would any patient believe their personal sensitive health data is safe online?" To further the national health IT effort, HHS has formed the American Health Information Community, an advisory panel that oversees four HHS workgroups leading national EHR initiatives. However, there is only one consumer representative on the 17-member panel, the Globe reports. To guarantee that patients have sufficient privacy and control over their health records, "more could be done to increase consumer participation in the e-health records process," said Ray Campbell, a privacy advocate and executive director of the Massachusetts Health Data Consortium. A major issue is how centralized health information databanks should be, according to the Globe. John Halamka, CIO for Harvard Medical School and chair of the Health IT Standards Panel, said a "very decentralized approach" has worked well so far. Also, he recommended that only limited information, such as names, birth dates and indications to where care has been given be kept in regional databases. "The good news is that the push to make medical records electronic is still a work in progress," according to the Globe. "It's not too late for more consumer voice" (Foreman, Boston Globe, 6/12).

Health IT Access Among Physicians Remains Low

Health IT Access Among Physicians Remains Low

June 07, 2006

The percentage of U.S. physicians who have access to IT that can perform at least four of five clinical functions almost doubled over the past four years, but the percentage of doctors who use the tools remains low, according to a report released on Wednesday by the Center for Studying Health System Change, the AP/Houston Chronicle reports.

For the report, HSC examined responses from two separate telephone surveys of members of the American Medical Association and the American Osteopathic Association. The first survey, conducted in 2000-2001, included responses from about 12,000 physicians. The second survey, conducted in 2004-2005, included responses from more than 6,600 physicians.

About 21% of respondents in the 2004-2005 survey said they had access to IT that can obtain clinical guidelines, access patient information or write prescriptions, compared with 11.4% in the 2000-2001 survey, the report finds. According to the report, about 65% of respondents in the 2004-2005 survey said they had access to IT that can obtain clinical guidelines, compared with 52.9% in the 2000-2001 survey.

However, almost 17% of respondents in the 2004-2005 survey said they did not have access to IT that can perform those three clinical functions or exchange data and images with other physicians or provide reminders to complete certain tasks, and only 20% said that they had access to technology that can perform one of those five clinical functions, according to the report.

Joy Grossman, a senior health researcher at HSC, said that many physicians do not use IT because of the cost and time required to implement the technology (Agovino, AP/Houston Chronicle, 6/6).

State Privacy and Security Subcontract Opportunities Announced Under Expanded HHS Contract with RTI

May 24, 2006

The U.S. Department of Health and Human Services (HHS) announced today that 22 states and territories have entered subcontracts with RTI International, Inc. (RTI) to address privacy and security policy questions affecting interoperable health information exchange (HIE). Additional states are expected to sign subcontracts within the next two weeks. HHS' Office of the National Coordinator for Health Information Technology (ONC) and the Agency for Healthcare Research and Quality (AHRQ) jointly manage and fund AHRQ's contract with RTI for this work. Today, the ONC is adding $5.73 million to the existing contract with RTI, bringing its total value to $17.23 million. The additional funding will make it possible to fund all proposals with technical merit, which were submitted in response to a January request for proposals from RTI.

Subcontractors will be working with health care professionals, patients and others in their states and territories to address privacy and security issues and identify solutions for broad application. This will include identifying variations in privacy and security practices and laws affecting electronic clinical HIE; developing best practices and proposed solutions to address identified challenges; and increasing expertise about health information privacy and security protection in communities. The states will also work to develop implementation plans for future HIE activities.

"One of the strongest early lessons we're learning from our research on electronic health information is that some of the main challenges for adoption are not technical issues. Rather, they're issues of inclusion and trust," said AHRQ Director Dr. Carolyn M. Clancy. "This work on privacy and security will leave an indelible mark on the ultimate formulation of a national health information network."

Acting Deputy National Coordinator for Health Information Technology Dr. Karen Bell said, "States and territories have a critical role in working with the health care industry and consumers so that health information continues to be appropriately protected as we move forward into the digital era of medicine. This effort to partner with states and territories will ensure that the health care system serves consumers' needs and meets the President's goal for health information technology."

The RTI contract serves as a broad and critical initiative to enable HIE. Identification of privacy and security issues under this contract with RTI, and the solutions that are ultimately crafted in response to those issues, will provide a foundation for future work by ONC and AHRQ, and facilitate health information exchange across states.

RTI International, a private, nonprofit corporation, awarded the subcontracts under the contract it entered into with AHRQ last September: "Privacy and Security Solutions for Interoperable Health Information Exchange." RTI will work in partnership with the National Governors Association (NGA).

The ONC is tasked with coordinating federal health IT programs across executive branch agencies, as well as coordinating with the private sector on its health IT efforts. Information about the ONC is available at www.hhs.gov/healthit.

AHRQ funds more than 100 projects throughout the nation as part of its $166 million health IT initiative. AHRQ's National Resource Center for Health Information Technology supports this initiative. Information about AHRQ's health IT portfolio is available at healthit.ahrq.gov.

HHS is working to support President Bush's initiative to use health IT to improve the nation's health care system.

The subcontracting states thus far are: Alaska, Arkansas, Colorado, Iowa, Illinois, Indiana, Kentucky, Massachusetts, Maine, Michigan, Minnesota, Mississippi, North Carolina, New York, Ohio, Oklahoma, Rhode Island, Utah, Washington, Wisconsin, West Virginia, and Wyoming.

Coalition Pushes for Privacy in Electronic Health Records

Coalition Pushes for Privacy in Electronic Health Records
========================================================================

A broad coalition of 26 organizations, led by Patient Privacy Rights,
has issued a letter urging that privacy be included as a core part of
any health information technology (HIT) system. Patient Privacy Rights
was joined by the American Conservative Union, the American Civil
Liberties Union, the Free Congress Foundation, the Christian Coalition
of America, and the Electronic Privacy Information Center in the letter.

Proponents of electronic access to health records argue that a HIT
system can ease medical treatment. For instance, patients who need
treatment when far from home will benefit if doctors can access their
medical records. However, the organizations said that patients should
have the ability to grant or deny access to that information in ordinary
circumstances. "The proper balance to ensure timely access to medical
records for treatment and preserve patient control of medical records
means allowing access in emergencies if consent cannot be obtained, but
requiring patient permission before records are disclosed in everyday
situations," the groups wrote.

The organizations also stressed the need for strong security measures
for any HIT system. In light of the many security breaches reported by
commercial and financial institutions, security standards for a HIT
system must be stronger than those currently used by the financial
services industry.

The flexibility of an electronic system of health records should also
allow patients to control the levels of access for different groups. For
instance, while treating physicians may need access to personal
information like names, addresses, and phone numbers, medical
researchers conducting statistical studies would not need such
information.

Congress is currently considering several health information technology
bills, each named the "Wired for Health Care Quality Act." Last
November, the Senate passed S. 1418, which is awaiting action in the
House. There are also two House companion bills, H.R. 4642 and H.R.
4726.

Patient Privacy Coalition Letter:


http://www.patientprivacyrights.org/site/PageServer?pagename=CoalitionSignOnLtr

EPIC's Medical Privacy Page

http://www.epic.org/privacy/medical/

Patient Privacy Rights

http://www.patientprivacyrights.org/

S. 1418:

http://thomas.loc.gov/cgi-bin/bdquery/z?d109:s.01418:

H.R. 4642:

http://thomas.loc.gov/cgi-bin/bdquery/z?d109:h.r.04642:

H.R. 4726:

http://thomas.loc.gov/cgi-bin/bdquery/z?d109:h.r.04726: