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.