Friday, February 26, 2010

Ready... Set... HIMSS!

I will spend some time this weekend getting ready for HIMSS. The theme for this year's event is "Change Is Everywhere...Opportunity Is Here." Unlike many of my colleagues, I have few parties planned and am trying to keep my schedule fairly flexible. I do have half a dozen important meetings, plenty of chats planned, and lots of people I can't wait to meet in real life. There are a couple parties I've accepted invitations to, and will probably find my way to a few more. But for the me, one overall purpose of attending this event is to participate in the "Meet the Bloggers Event" at the Social Media Center, and also to hear some of the great keynote addresses, while making important connections and hopefully seeing some very interesting product launches. I've been offered a couple behind the scenes looks at some new products, so expect some interesting information to come from the event.

I expect some of the scheduled highlights (besides the social media events) to be Wednesday March 3, when both Federal CTO Aneesh Chopra and National Coordinator for Health Information Technology David Blumenthal, MD, MPP, will give keynote addresses. There are also going to be quite a few ONC staffers on hand and even some folks from CMS. This year is likely the biggest year for health IT in history, and there is certainly quite a bit of interest in meaningful use of EHRs, HIE, RECs, SHARP, Beacon Communities and on and on. I expect this HIMSS will have a distinct government focus mingled in with the usual private sector thrust.

And of course there are the exhibits - practically every conceivable vendor even remotely related to health IT will be on hand to hawk their wares and promote their products. I will take a couple days and announce my unbiased impression of the best I find. Since I make no money doing this and do not get paid by any vendor or HIMSS you can be confident that I will be my usual honest and slightly snarky self. This should be an interesting week and I'll try to keep the information flowing...

The most frequent error in Medicine

The most frequent error in medicine seems to occur nearly one out of three times a patient is referred to a specialist. A new study found that nearly a third of patients age 65 and older referred to a specialist are not scheduled for appointments and therefore do not receive the treatment their primary care doctor intended.

According to a new study appearing in the February 2010 issue of the Journal of Evaluation in Clinical Practice (available on line), only 71 percent of patients age 65 or older who are referred to a specialist are actually scheduled to be seen by that physician. Furthermore, only 70 percent of those with an appointment actually went to the specialist's office. Thus, only 50 percent (70 percent of 71 percent) of those referred to a specialist had the opportunity to receive the treatment their primary care doctor intended them to have, according to the findings by researchers from the Regenstrief Institute and the Indiana University School of Medicine.

From the study:
Better information systems are likely to improve several aspects of care. For clinicians, systems can be designed to identify multiple orders or appointments. Systems can provide more effective training about referrals, more complete clinical information and better tools for decision support and documentation.
Communication systems are also critical for effective referral. Systems for electronic messaging between primary- and secondary-care clinicians can be especially useful. Walter Reed Army Medical Center implemented an 'Ask a Doc' system based on electronic mail, with average response times to specialty consultation of less than 1 day. Although messaging systems help, referrers and specialty consultants benefit from talking personally and agreeing on goals.
The Institute of Medicine, in its seminal report "To Err is Human," defines a medical error as a "wrong plan" or a failure of a planned action to be completed.

"Patients fail to complete referrals with specialists for a variety of reasons, including those that the health care system can correct, such as failure of the primary care doctor's office to make the appointment; failure of the specialist's office to receive the request for a consultation—which can be caused by something as simple as a fax machine without paper – or a failure to confirm availability with the patient," said Michael Weiner M.D., M.P.H., first author of the study.

"There will always be reasons – health issues or lack of transportation, for example – why a referred patient cannot make it to the specialist he or she needs, but there are many problems we found to be correctable using health information technology to provide more coordinated and patient-focused care. Using electronic medical records and other health IT to address the malfunction of the referral process, we were able to reduce the 50 percent lack of completion of referrals rate to less than 20 percent, a significant decrease in the medical error rate," said Dr. Weiner.

The JECP study followed 6,785 primary care patients seen at an urban medical institution, all over age 65, with a mean age of 72. Nearly all (91 percent) of the patients were covered by Medicare.

"This is not necessarily the fault of patients or doctors alone, but it may take both working together – along with their health system – to correct this problem. Our study highlights how enormous a problem this is for patients who were not getting the specialized care they needed. Although our findings would likely differ among institutions, unfortunately overall trends are similar in other parts of the country" said Dr. Weiner.


Dr. Weiner is director of the Regenstrief Institute's Health Services Research Program, director of the Indiana University Center for Health Services and Outcomes Research, and director of the VA Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice at the Roudebush VA Medical Center.

Co-authors of the study are Anthony J. Perkins, M.S., of the Regenstrief Institute and the IU Center for Aging Research, and Christopher M. Callahan, M.D., a Regenstrief Institute investigator and Cornelius and Yvonne Pettinga Professor in Aging Research at the IU School of Medicine. Dr. Callahan is founding director of the IU Center for Aging Research.

This study was supported by the National Institute on Aging.

The Regenstrief Institute and the IU School of Medicine are located on the campus of Indiana University-Purdue University Indianapolis.


Thursday, February 25, 2010

Brain implant reveals the neural patterns of attention

A paralyzed patient implanted with a brain-computer interface device has allowed scientists to determine the relationship between brain waves and attention.

Characteristic activity patterns known as beta and delta oscillations have been observed in various regions of the brain since the early 20th century, and have been theoretically associated with attention. The unique opportunity to record directly from a human subject's motor cortex allowed University of Chicago researchers to investigate this relationship more thoroughly than ever before.

"This gave us a really unique opportunity to record, at the micro scale, signals from the human motor cortex," said Nicholas Hatsopoulos, PhD, professor in the Department of Organismal Biology and Anatomy and Chair of the Committee on Computational Neuroscience.

The experiments, published this week in the journal Neuron, reveal the intricate dynamics of the attentive brain. Beta oscillations can be read as a reflection of how much attention a subject is paying to the task at hand, while slower delta oscillations act as an internal metronome, allowing the brain to anticipate moments when attention is most needed.
"Our study shows that when a person can count at a rhythm provided by an external stimulus, your brain can act as a metronome to take advantage of this timing and become more efficient," said Maryam Saleh, graduate student in the Committee on Computational Neuroscience and lead author of the study.

The experimental subject was implanted with a BrainGate neuroprosthetic implant in 2006, a device that allows quadriplegic individuals to control a computer cursor using brain activity. As part of a clinical trial, a small chip containing nearly 100 microelectrodes was implanted in the subject's primary motor cortex, where electrical signals could be translated by computer into cursor motion directed by the patient's thoughts.

In the experiments described in Neuron, Saleh and colleagues from the laboratory of Nicholas Hatsopoulos recorded electrical activity, called local field potentials, collected by the implanted chip as the subject performed a simple computer task. The subject was shown a series of five instructions of where to move a cursor, but told to only follow the second or fourth instruction and disregard the rest.

The recordings found a characteristic pattern of activity as the subject paid close attention to the task. High-frequency beta oscillations increased in strength as the subject waited for the relevant instruction, with peaks of activity occurring just before each instructional cue. After receiving the relevant instruction and before the subject moved the cursor, the beta oscillation intensity fell dramatically to lower levels through the remaining, irrelevant instructions.
"Previously, no one has been able to dissociate if beta oscillations are related to attention or to just holding, waiting to initiate movement," Saleh said. "Our results show that these oscillations are tied to the anticipation of oncoming information that is used to make a movement."

The slower delta oscillation also showed a regular pattern as the subject performed the task, adjusting its frequency to mirror the timing of each instructional cue. The authors suggest that this "internal metronome" function may help fine-tune beta oscillations, so that maximum attention is paid at the appropriate time.

"There are lots of stimuli in the world that have rhythm," said Jacob Reimer, post-doctoral researcher at Baylor College of Medicine and another author of the study." If you're waiting for a signal that is informative, you could pay attention constantly for a long period of time. But if that thing you're waiting for has some rhythmicity to it, maybe a more efficient method is to only pay attention 'on the beat.'"

For example, when someone is playing tennis or basketball, the brain may utilize the rhythm of a volley or a dribble to better attune its attention and motor response. To make this fine-tuning possible, electrical oscillations at different frequencies in cortex may play off each other like the instruments of a jazz band.

"The slow rhythm is kind of like the rhythm section, and you anticipate notes at particular moments in time based on that slower rhythm." Hatsopoulos explained.

This new understanding of the relationship between brain activity and attention may have relevance in the field of neuropsychology, where EEG recordings are able to pick up beta and delta oscillations with reduced spatial resolution. A diagnostic and therapeutic tool could be developed that uses such recordings to assess a person's attention from moment to moment, Hatsopoulos speculated, with the signal fed back to the person to improve their attention.
The rhythmic patterns of oscillations may also be useful in developing better brain-machine interface technology for quadriplegic individuals to operate prosthetics, Saleh said.

"The brain-computer interface is meant to help a person move a cursor with his thoughts about movement," Saleh said. "But when a person is 'plugged into' a brain-computer interface, he doesn't always want to use it; occasionally, he might just want to tune out and do nothing. Using features from these oscillations, the computer can determine when a patient is ready to move."

The ability to understand the role these oscillations play in the motor cortex of humans was "unbelievably valuable," said Charles Schroeder, a professor of psychiatry at Columbia University College of Physicians and Surgeons who has previously studied low-frequency oscillations in cortex.

"All these things converge on this idea that low-frequency oscillations reflect the brain's plans; they are really critical," Schroeder said. "Understanding the oscillatory dynamics of cortex helps you think about how you can develop therapies that help the cortex learn or re-learn after damage."

The paper, "Fast and Slow Oscillations in Human Primary Motor Cortex Predict Oncoming Behaviorally Relevant Cues," will appear in the February 25, 2010 issue of Neuron. Other authors on the paper include Richard Penn of Rush University Medical Center and Catherine L. Ojakangas of the University of Chicago.

2-24 HIT Standards Meeting

The HIT Standards Committee met on February 24, 2010. The meeting materials from the meeting are below. Here is the audio:



Wednesday, February 24, 2010

Upcoming ONC FACA Meetings

From the Federal Register ~

The HIT Policy Committee Workgroups will hold the following public meetings during March 2010:

March 4th Meaningful Use Workgroup, 10 a.m. to 12 p.m./Eastern Time;

March 9th Strategic Plan Workgroup, 9 a.m. to 12 p.m./Eastern Time;

March 16th NHIN Workgroup, 2:30 p.m. to 5 p.m./Eastern Time;

March 25th Privacy & Security Policy Workgroup, 2 to 4 p.m./Eastern Time;

March 29th Adoption/Certification Workgroup, 10 a.m. to 12 p.m./Eastern Time.

The HIT Standards Committee Workgroups will hold the following public meetings during March 2010:

March 8th Implementation Workgroup, 9 a.m. to 4 p.m./Eastern Time; *

     Implementation Starter Kit: Lessons & Resources to Accelerate Adoption *

March 22nd Implementation Workgroup, 3 to 4 p.m./Eastern Time;

March 23rd Clinical Operations Vocabulary, 9 a.m. to 4 p.m./Eastern Time;

March 26th Privacy & Security Workgroup, 2 to 4 p.m./Eastern Time;

March 30th Implementation Workgroup, 9 to 11 a.m./Eastern Time;

March 31st Clinical Quality Workgroup, 10 a.m. to 12 p.m./Eastern Time.

Tuesday, February 23, 2010

Federal Health IT Task Force

HHS will create a new interagency task force to improve and coordinate how the government implements health information technology. In a memo to 6 federal agencies (, HHS secretary Kathleen Sebelius and HHS director Peter Orszag write that this new task force will replace the existing health IT interagency group. “This legacy structure is not a good fit for the new environment” that includes the ONC, two FACA's, and “increased congressional engagement, and attention from a diverse body of interests in the private and public sectors,” the memo stated. The task force will include the departments of Agriculture, Commerce, Defense and Veterans Affairs, and the Social Security Administration, the Office of Personnel Management and the federal chief information officer and federal chief technology officer.

"The purpose of the HIT Task Force will be to assist with policy development, coordination and implementation of Federal HIT activities, as well as to improve transparency of federal government activities related to HIT and communication among federal agencies as they execute federal HIT policy," says the memo.

"The HIT Task Force would also have several working groups defined at the first meeting to address a variety of HIT issue areas in more detail. These areas would focus on subjects where coordination among the agencies is essential to policy implementation... It is anticipated that the working groups would be open to individuals from all Federal agencies, giving them the opportunity to participate in these groups."

The memo says the purpose of limiting the task force to the eight agencies is that they want to "provide a forum for the key agencies who are the primary producers, consumers, and implementers of HIT in the federal government, while opening up the working groups to all federal agencies allows for a broad participation across the government on specific HIT issues. We believe it imperative that policy and technical representation be integrated in these communities, so that the efforts of both can be fully informed and coordinated."

Agencies must designate a senior leader to serve on the interagency task force by Feb. 26. I will post more information on this group as it becomes available.

CMS "Meaningful Use" Conference Call

February 23, 2010 CMS held a conference call on meaningful use of Electronic Health Records. The announcement and handouts are below:

CMS’ proposed rule for the EHR incentive programs including:
o Who is eligible
o What constitutes meaningful use
o How to demonstrate meaningful use
o What incentives are available under Medicare and Medicaid
· How to make comments
· Where to find additional resources

Hear first hand from the CMS Experts

When: Tuesday, February 23rd
Time: 1:30-2:30 pm EST

We suggest you call in early as lines are limited.

To join the meeting, dial 1-866-501-5502
The conference ID is 58353012

Monday, February 22, 2010

Caltech Neuroscientists Find Brain System Behind General Intelligence

A collaborative team of neuroscientists at the California Institute of Technology (Caltech), the University of Iowa, the University of Southern California (USC), and the Autonomous University of Madrid have mapped the brain structures that affect general intelligence. 

The study, to be published the week of February 22 in the early edition of the Proceedings of the National Academy of Sciences, adds new insight to a highly controversial question: What is intelligence, and how can we measure it? 

The brain regions important for general intelligence are found in several specific places (orange regions shown on the brain on the left). Looking inside the brain reveals the connections between these regions, which are particularly important to general intelligence. In the image on the right, the brain has been made partly transparent. The big orange regions in the right image are connections (like cables) that connect the specific brain regions in the image on the left.
[Credit: Courtesy of PNAS]

The research team included Jan Gläscher, first author on the paper and a postdoctoral fellow at Caltech, and Ralph Adolphs, the Bren Professor of Psychology and Neuroscience and professor of biology. The Caltech scientists teamed up with researchers at the University of Iowa and USC to examine a uniquely large data set of 241 brain-lesion patients who all had taken IQ tests. The researchers mapped the location of each patient's lesion in their brains, and correlated that with each patient's IQ score to produce a map of the brain regions that influence intelligence. 

"General intelligence, often referred to as Spearman's g-factor, has been a highly contentious concept," says Adolphs. "But the basic idea underlying it is undisputed: on average, people's scores across many different kinds of tests are correlated. Some people just get generally high scores, whereas others get generally low scores. So it is an obvious next question to ask whether such a general ability might depend on specific brain regions."

The researchers found that, rather than residing in a single structure, general intelligence is determined by a network of regions across both sides of the brain. 

"One of the main findings that really struck us was that there was a distributed system here. Several brain regions, and the connections between them, were what was most important to general intelligence," explains Gläscher. 

"It might have turned out that general intelligence doesn't depend on specific brain areas at all, and just has to do with how the whole brain functions," adds Adolphs. "But that's not what we found. In fact, the particular regions and connections we found are quite in line with an existing theory about intelligence called the 'parieto-frontal integration theory.' It says that general intelligence depends on the brain's ability to integrate—to pull together—several different kinds of processing, such as working memory." 

The researchers say the findings will open the door to further investigations about how the brain, intelligence, and environment all interact.

Other coauthors on the paper, "The distributed neural system for general intelligence revealed by lesion mapping," are David Rudrauf and Daniel Tranel of the University of Iowa; Roberto Colom of the Autonomous University of Madrid; Lynn Paul of Caltech; and Hanna Damasio of USC. The work at Caltech was funded by the National Institutes of Health, the Simons Foundation, the Deutsche Akademie der Naturforscher Leopoldina, and a Global Center of Excellence grant from the Japanese government.


Health Reform in the Red Zone (reprise)

Last September I wrote about the President proposing his own health reform package. Now that the plan has finally been proposed I thought I would republish that post and look at it in light of the Whitehouse health reform proposal. I have been reading through it and will be watching the health reform summit this Thursday with interest to see what develops. To carry the football analogy a little further, Mr. Obama may need to settle for a field goal. CBO Director Elmendorf said in a blog post that he had received many requests for a cost analysis of the president’s plan, but unfortunately the Presidents plan does not "provide sufficient detail on all of the provisions. Therefore, C.B.O. cannot provide a cost estimate for the proposal without additional detail" he said. If Whitehouse estimates of $950 billion are accurate, then it will put the total cost of the plan right between the $871 billion of the Senate bill and the $1.05 trillion of the House proposal. How to pay for this will be a sticking point going forward...
Healthcare reform efforts are inside the twenty yard line with less than two minutes to go. President Obama has been trying to guide his team through a difficult and slippery first three quarters of attempting to make a touchdown on healthcare reform, and so far their is no score. There have been fumbles, fouls, and dropped balls, and what sometimes seemed hot dogs on his own side not playing as a team.
I have said before that I believe the President will propose his own reform package this fall, and I think after he addresses Congress this week we will see the Whitehouse developing their own bill. So far they have resisted taking positions on many specific elements of a the House and Senate healthcare bills, instead expressing openness to different ideas, while allowing Congress to go its own way. But this approach has left many lawmakers divided over some of the more controversial elements, such as how to control costs. Since many Americans seem to favor of a slower, less ambitious approach, the President is moving towards a proposal that might bear his name and could carry serious political risks. But it is time for Mr Obama to take the ball and run with it.
The biggest obstacle is overcoming opposition to a public option, which the President would prefer, but has said is not absolutely necessary. One idea that he may favor has been proposed by by Sen. Olympia J. Snowe (R-Maine) is the concept of a "trigger" in which a government run program would be implemented only if private insurers were unable to deliver affordable insurance plans to most consumers within three to five years. This is the same type of "trigger" used in the Bush-sponsored Medicare prescription drug law. So far, the government drug coverage has not been needed.
"If somehow the private market doesn't respond the way that it's supposed to, then it would trigger a public option or a government-run option, but only as a fail-safe backstop to the process," Sen. Ben Nelson (D-Nebraska) said on CNN's "State of the Union" program. "And when I say trigger, you know, out here in Nebraska, in the Midwest, I don't mean a hair trigger."
The "Gang of Six" is still working on a plan that would included an insurance co-op, and there is still the possibility that the President may allow some form of tort reform and the ability for health insurance to be purchased across state lines into the bill. An incremental approach with three or four bills may be another way forward, instead of going for everything at once. The lessons of the past will not be lost on this administration, and perhaps it might be time for thinking of settling for a field goal instead of driving for the end zone.

"Individual commitment to a group effort -- that is what makes a team work, a company work, a society work,
a civilization work."
Vince Lombardi

ONC Organization Chart

The following organizational chart is the latest information from the Office of the National Coordinator

Complete contact information can be found on my more extensive list - we are making progress!

ONC Org Chart - Office of the National Coordinator Organizational Chart

Whitehouse Health Reform Proposal with Some Republican Ideas

The President has unveiled the Whitehouse proposal for health reform. There are a few points where there is common ground with the Republican agenda.

Review of new Republican initiatives included in the President’s Proposal:

  • Comprehensive Sanctions Database. The President’s Proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General.  This database will provide a central storage location, allowing for law enforcement access to information related to past sanctions on health care providers, suppliers and related entities.

    • (Source: H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill))
  • Registration and Background Checks of Billing Agencies and Individuals. In an effort to decrease dishonest billing practices in the Medicare program, the President’s Proposal will assist in reducing the number of individuals and agencies with a history of fraudulent activities participating in Federal health care programs.  It ensures that entities that bill for Medicare on behalf of providers are in good standing.  It also strengthens the Secretary’s ability to exclude from Medicare individuals who knowingly submit false or fraudulent claims.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Expanded Access to the Healthcare Integrity and Protection Data Bank.  Increasing access to the health care integrity data bank will improve coordination and information sharing in anti-fraud efforts. The President’s Proposal broadens access to the data bank to quality control and peer review organizations and private plans that are involved in furnishing items or services reimbursed by Federal health care program.  It includes criminal penalties for misuse.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers. In attacking fraud, it is critical to ensure the contractors that are paying claims are doing their utmost to ensure excluded providers do not receive Medicare payments. Therefore, the President’s Proposal provision holds Medicare Administrative Contractors accountable for Federal payment for individuals or entities excluded from the Federal programs or items or services for which payment is denied.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Community Mental Health Centers. The President’s Proposal ensures that individuals have access to comprehensive mental health services in the community setting, but strengthens standards for facilities that seek reimbursement as community mental health centers by ensuring these facilities are not taking advantage of Medicare patients or the taxpayers.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Limiting Debt Discharge in Bankruptcies of Fraudulent Health Care Providers or Suppliers. The President’s Proposal will assist in recovering overpayments made to providers and suppliers and return such funds to the Medicare Trust Fund.  It prevents fraudulent health care providers from discharging through bankruptcy amounts due to the Secretary from overpayments.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Use of Technology for Real-Time Data Review. The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly.  It establishes a system for using technology to provide real-time data analysis of claim and payments under public programs to identify and stop waste, fraud and abuse.

    • (Source:  Roskam Amendment offered in House Ways & Means Committee markup)
  • Illegal Distribution of a Medicare or Medicaid Beneficiary Identification or Billing Privileges.  Fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year.  Individuals looking to gain access to a beneficiary’s personal information approach Medicare and Medicaid beneficiaries with false incentives.  Many beneficiaries unwittingly give over this personal information without ever receiving promised services.   The President’s Proposal adds strong sanctions, including jail time, for individuals who purchase, sell or distribute Medicare beneficiary identification numbers or billing privileges under Medicare or Medicaid – if done knowingly, intentionally, and with intent to defraud.

    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Study of Universal Product Numbers Claims Forms for Selected Items and Services Under the Medicare Program. The President’s Proposal requires HHS to study and issue a report to Congress that examines the costs and benefits of assigning universal product numbers (UPNs) to selected items and services reimbursed under Medicare. The report must examine whether UPNs could help improve the efficient operation of Medicare and its ability to detect fraud and abuse.
    • (Source:  H.R. 3970, “Medical Rights & Reform Act”, Roskam Amendment offered in House Ways & Means Committee markup)

Saturday, February 20, 2010

Importance of the HITRC

HHS has allocated an initial $50 million to be invested in establishing the national Health IT Research Center (HITRC). The HITRC will gather relevant information on effective practices from a wide variety of sources across the country and help the Regional Extension Centers (RECs) collaborate with one another and with relevant stakeholders to identify and share best practices in EHR adoption, effective use, and provider support. The HITRC will build a virtual community of shared learning to advance best practices that support providers’ adoption and meaningful use of EHRs. I imagine this is going to use kind kind of social media component that will allow real time collaboration.

The legislation states the HITRC will assemble and disseminate materials to support and address the needs of all prioritized providers, including but not limited to materials addressing the unique needs of providers serving Native Americans, persons with limited proficiency in the English language, persons with disabilities, and other historically underserved populations, as well as those that serve patients with maternal, child, and behavioral health needs. But interpretation of exactly what defines "historically underserved populations" is vague. I hope that rural communities are prioritized because that seems to me to be an area of great need.

The first awards for the RECs have been announced and they are beginning to ramp up. The RECs will become members of a consortium that will be coordinated and facilitated by the HITRC. Research and analysis of best practices regarding health IT utilization rests primarily with the HITRC, dissemination and implementation of those best practices learned from the HITRC will rest with the regional centers.

Federal CTO Aneesh Chopra announced on the FACA Blog that on March 8, 2010 the Implementation Workgroup of the Health IT Standards Committee will hold a public hearing on “Implementation Starter Kit: Lessons and Resources to Accelerate Adoption” to help providers achieve meaningful use by, in part, surfacing examples of effective meaningful use implementation preparation. He is asking us to post questions and comments about implementation opportunities and challenges we are facing today and for which we would either like to share or would welcome support. Unfortunately the response so far has been underwhelming. I would encourage everyone to consider posting some real life examples so we are not operating in a theoretical world but with actual experiences to develop best practices.

Considering the timing of the needs for the HITRC to develop best practices and this upcoming Implementation Workgroup meeting, I imagine that these stories could become templates that would be used to create effective adoption and implementation strategies. Every EHR implementation has a story to tell - it may be a wonderful example, or it could be a terrible warning. But now is the time to make your voice heard.

Thursday, February 18, 2010

Physician Office Usage of Electronic Healthcare Records Software

EHR adoption rate in U.S. physician practices is 36.1 percent, a 3.2 percent increase over one year ago, according to a report from health IT company SK&A, a Cegedim company.

From their press release:

As healthcare providers make preparations to implement EHR solutions and qualify for federal incentives outlined in the American Recovery and Reinvestment Act of 2009, SK&A, A Cegedim Company, today released its updated "Physician Office Usage of Electronic Healthcare Records Software" report, which shows a 36.1% EHR adoption rate in U.S. medical offices -- a 3.2% increase since the February 2009 version of the study.
Like its predecessor study, the latest report identifies physician adoption rates by office size, practice size, practice specialties, patient volume, ownership, geography and other variables. This updated study also measures the level of software functionality available to and being utilized by physicians in medical offices to support the government's newly defined "meaningful use" criteria.

SK&A's study, which was based on completed telephone surveys with 180,000 U.S. physician offices, shows that 36.1% of physician offices are using EHR systems -- a 3.2% increase in usage since the 2009 report's adoption rate of 32.9%. Trends from the study show:

-- Physicians primarily use EHR systems for electronic notes (28.3%), as opposed to electronic labs/x-rays and electronic prescribing.

-- EHR adoption rates increase as the number of physicians, number of exam rooms and daily patient volume rise.

-- EHR adoption is more prevalent in hospital- or health system-owned sites. Hospital-owned and health-system-owned sites have adoption rates of 44.1% and 50.2%, respectively. On the contrary, non-hospital-owned and non-health-system-owned sites have adoption rates of 34.4% and 34.2%, respectively.

-- The specialty areas with the highest adoption rates include dialysis, critical care medicine and radiology. Those specialties with the lowest adoption rates include allergy/immunology, general surgery and general practice.

Editor's Note: For a copy of the summary findings for publication, please contact Jack Schember, SK&A Vice President of Marketing, at 800-752-5478, ext. 1259.


2-17 HIT Policy Committee

The HIT Policy Committee gathered for its second meeting of the year on February 17th in Washington, DC. The majority of the meeting time was dedicated to discussing recommendations of the Meaningful Use Notice of Proposed Rulemaking (NPRM) and Standards and Certification Interim Final Rule (IFR). Four Committee workgroups presented recommendations for the existing criteria, to better enable the electronic health records (EHR) incentive program to achieve its objectives and facilitate progress toward the ultimate goal of improving health and health care of all Americans.
The Meaningful Use Workgroup began by laying out a series of 12 recommendations, including proposals to make progress note documentation a part of the Stage 1 meaningful use definition and to allow eligible providers a certain degree of flexibility in meeting the meaningful use criteria. Next, the Adoption/Certification Workgroup presented comments on eligible provider reporting metrics and interoperability standards. Both the Adoption/Certification and the Health Information Exchange workgroups put forward recommendations regarding the laboratory portions of the NPRM and IFR. Finally, the Privacy and Security Policy Workgroup proposed ways to strengthen existing meaningful use and certification criteria relevant to privacy and security, as well as concerns and future policy and standards priorities.
Following dialogue about the NPRM and IFR, the HIT Policy Committee shifted attention to its effort in creating a set of recommendations for the Nationwide Health Information Network (NHIN). The NHIN Workgroup focused the meeting’s discussion on the role of enabling organizations and associated functions and services, encompassing a minimal core set of services and functions needed to support standards-based interoperability along with further services to support additional interoperability at scale.
The last segment of the meeting was devoted to reviewing the framework for the Federal Health IT Strategic Plan. The Strategic Planning Workgroup outlined the framework’s vision and four key themes, which center around meaningful use, development and support of a policy and technical infrastructure, incorporation of privacy and security solutions into every phase of health IT adoption and use, and transformation of the current healthcare delivery system into a learning health system.

The meeting materials from the meeting are below. Here is the audio:



Who's Who at the ONC

I have been generally very impressed with the efforts at implementation of government 2.0 principles, but here is one area where there needs much greater transparency at the Office of the National Coordinator and this in listing their staff and contractors. To avoid the impression that identities of personnel and contractors are being withheld from the public to prevent the public from knowing who they are and what their past and present affiliations might be, the ONC should immediately release contact information and titles for all the staff. (Update 5/28/10 - much of this information has now been released).

HHS does have a listing of public employees. Unfortunately the ONC is not in this list. However, doing some creative searching I was able to create the following list with active links to their contact information pages. But, alas many of the titles are blank, much of the data are outdated, and there seems to still be some missing data.

Last name First name Job title
Alvarez Juan
Andriesen Brett
Anozie Emily Administrative Assistant
Anthony Elise Policy Advisor
Arbogast Carol Director Human Resources
Ashkenaz Peter
Baker Alexander Project Officer
Barnes Michelle Administrative Assistant
Becker Targi Management Analyst
Black Erin
Bonner Tiffany Intern
Boone Edna Contractor
Borja Tom
Brooks Aja Policy Analyst
Brown Jennifer
Buchele Libbie
Bundy Yvette Management Analyst
Butler Tiffany
Cao Yolanda
Caton-Peters Helen Information Technology Specialist
Celentano Kristina
Chambers Cortney Program Analyst
Chaput Daniel Public Health Analyst
Charles Dustin
Chikatla Ruhana Executive Assistant
Choi Christy
Choi Mera Program Analyst
Chrapaty Kevin Contractor
Clark Asara Program Analyst
Colby-Elborn Sharon
Consolazio Michelle Program Analyst
Constant Monifa
Costa Bianca
Costa Catherine Innovator In Resisdence
Coughlin Brett Communications Specialist
Coy Caroline Presidential Management Fellow
Cramer Jennifer
Cronin Kelly Director Office of Programs and Coordination
Dandashi Fatma Contractor
Daniel James
Daniel Jodi Director of Policy and Research
Darbouze Farrah
Davis Seon Program Analyst
Day Chartese Supervisory Communication Manager
Day Wes
Dean Kevin
DeSalvo Karen National Coordinator
Digiacomo Nicholas Project Coordinator
Eckerman Ivy
Erickson Christina
Fowler Crystal Program Coordinator
Frazier Jennifer
Frazier Pavla Nurse consultant
Gabriel Meghan
Galvez Erica
Gettinger Andrew IPA
Ghebresillassie Lisa
Govan-Jenkins Wanda
Gray Aaron
Halloun Carmel
Hammond-Hatcher Deone
Haque Ahmed Director Office of Programs and Engagement
Haynes (Harris) Yvette
Hedgepeth Blair Legislative Liason
Heintzman Elizabeth Intern
Heisey-Grove Dawn
Himelright Michele Supervisory CAM (Acting)
Hogan Michelle Financial Analyst
Hollin Ilene Student Trainee
Holloway Jason
Hopewell D'Lisa
Hua Jiuyi IT Specialist
Hughes Penelope Intern
Hunt David Medical Officer
Ihlenfeld Matthew
Jain Trishla Intern
Jessup Larry
Johnson Janelle Intern
Johnson Patricia Executive Assistant
Jones Jerome Financial Analyst
Jones Michael Contractor
Justus Ralph
Kalbfleisch Gail Director FHA
Keesey Peter
Kendrick David Principal Investigator
Kenyon Kathy
Khan Kashif Project Manager
Khetan Vanitha Contractor
Kilgore Wendy
Klintworth Paul
Krishnamoorthy Sathiyanarayanan
Lamadine Beh Administrative Assistant
Larsen Kevin
Larson Eric
Lazzaro Victor
Leavelle Cannon Program Analyst
Lehrer Evan Intern
Lewis Lisa
Lipinski Michael Policy Analyst
Livingston Ebony Financial Analyst
Lueck Greg
Mactaggart Patricia IPA
Madlansacay Cheryl
Makar Ellen Program Analyst
Marchesini Kathryn
Marks LaShawn Management Analyst
Marshall Carmelita Summer Intern
Meklir Samantha Senior Policy Advisor
Mertz Kory Program Manager
Metcalf John Contractor
Meter Erin
Mock Tracey Program Manager
Mohla Chitra Management & Program Analyst
Monterastelli Mark External Entrepreneur
Moore Mary Executive Assistant
Moriarty Lana Director
Morrison Michael
Morton Alicia Director Health IT Certification Program
Muir Christopher Senior Program Analyst
Murphy Judy
Murray Michelle Program Analyst
Nelson Rachel Special Assistant to Deputy Nat'l Coordinator for HIT
Nguyen Ngoc Senior Developer
Norman John Program Officer
O'rourke Lena Contractor
Palena Hall Elizabeth
Patel Vaishali
Pazinski Seth Division Director Planning and Operations
Perlie Laverne Nurse Consultant
Perry Cynthia
Pinkney Rudette
Porotesano Charity Truman-Albright Fellow
Posnack Steven Policy Analyst
Prendergast Erin Intern
Pretto Marissa
Purnell-Saunders Scott Program Analyst
Rahn Matthew Program Analyst
Ramsey Arlene
Ramsey Jamil Contractor
Rancourt John Program Analyst
Reed Cinyon
Rego Susette Project Manager
Reider Jacob Director Chief Medical Officer
Reyes Natalie
Richie Lauren Public Health Analyst
Roberts Vernette
Ryan Caitlin Business Administrator
Samy Leila
Sarnowski Lisa-Nicole
Savage Lucia Chief Privacy Officer
Savoy Kimberly
Searcy Talisha Supervisory Social Scientist
Shanbhag Krishnakant
Shelton Leo Program Analyst
Shevlin David Junior Analyst
Shimabukuro John
Shkarovsky Gerald Program Management Office Functional Analyst
Showen Kristin Intern
Siminerio Erin Policy Analyst
Skipper Jamie
Stevens Lee Senior Program Analyst
Styma Amy Program Analyst
Swain Matthew
Szemraj Nancy Program Analyst OPC
Tate Algeria
Tavernia Kimberly
Taylor Tevon
Thomas Alice Contractor
Thomas Vincent IT Desktop Support Analyst
Thompson Lauren FHA Program Lead
Thompson-Teagle Yolonda Grants Management Specialist
Todd Nickol
Tomlinson Andrew Grants Management Specialist
Toro Cameline Policy Analyst
Townsend Sonya Administrative Assistant
Tumati Bheeshma Contractor
Tuten Paul
Wagner Steven
Walters Acheeria Briefings and Logistics Analyst
Wanis Maggie Program Analyst
Warner Keviar Contract Specialist
Wesley Ellen
White Jon Acting Director OCQS
Wiggins Davina Contactor
Wilburg Seon Management Analyst
Wilkins Tricia Project Officer
Williams Claudia
Wilson Douglas Contractor
Wilson Ryan Contractor
Wittie Michael Program Analyst
Wong Adam
Woodhead Amanda Sr. Stakeholder Outreach Coordinator
Wu Lauren Policy Analyst
Wyatt Gretchen Policy Analyst
Yuan Yuan Zhang Web Producer
I am very pleased with the additional information that is being provided on the ONC web site ~ Things are continuing to improve and I have updated the contact information below (updated 10/1/2010)

Federal Register Notice: December 1, 2009
Organization, Functions, and Delegations of Authority; Office of the National Coordinator for Health Information Technology

Below are listed responsibilities for each office:

Office of the National Coordinator: Organization
Description of Organizational Structure and Offices
The Office of the National Coordinator for Health Information Technology (ONC) is directed by the National Coordinator and is assisted by the Deputy National Coordinator for Operations, the Deputy National Coordinator for Programs & Policy, the Chief Scientist, the Chief Privacy Officer, and the Office of Economic Modeling and Analysis.
Within the Deputy National Coordinator for Operations are: the Office of Communications; the Office of Oversight; the Office of Mission Support; and, the Office of Strategic Initiatives.
Within the Deputy National Coordinator for Programs & Policy are: the Office of Policy and Planning; the Office of Standards and Interoperability; the Office of Provider Adoption Support; and, the Office of State and Community Programs.

The Office of the Deputy National Coordinator for Programs and Policy assumes functions previously performed by the Office of Health Information Technology Adoption, the Office of Interoperability and Standards, the Office of Adoption Provider Support, the Office of State and Community Programs, and the Office of Policy and Planning.  The new office will lead ONC programs related to health information exchange, regional extension centers, training of the health IT workforce, and the development of technical standards for interoperability, security, and certification of health IT systems.  The new office comprises:
  • The Office of Standards and Interoperability, with responsibility for standards, security, certification, the Nationwide Health Information Network, Federal Health Architecture and the CONNECT program;
  • The Office of Provider Adoption Support, which administers the Regional Extension Centers program and health IT workforce development;
  • The Office of State and Community Programs, which administers the state-level health information exchange program and the Beacon Communities Program; and
  • The Office of Policy and Planning, which is realigned to include all policy development, including privacy and security policy, and is liaison with legal affairs and legislative affairs, regulations development  and externally focused strategic planning.
The Office of the Deputy National Coordinator for Operations is responsible for activities that are vital to supporting ONC’s numerous programs and enhancing ONC’s ability to communication about health IT.  This office comprises:
  • The Office of Communications, which is responsible for stakeholder communications and constituency relations;
  • The Office of Mission Support, which supports day-to-day operations, including new grants processing, contracts management, budget execution and reporting, and human resources;
  • The Office of  Oversight, which assures oversight of grants, internal and external performance reporting, and auditing; and
  • The Office of Strategic Initiatives to oversee internal strategic planning, special projects, and budget formulation.
The Office of Economic Analysis and Modeling provides analyses to the National Coordinator, including advanced modeling of the U.S. health care system for simulating the micro- and macroeconomic effects of investing in health IT.
The Office of the Chief Scientist is responsible for research and for identifying innovations in information technology that can be applied in health care settings, and which will be the ONC interface for international activities.
The Office of the Chief Privacy Officer, a position mandated by the Recovery Act, advises on privacy, security, and data stewardship of electronic health information and coordinate ONC’s privacy and related efforts with similar privacy officers in other Federal agencies, State and regional agencies, and foreign countries.