| TOP RHIO NEWS  Brailer Says RHIOs Are Crucial
In his keynote address at the 2006 Annual HIMSS Conference and Exhibition, National Coordinator for Health Information Technology (ONC) Dr. David Brailer said his office will be focusing its efforts on forming guidelines and minimum standards to help regional health information organizations (RHIOs) form and grow. “I did not start out by believing the national solution will be a network of regional networks,” he said. “Our goal with the national health information network is to allow those who do not want to [participate in RHIOs] not have to do it. We want RHIOs to know where we are heading so they can make their plans accordingly.”
Calling RHIOs ‘crucial’ to the nation's move toward an electronic health information system, Brailer also announced plans for a new RFP within two months assessing existing RHIO efforts and developing best practices guidelines. Brailer said he would like to see a RHIO in every state, establishing governance and local structure to a national health information network (NHIN). NHIN Prototypes Discussed at HIMSS Conference
Dr. John Loonsk, director of interoperability standards for the ONC, moderated a discussion among representatives from the four companies chosen by HHS to create prototypes for a NHIN. The discussion, which took place at HIMSS 2006, offered insight into the approaches that each of the companies - Accenture, Computer Sciences Corporation, IBM and Northrop Grumman - is taking to develop a viable data exchange model for the U.S.
Loonsk said most of the prototypes have not yet achieved significant information exchange but that there have been "a number of very encouraging efforts to improve data sharing." He reminded attendees that the prototypes still are in the first phase of development and that the groups all are confronting "regional risk factors" that need to be addressed strategically.
Although the companies all are taking slightly different approaches to designing their prototypes, they each envision a network that can accommodate significant variation between communities. For the most part, the prototypes steer away from central data repositories and instead employ record locator services to sleuth out information on a local level.
According to Loonsk, there will be four public forums - in May, July, October and another towards the end of the year - during which health IT stakeholders will be able to inquire about progress. The expectation is to have a prototype by the end of the year, he added. Although the prototype probably will not be "implementable" by the end of 2006, it will be ready to move into "next-step efforts." Australia Reconsidering eHealth….Could This Happen in the U.S.?
Health IT experts in Australia are calling on Prime Minister John Howard to take control of the faltering national e-health reform agenda, according to AustralianIT.com. Frustration is rising over changes to plans for the centerpiece HealthConnect network, and a perception the federal government is trying to shove responsibility for health technology to the states. Independent consultant David More said the vision of HealthConnect as a "health market change management strategy," rather than a blueprint for a lifelong shared e-health record, was disturbing. CalRHIO Sets Agenda for 2006
CalRHIO, which provides services to RHIOs in California, has announced its agenda for 2006. The organization is preparing several guidance documents that will include recommendations for a statewide infrastructure to facilitate the sharing of patient records, a list of data sharing standards that providers and vendors can reference when designing or purchasing systems, and a recommendation for the kind of data that should be included in records and exchanges.
In addition, CalRHIO is working on standardized agreements to outline terms under which sensitive data should be exchanged and a pilot project to enable emergency departments to obtain patient information from pharmacies, laboratories and insurers. Inland Empire RHIO Formed
The initial seminal meeting of the Inland Empire RHIO was held on February 21at the
San Bernardino and Riverside County Medical Associations. The Inland Empire RHIO represents a combined provider base of almost 4,000 physicians serving a population of roughly 4.5 million people. “The agenda included an overall representation and historical perspective of RHIOs in general and specifics regarding our region, said Dr. Gary M. Levin, coordinator of the Inland Empire RHIO Task Force. There was a high level of interest and several potential stakeholders have agreed to join the steering committee. Moreover, CalRHIO has offered a business model, which will be considered. Several vendors demonstrated their version of "portals," he added. The overall opinion of the providers was that the portal is more important at this point than the EMR. Physicians need to have access to hospital, radiology and other reports generated by other providers, which a portal can facilitate either by push or pull technology or "spider" algorithms. Back to top ADVOCACY AND PUBLIC POLICY AMA to Develop More than 100 Standards
The American Medical Association has signed a pact with Congress promising to develop more than 100 standard performance measures, which doctors will report to the federal government in an effort to improve the quality of care. The deal comes as the Bush administration pushes "pay for performance" arrangements with various healthcare providers in an effort to publicize their performance and link Medicare payment to quality. And it mirrors efforts in the private sector, where consumer groups, insurance companies and large employers who pay for healthcare are demanding more information on the quality of care. However, in a separate letter to Congressional leaders, ten national physician groups representing a wide range of specialties wrote "We are dismayed that an agreement was reached on issues that are critical to the future of our specialties and our patients without our participation or knowledge. The American Medical Association cannot be the sole representative for the groups who are paramount to the development and implementation of quality measures." The Community Work Groups Make Progress
The American Health Information Community (the Community) consumer empowerment work group met on February 21 to discuss the creation of a model electronic health record for consumers and providers within a year. The consumer work group is focusing on helping consumers make the transition to health IT. Personal health records will be an essential part of the Community’s goal of a national IT infrastructure, said Kevin Hutchinson, a member of the panel and president and CEO of SureScripts. The PHRs will contain patients' medical and drug histories, will be easy to update and eventually will be integrated into practice management systems in physician offices. The next scheduled meeting is March 20. The EHR work group is focusing on physician offices instead of patients. According to Hutchinson, the two committees will collaborate and provide "the perfect complement to developing the kind of integrated systems that most officials foresee. Rhode Island to Issue $20 Million Bond to Create Health Information Network
Rhode Island Gov. Donald Carcieri (R) announced plans to establish a $20 million bond to develop a real-time patient health information network. As more providers adoptEHRs, the state funding would play an essential role in designing, implementing and overseeing a health information network, Government Technology reports. In addition, the bond would help influence federal and private resources to secure hardware, software and network capabilities needed to share, secure and compile medical data. "We need to bring healthcare into the information age," Carcieri said. "Relying on paper records means that critical information may not be available to patients when they most need it." Also, a health information system would reduce healthcare costs by eliminating redundancies, according to Carcieri. EHR Bill Fails in Wyoming
In a tie vote on February 21, the Wyoming Senate stopped legislation that would have made Wyoming the first state in the country to create an EHRnetwork. Opponents of the bill questioned whether the multimillion-dollar system would actually be launched. State Sen. Phillip Nicholas (R) said he had "grave concern as to whether the plan [would] ever work," the Associated Press reports. Critics of the bill also cited privacy concerns.
The bill's supporters argued that the proposed EHR network would reduce healthcare costs and improve care. Back to top RHIO SPOTLIGHT Physicians in Israel Reaping Benefits of RHIOs
More than 60% of Israel’s population is benefiting from its RHIO, CLALIT Health Services. “Our physicians wonder how they practiced without our RHIO,” said Dr. Orna Blondheim, CEO of CLALIT Health Services. “It’s better for the patients. In the future, the smart consumer will demand it. If aviation had the same rate of error that occurs in medicine, no one would ever fly. The healthcare world must be as safe as the aviation world. We expect human error because no one is perfect but we must do better.” The key to their success was very senior level people who were dedicated to the idea and the rest flowed naturally, Dr. Blondheim explained. “Now physicians see the advantages. Our physicians are in several networks. Medicine is socialized in Israel. There’s no support outside so physicians choose to be in our network. Three of the four organizations in the network require electronic medical records and the health fund helps with the other.” However, the problem was there were different EMRs within the same hospital. “We knew that was bad. Medicine is more complex now and patients do not know so we can’t rely on the patient and the family to bring us information. No banking system would work that way so why medicine. The medical world was behind for a lot of reasons. Change was necessary.” First, they defined what they wanted, set prerequisites, and organized committees. Then they needed a solution. The organization began with a local pilot project in southern Israel. “We began just by connecting departments within one organization, which was a start-up company, and that paved the road for continuing, she noted. “We began developing the concept in the late 90s.” The RHIOs’ prerequisites included no central database, complete ownership by people who formed the EMR, retrieval of information in one minute, security and privacy (compliance with national and international laws), full integration, minimal data sets, user friendly, and connectivity with existing and future operating systems. They also organized committees for consumers and hospitals, said Dr. Blondheim. Each group had their own Steering, Users, and Legal and Ethics Committees. People from every profession were involved. The profiles of the users varied so they had to be involved at the outset. “We have so many success stories,” said Dr. Blondheim. There was a young woman who was about to be admitted for elective surgery. However, she remembered the night before the surgery she had an allergic reaction to anesthesia during a previous surgery. However, she couldn’t recall the specifics. Fortunately, we were able to obtain her EMR, which included her allergies. In another case, a child with numerous childhood illnesses was seen by several doctors because the parents chose to change physicians. Fortunately, the doctors were making decisions regarding the child’s health with his complete medical history.” Back to top TECHNOLOGY CORNER RHIOs Giving Master Person Index Technology New Meaning
Enterprise master person index (EMPI) technology is already successfully used in various segments of the healthcare delivery system. In a RHIO environment, the EMPI matches and aggregates medical records and information across participating systems without requiring either existing (social security number) or new (national health number) common identifiers to locate and match patient information. Back to top RHIO FEDERATION UPDATE RHIO Federation Members Reap Many Benefits
To support the emerging RHIO industry with education, outreach, networking, tools, resources, and advocacy support, the HIMSS RHIO Federation launched on October 21, 2005. The RHIO Federation Website now features information on lessons learned, case studies, current issues and trends as well as RHIO Federation projects. At 56RHIO members and counting, participating RHIOs receive free monthly education sessions on timely topics that affect their business as well as access to HIMSS' RHIO Federation Portal. There is no charge for RHIOs to join the Federation. Each RHIO will provide a point of contact to the Federation and will be connected with the Chapter RHIO Federation Roundtable member in their geographic location. Members of the RHIO Federation are supported by a 110-HIMSS-member task force, a 38-person Chapter RHIO Federation Roundtable in support of regional and local activities, and four work groups building official HIMSS' definitions, position statements, pilot projects and an industry-focused guidebook. If you are a RHIO and interested in participating in the RHIO Federation, contact David Clark at dclark@himss.org or at 703-837-9816. Back to top ASK THE EXPERT How will RHIOs work with emergency departments? A RHIO may afford some capacity to ameliorate information issues with better communication between hospitals, ambulatory public health clinics and providers who will accept uninsured patients. Hospitals may be willing to underwrite parts of the RHIO cost to provide this service to the emergency department, thereby lessening their individual burden. As the crisis has deepened more and more hospitals have closed their emergency room doors, transferring additional load to still functioning emergency rooms.
For more information on this topic, click here. Back to top RESOURCES Health IT Resources Available Online at AHRQ
HHS' Agency for Healthcare Research and Quality (AHRQ) launched a new suite of "learning resources" designed to help healthcare providers adopt health information technologies quickly and effectively. The step represents a new phase for the AHRQ National Resource Center on Health Information Technology, as the Agency acts rapidly to convey the lessons learned through AHRQ-funded projects and other sources. The new resources are at the center's web site, http://www.healthit.ahrq.gov. CHCF Issues Report on ePrescribing
Doctors write more than 3 billion prescriptions each year, with a combined value that tops $221 billion. Within the complex and largely automated prescription drug industry, the information flow between physicians and pharmacies remains the only part of the process that isn’t managed electronically. This California Health Care Foundation-funded report, The Prescription Infrastructure: Are We Ready for ePrescribing?, provides a comprehensive overview of the prescribing process, including the organizational, financial, and technical elements that influence how prescriptions are handled today. It examines the issue of ePrescribing (eRx) — currently practiced by only 15% of physicians — including the opportunities it presents to streamline information management and the potential payoffs for both clinicians and pharmacies. First National RHIO Finance Survey Planned
A newly designed survey, titled "RHIO Startup Funding and Finance for Life: Survey of Regional Health Information Organization Finance," is being prepared by Healthcare IT Transition Group. The survey questionnaire will be distributed to a large sample of RHIO/HIE leaders next month. Results of this first national RHIO finance survey will be reported at the upcoming national conference of the Workgroup for Data Interchange (WEDI), and will be published in May. RHIO personnel who would like to respond to the survey questionnaire are encouraged to request the questionnaire at this link. Back to top CALENDAR OF EVENTS RHIO EVENTS HIMSS Hawaii Chapter
Honolulu, HI
April 5, 2006
Topic: RHIO Update
Speaker: David Clark
Contact Person: Steven Hurlbut
shurlbut@queens.org HIMSS NCA Chapter
Key Bridge Marriott
Rosslyn, VA
April 20, 2006
Topic: RHIOs: Lessons Learned from the Field
Contact Person: David Clark
dclark@himss.org Gain New Insights on Successful RHIO Development
If you are a stakeholder in a RHIO or you currently play a role in EHR transformation, you won't want to miss this powerful webinar on using service- oriented architecture (SOA). Presented on March 13 by the HIMSS RHIO Federation, this online session will reveal how SOA can help RHIOs save money by leveraging existing IT infrastructures to support local efforts. - Alan Boucher, Director of Health Care Architecture within the Digital Health Group at Intel Corporation, will share his expertise in the delivery of products, technologies and platforms for healthcare IT, along with new insights on national healthcare infrastructures and the personal health, biotech and pharmaceutical sectors.
- Peter T. van der Grinten, General Manager, dbMotion Inc., will share how the Calit Health Services RHIO in Israel utilized SOA to build a health information exchange that now serves more than 3.5 million individuals. Mr. van der Grinten, with an extensive background in EMR usage and software development and HL7 experience, has successfully managed the installations of clinical systems for nursing, physician, and pharmacy environments.
Only $50 for HIMSS members and $145 for non- members.
Register/more information OTHER EVENTS HIMSS to Sponsor Six Conferences for Independent Physicians
The HIMSS’ Physicians Adopting Computer Technology (PACT) Conference is a one-day event, launched in 2004, that features a distinguished group of award winning, nationally recognized presenters who bring home the realities of the EHR. Exhibitors can take advantage of this exclusive opportunity to showcase their product to this targeted audience. During the conference, physician attendees hear from colleagues who have succeeded in EHR implementation and who are eager to share their real-world implementation experience in their own practices. Each PACT conference is designed to attract physicians in small (1-4 physicians) and large (10+ physicians) practices, as well as technology professionals, office managers and administrators who are responsible for EHR decision-making. The 2006 PACT conferences will be held on the following dates: March 11 – Denver, Colo.; March 18 – New York, N.Y.; March 25 – San Francisco, Calif.; April 22 – Dearborn, Mich.; May 6 – Kingsport, Tenn.; and June 24 – Boston, Mass. Share Your EHR Solution with Physicians - Exhibit at PACT. Visit our web site, www.himss.org/pact. Companies interested in exhibiting should contact Kelly Laidler via email, klaidler@himss.org, or at 312-915-9285. Plan Ahead: National Health IT Week and Advocacy Day, June 5-9 in Washington
Health IT public policy issues have taken center stage in Washington, DC. In order to continue to influence change and transform healthcare, HIMSS has joined with other industry stakeholder groups to co-sponsor the first National Health IT Week, which will be held June 5-9 in Washington, DC. During National Health IT Week, there will be an industry-wide Advocacy Day at the Ronald Reagan Building and International Trade Center on Tuesday, June 6, 8:00 a.m. to 6:30 p.m. This event will be open on a complimentary basis to all HIMSS members. At a minimum, all hapters should plan to sponsor their Chapter Advocate(s) for the HIMSS co-sponsored Health IT Week Advocacy Day and the HIMSS Summit, June 7 and 8. Two scholarships will be available this year for Chapter Advocates to attend Health IT Week Advocacy Day. Interested Chapters should contact Tom Keefe at tkeefe@himss.org. American Health Information Community Workgroup Meetings Scheduled
The American Health Information Community (the Community) has released the calendar for workgroup meetings in 2006. The workgroups—biosurveillance, consumer empowerment, chronic care , and electronic health records—are scheduled to meet approximately 10 times per year, each. The workgroups will make recommendations to the Community that will produce tangible and specific value to the health care consumer that can be realized within a one-year period. Members of the public can listen in on the meetings via the Web. Details on how to access each workgroup meeting are available under that workgroup's page of the Community's web site. Questions and comments about the Community workgroups should be directed to onchit.request@hhs.gov or 866-505-3500.
HIMSS RHIO Connection is your official source for timely, comprehensive coverage and analysis of the RHIO Revolution. We hope you have enjoyed the RHIO Connection. If you and your colleagues would like to permanently subscribe to each and every complimentary edition, click here. HIMSS Integration and Interoperability Team
David E. Clark, MIM, Director of Integration and Interoperability, 703-837-9816
Sharolyn Rosier Hyson, MPP, Editor of the RHIO Connection and Manager of Public Policy Communications, 703-837-9819
Noel Quander, Coordinator of Integration and Interoperability, 703-837-9824
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