The NwHIN Power Team, a subcommittee of the HIT Standards Committee, has been working over the past few months to analyze and score the NwHIN Exchange (SOAP) and Direct (SMTP/SMIME) specifications on such criteria as:
Need for specified capability
Maturity of the specification
Maturity of the underlying technology used in the specification
Deployment and operational complexity
Industry adoption
Available alternatives
The Power Team reviewed and refined these scores through several iterations, and will present their final analysis and recommendations at the September 28, 2011 HIT Standards Committee meeting.Below are the slides from the NwHIN Power Team recommendations:
Based on industry experience and investments in these efforts not only by health IT suppliers but also by provider organizations, the EHR Association has provided comments to the NwHIN Power Team, focused on several key points, including:
Vendor readiness to support the NwHIN Patient Discovery, Query for Documents, and Retrieve (IHE XCPD & XCA) standards is more advanced than reflected in the Power Team analysis.
We encourage the Power Team to address the gap resulting from the decision to not consider the use case for sharing health Information among HIE communities.
Concerns expressed regarding the “complexity” of the Patient Discovery specification do not reflect the reality that this complexity comes not from the specifications, but from policy decisions not to develop shared patient identification principles and related operational deployment issues.
The rationale for proposing to develop a RESTful approach as an alternative to the NwHIN needs to be validated.
The Power Team discussion about why a specification gets a low or medium rating should be documented for the sake of transparency.
The full comments (available here) containing a detailed discussion have been submitted to the Power Team. I will post more after the Power Team makes their recommendations to the HIT Standards Committee.
The EHR Association is comprised of industry experts in the field of healthcare information technology with a broad scope of expertise such as medical and clinical informaticists, physicians, nurses, pharmacists, and technology experts who not only represent the EHR software industry but also interact and represent the entire healthcare community. The EHR Association offers unmatched experience and expertise, and provides a forum and structure for EHR leaders to work toward standards development, interoperability, the EHR certification process, performance and quality measures, HIT legislation, and other EHR issues.
On September 9, 2011 the U. S. House Ways and Means Health Subcommittee held a hearing on the consolidation taking place in the healthcare industry. The hearing focused on the impact healthcare consolidation is having on the cost of private health insurance, Medicare spending, and beneficiary costs. The subcommittee's ranking member, Rep. Pete Stark (D-Calif.) Rep. Charles Boustany (R-La.) said "It's refreshing to see our majority raise concerns about competition in the marketplace and how it may result in outcomes that are bad for consumers and for Medicare." Rep. Charles Boustany (R-La.) a cardiovascular surgeon and chairman of the Ways and Means oversight panel, said the healthcare reform law focused too much on getting doctors and hospitals to work together and not enough on the potential downsides.
Chairman Wally Herger (R-CA) called the meeting with the following statement:
Recent years have seen a large number of acquisitions and mergers in the health care industry. Among typical transactions, hospitals are buying or merging with other hospitals, hospitals are purchasing physician practices, physician practices are merging with physician groups, and large insurance companies are purchasing smaller plans. Industry experts expect regulations and policies contained in the new health care overhaul to exacerbate this trend.
While such consolidation may facilitate greater efficiencies and deliver higher quality services by eliminating duplication and excess capacity, many experts are concerned that some consolidations are being driven primarily by a desire to increase reimbursements. Richard Feinstein, director of the Bureau of Competition at the Federal Trade Commission, warned that provider consolidation “can create highly concentrated markets that may harm consumers through higher prices or lower quality care.”
In announcing the hearing, Chairman Herger stated, “While consolidation within the health care industry is not new a phenomenon, all signs point to it accelerating in the coming years. In some circumstances, consolidation produces desirable results like improved efficiency and quality. However, we must ensure that consolidation is not simply used as a tool to increase revenues by driving up Medicare spending and the cost of private health insurance. This hearing will provide members with a better understanding of what is currently taking place, what is expected to occur, and how we can protect America’s seniors and those with private health insurance and the employers who offer it.”
The following witness presented during the hearing:
Martin Gaynor, PhD
Professor, H. John Heinz III School of Public Policy and Management, Carnegie Mellon University
(Testimony)
Paul B. Ginsburg, PhD
President, Center for Studying Health System Change
(Testimony)
Dianne Kiehl
Executive Director, Business Health Care Group
(Testimony)
Michael Guarino
Member, Board of Directors, Ambulatory Surgery Center Association
(Testimony)
David Balto
Senior Fellow, Center for American Progress Action Fund
(Testimony)
The American Medical Association (AMA) also submitted a statement during the hearing on the topic. The AMA’s statement examined the current state of consolidation in the health care industry, including areas where changes are needed to protect patients and encourage the success of new models of patient care.
“Existing antitrust policies allow significant consolidation in some areas of our health care system while overly restricting the coordination of care by physicians,” said AMA President Peter W. Carmel, M.D. “It is time to update these policies to allow physicians in all practice sizes the ability to lead and participate in innovative new models of care while protecting patients from anticompetitive practices.”
A full 78 percent of office-based physicians in the United States work in practices with nine physicians or less, and a majority of those are in practices of one to four. Under existing antitrust enforcement policies, these physician practices are effectively prohibited from forming clinically integrated groups that can jointly contract with private payers and participate in care improvement and coordination efforts.
Over the last decade AMA studies have consistently found that a wide majority of local health insurance markets across the nation are highly concentrated, which can mean decreased competition and higher prices for patients. The trend of hospitals merging and acquiring physician practices can also lead to reduced competition and an increase in the amount of care patients receive in more costly inpatient settings.
“We applaud the Ways and Means Committee for examining current policies related to consolidation in health care,” Dr. Carmel said. “We will continue to work with them to design policies that encourage the development of innovative, physician-led new models of patient care designed to improve quality, lower costs and promote competitive health care markets.”
The National Association of Chain Drug Stores (NACDS) has asked for scrutiny on the proposed merger of pharmacy benefit managers Express Scripts and Medco and outlined the “problems” it believes would result from the mega-merger in a letter submitted to the committee. NACDS stressed that the anticompetitive nature of this merger ultimately will hurt patients the most, limiting their choice in how and where they obtain their pharmacy services and prescription medications.
“NACDS thanks the Committee for consideration of our comments on healthcare industry consolidation. We are extremely skeptical that the American public can trust a ‘super PBM’ to look out for the best interests of patients and payors, including Medicare Part D, or to pass any purported ‘savings’ along to beneficiaries and other consumers. These concerns are compounded by the fact that the PBM industry as a whole is virtually unregulated,” NACDS concluded in its comments.
Three House Democrats also urged the Federal Trade Commission to closely scrutinize the merger in a letter to FTC Chairman Jon Leibowitz.
"The proposed merger would affect hundreds of millions of Americans with private health insurance and have a potentially significant impact on drug cost for government programs," said Reps. Henry Waxman (D., Calif.), Frank Pallone Jr. (D., N.J.) and Diana DeGette (D., Colo.).
NATIONAL HEALTH INFORMATION TECHNOLOGY WEEK, 2011 BY THE PRESIDENT OF THE UNITED STATES OF AMERICA
A PROCLAMATION
Technological advances have always driven America's economy forward and improved the lives of our people, from the industrial innovations of the nineteenth century to today's cutting edge science. Progress in our Nation's health care system is no different, and hinges on the work of hospitals, private practices, and information specialists as they modernize our health information systems. During National Health Information Technology Week, we highlight the critical importance of secure and efficient information systems to improving the delivery of health care in the United States.
Health information technology connects doctors and patients to more complete and accurate health records. Tools like electronic health records and electronic prescriptions help patients and providers make safer, smarter decisions about health care. This technology is critical to improving patient care, enabling coordination between providers and patients, reducing the risk of dangerous drug interactions, and helping patients access prevention and disease management services. It is currently being used with great success to coordinate and improve care for members of our Armed Forces, as well as our Nation's veterans. Better technology can also cut costs for providers by reducing paperwork and duplicative tests.
Ensuring the security of health information records is a top priority for my Administration. The American Recovery and Reinvestment Act, passed in 2009, promotes the use of Health IT while significantly strengthening Federal laws protecting patient privacy. Entities violating privacy laws are now subject to increased penalties. The Recovery Act also provides landmark financial incentives to eligible professionals and hospitals that adopt and meaningfully use electronic health records while protecting the privacy and security of health information.
Everyone can play a role in improving our health care system. An important part of this vision is recognizing the pivotal role patients play in maintaining and improving their own health. Patients can work with their doctors to access information about their care. And those who design and implement Health IT systems can enable software that puts patients and their families at the center of their own care, empowering and engaging them in reaching their health goals.
America is home to the world's best universities and technical schools, and the most creative scientists and entrepreneurs. As we challenge ourselves to push forward into a new century of health technology, we will continue to foster and promote the innovative spirit that has made our country what it is today.
NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim September 11 through September 17, 2011, as National Health Information Technology Week. I urge all Americans to learn more about the benefits of Health IT by visiting HealthIT.gov, take action to increase adoption and meaningful use of Health IT, and utilize the information Health IT provides to improve the quality, safety, and cost effectiveness of health care in the United States.
IN WITNESS WHEREOF, I have hereunto set my hand this twelfth day of September, in the year of our Lord two thousand eleven, and of the Independence of the United States of America the two hundred and thirty-sixth.
I will never forget ten years ago on September 11, 2001. That day I woke up to a beautiful sunny morning and went out on the front porch to smoke a cigarette. It was the last one in the pack, so I knew I would be stopping by the store to pick up some more. My wife Joan called me in the house to see what was happening on the news. Naturally we were stunned as we saw these events unfold. As the hours went by I didn't even notice that I would usually have had a smoke by then. I told Joan, "Hey, that was my last cigarette!" meaning that I was out and would need go get more. She said "Really?" perhaps misunderstanding, but as it turns out that was indeed the last cigarette I have smoked. Considering the events of that day, it seemed natural to make the final decision to embrace life.
Later in the day we watched as the members of Congress gathered on the steps of the Capitol Building to pray and sign God Bless America. My son Jason, who was 14 years old at the time, said, "Dad, we should do something like that here." We called the mayor's office and after some discussion and many telephone calls that day it ended up that over 1,000 people gathered together as a united community in front of City Hall in The Dalles, Oregon to pray, sing and mourn together. This was the day I started to become more politically active, serving on boards and committees and eventually holding elected office.
As I reflect on the past ten years, I am sometimes amazed at the changes in our world and in my life. In the days after 9-11 our nation was united and there was a sense of caring for each other on such a broad scale. This unity and strength of purpose did not always hold fast, but on days like today when we commemorate the tenth anniversary of that fateful day I am hopeful. I am hopeful that one day we will live in a world where people are kind to each other, where understanding others is more important than getting our own way, and where peace reigns.
The need for robust health information exchange (HIE) continues to grow, and not just because it is a part of the meaningful use incentive program. Having infrastructure to support HIE will be a critical component to enable new payment and care delivery models like accountable care organizations and medical homes.
Background on HIE Efforts
There has been a strong national effort in developing the Nationwide Health Information Network (NwHIN), as well as a dramatic increase in local and regional efforts to create viable health information exchange organizations (HIOs). These efforts include the Direct Project, which created a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. The Direct Project -- which was sponsored by the Office of the National Coordinator for Health IT -- has become an important on-ramp to the health information superhighway.
But just as state and local governments alone could not build and maintain the Interstate Highway system, the federal government has stepped in to provide funding and a policy framework to develop the NwHIN. As part of the HITECH Act -- most famous for its incentives for the meaningful use of electronic health records -- 56 states and territories received $548 million to build out HIE capabilities at the state level, with a requirement that nearly a third of their budget be allocated toward interstate exchange...
