Telehealth Monitor

Health information technology leaders made the case for linking the economic stimulus plan to the broader goals of health reform, including improved heath care services and population health, at a conference in Washington, D.C., yesterday.

The health IT provisions of the stimulus were designed to correct the failure of the market to spur the adoption of health IT and to demonstrate its value. In doing so, it will also be a tool to meet the aims of health reform, said Dr. David Blumenthal, the nation’s health IT coordinator, at a May 20 conference sponsored by the Brookings Institution.

Under the American Recovery and Reinvestment Act, physicians and hospitals will be entitled to increased Medicare and Medicaid payments starting in 2011 if they can demonstrate “meaningful use” of electronic health records. ONC has said they would define the term by early summer.

via Blumenthal: Stimulus a ‘sweetener, not determinant’ of health IT adoption — Government Health IT.

With billions in stimulus dollars available to help doctors and hospitals digitize their health records, it stands to reason that tech companies want to make spending that money as easy as possible.

Several of the players–Allscripts, Cisco, Citrix, Dell, Intel, Intuit, Microsoft, and Nuance Communications–have teamed up in an alliance aimed at educating doctors on the many tools available to help set up electronic health records.

The EHR Stimulus Alliance is pulling out all the stops, with a road tour, Webcasts, telephone hotline, and other tools all aimed at demystifying the technology and showing case studies of where it has worked.

President Obamas stimulus package provides on the order of $20 billion for health care technology, with the central focus being nudging hospitals and doctors to move their records from manila folders to computers. Even with the money, though, its seen as a daunting task.

“The EHR Stimulus Alliance is a unified movement toward turning the national dialogue surrounding the EHR transition into action,” Nuance Healthcare President John Shagoury said in a statement. “Each of the partners involved has unique solutions that are crucial to EHR implementation. In our case, because most doctors speak at least three times faster than they type, speech recognition technology helps increase the meaningful use and efficiency of EHRs by decreasing physician reliance on the keyboard and mouse.”

via Tech giants line up for e-health dollars | Beyond Binary – CNET News.

With federal stimulus programs waving a $20 billion carrot in front of health care providers, it’s a sure bet that many more hospitals and medical practices will be deploying e-medical record systems over the next several years. But many health-care organizations will likely discover that implementing these systems is one thing; keeping the technology performing to the satisfaction of clinicians is another.

E-medical record systems require doctors and nurses to make huge changes in the workflow habits involved with patient care. That in itself is a tough sell. But if systems performance problems prevent clinicians from accessing crucial patient data or ordering drugs or tests in a timely way, that can become a matter of life or death.

Performance monitoring tools that help IT staff quickly identify and diagnose application, infrastructure, and other systems performance problems before the trouble impacts users can greatly boost clinicians’ satisfaction, say health care IT leaders who have deployed e-medical records and other health IT systems.

via Monitoring Tools Can Boost E-Health Record Systems Performance — Health IT — InformationWeek.

GE, Google, and others, in a stimulus-fueled frenzy, are piling into the business. But electronic health records have a dubious history

Neal Patterson likens the current scramble in health information technology to the 19th century land rush that opened his native Oklahoma to homesteaders. Cerner (CERN), the large medical vendor Patterson heads, is jockeying for new business spurred by a $19.6 billion federal initiative to computerize a health system buried in paper. “It’s a beautiful opportunity for us,” the CEO says.

The billions in taxpayer funds—part of the $787 billion economic stimulus—also have energized tech titans General Electric (GE), Intel (INTC), and IBM (IBM), all of which are challenging Cerner and other traditional medical suppliers. Microsoft (MSFT) and Google (GOOG) aim to put medical records in the hands of patients via the Web. Wal-Mart (WMT) is teaming with computer maker Dell (DELL) and digital vendor eClinicalWorks to sell information technology to doctors through Sam’s Club stores.

Under the federal stimulus program enacted in February, hospitals can seek several million dollars apiece for tech purchases over the next five years. Individual physicians can receive up to $44,000. These carrots should encourage the proliferation of technology that will computerize physician orders, automate dispensing of drugs, and digitally store patient records. If providers participate broadly, those files are supposed to be accessible no matter where a consumer goes for treatment. President Barack Obama says the changes will improve care, eliminate errors, and eventually save billions of dollars a year. There’s also a stick: The federal government will cut Medicare reimbursement for hospitals and medical practices that don’t go electronic by 2015.

via The Dubious Promise of Digital Medicine – BusinessWeek.

Chicago — Doctors and hospitals could receive as much as $39 billion in economic stimulus funds during the next five years to acquire electronic health record systems, a top Healthcare Information and Management Systems Society official said on the opening day of the organization’s four-day conference here.

Though the Recovery Act provided $17 billion for payments to clinicians and hospitals through the Centers for Medicare and Medicaid Services, actual spending could be more than double that figure, depending on the rate of e-records adoption, said Dave Roberts, HIMSS vice president for government relations, during a press briefing on Saturday.

Roberts said the $17 billion in the stimulus package is an estimate of funding needed to meet the act’s pledge of giving providers that use health information technology systems in a “meaningful way” $44,000 each during a five-year period to defray expenses, starting with an $18,000 payment in 2010. The e-records initiative is an entitlement program like Social Security, he said.

Roberts said his $39 billion estimate was based on a Congressional Budget Office analysis. CBO estimated that information technology could reduce overall health care costs by $15 billion for that same time period as a result of increased efficiencies, he added.

via Nextgov – Adopting e-health records could cost more than anticipated.

Dr. David Blumenthal offered this week a first significant glimpse into how he views the policy choices ahead of him as he prepares to take over as national coordinator for health IT. 

In a perspective piece published April 9 by the New England Journal of Medicine, Blumenthal said that to carry out Congress’ intentions in the recently passed health IT stimulus legislation, it will be important not to set the bar too high for providers to qualify for health IT funding. 

The current certification process for health IT needs tightening, he said.

Congress provided $20 billion in health IT incentives in the American Recovery and Reinvestment Act as the means to improve the quality of health care, not as an end in itself, Blumenthal said. 

“Under the pressure to show results, it will be tempting to measure…the payoff from the $787 billion stimulus package in narrow terms — for example, the numbers of computers newly deployed in doctors’ offices and hospital nursing stations,” Blumenthal said. 

“But that does not seem to be Congress’ intent. It wants improvements in health and health care through the use” of health IT.

via Blumenthal signals position on key stimulus policies — Government Health IT.

Breaking into the health-care industry can be daunting. Doctors, hospitals, insurance companies and patients speak different languages and have vastly different needs.

But more than $19 billion in stimulus money intended to revamp the nation’s health system has piqued the interest of some local tech companies that have in the past shied away from the complex industry. And for companies with expertise in the business, stimulus dollars mean new opportunities.

“Health care is thought to be a safer place right now because more money is coming from the government, and it’s not really something anyone can cut back on,” said Michael Slage of Arlington, founder of HealthEngage, a firm that develops applications that help patients manage conditions such as diabetes and asthma. “Everyone senses that there’s all this money out there.”

The Obama administration is pushing to digitize health records; electronic records depend on fast data networks, interoperable software systems and devices to enter and track patient data.

via Kim Hart – Kim Hart’s The Download – washingtonpost.com.

WASHINGTON – The economic stimulus package has allotted $17.2 billion to reward Medicare and Medicaid providers who can prove they are using certified healthcare IT “in a meaningful way.”

The incentives are scheduled to take effect starting Oct. 1, 2011. Experts say providers should not waste time getting prepared because there is a shortage of change management experts available to help.

According to Dave Garets, president and CEO HIMSS Analytics, 94 percent of hospitals currently don’t have enough healthcare IT in place to meet the stipulations required to receive bonuses. Under the new law, they must prove “meaningful use,” which will require capturing certain data.

Garets expects that healthcare organizations will adopt healthcare IT “with a vengeance” in 2009. He and other members of the Healthcare Information and Management and Systems Society are concerned there are “precious few” change management experts to help providers make the complicated transition to healthcare IT by 2011.

via Industry News | Healthcare IT News.

Before stimulus bill broadband grants flow to local governments, the federal government is seeking input on grant requirements from “interested parties,” according to the Federal Register. The National Telecommunications and Information Administration (NTIA) will begin holding meetings on March 2 and continue until further notice. The NTIA is part of the U.S. Department of Commerce, which is distributing $4.7 billion of the $7.2 billion President Barack Obama detailed in his stimulus package for municipal broadband.

Taking advantage of the meetings is critical for local governments, warned Craig Settles, a municipal broadband analyst.

“Incumbents and large providers know about these meetings, and they’ll try to dominate the process to get RFP requirements that favor them,” Settles commented. “Communities and smaller providers could lose out, and as a result their economies won’t benefit nearly as much as they would if communities are active participants in this process.”

To schedule a meeting, call Barbara Brown at the NTIA at (202) 482-4374 or e-mail her at bbrown@ntia.doc.gov. Brown hasn’t returned a voicemail from Government Technology yet asking whether “interested parties” may do the meetings via conference call.

The NTIA’s $4.7 billion share of the overall $7.2 billion will fund urban and rural broadband while the Rural Utilities Service (RUS) — part of the U.S. Department of Agriculture — will distribute the remaining $2.5 billion for rural broadband exclusively.

Given that vendors and nonprofits will compete for the dollars alongside governments, municipalities should at least demand requirements forcing vendors and nonprofits to collaborate with cities and counties on any deployments, Settles recommended. With no local government input, vendors and nonprofits could build networks that grow their own bottom lines, but don’t serve the goals of the local governments. For example, a municipality might want the network to support job creation, health care, telemedicine and digital inclusion. Different forms of broadband serve different goals better than others.

via Stimulus Broadband Feedback from Locals Solicited by Federal Government.

Download the final clean version of the economic stimulus bill.

DIVISION A—APPROPRIATIONS PROVISIONS

TITLE I—AGRICULTURE, RURAL DEVELOPMENT, FOOD AND DRUG ADMINISTRATION, AND RELATED AGENCIES DEPARTMENT OF AGRICULTURE, RURAL UTILITIES SERVICE

DISTANCE LEARNING, TELEMEDICINE, AND BROADBAND PROGRAM
For an additional amount for the cost of broadband loans and loan guarantees, as authorized by the Rural Electrification Act of 1936 (7 U.S.C. 901 et seq.) and for grants (including for technical assistance), $2,500,000,000: Provided, That the cost of direct and guaranteed loans shall be as defined in section 502 of the Congressional Budget Act of 1974: Provided further, That, notwithstanding title VI of the Rural Electrification Act of 1936, this amount is available for grants, loans and loan guarantees for broadband infrastructure in any area of the United States: Provided further, That at least 75 percent of the area to be served by a project receiving funds from such grants, loans or loan guarantees shall be in a rural area without sufficient access to high speed broadband service to facilitate rural economic development, as determined by the Secretary of Agriculture: Provided further, That priority for awarding such funds shall be given to project applications for broadband systems that will deliver end users a choice of more than one service provider: Provided further, That priority for awarding funds made available under this paragraph shall be given to projects that provide service to the highest proportion of rural residents that do not have access to broadband service: Provided further, That priority shall be given for project applications from borrowers or former borrowers under title II of the Rural Electrification Act of 1936 and for project applications that include such borrowers or former borrowers: Provided further, That priority for awarding such funds shall be given to project applications that demonstrate that, if the application is approved, all project elements will be fully funded: Provided further, That priority for awarding such funds shall be given to project applications for activities that can be completed if the requested funds are provided: Provided further, That priority for awarding such funds shall be given to activities that can commence promptly following approval: Provided further, That no area of a project funded with amounts made available under this paragraph may receive funding to provide broadband service under the Broadband Technology Opportunities Program: Provided further, That the Secretary shall submit a report on planned spending and actual obligations describing the use of these funds not later than 90 days after the date of enactment of this Act, and quarterly thereafter until all funds are obligated, to the Committees on Appropriations of the House of Representatives and the Senate.

Subtitle A—Promotion of Health Information Technology

The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by adding at the end the following:

‘‘TITLE XXX—HEALTH INFORMATION TECHNOLOGY AND QUALITY
‘‘Subtitle A—Promotion of Health Information Technology
‘‘SEC. 3001. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY.
‘‘SEC. 3002. HIT POLICY COMMITTEE.
‘‘(a) ESTABLISHMENT.—There is established a HIT Policy Committee to make policy recommendations to the National Coordinator relating to the implementation of a nationwide health information technology infrastructure, including implementation of the strategic plan described in section 3001(c)(3).
‘‘(b) DUTIES.—
‘‘(1) RECOMMENDATIONS ON HEALTH INFORMATION TECHNOLOGY INFRASTRUCTURE.—The HIT Policy Committee shall recommend a policy framework for the development and adoption of a nationwide health information technology infrastructure that permits the electronic exchange and use of health information as is consistent with the strategic plan under section 3001(c)(3) and that includes the recommendations under paragraph (2). The Committee shall update such recommendations and make new recommendations as appropriate.
‘‘(2) SPECIFIC AREAS OF STANDARD DEVELOPMENT.—
‘‘(A) INGENERAL.—The HIT Policy Committee shall recommend the areas in which standards, implementation specifications, and certification criteria are needed for the electronic exchange and use of health information for purposes of adoption under section 3004 and shall recommend an order of priority for the development, harmonization, and recognition of such standards, specifications, and certification criteria among the areas so recommended. Such standards and implementation specifications shall include named standards, architectures, and software schemes for the authentication and security of individually identifiable health information and other information as needed to ensure the reproducible development of common solutions across disparate entities.
‘‘(B) AREAS REQUIREDFORCONSIDERATION.—For purposes of subparagraph (A), the HIT Policy Committee shall make recommendations for at least the following areas:
‘‘(i) Technologies that protect the privacy of health information and promote security in a qualified electronic health record, including for the segmentation and protection from disclosure of specific and sensitive individually identifiable health information with the goal of minimizing the reluctance of patients to seek care (or disclose information about a condition) because of privacy concerns, in accordance with applicable law, and for the use and disclosure of limited data sets of such information.
‘‘(ii) A nationwide health information technology infrastructure that allows for the electronic use and accurate exchange of health information.
‘‘(iii) The utilization of a certified electronic health record for each person in the United States by 2014.
‘‘(iv) Technologies that as a part of a qualified electronic health record allow for an accounting of disclosures made by a covered entity (as defined for purposes of regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996) for purposes of treatment, payment, and health care operations (as such terms are defined for purposes of such regulations).
‘‘(v) The use of certified electronic health records to improve the quality of health care, such as by promoting the coordination of health care and improving continuity of health care among health care providers, by reducing medical errors, by improving population health, by reducing health disparities, by reducing chronic disease, and by advancing research and education.
‘‘(vi) Technologies that allow individually identifiable health information to be rendered unusable, unreadable, or indecipherable to unauthorized individuals when such information is transmitted in the nationwide health information network or physically transported outside of the secured, physical perimeter of a health care provider, health plan, or health care clearinghouse.
‘‘(vii) The use of electronic systems to ensure the comprehensive collection of patient demographic data, including, at a minimum, race, ethnicity, primary language, and gender information.
‘‘(viii) Technologies that address the needs of children and other vulnerable populations.
‘‘(C) OTHER AREAS FOR CONSIDERATION.—In making recommendations under subparagraph (A), the HIT Policy Committee may consider the following additional areas:
‘‘(i) The appropriate uses of a nationwide health information infrastructure, including for purposes of—
‘‘(I) the collection of quality data and public reporting;
‘‘(II) biosurveillance and public health;
‘‘(III) medical and clinical research; and
‘‘(IV) drug safety.
‘‘(ii) Self-service technologies that facilitate the use and exchange of patient information and reduce wait times.
‘‘(iii) Telemedicine technologies, in order to reduce travel requirements for patients in remote areas.
‘‘(iv) Technologies that facilitate home health care and the monitoring of patients recuperating at home.
‘‘(v) Technologies that help reduce medical errors.
‘‘(vi) Technologies that facilitate the continuity of care among health settings.
‘‘(vii) Technologies that meet the needs of diverse populations.
‘‘(viii) Methods to facilitate secure access by an individual to such individual’s protected health information.
‘‘(ix) Methods, guidelines, and safeguards to facilitate secure access to patient information by a family member, caregiver, or guardian acting on behalf of a patient due to age-related and other disability, cognitive impairment, or dementia.
‘‘(x) Any other technology that the HIT Policy Committee finds to be among the technologies with the greatest potential to improve the quality and efficiency of health care.
‘‘(3) FORUM.—The HIT Policy Committee shall serve as a forum for broad stakeholder input with specific expertise in policies relating to the matters described in paragraphs (1) and (2).
‘‘(4) CONSISTENCY WITH EVALUATION CONDUCTED UNDER MIPPA.—
‘‘(A) REQUIREMENTFORCONSISTENCY.—The HIT Policy Committee shall ensure that recommendations made under paragraph (2)(B)(vi) are consistent with the evaluation conducted under section 1809(a) of the Social Security Act.
‘‘(B) SCOPE.—Nothing in subparagraph (A) shall be construed to limit the recommendations under paragraph (2)(B)(vi) to the elements described in section 1809(a)(3) of the Social Security Act.
‘‘(C) TIMING.—The requirement under subparagraph
(A) shall be applicable to the extent that evaluations have been conducted under section 1809(a) of the Social Security Act, regardless of whether the report described in subsection (b) of such section has been submitted.
‘‘(c) MEMBERSHIP AND OPERATIONS.—
‘‘(1) INGENERAL.—The National Coordinator shall take a leading position in the establishment and operations of the HIT Policy Committee.
‘‘(2) MEMBERSHIP.—The HIT Policy Committee shall be composed of members to be appointed as follows:
‘‘(A) 3 members shall be appointed by the Secretary, 1 of whom shall be appointed to represent the Department of Health and Human Services and 1 of whom shall be a public health official.
‘‘(B) 1 member shall be appointed by the majority leader of the Senate.
‘‘(C) 1 member shall be appointed by the minority leader of the Senate.
‘‘(D) 1 member shall be appointed by the Speaker of the House of Representatives.
‘‘(E) 1 member shall be appointed by the minority leader of the House of Representatives.
‘‘(F) Such other members as shall be appointed by the President as representatives of other relevant Federal agencies.
‘‘(G) 13 members shall be appointed by the Comptroller General of the United States of whom—
‘‘(i) 3 members shall advocates for patients or consumers;
‘‘(ii) 2 members shall represent health care providers, one of which shall be a physician;
‘‘(iii) 1 member shall be from a labor organization representing health care workers;
‘‘(iv) 1 member shall have expertise in health information privacy and security;
‘‘(v) 1 member shall have expertise in improving the health of vulnerable populations;
‘‘(vi) 1 member shall be from the research community;
‘‘(vii) 1 member shall represent health plans or other third-party payers;
‘‘(viii) 1 member shall represent information technology vendors;
‘‘(ix) 1 member shall represent purchasers or employers; and
‘‘(x) 1 member shall have expertise in health care quality measurement and reporting.
‘‘(3) PARTICIPATION.—The members of the HIT Policy Committee appointed under paragraph (2) shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of the Policy Committee.
‘‘(4) TERMS.—
‘‘(A) INGENERAL.—The terms of the members of the HIT Policy Committee shall be for 3 years, except that the Comptroller General shall designate staggered terms for the members first appointed.
‘‘(B) VACANCIES.—Any member appointed to fill a vacancy in the membership of the HIT Policy Committee that occurs prior to the expiration of the term for which the member’s predecessor was appointed shall be appointed only for the remainder of that term. A member may serve after the expiration of that member’s term until a successor has been appointed. A vacancy in the HIT Policy Committee shall be filled in the manner in which the original appointment was made.
‘‘(5) OUTSIDE INVOLVEMENT.—The HIT Policy Committee shall ensure an opportunity for the participation in activities of the Committee of outside advisors, including individuals with expertise in the development of policies for the electronic exchange and use of health information, including in the areas of health information privacy and security.
‘‘(6) QUORUM.—A majority of the member of the HIT Policy Committee shall constitute a quorum for purposes of voting, but a lesser number of members may meet and hold hearings.
‘‘(7) FAILURE OF INITIAL APPOINTMENT.—If, on the date that is 45 days after the date of enactment of this title, an official authorized under paragraph (2) to appoint one or more members of the HIT Policy Committee has not appointed the full number of members that such paragraph authorizes such official to appoint, the Secretary is authorized to appoint such members.
‘‘(8) CONSIDERATION.—The National Coordinator shall ensure that the relevant and available recommendations and comments from the National Committee on Vital and Health Statistics are considered in the development of policies.
‘‘(d) APPLICATION OF FACA.—The Federal Advisory Committee Act (5 U.S.C. App.), other than section 14 of such Act, shall apply to the HIT Policy Committee.
‘‘(e) PUBLICATION.—The Secretary shall provide for publication in the Federal Register and the posting on the Internet website of the Office of the National Coordinator for Health Information Technology of all policy recommendations made by the HIT Policy Committee under this section.

Subtitle C—Grants and Loans Funding
SEC. 13301. GRANT, LOAN, AND DEMONSTRATION PROGRAMS.
Title XXX of the Public Health Service Act, as added by section 13101, is amended by adding at the end the following new subtitle:

Subtitle C—Grants and Loans Funding

SEC. 13301. GRANT, LOAN, AND DEMONSTRATION PROGRAMS.

Title XXX of the Public Health Service Act, as added by section 13101, is amended by adding at the end the following new subtitle:

‘‘Subtitle B—Incentives for the Use of Health Information Technology
‘‘SEC. 3011. IMMEDIATE FUNDING TO STRENGTHEN THE HEALTH INFORMATION TECHNOLOGY INFRASTRUCTURE.
‘‘(a) INGENERAL.—The Secretary shall, using amounts appropriated under section 3018, invest in the infrastructure necessary to allow for and promote the electronic exchange and use of health information for each individual in the United States consistent with the goals outlined in the strategic plan developed by the National Coordinator (and as available) under section 3001. The Secretary shall invest funds through the different agencies with expertise in such goals, such as the Office of the National Coordinator for Health Information Technology, the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, the Centers of Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and the Indian Health Service to support the following:
‘‘(1) Health information technology architecture that will support the nationwide electronic exchange and use of health information in a secure, private, and accurate manner, including connecting health information exchanges, and which may include updating and implementing the infrastructure necessary within different agencies of the Department of Health and Human Services to support the electronic use and exchange of health information.
‘‘(2) Development and adoption of appropriate certified electronic health records for categories of health care providers not eligible for support under title XVIII or XIX of the Social Security Act for the adoption of such records.
‘‘(3) Training on and dissemination of information on best practices to integrate health information technology, including electronic health records, into a provider’s delivery of care, consistent with best practices learned from the Health Information Technology Research Center developed under section 3012(b), including community health centers receiving assistance under section 330, covered entities under section 340B, and providers participating in one or more of the programs under titles XVIII, XIX, and XXI of the Social Security Act (relating to Medicare, Medicaid, and the State Children’s Health Insurance Program).
‘‘(4) Infrastructure and tools for the promotion of telemedicine, including coordination among Federal agencies in the promotion of telemedicine.
‘‘(5) Promotion of the interoperability of clinical data repositories or registries.
‘‘(6) Promotion of technologies and best practices that enhance the protection of health information by all holders of individually identifiable health information.
‘‘(7) Improvement and expansion of the use of health information technology by public health departments.
‘‘(b) COORDINATION.—The Secretary shall ensure funds under this section are used in a coordinated manner with other health information promotion activities.
‘‘(c) ADDITIONAL USEOF FUNDS.—In addition to using funds as provided in subsection (a), the Secretary may use amounts appropriated under section 3018 to carry out health information technology activities that are provided for under laws in effect on the date of the enactment of this title.
‘‘(d) STANDARDS FOR ACQUISITION OF HEALTH INFORMATION TECHNOLOGY.—To the greatest extent practicable, the Secretary shall ensure that where funds are expended under this section for the acquisition of health information technology, such funds shall be used to acquire health information technology that meets applicable standards adopted under section 3004. Where it is not practicable to expend funds on health information technology that meets such applicable standards, the Secretary shall ensure that such health information technology meets applicable standards otherwise adopted by the Secretary.