State Funding for #HIE and Regional Extension Centers

Today there is a major announcement regarding the availability of grants worth $1.2 billion to help hospitals and health care providers implement and use electronic health records. The grants are funded by the American Recovery and Reinvestment Act of 2009 (ARRA) and will help health care providers qualify for new incentives that will be made available in 2011 to doctors and hospitals that meaningfully use electronic health records.

Vice President Joe Biden and HHS Secretary Kathleen Sebelius, joined by David Blumenthal, the national coordinator for health information technology, will formally announce the application process for the $1.2 billion in grants to help expand the nation's electronic medical records system. The grants include $598 million to establish 70 Health Information Technology Regional Extension Centers to help hospitals and clinicians, and $564 million to help states improve information sharing.

Biden, in a statement, said by expanding the use of electronic health records, "We are making health care safer; we're making it more efficient; we're making you healthier; and we're saving money along the way."

Electronic health records can improve the quality of care, reduce medical errors, and make doctors and hospitals more efficient. Thus the ARRA included new resources to help build a nationwide, interoperable health information network. This network will be built on a foundation of incentives to encourage doctors and hospitals to use electronic health records and protections for medical privacy. We know through example that health information technology is working in communities across the country. Earlier this year, Secretary Sebelius toured Omaha's Alegent Health Lakeside Hospital to see how one hospital is using health information technology. There is new video showing some of the highlights of her trip. You can watch the video here:

Received via email from Jeanne Lambrew - Director, HHS Office of Health Reform

E-Prescribing Overview

I am certain that meeting the "meaningful use" criteria will include e-prescribing. A prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care is an important element in improving the quality of patient care.

Electronic prescribing, or e-prescribing is the computer-based electronic generation, transmission and filling of a prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, nurse practitioner, or physician assistant to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. A more formal definition of e-prescribing is provided in the Medicare Part D prescription drug program:

E-prescribing means the transmission, using electronic media, of prescriptionor prescription-related information between a prescriber, dispenser, pharmacy benefit manager, or health plan, either directly or through an intermediary,including an e-prescribing network. E-prescribing includes, but is not limited to,two-way transmissions between the point of care and the dispenser.

You have basically two choices available when you consider an e-prescribing system: either a stand-alone system, or e-prescribing within an EHR system. To qualify for financial incentives under ARRA prescribers will need to be using a “qualified” e-prescribing system. A “qualified” e-prescribing system must be capable of performing all of the following functions:

• Generating a complete active medication list incorporating electronic data received from applicable pharmacy drug plan(s) if available
• Selecting medications, printing prescriptions, electronically transmitting prescriptions, and conducting all safety checks (safety checks include: automated prompts that offer information on the drug being prescribed, potential inappropriate dose or route of administration, drug-drug interactions, allergy concerns, or warnings or cautions)
• Providing information related to the availability of lower cost, therapeutically appropriate alternatives (if any)
• Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan

Most e-prescribing systems and many EHRs have these capabilities. Certainly vendors are working to meet these criteria so that users will be considered "meaningful users" and thus qualify for incentive payments. For further resources on e-prescribing see:

E-Prescribing report to congress

Draft 2010 EHR E-Prescribing Measure Specifications

Electronic Health Records and the 21st Century Health Care System

A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology

In my role as National Coordinator for Health IT, I have the privilege to be part of a transformative change in health care that will help to extend the benefits of health information technology (HIT) to all Americans. With the passage earlier this year of the Health Information Technology for Economic and Clinical Health (HITECH) Act, we have the tools to begin a major transformation in American health care made possible through the creation of a secure, interoperable nationwide health information network.

Of course, this system is not an end in itself. Rather, it will enable countless other improvements in the quality and efficiency of health care that will make Americans healthier and their economy stronger.

My personal belief in this transformation is not based on theory or conjecture. As a primary care physician for over 30 years, I spent the first twenty shuffling papers in search of missing studies and frequently hoping, during middle-of-the-night emergencies, that I knew enough about patients’ medical histories to make good decisions. All that changed when I began to have access to patients’ electronic medical records. It made me a much better doctor. I would never go back, and neither would the vast majority of American physicians who have made the leap into the electronic age.

In fact, it would be hard for any health professional today to escape the conclusion that the antiquated, paper-dominated system we now have in place isn’t working well for patients, creates added costs and inefficiencies, and isn’t sustainable. As we look at our nation’s annual health care expenditures of approximately $2.5 trillion, there are many ways our current system fails both patients and providers. It is clear that change is necessary.

But how and why is nationwide electronic health information exchange so critical to achieving such change? Most importantly, because it provides the best opportunity for each patient to receive optimal care. The technology will make patients’ complete medical information securely and reliably available to health care providers where and when it is needed – when clinician and patient are together facing medical decisions that can make a lasting difference.

Better, faster, more reliable and efficient care also ultimately reduces system-wide costs by delivering results that help to avoid expensive or prolonged hospitalization from delayed or ineffective treatment, avert costly and sometimes fatal adverse events and unnecessary procedures, and can help to eliminate the onset of disease by better informed management of each patient’s health.

The goal of assuring an electronic health record for every American is daunting. We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration.

We also recognize that we cannot achieve the benefits of a nationwide health information system unless we can assure all Americans that their personal health information will remain private and secure when this system exists. Putting into place safeguards for the privacy and security of this information, when it is in electronic form, will be an ongoing priority that influences and guides all of our efforts.

In the days, weeks, and months ahead, we will be rolling out a number of pivotal initiatives called for under the HITECH Act. I urge you to join and support us as we lay the foundation for every American to benefit from an electronic health record, as part of a modernized, interconnected, and vastly improved system of care delivery. We at ONC will be making every effort to keep you updated and fully engaged in all the steps of this national journey.

Sincerely,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

Lone Ranger and the Hole in the Wall Gang of 6

President Obama has been very skillfully navigating the tricky waters of healthcare reform to this point. He has allowed Congress to take the ball thus far, and even though everyone keeps talking about Obama's Health Reform Plan, it is important to note that the President has not proposed a plan yet! Notice the difference between the way that this administration and the Clinton administration have approached reform - President Obama is allowing Congress to make all the initial mistakes, and he will come riding in after the dust settles to save the day. As Paul Krugman pointed out back in February there are big differences in Obama's approach to reform and Clinton's, and most of these are due to political realities.

There are now various plans, at various stages in both the House and the Senate, of which various aspects of each are being vigorously debated. The only plan that appears able to actually pass is still being worked out in the Senate Finance Committee by the so-called Gang of Six (three Democrats and three Republicans). These six hold the key to the President's plans for reform. They are:

Chairman Max Baucus (D-MT) has repeatedly stated that he will work on a bipartisan compromise. He agreed to keep negotiating with the rest of the gang through September despite pressure from the White House to vote on a health reform measure before the August recess. In the Great Falls Tribune, Baucus said "There's no bill yet because I haven't written it. There's just a lot of ... stuff out there. Health reform is not dead or dying; there's just a lot of misinformation out there." Baucus says he is committed to eliminating the current pay-per-procedure system and replacing it with one focused on quality outcomes. He has put healthcare cooperatives and a national insurance pool at the top of the list of reforms for health insurance.

Chuck Grassley (R-IA), a 28-year Senate veteran, faces a possible primary challenge in next year's election so he is being very careful. At a town hall meeting, a constituent told Grassley that if he helped get this bill passed he would lose the election. Grassley seems to have a real desire to reform healthcare, and has offered preliminary support for the health care co-op idea advanced by Kent Conrad (D-ND). Grassley has said, "Not all Democrats think the same and there's some that are like me, who do not want any more government interference in health care." If Grassley leaves the Gang, there is a big hole in the wall for any bipartisan compromise.

Kent Conrad (D-ND) is responsible for the healthcare cooperatives idea, which is now seen as the only path to a bipartisan compromise. Under the Conrad plan, cooperatives would be national in scope, and would receive startup money from the federal government. In the Wall Street Journal he said, "It is the only plan that has bipartisan support in the Senate." He also claimed, "It's quite clear the public option does not have the votes." Conrad was elected with 69% of the vote in 2006, but has recently been accused of receiving favorable terms on a loan on his second home issued by Countrywide Financial (since absorbed by Bank of America during the financial meltdown).

Olympia Snowe (R-ME) has been involved with healthcare issues since she was first elected in 1994. During the run-up to the health care reform debate, Snowe sponsored (along with Democrat Dick Durbin of Illinois) a bill establishing the Small Business Health Options Program (SHOP), which would enable small companies and the self employed to form state or nationwide health insurance purchasing pools. She holds one of the safest seats in the country, having won 74% of the vote in 2006, and is widely viewed as a moderate Republican.

Jeff Bingaman (D-NM), was elected to his seventh term in a 2006 landslide. Like Conrad, Bingaman is from a more conservative and rural western state. He opposes the public insurance option proposed by the House. He has been open to the idea of health care cooperatives as a way to help the uninsured. According to Politico, Bingaman favors a series of "benchmarks" to gauge the success of the health plan as it unfolds. Bingaman says, "I think that makes sense. You could make an evaluation and midcourse corrections if needed. I think that's the prudent thing to do."

Mike Enzi (R-WY) is the most conservative member of the Gang. The New York Times says, "An accountant and former computer programmer, he is the shrewd numbers man with a common sense outlook." He is considered to be in a safe seat. On healthcare reform, Enzi says, "We're past due for doing it, and the American people want it," but also says, "I don't think they like what they see so far." Enzi favors the co-op idea and has also sponsored legislation similar to Snowe's that offers small businesses and individuals the right to buy insurance from a national pool. Senator Enzi is firmly opposed to abortion and illegal immigration, so expect that these views will be reflected in legislation that comes out of Senate Finance.

The Gang of Six faces a difficult climb to work out the deatils of reform. Enter the Lone Ranger, President Barack Obama! He has been watching carefully and whether you agree with his ideas or not you have to admit he is maneuvering brilliantly. When the Whitehouse makes their reform proposal it will be with broad support that is guaranteed to pass. It won't have everything he or his supporters want in it, but such is the nature of the political process and compromise.