The Role of Health IT in Transforming Healthcare

The Bipartisan Policy Center's (BPC) Task Force on Delivery System Reform and Health IT released a very timely set of recommendations for the most effective use of health IT dollars to support coordinated, accountable, patient-centered health care. The full report is available HERE. There was a webcast discussing the release of the report. Senators Tom Daschle and Bill Frist, Co-Leaders of BPC’s Health Project, and Governor Ted Strickland made remarks at the event. BPC Health IT Task Force members, including John Engler, President of the Business Roundtable, and Karen Ignagni, President and Chief Executive Officer of America's Health Insurance Plans, also provided insights on the findings and recommendations in the report.

The report recognizes that there remain several gaps in and barriers to achieving the health IT capabilities needed to support these common attributes of high performance and new models of care:

1.  Misaligned Incentives New models of care, supported by the health IT capabilities required for their success, will not become the norm without transforming the nation’s primarily volume-based payment model to one that promotes higher quality, more cost-effective care.
2. Lack of Health Information Exchange While the exchange of information across the multiple settings where care and services are delivered is a central and necessary component of coordinated, accountable and patient-centered models of care, the level of health information exchange in the U.S. is extremely low.
3. Limited Level of Consumer Engagement Using Electronic Tools Health IT plays a critical role in supporting patient centered care, yet use of electronic tools to coordinate care, drive provider-patient communication, and empower patients to manage their health and health care is not widespread.
4. Limited Levels of EHR Adoption While EHRs are a necessary foundational component for new models of care, the level of EHR adoption and Meaningful Use among physicians, hospitals and other provider organizations remains low.
5. Privacy and Security Concerns Consumers expect that their health information will be kept private and secure. Solidifying public trust in health IT and electronic health information exchange initiatives will require assurance about the processes used to protect the privacy and security of health information.
6. Multiple Federal Priorities Require Focus and Attention Health care organizations are faced with numerous requirements associated not only with health IT, but also with delivery system and payment reforms, health care coverage and access challenges, administrative improvements, and program integrity brought about by the Patient Protection and Affordable Care Act (ACA) of 2010, HITECH and other federal, state and private sector programs.

But just as importantly the report lays out solutions that could be implemented in a bipartisan way to address these gaps. The full report goes into great detail on how to address each the key issues raised. One important recommendation regarding EHR adoption is to improve the usability and safety of EHRs and accelerate the maturation of the EHR market. They propose that vendors, clinicians, hospitals and other providers should collaborate to identify common challenges and issues related to usability, including those with implications for patient safety, and develop and execute strategies to overcome them. I believe that usability should be a component of the standards and certification criteria for future stages of meaningful use.

They also make some suggestions to increase engagement of consumers using technology tools. They urge that the consumer awareness campaign initiated by ONC be built upon, and that both the public and private sectors should take additional steps to demonstrate how electronic tools can help consumers manage their health and engage further with their providers. This should be an encouragement to Lygeia Ricciardi, the ONC's Consumerista.

They also make detailed recommendations on how to build a business case for health information exchange. Aside from encouraging expansion of requirements for meaningful use they also recommend that Federal, state and private sector purchasers and payers should require that data standards adopted by the secretary be reflected in the specifications associated with clinical quality measures required by their payment or incentive programs. Health information exchange is a critical component of any strategy to use health IT to improve care and lower costs. I know that policy makers are taking these recommendations into serious consideration. I strongly recommend anyone interested in using technology to improve health care read this report. 

Get Ready for EHR and NwHIN Rules

Stage 2 Meaningful Use and NwHIN Governance Rules

Sometime in the next month three long awaited proposed rules from CMS and the ONC should be published. You can see below the links to the Unified Regulatory Agenda submission. These rules are under review by the Office of Management and Budget (OMB) and should be published in the Federal Register within the next month or so:

Medicare and Medicaid Electronic Health Record Incentive Program--Stage 2 (CMS-0044-P)

New and Revised Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology

Governance for a Nationwide Health Information Network

The Office of Information and Regulatory Affairs (OIRA) is located within the OMB. OIRA has a great dashboard that gives an overview of rules under review. This dashboard graphically presents information about rules under OIRA review through an easy-to-use interactive display, and it allows the public to sort rules by agency, length of review, state of rulemaking, economic significance, and international impacts. I will be following the rule making process closely and posting updates as information is available.

The NwHIN Governance rule is being done with a Advance Notice of Proposed Rulemaking (ANPRM). This is a step that entails publishing the agency's initial analysis of the subject matter, often asking for early public input on key issues. Any data or communications regarding the upcoming rule would be made available to the public for review. Occasionally, a board of potentially affected parties is comprised to do give-and-take bargaining over rulemaking subject-matter which would otherwise result in deadlocked opposition by an interested party. This is commonly called "negotiated rulemaking", and usually results in a more custom-tailored proposed rule.

Stage 2 Meaningful Use will be deferred for an extra year for those who attested in 2011

Stopping Internet Pirates

There has been much written about the legislative efforts called SOPA and PIPA. One of the best discussions on the subject is on Tim O'Reilly's Google + feed. The outcry over this terrible piece of legislation is one of the most effective grassroots campaigns I've ever seen. Citizens took to social media platforms, many websites protested throughout the day, and Congress listened. Several members of Congress switched their position. Despite powerful lobbying forces in Washington, D.C. attempting to guide this legislation through, the chances of it passing, or the President signing it are quite dim. So chalk on up for the good guys and the power of social media! There is a better way to deal with foreign websites who are trafficking in pirated content than infringing on the liberty and freedom of American citizens.

As reported in the Los Angeles Times the SOPA protests led 8 million Americans to look up representatives in Congress. Google reported 4.5 million people had signed its petition asking lawmakers to reject SOPA/PIPA. Twitter said 2.4 million SOPA-related tweets were sent in the first 16 hours of the day Wednesday. Below is an interesting YouTube video of a protest held in at the San Francisco Civic Center Jan. 18, 2012. Angel investor Ron Conway, Internet Archive co-founder Brewster Kahle and MC Hammer spoke out against SOPA.

Further Analysis of Data on Meaningful Use Attestation

Comments on my previous post about the data on meaningful use attestation as well as emails, and conversations on social media have led me to want to show the specific data for inpatient and ambulatory attestations. I also include the excellent presentation to the HIT Policy Committee by Robert Tagalicod, Robert Anthony, and Jessica Kahn from CMS on their analysis of the data (including the element not available on data.gov - the money paid out in incentive payments). So first let's look at the Eligible Hospital attestations. Here are the top ten vendors on the inpatient side so far:

It is interesting that Cerner and Meditech are really doing great, while Epic is lagging so far on hospital attestations on the inpatient side, and it's important to note that HCA is using modular systems that incorporate much of Meditech's product. Here are the top ten vendors by attestation for EPs:

It appears that EPIC is by far the vendor with the greatest number of EP attestations (although I suspect that these are employed providers of large health systems). As the Medicaid programs are launched in all the states and those EPs attesting under AIU began to come in I suspect we will see greater numbers for vendors who are in smaller practices.

EHR Incentive Program Analysis

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