CMS Conference Presentations on Multi-State Health IT Collaborative Posted

Posted on March 30, 2010 by Mike Squires

CMS Second Annual Multi-State Health IT Collaborative for E-Health Conference
February 8–9, 2010: Agenda and Presentations Posted
Washington, DC
This Centers for Medicare & Medicaid Services (CMS) conference focused on federal-state collaboration on the HITECH rollout of electronic health records and health information exchange, and how Medicare and Medicaid Health IT programs and other ONC initiatives worked together. News, agenda, and the 20 presentations are posted below.

According to HIMSS News of February 12, 2010, 35 states had summitted State Medicaid HIT Plans for to receive planning funds for the Medicaid portion of the EHR Incentive Program. As HIMSS News explained “Plans are required to include the current HIT landscape in the state, the State’s Five-Year Vision for incorporating multiple resources (HIEs, Medicaid resources, local and state-wide resources, etc.), and the State’s vision for Oversight and Implementation.” As of March 24, 2010, 32 state (or territory) Medicaid programs had been awarded a total of $50 million for the 90/10 Medicaid Admin program. (See e-Healthcare Marketing post for table of states and amounts awarded.)

e-Healthcare Marketing has excerpted and posted the full agenda for the two-day conference and the 20 presentations, all of which appeared useful in more fully understanding the role of CMS and the states.
“CMS Second Annual Conference Site”: Materials
Program Agenda for both days in pdf format.

PROGRAM AGENDA–DAY ONE
Monday, February 8, 2010 (pdf version for Day One)

Welcome Remarks
This welcome session will highlight the importance of States in E-Health and will preview many of the health information technology (HIT) discussions planned throughout the conference, including priorities and lessons learned about promoting Electronic Health Record (EHR)/Health Information Technology adoption and key implementation issues for the Medicaid EHR Incentive Programs.
–Teresa Niño, Director, Office of External Affairs, Centers for Medicare & Medicaid Services (CMS)
–Cynthia Mann, Director, Center for Medicaid and State Operations, CMS

Concurrent Sessions I
Establishing Health Information Exchange Governance*
*(As a result of last-minute agenda changes, this session was combined with Health Information Technology and Exchange Planning.)
This session will provide guidance and tips on the different models of HIE governance that States could consider and the impacts/considerations for each.
Co-Moderators:
–Julie Alberino, Technical Director Region II, CMS
–Lee Stevens, Regional Manager, Office of the National Coordinator for Health Information Technology (ONC)
Speaker:
–Anthony Rodgers, Principal, Health Management Associates

Health Information Technology and Exchange Planning
(As a result of last-minute agenda changes, this session was combined with Establishing Health Information Exchange Governance.)
This session will outline important steps and considerations when planning for HIT/E projects, including legal issues, stakeholder involvement, existing infrastructure, and how CMS 90/10 FFP can be applied to the different models.
Speakers:
–Kelly Cronin, Director, Office of Programs and Coordination, ONC
–Denise Bazemore, Technical Director for State Systems, Center for Medicaid and State Operations, CMS
–Denise Webb, State Health IT Coordinator, Wisconsin Department of Health Services
–Jonah Frohlich, Deputy Secretary of Health Information Technology, California Health and Human Services Agency

Role of Managed Care in Health Information Technology and Exchange
This session will outline how Medicaid Managed Care Organizations can facilitate and support HIT/EHR promotion and the success of the Medicaid EHR Incentive Programs.
Moderator:
–Michelle Mills, Policy Analyst, Center for Medicaid and State Operations, CMS
Speakers:
–Dr. Kenneth Yale, Executive Director, AmeriChoice
–Lawrence Clark, SMHP Director, Pennsylvania Medicaid

Health Information Exchange Financing
This session will focus on the parameters of the CMS 90/10 administrative matching funds for statewide HIEs, ONC HIE’s funding, and will also present sustainable HIE financing from other sources.
Speakers:
–Rick Friedman, Director, Division of State Systems, Center for Medicaid and State Operations, CMS
–Mat Kendall, Acting Director of the Office of Provider Adoption Support, ONC
–Jack Shafer, West Virginia Primary Care Network

The CMS HITECH Proposed Rule
This session will offer the Federal perspective on the Medicaidrelated portions of the NPRM, CMS expectations, and what areas States need to focus on in the short term. Participants will be encouraged to ask questions of the CMS panel members, who will do their best to answer, with the caveat that the rule is proposed, not final.
Moderator/Speaker:
–Rick Friedman, Director, Division of State Systems, Centers for Medicaid and State Operations, CMS
Panel:
–Jessica Kahn, Technical Director for HIT, Center for Medicaid and State Operations, CMS
–Donna Schmidt, Technical Director for Quality, Evaluation & Health Outcomes, Center for Medicaid and State Operations, CMS
–Michelle Mills, Health Policy Analyst, Center for Medicaid and State Operations, CMS
–Judith Haron, Attorney, Office of General Counsel, U.S. Department of Health & Human Services

Office Hours: Talk With the Experts
These smaller, informal sessions are for you to ask the experts questions on HITECH implementation. These roundtable sessions are designed to be interactive. Please sign up in advance when you register onsite.
A. CMS 90/10 Financing for HITECH Implementation
Experts:
–Denise Bazemore, Technical Director, CMS
–Rick Friedman, Director, Center for Medicaid and State Operations, CMS
Pose questions about possible uses of the CMS 90/10 Administrative funding. Note that CMS will discuss our guiding principles for use of this funding, but answers are not in lieu of an approved P-APD or IAPD.

B. Technical Assistance Resources for State Agencies
Experts:
–Sherry Armstead, Technical Director, CMS
–Erin Grace, Senior Manager of HIT, Agency for Healthcare Research and Quality
–Mark Yanick, Public Health Analyst, Health Resources and Services Administration
Ask questions and receive detailed responses about the currently available and soon-to-be available federally funded technical assistance resources for State Agencies.

C. MMIS/MITA and HIT Integration
Experts:
–Dr. James Figge, Medical Director, New York State Department of Health
How do MITA and HITECH intersect? Ask a CMS and State representative how the MITA framework can be successfully applied to your State’s expanding HIT/E activities.

D. Approved CMS P-APDs & First Steps
Experts:
Lawrence Clark, SMHP Director, Pennsylvania Medicaid
Hear from other States that have approved HITECH P-APDs and ask about first steps, planning methodologies, how they hope to coordinate with their ONC HIE cooperative agreements, etc.

E. CMS Expectations for State Medicaid HIT Plans
Experts:
–Julie Alberino, Technical Director, CMS
–Jessica Kahn, Technical Director for HIT, CMS
–Michelle Mills, Health Policy Analyst, CMS
–Donna Schmidt, Technical Director for Quality, Evaluation & Health Outcomes, Center for Medicaid and State Operations, CMS
Talk to your CMS colleagues about the expected contents of State Medicaid HIT Plans. Ask questions about revamping older plans, starting from scratch, and/or how the Medicaid plans intersect with the ONC HIE plans.

Promoting Electronic Health Records Adoption/ Communications/ Outreach
This session will focus on strategies to encourage EHR adoption, and communication and outreach about the EHR efforts and identify effective messaging and roles for States.
–Christina Nye, Division Director, Florida Agency for Health Care Administration
–David Collins, Healthcare Information and Management Systems Society
–Mat Kendall, ONC

DAY TWO AGENDA
February 9, 2010 (pdf Version)

The Word From ONC: Health Information Technology and Health Care Transformation
Moderator:
–Alan Weil, Executive Director, National Academy for State Health Policy
Speaker:
–Dr. David Blumenthal, National Coordinator for Health IT, ONC

Maximizing Federal Health Information Technology and Exchange Funding
This session will focus on available Federal resources for HIT/E to States and how to best leverage them to achieve broad HIT/EHR adoption and achieve the goals of the HITECH Act. Speakers will identify for States the funding available for the different components of HIT/E development and maintenance.
Moderator:
–Patricia MacTaggart, Lead Research Scientist, George Washington University
Speakers:
–Kelly Cronin, Director, Office of Programs and Coordination, ONC
–Rick Friedman, Director, Division of State Systems, Center for Medicaid and State Operations, CMS
–Susan Lumsden, Director, Division of State and Community Assistance, Office of Health Information Technology, Health Resources and Services Administration

CONCURRENT SESSIONS II
Lessons Learned and Best Practices for Medicaid Health Information Technology Promotion
This session will highlight critical lessons learned and 20/20 hindsight from State Medicaid Agencies who have been working on HIT/EHR adoption projects.
Moderator:
–Jessica Kahn, Technical Director for HIT, Center for Medicaid and State Operations, CMS
Speakers:
–Dr. James Figge, Medical Director, New York State Department of Health
–Kim Davis-Allen, Alabama Medicaid
–Anthony Rodgers, Principal, Health Management Associates

Provider Readiness—Large, Small, and Solo Practices
This session will focus on challenges to HIT/EHR adoption facing providers in various practice sizes and how to best tailor your State’s approach to each as you implement the EHR Incentive Program.
Moderator:
–Nikki Highsmith, Senior Vice President for Programs, Center for Health Care Strategies
Speakers:
–Dr. Jonathan White, Health IT Director, Agency for Healthcare Research and Quality
–Dr. Sarah Chouinard, Medical Director, Community Health Network of West Virginia
–Dr. Farzad Mostashari, Senior Advisor to the National Coordinator, ONC

CONCURRENT SESSIONS III
CMS Draft Guiding Principles for Use of the 90/10 Administration Funds
After approval of the HIT P-APD and the State Medicaid HIT Plan (SMHP), State Medicaid Agencies will focus next on the activities necessary for implementing their EHR Incentive Program. This session will highlight key issues concerning implementation and offer an opportunity for Q&As from the audience.
Speakers:
–Rick Friedman, Director, Division of State Systems, Center for Medicaid and State Operations, CMS
–Jessica Kahn, Technical Director for HIT, Center for Medicaid and State Operations, CMS
–Michelle Mills, Health Policy Analyst, Center for Medicaid and State Operations, CMS

Medicaid Management Information Systems (MMIS) and Health Information Technology Integration and Coordination
This session will provide insight into the role of States’ MMIS systems and MITA as well as the future of HIT/E efforts in light of States’ implementation of the Medicaid EHR Incentive Program.
Moderator:
–Denise Bazemore, Technical Director for State Systems, CMS
Speakers:
–Robert Guenther, Technical Director for MITA, CMS
–Dr. James Figge, Medical Director, New York State Department of Health
–Carol Robinson, HIT Coordinator, State of Oregon

Harmonization of Privacy and Security for Health Information Exchange
This session will focus on how States could assess and address overlapping privacy and security issues related to HIE as they pertain to Federal and State laws, and beneficiary perceptions.
Moderator:
–Joy Pritts, J.D., Research Associate/Professor, Health Policy Institute, Georgetown University (since meeting moved to Chief Privacy Offficer, ONC)
Speaker:
–LaRah Payne, Senior Policy Analyst/Privacy Officer, District of Columbia Medicaid

Presentations in pdf format
The final conference presentations (20) are available for download and viewing in PDF format on the CMS Conference site.
Links to the 20 presentations in PDF format are also available below.

Health IT Policy Cmte Meets: Phone Only, April 5

Posted on March 29, 2010 by Mike Squires

Health IT Policy Cmte Meeting: Phone Only, April 5, 2010
Per ONC email on March 26, “There will be a short conference call of the HIT Policy Committee (HITPC) on Monday, April 5th, 10-11 a.m. ET. HITPC will be discussing their comments on the Certification IFR. Members of the public may listen in via phone (there will be no Web conference). ”

Dial In
US Toll Free: 1-877-705-6006

For more information on the HIT Policy Committee, visit: http://healthit.hhs.gov/PolicyCommittee

CMS Awards Total of $50 Million to 32 State Medicaid EHR Programs

Posted on March 29, 2010 by Mike Squires

CMS Awards Total of $50 Million to 32 State Medicaid Programs
for Electronic Health Records Incentive Program
The six state Medicaid programs that received federal matching funds for electronic health record incentive program announced March 24, 2010 by the Centers for Medicare and Medicaid (CMS) were the latest in the series of 32 states since November 2009 that were awarded a total of $50,162,000. That’s according to a search of CMS press releases on March 29, 2010.

See the alphabetical list below with amounts awarded and dates of the press releases.

As an example, the press release for North Carolina, one of the states receiving matching funds on March 24, 2010 received $2.29 million and one of the higher amounts, said “The Recovery Act provides a 90 percent federal match for state planning activities to administer the incentive payments to Medicaid providers, to ensure their proper payments through audits and to participate in statewide efforts to promote interoperability and meaningful use of EHR technology statewide and, eventually, across the nation.”

According to a recent presentation by CMS, the Statutory Conditions of Use of the 90/10 HITECH Admin Funds are three fold, and vary based on the specific plan proposed by the state and agreed to by CMS:
“1. Administration of incentives, including tracking of meaningful use by Medicaid EPs and eligible hospitals;
2. Oversight, including routine tracking of meaningful use attestations and reporting mechanisms; and
3. Pursuing initiatives to encourage the adoption of certified EHR technology for the promotion of health care quality and the exchange of health care information.”

According to the report by Bernie Monegain in Healthcare IT News on March 25, 2010, ”Colorado will use its federal matching funds for planning activities that include conducting a comprehensive analysis to determine the current status of healthcare information technology activities in the state.” In addition to Colorado and North Carolina, the other state Medicaid EHR awards announced on March 24, 2010 were Mississippi, Nevada, Utah, and Wyoming.

The midpoint of the 32 awards was about $1.4 million, with New York’s Medicaid program (announced December 24, 2010) receiving the largest, $5.91 million.

CMS Matching Funds for EHRs

State	Amount	Date
Alabama	$269,000	2/26/2010
Alaska	$900,000	1/21/2010
Arizona	$2,890,000	2/26/2010
Arkansas	$815,000	2/26/2010
California	$2,480,000	12/9/2009
Colorado	$798,000	3/24/2010
Florida	$1,690,000	2/26/2010
Georgia	$3,170,000	12/9/2009
Idaho	$142,000	12/9/2009
Illinois	$2,180,000	2/26/2010
Iowa	$1,160,000	11/23/2009
Kansas	$1,700,000	2/26/2010
Kentucky	$2,600,000	1/21/2010
Maine	$1,400,000	2/26/2010
Michigan	$1,520,000	2/26/2010
Mississippi	$1,470,000	3/24/2010
Montana	$239,000	12/9/2009
Nebraska	$894,000	2/26/2010
Nevada	$1,050,000	3/24/2010
New York	$5,910,000	12/9/2009
North Carolina	$2,290,000	3/24/2010
Oklahoma	$587,000	2/26/2010
Pennsylvania	$1,420,000	1/4/2010
South Carolina	$1,480,000	1/21/2010
Tennessee	$2,700,000	1/4/2010
Texas	$3,860,000	12/9/2009
US Virgin Islands	$232,000	12/9/2009
Utah	$396,000	3/24/2010
Vermont	$294,000	2/26/2010
Virginia	$1,660,000	2/26/2010
Wisconsin	$1,370,000	1/21/2010
Wyoming	$596,000	3/24/2010
TOTAL	$50,162,000

Source: CMS Site Press Releases

For additional information on CMS role in conjunction with ONC on Health IT Initiative, see e-Healthcare Marketing post on February 2010 conference.

Health Reform Bill References to Health Information Technology–Part II

Posted on March 27, 2010 by Mike Squires

Health Reform Bill References (After Page 1,050) to Health Information Technology–Part II
This Part II post covers references that appear after page 1,050 to health information technology and the Office of the National Coordinator for Health IT in the“Patient Protection and Affordable Care Act” approved by the House of Representatives on March 21, 2010 and passed by the Senate in December 2009. Page numbers at the end of each reference are based on the Senate pdf: [PDF of Senate version which was approved by House]

For Part I of “Health Reform Bill References to Health IT” on e-Healthcare Marketing, with references to Health IT in the first 1,050 pages, click here. (Numbering continues from part I.)

23. SEC. 3502. (Continued from Part I of post on Health Reform Bill) ESTABLISHING COMMUNITY HEALTH TEAMS TO SUPPORT THE PATIENT-CENTERED MEDICAL HOME“(6) provide support necessary for local primary care providers to—…(J) establish a coordinated system of early identification and referral for children at risk for developmental or behavioral problems such as through the use of infolines, health information technology, or other means as determined by the Secretary;” p. 1051
24. ”(7) provide 24-hour care management and support during transitions in care settings including—…(9) demonstrate a capacity to implement and maintain health information technology that meets the requirements of certified EHR technology (as defined in section 3000 of the Public Health Service Act (42 U.S.C. 300jj)) to facilitate coordination among members of the applicable care team and affiliated primary care practices;” p. 1054
25. “(b) PERSONALIZED PREVENTION PLAN SERVICES DEFINED…‘‘(F) To the extent practicable, the Secretary shall encourage the use of, integration with, and coordination of health information technology (including use of technology that is compatible with electronic medical records and personal health records) and may experiment with the use of personalized technology to aid in the development of self-management skills and management of and adherence to provider recommendations in order to improve the health status of beneficiaries.” p. 1158.
26. ‘‘SEC. 3101. DATA COLLECTION, ANALYSIS, AND QUALITY…‘‘(3) DATA MANAGEMENT.—In collecting data described in paragraph (1), the Secretary, acting through the National Coordinator for Health Information Technology shall—‘‘(A) develop national standards for the management of data collected; and‘‘(B) develop interoperability and security systems for data management.” p. 1222
27. “Subtitle B—Innovations in the Health Care Workforce SEC. 5101. NATIONAL HEALTH CARE WORKFORCE COMMISSION…(ii) An analysis of the nature, scopes of practice, and demands for health care workers in the enhanced information technology and management workplace.” p. 1255
28. “Subtitle D—Enhancing Health Care Workforce Education and Training…‘‘(3) PRIORITIES IN MAKING AWARDS.—In awarding grants or contracts under paragraph (1)the Secretary shall give priority to qualified applicants that—‘‘(H) provide training in enhanced communication with patients, evidence-based practice, chronic disease management, preventive care, health information technology, or other competencies as recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry and the National Health Care Commission established in section 5101 of the Patient Protection and Affordable Care Act;” p. 1321
29. SEC. 5405. PRIMARY CARE EXTENSION PROGRAM…(grants to) ‘‘(H) provide training in enhanced communication with patients, evidence-based practice,chronic disease management, preventive care, health information technology, or other competencies as recommended by the Advisory Committee on Training in Primary Care Medicine and Dentistry and the National Health Care Workforce Commission established in section 5101 of the Patient Protection and Affordable Care Act;” p.1412
30. Subtitle G—Improving Access to Health Care Services SEC. 5604. CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMUNITY-BASED MENTAL HEALTH SETTINGS…(1) ELIGIBLE ENTITY.—The term ‘eligible entity’ means a qualified community mental health program defined under section 1913(b)(1). ‘‘(2) SPECIAL POPULATIONS.—The term ‘special populations’ means adults with mental illnesses who have co-occurring primary care conditions and chronic diseases. ‘‘(b) PROGRAM AUTHORIZED.—The Secretary, acting through the Administrator shall award grants and cooperative agreements to eligible entities to establish demonstration projects for the provision of coordinated and integrated services to special populations through the co-location of primary and specialty care services in community-based mental and behavioral health settings…‘‘(1) IN GENERAL.—For the benefit of special populations, an eligible entity shall use funds awarded under this section for—‘‘(C) information technology required to accommodate the clinical needs of primary and specialty care professionals; p. 1488
31. ”SEC. 6114. NATIONAL DEMONSTRATION PROJECTS ON CULTURE CHANGE AND USE OF INFORMATION TECHNOLOGY IN NURSING HOMES.” Demonstration project “for the development of best practices in skilled nursing facilities and nursing facilities for the use of information technology to improve resident care.” p. 1597
32. ”Subtitle D—Patient-Centered Outcomes Research SEC. 6301. PATIENT-CENTERED OUTCOMES RESEARCH” Institute…”The Office of Communication and Knowledge Transfer (referred to in this section as the ‘Office’) at the Agency for Healthcare Research and Quality (or any other relevant office designated by Agency for Healthcare Research and Quality), in consultation with the National Institutes of Health, shall broadly disseminate the research find2ings that are published by the Patient Centered Outcomes Research Institute established under section1181(b) of the Social Security Act (referred to in this section as the ‘Institute’) and other government-funded research relevant to comparative clinical effectiveness research….The Office shall also develop a publicly available resource database that collects and contains government-funded evidence and research from public, private, not-for profit, and academic sources.” ‘‘(2) REQUIREMENTS.—The Office shall provide for the dissemination of the Institute’s research findings and government-funded research relevant to comparative clinical effectiveness research to physicians, health care providers, patients, vendors of health information technology focused on clinical decision support, appropriate professional associations, and Federal and private health plans. Materials, forums, and media used to disseminate the findings, informational tools, and resource databases shall—23 ‘‘(A) include a description of considerations for specific subpopulations, the research methodology, and the limitations of the research, and the names of the entities, agencies, instrumentalities, and individuals who conducted any research which was published by the Institute; and ‘‘(B) not be construed as mandates, guidelines, or recommendations for payment, coverage, or treatment. ‘‘(b) INCORPORATION OF RESEARCH FINDINGS.—The Office, in consultation with relevant medical and clinical associations, shall assist users of health information technology focused on clinical decision support to promote the timely incorporation of research findings disseminated under subsection (a) into clinical practices and to promote the ease of use of such incorporation.” p.1649
33. ‘‘PART II—PROGRAMS TO PROMOTE ELDER JUSTICE SEC. 2041. ENHANCEMENT OF LONG-TERM CARE.‘‘(a) GRANTS AND INCENTIVES FOR LONG-TERM CARE STAFFING.—…‘‘(b) CERTIFIED EHR TECHNOLOGY GRANT PROGRAM.—‘‘(1) GRANTS AUTHORIZED.—The Secretary is authorized to make grants to long-term care facilities for the purpose of assisting such entities in offsetting the costs related to purchasing, leasing, developing, and implementing certified EHR technology (as defined in section 1848(o)(4)) designed to improve patient safety and reduce adverse events and health care complications resulting from medication errors. ‘‘(2) USE OF GRANT FUNDS.—Funds provided under grants under this subsection may be used for any of the following: ‘‘(A) Purchasing, leasing, and installing computer software and hardware, including handheld computer technologies.‘‘(B) Making improvements to existing computer software and hardware.‘‘(C) Making upgrades and other improvements to existing computer software and hardware to enable e-prescribing.‘‘(D) Providing education and training to eligible long-term care facility staff on the use of such technology to implement the electronic transmission of prescription and patient information.” p. 1791
34. SEC. 10109. DEVELOPMENT OF STANDARDS FOR FINANCIAL AND ADMINISTRATIVE TRANSACTIONS…‘‘(B) SOLICITATION OF INPUT.—For purposes of subparagraph (A), the Secretary shall seek input from— ‘‘(i) the National Committee on Vital and Health Statistics, the Health Information Technology Policy Committee, and the Health Information Technology Standards Committee; p. 2121
35. SEC. 10305. DATA COLLECTION; PUBLIC REPORTING…(2) COLLECTION AND AGGREGATION OF DATA.— The Secretary shall collect and aggregate consistent data on quality and resource use measures from information systems used to support health care delivery, and may award grants or contracts for this purpose. The Secretary shall align such collection and aggregation efforts with the requirements and assistance regarding the expansion of health information technology systems, the interoperability of such technology systems, and related standards that are in effect on the date of enactment of the Patient Protection and Affordable Care Act. p. 2182
36. SEC. 10410. CENTERS OF EXCELLENCE FOR DEPRESSION.(a) SHORT TITLE.—This section may be cited as ‘‘Establishing a Network of Health-Advancing National Centers of Excellence for Depression Act of 2009’’ or the‘‘ENHANCED Act of 2009’’…‘‘(2) IMPROVED TREATMENT STANDARDS, CLINICAL GUIDELINES, DIAGNOSTIC PROTOCOLS, AND CARE COORDINATION PRACTICE.—Each Center shall collaborate with other Centers in the network to—…‘‘(D) use electronic health records and telehealth technology to better coordinate and manage, and improve access to, care, as determined by the coordinating center.” p. 2311

[PDF of Senate version which was approved by House]

For Part I of “Health Reform Bill References to Health IT” on e-Healthcare Marketing, with references to Health IT in the first 1,050 pages, click here.

Please make comments, suggestions or corrections to this post via the Comments box or an email to the producer of e-Healthcare Marketing. Thank you.

NJ Awarded $11.4 Million Grant for Electronic Health Records

Posted on March 27, 2010 by Mike Squires

NJ Awarded $11.4 Million Grant for Electronic Health Records
March 25, 2010 Press Release from Poonam Alaigh, MD, MSHCPM, FACP, Acting Commissioner, NJ Dept of Health and Senior Services: ”New Jersey will receive $11.4 million in federal funds over the next four years to fund electronic health records projects that will allow hospitals, doctors and health insurance companies to share electronic medical records in real time over secure networks.

(Update: Dr. Alaigh was sworn in as commissioner on March 26, 2010.)

“The state will work with the health care industry to create four regional Health Information Exchanges (HIEs) that will share information such as lab results and medication histories among health care providers around the state. HIEs hold the promise of improving health care quality and efficiency by eliminating duplicative testing, avoiding dangerous medication interactions and providing information about patient histories with other facilities that will help physicians improve care.

“The funding, awarded under the federal American Recovery and Reinvestment Act of 2009, moves the state closer to the national goal of achieving interoperable electronic health records transfer capability by the year 2014.

“The Department of Health and Senior Services led a multi-departmental effort to apply for the grant and to jointly submit a state plan for Health Information Technology.

“Health and Senior Services Commissioner Dr. Poonam Alaigh and Banking and Insurance Commissioner Tom Considine explained that the goal of the initiative is to increase patient safety and reduce medical costs. The Department of Human Services, which runs the state’s Medicaid program, is also involved in the initiative.

“‘The real-time exchange of clinical data among health-care providers represents a central pillar of health-care reform,’ said Dr. Alaigh. ‘If we’re going to get serious about reducing costs, if we’re going to get serious about managing patients with chronic disease, and if we’re going to get serious about coordinating care, then accurate and robust data at the point of care is fundamental.’

“Commissioner Considine said, ‘These infrastructure projects are important building blocks in creating a network-wide electronic health records system,’ said Commissioner Considine. ‘These projects will help lead the way toward better and safer medical care for the people of New Jersey.’

“‘When we began this effort more than a decade ago, we knew it would be an ambitious undertaking,’ said Commissioner Considine. ‘An electronic health records system translates to important cost savings for hundreds of thousands of people.’

“When these projects are completed by March 2014, treatments including diagnostic tests such as legally required lead screening for children will be tracked, preventing unnecessary duplicate services. Another benefit of electronic health records is that any possible adverse reactions, such as drug allergies, would be known by the treating medical staff.

“New Jersey’s work on health information technology began in 1999 with the establishment of the Office for Electronic Health Information Technology (e-HIT). As required by ARRA, all states must develop a health IT network that registers every citizen by the end of 2015.

“The grant award marks the culmination of a process among several departments of state government and the Office of the National Coordinator for Health Information Technology. The Statewide Health Information Exchange Cooperative Agreement Program—offered by the Office of the National Coordinator for Health Information Technology—required states to submit state Health IT Plans that addressed several issues, including privacy, security, and technical infrastructure.

“The four exchanges that received funding have statewide coverage and were selected last fall through a competitive Request for Application process.”

ONC Dir of Policy & Planning Jodi Daniel: Bio & Role Added to Web

Posted on March 26, 2010 by Mike Squires

ONC Director of Office
of Policy & Planning
Jodi Daniel, JD, MPH
Role & Bio Added to Web site
Having served since October 2005, Jodi Daniel is one of the longest standing members of the Office of the National Coordinator (ONC) for Health IT and a regular presence at the HIT Policy and Standards Committee meetings. Daniel’s role, bio, and picture were put up in the ONC site on March 26, 2010.

“Jodi Daniel has served as Director in the Office of the National Coordinator for Health Information Technology (ONC), Department of Health and Human Services (HHS), since October 2005. In her current role as Director of the Office of Policy and Planning, she is responsible for considering and addressing the policy implications of key health information technology (HIT) activities. This includes establishing new policies and working with other Federal agencies and organizations and State governments to coordinate efforts and assure that existing and developing policies are consistent (HIT) and health information exchange activities and nationwide goals. She leads ONC’s regulatory and legislative activities and manages ONC’s federal advisory committees, which provide advice on all HIT policy and standards related matters. She is also responsible for the development of ONC’s HIT strategic plan to shape the direction of Federal HIT activities.

“Ms. Daniel developed expertise in legal issues and HHS’s strategies regarding HIT as the first Senior Counsel for Health Information Technology in the Office of the General Counsel of HHS. In this role, she was responsible for coordinating all legal advice regarding health information technology for HHS, and was the lead attorney for ONC. Ms. Daniel founded and chaired the health information technology practice group within OGC and worked closely with the Centers for Medicare and Medicaid Services in the development of the e-prescribing standards regulations and the proposed Stark and anti-kickback rules regarding e-prescribing and electronic health records.

“Ms. Daniel also brings with her a strong background in health information privacy. As an Attorney in the Civil Rights Division of the Office of General Counsel, she was a senior member of the core team responsible for developing policies and drafting the final HIPAA Privacy Rule, the Privacy Rule modifications, and the HIPAA Enforcement Rule.

“Before joining HHS, Ms. Daniel was a health care associate at Ropes & Gray, where she advised health care providers and payers on transactional, regulatory, and legislative issues. She also worked at MetLife as an internal management consultant and a health benefits consultant.

“Ms. Daniel earned a law degree from Georgetown University and a Masters in Public Health from Johns Hopkins University.”

Leveraging Health IT for Patient Empowerment Webinar – Apr 8 from AHRQ

Posted on March 25, 2010 by Mike Squires

Leveraging Health IT for Patient Empowerment Webinar
Sponsored by AHRQ National Resource Center for Health IT
April 8, 2010 3:00 – 4:30 p.m., EDT
Emailed and accessed on Web March 25, 2010.

“Free 90-minute teleconference will explore the latest research on how patients can utilize health IT to increase participation in their healthcare. Sponsored by the Agency for Healthcare Research and Quality’s (AHRQ) National Resource Center for Health IT.”

Presenters:

“Alexander Krist, M.D., M.P.H., serves as an Assistant Professor in the Virginia Commonwealth University (VCU) School of Medicine’s Department of Family Medicine. The majority of his research is conducted through the VCU Department of Family Medicine’s multidisciplinary research team and its practice-based research network (the Virginia Ambulatory Care outcomes Research Network) of more than sixty primary care practices, spanning six health systems assembled to coordinate on research projects. In 2004 he helped direct his practice to implement a paperless electronic health record including e-prescribing, laboratory and radiology interfaces, electronic billing, performance monitoring, and a registry for population management.
“Christine Ritchie, M.D., M.S.P.H., is an Associate Professor at the University of Alabama Birmingham (UAB) School of Medicine’s Center for Palliative Care. She holds the title of Director of the UAB Center for Palliative Care and Director of the Palliative Care Section within the Division of Gerontology and Geriatric Medicine. She served as the VA Network 9 Palliative Care Consult Team mentor, a member of the VA Network 9 Health Systems Council, and co-chair of the Network 9 Geriatrics and Extended Care Committee.
“Christine Sinsky, M.D., B.S., is a General Internist at Medical Associates Clinic and Health Plans, in Dubuque, Iowa. She is a frequently invited lecturer on practice innovation, redesign, and the patient centered medical home (PCMH) and has been a presenter at the Patient Centered Primary Care Collaborative Stakeholder meeting. She serves on the physician advisory panel for the National Committee for Quality Assurance (NCQA) physician recognition programs and is a Director on the American Board of Internal Medicine.“

“Dr. Sinsky will introduce the topic by providing an overview of challenges and innovations facing patient empowerment and health IT systems. Building on this foundation, Dr. Krist will discuss findings from a randomized controlled trial to evaluate the impact of a personal health record (PHR). In his presentation he will explain how this PHR links patients to their health information in their physician’s electronic medical record (EMR) and provides personally tailored prevention recommendations to patients. Dr. Ritchie will discuss ongoing research in developing evidence-based tools to support patient-centered care. She will explain the findings from a randomized controlled trial investigating how to utilize IT systems to support patients with complex medical conditions as they transition from hospital to home-based care. To conclude our presentation, Dr. Sinsky will discuss her on-the-ground experience with empowering patients via IT systems in clinical settings and the key barriers and enablers to success.”

To register for the teleconference, please visit: https://ahrq.peachnewmedia.com/store/seminar/seminar.php?seminar=4324 and select “Register.”

DEA: The Electronic Prescribing of Controlled Substances IFR is now available

Posted on March 25, 2010 by Mike Squires

The Electronic Prescribing of Controlled Substances IFR
To be Issued by DEA for Public Comments
The Drug Enforcement Administration is revising its regulations ”to provide practitioners with the option of writing prescriptions for controlled substances electronically.”

Office of National Coordinator (ONC) for Health IT emailed this notice on March 25, 2010. Summary from Interim Final Rule (IFR) can be seen below text from email.
“Yesterday (3/24) the Office of the Federal Register made available for public inspection an Interim Final Rule with Request for Comments from the Drug Enforcement Administration (DEA), Department of Justice on Electronic Prescribing of Controlled Substances. The Interim Final Rule specifies the rules that health care providers will need to follow in order to electronically prescribe controlled substances in accordance with the law. Since DEA published the Notice of Proposed Rulemaking for electronic prescribing of controlled substance, ONC, CMS, AHRQ and other HHS staff have worked closely with DEA to develop the policies in the Interim Final Rule. The Interim Final Rule is expected to be published in the Federal Register on Wednesday, March 31 and will include a 60 day comment period. To view the Interim Final Rules go to: http://www.federalregister.gov/inspection.aspx#spec_D”
# # #

Electronic Prescriptions for Controlled Substances
Excerpts from IFR for inspection at site of Federal Register
Federal Register PDF of Interim Final Rule
DEPARTMENT OF JUSTICE
Drug Enforcement Administration
21 CFR Parts 1300, 1304, 1306, 1311
[Docket No. DEA-218I]
RIN 1117-AA61

AGENCY: Drug Enforcement Administration (DEA), Department of Justice
ACTION: Interim Final Rule with Request for Comment.

SUMMARY: The Drug Enforcement Administration (DEA) is revising its regulations to provide practitioners with the option of writing prescriptions for controlled substances electronically. The regulations will also permit pharmacies to receive, dispense, and archive these electronic prescriptions. These regulations are an addition to, not a replacement of, the existing rules. The regulations provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining the closed system of controls on controlled substances dispensing; additionally, the regulations will reduce paperwork for DEA registrants who dispense controlled substances and have the potential to reduce prescription forgery. The regulations will also have the potential to reduce the number of prescription errors caused by illegible handwriting and misunderstood oral prescriptions. Moreover, they will help both pharmacies and hospitals to integrate prescription records into other medical records more directly, which may increase efficiency, and potentially reduce the amount of time patients spend waiting to have their prescriptions filled.

DATES: This rule has been classified as a major rule subject to Congressional review. The effective date is [INSERT DATE 60 DAYS AFTER PUBLICATION IN THE FEDERAL REGISTER]. However, at the conclusion of the Congressional review, if the effective date has been changed, the Drug Enforcement Administration will publish a document in the Federal Register to establish the actual effective date or to terminate the rule. The incorporation by reference of certain publications listed in the rule is approved by the Director of the Federal Register as of [INSERT DATE 60 DAYS AFTER DATE OF PUBLICATION IN THE FEDERAL REGISTER].

Written comments must be postmarked and electronic comments must be submitted on or before [INSERT DATE 60 DAYS FROM DATE OF PUBLICATION IN THE FEDERAL REGISTER]. Commenters should be aware that the electronic Federal Docket Management System will not accept comments after Midnight Eastern Time on the last day of the comment period.

ADDRESSES: To ensure proper handling of comments, please reference “Docket No. DEA-218” on all written and electronic correspondence. Written comments sent via regular or express mail should be sent to the Drug Enforcement Administration, Attention: DEA Federal Register Representative/ODL, 8701 Morrissette Drive, Springfield, VA 22152. Comments may be sent to DEA by sending an electronic message to dea.diversion.policy@usdoj.gov. Comments may also be sent electronically through http://www.regulations.gov using the electronic comment form provided on that site. An electronic copy of this document is also available at the http://www.regulations.gov web site.

Listening Session for Health IT Strategic Framework: April 6

Posted on March 24, 2010 by Mike Squires

Listening Session for Health IT Strategic Framework: April 6, 2010
Preview HIT Strategic Framework: Strategic Themes, Principles, Objectives, and Strategies
Review 2008 Strategic Plan
ONC emailed and posted information March 24, 2010, about the listening session scheduled for April 6, 2010. The plan dated March 23, 2010 is marked as version 30, and a version has been previously shared online and discussed as part of at least one HIT FACA public meeting. Information on session is excerpted from ONC email and Web site.

“The Strategic Plan Workgroup of HIT Policy Committee will hold a public listening session on April 6, 2010, 12pm ET, to obtain feedback on the Health IT Strategic Framework. This Framework will be a key input to the Federal Health IT Strategic Plan.*

”The objective of the listening session is to obtain feedback from the healthcare community regarding the Health IT Strategic Framework which will become foundation for the updates to the Federal Health IT Strategic Plan. The Health IT Strategic Plan will focus on 2011 through 2015 time period as well as lay the ground work for the period beyond 2015 to create a learning health system through the effective use of HIT.”

Draft Framework (pdf) has been posted on ONC Health IT Web site for review.

“Registration for this event will be required in order to accommodate the number of interested parties. Visit http://events.signup4.com/hitstrategic to register to attend the session. Meeting materials will be posted at http://healthit.hhs.gov/StrategicPlanWG as they become available. Thank you for your interest.”

“*The HITECH Act requires the Office of the National Coordinator for Health Information Technology (ONC), in consultation with other appropriate Federal agencies, to update the Federal Health IT Strategic Plan published in June 2008.”

Health IT Strategic Framework: Strategic Themes, Principles, Objectives, and Strategies
PDF version with selected excerpts below.

Strategic Planning Scope
“–The Federal Health IT Strategic Plan Update will encompass three levels:
          –The full array of entities in the public and private sectors who have a role in affecting and implementing the use of HIT to improve health and health care;
          –The broad array of Federal HIT policies, regulations, systems, and activities; and
          –The specific mandate, authorities, and role of the ONC.

–The Update will emphasize the implementation of legislative imperatives to achieve widespread adoption and meaningful use of HIT.

–The Update will also focus on features that would be essential to continue the adoption and value of HIT beyond ARRA funding.

–The Health IT Strategic Plan Update will focus on 2011 through 2015 time period.

–It will also focus on laying the ground work for the period beyond 2015 to create a learning health system through the effective use of HIT.”

VISION AND PREAMBLE
“Vision – A learning health system that is patient-centered and uses information to continuously improve health and health care of individuals and the population.

“A learning health system is a system that is designed to generate and apply the best evidence for the collaborative health care choices of each patient and provider; to drive the process of new discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care. A learning health system focuses on the needs of individuals and population health and aims to create a health system that is Patient-centered, Safe, Timely, Effective, Efficient, Equitable. An effective learning health system is where individuals can make informed decisions about their health and health care; patients can exercise choices about sharing of their data; decision makers have access to the right information at the right time in a secure environment; the health delivery system is more efficient; and the health care industry continues to improve population health.

“Health Information Technology (HIT) provides a critical infrastructure for an effective learning health system. HIT offers tools that can expand current capabilities to collect and manage data that can help creation of a sustainable system that facilitates getting the right care to people when they need it and then captures the results for improvement in care, and create and share knowledge.

“Despite the important role of HIT to a learning health system, only a small number of health care organizations have implemented a comprehensive EHR. Getting to widespread adoption and use of HIT is one component of a reformed system – necessary, but not sufficient to effect, the broad change needed in our health system.

“Inherent in the vision of a learning health system is a set of values that provide the foundation for public policies at the Federal and state levels aimed at reforming and improving the health system. The HITECH Act specifies this broader set of values and helps to focus Federal health policy regarding information technology in the following areas:

–Improving privacy and security protections for health information;

–Facilitating individual access to his or her health information;

–Improving quality of health care by improving care coordination, reducing medical errors, reducing chronic disease, reducing health disparities, improving population health, and advancing research and education;

–Addressing the needs of children and other vulnerable populations;

–Collecting information for quality reporting, biosurveillance, public health, medical and clinical research, and drug safety; and

–Improving efficiency and reducing the burden on patients and health care professionals.

“The HIT policies and programs of ONC and its Federal partners aspire to achieve this vision and its inherent values, leveraging the programs authorized by the HITECH Act. To achieve this vision, a transformation of our current health care delivery system is required.

“To begin this transformation, the Federal government proposed a set of priorities for meaningful use of HIT which can also be applied broadly to help achieve the vision. They include:

–Improve quality, safety, efficiency and reduce health disparities;

–Engage patients and families in their health care;

–Improve care coordination;

–Improve population and public health; and

–Ensure adequate privacy and security protections for personal health information.

“Implicit in enabling the HITECH Act and addressing the health priorities are a number of roles that only the Federal government can play in promoting the adoption and use of HIT. One key role involves the provision of resources to support the public-good infrastructure (serving public health, biomedical research, quality improvement, and emergency preparedness). The government also has a role to play when information asymmetries hinder the development of a private market. The efforts involving standards, implementation specifications, and certification criteria are a solution to such problems. Government action is also necessary to spur the adoption of HIT and the development of means for health information exchange to assure the critical mass of users necessary to create a self-sustaining system of interoperable HIT. Finally, working to improve the efficiency of public and population health programs is clearly a government responsibility.

“The Health IT Strategic Framework enumerates critical government roles in the pursuit of a health system that uses information to empower individuals and to improve the health of the population.”

Premable to Strategic Framework (Selected sections)
“The proposed Federal HIT strategies are grouped into four Themes:
1) Meaningful Use of Health Information Technology,
2) Policy and Technical Infrastructure,
3) Privacy and Security, and
4) Learning Health System.

“Themes 1, 2 and 3 focus on establishing the foundation and infrastructure to support a learning health system and Theme 4 focuses on leveraging these resources to create a learning system. These themes are interrelated and must work together to achieve the vision set forth in this Framework.

“Theme 1 focusing on Meaningful Use describes steps towards using HIT to improve care and support a learning health system.

“Themes 2 and 3 focus on the infrastructure for HIT.

“Theme 2 focuses on Policy and Technology infrastructure that is necessary to support Meaningful Use as well as the learning health system for broader HIT i.e. not only EHR but also health information exchange, and other HIT components.

“Theme 3 addresses Privacy and Security issues and challenges related to broader HIT as well.

“Finally, Theme 4 focuses on leveraging these resources to create a learning health system.

“Each Theme… includes a goal, guiding principles, objectives and strategies. The ONC strategic plan will include specific tactics and measures for each Theme.”

Referenced Documents
The (2008) ONC-Coordinated Federal Health IT Strategic Plan: 2008-2012 (pdf)
Dated: June 3, 2008

Nationwide Privacy and Security Framework for
Electronic Exchange of Individually Identifiable Health Information (pdf)
Dated: December 15, 2008. Still considered the benchmark document, the framework describes eight principles that “are expected to guide the actions of all health care-related persons and entities that participate in a network for the purpose of electronic exchange of individually identifiable health information. These principles are not intended to apply to individuals with respect to their own individually identifiable health information.”

ONC Releases Whitepaper on Consumer Consent Options for Electronic HIE

Posted on March 24, 2010 by Mike Squires

ONC Releases Whitepaper on Consumer Consent Options for Electronic Health Information Exchange
Emailed from ONC on March 24, 2010
“The whitepaper examines issues regarding whether, to what extent, and how individuals should have the ability to exercise control over their health information in an electronic health information exchange environment. It looks at existing approaches and details policy options, considerations, and analysis. This whitepaper will serve as input to, and be reviewed by, the HIT Policy Committee’s Privacy and Security Workgroup as it prepares to make recommendations related to consumer consent in an electronic health information exchange environment. The whitepaper is the first in a series of privacy and security reports developed by George Washington University under contract with ONC.”

Privacy and Security Whitepaper Series
Consumer Consent Options for Electronic Health Information Exchange: Policy Considerations and Analysis

Cover Page and Executive Summary [PDF - 40 KB]

Consumer Consent Options — Complete Whitepaper [PDF - 735 KB]

Appendix A: State Model Table [PDF - 73 KB]

Appendix B: State Law Table [PDF - 62 KB]

Appendix C: Other Countries [PDF - 60 KB]

Privacy and Security and Health Information Technology
Excerpted from ONC on March 24, 2010.
“Electronic health information exchange promises an array of potential benefits for individuals and the U.S. health care system through improved clinical care and reduced cost. At the same time, this environment also poses new challenges and opportunities for protecting individually identifiable health information. In health care, accurate and complete information about individuals is critical to providing high quality, coordinated care. If individuals and other participants in a network lack trust in electronic exchange of information due to perceived or actual risks to individually identifiable health information or the accuracy and completeness of such information, it may affect their willingness to disclose necessary health information and could have life-threatening consequences. Coordinated attention at the Federal and State levels is needed both to develop and implement appropriate privacy and security policies. Only by engaging all stakeholders, particularly consumers, can health information be protected and electronically exchanged in a manner that respects variations in individuals’ views on privacy and access.”

(The section above labelled “Privacy and Security Whitepaper Series” contains the links to the first White Paper. ONC shared additional resources shown below.)

Other Resources

e-Healthcare Marketing

Health Information Exchange, Electronic Health Records and Personal Health Records

Monthly Archives: March 2010