November 20, 2011 10:05 pm   Posted by

One-third of nation’s primary care providers enrolled in health IT extension centers by Mary Mosquera

Regional health IT extension centers have signed up more than 100,000 physicians, or one third of all primary care providers in the nation, to help them deploy electronic health records, reaching its goal slightly ahead of its yearend schedule.

And 70 percent of all primary care providers in small practices in rural areas around the country are working with the extension centers, and in some states, it’s practically 100 percent, said Dr. Farzad Mostashari, the national health IT coordinator.

Those are among the efforts through which the Office of the National Coordinator for Health IT’s toolbox has established a beachhead, he said at a Nov. 17 summit spotlighting the progress of the extension centers, health information exchange, and beacon or model health IT communities to help to transform health care.

“Our challenge to extension centers is that every Medicaid provider that you’re working with must get $22,000 in the next six months, not because of the money but because it’s a concrete indicator of our commitment to them that this is real. Then take those who have adopted and keep moving toward meaningful use,” Mostashari said, referring to the incentive for Medicaid EHR adopters.

The 62 extension centers created by ONC offer hands-on assistance to providers in getting over the hurdles of establishing EHRs, such as vendor selection and project management.

The trained health IT workforce also has expanded through 81 community colleges offering health and IT training. The community colleges in the ONC program have enrolled 20,000 professionals in the past year, 5,000 more than the goal, and produced 5,000 graduates.

Despite the tremendous need for these positions in hospitals, health plans and clinics and vendors, it is still difficult to link the demand with the supply, he said.

For health information exchange, the conversation has changed from “gauzy vision to real-life how-to,” he said. The Direct Project is a version of secure messaging for simple and direct exchanges between providers, or providers and labs or providers and patients. It is a streamlined version of the Nationwide Health Information Network (NwHIN) Exchange for securely sharing patient information via the Internet.

Providers can move messages now but next must figure out how to integrate exchanges into their workflow. ONC and public and private organizations working together are considering an implementation guide, how best to communicate information and the critical data that needs to be exchanged.

Dr. David Blumenthal, the previous national health IT coordinator, recounted the progress in EHR adoption and health information exchange based on the difference upon his return earlier this year to Partners Health System in Boston.

“Meaningful use has become a fact of life. Two years ago it was a distant possibility. Today there is a sense of urgency attached to it,” he said.

He also discovered unanticipated secondary gains. The requirement for sharing a care summary with patients at the end of their visits revealed that some physicians had not been writing much in the way of notes or recording medications, vital signs or care plans, and so didn’t have anything to show their patients.

“I never could have anticipated that the actual fear of embarrassment of handing your patients something that is below the standard of what you would expect from your physician and they expect from you would be a major motivator in terms of upgrading the quality of information that is available in our healthcare system. But you can never anticipate what’s going to change professional behavior,” he said.

To encapsulate the progress that is occurring, Mostashari related a visit with a solo practitioner in San Francisco serving mostly Medicaid patients. The physician used an extension center to help implement an EHR, which is remotely hosted, and meet security requirements. He began sharing information with 50 other providers who are served by the same independent physicians’ association (IPA), when it asked its providers open their notes to their colleague members to advance care coordination.

These doctors knew each other, and their financial future is tied together. California paid them 180 percent of Medicaid fee for service because as a group they have lowered unnecessary hospital admissions.

They are now indexing data like a Google search of their EHRs to be able to synthesize all the information and doing predictive modeling. His IPA has applied to be an accountable care organization.

“He said the critical switch for him was when he realized that it’s not my record anymore; it’s the patient’s record,” Mostashari said.

November 20, 2011 9:52 pm   Posted by

D.C. Report: IOM Health IT Report Released, HITSC Seeks Comments, HIE Standards Confirmed By Jeff Smith, Assistant Director of Advocacy at CHIME

OM Drops Long-Anticipated Report on Health IT and Patient Safety Washington was abuzz this week with the release of the Institute of Medicine’s 197-page report “Health IT and Patient Safety: Building Safer Systems for Better Care.” The much anticipated report said that current market forces are not adequately addressing potential risks associated with use of health IT and that more attention needs to be brought to patient safety and EHRs. IOM made ten recommendations (.pdf), including the need for HHS to develop a multi-stakeholder strategy within one year to “assess the impact of health IT on patient safety and minimizing the risk of its implementation and use.” Another recommendation would establish two new federal bodies: the HHS Health IT Safety Committee would set criteria for the safe use of HIT; while an independent federal agency modeled after the National Transportation Safety Board would investigate incidents. These recommendations were given in light of “mixed opinion on how FDA regulation would impact the pace of innovation but identified several areas of concern regarding immediate FDA regulation.” Some members of the report favored a scheme that gave FDA the authority to regulate EHRs as “Class III” devices – the most strictly regulated of medical devices – while others felt the FDA would likely restrict market innovation in health IT, which could also jeopardize patient safety.

However, Recommendation 9a states: “If progress toward safety and reliability is not sufficient as determined by the Secretary, the Secretary should direct the FDA to exercise all available authority to regulate EHRs, health information exchanges, and PHRs.” And 9b follows: “The Secretary should immediately direct the FDA to begin developing the necessary framework for regulation. Such a framework should be in place if and when the Secretary decides the state of health IT safety requires FDA regulation as stipulated in Recommendation 9a above.” See also, Dr. Farzad Mostashari’s response to the IOM report in a blog post on the ONC’s website.

CHIME is examining the IOM report for possible response. Please contact Sharon Canner or Jeff Smith for more information.

ONC Advisory Group Seeks Comments on Exchange Specifications Through a post on the Federal Advisory Committee Blog this week, the Health IT Standards Committee (HITSC) is seeking comments from anyone who has experience exchanging information through the Nationwide Health Information Network (NwHIN) using Exchange specifications and protocols. On September 28, 2011, the HITSC provided recommendations regarding standards and specifications for the nationwide health information network, via a transmittal letter (.pdf). As part of the transmittal letter, HITSC recommended that ONC perform further assessment of industry adoption, and deployment, operational, and administrative complexity of the Exchange specifications – especially from those who have implemented these specifications in organizations other than Federal agencies, and from organizations that have implemented a technology stack different from that represented in the Exchange specifications. ONC requests feedback on fourteen questions ranging from wanting to know the business function supported by Exchange in your organization to asking how easy or difficult the Exchange specifications were to understand, interpret, and implement. Find out more information on the Request for Comment here.

HIPAA Compliance Audits on the Horizon According to the HHS Office of Civil Rights, a pilot audit program to ensure covered entities and business associates are complying with the HIPAA Privacy and Security Rules and Breach Notification standards has begun. A three-step process has been in development since July and a test of twenty initial audits will begin in November and go through April, OCR indicated on its website. The OCR responded by saying the audit program launched Nov. 4 with the sending of notification letters to five of the first 20 entities to be audited. The OCR intends to complete upwards of 150 audits by the end of calendar 2012. According to OCR, audits are primarily a compliance improvement activity. The Office will review the final reports, including the findings and actions taken by the audited entity to address findings and the aggregated results of the audits will enable OCR to better understand compliance efforts with particular aspects of the HIPAA Rules. “Should an audit report indicate a serious compliance issue, OCR may initiate a compliance review to address the problem, the Office said, “OCR will not post a listing of audited entities or the findings of an individual audit which clearly identifies the audited entity.”

Multistate Workgroup Agrees to HIE Standards A broad coalition of eight state health information organizations (HIOs) and eleven health IT vendors have agreed to a set of technical specifications that they hope will help standardize health information exchange. The EHR/HIE Interoperability Workgroup was established by the New York eHealth Collaborative (NYeC) and is comprised of its federally designated counterparts in seven states, including California, Colorado, Maryland, Massachusetts, New Jersey, New York, and Oregon. The Workgroup has published Version 1.0 of specifications on two use cases for a compliant Continuity of Care Document, with corresponding functional and technical specifications for each. The first use case, Statewide Send and Receive Patient Record Exchange, describes how encrypted health information can be transmitted over the internet. Developments made by the Direct Project and the Nationwide Health Information Network Exchange informed the Send and Receive use case. The second, the Statewide Patient Data Inquiry Service Use Case, describes the clinician’s ability to query an HIE for relevant data on a specific patient. Specifications for this second use case identify how the consortium agrees to leverage the IHE Profiles and NwHIN Exchange production specifications to facilitate patient queries and CCD retrieval. The documentation included in the Statewide Patient Data Inquiry Service includes a Functional Specification, Technical Specification, Summary CCD Document, and CDA Source of Information.

Health Data Privacy Takes Center Stage during Capitol Hill Hearing The Senate Judiciary Privacy, Technology and the Law Subcommittee held a hearing November 9, 2011 titled “Your Health and Your Privacy: Protecting Health Information in a Digital World.” In his opening statement, Chairman Al Franken (D-Minn.) conveyed his understanding in the power of health information technology to improve health outcomes and make care more efficient. However, he also acknowledged a growing need to address privacy concerns with the healthcare industry making such a push to go digital. Ranking minority member Tom Corburn (R-Okla.), a physician himself, expressed reservations that electronic health information can ever be adequately secured and wondered if the EHR Incentive Program was the correct course of action. “I have a real concern both for the privacy issue but also the goal that we’re trying to accomplish may not be accomplishable,” he said.

Chairman Franken also strongly called for the Obama Administration to publish the final enforcement rules for business associates under HIPAA two and a half years after passage of the HITECH Act (part of the American Recovery and Reinvestment Act of 2009). He emphasized that the public’s trust in the privacy and security of their health information is necessary to gain the widest adoption of electronic health records and health information exchange and to reap the full benefits they will bring to our healthcare system.

Among the witnesses Kari Myrold, Privacy Officer at Hennepin County Medical Center in Minneapolis, MN focused on how the I-35W Bridge collapse in 2007 solidified for her hospital why electronic health records were the way to go. Doctors at Hennepin realized the value of being able to tend to those victims more quickly and more effectively by calling up patients’ charts and track patients throughout the hospital and in other systems far easier than paper records. Kari also mentioned that Hennepin has continued to invest in EHRs; under the leadership of CIO Joanne Sunquist, Hennepin successfully attested to Meaningful Use in August. She continued during the Q&A to talk about the big picture of why hospitals put so much effort into securing patient data. “Patients need to be comfortable and have confidence in their providers so that when they’re in there seeking treatment they want to make sure that they’re able to disclose everything that they need to disclose in order to get the right treatment. And having that confidence means that their information is going to be protected.”

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November 16, 2011 9:48 pm   Posted by

U.S. Supreme Court Accepts Affordable Care Act Case By Mark Hagland

On Nov. 14, the Supreme Court announced that it would hear one of several cases that have been working their way through the federal court system challenging the Affordable Care Act (ACA), the federal healthcare reform legislation passed by Congress and signed into law in March 2010 by President Barack Obama.

The nation’s high court’s announcement came just six days after the U.S. Court of Appeals for the District of Columbia Circuit had affirmed the entire ACA on Nov. 8. That ruling was the fourth among four federal appeals courts that had taken on legal challenges to the ACA. Among the four federal appeals courts, two of the courts (the D.C. court and the Sixth District court in Cincinnati) had affirmed the entire law, while the Fourth District court in Richmond had declared the plaintiffs in the two cases it heard to have lacked the legal standing to bring their cases. However, the Eleventh District Court of Appeals in Atlanta had ruled against the individual insurance mandate in a 2-1 decision on Aug. 12, though that court had also determined that the ACA as a whole was constitutional.

In sum, no federal appellate court has struck down the entire ACA as unconstitutional, while the Eleventh Circuit had struck down only the individual mandate element of the law. Still, the U.S. Supreme Court has agreed to take on the entire law, and could rule the entire law constitutional; could rule the entire law unconstitutional; or could rule only on the constitutionality of the individual mandate. The nation’s highest court could also choose to rule that it is too early to rule on the constitutionality of the ACA, based on the fact that its individual mandate element does not become effective until 2014, by applying a federal law that says that legal challenges cannot be brought to taxes until those taxes are actually levied.

The Republican leadership in the U.S. Congress has declared itself uniformly opposed to the ACA, and has encouraged the legal cases challenging its constitutionality, while most Democrats in Congress voted for the ACA and continue to support it. Meanwhile, the Obama administration on Sep. 28 announced that it would not seek a full appeals court review of the Aug. 12 decision, and instead petitioned the U.S. Supreme Court to take that case, with the Justice Department stating on Sep. 28 that, “Throughout history, there have been similar challenges to other landmark legislation, such as the Social Security Act, the Civil Rights Act and the Voting rights Act, and all of those challenges failed. We believe the challenges to the Affordable Care Act—like the one in the Eleventh Circuit—will also ultimately fail and that the Supreme Court will uphold the law.”

On Nov. 14, Speaker of the House of Representatives John Boehner (R-Ohio), said in a statement, “This government takeover of healthcare is threatening jobs, increasing costs, and jeopardizing coverage for millions of Americans, and I hope the Supreme Court overturns it.” Meanwhile, in a statement also on Nov. 14, White House communications director Dan Pfeiffer said, “We know that the Affordable Care Act is constitutional and are confident the Supreme Court will agree.”

The justices have announced that they will hear five-and-a-half hours of arguments, an exceptionally long block of time dedicated to the questions around healthcare reform. Legal experts made note of the length of time being scheduled for oral arguments, in a case that is unprecedented, given the complexity of the legislation involved, as well as the fact that the Supreme Court will be ruling on the constitutionality of that legislation during the course of a presidential campaign.

The outcome, experts agreed, is potentially very open. Paul Rothstein, a professor of law at Georgetown University Law School, told MSNBC’s Thomas Roberts on Nov. 14 that “There are just too many variables here” to be able to predict with any certainty how the nation’s high court might ultimately rule, adding that “it’s an issue that cuts across conservative and liberal lines. Some of the justices in the courts below that have ruled in favor of the Obama healthcare plan have been Republicans, and vice-versa; so it’s really very hard to call it.”

Rothstein went on to say that “The Supreme Court, even though it’s taken the case, could decide that it’s too early to call it, based on the idea that people don’t have the right to challenge it until their ox is gored. Also, there’s a law that says that you can’t challenge a tax until it has to be paid. So we really don’t know what the Supreme Court is going to do. There are also lots of regulations besides the individual mandate, and they’re going to have to decide [about those], too.”

The high court is expected to hear oral arguments by sometime in March 2012, and will likely issue a ruling by June.

November 4, 2011 4:15 pm   Posted by

Military Veterans an Ideal Population to Boost Healthcare Corps By Stephen Hanson, PA-C

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The physician assistant profession finds its roots heavily grounded in the military. The first PAs entered our healthcare system in 1967, and were Navy corpsmen and medics returning from the war in Vietnam. The profession itself was created by Dr. Eugene A. Stead, who also designed the initial PA program at Duke University.

Since then, the PA profession has exploded and there are more than 81,000 certified PAs in the country — 70 percent of whom are women. Six thousand PA students graduate each year from over 150 PA programs and enter virtually every specialty of medicine, and the profession still has a strong presence in the military.

PAs are vital members of the healthcare team and ensure access to care for all patients, especially those in the medically underserved remote areas and urban communities. This was true when the profession was initially established in the 1960s, and remains true today.

So it was exciting to see that President Obama recently renewed the administration’s commitment to providing support to veterans looking for work when they leave the military, as a pathway to a fulfilling career for veterans.

Under this initiative, the administration will make it easier for veterans to receive the training, education, and credentials they need to transition to the civilian workforce or to pursue higher education.

The shortage of physicians who deliver direct patient care is a very complex issue, given the evolving healthcare system and prediction that massive numbers of additional new healthcare providers will be needed.

Now that PAs are better recognized within the healthcare system, the pressing question remains for legislators as well as President Obama: How quickly can these returning veterans be trained as physician assistants?

Educating physicians, physician assistants, and nurse practitioners is an expensive and time-consuming proposition. In the current economic environment, it is difficult for all professional ranks to find enough qualified, quality applicants who have successfully complete medical training.

So I was relieved and really happy the about a program that begins to solve at least one part of this problem.

One of many significant concerns in these economic times is the unemployment rate in our community and nation. In what I consider a win-win, this program will encourage and assist returning veterans, many of whom have significant healthcare training and experience in the military, to be trained in physician assistant programs and eventually improve access to quality healthcare to those who need it most.

Today, demand for primary-care physicians, physician assistants, and other healthcare providers is very high. With significant levels of unemployment in our country, it makes sense to provide an avenue to capitalize on veterans’ training and experience in healthcare, in retraining them as physician assistants, and rapidly deploying them to areas of greatest need.

I am glad that our military personnel will be coming home from the Middle East in the near future. For those like me who are concerned that this will put additional strain on our already fragile economy, the president’s plan to utilize this valuable resource makes excellent sense and will help both the healthcare system and our returning veterans.

I am hoping that institutions of higher PA education will move rapidly to take advantage of this program and begin admitting veterans with appropriate experience and credentials into PA programs as quickly as possible. We will all benefit.

Find out more about Stephen Hanson and our other Practice Notes bloggers.

This blog was provided in partnership with the American Academy of Physician Assistants. For more information, visit www.aapa.org.

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