The Steering Committee Held a Session on Community HIE Networks

Representative Patrick Kennedy (D-RI) co-chairing the House 21st Century Healthcare Caucus along with Representative Tim Murphy (R-PA), stressed that the members need to be more aware and give more attention to the current legislation relating to health IT and ehealth. He told the audience at the Steering Committee on Telehealth and Healthcare Informatics session held on Capitol Hill on September 14, 2005, that the 21st Century Health Information Act introduced by himself and Representative Tim Murphy is a catalyst for change.

Janet Marchibroda, Chief Executive Officer, eHealth Initiative and Foundation and a series partner, announced that health IT activity is on the rise, according to the recently released eHealth Initiative report, “Emerging Trends and Issues in Health Information Exchange”. Over 100 respondents from 45 states and the District of Columbia identified exchange efforts in the survey.

One of the greatest challenges among health information exchange efforts is how to secure upfront funding. Ninety-one percent of all respondents cited funding as either very difficult or moderately difficult. Concerning the task of developing a sustainable business model, 84% of all respondents cited that developing a sustainable business model is also very difficult or moderately difficult.

There is still a great deal of work to do in terms of:

• Aligning financial and other incentives needed for electronic health information exchange
  
• Designing innovative programs to facilitate public and private sector seed funding to support widespread interoperability
  
• Expanding and clarifying the role of states
  
• Engaging multiple and diverse stakeholders
  
• Supporting national efforts to achieve the adoption of standards
  

The delivery of healthcare in New York State occurs in many different settings, from physician’s offices to hospitals, and from downstate cities to rural upstate towns, according to C. William Schroth, Chairman, New York State Government, Health Information Technology Work Group. The state has a vast diversified system with 230 hospitals, 665 nursing homes, 66,000 physicians, and 4,400 pharmacies.

New York State is making financial investments with the passage of the HEALNY legislation which authorized $1 billion over four years to form and restructure the healthcare structure. Other measures have the Federal-State Health Reform Partnership (F-SHRP) investing in HIT, and developing specific HIT grant sources. Other important budget initiatives in 2005-2006 include $3 million to be used for physician HIT development, and $10 million to be used for P4P initiatives in the state.

Jan Root, PhD, Assistant Executive Director, Utah Health Information Network, explained that the network is a non-profit coalition of competing entities, and provides the healthcare consumer with reduced costs, improved healthcare quality and access, so as to bring equitable value to all members.

Dr. Root pointed out that the network is a value added network and not a clearinghouse, with the network operating as a central hub to exchange standardized messages connecting all members. The network simply acts like a post office and just delivers mail, but does not store, edit, or evaluate the quality of data.

The challenges in selling clinical exchanges seems to be in explaining the value to the bottom line, determining the costs to do clinical exchanges, and making it clear that quality improvements will result.

Honorary Steering Co-Chairs are Senators Kent Conrad (D-ND) and Mike Crapo (R-ID), along with Representatives Eric Cantor (R-VA) and Rick Boucher D-VA). The Steering Committee is coordinating activities with the House 21st Century Health Care Caucus.

The Steering Committee is coordinated by John Scott of the Center for Public Service Communications (703) 536-5642 or jcscott@cpsc.com and Neal Neuberger of Health Tech Strategies, LLC (703) 790-4933 at nealn@hlthtech.com.


Health Information Technology was the Topic at a Briefing Recently Held on Capitol Hill

According to a new RAND study, estimates are that with 90% adoption of an electronic medical records system, there is potential for saving $77 billion annually in health care efficiency, plus saving another $4 billion annually by reducing medical errors.

Richard Hillestad, PhD, Senior Systems Analyst, RAND, speaking at a briefing on September 16, 2005, sponsored by the Journal of Health Affairs, led the RAND two year study that found that costs of $10 billion per year are modest relative to savings, and that it would be possible for potential safety and health benefits to double the savings. The study found that it would cost hospitals about $98 billion and physicians about $17 billion to install electronic medical records systems.

The report strongly suggests that it is time for the government and others who pay for healthcare to aggressively promote health IT since the market is not working well, the government is the largest employer and healthcare payer, and the government has the opportunity to steer adoption of a standardized interoperable system.

For more information on the briefings go to http://www.allhealth.org or for more information on the RAND study, go to http://www.rand.org.


Secretary HHS Speaks at the Second Health IT Summit

Dealing with the after effects of Katrina really presents a good case for electronic health records since one million people have been evacuated and most of their paper medical records were destroyed said Michael Leavitt, Secretary HHS, speaking at the Second Health IT Summit held in Washington D.C. on September 8, 2005.

HHS is dealing with the enormous problems resulting from the disaster. For example, so far, HHS has set up 9 d-mat teams, set up field hospitals in vacant buildings, set up temporary hospitals generating electronic medical records, set up equipment to send lab tests, and was able to organize a conference call within three hours with leaders of hospital organizations to include 2000 people.

The American Health Information Community, a public and private organization, evenly split between private and public members working groups will identify critical areas and set up standards to be used in exchanging health information. According to the Secretary, bio-surveillance and electronic prescribing are high on the list, since dealing with disasters such as Katrina makes it absolutely necessary for emergency health providers, to be able to immediately share data.

According to the Secretary, HHS is in the process of making several contract awards, one of which would create a standards harmonizing organization, and another contract would develop a health IT product accreditation organization. Basically the contracts will create an architecture for health IT.


Update on Katrina Telemedicine Related Actions Taking Place

Some of the telemedicine activities taking place in response to the hurricane. These include:

• HHS is working with the military to deploy 40 medical needs shelters throughout the region. NIH intends to use telemedicine in at least one facility to reach specialists within NIH
  
• LSU Health Sciences Center is working with ATA and several ATA members to restore and expand the telemedicine system. Communications networks have been restored and redirected to their Shreveport and Baton Rouge facilities, linking to other centers around the state. They are looking into creating a special consultation center in Baton Rouge that would be staffed with physicians and other health professionals displaced from New Orleans and neighboring areas
  
• The University of Texas Medical Branch has a telemedicine unit set up and operating in a Red Cross shelter on Galveston Island where there are about 350 people, about three miles from the hospital
  
• The Army Office of the Surgeon General, Health Care Operations is using the Army’s “Knowledge On-Line” a teleconsulting system to help the victims
  
• DOD’s Theater Medical Information Program has shipped handheld devices to FEMA. The Battlefield Medical Information System-Tactical will also be used to help FEMA
  
• The American Red Cross is quickly deploying satellite communications and other IT systems in affected areas
  
• Jackson Memorial Hospital in Mississippi set up a telemedicine network in all four hospital emergency rooms and is linked to several mobile units
  
• North Carolina sent an 80 bed field hospital to Bay St. Louis, Mississippi and is considering using telemedicine
  
• Children’s Hospital in Birmingham Alabama is working to link several hospitals with videoconferencing
  
• TRICARE Management Activity now has a web site http://www.tricare.osd/mil/katrina/index.cfm for beneficiaries affected by Katrina
  
• Copies of electronic health records for 50,000 patients treated at the New Orleans Veterans Affairs Medical Center were sent to Houston where they are now accessible
  

Federal Government Actions to Help Katrina Victims

The federal government has gone online to make medical information available to physicians with information available from pharmacies and other healthcare providers. Soon other Medicaid records will be available from Mississippi and Louisiana.

HHS announced that the federal government will speed up the award of grants to establish 26 new health center sites in areas impacted by the hurricane. Approximately $2.3 million in fiscal year 20005 funds going to these sites will get healthcare resources up and running quickly in disaster areas and in neighboring states treating evacuees.

The funds will go to nine sites in Texas, five in Louisiana, four each in Florida and Oklahoma, two in Georgia, and one each in Mississippi and Tennessee. The organizations that will receive the funds already have won grants to create new health centers. Originally, the initial distribution of funds had been set for December 2005.

NIH has set up a Katrina Call Center designed for primary care physicians who are treating patients in the disaster zone so that they will be able to receive advice from medical experts around the country on toxic concerns, infectious diseases, tropical or geographical medicine, oral medicine, ophthalmology, psychiatry, cardiac pulmonary diseases, genetic diseases, pediatric endocrinology, pediatric metabolism, obstetrics/gynecology, cancer, and adult endocrinology.

HHS has set up a toll free hotline for people in crisis where callers are connected to a network of local crisis centers across the country.

NCI’s Cancer Information Service is working with the American Society of Clinical Oncology and has established 1-800-4-Cancer as a contact point for oncologists and cancer patients to find help for displaced cancer patients to so that they are able to receive cancer-related care.


Second Health IT Summit Discusses Financial Incentives for Health IT

In a session at the 2nd HIT Summit, Linda Magno, Director, Medicare Demonstrations Program Group, Office of Research, Development and Information, CMS, discussed how Medicare is using demonstrations to make the health IT vision possible. She talked about several demonstration programs, with one ongoing, one demonstration seeking proposals, and another demonstration to be initiated soon.

These include:

• The Physician Group Practice Demonstration started in April 2005 with ten large physician groups rewarding physicians for improving quality and outcomes. The program promotes efficiency through investment in administrative structure and processes. Process and outcome measures will be done in cases where there is congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer screening
  
• The Medicare Management Performance Demonstration will have 800 practices participating in DOQ-IT projects in Arkansas, California, Massachusetts, and Utah. The demonstration will promote the use of technology focusing on small to medium sized physician practices. The demonstration program is in final design and should roll out in the fall of 2005
  
• CMS is now seeking proposals for the Medicare Health Care Quality Demonstration, which is a five year project open to collaborations and community healthcare organizations. The demonstration will provide incentives for improving quality, safety, and efficiency by integrating health IT into clinical practices, and by eliminating unwarranted variations in practices. The demonstration will identify the delivery and payment models that incorporate incentives
  
  

Tom Williams, Executive Director, Integrated Healthcare Association continued the discussion on financial incentives and described a California case study on a Pay for Performance (P4P) project to create incentives in order to drive improvements in clinical quality and patient experience. The program uses a common set of measures, a public scorecard, and health plan payments. Health plans and over 225 medical groups and IPAs with 35,000 physicians, and $6.2 million HMO commercial enrollees are involved.

The organizing principles for the program requires that all data collection be limited to electronic information, data from all the participating health plans be aggregated for a total patient population by physician organizations, and financial incentives are to be paid for IT adoption to support the structure needed for data collection and patient management.

Health IT was measured for clinical data integration activities from patient registries, actionable reports, and electronic HEDIS results. Measurements on IT included point-of- care technology using e-prescribing, e-access to lab results, e-access to clinical notes, e- retrieval of patient reminders, and e-messaging.

The results showed that the health plan incentive payments in 2003 included an estimated $40 million payout by participating plans in all groups, with 74 of the 215 groups qualifying for IT measure payments in 2003, and 119 of the 225 groups qualifying for IT measure payments in 2004.

According to Williams, there are still plenty of issues to discuss, but generally public reporting is viewed favorably, public reporting is viewed as a strong motivation to perform, physician groups believe that the measures are reasonable, physician groups are comfortable with being held accountable for measures, and P4P has inspired significant efforts to collect relevant data.


HRSA’s Office of Rural Health Policy Releases Strategic Plan FY 2005-2010

OHRP has released the Strategic Plan for 2005-2010 that outlines three long term goals:

• Goal 1: Improve the health and wellness of people living in rural communities and in the U.S. Mexico border region. Some of the objectives are to modernize and effectively manage the Office of Rural Health Policy information systems and the grant making process, maintain a national rural health and human services clearinghouse, and create and maintain a web site that focuses on Delta States Grant funding opportunities
  
• Goal 2: Improve the financial viability of small rural hospitals, rural health clinics and other rural providers. One of the objectives includes working with rural health clinics on initiatives including health IT and managed care contracting
  
• Goal 3: Sustain and improve access to outpatient, inpatient, pharmaceutical, and emergency room care in rural communities and along the U.S. Mexico border region. Some of the objectives are to work with rural providers, community leaders, and state grantees to develop an understanding of how and where to best implement advancements in health IT, and how best to provide technical assistance to improve the access to pharmacy services in rural areas
  
  

To read the full report, go to http://ruralhealth.hrsa.gov/policy/StrategicPlan.asp.


NCI’s SBIR Request for Contract Proposals is due in November

The Veterans Health Administration’s enterprise wide computerized patient record, along with the use of telehealth technologies, has developed a working prototype of a home-based system to provide coordinated care for chronic conditions. Also, the VHA in partnership with the National Cancer Institute has developed a system for coordinating cancer care that is made up of these components.

The VHA/NCI system has shown promise for the effective management of symptoms and high quality of life during cancer treatment. The health information infrastructure to support this system requires a high level of interoperability as does the human communication process that make the coordination among the team seamless and dependable.

The goal of the SBIR request is to continue to develop an automated coordinated cancer care tracking program so that all cancer care team members will be able to view the VA/NCI cancer care coordination processes. At this point, NCI is looking to track health status and outcomes data, symptom management recommendations, and interventions and decision points in real-time. Ideally the software should include real-time visual simulation of the coordination process with alerts, and reminders. This program is not to be a stand alone product, but should also integrate into a larger system of home-based coordinated cancer care.

The VA/NCI home centered coordinated cancer care system holds promise for the thousands of veterans who have cancer and hopefully, this project will be standardized and extended to others outside of the VA.

The SBIR proposals are due November 1, 2005 with $100,000 budgeted for Phase I, and $750,000 budgeted for Phase II. It is anticipated that there will be one or two awards. Go to http://grants.nih.gov/grants/funding/SBIRContract/PHS2006-1.doc, or Contact Meryle Bloomrosen at meryl.bloomrosen@ehealthinitiative.org or Linda Harris at lindaehealth@nih.gov or call (301) 451-9477.


The Public’s Attitudes towards HIPAA and HIT Discussed at the 2d HIT Summit

Dr Alan F. Westin, Director, Program on Information Technology, at the Health Resources and Privacy Center for Social and Legal Research commented on how healthcare is moving toward EHRs and interoperable networks, and as a result, the public attitudes on healthcare privacy is a very critical issue.

The public considers health and financial information the most sensitive information needing the greatest protection. Trust in healthcare practitioners to provide confidentiality is high, but the trust for data security is low because of ID thefts and security leaks. The public is most worried about the movement of personal health information into organizations administering consumer, employment, and government programs.

Interestingly, the recent 2005 Harris National surveys, asked individuals if they had ever received a HIPAA health privacy notices, 67% said yes, but almost 32% said that they don’t remember receiving a HIPAA privacy notice. When asked whether the expected benefits to patients when using an electronic medical record system would outweigh the potential risks to privacy, the public is divided right down the middle. This leads half the public to conclude that potential EHR benefits do not outweigh privacy risks.

According to Dr. Westin, privacy by design functions need to be built into current electronic health record projects going beyond HIPAA rules, there is a need to develop better computer-aided patient empowerment processes for record access, to incorporate privacy by design concepts into the national EHR standards, do studies to track privacy issues in real world settings, and monitor public and sub-group reactions to privacy as it relates to electronic health records by continuing to do sophisticated local and national surveys.

Dr Westin’s program on Information Technology, Health Records and Privacy has prepared a working paper “Computers, Health Records and Citizens’ Rights in the Twenty First Century” and is available at http://www.privacyexchange.org or at http://www.pandab.org.


Indian Health Service Announces a Cooperative Agreement Award

IHS has announced signing a cooperative agreement with the National Native American Emergency Medical Services Association (NNAEMSA) to fund a demonstration project to improve emergency medical services and communications between the IHS and emergency providers, and between other federal agencies, professional organizations, and Native American EMS. The goal is to:

• Support an annual education conference with the involvement of IHS
  
• Publish a newsletter
  
• Disseminate accurate information and education regarding EMS and EMS providers to federal, and state EMS and state administering agencies
  
• Establish links with other national Indian organizations, and professional EMS related groups
  
• Participate with the Department of Homeland Security, HHS, and the Mountain Plains Health Consortium to adopt and implement the National Incident Management System, Incident Command System, and study emergency preparedness requirements for first responders
  
  

The agreement is for a five year project period effective on September 15, 2005 to September 14, 2010. Total funding for the project is $450,000 with funding of $90,000 available in FY 2005.

For more information contact, Cathy Stueckemann, Public Health Advisor, Division of Nursing, Office of Clinical and Preventive Services at (301) 443-2500.


Still Time to Register for Partners Telemedicine Symposium in Boston on September 26-27, 2005

Partners Telemedicine’s 2nd Annual Symposium “Accelerating the Use of Communication Technology: Trends, Innovations, Critical Issues, and Value Statement” will highlight current and emerging trends in electronic healthcare applications, technology, transformational telehealth, venture capital, operational issues, and “C” level decision-making.

The meeting to be held on September 26-27, 2005 at the Conference Center at Harvard Medical will be of particular appeal and interest to business, technology, and health professionals with most of the symposium sessions having keynote presentations followed by moderated interactive discussions.

The British Consulate is a major symposium sponsor supporting the participation and involvement of the UK government and industry leaders. The presenters will share knowledge and the experience of the UK national program for healthcare information technology.

For a complete list of presenters and for more information, go to http://www.telemedicine.partners.org and click on Symposium at the top of the page. Companies wishing to sponsor or exhibit should contact Joe Ternullo Esq. Associate Director, Partners Telemedicine at jterjullo@partners.org or call (617) 726-4207.

The editor of this newsletter is Carolyn Bloch. Bloch Consulting Group is not responsible for the information provided on other Web sites. If you have any comments or additions, please contact cb@cbloch.com