Friday, September 24, 2010

Preparing for Higher Stages in Meaningful Use

The Meaningful Use Workgroup will make recommendations to the HIT Policy Committee on how to define meaningful use in the short- and long-term; the ways in which electronic health records (EHRs) can support meaningful use; and how providers can demonstrate meaningful use. At their September 22, 2010 meeting they began to look at stages two and three of meaningful use. The big announcement from Tony Trenkle of CMS were plans to correct some inconsistencies in the meaningful use final rule. They will be posted to the website with more detailed guidance for providers on how to meet quality measures required by the health IT incentive program.

Work group members went line by line creating a spreadsheet and spent much of their time going through proposals for recommendations to higher phases of meaningful use. The audio from the meeting and spreadsheet are embedded below.

Tuesday, September 21, 2010

HIT Standards Committee 9 21 2010 Meeting Materials

Since I don't see the meeting materials posted yet from today's HIT Standards Committee I have posted them below:

Update: The materials are now posted on the ONC website and John Halamka has posted his usual stellar synopsis.

Saturday, September 18, 2010

HIMSS Health IT Map

The HIMSS State HIT Dashboard is pretty cool. The only thing I see missing is the Beacon Community awards which are listed at the ONC website. There is still a lot of data gathering going on, particularly in the area of health information exchange, so be sure to contact your local chapter if you see something missing. Or you can directly contact Pam Matthews, Sr. Director, Regional Affairs at pmatthews@himss.or ; or Holly Gaebel, Coordinator, Regional Affairs at (btw, registration for HIMSS 2011 is open:

Friday, September 17, 2010

EHR Certification Capacity Expanded: Additional Certification Body Named by ONC

The Office of the National Coordinator for Health Information Technology (ONC) named InfoGard Laboratories, Inc., San Luis Obispo, Calif. as an ONC-Authorized Testing and Certification Body (ONC-ATCB). The addition of InfoGard Laboratories, Inc. as an ONC-ATCB provides more options for EHR vendors to have their products tested and certified for compliance with the standards and certification criteria that were issued by the U. S. Department of Health and Human Services earlier this year.
Certification of EHRs is part of a broad initiative undertaken by Congress and President Obama under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009.  HITECH created new incentive payment programs to help health providers as they transition from paper-based medical records to EHRs.  Incentive payments totaling as much as $27 billion may be made under the program.  Individual physicians and other eligible professionals can receive up to $44,000 through Medicare and almost $64,000 through Medicaid.  Hospitals can receive millions.
To qualify for the incentive payments offered by the Centers for Medicare & Medicaid Services (CMS) providers must not only adopt, but also demonstrate the meaningful use of, certified EHR systems.  

ONC authorized the first two ONC-ATCBs in late August, 2010.  Additional applications are under review.  

For more information about the ONC certification programs visit
To learn more about InfoGard Laboratories, Inc. visit

Thursday, September 16, 2010

‘Friendship paradox’ helps predict spread of flu

The Friendly Way to Catch the Flu
The largest component, 714 people, of the social network studied by Fowler and Christakis, on Dec. 8, 2009. Infected individuals are colored red, friends of infected individuals are colored yellow, and circle size is proportional to the number of friends infected. A movie tracks the spread of the flu from Sept. 1 through Dec. 31, 2009.
Credit: Nicholas Christakis
Your friends are probably more popular than you are. And this “friendship paradox” may help predict the spread of infectious disease.

Nicholas Christakis, professor of medicine, medical sociology and sociology at Harvard University, and James Fowler, professor of medical genetics and political science at the University of California, San Diego, used the paradox to study the 2009 flu epidemic among 744 students. The findings, the researchers say, point to a novel method for early detection of contagious outbreaks.

Analyzing a social network and monitoring the health of its central members is an ideal way to predict an outbreak. But such detailed information simply doesn’t exist for most social groups, and producing it is time-consuming and expensive.

The “friendship paradox,” first described in 1991, potentially offers an easy way around this. Simply put, the paradox states that, statistically, the friends of any given individual are likely more popular than the individual herself. Take a random group of people, ask each of them to name one friend, and on average the named friends will rank higher in the social web than the ones who named them.

If this is hard to fathom, imagine a large cocktail party with a host holding court in the center while, at the fringes, a few loners lean against the walls staring at their drinks. Randomly ask the party-goers to each name a friend, and the results will undoubtedly weigh heavily in the direction of the well-connected host. Few people will name a recluse.

And just as they come across gossip, trends and good ideas sooner, the people at the center of a social network are exposed to diseases earlier than those at the margins.

As the 2009 influenza season approached, Christakis and Fowler decided to put these basic features of a social network to work, contacting 319 Harvard undergraduates who in turn named a total of 425 friends.

Monitoring the two groups both through self-reporting and data from Harvard University Health Services, the researchers found that, on average, the friends group manifested the flu roughly two weeks prior to the random group using one method of detection, and a full 46 days prior to the epidemic peak using another method.

“We think this may have significant implications for public health,” said Christakis. “Public health officials often track epidemics by following random samples of people or monitoring people after they get sick. But that approach only provides a snapshot of what’s currently happening. By simply asking members of the random group to name friends, and then tracking and comparing both groups, we can predict epidemics before they strike the population at large.  This would allow an earlier, more vigorous, and more effective response.”

“If you want a crystal ball for finding out which parts of the country are going to get the flu first, then this may be the most effective method we have now,” said Fowler. “Currently used methods are based on statistics that lag the real world – or, at best, are contemporaneous with it. We show a way you can get ahead of an epidemic of flu, or potentially anything else that spreads in networks.”

Indeed, the authors note that the same method could be used very widely – to anticipate epidemics of behaviors like drug use or even the diffusion of ideas or fashions.

John Glasser, a mathematical epidemiologist at the Centers for Disease Control in Atlanta, GA, who was not involved in this research, said: “Christakis’ and Fowler’s provocative study should cause infectious disease epidemiologists and public health practitioners alike to consider the social contexts within which pathogens are transmitted. This study may be unique in demonstrating that social position affects one’s risk of acquiring disease. Consequently, epidemiologists and social scientists are modeling networks to evaluate novel disease surveillance and infection control strategies.”

The study, published by PLoS ONE, was funded by Harvard University.

Fowler and Christakis are coauthors of “Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives.”


Monday, September 13, 2010

Information Exchange Workgroup 9-13-2010

Here are the slides from the The Information Exchange Workgroup of the HIT Policy Committee from September 13, 2010. This Workgroup will make recommendations on policies, guidance governance, sustainability, architectural, and implementation approaches to enable the exchange of health information and increase capacity for health information exchange over time.

Unfortunately after slide 19 the public was kicked out of the call, so we do not actually know what the discussion was around the rest of the slides.

Friday, September 10, 2010

Wednesday, September 8, 2010

Governance Workgroup ~ 9-3-2010

The Governance Workgroup is tasked to draft a set of recommendations on the scope and process of governance for nationwide health information exchange, including measures to ensure accountability and oversight.

They held their first meeting Friday, September 3, 2010 and the audio and slides are below.

Tuesday, September 7, 2010

Private Sector and Meaningful Use

There was an article in the September 2010 Health Affairs How Health Plans, Health Systems, And Others In The Private Sector Can Stimulate ‘Meaningful Use’ written by David Blumenthal, M.D., National Coordinator for Health IT; Sachin H. Jain, M.D., Special Assistant to the National Coordinator; Joshua Seidman the Director, Meaningful Use, in the Office of the National Coordinator. They argue that the private sector can further accelerate health IT adoption by implementing these five strategies that are complementary to the CMS incentive programs:
  • enhanced incentive payments to providers from private-sector payers
  • benefit designs, such as lower copayments, that will steer patients to providers who are “meaningful users”
  • adopting other strategies to encourage consumers to see these providers, such as through a “star” rating system
  • requiring clinicians to be meaningful users to participate in payer contracts or qualify for hospital admitting privileges
  • alignment between meaningful use and other regulatory imperatives
They point out that many payers such as Highmark Blue Cross Blue Shield, WellPoint, Aetna, and UnitedHealthCare have announced programs to better align their existing incentive programs with the definition of meaningful use. The article states:
The industry also could offer loans for small physician practices and hospitals that lack investment capital to purchase the health IT necessary to qualify for meaningful use incentive payments. WellPoint, for example, has said it will launch in 2011 a zero-interest loan program for hospitals in rural, critical access, or medically underserved areas of California and Georgia to enable them to adopt health IT and achieve meaningful-use criteria.
UnitedHealth Group is also deploying its performance-based contracting program, which provides outcomes-based financial incentives to physicians who use EHRs in ways that meet meaningful-use criteria. The article also suggests that health plans and employers could offer patients lower copayments for seeking care from providers that have demonstrated meaningful use.

One of the more provocative methods of further encourage meaningful use of health IT could be the suggestion that hospitals, health systems, and physician networks by requiring it as a condition for participation in these contracts or as a condition of receiving admitting privileges. This may meet with some stiff resistance in the provider community...

Perhaps the first adoption we'll see of these strategies is in the area of regulatory alignment. If bodies such as National Committee for Quality Assurance (NCQA) and the Joint Commission ( formerly the Joint Commission on Accreditation of Healthcare Organizations or JCAHO) incorporate meaningful use requirements into their accreditation process it will certainly drive adoption. . The American Board of Medical Specialties (ABMS) has said that it would incorporate tools to promote meaningful use of health IT into its maintenance-of-certification program. ABMS is also interested in data interchange utilities that would enable physicians to submit Physician Reporting Quality Initiative and health IT meaningful-use measures to the boards in the same format used by the CMS in an effort to avoid redundant data submissions.

The piece ends with a call to collaboration that makes a strong case for all of the different sectors to work together to achieve the aims of meaningfully using health IT to improve care and lower healthcare costs. We can not, and should not, rely on the government to do everything for us. It is going to take cooperation between the government and all of the various private sector stakeholders to reach our common ends.


Thursday, September 2, 2010

Step away from the fire hose and put down the data

There has been a lot of talk lately about whether the Internet and technology makes you smarter or dumber. Clay Shirky says, "Just as required education was a response to print, using the Internet well will require new cultural institutions as well, not just new technologies." While Nicholas Carr posits, "We have to forge or strengthen the neural links needed to counter our instinctive distractedness, thereby gaining greater control over our attention and our mind. It is this control, this mental discipline, that we are at risk of losing as we spend ever more time scanning and skimming online."

Whether my tweeting, blogging and constant Internet and email use makes me more or less intelligent is a debatable point - but there is no doubt in my mind that every so often it helps me to step away from the fire house and put down the data. This afternoon I will be heading to the beautiful Wallowa Lake area and the Hell's Canyon Area. I'm leaving behind my laptop and and technology (and very happy about the new GMail Priority Inbox) This will be similar to when I went to the Oregon coast this past January. So I will be off line for the next 100 hours or so... I look forward to catching up with all your tweets, blogs and emails when I get back.