By John Moore

New York State has awarded about $60 million in grants for localized health information technology projects, one of three rounds of grants recently issued under the state’s Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) initiative.

Gov. David Paterson announced grants totaling $436 million on Sept. 25. In addition to health IT, the grants will fund collaborative projects among hospitals and improvements to long-term care.

The state will allocate the funds through its Department of Health and the Dormitory Authority of the State of New York.

The health IT portion of the grants, HEAL NY Phase 10, targets community-based projects focused on information sharing. Examples include a $6.7 million grant to the Fort Drum Regional Health Planning Organization to help launch electronic health records and health information exchange to “improve coordination of care for adult patients with chronic pulmonary disease,” according to the health department.

HEAL NY Phase 11, meanwhile, provides more than $174 million in grants that aim to promote collaborative arrangements among hospitals in an effort to boost the quality and efficiency of care delivery. In HEAL NY Phase 12, more than $172 million in grants will be issued to 19 applicants for long-term care related projects.

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By Asrat Kebede

Nearly $1.2 billion in economic stimulus law funds are now available as grants for health information technology, Vice President Joe Biden announced today. About half of the funding will go to establish dozens of regional education centers across the country, and the other half will help state agencies set up health information exchange systems.

Congress approved the funding as part of the economic stimulus law to promote the adoption of electronic health record (EHR) systems. Lawmakers included $45 billion in incentive payments to doctors’ offices and hospitals that buy and meaningfully use digital health records, and $2 billion to promote health information exchange.

The Health and Human Services Department will issue rulemaking later this year to define the terms of certification and meaningful use.

“With 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, ” Biden said in a statement today.

Grants totaling $598 million will be used to get 70 Health IT Regional Extension Centers up and running. The centers will give hands-on help to doctors and hospital staff in selecting, acquiring and deploying certified EHR systems.

An additional $564 million in grants is available to states to support the development of mechanisms for sharing of patient medical information within a framework of an “emerging nationwide system of networks,” the statement said.

Both sets of grants will be issued starting in fiscal 2010. The extension program grants will be awarded on a rolling basis: 20 in the first quarter of the fiscal year, 25 in the third quarter, and the remainder in the fourth quarter.

HHS will dedicate $50 million to creating the Health IT Research Centers will help the regional extension center identify and share best practices and collaborate with each other, the statement said.

The centers together will support at least 100,000 primary care providers, through participating nonprofit organizations, in achieving meaningful use of EHRs, the statement said.

The health information exchange grants will be awarded through the State Health Information Exchange Cooperative Agreement Program. States may choose to enter multistate arrangements. State agencies will be required to provide matching funds starting in 2011.

A group sponsored by the National Governors Association recently advised state agencies to begin their planning on health information exchanges, which will be required to achieve meaningful use of digital health records.

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Two weeks ago, the Obama administration offered nearly $1.2 billion in stimulus-funded grants to set up state-run health information exchanges, and create 70 “health IT regional extension centers” to help physicians adapt to the digital era, a term officials defined in greater detail during a conference call late last week, Modern Healthcare reports. “As many as 1,250 participants logged- or dialed-in to hear and ask questions about the ground rules to apply” for the grant money “to be awarded over a four-year period to about 70 not-for-profit organizations that will run the regional extension centers.”

The centers will spend more than $500,000 a year, mostly on services for physicians; serve approximately 1,000 doctors each, mainly at smaller primary care offices; help doctors select an effective electronic record system; help them implement it and achieve “meaningful use,” the administration’s requirement for doctors hoping to get other stimulus payments; provide “in-depth” technical support on “a narrow list of vendor systems.” A caller pointed out that the government’s role in recommending and supporting individual, private vendors raised a potential conflict of interest for state officials choosing the potential grantees that will set up the centers.

Half of the grant money will go directly to states to help establish “a widespread and sustainable health information exchange,” American Medical News reports. “Legal, financial and technical support is necessary to enable secure exchange of sensitive patient data across health care systems, according to HHS. The program will help fund efforts at the state level to implement directories and technical services to enable interoperability within and across states. Some health IT experts say such assistance is vital in helping physician practices become meaningful users”.

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By Neil Versel

Dr. David Blumenthal, the national coordinator for health information technology, gave a strong indication of how HHS ultimately will define “meaningful use,” the standard that providers must meet to be eligible for Medicare and Medicaid EMR bonuses, by warning that hospitals unwilling to share data with others risk being shut out of the stimulus funding. “There’s a fair amount of money in the law for hospitals that adopt interoperability,” the Dallas Morning News quotes Blumenthal as saying. “If they don’t, they’re not likely to be eligible for payment.”

Although the three largest hospital operators in the Dallas-Fort Worth are implementing EMRs, there is no means for health information exchange between the systems or with smaller providers. The Dallas-Fort Worth Hospital Council is only now working on an HIE feasibility study, and is seeking grant funding to lay the groundwork for data sharing, the newspaper reports.

In McAllen, TX, recently named the second-most-expensive healthcare market in the country, one physician executive believes that interoperability could help rein in some of the spending.

Let me know for further assistance.

http://www.fierceemr.com/story/blumenthal-must-share-data-get-stimulus-money/2009-06-25

As the Obama administration works to garner support for healthcare reform, about $1.2 billion in grants were announced on Friday to help hospitals and healthcare providers implement and use electronic health records.

Announcing the grants in Chicago, US Vice President Joe Biden said the $1.2 billion would be funded by the $787 billion economic stimulus plan.

“With electronic health records, we are making health care safer; we are making it more efficient; we are making you healthier; and we are saving money along the way. These are four necessities we need for healthcare in the 21st-century,” Biden said during an appearance at a hospital with Health and Human Services secretary Kathleen Sebelius.

Expanding the use of electronic health records is fundamental to reforming the country’s healthcare system, Sebelius said, adding that electronic health records would help reduce medical errors, make healthcare more efficient and improve the quality of medical care for all Americans.

“You are going to be able to save a lot more lives and save tens of billions of dollars,” Biden told about 100 medical professionals.

Of the total money, $598 million would be used to establish 70 health information technology regional extension centers, which would help hospitals select and implement electronic health record systems.

Grants totalling $564 million would go to States and Qualified State Designated Entities to support the development of mechanisms for information sharing within an emerging nationwide system of networks.

The grants would be awarded beginning fiscal year 2010. Biden also expressed confidence that the healthcare legislation would be passed.

“Soon we are all going to get much better health care at a more rationale price…We are not taking the system that works away from any American. We are making the stuff that doesnt work, work better,” he added.

Pointing out that the economic stimulus package is working to improve the economy, Biden said, “We stopped the free fall. Now we are beginning to ascend again”.

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The U.S. healthcare system works better for insurance companies than it does for citizens, President Barack Obama wrote in a New York Times op-ed piece Sunday.

Obama said Congress must pass healthcare reform this year to weaken the power of insurance companies and protect the millions of U.S. residents who lack insurance or pay too much for it.

“If we maintain the status quo, we will continue to see 14,000 Americans lose their health insurance every day,” Obama wrote. “Premiums will continue to skyrocket. Our deficit will continue to grow. And insurance companies will continue to profit by discriminating against sick people.”

Under his administration’s plan, those without health insurance would have a choice of affordable coverage whether they move, change jobs or lose their job, he said.

Healthcare costs would be reduced by cutting hundreds of billions of dollars in waste from Medicare and Medicaid while eliminating unwarranted subsidies to insurance companies, Obama wrote, adding Medicare would be made more efficient by ensuring tax dollars go directly to care for seniors instead of going to insurance companies.

“I don’t believe anyone should be in charge of your healthcare decisions but you and your doctor — not government bureaucrats, not insurance companies,” Obama said.

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By Joseph Conn

Another month, another matrix in the development of definitions of “meaningful use,” the key criteria providers must meet to unlock tens of billions of dollars of federal healthcare information technology subsidies under the American Recovery and Reinvestment Act of 2009.

The Health Information Technology Policy Committee, a creature of the stimulus law, received a third set of recommendations from its meaningful-use work group. The recommendations were again detailed, as were their predecessors handed over by the group in June and July, in a spreadsheet or “matrix” format.

The HIT Policy Committee accepted the recommendations, which under the order of events set out in the stimulus law the committee will forward to the Office of the National Coordinator for Health Information Technology at HHS, which will hand them over to the CMS for official rulemaking. All of these hand-offs will occur fairly seamlessly since David Blumenthal, the physician head of the ONC, is chairman of the HIT Policy Committee and Tony Trenkle, director of the Office of eHealth Standards and Services at the CMS, is a policy committee member. Both men attended Friday’s meeting.

This latest batch also stuck to the original staging schedule first proposed by the work group in June of creating three sets of increasingly more complex meaningful-use criteria, which hospitals and office-based physicians must meet to qualify for the subsidy payments. The matrix includes a dozen broad goals, more specific objectives and proposed metrics by which compliance with the goals and objectives can be measured. The lowest bar is set for 2011, the first year electronic health-record subsidy payments can be made under the Medicare portion of the technology funding program.

For example, one care goal is to provide a patient healthcare team access to “comprehensive patient health data.” In 2011, one objective proposed for meeting that goal is a requirement that all hospitals use computerized physician order entry, or CPOE, systems for at least 10% of orders by doctors, nurses and physician assistants. By 2013, the work group proposed raising the bar, requiring that 100% of hospital orders be initiated using CPOE. In 2015, the objective switches from using a specific system, CPOE, to achieving “minimal levels of performance” that can be measured using clinical outcomes standards to be agreed upon sometime between now and then.

The other highlight of the meeting was the report and recommendations by the policy committee work group on EHR system certification and adoption. Under the stimulus law, only certified EHR systems qualify for federal subsidies, and only if they are used in a “meaningful manner.” In the past, the federal government deemed the certification of an EHR by the not-for-profit Certification Commission for Health Information Technology as good enough to meet its certification requirements for Stark and anti-kickback exceptions for EHR subsidies made by hospitals to office-based physicians. CCHIT took its cues on certification criteria from the American Health Information Community, the Bush administration’s counterpart to the HIT Policy Committee, and developed a program that tested vendors’ products on their ability to perform more than 300 functions.

But the stimulus act, which became law in February, did not specify that CCHIT would be even an acceptable certification body for EHRs for stimulus law subsidies, much less the only certification body with deeming authority as in the past.

To guide the new way forward, the certification and adoption work group made five recommendations, which were accepted by the policy committee.

First, the group recommended that certification under the stimulus law should focus solely on the functions needed to meet the meaningful-use standards. The statute provides eight specific areas that the HIT Policy Committee must consider in making its recommendations on meaningful use, plus 10 other areas that the policy committee might also consider.

Still, at least initially, the number of criteria against which systems will be tested under the stimulus law is likely to be far fewer than the 300 or so in the most recent CCHIT testing regime. In June, CCHIT announced its intention to continue to offer its comprehensive testing program, but also would add new testing and certification schemes tailored to the meaningful-use criteria as they are developed.

Second, according to the recommendations, progress needs to be made on testing and certifying systems that have the functionality to meet privacy, security and interoperability requirements called for in the stimulus act. Those include some amendments to the federal privacy law under the Health Insurance Portability and Accountability Act of 1996, such as the requirement that the systems be able to produce and report audit trails of where and when disclosures of patient information has been made, and to manage patient consents to release information, including a new authority that patients can block the release of their treatment information to their insurance company if they pay for treatment out-of-pocket.

Third, the work group recommended generally that the certification process be made more objective and transparent, with a specific recommendation that the federal National Institute of Standards and Technology, an agency of the Commerce Department, be tasked with helping the ONC develop a process to establish a separate and independent accreditation procedure for certification organizations such as CCHIT and any additional organizations that might join CCHIT in certifying EHRs to stimulus law criteria.

Fourth, the work group suggested that the certification process needs to be standardized so there is a level playing field for all seekers of EHR certification, whether they are commercial vendors of proprietary software systems, provider organizations that have developed home-grown systems, or communities or service providers of open-source EHR systems.

Finally, the work group recommended that the ONC and the CMS leverage as much as possible the work that has been done to date developing a certification program. Since an initial, official definition of meaningful use isn’t expected from the CMS until early next year, the work group recommended establishing a “preliminary certification process” so vendors can begin preparing their systems to what will be a likely set of criteria. CCHIT, for example, has prepared an analysis of its current testing and certification criteria and how they stack up against what might be expected to meet meaningful use under a new certification regime.

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By Mary Mosquera

The Obama administration is expected to announce as early as Friday plans to award a series of grants to assist healthcare providers acquire and use health IT properly as well as to help states set up health information exchanges.

National health IT coordinator Dr. David Blumenthal is scheduled to join Vice President Joe Biden and HHS Secretary Kathleen Sebelius Aug. 20 for a discussion with physicians, nurses and administrators from Chicago’s Mt. Sinai Hospital. They are expected to discuss health reform, including health IT infrastructure and preventative care, according to a White House statement.

The American Recovery and Reinvestment Act provided the Office of the National Coordinator $2 billion to promote the meaningful use of health IT. Up to $300 million was intended to help establish state HIEs; another share would fund regional training centers to help physicians and hospitals incorporate health IT into their practices.

In an e-mailed statement today, Blumenthal laid out the administration’s case for the importance of the health IT funding targets.

Nationwide electronic HIE “provides the best opportunity for each patient to receive optimal care,” Blumenthal said. The technology will make patients’ complete medical information securely available to their health care providers where and when it is needed, “when clinician and patient are together facing medical decisions that can make a lasting difference.”

“My personal belief in this transformation is not based on theory or conjecture,” said Blumenthal, who has been a primary care physician for 30 years.

“I spent the first 20 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,” he said, adding that it made him a better doctor. He started using electronic records 10 years ago.

With the U.S. spending $2.5 trillion annually on healthcare, it is clear that change is necessary, he said. “Better, faster, more reliable and efficient care also ultimately reduces system-wide costs,” he said.

To realize the benefits of a nationwide health information system will also require that personal health information remain private and secure. “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,” he said.

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Experts say electronic health records will slash health care costs, but hospitals wonder when — and how — they’ll be able to realize those savings.

By David Goldman, CNNMoney.com staff writer

The health care industry is poised to realize huge savings by implementing electronic health records systems, but who really benefits is up for debate.

Digitizing health records is a big part of the Obama administration’s health reform agenda, with the president arguing that EHR will save taxpayers from wasteful spending by making health care more efficient.

But huge upfront costs and a questionable return on investment for hospitals have some screaming for broader reforms.

A recent Congressional Budget Office report said the health reform bills wouldn’t sufficiently rein in costs nor would they trickle down savings to the average American with employee-sponsored insurance.

But a separate report from the CBO said the Recovery Act program that provides incentives to implement electronic health records in hospitals nationwide would save the government more than $12 billion in Medicare and Medicaid costs over the next 10 years.

Though that doesn’t sound like much, considering American consumers, businesses and governments spent approximately $2 trillion on health care last year, other studies show the savings are potentially ten times that amount for the entire health care industry.

Still, that’s just part of the story. Making hospitals more efficient could actually hurt their bottom line. Insurance companies are willing to pay more for longer and more complicated patient treatments, so cutting down on costs may only be part of the solution.

How digital health saves costs. The first, most obvious cost saving comes from the time EHRs save just from turning them on.

Since patient information lives in a database, an electronic health record system means patients don’t need to take the time to explain medical history to new doctors. EHRs help doctors diagnose faster, significantly cut down on the time it takes hospital staff to chart patients’ information and ultimately slash the length of an average patient visit.

A recent study at the Christiana Care emergency room in Wilmington, Del., showed that just having the ability to download and print out a file with a patient’s medical history saved the ER $545 per use, mostly on reduced waiting times.

With payroll generally serving as the single largest hospital expense, the creation of a digital system means hospitals can use their staff more efficiently.

“Doctors are paid by the minute, and they don’t have a clue who the patients are,” said David St. Clair, chief executive of health tech company MEDecision, which conducted the Christiana Care study. “Anything the system can tell them makes workflow easier and faster.”

Beyond the ER, St. Clair estimated that EHR will result in total cost savings of $100 per patient per year. Sudhakar Ram, CEO of health IT firm Mastek, put that figure as high as $200 per patient per year. Mastek recently won a contract to create a central depository for health records for the UK’s National Health Service.

Applied industry-wide, total savings could range up to $100 billion over the next 10 years, according to research group RAND.

Further out, as hospitals fully implement EHR and begin to cut back on duplications, misdoses and medical errors, cost reduction could total as much as $50 billion a year, said Ram.

Cost savings don’t always mean more money. Those same cost reductions ultimately mean hospitals are getting less money.

The health-care system, as currently devised, allows savings for the health insurers, but not for those providing and receiving the care, said David Brailer, chairman of Health Evolution Partners and former health tech czar under President George W. Bush.

“We can influence care in a way that saves money, but we cannot tell you we’ll have a robust return on investment,” said Gail Donovan, chief operating officer for Continuum Health Partners, a New York network of 12 hospitals. Donovan said the network’s 10-year cost for health information technology is $100 million.

Electronic health records cost tens of millions of dollars upfront for a typical hospital to implement. They also take years to set up and hours to train physicians.

“I’m still shocked that there is a business argument for electronic medical records because it kills the very thing that makes hospitals money,” said Brailer. “The way we pay for health care penalizes efficiency.”

Solutions: charge more. St. Clair argues that hospitals that can prove they are saving money and time — and seeing more patients as a result — will be able to convince the insurance industry to pay more for hospitals’ services.

“If hospitals are able to demonstrate savings, they’ve got to charge more money to commercial insurers,” said St. Clair. “The insurers would be happy to do that, because they’re willing to improve the quality of care and don’t want to screw over the hospital in the process. That’s how hospitals will get more profits.”

But Brailer said that’s wishful thinking. He instead advocates for a “pay for performance” system, in which insurers pay hospitals a lot for a job well done and nothing for a bad job. That puts the burden on the hospitals to treat patients well and efficiently, rather than the current system in which hospitals can make more when patients stay sick.

“If we had that system, we wouldn’t need a stimulus plan for EHR, because every hospital would already have one to improve their results,” Brailer said. “Hospitals should be accountable for their results.”

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President Obama held a town hall meeting in New Hampshire today, Tuesday, August 11, in an effort to calm fears over the Democrats’ legislative initiatives to reform healthcare in this country. The meeting was structured, and no visible emotional outbursts were seen as in other meetings with lawmakers across the country.

Obama answered questions posed by attendees, emphatically telling the audience that the current healthcare system solely benefits the insurance industry. With 46 million in the country without health insurance, he tried to reassure his audience that they would be able to keep their current coverage and doctor and that the government would not be “in charge”. Obama hammered on the fact that the government and insurance bureaucrats should not be meddling, that pre-existing conditions will be covered and that insurance companies would not be able to drop or deny coverage or water down coverage. Many of the questions on voter’s minds that were expected to be answered, especially with respect to employers and small businesses, were not addressed.

Numerous recent polls show support for healthcare reform is eroding, and the President’s numbers are dropping as well over fears that a government takeover of our healthcare system in the U.S. will lead to a Canadian style system with long waits for treatments and referrals.

The President’s message today was supposed to address people who already have insurance through their employers and highlight how his proposals would affect them. HAI monitored the town hall meeting and didn’t find the retool of the White House message to have answered those questions. Another town hall meeting with Obama is scheduled for Bozeman, Montana on Friday, and on Saturday, Obama will be in Grand Junction, Colorado.

Meanwhile, the White House has opened a Reality Check website with a viral tool aimed at online healthcare combat on everything from rationing to euthanasia. The website incorporates lessons learned from the Obama presidential campaign, and shows the White House is becoming more aggressive in dispelling what they call misinformation in the healthcare debates.

The August Congressional Recess is not even half over, and Democratic lawmakers are very much at risk of losing control of the public debate over healthcare reform, facing wary constituents and facing a barrage of accusations and criticism over their writing of the legislation prior to leaving Washington. Powerful groups on both sides of the debate are using the August recess to hammer home to lawmakers that there are very serious political consequences to the healthcare issue.

Senators working on a yet to be released draft bill said earlier this week that President Obama would like to get something passed for healthcare reform and then start negotiating in a House-Senate conference committee. Some Democrats support the public option, but it will be a tough sell for Republicans if they want to get a bill through the Senate. The flashpoint in the debate has become the question of whether a healthcare overhaul should include a public option. As the debate rolls on, Americans are questioning what the shape and size of the government’s role in the economy should be, especially on the heels of Congress passing three massive economic stimulus bills.

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