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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Senate Scrutinizes EHR Interoperability

Senate Scrutinizes EHR Interoperability | EHR and Health IT Consulting | Scoop.it

Electronic health record interoperability and secure health information exchange have been key areas of focus for federal health IT leaders in recent months. Now these topics are getting even more attention from Congress.

The Senate Committee on Health, Education, Labor and Pensions is launching a working group focused on identifying ways to improve EHRs, including facilitating secure information exchange between EHR systems from disparate vendors and between healthcare providers.

A source in the office of Sen. Patty Murray, D-Wash., tells Information Security Media Group that the goal of the working group is to make some legislative and administrative recommendations by the end of the year.

"As we focus on making our healthcare system work better for families, the promise of electronic health records could not be more important," Murray said in a statement provided to ISMG. "However, as researchers, providers and patients gather and use more health information, we need to be aware of the cyber-criminals who want to exploit that information. Patients and providers need to know that their information is safe and secure, so I look forward to working with my colleagues to develop strategies to protect privacy and meet today's challenges."


Frustrated by Pace of Change

The new Senate workgroup is the culmination of years of activity by Congressional members, says David Holtzman, vice president of compliance at the security consulting firm CynergisTek. "They are frustrated by the slow pace of change by the Department of Health and Human Services, and the companies that are in the EHR marketplace to address interoperability and patient safety issues," he says.

Holtzman adds that he hopes that the workgroup "can find a path toward restoring balance" between the needs of healthcare providers to have EHR systems that are accessible, yet secure, while facilitating information sharing with other providers - regardless of technology platform.

Because nearly $30 billion has been spent so far on HITECH Act incentives payments to hospitals and physicians for making "meaningful use" of EHRs, Congress is scrutinizing whether taxpayers are getting a return on this investment. EHRs from different vendors, for instance, often don't easily exchange data. By improving EHR interoperability so that patient data can be securely exchanged among healthcare providers nationally, treatment outcomes, as well as patient safety, can potentially be improved.

EHR interoperability is also critical to a "Precision Medicine Initiative" that President Obama unveiled in his State of the Union address (see Precision Medicine: Privacy Issues).

Precision medicine, also known as personalized medicine, involves the use of genomic, environmental, lifestyle and other personal data about patients so that clinicians can better tailor medical treatments that are potentially more effective, based on an individuals' characteristics.

During a May 5 hearing by the Senate committee, Karen DeSalvo, M.D., who heads the Office of the National coordinator for Health IT within HHS, said that the exchange of health data, including for precision medicine efforts, facilitates "more liquidity" of information, but with that, comes risks. "We're ramping up additional security. ... It's a top priority," she said.

DeSalvo told committee members that ONC, which oversees standards and policies of the HITECH Act programs, is ready to collaborate with the working group on EHR interoperability and related issues.
Working Group Goals

In a statement, the Senate committee says the goals of the new bipartisan working group are to help identify ways that Congress and the Obama administration can work together to:

    Help doctors and hospitals improve quality of care and patient safety;
    Facilitate information exchange between different EHR vendors and different health professionals;
    Empower patients to engage in their own healthcare through convenient, user-friendly access to their personal health information;
    Leverage health information technology capabilities to improve patient safety; and
    Protect patient privacy and security of health information.

The working group, which is composed primarily of committee members' staff, will invite participation from health professionals, health information technology developers, relevant government agencies, and other experts specializing in health information technology, according to the committee statement.
HITECH Scrutiny

Sen. Lamar Alexander, R-Tenn., chair of the Senate health committee, said in a statement about the new working group: "After $28 billion in taxpayer dollars spent subsidizing electronic health records, doctors don't like these electronic medical record systems and say they disrupt workflow, interrupt the doctor-patient relationship and haven't been worth the effort.

"The goal of this working group is to identify the five or six things we can do to help make the failed promise of electronic health records something that physicians and providers look forward to instead of something they endure."

The scrutiny over EHR interoperability and secure health information exchange also stretches to the House of Representatives. In March, Rep. Michael Burgess, M.D., R-Texas, unveiled legislation that calls for devising new methods for measuring whether EHR vendors are compliant with interoperability standards (see Bill Proposes EHR Interoperability Plan).

That bill proposes establishing a Congressionally appointed committee, to be known as the "Charter Organization," that would recommend methods for measuring whether EHR systems that qualify for the HITECH Act incentive program satisfy key interoperability criteria.
10-Year Vision

Interoperability and secure health information exchange is the focus of ONC's 10-year roadmap. ONC is reviewing public comments it received on its draft roadmap, and hopes to issue its next proposed version of the 10-year plan later this year.

In addition to its 10-year plan, ONC recently issued a report to Congress about information blocking, outlining how the secure exchange of health information is sometimes intentionally and unreasonably blocked by healthcare organizations, technology services providers and electronic health record vendors. In some cases, the players are inappropriately invoking HIPAA privacy and security concerns, ONC says (see Overcoming Health Info Exchange Blocking).

In an interview with Information Security Media Group at the recent HIMSS conference in Chicago, ONC Chief Privacy Officer Lucia Savage said misunderstandings about HIPAA often contribute to healthcare providers not engaging in the exchange of patient electronic health information. "We need to be a lot clearer about what the HIPAA rules are and how they support interoperable exchange," she says.


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Six Things to Know About Stage 3 of Meaningful Use

Six Things to Know About Stage 3 of Meaningful Use | EHR and Health IT Consulting | Scoop.it

Have you had a chance to read through the proposed rule for the Stage 3 rules of the government's EHR incentive program? If not, we've got you covered.

Here are six things to know about the proposed rule:


1. The rule proposes a significant change to the structure of the meaningful use program by establishing a single stage for meaningful use (Stage 3) starting in 2018. This means that in 2018 and following years, all providers (regardless of prior participation in the program) would need to meet the Stage 3 rules. In 2017, providers could participate in Stage 1, Stage 2, or Stage 3, but in 2018, all would need to attest to Stage 3. The proposed rule notes that the program requirements may change slightly in future years, but Stage 3 would remain the final stage moving forward.

 

2. The proposed rule indicates that Stage 3 would continue to "build on the groundwork" established in Stage 1 and Stage 2.  Many of the measures included in the proposed rule focus on increasing interoperability, information exchange, and patient engagement. Though many of the measures associated with these initiatives are similar to the measures in Stage 2 (but with higher thresholds), there are also some new measures associated with them.


3. The proposed rule establishes a full-year reporting period. The proposed rule specifies that the meaningful use reporting period would be a full year for both physicians and hospitals starting in 2017 and in future years. The only exceptions would be Medicaid eligible providers and hospitals attesting to meaningful use for the first time (they would have a 90-day period).


4. The proposed rule requires electronic quality reporting. Starting in 2018, CMS would require electronic quality reporting for providers who would need to implement five clinical decision support interventions related to four or more quality measures.


5. The proposed rule includes fewer objectives in Stage 3, but many of the measures associated with these objectives may be more challenging. Providers would only need to meet eight objectives in Stage 3 (though some of these objectives have multiple measures associated with them). The proposed rule also includes new requirements that may be difficult for providers.

 

6. The proposed rule includes some flexibility when it comes to the requirements. The proposed Stage 3 objectives include some flexibility, which could make it easier for providers to successfully attest. For instance, for the "coordination of care through patient engagement" objective, providers would only need to meet thresholds of two of three measures and attest to the numerators and denominators of all three measures. And, for the "health information exchange" objective, providers would need to meet the thresholds of two of three measures and attest to the numerators and denominators of all three measures.


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Senate panel to look into EHR usability

Senate panel to look into EHR usability | EHR and Health IT Consulting | Scoop.it

Unhappy with the state of electronic health records across the country two U.S. Senators have decided to take the matter into their own hands.


Lamar Alexander, a Republican from Tennessee and chair of the Senate Committee on Health, Education, Labor and Pension, or HELP, and Ranking Member Patty Murray, a Democrat from Washington State, announced Wednesday they would form a bipartisan, full health committee working group to identify ways to improve electronic health records.


"After $28 billion in taxpayer dollars spent subsidizing electronic health records, ‎doctors don't like these electronic medical record systems and say they disrupt workflow, interrupt the doctor-patient relationship and haven't been worth the effort," said Alexander in a news statement. "The goal of this working group is to identify the five or six things we can do to help make the failed promise of electronic health records something that physicians and providers look forward to instead of something they endure."


"As we focus on making our healthcare system work better for families, electronic health records could not be more important," Murray added. "Having more and better information can make all the difference for patients."


The goals of the committee's working group, as stated by Alexander and Murray, are to help identify ways Congress and the administration can work together to:


  • Help doctors and hospitals improve quality of care and patient safety;
  • Facilitate information exchange between different electronic record vendors and different health professionals, or interoperability;
  • Empower patients to engage in their own healthcare through convenient, user-friendly access to their personal health information;
  • Leverage health information technology capabilities to improve patient safety; and
  • Protect patient privacy and security of health information.


The bipartisan staff meetings will involve participation from health professionals, health information technology developers, relevant government agencies and other experts specializing in health information technology, Alexander said. Participation is open to all members of the Senate's health committee.



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No ICD-10 Delay Included in Latest Congressional Spending Bill | EHRintelligence.com

No ICD-10 Delay Included in Latest Congressional Spending Bill | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
Lawmakers have not included an ICD-10 delay in the 2015 Congressional spending omnibus.

Rumors of another ICD-10 delay appear to be greatly exaggerated – this time, at least.  Despite calls from the Medical Society of New York to include an additional two-year delay of ICD-10 in the $1 trillion omnibus spending bill that funds most Congressional activities through the majority of 2015, the legislation did not include an additional push-back of the health information management schema before lawmakers agreed on the final form of the bill.

While the legislation is certainly not the only opportunity for Congress to scupper the new code set, it does give providers some confidence going into the holidays that ICD-10 will continue as planned on October 1, 2015.  Uncertainty about the actual implementation date has left many healthcare organizations wondering about the point of spending time, effort, and money on upgrade systems and processes to be compliant with ICD-10 requirements.  Advocates of postponing ICD-10, or scrapping it all together, have tried to feed on these worries to build momentum for their cause.

“The onerous penalties tied to these mandates add to the hysteria that is running through physicians’ offices and is generating many early retirements,” states the Medical Society of New York in a letter addressed to Rep. John Boehner in November. “If every entity in the complex medical payment pyramid does not function perfectly on October 1, 2015 then physicians’ income goes to zero which is a steep price to pay for a new imperfect coding system.”

The American Medical Association, another staunch advocate of abandoning the ICD-10 mandate, has also raised arguments about the cost of implementation and the burden on physicians to comply with the new codes in addition to several other major healthcare reform initiatives.  Boasting that the AMA has held off ICD-10 for more than ten years, Dr. Robert Wah recently made a speech decrying ICD-10’s less common codes and urging providers to join his organization in opposition to the code set.

However, after the most recent delay from 2014 to 2015 shocked ICD-10 proponents and threw the industry into turmoil, many organizations just want to get it over with.  In another letter to Rep. Boehner, this time from a coalition of hospital and health systems, ICD-10 advocates note that repeated delays have been highly disruptive, costly, and frustrating for the healthcare community.

“The delay added billions of dollars in extra costs,” state the American Hospital Association, Premier Healthcare Alliance, and a number of health systems.  “Many of our members had to quickly reconfigure systems and processes that were prepared to use ICD-10 back to ICD-9.  A further delay would only add additional costs as existing investments would be further wasted and future costs would grow.

Wrangling over the true financial impact of implementation has added to the confusion among healthcare providers, who have been chronically lagging behind recommended timelines and guidelines for testing, education, and upgrades.  “The lack of progress by providers, in particular smaller ones, remains a cause for concern as we move toward the compliance deadline,” said Jim Daley, WEDI chairman and ICD-10 Workgroup co-chair in a September letter to HHS Secretary Sylvia Burwell. “Delaying compliance efforts reduces the time available for adequate testing, increasing the chances of unanticipated impacts to production. We urge the industry to accelerate implementation efforts in order to avoid disruption on Oct. 1, 2015.”

Lawmakers have until Thursday to vote through the omnibus spending bill if they are to avoid another paralyzing governmental shutdown.  While the most recent ICD-10 delay was slipped into the SGR reform bill without much notice, it does not appear that the divisive code set will make a cameo in this latest bipartisan agreement.



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