By Neil Versel

Dr. David Blumenthal has been national coordinator for health information technology for a little more than six months now, and for all the health IT meetings I go to, teleconferences I listen in on and webinars I participate in, Wednesday was the first time I’d had the opportunity to hear him speak.

In delivering the opening keynote to the College of Healthcare Information Management Executives (CHIME) Fall CIO Forum in Indian Wells, Calif., Blumenthal didn’t break a whole lot of new ground, but he did bring the national EMR strategy into sharper focus, give an update on some progress within the federal government, demonstrate his deep passion for healthcare quality improvement, and even put the vendor community on notice. (See the story in this week’s issue for more on his vendor-related comments.)

“You all are the very core of our success,” Blumenthal told this gathering of CIOs in the California desert. It was nothing they didn’t already know. He did say, however, that even without the healthcare reform being debated in Washington right now, the HITECH Act–the health IT portion of the American Recovery and Reinvestment Act–still is “unprecedented” in the scope of change it will effect.

Blumenthal highlighted four things that flow from HITECH: “meaningful use” of EMRs–something we all know about; the Health IT Policy Committee and Health IT Standards Committee to advise HHS; privacy and security of health data, symbolized by the tightening of HIPAA; and, of course, the federal subsidy program. Blumenthal believes that the last point probably gets more attention than it deserves. “There’s the money, which is important, but it isn’t the whole thing,” he said.

“What Congress has basically asked us to do with this legislation is to change the practice of medicine,” Blumenthal said. “It’s really a matter of change management rather than technology.”

Blumenthal is prohibited by federal ethics standards from discussing deliberations on the forthcoming parameters for meaningful use, but he reiterated that a proposed rule will be out by the end of the year, and that HHS is still on target to finalize the definition next spring, following a 60-day public comment period on the proposal. He also said that his office is talking with other federal agencies with experience encrypting and securing sensitive electronic data, something that will be hugely important in healthcare as more patient information is computerized.

Blumenthal added that the health IT extension centers will be modeled after the long-established USDA Agricultural Extension Service. “This is all about technology transfer from government to industry,” he said. He also called on the hundreds of healthcare CIOs in attendance to provide leadership and educate hospital CEOs about the importance of

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By Mary Mosquera

The National Institutes of Health awarded Kaiser Permanente $54 million in grants for projects that will tap clinical information from the provider’s mammoth electronic health record database to study links between genes and conditions such as heart disease, obesity, diabetes and aging.

The NIH funding originated with the HITECH Act, which allocated $400 million to NIH to support comparative effectiveness research.

The largest of the 22 awards provides $24.8 million to study the influence of genes and the environment on health, disease and longevity over time and across diverse groups of people. The grants will fund genotyping of 100,000 Kaiser members in Northern California. The University of California in San Francisco is also a partner in the research.

The analysis will link genetic information with historical clinical data taken from health surveys and Kaiser’s electronic health record database, according to Raymond Baxter, senior vice president for Kaiser. Researchers will add to the study environmental information, such as air and water quality and proximity to parks and healthy foods.

Dr. Richard Hodes, NIA director of the National Institute on Aging, said genetic information generated by the project may help researchers discover genetic factors that explain differences between people in response to medications.

“This would help doctors provide patients with the best medicines for them individually,” he said.

The grant package included $7.2 million in funding to develop a cardiovascular surveillance system for a collaborative of 14 different health plans across the U.S.

A $3.3 million grant will create a National Research Database to organize Kaiser Permanente’s electronic health records.

A $1,005,372 portion of the funding will be used to integrate the Kaiser Permanente electronic medical record to measure rehabilitation outcomes for stroke patients. Another $99,971 was allocated to study the use of natural language processing to extract data from the electronic medical record.

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By Neil Versel

The Health Resources and Services Administration is allocating some of its $2 billion in federal stimulus funding to help safety-net healthcare providers purchase EMRs and other health IT. This week, the HHS agency awarded $27.8 million in grants to 27 organizations that serve low-income and uninsured populations. The majority of the money–$22.6 million, covering 18 grants–will go toward EMR implementation projects. Another five of the grants are meant to help organizations that already have EMRs use their systems to improve patient outcomes, while others will go toward health information exchange.

“The grants make sure that our most vulnerable citizens will benefit from health information technology,” national health IT coordinator Dr. David Blumenthal says. The Office of the National Coordinator for Health Information Technology will coordinate the awards alongside the $1.2 billion ONC is allocating to state-level health information exchange and health IT extension centers.

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By Wendy Johnson

Physician practices and hospitals that have yet to select or implement an EMR system should get a move on. Those who wait until next year will face a “high risk” of failing to achieve “meaningful use” of health IT in time for the 2011-12 federal incentives, Mark Leavitt, chairman of the Certification Commission for Healthcare Information Technology, warned at the annual AHIMA conference on Monday in Grapevine, Texas.

“You’re dreaming if you think you can achieve it in less than a year,” Leavitt said, referring to hospitals. Achieving meaningful use of an EMR system will take at least 18 months, if not two years, he warned.

HHS expects to publish its criteria for certification of EMRs under the American Recovery and Reinvestment Act, as well as its definition of “‘meaningful use” for qualifying for ARRA Incentives, by the end of the year. Both measures should be finalized by spring 2010 after a public comment period. All told, the federal government will pony up $34 billion in incentives for meaningful use of certified EMR technology–the equivalent of what the U.S. spent to send the first man to the moon, Leavitt said.

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HHS Secretary Kathleen Sebelius today announced awards totaling $27.8 million to health center-controlled networks and large multi-site health centers to implement electronic health records (EHR) and other health information technology (HIT) innovations. The funds are part of the $2 billion allotted to HHS’ Health Resources and Services Administration (HRSA) under the American Recovery and Reinvestment Act of 2009 (ARRA) to expand health care services to low-income and uninsured individuals through its health center program.

“The increased use of health information technology is a key focus of our reform efforts because it will help to improve the safety and quality of health care generally while also cutting waste out of the system,” said Secretary Sebelius.

“These funds to expand and upgrade electronic health records systems will make a huge difference for health centers struggling to provide health care to the growing number of people in need,” said HRSA Administrator Mary Wakefield, Ph.D., R.N.

“Broad use of health information technology has the potential to improve health care quality, prevent medical errors, and increase the efficiency of care provision,” added David Blumenthal, National Coordinator for Health Information Technology. “This program supports the Department’s overall efforts to assist physicians and hospitals in adopting and becoming meaningful users of health information technology.”

Eighteen grants totaling more than $22.6 million will support EHR implementation. Grants totaling more than $2.6 million will help four grantees implement a variety of HIT innovations, including the creation of health information exchanges among different providers and the incorporation of HIT at dental delivery sites. Another five grants totaling over $2.5 million will help health centers devise plans to use existing EHRs to improve patient health outcomes.

HRSA received $2 billion through the Recovery Act to expand health care services to low-income and uninsured individuals through its health center program. To date, more than $1.3 billion of these funds have been awarded to community-based organizations across the country. HRSA-supported health centers treated 17 million patients in 2008, 40 percent of whom have no health insurance.

In addition, HRSA received $500 million in Recovery Act workforce funds—$300 million to expand the National Health Service Corps (NHSC) and another $200 million for other health care workforce programs. The NHSC funds will pay for student loan repayments for primary care medical, dental, and mental health clinicians who will practice for a minimum of two years in NHSC sites that treat underserved and uninsured people. Recently, awards totaling $33 million—part of the $200 million total—were announced to expand the training of health care professionals.

The list of grant recipients follows:

alth Resources and Services Administration (HRSA), part of the U. S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable.  For more information about HRSA and its programs, visit www.hrsa.gov.

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http://www.hhs.gov/news/press/2009pres/09/20090929a.html

By the Associated Press

President Barack Obama, faced with falling approval ratings and increasingly impatient with Senate negotiations over health care, is weighing a shift in strategy that would offer more details of his goals for overhauling the nation’s healthcare system.

The president is considering a speech in the next week or so in which he would be “more prescriptive” about what he feels Congress must include in a bill, top adviser David Axelrod said Tuesday in an interview. The speech might occur before the Sept. 15 deadline the White House gave to Senate negotiators to seek a bipartisan bill, Axelrod said. He suggested that two key Republicans have not bargained in good faith.

Congress reconvenes next Tuesday after an August recess in which critics of Obama’s health proposals dominated many public forums.

Some Obama allies, watching his approval ratings tumble in polls along with support for a healthcare overhaul, have urged the president to take a more hands-on approach. They feel he gave too much leeway to Congress, where one bill has passed three House committees, another has passed a Senate committee and a third has been bogged down in protracted negotiations in the Senate Finance Committee.

Axelrod indicated that Obama would not offer new proposals but would be more specific about his top priorities.

“The ideas are all there on the table,” Axelrod said. “Now we are in a new phase, and it’s time to pull the strands of these together.”

He said there is serious discussion in the White House of Obama “giving a speech that lays out in specific ways what he thinks” about the essential elements of a healthcare bill.

Axelrod said it was possible that the speech could occur before a planned Sept. 15 Obama address on healthcare in Pittsburgh.

Obama has called for innovations such as a public health insurance plan to compete with private insurers, but he has not insisted on it. It was not clear Tuesday the degree to which he might press for various proposals in a new speech.

Obama also plans to meet with Democratic congressional leaders on Tuesday.

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http://www.modernhealthcare.com/article/20090902/REG/309029973/-

By Neil Versel

There’s a lot more going on with the health IT portion of the stimulus than just the back-and-forth over defining “meaningful use” of EMRs. For example, there’s the Medicaid option for physicians, who can earn up to $63,750 each, rather than the $44,000 maximum through Medicare, if they have a large Medicaid patient pool.

CMS is prepping for the Medicaid incentives by informing states that they can apply now for federal funding to cover 90 percent of their administrative planning. A letter that went to state Medicaid directors this week also says that states must take steps to make sure provider EMRs are compatible with state or federal administrative systems for electronic claims submission, that states should consider Medicaid planning in the context of statewide health IT programs and that states should coordinate any incentive-related activities with regional CMS offices.

CMS promises additional guidance as it becomes available and says the federal agency before the end of the year will publish proposed regulations addressing the issues raised in the letter.

To learn more about federal-state collaboration on Medicaid EMR incentives:

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Source: US National Governors’ Association

As the national dialogue on health care reform continues, health information technology (IT) and health information exchange (HIE) have emerged as critical means to ensuring a health care system that is affordable, effective, safe and transparent. A new report from the State Alliance for e-Health, Preparing to Implement HITECH: A State Guide for Electronic Health Information Exchange, aims to help states lead the way in using health IT and HIE and guide them as they begin instituting the federal Health Information Technology for Economic and Clinical Health (HITECH) Act.

The State Alliance for e-Health, a consensus-based, executive-level body composed of governors, state legislators, attorney generals and state commissioners, was created by the NGA Center for Best Practices in 2006 to address the unique role states can play in facilitating adoption of health IT and HIE. The HITECH Act, enacted as part of the 2009 American Recovery and Reinvestment Act, expands the role of states in fostering health information exchange and adoption of electronic health records over the next five years.

“Governors understand that swift and thoughtful action is needed at the state level to plan and implement a national system of health information exchange, “said Tennessee Gov. Phil Bredesen, co-chair of the State Alliance. “Widespread adoption and use of electronic health records provide a critical foundation for improving health outcomes and cost-effectiveness.”

The report recommends actions states should begin undertaking now to successfully implement the HITECH Act, including:

• Preparing or updating the state plan for HIE adoption;
• Engaging stakeholders;
• Establishing a state leadership office to manage the different phases of HIE implementation;
• Preparing state agencies to participate; implementing privacy strategies and reforms;
• Determining the HIE business model;
• Creating a communications strategy; and
• Establishing opportunities for health IT training and education.

“States already have taken the lead in modernizing the health care system by advancing the use of health IT, electronic health records, e-prescribing and electronic exchange of health information,” said Vermont Gov. Jim Douglas, NGA Chair and co-chair of the State Alliance. “We now have an opportunity to accelerate adoption of health IT across the states and create a truly comprehensive health care system that is effective, affordable and accountable.”

The report and state initiatives to implement health IT and electronic HIE will provide a central focus for the State Alliance for e-Health’s semi-annual conference, to be held August 7 in Burlington Vermont.

The State Alliance – supported by funding from the U.S. Department of Health and Human Services – provides a nationwide forum through which governors, state policymakers and other stakeholders can work together to identify effective HIT policies and best practices and explore solutions to challenges related to the exchange of health information.

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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

By Neil Versel

Vice President Joe Biden, HHS Secretary Kathleen Sebelius and national health IT coordinator Dr. David Blumenthal are in Chicago today to announce $1.2 billion in federal grants to promote EMR use and interoperability. The money represents the bulk of the $2 billion in stimulus funds allocated to the Office of the National Coordinator for Health Information Technology.

Of the $1.2 billion, the administration plans to spend $589 million on health IT extension centers to assist hospitals physician practices in selecting and implementing EMRs. The other $564 million will go to encourage health information exchanges and help build the Nationwide Health Information Network. “Electronic health records can help reduce medical errors, make healthcare more efficient and improve the quality of medical care for all Americans. These grants will help ensure more doctors and hospitals have the tools they need to use this critical technology,” Sebelius says.

The administration officials are speaking at Mount Sinai Hospital, an aging facility in an impoverished West Side neighborhood, where just 7 percent of patients have commercial insurance. Biden is leading a roundtable discussion on comprehensive healthcare reform, focusing, in part, on health IT infrastructure, his office says.

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