By Rebecca Vesely / HITS staff writer

Proposed rules on the meaningful use of electronic health records will be made public by the end of the year or perhaps sooner, said David Blumenthal, national coordinator for health information technology at HHS.

In a speech before the American Medical Informatics Association’s annual symposium in San Francisco, Blumenthal stressed that health IT must be focused on the goal of making the healthcare system work better for patients and providers.

It’s not the technology that’s important, but its effect,” Blumenthal said. “That’s the purpose of the stimulus bill.”

The American Recovery and Reinvestment Act of 2009 included Medicare and Medicaid incentives to eligible providers such as physicians and hospitals to boost adoption of EHRs. To receive the incentive payments, providers must demonstrate “meaningful use” of a certified EHR. The CMS, in conjunction with Blumenthal’s office, is developing the proposed rule that provides greater detail on the incentive program and a definition of meaningful use. The stimulus law, enacted in February, appropriated $2 billion to Blumenthal’s office to create the infrastructure for meaningful use.

After a comment period, the final rule on meaningful use will be released in the spring, Blumenthal said.

While Blumenthal declined to give a specific definition of meaningful use, he offered some hints. People working in health IT should think about EHRs “not as a technology project, but as a change-management project,” he said. Components of meaningful use include sociology, psychology, behavior change and the “mobilization of levers to change complex systems and improve their performance,” he added.

Through the stimulus law, Congress mandated that meaningful use become more focused over time, with yearly benchmarks. There has been a “lively discussion” in the Obama administration of that timetable in the proposed rulemaking of meaningful use, Blumenthal said.

“We will be looking for your feedback,” Blumenthal told the assembled association of nearly 2,000 members who attended the conference held at the Hilton San Francisco Union Square this week. “Rulemaking is not the end of the conversation.”

Privacy and security are absolutely critical to the widespread adoption of health IT, Bluementhal said, adding that this is also on top of his agenda. “Without the trust of the public, we will not be successful in getting everything out of the potential of health informatics.”

In the next few months, his office will convene a working group on privacy and security to look at what else is necessary to ensure the public’s trust beyond what is instructed by Congress in the stimulus law, he said.

“We need to be extremely vigilant and aggressive in terms of developing standards around privacy and security,” Blumenthal said.

And his office is moving forward with its first grant programs under the stimulus law. Last summer, Blumenthal announced two grant programs mandated by the stimulus law. The first is $700 million in grants to establish up to 70 health IT regional extension centers nationwide, which will offer technical assistance, guidance and information on best practices to support and accelerate providers’ efforts to become meaningful users of EHRs. The second program offers $560 million in grants to states to develop health information exchange capacities among providers.

The first round of grant recipients will be announced soon, Blumenthal said. HHS received about 90 applications for the first 20 slots in the health IT regional extension center program, he said, adding that he was encouraged by the volume and quality of the grant applications.

“The grants to states, we believe, are another good bet,” he said.

Blumenthal also gave some hints on his office’s plans to develop and announce programs to increase the supply of trained health IT workers.

“The skills needed are not necessarily what our teenage children have,” Blumenthal said, which brought laughter from the crowd.

Specifically, the nation needs professionals who understand meaningful use and improved processes of care, the ability to redesign workplaces to integrate the new technology and to help providers use the technology to its full potential, he said.

“The training needed is well beyond the installation of information technology,” he said.

Blumenthal expressed great confidence that health IT can be a foundation for fundamental change in the healthcare system.

“I believe it will be a short time before EHRs are as common in medicine as the stethoscope, the cardiogram, the MRI and other core tools,” he said. “I think we’re already moving in that direction.”

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Rep. Ann Kirkpatrick announced today that the Department of Health and Human Services (HHS) will be making $1,437,515 available to North Country HealthCare to help improve access to quality care in Greater Arizona. The funds are part of $851 million in grants that HHS will release to address facility and equipment needs at health care centers nationwide through the American Recovery and Reinvestment Act.

The announcement comes as the Congresswoman finishes her “Standing Up for Rural Arizona” tour, which included a stop at the opening of a new North Country clinic in Show Low. That facility was established with $1.3 million in Recovery Act funds. North Country will use this new grant to expand their clinics in Winslow and Kingman and to improve information technology and electronic health records infrastructure at their eleven sites across northern

Arizona.

“Rural Arizonans are being underserved by our current health care system, and this sort of investment allows us to benefit from 21st-century technology while reducing our costs,” said Rep. Kirkpatrick. “The staff at North Country does a great job with the resources they have. This grant will enable them to help even more folks in our communities access the services and treatment they need.”

The grants are being allocated through the Capital Improvement Program, which will support the construction, repair and renovation of over 1,500 health center sites across the country. Arizona health centers are benefitting from more than $16 million in funding for health technology improvements, with over $4 million granted to community health clinics in the First District.

“North Country HealthCare is busier than ever, and we are seeing more people show up who have lost their insurance,” said Ann Roggenbuck, North Country HealthCare president. “If they have a medical home, they are more likely to get the health care services they need and take care of medical problems before they get out of hand.”

This is the third round of health center grants provided through the Recovery Act. On March 2, HHS announced that $155 million would be available to establish 126 new health center sites, including the new Show Low clinic. Later that month, HHS released $338 million in Increased Demand for Service grants to help health centers provide care for additional patients. This included $449,304 for North Country, which provided 113,000 patient visits for medical, dental, and behavioral health care last year.

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Bernie Monegain, Editor

CHICAGO – The Obama adminstration’s chief for healthcare IT technology David Blumenthal, MD, was on the healthcare IT message from dawn to dusk Thursday - a part of the White House campaign to save its troubled healthcare reform plans.

The day started with an open letter from Blumenthal about the benefits of electronic health records and ended with another open letter from him on the $1.2 billion HITECH grants that had been announced earlier in the day.

Blumenthal joined Vice President Joseph Biden and Health and Human Services Secretary Kathleen Sebelius at Mt. Sinai Hospital on Chicago’s West Side for a roundtable discussion with nurses, doctors and administrators.

At the forum, the trio announced $1.2 billion in HITECH grants would be released - $598 million to create 70 health information technology extension centers across the country to help physicians and hospitals implement electronic health records and $564 million to help states support the development of health information exchanges.

“This is just the first wave of resources invested in health technology aimed at really transforming our paper-driven system to an electronic system over the next several years, providing help and support for hospitals and doctors as they make this conversion,” Sebelius said.

“It’s no coincidence that these two grant programs are leading the way,” Blumenthal said in this open letter at the end of the day. “Key to the successful adoption and meaningful use of EHRs is the assurance that providers have the help and guidance they need to select, implement and maintain a certified EHR system. In addition, we need the various and often disparate local, statewide and regional systems to work together, regardless of location and differing state and federal standards or policies, to enhance patient care.”

After the roundtable at Mt. Sinai, Sebelius introduced Blumenthal on a teleconference with the media. Blumenthal spoke briefly and responded to questions about concerns over data security and the definition of meaningful use of healthcare IT, a measure that will determine which providers are eligible to receive extra payments from Medicare and Medicaid.

He said the definition would be completed by the end of the year. On the security issue, he said the Health Information Technology Policy Committee would be asked to take up the topic of security soon.

“We understand that is critical,” he said. “The information that is passed within the healthcare system has to be secure or the public won’t have confidence in those electronic health records.”

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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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Bernie Monegain, Editor

President Barack Obama told participants in an AARP tele-town hall Tuesday that electronic health records will help put an end to the inefficiencies they have experienced in healthcare.

“We’re also working to computerize medical records, because right now too many folks wind up taking the same tests over and over and over again because their providers can’t access previous results,” he said at the session at AARP headquarters. “Or they have to relay their entire medical history – every medication they’ve taken, every surgery they’ve gotten – every time they see a new provider. Electronic medical records will help to put an end to all that.”

Obama met at AARP headquarters in the nation’s capital with AARP CEO A. Barry Rand, AARP President Jenny Chin Hansen, moderator and AARP radio host Mike Cuthbert and an audience of about 60 retirees. He took questions from the audience, as well as from telephone calls and e-mails.

In a statement, Rand posted on the AARP site earlier this month, he said: “All Americans should have affordable healthcare choices. But our current healthcare system costs too much, wastes too much, makes too many mistakes and gives us back too little value for our money.”

He spoke about ending billion-dollar subsidies to insurance companies for Medicare Advantage, using nurse practitioners for home healthcare follow-up visits after hospitalizations, proving incentives for physicians to work as a team, creating a healthcare exchange for affordable coverage, including a public option and paying for improvements with greater efficiencies.

In response to a question about negative ads that emphasize the cost of healthcare reform and the high cost of automating the system, Obama acknowledged the upfront costs and mentioned his recent visit to the Cleveland Clinic.

“In order for us to save money, in some cases, we’ve got to spend some money up front,” he said. “Let me give you some very specific examples. Healthcare IT: Healthcare is the only area where you still have to fill out five different forms – when you go into a bank you don’t have to do that. You’ve got an ATM. If you use your credit card, they’ll find you real quick and the billing is real easy – right? But if for some reason you want healthcare, you fill out pencil and paper – I guess they Xerox it – they give it to somebody else. Sometimes you see their files and it’s all stuffed with papers, and nurses can’t read the doctor’s handwriting.”

“So for us to set up a system like they have at the Cleveland Clinic that I just visited in Ohio, where every medical record – your privacy is protected, but everything is digitalized,” he added. “Everything – the minute you take a test, it goes to all the doctors and all the specialists that you might end up dealing with. So you end up just having that one test instead of having to then go back to the doctor again and again and again and have a bunch of different tests. Well, that saves money, but you’ve got to get the computer equipment in the first place to do it. So in some cases we’ve got to spend some money on the front end.”

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highlights-digital-health-records

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

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Molly Merrill, Associate Editor

ANNANDALE, VA – President Obama called for fixing the broken healthcare system by building upon investments made in electronic medical records in a town hall meeting held Wednesday.

The town hall was held at Northern Virginia Community College in Annandale, Va., where the president took questions the public submitted online regarding healthcare reform.

“I know that people say the costs of fixing our problems are great - and in some cases, they are,” Obama said. “The costs of inaction, of not doing anything, are even greater. They’re unacceptable. And that’s why this town hall and this debate that we’re having around healthcare is so important.”

The president highlighted the continued use of electronic medical records as one way to help drive down costs.

“We already made those investments in the Recovery Act - because when everything is digitalized, all your records - your privacy is protected, but all your records on a digital form - that reduces medical errors. It means that nurses don’t have to read the scrawl of doctors when they are trying to figure out what treatments to apply. That saves lives; that saves money; and it will still ensure privacy,” the president said.

Obama said the government has already identified $950 billion over 10 years that will be used to pay for healthcare reform. He said this “doesn’t even include the savings that we’re going to get from prevention, or the savings that we’re going to get from health IT - because in using congressional jargon, which I’m never supposed to do because nobody understands it - it’s not scorable.”

“And what that means is, is that the Congressional Budget Office can’t identify exactly how much you would save - even though everybody believes that it will end up saving a lot of money, we can’t put a hard number on it,” Obama said.

The president ended his speech by calling for the American people to “stand up and say now is the time.”

“We can create a healthcare system that gives you choice, allows you to keep your doctor, drives down costs, makes sure that every American doesn’t have to worry if they lose or change their jobs. That’s our aim. That’s our goal. We’re going to make it happen this year.”

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