By Neil Versel,

National health IT coordinator Dr. David Blumenthal isn’t allowed to say what the final rules for meaningful use of EMRs will look like until HHS releases its formal proposal, but every time he gives a speech, he drops a new hint or two about what he’s thinking. Monday in San Francisco, Blumenthal largely gave attendees at the American Medical Informatics Association’s annual symposium what they wanted to hear by reiterating his philosophy that technology simply is an enabler of quality improvement, not a panacea for healthcare.

“The meaningful use framework will be about the goals of care, not the technology,” Blumenthal said. While he didn’t elaborate on that statement, he did state the position of the Obama administration–one largely held by the informatics community, if not the broaded healthcare industry–that the billions of dollars in federal subsidies aren’t simply meant to buy EMRs for providers. “It’s not the money that will turn out to be the most important,” Blumenthal said.

Instead, the net $19 billion investment is a way to demonstrate that EMRs should and will be accepted in the fairly near future as “symbolic of professionalism in medicine,” just as much as the stethoscope or examination table are today. “The idea that government should subsidize health IT will be as foreign an idea that the government should buy stethoscopes or exam tables for doctors,” Blumenthal explained.

“Information is really the lifeblood of medicine,” Blumenthal added. “Health information technology is its circulatory system.”

During the Q&A portion of the session, legendary medical informaticist Dr. Clement McDonald, the longtime director of the Regenstrief Institute for Health Care in Indianapolis and now the head of the Lister Hill National Center for Biomedical Communications of the National Library of Medicine, questioned this analogy. McDonald said HHS should approach health IT the way the Environmental Protection Agency regulates water quality. “Put a little onus on the polluters,” McDonald said, referring to providers of “dirty” data that’s useless. He drew a small round of applause.

Above article published on http://www.fierceemr.com/story/meaningful-use-will-focus-goals-care-not-technology-blumenthal-says/2009-11-16

By Gautham Nagesh

The Centers for Medicare and Medicaid Services will reimburse states that issue incentive payments to health care providers to encourage adoption of electronic medical records, according to guidance released on Sept. 1.

A letter from CMS Director Cindy Mann to state Medicaid directors details a program under the 2009 American Recovery and Reinvestment Act that offers financial incentives for eligible Medicare and Medicaid providers to adopt interoperable electronic health records. Approximately $20 billion will be distributed to providers by 2014, mostly in the form of grants.

The payments will help defray the costs of deploying electronic health record systems and can be used to pay for hardware, software, support services and training. But the grants will not necessarily cover the entire cost of installing such systems.

“The incentive payments are not direct reimbursement for such activities. Rather they are intended to serve as an incentive for eligible providers to adopt and meaningfully use certified EHR technology,” Mann said in her letter.

The funds can be used only for electronic health records technology that is certified and interoperable with state or federal administrative management systems.

“Therefore, states risk making unallowable incentive payments prior to receiving guidance on how to make these systems compatible,” Mann wrote.

States are immediately eligible to request 90 percent reimbursement for administrative costs associated with planning and issuing the payments. But that money comes with significant conditions attached. For administrative reimbursement, states must obtain prior approval from CMS for any planning activities or expenditures. They also must provide documentation demonstrating adequate oversight of their incentive programs.

Under the Recovery Act payments would be limited, based on average costs of setting up electronic health record systems, which have yet to be determined. Mann said the secretary of Health and Human Services will establish guidance on those limits.

CMS plans to issue a proposed rule by the end of the year that will contain more detailed information, and will work with states to determine when they are ready to begin issuing payments.

Above article published on

http://www.nextgov.com/nextgov/ng_20090904_7905.php?oref=topnews

Analyst predicts a steady rise, fueled by stimulus funds

By Alice Lipowicz

State and local governments, using money provided under the economic stimulus law, will increase spending on health care information technology over the next few years, according to a report from the market research firm Input. The state and local market for the technology is expected to grow to $9.6 billion by 2014, from $7.6 billion in 2009, a compound growth rate of 4.6 percent, the report states.

State and local agencies also are investing in electronic health records systems, which are a primary component of health IT. Their spending on such systems is projected to expand from $850 million this year to $1.85 billion in 2014, according to Input’s “Health IT Transformation: FY2009-FY2014 State and Local Market Forecast,” which was released Aug. 26.

The agencies’ electronic health record spending will spike from 2009 to 2013 due to the economic stimulus law funding and then will level off, with a 17 percent compound growth rate over the period, Input said.

The flow of money for state and local health IT is complicated, with at least three federal sources of funding — the stimulus law, Medicaid supplemental payments and annual budgets — and spending from 11 different types of state and local agencies, including hospitals, clinics, mental health facilities, prisons, regional health organizations, Medicaid, children’s health programs and IT departments.

State and local agencies are buying 14 different types of health IT products and services, including software and systems for EHRs, decision support, clinical data, pharmacy, lab, patient tracking, health information exchange, telehealth, and disease outbreak management, Input said.

The State Alliance for eHealth, which the National Governors Association sponsors, recently encouraged state and local governments to prepare strategies and plans for health information exchange and other components of the economic stimulus law.

Above article published on

http://fcw.com/articles/2009/08/27/state-and-local-agencies-spending-more-on-health-it-input-says.aspx

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”.

Above article published on

http://www.kaiserhealthnews.org/Daily-Reports/2009/August/31/Health-IT-Monday.aspx

By: Howard Anderson, HDM Breaking News

Although the federal economic stimulus package will spur an increase in spending on clinical applications in the months ahead, many hospitals and clinics are now taking their time studying their options, two researchers say.

“The steady drumbeat of inevitability is changing the debate from not ‘if’ we’ll get an electronic health record but ‘when’,” says Eric Brown, research director at Forrester Research Inc., Cambridge, Mass. “There’s a tipping point at which we’ll see big growth, but we’re not there yet.”

Because of the conservative nature of health care organizations, the growth in demand will be “a slow, steady progression” rather than a spike, Brown contends. “Health care rarely meets pundits’ expectations for growth.”

Under the American Recovery and Reinvestment Act, hospitals and physician group practices can qualify for billions of dollars in extra payments from Medicare and Medicaid if they make meaningful use of qualifying electronic health records systems. But to achieve maximum payments, they must hit certain deadlines. For example, physician groups must have a qualifying EHR system in place by 2012.

“What we’re seeing now is a lot of intense research going on” at hospitals and clinics, says Chris O’Neal, director of corporate reporting at KLAS Enterprises, an Orem, Utah-based research firm that rates provider satisfaction with software. “The spike in demand is coming.”

A KLAS survey in May of 155 health care CIOs and other executives regarding the stimulus incentives found that 43% had no plans for immediate changes but were watching the market, while 30% said the stimulus likely would speed up their I.T. investments.

Providers are doing careful research on EHR vendors, O’Neal believes, because “they cannot afford a misstep” which might cause them to miss a critical deadline for qualifying for a stimulus payment.

Among hospitals, O’Neal expects strong demand for computerized physician order entry systems, which most organizations lack, as well as clinical documentation for nurses. The stimulus program likely will require both of these components for hospitals to qualify for EHR incentive payments, he notes.

Brown says many hospitals will face a difficult challenge when persuading physicians to actually use CPOE. “Will they pay physicians a percentage of the money they get from the stimulus if they use CPOE?” Brown asks. “I’m not sure.”

O’Neal says many smaller clinics will consider using remotely-hosted EHRs accessible over the Internet. Brown says this model could prove attractive to risk-averse small practices with limited budgets that want to get a piece of the stimulus action.

Above article published on

http://www.healthdatamanagement.com/news/stimulus-38773-1.html

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”.

Above article published on

http://business.rediff.com/report/2009/aug/21/us-1-point-2-bn-dollar-grant-for-electronic-health-records.htm

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 Adriel Bettelheim

President Obama plans to huddle with his Cabinet and top advisers on Friday and Saturday to review lessons learned from his first six months in office. There’s bound to be some gnashing of teeth over the pace of the health care overhaul, and also some satisfaction over signs the economy is staggering back.

But based on his remarks at Wednesday’s town halls in Raleigh, N.C. and Bristol, Va., don’t expect a major recalibration of the administration’s message.

Obama continued to strenuously defend economic relief efforts launched in the aftermath of last fall’s financial crisis and lay some blame at the feet of former President George W. Bush. And he eagerly portrayed himself as a responsible steward of taxpayers’ money, to deflect persistent Republican charges that he’s incapable of controlling federal spending.

“I know that some critics in Washington think we’ve been slow to get these projects started,” Obama said in Raleigh, referring to work funded by the $787 billion economic stimulus package (PL 111-5). “They are saying we should have broken ground on all our highway projects on the first day. But everyone knows that’s impossible, especially because I wanted to be sure we did our homework and invested tax dollars only in those projects that actually created new jobs and jumpstarted our economy.”

Speaking in a state where the jobless rate is 11 percent, Obama said while there’s still much work left to be done to assure a complete recovery, “there is little debate that these steps, taken together, have helped stop our economic freefall.”

Obama also fired back at critics who blame him for running up the federal deficit, saying he inherited a $1.3 trillion shortfall. Without mentioning Bush by name, Obama said the staggering deficit was “a debt that is partially a result of two tax cuts that went primarily to the wealthiest few and a Medicare drug program, none of which was paid for.”

Finally, Obama continued to subtly recalibrate his health care message, casting the debate as one that revolves around curbing insurance companies’ less-savory business practices.

He outlined a series of consumer-protection measures aimed at preventing health plans from denying coverage to individuals who have preexisting medical conditions, dropping coverage for individuals who become seriously ill or charging unlimited out-of-pocket expenses. He also said the health overhaul would force the plans to pay for preventive care and routine checkups and remove arbitrary caps on the amount of coverage individuals can receive in a given year or in a lifetime.

Of course, many of these proposals aren’t major sticking points in the current debate. But talk about contentious stuff like public insurance options and how to pay for the overhaul should probably best be left to staff retreats and closed-door negotiating sessions on Capitol Hill.

Above article published on

http://blogs.cqpolitics.com/balance_of_power/2009/07/
obama-defends-stimulus-health.html

As President Obama continued his push to reform the U.S. health care system, he highlighted the Cleveland Clinic as a model for how effective health IT systems can improve care and lower costs, Healthcare IT News reports.

Obama visited the Cleveland Clinic on Thursday and viewed a presentation on the center’s health IT initiatives.

Cleveland Clinic executives also spoke with the president about patient-centered health IT projects involving Microsoft HealthVault, Google Health and MyChart. MyChart currently connects 202,000 patients to an online portal for appointment scheduling, prescription management, preventive health reminders and test results.

C. Martin Harris, Cleveland Clinic’s CIO and a member of HHS’ Health IT Standards Committee, said the center “is developing health IT that gives patients the power to better manage their health care.”

Harris added that the Cleveland Clinic is “focused on helping lead the nation toward a comprehensive electronic medical records system that will reduce medical errors, improve quality and lower costs.”

During a town-hall meeting later that day, Obama said the Cleveland Clinic has “one of the best health IT systems in the country.” He said the center’s electronic health technology allows it to:

• Boost patient care;
• Coordinate with other health workers in the community;
• Improve chronic disease management;
• Monitor treatment efficacy;
• Reduce duplicate testing; and
• Track patient health and progress.

Obama said, “And here’s the remarkable thing: They actually have some of the lowest costs for the best care” (Monegain, Healthcare IT News, 7/24).

Ezekiel Emanuel, a physician and health policy adviser to the Obama administration, said the Cleveland Clinic has a “fantastic health IT system, which is a necessary component of changing the game” in health care reform (Brown, Washington Post, 7/23).

Above article published on

http://www.ihealthbeat.org/Articles/2009/7/24/Obama-Continues
-To-Tout-Health-IT-as-a-Key-to-Health-Reform.aspx

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