CMS/ ONC Release Final Meaningful Use Rules:

  • On July 13th the Centers for Medicare & Medicaid Services (CMS), issued a final rule defining the minimum requirements that providers must meet through their use of certified EHR technologies in order to qualify for incentive payments. This Final Rule is the first step of an incremental approach to adopting standards, implementation specifications, and certification criteria to enhance the interoperability, functionality, utility, and security of health IT and to support its meaningful use. The certification criteria adopted in this initial set establish the required capabilities and related standards and implementation specifications that certified electronic health record (EHR) technology will need to include in order to, at a minimum, support (beginning in 2011) the attainment of Stage 1 meaningful use requirements by eligible professionals and eligible hospitals under the Medicare and Medicaid EHR incentive programs.
  • The final rule includes modifications that address stakeholder concerns while retaining the intent and structure of the incentive programs. The final rules are thought by industry experts to be a significant improvement from the earlier drafts,
  • The CMS fact sheet can be found here.

Program Information Notice on State HIE:

  • The Office of the National Coordinator for Health IT (ONC) issued a Program Information Notice (PIN) on July 6th 2010 addressed to award recipients in the State HIE Cooperative Agreement Program. This PIN provides guidance on key deliverables and responsibilities for states and recipients for FY2011. The key functional deliverables are aimed at specific meaningful use criteria and include: E-prescribing, receipt of structured lab results, and sharing patient care summaries across unaffiliated organizations.

Of the six key policy goals defined for 2011, the key ones include:

  • Ensure the privacy and security framework for state HIE is consistent with Federal guidelines and standards found here.
  • Implement a strategy to fill in the meaningful use gaps for state HIE
  • Coordinate with Medicaid and public health programs to create an integrated approach
  • This guidance is important for CHCs as it clearly states the functional areas that State HIE should focus on in 2011 and also directs state HIE to try to fill in the gaps in meaningful use and to coordinate with Medicaid programs. This aligns state HIE efforts more closely with CHC initiatives and provides some guidance for participation.

New Privacy and Security Changes Under HITECH:

  • On July 8, 2010, Secretary Kathleen Sebelius and the DHHS Office for Civil Rights (OCR) announced that the 1996 HIPAA Privacy and Security Rules will be modified to add new protections. The proposed new regulations pursuant to HITECH are intended to improve patient privacy and security in health information exchange by extending OCR’s enforcement, giving patients the right to receive their medical information electronically, and setting new limits on the use of protected health information. Among other things, the new regulations will extend OCR’s enforcement to business associates, and set new limits on the sale of individuals’ information. In addition, the rule partially clarifies the privacy status of Personal Health Records (PHRs) by clarifying that PHRs maintained on behalf of covered entities acting in partnership are considered business associates for purposes of the law. However the status of some other types of PHR is still vague – including entities that are software manufactures, health websites, and search engines. DHHS guidance can be found here.

Using Online Communication to Enhance Primary Care:

  • A paper by Dr. Ronald F. Dixon in the current issue of Health Affairs 29, no. 7 (2010): 1364-1369), Enhancing Primary Care Through Online Communication, describes three modes of online communication that can be used in the delivery of healthcare & discusses the impediments and benefits of each. These modes are asynchronous (or non-simultaneous) consultation through the use of secure messaging, real-time consultation via videoconferencing or chat , and remote physiological monitoring using in-home or mobile devices. Studies are cited that show each of these modes can be effective in improving outcomes. The author, a practicing physician, believes that the main impediments to the broader dissemination of these tools include non-alignment with the payment system and lack of integration of communication applications with currently used systems (EHR, PM etc.), but suggests that the provider-patient relationship, especially in the management of chronic diseases, would be greatly improved by their use. Abstract available here.
  • Another paper in the same issue by Yi Yvonne Zhou and colleagues titled, Improved Quality At Kaiser Permanente Through E-Mail Between Physicians And Patients reports on a study of just over 35,000 patients at Kaiser-Permanente with diabetes, hypertension or both. Use of email to interact with patients over a two month period resulted in a significant (2%-6.5%) improvement in quality measures for HbA1c, cholesterol and blood pressure screening and control. http://content.healthaffairs.org/cgi/content/abstract/29/7/1370

National Progress Report on eHealth:

  • The eHealth Initiative (eHI) has released its 2010 National Progress on eHealth. The report includes “a review of progress relative to strategies and actions to utilize health information technology (HIT) and health information exchange (HIE) to improve healthcare quality, safety and efficiency”. The report, the result of an online survey and committee process that included unput form and participation by over 100 experts in HIT, shows significant activity and progress, but also indicates that many stakeholders have reservations about current programs.
  • Several of the key findings are as follows:
    – 61% of respondents believe that significant progress has been made in the adoption and use of HIT since 2007;
    – 55% believe that the value of HIE is not clearly understood, and 67% believe that the outreach efforts to consumers about the value of EHRs and HIE have been ineffective;
    – 56% believe that EHR use and HIE have improved care delivery
    – A large number of providers are concerned that “the processes and metrics for accelerating adoption and use of HIT and HIE may deter provider participation and delay the transformation to a patient-centered system”;
    – Similarly, there is concern that current programs driving payment reform and coding updates could discourage adoption of HIT;
    – Finally, clear, effective and understandable policies for privacy and security of protected health information are the keys to building consumer trust for HIT and HIE.
  • The executive summary can be found here.

FCC Plan Expands Broadband for Healthcare

  • Pursuant to the Federal Communications Commission (FCC) Broadband Plan issued in March as part of federal recovery efforts, (http://www.broadband.gov/plan/) the Commission voted unanimously on July 15th to consider a plan for expanding on the 15 year old Universal Service Access effort which provides up to $400 million per year in phone bill surcharges to help level the costs of broadband for rural healthcare facilities. The original program has been widely regarded as a failure given its limitations.
  • The new plan would increase the subsidies to providers, cover the constructions costs of new and upgraded broadband networks, and for the first time allow a rbroader range or providers including skilled nursing facilities, acute care facilities, administrative offices, data centers and renal dialysis centers to qualify for payments. The Notice of Proposed Rule Making provides for 30 days of public comment before the order may be finalized. See: http://www.fcc.gov/
  • Already, groups including the American Telemedicine Association have suggested that the plan doesn’t go nearly far enough to fix long-standing program deficiencies.
  • In a related development, Congressional leaders including Senator Max Baucus (D-MT), Senate Finance Committee Chair have reportedly discussed the possibility of reallocating a portion of ARRA Recovery Act funds made available for broadband programs in various industries to help pay for continuation of jobless benefits. See here.