By Jim Dawson

Inside Science News Service

WASHINGTON (ISNS) –The progress and problems in developing a national system of electronic medical records topped the agenda Thursday as the Obama Administration’s “best and brightest” from the world of science, medicine and technology gathered in Washington for the inaugural meeting of the President’s Council of Advisors on Science and Technology (PCAST).

David Blumenthal, the national coordinator for health information technology, said there was an “appalling lack of use of technology” in the U.S. medical record-keeping system. “Only 20 percent of physicians and 10 percent of hospitals have meaningful electronic records,” he told the 21-member panel. The transition from the paper-based medical record-keeping system to an electronic one is a priority in President Barack Obama’s push for health care reform, Blumenthal said, as a way to save money over the long run and improve the quality of health care.

In February, Obama signed the American Recovery and Reinvestment Act, which would put $20 billion toward what Blumenthal called a “completely revised, interoperable, integrated health information system.” The system, which is supposed to be functional by 2014, will actually be many different electronic records systems developed by private companies that meet a host of federal standards and requirements that are currently being developed.

“Paper records put us in a suboptimal position [to improve health care],” said Eric Lander, a co-chair of PCAST and the director of the Broad Institute, a medical genetics research program in Cambridge, Mass., run by both Harvard University and the Massachusetts Institute of Technology. An electronic records system, in addition to allowing a patient’s medical records to be shared among doctors, could allow medical researchers to “mine data and combine data” to do faster, more sophisticated medical studies, he said.

Blumenthal said the point of the system isn’t the technology itself, but how that technology is used. “There is very little about the health care system that doesn’t concern us or that we can’t affect in some way,” he said. “We are enabling information to be more accurate and available at the point of care.”

“Use” is one of three area of concern for the scientists and others developing the records system. The other areas focus on getting doctors and hospitals to adopt the electronic system, and, once they have it, how to use it to efficiently exchange information.

The “adoption” issue addresses the difficult question of “which technology should be used, which [computer] platforms are mostly likely to support innovation and change,” Blumenthal told the committee. “And we have to realize that anything that is adopted now will be primitive by the time this entire system is put into place.”

The “exchange” issue involves a host of questions and problems, he said. Should the records system be centralized? How can the system make medical records easy to study and share among doctors, but at the same time guard the privacy of patients and make them secure? “Privacy and security must be assured,” Blumenthal said.

PCAST member Eric Schmidt, the Chairman of Google, in Mountain View, Calif., asked if patients would own their electronic medical records. Aneesh Chopra, the chief technology officer at the administration’s Office of Science and Technology Policy, replied that patients would be given summaries of their records. Schmidt shook his head and said, “that isn’t the same.”

In describing ways an electronic system could benefit medical research, Chopra noted that 40 percent of the U.S. population will at some point be diagnosed with cancer, “but today less than 5 percent of cancer patients have their information in a shareable form that is suitable for research. Why can’t every cancer patient be treated like someone in a clinical trial?” he asked. With electronic medical records, they could be, he said.

John Glaser, a doctor and advisor to the national coordinator for health information technology, detailed a list of benefits in patient treatment that would come from an electronic records system. The system would allow small hospitals and medical practices to have access to patient information on a more sophisticated, interconnected level, he said.

Patients typically see several doctors and they often assume the doctors are talking to each other. They usually aren’t, he said, but with the new records system they would be. Drug interactions would be more apparent, and treatments and procedures done by one doctor could create patterns that reveal a disease like diabetes to another physician working with the records.

The trick, Blumenthal said, is “structuring the [health] market to use the system and allow for innovation, but also maintain order. And we have to assure privacy and integrity in the system. If someone is talking to their doctor about STDs (sexually transmitted diseases), they want to know their records are secure,” he said.

He concluded by noting that while Denmark and other Scandinavian countries are far ahead of the U.S. in the use of electronic records, “nobody has developed an exchange system [of electronic medical records] in a country that is anything like the U.S. in size, population, cultural value differences, and economic structure.”

“We have to live in the world we have,” he said to the scientists and others working to establish the new system.

Above article published on

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State governments around the country are working to facilitate, and in some cases, enhance, Washington’s stimulus-funded incentives for doctors and hospitals that adopt new health information technology. “A group of the nation’s governors and state officials has released a guide for state implementation of the Health Information Technology for Economic and Clinical Health Act,” the formal name for the portion of the stimulus bill, McKnight’s Long-Term Care News reports. A key recommendation is that state leaders create health information exchanges so providers can readily share information to improve coordination of care (8/7).

Meanwhile, members of the National Lieutenant Governors Association called for support of “advance interoperable health IT and its adoption among providers” in a resolution this week, Modern Healthcare reports. They call on states to adopt systems with the stamp of approval of the Certification Commission for Health Information Technology, a group affiliated with an e-health industry association (DerGurahian, 8/6).

Louisiana went a step further with “a bill that would create a loan program for physicians and hospitals hoping to buy an electronic health record system,” American Medical News reports. The state health department will seek other stimulus funding to seed the loans. The bill also will create the Louisiana Rural Health Information Exchange (Dolan, 8/6). (Other states, such as Maryland, have taken similar action in recent weeks).

At the local level, Florida officials are reviving two e-health projects in the Miami and Palm Beach areas to pursue the stimulus funding, the Sun-Sentinel reports. One project, run by the South Florida Health Information Exchange, had succeeded in digitizing the records for dozens of clinics and setting up protocols to share them with a local hospital, before funding dried up and the program became dormant (LaMendola, 8/6).

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August/07/Health-IT-Fri.aspx

DENIS STAUNTON in Washington

US PRESIDENT Barack Obama has promised to overhaul the American healthcare system by the end of this year – without Republican support if necessary.

Speaking in Indiana after a town hall meeting to promote his economic policies, the president said he would prefer to sign a bipartisan healthcare Bill but it was not yet clear if negotiations with Republicans would prove fruitful.

“Sometime in September we’re going to have to make an assessment,” he told MSNBC. “I promise you, we will pass reform by the end of this year because the American people need it.”

Mr Obama told his audience in Elkhart, which experienced the sharpest unemployment rise in the US last year, that he would issue $2.4 billion in taxpayer grants to create electric cars and tens of thousands of jobs.

“For too long, we failed to invest in this kind of innovative work, even as countries like China and Japan were racing ahead,” he said.

“That’s why this announcement is so important – this represents the largest investment in this kind of technology in American history.”

Mr Obama identified energy, innovation, healthcare and education as the pillars of the new US economy he wants to build from the wreckage of the recession.

“Now, there are a lot of people out there who are looking to defend the status quo. There are those who want to seek political advantage. They want to oppose these efforts.

“Some of them caused the problems that we got now in the first place, and then suddenly they’re blaming other folks for it. They don’t want to be constructive. They don’t want to be constructive; they just want to get in the usual political fights back and forth,” he said to applause.

“But you and I know the truth. We know that even in the hardest times, against the toughest odds, we have never surrendered. We don’t give up. We don’t surrender our fates to chance. We have always endured. We have worked hard, and we have fought for our future.

“Our parents had to fight for their future; our grandparents had to fight for their future. That’s the tradition of America.

“This country wasn’t built just by griping and complaining. It was built by hard work and taking risks. And that’s what we have to do today.”

Republicans, who have opposed all Mr Obama’s key proposals, from the economic stimulus package to healthcare reform, see in the president’s declining popularity an opportunity to make gains in next year’s congressional elections.

“President Obama is now looking like a mere mortal, as opposed to someone who previously exceeded gravity,” said John Cornyn, chairman of the National Republican Senatorial Committee.

“I think there will be a significant number of voters who, leading up to 2010, will wonder if they voted for someone they didn’t get.”

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By JANE ZHANG

Federal health agencies, seeking to hand out stimulus funds to research the effectiveness of various medical treatments, said they will include projects that look in part at the cost of drugs and other treatments.

The approach — which was unveiled in a report to Congress this week by the Agency for Healthcare Research and Quality and the National Institutes of Health, both agencies under the Department of Health and Human Services — could provide more fodder to conservatives worried that the government might use the results of such studies to limit health care to consumers.

Administration officials have said they want to use stimulus funds to help doctors and patients choose more-effective treatments and ultimately, help rein in rising health-care costs. Democrats are considering including measures that would support such research as part of health-care legislation making its way through Congress.

The Agency for Healthcare Research and Quality, which has $300 million to spend on comparative research, mostly in the fiscal year starting Oct. 1, said it would increase funding to projects that focus on arthritis, cancer and 12 other conditions that are often costly to treat.

“This is unprecedented investment in helping clinicians and patients identify what’s the best for them in treatment,” said Carolyn Clancy, the agency’s director, in an interview.

The NIH, which is earmarked to spend $400 million in comparative-treatment studies over two years, will fund projects that include cost as a factor in their studies, said Richard J. Hodes, director of the NIH’s National Institute on Aging.

The NIH has received 1,800 research applications, but hasn’t figured out how many fall under the definition of “comparative effectiveness research,” Dr. Hodes said. The agency will award the first grants in August.

The two agencies don’t set policy, but their work helped officials running government programs such as Medicare, the insurance program for the elderly and disabled, decide which treatments to cover. Nicholas Papas, an HHS spokesman, said under the stimulus law, Medicare can’t use the research to deny coverage to patients.

Above article published on

http://online.wsj.com/article/SB124907957435498005.html

By Sheldon Alberts, Washington Correspondent, Canwest News Service

WASHINGTON — facing possible defeat on his signature domestic policy priority, President Barack Obama appealed on Wednesday for Americans to put aside fears about health care reform and back sweeping changes that include the creation of a government-run medical insurance program.

During a prime time news conference in which he linked passage of health care legislation to the nation’s overall economic stability, Mr. Obama also claimed his administration’s controversial US$787-billion stimulus package and financial industry bailouts had all but rescued the American economy from collapse.

“As a result of the action we took in those first weeks (in office), we have been able to pull our economy back from the brink,” Mr. Obama said.

The president’s declaration of victory in the fight to save the economy came amid a wave of recent criticisms that the stimulus has done little to stem the tide of job losses. It’s expected the U.S. unemployment rate could rise above 10% later this year.

“We still have a long way to go,” Mr. Obama acknowledged. “I’ll be honest with you – new hiring is always one of the last things to bounce back after a recession.”

With Congress now wavering on White House demands to pass a US$1-trillion-plus health care bill before the fall, Mr. Obama warned a failure to overhaul the system now will lead to ballooning costs and force millions of more Americans to lose their coverage over the next decade.

“If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket,” Mr. Obama said. “If we do not act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction.”

Answering Republican opponents who this week predicted the health care issue would be his “Waterloo,” Mr. Obama made a defiant prediction: “We will do it this year.”

Mr. Obama’s decision to spend precious political capital by making a personal health care plea to Americans – it was his fourth prime time press conference since taking office in January — came as the White House struggled to keep conservative Democrats from abandoning him on the issue.

The most contentious elements of the health plan include a proposal to pay for health reform by taxing the wealthiest Americans, and the politically risky idea of launching a publicly-run health insurance system that competes directly with U.S. private insurers.

Already, leaders of one key House of Representatives Committee have put off voting on a version of the legislation after admitting they lacked enough support from Republicans and Democrats to get it passed.

In the Senate, meantime, Democrats who control the committees crafting health care legislation say Mr. Obama’s August deadline for passage of a bill is too ambitious. They argue there is no need to rush, especially with Americans increasingly wary of the price tag.

“I think it’s important that there be pressure (from the president). Otherwise sometimes things tend to drift,” said Senator Kent Conrad, a North Dakota Democrat and a member of the Senate finance committee.

“But this is hard. There’s just no way around it.”

Countered Mr. Obama: “If you don’t set deadlines in this town, things don’t happen. The default position is inertia.”

The nervousness among some Democratic lawmakers has been triggered, in part, by a series of polls showing the country is not sold on Mr. Obama’s plan.

A Rasmussen survey released Wednesday showed just 44% of Americans in favour of health reform proposals – even though a detailed bill has yet to emerge from Congress – while 53% are against.

But Mr. Obama cast the U.S. health system as broken and increasingly unaffordable. Americans spend $2.5-trillion a year on health care and yet 47-million residents go without medical insurance.

Ballooning costs of existing government health programs – Medicare for Americans 65 and over, and Medicaid for the poorest U.S. citizens – are weighing down the federal balance sheet, Mr. Obama said.

“Let me be clear: if we do not control these costs, we will not be able to control our deficit,” he said.

Mr. Obama has accused Republicans of fuelling public concern with misleading claims that his reforms would set the U.S. on a path to government-run, single-payer health care — with Canadian medicare being offered as the ‘socialized’ medicine Americans must avoid at all costs.

“What the heck do we want to become England or Canada for,” Rudy Giuliani, the former New York mayor and failed Republican presidential candidate, said Wednesday in a televised interview.

Mr. Obama dismissed the idea of a government takeover of health care, saying a public insurance system would complement, not replace, private companies.

“It will keep government out of health care decisions, giving you the option to keep your (private) insurance if you’re happy with it,” he said.

Other Republicans have cast the health care battle as their best chance to deal Mr. Obama, whose personal approval ratings have slipped under 60%, a crippling political blow just six months into his presidency.

“We need to put the brakes on this president. He’s been on a spending spree since he took office,” Senator Jim DeMint, a South Carolina Republican, told NBC’s Today Show.

“It’s not personal. But we’ve got to stop his policies … They’re loading trillions of dollars of debt onto the American people.”

Above article published on http://www.vancouversun.com/health/Obama+asks+Americans+aside+
health+care+fears/1817740/story.html

By Matthew DoBias

President Barack Obama moved to stem growing criticism of his blueprint to overhaul the U.S. healthcare system, warning a national audience not to “become consumed in the game of politics” and underscoring the potential benefits everyday individuals could reap under a wholly reformed system.

In a news briefing that focused almost entirely on healthcare, the president tried to put the focus on the personal rather than the political.

“My hope is, and I’m confident that, when people look at the cost of doing nothing, they’re going to say, ‘We can make this happen. We’ve made big changes before that resulted in a better life for the American people,’” Obama said.

Over the past three weeks, Obama’s push to fundamentally change how care is provided and paid for has come under attack from a bloc of fiscally conservative Democrats, stalwart Republicans and both right- and left-leaning interest groups.

Longtime policy shapers have begun to tie the president’s upstart reform efforts to one that failed spectacularly in the early 1990s. Such comparisons could prove to be as damaging as any legislative setback or missed deadline.

The president reiterated a pledge not to support any new taxes that would hit the middle class. His steadfast opposition to a tax on health benefits has rankled some lawmakers who had hopes of using such a levy to help defray the expected $1 trillion overhaul price tag.

“If I see a proposal that is primarily funded through taxing middle-class families, I’m going to be opposed to it,” he said. But, he added that he’s open to other tax proposals now being hashed out by congressional leaders.

And Obama also backed a measure that would give the Medicare Payment Advisory Commission expanded powers to enact many of its payment recommendations with limited chances for Congress to alter such proposals

Above article published on http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090722/
REG/307229963&AssignSessionID=173353830933946

More than 50% of healthcare providers surveyed by IVANS do not believe the federal stimulus package will successfully encourage health IT adoption.

By Marianne Kolbasuk McGee InformationWeek

Although a majority of healthcare providers remain skeptical about how they’ll benefit by the federal government’s $20 billion stimulus program, many plan to forge ahead anyway, according to a report released this week.

About seven in 10 healthcare providers believe electronic medical records will have a positive impact on their businesses and patient care, but 80% say the lack of money is their biggest obstacle to deploying health IT systems, said the new report by IVANS, a supplier of EDI and network services to the insurance industry.

The nationwide, e-mailed survey of 508 healthcare providers — including hospitals, clinics, private medical practices, nursing homes, home healthcare organizations and medical billing companies — found that while nearly 40% plan to forge ahead with e-medical record deployments within the next 12 months, more than 50% of healthcare providers do not believe the federal stimulus package will successfully encourage health IT adoption.

Healthcare providers’ doubt appears to be rooted to several factor, most notably uncertainty about the specifics of the government’s eligibility requirements for receiving HIT-related rewards. Starting in 2011, the federal government is expected to begin awarding approximately $20 billion over the next five years, rewarding higher Medicare and Medicaid reimbursements to doctors and hospitals that demonstrate “meaningful use” of health IT.

However, the details of what will constitute “meaningful use” haven’t been worked out yet. The federal government is in the process of investigating and defining the scope of what “meaningful use” of health IT will qualify for the American Recovery and Reinvestment Act of 2009’s HITECH (Health Information Technology for Economic and Clinical Health) stimulus funding incentives. Just this week, a federal advisory panel — the HIT Policy Committee — unveiled some of its recommendations for the “meaningful use” definition.

“They’re on the right track,” said Clare DeNicola, IVANS CEO, of the HIT Policy Committee’s recommendation so far to the U.S. Dept. of Health and Human Services about the “meaningful use” definition. “It’s not about technology, it’s about the care — we can’t lose sight of that,” she said about the committee’s suggestions for how IT can be used for improving quality of patient care and public health.

Also fueling uncertainty among healthcare providers participating in the survey was this: Home healthcare providers and nursing homes were among the 508, healthcare providers polled. However, so far the HITECH federal stimulus legislations is vague on how those healthcare providers will participate in the new programs, despite the growing population of aging baby boomers who’ll likely increasingly require their services in coming years.

In fact, despite their skepticism and uncertainly about the government incentive programs, about four in 10 healthcare providers are planning to implement e-medical record systems over the next 12 months.

Many are already making investments in IT, including those that can help support e-medical record deployments, including wireless networks, business continuity technologies and connectivity to remote locations.

“Healthcare providers are wary but they are moving forward with technology innovations,” said DeNicola. “They’re not driven so much by the stimulus funds as they are in their belief that these technologies can help improve their businesses and patient care,” she said.

Finally, when survey participants were asked who should take the lead on driving adoption of healthcare IT to ensure its success, 47% of healthcare providers named themselves; 21% suggested the government should lead; 14% said healthcare insurers/payers should have that responsibility; and 18% were divided between industry associations and consumers leading the charge, according to the report.

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By KRISTEN WYATT
ASSOCIATED PRESS WRITER

COLORADO SPRINGS, Colo. — Homeless teenagers at a central Colorado shelter are feeling the effect of the government’s economic stimulus package. It’s the feeling of a dentist’s drill.

The 20 runaway youths living at the Urban Peak shelter had no regular dental care until this spring, when a $1.3 million stimulus grant to a community health center paid for a mobile dental and medical clinic to visit once a month. The residents now get medical and dental screenings, and cavities filled, right from their shelter’s parking lot.

“I knew my teeth needed to be fixed but I had no money,” says Michelle Daulton, 18, who has been living at the shelter for about four months and hadn’t seen a dentist since she was 13.

Now she’s had three chipped teeth repaired. “It was absolute and pure relief, I mean that,” she said.

From the Colorado homeless shelter to rural Pennsylvania clinics that can accept new patients, health centers that serve the poor are among the first places the federal stimulus package is being spent.

The stimulus law sets aside $2.5 billion for free and low-cost health clinics, and a big chunk of it - about $500 million - is already being spent. The White House has promised another burst of money this summer.

“This has really been a boost for us,” said Bob DeFelice, CEO of First Choice Community Health Care. “It’s allowed a level of stability in some very difficult times.” DeFelice’s group runs nine community health clinics around Albuquerque, N.M., and used a $703,000 grant to hire two physicians and four support staffers.

Health clinic executives say the money will allow them to keep their doors open as the rolls of uninsured patients grow. An estimated 64 million people use rural health clinics, a number that is expected to rise as people lose their jobs and health insurance.

“We’re seeing more and more people,” said Edward Michael, president of the Rural Health Corp. in Wilkes-Barre, Pa. The six-clinic group in northeastern Pennsylvania had no room for new patients until it received a $311,000 grant in April. Now, Michael says, his clinics can expand from seeing 18,000 patients last year to 19,000 this year.

“You know, we weren’t there back in the Depression, so we never experienced being back in the ’30s standing in line for food, standing in line for a doctor,” Michael said. “This money is really going to prevent a lot of long-term hardship.”

The health clinic grants are one-time boosts, not long term health care fixes. The stimulus won’t make up for a lack of doctors in poor and rural areas, a shortage the Association of American Medical Colleges says is growing and could reach 159,000 doctors by 2025.

“I look at the stimulus bill as one step to health care reform,” said Maggie Elehwany, vice president for government affairs and policy at the Washington-based National Rural Health Association. “It isn’t everything.”

While Congress considers a health care overhaul, clinic workers hope just to keep up with basic needs such as vaccinations and exams.

“I can’t imagine not having the stimulus money right now because we wouldn’t be able to do any of this,” said Nicole Noll, who drives the mobile health clinic to the teen homeless shelter and rural elementary schools.

The van was provided by Ronald McDonald House Charities. But stimulus money pays for Noll, the doctors and the dentists.

Far more than a brighter smile can be at stake in dentistry. In Maryland, a 12-year-old boy whose Medicaid coverage had lapsed, Deamonte Driver, died in 2007 after bacteria from the abscess of an aching tooth spread to his brain. An $80 tooth extraction might have saved his life.

“I’m so glad they did this,” Michelle Daulton said. “My parents were cheap. They never took me to the dentist. And when you don’t have any money, your teeth, you just leave ‘em alone. Not anymore.”

Above article published on

http://www.seattlepi.com/national/1110ap_stimulus_health_clinics.html

By Joseph Conn / HITS staff writer

Part two of a two-part series (Access part one):

The Certification Commission for Healthcare Information Technology has put on hold the rollout of its new sets of completed testing criteria for multiple health IT systems while it waits for HHS to release its plans for certifying IT under the American Recovery and Reinvestment Act of 2009, also called the stimulus law.

Earlier this month, CCHIT announced it had completed work on updated versions of test scripts and criteria for use in the 2009-10 round of testing and certification.

The commission also announced it will publish in either June or July an updated certification handbook explaining the testing and certification process. But CCHIT Chairman Mark Leavitt said that it won’t be taking applications from IT vendors for testing and certifying their electronic health record and other systems until HHS acts

Leavitt said that CCHIT will defer launch of its 2009-10 testing programs until its people have had a chance to look at the initial batch of HHS-approved criteria under the stimulus act. The law mandates the creation of an HIT Policy Committee and an HIT Standards Committee to develop and review IT certification criteria as well as health information transmission standards and implementation specifications.

“The policy and standards committees have some very tight deadlines,” Leavitt said.

“HHS has to take it through a public rulemaking and then it goes to OMB,” Leavitt said, referring to the White House’s Office of Management and Budget.

To keep the whole process on schedule, the policy and standards committees have to be done with their work by Aug 21, Leavitt said. “Since we want to conform our process to what those committees’ recommendations are, we want to hold our process,” until the committees’ work is completed. “They may want to add or subtract something. This will give us a chance to adapt the 2009-2010 process” to the stimulus act.

Initially, CCHIT certification lasted for three years, but testing was updated annually. Going forward, Leavitt said, he’s guessing certification will be on a two-year cycle.

CCHIT has been criticized in some quarters for certifying systems only on functionality, but not ease of use. Leavitt said that CCHIT is “beginning to investigate how to test usability.”

“There are a number of ways to do it, but we have to look for ways that are objective, that we can repeat,” Leavitt said.

One way, Leavitt said, would be to “look for the most common tasks and then count the number of clicks to do those tasks.” Those would include what Leavitt, himself a physician, calls “the speed-dial tasks in a physician’s office,” including refilling a prescription or taking a history on a new patient.

“You test that part of the product and you literally time it,” Leavitt said. Vendors could be asked to bring in their systems and their best user and test them on these common tasks. “If it takes 150 clicks and 10 minutes, you have a big problem.

“The other end of the spectrum is you survey users,” Leavitt said. “We ask the vendors for 10 sites. We want to see at least one that’s measuring quality, or using (the system) to manage chronic disease. Or even do a survey as part of the reimbursement payment process.”

The survey results could provide data on how many customers of a given system have applied for reimbursement under the “meaningful use” standard in the stimulus act vs. how many have qualified under that standard.

Leavitt said that the new certification criteria for 2009-10 have “a big focus on interoperability, including a requirement that EHRs be able to input and store data using the Continuity of Care Document format developed by standards development organizations Health Level 7 in collaboration with ASTM International.

Another test area—an option, not a requirement this year—will be whether the systems incorporate the interoperability specification approved by the federally supported Healthcare Information Technology Standards Panel that deals with querying another data source, such as a health information exchange, for the existence of patient records.

“If they do it, we give them a gold star and everyone will know it, but if they don’t, they’ll still get certified,” Leavitt said.

Another testing requirement that was on the CCHIT road map for inclusion in future certification criteria was that all EHRs be able to link the diagnosis code with an electronic prescription and be able to communicate the diagnosis code and prescription information together in a single electronic prescription sent to a drugstore or pharmacy benefit manager outside the physician’s practice.

The American Medical Association has a long-standing and oft-reaffirmed policy against any requirement to include diagnosis codes on prescriptions “to protect patient confidentiality and to minimize administrative burdens.”

According to a grid of CCHIT testing criteria posted on the organization’s Web site, the specific listing of this testing requirement “will be removed in 2009 when the corresponding Foundation criterion is tested.” The requirement itself isn’t being eliminated, however.

Leavitt said that by requiring EHRs be able to combine prescription data with a patient’s diagnosis doesn’t mean physicians will be forced to do so.

“The AMA doesn’t want you to provide it. Fine. Don’t provide it,” Leavitt said. “That’s a policy decision, so go ahead and fight that one out.”

But there are safety benefits, Leavitt said, allowing a second set of eyes to review the applicability of the prescription for the specified diagnosis. “It’s a potential way to reduce errors.” And there are financial considerations. “For some medications, in some prescribing situations, you’re required to do it. I believe it has to do with health plans qualifying patients to be on a medication.”

Another controversial requirement that was originally proposed as a separate line item in the 2009 criteria would require building into EHRs a back door to allow access by insurance companies for fraud control. The requirement would make EHRs conform to a recommendations in the 2007, HHS-funded report by RTI International “Recommended Requirements for Enhancing Data Quality in Electronic Health Records Systems,” which, despite the title, primarily dealt with the issue of medical billing and payment fraud control.

According to CCHIT spokeswoman Sue Reber, that specific testing criterion also was de-listed—but not eliminated—sometime before the first draft of the 2009 criteria was published “because it is redundant with existing security criteria in the area of ‘access control.’ ”

Above article published on

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By Steven Kraus, DC, DIBCN, CCSP, FASA

This spring, I traveled extensively to Washington, D.C., for a variety of reasons, mainly to advocate on behalf of chiropractic physicians as our government initiates massive health care reform efforts.

I attended the HL-7 Conference, which is an invitation-only gathering of health care officials dedicated to setting the programming standards for health information exchanges (HIEs) and standards for required data for electronic health records (EHRs).

The conference, sponsored by the Agency for Healthcare Research and Quality, has historically been limited to hospital and allopathic audiences. This year’s group was expanded for the first time to include other health care experts, and I was the designee from the chiropractic profession. My goal and commitment to the profession remains clear: I want to ensure that the interests of chiropractic physicians are considered in any and all discussions related to policy-making for health care information technology. And in the case of HL-7, chiropractic participation is critical so the concerns of our profession with regard to the development of HIEs will be heard.

The catalyst for broadening this conference audience was presumably the economic stimulus package, formally known as the American Recovery and Reinvestment Act (ARRA) of 2009, which includes more than $19 billion to fund the introduction of electronic health records in every physician office in America. The section of the ARRA that deals specifically with this appropriation is the HITECH Act, which outlines the requirements for funding eligibility. To be qualified for incentive payments offered through the legislation, doctors must adopt qualified EHRs that have the functionality to communicate with HIEs, making the standards by which HIEs are governed extremely important and elevating the prominence of interfacing capabilities with other systems.

I’ll discuss more about the requirements for incentive payments later in this article, but the main reason I share my involvement with the creation of health care information technology standards is to demonstrate how the general health care industry is finally opening its arms to the chiropractic profession. We’ve been dancing on the periphery for years, but finally, we are gaining recognition as an essential component of health care delivery and actively participating in these important discussions regarding policy, standards and reform.

Reform = Collaboration + Technology

Speaking of reform, during that same visit to D.C., I also met with Sen. Tom Harkin’s staffers as well as government relations personnel from the American Chiropractic Association to discuss the evolving model of reform for our health care system. As I shared in a previous column, elements of several models are under consideration including the Medical Home Model, which relies heavily on collaboration among health care professionals in order to improve the quality of patient care. Harkin and several of his colleagues are outlining a comprehensive national health care reform plan we can expect to be introduced later this year.

The cornerstone of that plan will be collaboration, and the framework to support collaboration will be driven by technology. While many uncertainties still remain, these two elements are certain. And with collaboration at the forefront, Harkin and others understand that chiropractic physicians and other nonmedical providers are an integral element of national reform. The reform movement is committed to supporting true wellness, something doctors of chiropractic have been preaching for years.

Now it’s time for us to rise to the occasion and continue walking our talk, while we have people watching us and listening. The first step in walking the talk is adopting EHRs. Why? Because technology will create the path to collaboration by assisting case management through registries, database queries, instant access to information, alerts and reminders, and all the related tools the digital age provides us. We need technology to form the health care teams that will improve patient care for every American.

With the anticipated health care reform model so heavily reliant on technology, those who do not adopt an EHR will be left out of the health care framework. In fact, the government is emphasizing the critical role an EHR will play in successful reform so heavily that it is funding the digital transition in its entirety. In order to adapt to the new model of health care, we must adopt an EHR. Since the government will pay for our EHR (up to $44,000 for each physician), we’re simply being asked to fund the energy and effort to implement it. Seems like more than a fair deal to me.

How to Access Your $44,000 Incentive

As I mentioned earlier, the process to fund your EHR is structured through incentive payments to physicians who adopt such systems. Not all health care professionals will be eligible for incentive payments, but doctors of chiropractic are an approved group, as they are covered by the Social Security code defining physicians, which the ARRA is using as its definition.

Two major areas will be evaluated by our government when determining payment approvals. First, the EHR system must be qualified, and second, the system must be used meaningfully by the chiropractic physician. A qualified EHR system must have the capacity to handle patient demographics and clinical health information, and also must have clinic management capabilities, as outlined by the entity that certifies qualified EHR. Only a certified EHR system will be eligible. The certifying body has not yet been announced, but the industry anticipates that the Certification Commission for Healthcare Information Technology (CCHIT) will be the likely choice since it was approved in 2006 by the government’s Office of the National Coordinator of Health Care Information Technology and Medicare to manage such efforts.

The second requirement, “meaningful use,” is determined by three important measures: (1) connectivity to health information exchanges and other EHR systems so they can share information when authorized by the patient; (2) regular reporting of quality measures to the Centers for Medicare & Medicaid Services (CMS), including capturing outcome assessments and performance of pain assessments; and (3) e-prescribing capability. Because we don’t have prescribing privileges, it is unknown at this time whether this will remain a requirement for doctors of chiropractic. With regard to reporting requirements, the general structure of the plan suggests that reporting of quality measures will likely be managed by the PQRI (Physicians’ Quality Reporting Initiative), a standardized mechanism that already exists.

As much as $44,000 can be paid as an incentive to a doctor for investing in a qualified EHR system. And in clinics with multiple physicians, each physician can qualify for the incentives, as long as the aforementioned terms are met. And while we know that CMS will be involved, its specific role is still being evaluated with regard to reporting and eligibility requirements for doctors participating in the incentive program. For example, minimum billing thresholds such as an annual $25,000 in covered services to CMS are being considered in order to be eligible for the incentive payments. However, there is some discussion on consideration for proportionate payments if the threshold is not met. So, if you average 16 Medicare patient visits a week, you would likely qualify. I will follow-up on this issue in a future article once the policies and standards relating to the Department of Health and Human Services and Medicare have been formally released.

To access the full $44,000, which is paid through Medicare in stages (four annual installments starting in 2011), the EHR system has to be qualified and used in a meaningful way starting in 2010. To clarify the timing, it is necessary to explain PQRI’s influence on the process. PQRI, which is expected to oversee reporting requirements, currently requires reporting on at least 80 percent of patients. To accommodate this requirement, the EHR system would need to be in use for the majority of the year prior to the first incentive payment, assuming adherence to PQRI standards will be required. Hence, EHR implementation in 2010 is necessary in order to receive an $18,000 first payment in 2011 and maximize the incentives available.

For new users, implementation of an EHR system typically requires 90 days to six months. Given the expectation that meaningful use will be necessary for the better part of 2010 in order to get a 2011 incentive payment, the implementation process for chiropractic physicians should begin promptly in 2009. Those who had the vision to implement a qualified EHR and can demonstrate meaningful use are already eligible for the full incentive payments.

Penalties for Not Transitioning to EHR

The Evolving Health Care Landscape: Technology Front and Center Those who choose not to transition to an EHR system will be penalized beginning 2015 and continuing through 2018. These penalties will be assessed through a reduction in your Medicare claims reimbursement on services billed. To further motivate adoption, some states have already passed laws that mandate EHR use after 2014 in order to attain a license to practice or to renew a license, concurrent with the stimulus plan. With financial and legal ramifications in play, the incentives to adopt an EHR now are enormous.

The Reform Cube

Given the benefits the government is providing chiropractic physicians, it is a wonder that any of us are still waiting to implement EHR. If the financial incentives are not enough motivation, doctors of chiropractic must consider what role they will play in the health care reform cube. Our health care landscape will soon shift to a different model; consider a cube in which quality, cost, and delivery of care through collaboration and access exist at each point, while technology sits squarely in the middle. Technology improves quality by offering reminders, alerts and other assistive techniques; technology lowers costs by reducing duplication of services; and technology improves collaboration and access by providing a mechanism to share patient health information across all providers. All of this allows for a robust clinic management system.

As chiropractic physicians, we strive to improve quality, we seek to reduce costs, and we crave the opportunity to collaborate on the health care team, so the cube is the ideal home for us. When we adopt the proper technology, we gain not only substantial financial support, but also membership in the cube. And isn’t membership what we’ve been asking for from the health care community all these years? This membership is not for the sake of privilege, but for the sake of having other providers refer patients to receive the benefit of chiropractic care, achieve wellness, and experience cost-effective and efficacious care naturally. Accept the invitation now - it won’t be offered again.

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