HIPAA Privacy Rule Accounting: Nine Questions from HHS Focusing on PHI Disclosures

Posted on May 5, 2010 by Mike Squires

Nine Questions About HIPAA Privacy Rule Accounting
for PHI Disclosures; Asked by HHS Office of Civil Rights
Excerpted from Federal Register under Proposed Rules section on Monday, May 3, 2010. (Vol. 75, No. 84; Page 23214). These are selections from the Request for Information about accounting for disclosures of protected health information (PHI). See PDF for full text and how to submit written comments, requested by May 18, 2010.

HIPAA Privacy Rule Accounting of Disclosures Under the Health Information Technology for Economic and Clinical Health Act; Request for Information
AGENCY: Office for Civil Rights, Department of Health and Human Services.

45 CFR Parts 160 and 164 RIN 0991–AB62

ACTION: Request for information.

SUMMARY: Section 13405(c) of the Health Information Technology for Economic and Clinical Health (HITECH) Act expands an individual’s right under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to receive an accounting of disclosures of protected health information made by HIPAA covered entities and their business associates. In particular, section 13405(c) of the HITECH Act requires the Department of Health and Human Services (‘‘Department’’ or ‘‘HHS’’) to revise the HIPAA Privacy Rule to require covered entities to account for disclosures of protected health information to carry out treatment, payment, and health care operations if such disclosures are through an electronic health record. This document is a request for information (RFI) to help us better understand the interests of individuals with respect to learning of such disclosures, the administrative burden on covered entities and business associates of accounting for such disclosures, and other information that may inform the Department’s rulemaking in this area.

DATES: Submit comments on or before May 18, 2010.

II. Questions
1. What are the benefits to the individual of an accounting of disclosures, particularly of disclosures made for treatment, payment, and health care operations purposes?

2. Are individuals aware of their current right to receive an accounting of disclosures? On what do you base this assessment?

3. If you are a covered entity, how do you make clear to individuals their right to receive an accounting of disclosures? How many requests for an accounting have you received from individuals?

4. For individuals that have received an accounting of disclosures, did the accounting provide the individual with the information he or she was seeking? Are you aware of how individuals use this information once obtained?

5. With respect to treatment, payment, and health care operations disclosures, 45 CFR 170.210(e) currently provides the standard that an electronic health record system record the date, time, patient identification, user identification, and a description of the disclosure. In response to its interim final rule, the Office of the National Coordinator for Health Information Technology received comments on this standard and the corresponding certification criterion suggesting that the standard also include to whom a disclosure was made (i.e., recipient) and the reason or purpose for the disclosure. Should an accounting for treatment, payment, and health care operations disclosures include these or other elements and, if so, why? How important is it to individuals to know the specific purpose of a disclosure—i.e., would it be sufficient to describe the purpose generally (e.g., for ‘‘for treatment,’’ ‘‘for payment,’’ or ‘‘for health care operations purposes’’), or is more detail necessary for the accounting to be of value? To what extent are individuals familiar with the different activities that may constitute ‘‘health care operations?’’ On what do you base this assessment?

6. For existing electronic health record systems:
(a) Is the system able to distinguish between ‘‘uses’’ and ‘‘disclosures’’ as those terms are defined under the HIPAA Privacy Rule? Note that the term ‘‘disclosure’’ includes the sharing of information between a hospital and physicians who are on the hospital’s medical staff but who are not members of its workforce.
(b) If the system is limited to only recording access to information without regard to whether it is a use or disclosure, such as certain audit logs, what nformation is recorded? How long is such information retained? What would be the burden to retain the information for three years?
(c) If the system is able to distinguish between uses and disclosures of information, what data elements are automatically collected by the system for disclosures (i.e., collected without requiring any additional manual input by the person making the disclosure)? What information, if any, is manually entered by the person making the disclosure?
(d) If the system is able to distinguish between uses and disclosures of information, does it record a description of disclosures in a standardized manner (for example, does the system offer or require a user to select from a limited list of types of disclosures)? If yes, is such a feature being utilized and what are its benefits and drawbacks?
(e) Is there a single, centralized electronic health record system? Or is it a decentralized system (e.g., different departments maintain different electronic health record systems and an accounting of disclosures for treatment, payment, and health care operations would need to be tracked for each system)?
(f) Does the system automatically generate an accounting for disclosures under the current HIPAA Privacy Rule (i.e., does the system account for disclosures other than to carry out treatment, payment, and health care operations)?
i. If yes, what would be the additional burden to also account for disclosures to carry out treatment, payment, and health care operations? Would there be additional hardware requirements (e.g., to store such accounting information)? Would such an accounting feature impact system performance?
ii. If not, is there a different automated system for accounting for disclosures, and does it interface with the electronic health record system?

7. The HITECH Act provides that a covered entity that has acquired an electronic health record after January 1, 2009 must comply with the new accounting requirement beginning January 1, 2011 (or anytime after that date when it acquires an electronic health record), unless we extend this compliance deadline to no later than 2013. Will covered entities be able to begin accounting for disclosures through an electronic health record to carry out treatment, payment, and health care operations by January 1, 2011? If not, how much time would it take vendors of electronic health record systems to design and implement such a feature? Once such a feature is available, how much time would it take for a covered entity to install an updated electronic health record system with this feature?

8. What is the feasibility of an electronic health record module that is exclusively dedicated to accounting for disclosures (both disclosures that must be tracked for the purpose of accounting under the current HIPAA Privacy Rule and disclosures to carry out treatment, payment, and health care operations)? Would such a module work with covered entities that maintain decentralized electronic health record systems?

9. Is there any other information that would be helpful to the Department regarding accounting for disclosures through an electronic health record to carry out treatment, payment, and health care operations?

Dated: April 26, 2010.
Georgina Verdugo,
Director, Office for Civil Rights.
See PDF for full text and how to submit written comments, requested by May 18, 2010.

Related articles
Mary Mosquera reported on May 3, 2010 in Government HealthIT, “To help guide the Health and Human Services Department in tightening rules for health information privacy, HHS has asked providers, payers and consumers to comment on the benefits and burdens of accounting for the disclosure of protected health information, even if the data is intended for treatment and billing purposes.”
Dom Nicastro, wrote a background and review of questions on May 3, 2010, for HealthLeaders Media.
Joseph Goedert wrote brief report in HealthData Management on May 3, 2010.

15 Health IT Beacon Communities Named with $220 Million in Funds

Posted on May 4, 2010 by Mike Squires

Vice President Biden, HHS Secretary Sebelius Announce Selection of 15 Health IT Pilot Communities through Recovery Act Beacon Community Program
The following statement was released from the Office of the Vice President, The White House May 4, 2010
<White House Video of VP Biden and Sec’y HHS Sebelius Announcement, click here or photo.>

Awards to Help Communities Achieve Meaningful Health Care Improvements through Technology, Lay Foundation for Industry Expected to Support Tens of Thousands of Jobs

VP Biden, Sec'y Sebelius

Washington, D.C. – Vice President Biden and U.S. Health and Human Services Secretary Kathleen Sebelius today announced the selection of 15 communities across the country to serve as pilot communities for eventual wide-scale use of health information technology through the Beacon Community program. The $220 million in Recovery Act awards will not only help achieve meaningful and measurable improvements in health care quality, safety and efficiency in the selected communities, but also help lay the groundwork for an emerging health IT industry that is expected to support tens of thousands of jobs.

“These pioneering communities are going to lead the way in bringing smarter, lower-cost health care to all Americans through use of electronic health records. Because of their early efforts, doctors across the country will one day be able to coordinate patient care with the stroke of a key or pull up life-saving health information instantly in an emergency – and for the residents of these communities, that future is about to become a reality,” said Vice President Biden. “Thanks to the Recovery Act’s historic investment in health IT, we’re not only advancing the way health care is delivered in this country, we’re also building a whole new industry along with it – one that will shape our 21st Century economy for generations to come and employ tens of thousands of American workers.”

“The most important health care innovations are those that are designed and tested by providers and community leaders all across the country. Beacon Communities will offer insight into how health IT can make a real difference in the delivery of health care,” said Secretary Sebelius. “The Beacon Community Program will tap the best ideas across America and demonstrate the enormous benefit health IT will have to improving health and care within our communities.“

The selected Beacon Communities will use health IT resources within their community as a foundation for bringing doctors, hospitals, community health programs, federal programs and patients together to design new ways of improving quality and efficiency to benefit patients and taxpayers. Each Beacon Community has elected specific and measurable improvement goals in each of three vital areas for health systems improvement: quality, cost-efficiency, and population health. The goals vary according to the needs and priorities of each community.

For example, in Tulsa, Oklahoma, a community dealing with an epidemic of obesity and type 2 diabetes that has the highest rate of cardiovascular disease deaths in the nation, the award will help 1,600 physicians and other providers participate in a new community-wide health information system that will help them better monitor and improve care transitions as patients move from one care setting to another. The award is expected to help increase appropriate referrals for cancer screenings, increase access to care for patients with diabetes with telemedicine, and reduce preventable hospitalizations and emergency department visits by 10 percent for conditions that could be better handled in clinical settings, yielding a potential cost savings of $11M per year in the Tulsa area for taxpayers and patients.

Other communities will use their Beacon Community awards to provide better control of blood pressure for diabetic and hypertensive patients, improvements in care coordination and chronic disease management, reductions in preventable emergency department visits and re-hospitalizations, reductions in health disparities, better rates of immunization for children and adults, and better adherence to smoking cessation and appropriate cancer screening guidelines. The Beacon projects are expected to initially create dozens of new jobs in each community paying an average of $70,000 per year for a total of 1,100 jobs up-front, while accelerating development of a nationwide health IT infrastructure that will eventually employ tens of thousands of Americans.

Additionally, Beacon Communities will be expected to access existing federal programs that are working to promote health information exchange at the community level. Close coordination with the Regional Extension Center Program, State Health Information Exchange Program, and the National Health Information Technology Research Center (HITRC), will ensure lessons learned are shared for the benefit of all. Over time, they will also work to leverage other existing federal programs and resources that are working to promote health information exchange at the community level, including the Department of Defense’s and the Department of Veterans Affairs’ development of a Virtual Lifetime Electronic Record (VLER) for all active duty, Guard and Reserve, retired military personnel, and eligible separated Veterans.

“Communities will be expected to build on an existing infrastructure of interoperable health IT and standards-based information exchange to show the promise for health IT. The Beacon Communities will offer evidence that widespread adoption of health IT and exchange of health information is both feasible and improves care delivery and health outcomes. The lessons learned through the program will be a roadmap for other communities to achieve meaningful use on a community-wide basis,” stated David Blumenthal, MD, MPP, national coordinator for health IT.”

The Beacon Community awards are part of an overall $100 billion federal government investment in science, innovation and technology the Administration is making through the Recovery Act to spur domestic job creation in emerging industries and create a long-term foundation for economic growth. The program was significantly oversubscribed with over 130 applications submitted for the initial 15 awards. Today’s awards are part of the $2 billion effort to achieve widespread meaningful use of health IT and provide for the use of an electronic health record (EHR) for each person in the United States by 2014. An additional $30 million is currently available to fund additional Beacon Community cooperative agreement awards. An announcement to apply will be made in the near future.

The 15 Beacon communities, their awards, and key strategies for success follow:

Beacon Community Awardee	Funding Amount	Beacon Community Goals for Population Health in Service Area
Community Services Council of Tulsa, Tulsa, Okla.	$12,043,948	Leverage broad community partnerships with hospitals, providers, payers, and government agencies to expand a community-wide care coordination system, which will increase appropriate referrals for cancer screenings, decrease unnecessary specialist visits and (with telemedicine) increase access to care for patients with diabetes
Delta Health Alliance, Inc., Stoneville, Miss.	$14,666,156	Focus on achieving improvements for diabetic patients by electronically linking isolated systems and practices for care management, medication therapy management and patient education
Eastern Maine Healthcare Systems, Brewer Maine	$12,749,740	Expand community connectivity, including long-term care, primary care and specialist providers, to existing Health Information Exchange and promote the use of telemedicine and patient self-management in order to improve care for elderly patients and individuals needing long-term or home care
Geisinger Clinic, Danville, PA	$16,069,110	Enhance care for patients with pulmonary disease and congestive heart failure by creating a community-wide medical home, promoting Health Information Exchange and extending Geisinger’s proven model for practice redesign to independent healthcare organizations throughout region
HealthInsight, Salt Lake City, Utah	$15,790,181	Improve Diabetes management performance measures by increasing availability, accuracy and transparency of quality reporting, leverage Intermountain Healthcare’s strategies to reduce health systems costs throughout the region, and improve public health reporting
Indiana Health Information Exchange, INC., Indianapolis, Ind.	$16,008,431	Expand the country’s largest Health Information Exchange to new community providers in order to improve cholesterol and blood sugar control for diabetic patients and reduce preventable re-admissions through telemonitoring of high risk chronic disease patients after hospital discharge
Inland Northwest Health Services, Spokane, Wash.	$15,702,479	Focus on increasing preventive services for diabetic patients in rural areas by extending Health Information Exchange and establishing anchor institutions in close proximity to remote clinics that will promulgate successes in health IT supported care coordination
Louisiana Public Health Institute, New Orleans, La.	$13,525,434	Reduce racial health disparities and improve control of diabetes and smoking cessation rates by linking technically isolated health systems, providers, and hospitals; and empower patients by increasing their access to Personal Health Records
Mayo Clinic Rochester, d/b/a Mayo Clinic College of Medicine, Rochester, Minn.	$12,284,770	Enhance patient management and, reduce costs associated with hospitalization and emergency services for patients with diabetes and childhood asthma and address reduce health disparities for underserved populations and rural communities
Rhode Island Quality Institute, Providence, R.I.	$15,914,787	Improve the management of patients with diabetes through several health IT initiatives to support Rhode Island’s transition to the Patient Centered Medical Home model and adapt infrastructure proven to improve childhood immunizations in order to achieve improvements in adult immunization rates
Rocky Mountain Health Maintenance Organization, Grand Junction, Colo.	$11,878,279	Enable robust collection of clinical data from health systems, providers, and hospitals in order to inform practice redesign to improve blood pressure control in patients with diabetes and hypertension, increase smoking cessation counseling, and reduce unnecessary emergency department utilization and hospital re-admissions
Southern Piedmont Community Care Plan, Inc., Concord, N.C.	$15,907,622	Improve care coordination for patients with diabetes, heart disease, hypertension, and asthma by engaging patients and providers in bidirectional data sharing through a Health Record Bank, empowering patients and family members to participate in self-management through patient portals, and expanding access to care managers to facilitate post-discharge planning
The Regents of the University of California, San Diego, San Diego, Calif.	$15,275,115	Expand pre-hospital emergency field care and electronic information transmission to improve outcomes for cardiovascular and cerebrovascular disease, empower patients to engage in their own health management through web portal and cellular telephone technology, and improve continuity of care for veterans and military personnel through the Veterans Affairs/Department of Defense Virtual Lifetime Electronic Record initiative
University of Hawaii at Hilo, Hilo, Hawaii	$16,091,390	Implement a region-wide Health Information Exchange and Patient Health Record solution and utilize secure, internet-based care coordination and tele-monitoring tools to increase access to specialty care for patients with chronic diseases such as diabetes, hypertension, and obesity in this rural, health-professional shortage area
Western New York Clinical Information Exchange, Inc., Buffalo, N.Y.	$16,092,485	Utilize clinical decision support tools such as registries and point-of-care alerts and reminders and innovative telemedicine solutions to improve primary and specialty care for diabetic patients, decrease preventable emergency room visits, hospitalizations and re-admissions for patients with diabetes and congestive heart failure or pneumonia, and improve immunization rates among diabetic patients

More information about Beacon Communities can be found at: http://Healthit.hhs.gov/Programs/Beacon.

Boston Health IT/HIE Conferences meets goals center stage and off stage

Posted on May 2, 2010 by Mike Squires

Blumenthal, governor put health IT center stage in Boston;
Off stage state HIE, Medicaid and other officials network
Guided by the deft hand of Massacussetts Secretary of Health and Human Services JudyAnn Bigby through a series

Blumenthal: Live, Projected, Streaming

of scheduling shifts, the Boston-based national conference on Health IT with 600 participants from 30 states on April 29-30, 2010, included inspirational keynotes from National Coordinator for Health IT David Blumenthal and Surgeon General Regina Benjamin, as well as an enthusiastic welcome from host Governor Deval Patrick who moderated a panel as well.

Off stage state HIE and Medicaid directors and leaders took the opportunity to network and compare notes, as well as take advantage of the smaller workshops where session leaders focused on encouraging discussion and bringing up issues that needed to be addressed in the accelerating Health IT federal-state initiative.

Bernie Monegain reported for Healthcare IT on April 30, 2010, “The government will announce ‘soon – it should be very, very soon’ which 15 communities of the 130 that applied will be awarded Beacon Community grants, National Coordinator for Health IT David Blumenthal, MD, said.” In addition to supporting improved electronic health record implementation and information exchange in communities that have already demonstrated great strengths in those capabilities, these Beacon communities will share lessons learned and best practices in achieving measurable outcomes in health care quality, safety, efficiency, and population health with communities across the country, according to the Office of the National Coordinator site.

CMIO.net story by Jeff Byers on April 29, 2010 was headlined “CMIO Blumenthal gets personal, calls for teamwork among health IT pros.” Seeing younger colleagues using electronic health records, Blumenthal noted, per Byers reporting, “I was not going to be the only one in my physician group of ten not using it.” Blumenthal’s message is increasingly appealing to physicians’ sense of professionalism and focus on delivering the best patient care.

Byers futher reported April 29, 2010 in CMIO.net on a discussion of the role of consumers and patients in Health IT by a ”Panel: How do HIEs, EMRs affect patient-physician experience?,” and provides the viewpoint of each of the panelists.

ComputerWorld’s article by Lucas Mearian on April 30, 2010 reported “Health IT funding to create 50,000 jobs; Sixty regional IT help centers will help health care facilities implement electronic medical records.”

In addition to regional collaboration meetings among state officials grouped according to CMS regions, Workshops included “Achieving Sustainable Success,” Making a Difference–Health IT and Clinical Quality Improvement,” “State Initiatives in Healthcare Reform,” “Successful HIEs–How They Did It and How Ii Helps,” “Jobs, Jobs, Jobs–Health IT and State Economic Development Policy,” Creating Effective Public/Private Partnerships,” “EHR Early Adopters–How They Did It and How It Helps,” and “Health IT, HIE, and Public Health.”

One key panel, providing a sweeping overview of Health IT policies and standards, was moderated by Internet publisher pioneer Tim O’Reilly of O”Reilly Communications.

State HIE Directors are reportedly meeting with the ONC next week, and this conference acted as a bit of a warmup, with relatively new officials getting to connect, and others catch up.

See previous post on conference on e-Healthcare Marketing.

NOTE: As Jackie Slivko pointed out on LinkedIn on May 3, 2010, “Local and regional healthcare leaders as well as key vendors were also present and had an unprecedented opportunity to connect, learn from each other and network. Kudos to Mass Health Data Consortium http://www.mahealthdata.org/ , and the eHealth Initiative at the Mass Technology Collaborative http://www.maehi.org/ , both of whom continue to provide related forums and seminars. For live video and more from the conference, see http://mahit.us/ .”

State Health Information Exchange Web Sites Compiled

Posted on April 30, 2010 by Mike Squires

State HIE Web Sites Compiled
This list of State HIE Web sites is a work in progress
compiled in honor of the National Health IT Conference
hosted by Massacussetts Governor Deval L. Patrick and
all its participants. In some cases, the Web site listed
may be for the state entity that received the award from
the Office of the National Coordinator for Health IT, and
not the HIE body itself. Please let me know of any corrections
or updates. — Mike Squires

State/Ter	HIE Web Site
AK	http://www.ak-ehealth.com/
AL	http://tiny.cc/b2gqq
AR	http://recovery.arkansas.gov/hie/
AZ	http://az.gov/recovery/index.html
CA	http://www.ehealth.ca.gov
CO	http://www.corhio.org/
CT	http://www.ct.gov/dph/cwp/view.asp?a=3755&Q=441982
DC	To be added
DE	http://www.dhin.org/
FL	http://www.fhin.net/FHIN/workgroups/HIECC.shtml
GE	http://tiny.cc/0zetj
HI	http://www.hawaiihie.org/
ID	http://www.idahohde.org/about.html
IL	http://www.hie.illinois.gov/
IN	http://www.ihie.org/
IA	http://www.idph.state.ia.us/ehealth/default.asp
KS	http://www.kanhit.org/
KY	http://ehealth.ky.gov
LA	http://www.lhcqf.org/
MA	http://www.maehi.org/
MD	http://mhcc.maryland.gov/
ME	http://www.hinfonet.org/
MI	http://www.michigan.gov/mihin
MN	http://www.health.state.mn.us/
MO	http://www.dss.mo.gov/mhd/cs/index.htm
MT	http://www.healthsharemontana.org
NC	http://www.nchica.org
ND	http://www.nd.gov/itd/
NE	http://www.nehii.org/
NH	http://www.dhhs.state.nh.us/DHHS/DHHS_SITE/hie.htm
NJ	http://www.nj.gov/health/bc/hitc.shtml
NM	http://www.nmhic.org/
NV	http://www.nehii.org/
NY	http://www.nyehealth.org/
OH	http://www.ohiponline.org/
OK	http://okhca.org/okhitech
OR	http://www.oregon.gov/OHPPR/
PA	http://www.gohcr.state.pa.us/
RI	http://www.riqi.org
SC	http://www.schiex.org
SD	http://doh.sd.gov/
TN	http://www.tennesseeanytime.org/ehealth/
TX	http://www.hhsc.state.tx.us
UT	http://www.uhin.org/
VA	http://www.hits.virginia.gov
VT	http://www.vitl.net/
WA	http://www.onehealthport.com/HIE/index.php
WI	http://dhs.wi.gov/
WV	http://www.wvhin.org/
WY	http://www.wyhio.org/

Regional Extension Center Awardee Web Sites Listed by Office of National Coordinator for Health IT (ONC)

Posted on April 30, 2010 by Mike Squires

Regional Extension Center (REC) Awardee Web Sites
Excerpted from ONC Site; Re-ordered by State Postal Code
These 60 REC awardees were announced in February and April 2010 by Office of National Coordinator for Health IT (ONC).
These Web sites may not yet contain information about the REC, its award, and the new responsibilities. Per a recent media conference call, ONC shared that awardees are at different stages of readiness to work with clinicians, and ONC is working with them or meeting with over next few weeks to guide them to launch as soon as possible.

Excerpted on April 30, 2010.

State/Ter	Regional Extension Center Awardees
AK	Alaska eHealth Network, Anchorage, AK
AL	University of South Alabama, Mobile, AL
AR	Arkansas Foundation For Medical Care
AZ	Arizona Health-e Connection, Phoenix, AZ
CA	Local Initiative Health Authority for Los Angeles County, Los Angeles, CA
CA	Northern California Regional Extension Center
CA	Southern California Regional Extension Center
CO	Colorado RHIO
CT	eHealthConnecticut, Inc., Rocky Hill, CT
DC	National Indian Health Board, Washington, DC
DC	District of Columbia Primary Care Association
DE	Quality Insights of Delaware, Inc., Wilmington, DE
FL	University of Central Florida, Orlando, FL
FL	Community Health Centers Alliance, Inc, St. Petersburg, FL
FL	University of South Florida, Tampa, FL
FL	Health Choice Network, Inc., Florida
GE	Morehouse School of Medicine, Inc., Georgia
HI	Hawaii Health Information Exchange, Honolulu, HI
IL	Northern Illinois University
IL	Northwestern University
IN	Purdue University
IO	Iowa IFMC
KS	Kansas Foundation for Medical Care Inc.
KY	University of Kentucky Research Foundation, Lexington, KY
LA	Louisiana Health Care Quality Forum, Baton Rouge, LA
LA	eQHealth Solutions, Inc, Baton Rouge, LA
MA	Massachusetts Technology Park Cooperation
MD	Chesapeake Regional Information System for our Patients, Baltimore, MD
ME	HealthInfoNet, Manchester, ME
MI	Altarum Institute, Michigan
MO	The Curators of the University of Missouri, Columbia, MO
MT	Mountain-Pacific Quality Health Foundation, Helena, MT
NC	University of North Carolina, Chapel Hill
ND	Key Health Alliance (Stratis Health), Minnesota – North Dakota
NE	CIMRO of Nebraska
NJ	New Jersey Institute of Technology, Newark, NJ
NM	LCF Research, New Mexico
NY	New York eHealth Collaborative (NYeC)
NY	Fund for Public Health New York
OH	Ohio Health Information Partnership
OH-KY-IN	Greater Cincinnati HealthBridge (Ohio-Kentucky-Indiana)
OK	Oklahoma Foundation for Medical Quality, Inc.
OR	OCHIN Inc. (Primary), Oregon
PA	Quality Insights of Pennsylvania, Inc. (Eastern), King of Prussia, PA
PA	Quality Insights of Pennsylvania, Inc. (Western), King of Prussia, PA
PR	Ponce School of Medicine, PR
RI	Rhode Island Quality Institute
SC	South Carolina Research Foundation, Columbia, SC
SD	Dakota State University, Madison, SD
TN	Qsource (Tennessee)
TX	The TAMUS Health Science Center Research Foundation, College Station, TX
TX	University of Texas Health Science Center at Houston, Houston, TX
TX	Dallas-Fort Worth Hospital Council Education and Research Foundation, Irving, TX
TX	Texas Tech University Health Sciences Center, Lubbock, TX
UT-NV	HealthInsight, Utah-Nevada
VA	VHQC and the Center for Innovative Technology for The Virginia Consortium
VT	Vermont Information Technology Leaders, Inc.
WA-ID	Qualis Health, Washington – Idaho
WI	MetaStar, Inc., Wisconsin
WV	West Virginia Health Improvement Institute Inc.

HISPC on ONC site: Health Information Security and Privacy Collaboration

Posted on April 29, 2010 by Mike Squires

The Health Information Security and Privacy Collaboration (HISPC)
Office on National Coordinator for Health IT has placed all HIPSC documents on its Web site. Much of the content on ONC’s HISPC front page is excerpted below. HISPC was a 2006-2009 series of projects produced under HHS contracts with as many as 42 states and territories.
Click here for HISPC page on ONC site.

Also see pdf of AIM (Act and Implementation Manual).

HISPC documents and accomplishments came up today at one of the Regional Collaboration Meeting breakout sessions at the Health IT Conference in Boston April 29-30, 2010. So this post id dedicated to responding to those questions and needs.

Location on ONC site showing breadcrumbs:
Home > ONC Initiatives > State Level Initiatives >
Health Information Security and Privacy Collaboration (HISPC)

Excerpted from ONC’s Section on April 29, 2010.
The Health Information Security and Privacy Collaboration
(HISPC)

“Established in June 2006 by RTI International through a contract with the U.S. Department of Health and Human Services (HHS), the Health Information Security and Privacy Collaboration (HISPC) originally comprised 34 states and territories. HISPC phase 3 began in April 2008, and HISPC now comprises 42 states and territories, and aims to address the privacy and security challenges presented by electronic health information exchange through multi-state collaboration. Each HISPC participant continues to have the support of its state or territorial governor and maintains a steering committee and contact with a range of local stakeholders to ensure that developed solutions accurately reflect local preferences.

“The third phase, comprises 7 multi-state collaborative privacy and security projects focused on analyzing consent data elements in state law; studying intrastate and interstate consent policies; developing tools to help harmonize state privacy laws; developing tools and strategies to educate and engage consumers; developing a toolkit to educate providers; recommending basic security policy requirements; and developing inter-organizational agreements.

“Each project is designed to develop common, replicable multi-state solutions that have the potential to reduce variation in and harmonize privacy and security practices, policies, and laws.

“Click on the boxes below to view more details about the Collaboratives and their products.”

EDUCATION

STATE LAW AND CONSENT POLICY

ORGANIZATIONAL POLICY

HISPC Reports on
State Law, Business Practices, and Policy Variations

“Conducted during 2009 as part of the Health Information Security and Privacy Collaboration (HISPC), the following compendium of 5 reports detail variations in state law, business practices and policy related to privacy and security and the electronic exchange of health information. For quick reference, several reports contain aggregate findings tables in their appendices. Summaries of each report are below.”

**For citation purposes, please use the date the reports were published and released to the public: January 13th, 2010.**

Report on State Medical Record Access Laws [PDF - 308 KB]

“This report analyzes state laws that are intended to require health care providers (specifically, medical doctors and hospitals) to afford individuals access to their own health information and to identify potential barriers to the electronic exchange of health information. Specific state law provisions examined: scope of medical records to which patients are afforded access, format of information furnished, deadlines for responding to requests, fees for furnishing copies, record retention laws and access to records of minors.”

Report on State Law Requirements for Patient Permission to Disclose Health Information [PDF - 2.25 MB]
“In Phase I of the HISPC project a majority of participants reported significant variation in the business practices and policies surrounding the need for and process of obtaining patient permission to use and disclose personal health information for a variety of purposes, including for treatment. This report furthers the initial work of this project by collating and analyzing state laws that govern the disclosure of identifiable health information for treatment purposes to identify commonalities and differences.”

Releasing Clinical Laboratory Test Results: Report on Survey of State Laws [PDF - 1.38 MB]
“For this report, state statutes and regulations were analyzed to determine to whom clinical laboratories may release test results. This report focused on clinical laboratory and hospital licensing laws (that contain standards for hospital laboratories). It also examined general state medical record access laws to determine whether they provided an avenue for patients to access their clinical laboratory results directly.”

Report on State Prescribing Laws: Implications for e-Prescribing [PDF - 331 KB]

“This report identifies and analyzes the impact and variation of state laws related to e-prescribing. The report addresses state laws related to the e-prescribing of controlled and non-controlled substances as well as topics such as record keeping and content requirements, out-of-state prescriptions, and generic substitution laws.”

Perspectives on Patient Matching: Approaches, Findings, and Challenges [PDF - 629 KB]
“This report analyzes various approaches to matching patients to their health information in the context of electronic health information exchange. Current and potential methods for matching patients to their health records are discussed, challenges to performing patient matching such as scalability and ease of use are analyzed, and the types of information some HIOs use to match patients to their health records is described.”

HISPC Seminar Series in PDF Formats
           Consumer Education and Engagement
           Provider Education Toolkit
           Interstate Disclosure and Patient Consent Requirements
           Harmonizing State Privacy
           Intrastate and Interstate Consent Policy Options    Collaborative
           Adoption of Standards Policies
           State Access and Disclosure Law Project
          Inter-Organizational Agreements

Mass Gov Hosting Nat’l Conference On Health IT April 29-30: Boston

Posted on April 29, 2010 by Mike Squires

Health IT: Creating Jobs, Reducing Costs and Improving Quality
A National Conference Hosted by Gov. Deval Patrick

According to Massachusetts Health Data Consortium, who’s supporting the conference, streaming video will be shown for parts of the conference on April 29 and 30:
Conference Blog with Video: http://mahit.us
http://www.livestream.com/publicintellect

Agenda
1:30 Welcome by Deval L. Patrick, Governor of Massachusetts
Thomas M. Menino, Mayor of Boston
Intro by Mitchell Adams, Exec Direc, Mass Technology Collaborative
Keynote Schedule revised; started with David Blumenthal
2:00 Keynote by David Blumenthal, MD, MPP
Nat’l Coordinator for Health IT
The State and National Vision for Health IT and HIE
Intro by JudyAnn Bigby, MD, Sec’y Mass Exec Office of HHS
3:00 Consumer-Centric: The Role of the Patient in Health IT and HIE
John Moore, Managing Director, Chilmark Research
Daniel Nigrin, MD, CIO, Children’s Hospital of Boston
Barbra Rabson, Exec Dir, Mass Health Quality Partners
David Szabo, Partner, Edwards, Angell Palmer & Dodge
Moderator: Paula Griswold, Exec Dir, Mass Coalition for the Prevention of Medical Errors.
This is a deep-dive into real vision of consumer/patient-centric healthcare. Challenges and opportunities, privacy and security challenges, patient control of PHI.
4:15 Regional Collaboration Meetings
State Officials in attendance, and others who wish to observe, will meet in breakout rooms, with states grouped by the 10 CMS regions.

Conference Blog with Video: http://mahit.us/
Agenda
Follow conference on Twitter:
http://twitter.com/#search?q=%23mahit

Blumenthal blogs “Promoting Use of Health IT: Why Be a Meaningful User”

Posted on April 27, 2010 by Mike Squires

Promoting Use of Health IT: Why Be a Meaningful User
Tuesday, April 27th, 2010 | Posted by: Dr. David Blumenthal
on ONC’s Health IT Buzz Blog. Excerpted from ONC site.

“As I write, physicians throughout the United States are deciding whether to become meaningful users of electronic health records by 2011 when Medicare and Medicaid start making extra payments to meaningful users. For some the decision may be pretty simple. Almost 200,000 doctors already have adopted EHRs and are using them at a basic or sophisticated level. For these physicians, the journey to meaningful use, and its financial and clinical rewards, may be comparatively short. Many other doctors, however, remain undecided.

“I don’t want to minimize the obstacles. When I started using an EHR, I found it challenging. I often longed for a dose of my old prescription pad (confession – I cheated once in a while). I chafed at reconciling medication lists, updating problem lists, scanning through seemingly endless consultant notes. (In the past, many wouldn’t have been available – lost somewhere in the paper world.) It was much easier to use the triplicate x-ray requisition I had used for 30 years than the radiology order entry software required by my EHR. My visits were longer and more complicated. Every time I turned on the computer, it seemed, I had to learn something new.

“But I am glad I did it, as are 90 percent of all physicians who adopt an EHR, according to a scientific survey published in the New England Journal of Medicine. My EHR made me a better doctor. I really knew what was going on with my patients. I could answer their questions better and more accurately. I made better decisions. I felt more in control.

“Physicians don’t go into medicine because it’s easy. They go through grueling training – spending endless days and nights at the bedside or in the OR. They face tough personal and clinical decisions throughout their professional lives. They constantly have to grow and learn to keep up with the science and practice of medicine. That’s what makes them the professionals they are. That’s what earns their patients’ and colleagues’ respect and admiration. That’s what gets them up in the morning knowing there’s nothing else they would rather be doing.

“The EHR is just another of the transitions that physicians are constantly called upon to make in the interest of their patients, their professional competence, and their professional self-esteem. Its advent is inevitable – no more avoidable than the arrival of the stethoscope in the early 1800s or anti-sepsis in the mid 1800s ( both of which some physicians furiously resisted) or the ICU in the mid-1900s. Positive change is often disruptive, but it is irresistible nevertheless. In 10 years, paper records will be the exception. Lagging physicians will be seen as quaint throwbacks, no longer at the top of their game, nostalgic reminders of a bygone age when offices brimmed with manila folders and piles of forms, or when nurses and doctors searched endlessly on hospital rounds for that one essential patient chart that always seemed missing from the nursing station. (How many millions of hours have clinicians spent wandering hospital floors looking for those elusive missing paper records?).

“Still, some physicians may be tempted to put off the inevitable, trying to postpone the disruption and expense. Why not wait five or six years? Maybe it will get easier? Less expensive?

“For several reasons. First, the sooner physicians start using an EHR, the sooner they and their patients will realize its benefits – the ability to share patient data with colleagues and patients, the ability to retrieve old data effortlessly, the ability to access patient records remotely, so they answer patient questions intelligently from home, or even from a medical meeting.

“Second, right now, the federal government is making a once in a lifetime, never to be repeated, offer: it will help physicians pay for the transition with up to $44,000 in extra fees from Medicare, or $63,750 from Medicaid. Physicians can take the leap now with financial and technical help from the government. Or they can do it on their own (or facing a financial penalty) in five years.

“Third, anyone who is building a practice, and wanting to recruit young, talented physicians needs to confront the reality that the next generation will expect and demand that their own medical home have a modern information system. I know this from personal experience. With two children in medical school, and a daughter in law who is an intern, I know young physicians will never settle for paper records. Wait, and the cream of the recruiting crop will pass you by.

“To me the choice is clear. Physicians’ professional, clinical and financial interests all point in the same direction. Become part of the future. Become a meaningful user of an electronic health record.”

–David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology

See ONC Health IT Buzz Blog to make direct comments.

Delaware Valley, Western PA HIMSS members visit PA Legislators in Harrisburg, Invited to Testify

Posted on April 27, 2010 by Mike Squires

HIMSS of Delaware Valley and Western Pennsylvania Invited to Testify After HIMSS Members Visit PA Legislators in Harrisburg
This post originally appeared on the PAeHI blog.
HARRISBURG (April 20, 2010)–After a full day series of meetings between 50 Pennsylvania state legislators and HIMSS members from Western Pennsylvania (WPHIMSS) and Delaware Valley (DVHIMSS) chapters in the Pennslvania Capitol Building, DVHIMSS Chapter President Tom Pacek was invited to speak at the April 22, 2010 House Insurance Committee public hearing about Health IT and Electronic Health Records in Ambler, PA.

The public hearing will review legislation authored by State Rep. Rick Taylor of Montgomery, titled the Health Information Technology Act (H.B. 2106). The bill would direct a portion of Pennsylvania’s HITECH funds to develop a database of electronic medical records in the state.

In the morning, Pennsylvania Senators Mike Folmer, Patricia Vance, Andrew Dinniman, Vincent Hughes, and John Wozniak participated in active discussions with HIMSS members in Senate offices.

The Senate meetings were followed by meetings with Pennsylvania Representatives Stan Taylor, Mike Turzai, Matt Baker, Josh Shapiro, Frank Oliver, and Mike Sturla in House offices with HIMSS members to learn more about Health IT needs and legislative requirements in Pennsylvania.

The day started with HIMSS delegates networking and speaking in small groups with 40 legislators over casual breakfasts in Conference Room 60 in the Capitol complex.

In addition to their support for quality medical care, general legislators were concerned about the financial sustainability of Health Information Exchange setups, as well as privacy and security issues.

Meetings were followed by lunch at the Harrisburg Country Club, with HIMSS members, sponsors, and Philip W. Magistro, Deputy Director, Implementation from the Governor’s Office of Health Care Reform; and David Toth from Represenative Taylor’s office. The session reviewed the morning meetings, a culmination of Advocacy events planned by the two chapters leading up to today, and looked ahead to next steps with comments from Magistro and Toth.

The Health Insurance Committee hearing is open to the public and will begin at 10 a.m. Thursday, April 22 at the Ambler Theater, located on 108 E. Butler Ave. in Ambler. Pacek and one or two other HIMSS members are expected to testify.

Today’s sessions were part of The Third Annual PA Healthcare IT Advocacy Event co-sponsored by DVHIMSS and WPHIMSS, whose Chapter president is Bonnie B. Anton, RN, MN. Additional organizers of this well-organized event will be named in a later version of this post.

Link to the Advocacy talking points “Better Care Through Information Technology” (pdf).
DVHIMSS Web site: http://dvhimss.org
WPHIMSS Web site: http://www.wpahimss.org

This post originally first appeared on the PAeHI blog.

CMS Awards Add’l $8.2 mil for Medicaid Health IT to Oregon, Puerto Rico, New Mexico, Washington, and Missouri

Posted on April 26, 2010 by Mike Squires

Five New CMS Awards for Health IT Programs for Medicaid
Brings Total to 37 State/Territory Medicaid Agencies
The Centers for Medicare and Medicaid (CMS) announced awards on April 26, 2010 totalling $8.2 million to Oregon, Puerto Rico, New Mexico, Washington, and Missouri for 90/10 Health IT federal matching programs for state/territory Medicaid agencies, with CMS providing 90% of the matching funds. Oregon received the largest award of $3.53 million in this date. With these new awards, CMS has awarded a total of $58.4 million to 37 states and territories. See the five April 26, 2010 awards and amounts listed below. See previous post on e-Healthcare Marketing for prior list of awards and amount, as well as additional background.

As in previous announcements, CMS says that the Medicaid awardee “will use its federal matching funds for planning activities that include conducting a comprehensive analysis to determine the current status of HIT activities in the state. As part of that process, (the state or territory) will gather information on issues such as existing barriers to its use of EHRs, provider eligibility for EHR incentive payments, and the creation of a State Medicaid HIT Plan, which will define the state’s vision for its long-term HIT use.”

All award announcements (April 26, 2010 and prior) can be viewed via a search of CMS press releases that this link launches.

April 26, 2010 Medicaid HIT Awards

State	Amount
Oregon	$3,530,000
Puerto Rico	$1,800,000
Missouri	$1,530,000
Washington	$967,000
New Mexico	$405,000
SubTotal 4/26/10	$8,232,000
Previous Awards	$50,162,000
New Total	$58,394,000