Proposed ONC Interoperability Roadmap to Improve Health Technology and Transform Care

The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) recently released “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap” version 1.0. The draft roadmap is a proposal to deliver better care and result in healthier people through the safe and secure exchange and use of electronic health information.

“HHS is working to achieve a better health care system with healthier patients, but to do that, we need to ensure that information is available both to consumers and their doctors,” said HHS Secretary Sylvia M. Burwell. “Great progress has been made to digitize the care experience, and now it’s time to free up this data so patients and providers can securely access their health information when and where they need it. A successful learning system relies on an interoperable health IT system where information can be collected, shared, and used to improve health, facilitate research, and inform clinical outcomes. This roadmap explains what we can do over the next three years to get there.”

The draft ONCE interoperability roadmap builds on the vision paper, “Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure,” issued in June 2014. Months of comment and feedback from hundreds of health and health IT experts from across the nation through ONC advisory group feedback, listening sessions and an online forum aided in the development of the roadmap.

“To realize better care and the vision of a learning health system, we will work together across the public and private sectors to clearly define standards, motivate their use through clear incentives, and establish trust in the health IT ecosystem through defining the rules of engagement. We look forward to working collaboratively and systematically with federal, state and private sector partners to see that electronic health information is available when and where it matters,” said Karen DeSalvo, M.D., national coordinator for health IT.

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HHS Gives $665 Million for State-led State Innovation Models to “Improve” Healthcare Quality

Twenty eight states, three territories and the District of Columbia will receive more than $665 million in Affordable Care Act funding to design and test healthcare payment and service delivery models that will try to improve healthcare quality and lower costs, Health and Human Services Secretary Sylvia M. Burwell announced.

Together with awards released in early 2013, more than half of states (34 states and three territories and the District of Columbia), representing nearly two-thirds of the population are participating in efforts to support comprehensive state-based innovation in health system transformation aimed at finding new and innovative ways to improve quality and lower costs.

The State Innovation Models initiative supports states in planning or implementing a customized, fully developed proposal capable of creating statewide health transformation to improve health care. Example initiatives include:

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New Meaningful Use Rule Allows “Flexibility” In Certified EHR Technology for 2014

The Department of Health and Human Services (HHS) published a new meaningful use rule that allows healthcare providers “more flexibility” in how they use certified electronic health record (EHR) technology (CEHRT) to meet meaningful use for an EHR Incentive Program reporting period for 2014. According to the HHS’ statement, “by providing this flexibility, more providers will be able to participate and meet important meaningful use objectives like drug interaction and drug allergy checks, providing clinical summaries to patients, electronic prescribing, reporting on key public health data and reporting on quality measures.”

“We listened to stakeholder feedback and provided CEHRT flexibility for 2014 to help ensure providers can continue to participate in the EHR Incentive Programs forward,” said Marilyn Tavenner, CMS administrator. “We were excited to see that there is overwhelming support for this change.”

Based on public comments and feedback from stakeholders, the Centers for Medicare & Medicaid Services (CMS) identified ways to help eligible professionals, eligible hospitals, and critical access hospitals (CAHs) implement and meaningfully use Certified EHR Technology. Specifically, eligible providers can use the 2011 Edition CEHRT or a combination of 2011 and 2014 Edition CEHRT for an EHR reporting period in 2014 for the Medicare and Medicaid EHR Incentive Programs; All eligible professionals, eligible hospitals, and CAHs are required to use the 2014 Edition CEHRT in 2015.

These updates to the EHR Incentive Programs support HHS’ commitment to implementing an effective health information technology infrastructure that elevates patient-centered care, improves health outcomes, and supports the providers that care for patients.

The rule also finalizes the extension of Stage 2 through 2016 for certain providers and announces the Stage 3 timeline, which will begin in 2017 for providers who first became meaningful EHR users in 2011 or 2012.

For more information about the EHR Incentive Programs, visit http://www.cms.gov/EHRIncentivePrograms. For more information about CEHRT, visit http://www.healthit.gov.

HHS Releases Data and Tools to Increase Transparency On Hospital Utilization at Health Datapalooza

With more than 2,000 entrepreneurs, investors, data scientists, researchers, policy experts, government employees and more in attendance, the Department of Health and Human Services (HHS) is releasing new data and launching new initiatives at the annual Health Datapalooza conference in Washington, D.C.

Today, the Centers for Medicare & Medicaid Services (CMS) is releasing its first annual update to the Medicare hospital charge data, or information comparing the average amount a hospital bills for services that may be provided in connection with a similar inpatient stay or outpatient visit. CMS is also releasing a suite of other data products and tools aimed to increase transparency about Medicare payments. The data trove on CMS’s website now includes inpatient and outpatient hospital charge data for 2012, and new interactive dashboards for the CMS Chronic Conditions Data Warehouse and geographic variation data. Also today, the Food and Drug Administration (FDA) will launch a new open data initiative. And before the end of the conference, the Office of the National Coordinator for Health Information Technology (ONC) will announce the winners of two data challenges.

“The release of these data sets furthers the administration’s efforts to increase transparency and support data-driven decision making which is essential for health care transformation,” said HHS Secretary Kathleen Sebelius.

“These public data resources provide a better understanding of Medicare utilization, the burden of chronic conditions among beneficiaries and the implications for our health care system and how this varies by where beneficiaries are located,” said Bryan Sivak, HHS chief technology officer. “This information can be used to improve care coordination and health outcomes for Medicare beneficiaries nationwide, and we are looking forward to seeing what the community will do with these releases. Additionally, the openFDA initiative being launched today will for the first time enable a new generation of consumer facing and research applications to embed relevant and timely data in machine-readable, API-based formats.”

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United States, Canada and Mexico Strengthen Information Sharing in Health Emergencies

The United States, Canada and Mexico have adopted a set of principles and guidelines on how the three countries’ governments will share in advance public information and communications products during health emergencies of mutual interest. U.S. Health and Human Services Secretary Kathleen Sebelius, Canada’s Minister of Health Rona Ambrose and Mexico’s Secretary of Health Mercedes Juan signed a Declaration of Intent, formally adopting the principles and guidelines, at a trilateral meeting today during the 67th World Health Assembly in Geneva, Switzerland.

“The United States, Canada and Mexico have had a long and close relationship in supporting and improving our collective ability to respond to public health events and emergencies of mutual interest when they arise,” Secretary Sebelius said. “This declaration reinforces our joint efforts to strengthen our national capabilities to communicate effectively with our respective populations.”

“Infectious diseases are not limited by countries’ borders, and neither are the ways through which we receive the news,” said Minister Ambrose. “This Declaration will help our countries work together on the essential task of communicating more effectively on public health issues, which will protect the health of all of our citizens.”

“The collaboration between the three North American countries has proved to be an extraordinary contribution to strengthening the security of health in the region,” said Secretary Juan. “The clear, transparent and timely exchange of information has been, and will remain, a central pillar of this cooperation, particularly for responding to public health emergencies.”

The Declaration of Intent calls on the three countries to:

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Medicare Fraud Strike Force Charges 90 People for $260 million in False Billing

Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in six cities has resulted in charges against 90 individuals, including 27 doctors, nurses and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $260 million in false billings.

Attorney General Holder and Secretary Sebelius were joined in the announcement by Acting Assistant Attorney General David A. O’Neil of the Justice Department’s Criminal Division, FBI Assistant Director Joseph Campbell, U.S. Department of Health and Human Services (HHS) Inspector General Daniel R. Levinson and Deputy Administrator and Director of the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity Shantanu Agrawal.

This coordinated takedown is the seventh national Medicare fraud takedown in Strike Force history.  The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

Since their inception in March 2007, Strike Force operations in nine locations have charged almost 1,900 defendants who collectively have falsely billed the Medicare program for almost $6 billion.  In addition, CMS, working in conjunction with HHS-OIG, has suspended enrollments of high-risk providers in five Strike force locations and has removed over 17,000 providers from the Medicare program since 2011.

The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.  Almost 400 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units and other federal, state and local law enforcement agencies participated in the takedown.

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HHS releases security risk assessment tool to help providers with HIPAA compliance

A new security risk assessment (SRA) tool to help guide health care providers in small to medium sized offices conduct risk assessments of their organizations is now available from HHS.

The SRA tool is the result of a collaborative effort by the HHS Office of the National Coordinator for Health Information Technology (ONC) and Office for Civil Rights (OCR). The tool is designed to help practices conduct and document a risk assessment in a thorough, organized fashion at their own pace by allowing them to assess the information security risks in their organizations under the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. The application, available for downloading at www.HealthIT.gov/security-risk-assessment also produces a report that can be provided to auditors.

HIPAA requires organizations that handle protected health information to regularly review the administrative, physical and technical safeguards they have in place to protect the security of the information. By conducting these risk assessments, health care providers can uncover potential weaknesses in their security policies, processes and systems.  Risk assessments also help providers address vulnerabilities, potentially preventing health data breaches or other adverse security events. A vigorous risk assessment process supports improved security of patient health data.

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HIT Thought Leadership Highlight: Dr. Garth Graham, The Aetna Foundation

Dr. Garth Graham

Garth Graham, M.D., M.P.H., specializing in cardiology, is the current president of the Aetna Foundation and former deputy assistant secretary at the U.S. Department of Health and Human Services (HHS) during both the Bush and Obama administrations. Here he discusses the Aetna Foundation, improving quality of care, how the health IT community continues to change, how can it best be used as a positive tool for better health outcomes, even at the individual level.

Tell me about the Aetna Foundation and your role within the organization? How does the Foundation impact healthcare community?

The Aetna Foundation is the philanthropic arm of Aetna, Inc. funding a number of activities across the country that promote thought-leadership and community-based impact as well as research around improving health outcomes. As the Foundation’s president, I oversee the philanthropic work, including grant-making strategies aimed at improving the health of people from underserved communities.

Overall, at the Aetna Foundation we seek to impact the healthcare community by supporting research and organizations focused on improving the health and wellness of individuals throughout the United States.

How do you go about working to improve the health status and quality of care of the individual and community?

Our Digital Health Initiative is the most recent example of our efforts to fund both national and local programs that are striving to limit healthcare disparities among vulnerable populations, as well as increase positive health and wellness outcomes for individuals. Through this initiative, we are supporting technology that can empower individuals with the convenience and control to meet their personal health and wellness goals.

We hope that by arming individuals with the best possible tools to improve their health, we can ultimately build healthier communities.

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Senators Call on HHS to Extend Deadline for Stage 2 of Electronic Health Records Incentive Program

John Thune
John Thune

Senator John Thune (R-S.D.), Chairman of the Senate Republican Conference, and Senator Lamar Alexander (R-Tenn.), Ranking Member of the Health, Education, Labor and Pensions Committee, were joined today by several of their colleagues in sending a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius, calling for a one-year extension for health care providers to complete the second stage of the electronic health records (EHR) incentive program, which is increasing the adoption of health information technology by hospitals and physicians across the country.

Lamar Alexander
Lamar Alexander

According a release, “providers who are ready to attest to Stage 2 in 2014 should be able to do so consistent with current policy, and the senators believe the administration must continue to push for interoperability.”

By the end of 2014, more than 500,000 hospitals and physicians will be required to upgrade their existing technology to demonstrate new standards of “meaningful use” to be eligible for the corresponding incentive payments.

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Ray Kinsella May Be Able to Help Meaningful Use Stage 2 Reach Patient Engagement’s “Field of Dreams”

Will meaningful use Stage 2 reach patient engagement?

Patient engagement now requires patient action. So says the Department of Health and Human Services in meaningful use stage 2.

As a patient, your physician is counting on you to engage with him or her. It’s up to you, folks, to bring it home. Your physician’s incentive, and ultimately his or her potential non-penalty for Medicare, is on your shoulders.

That’s an awful lot of weight to bear. Can’t you feel it? It’s overwhelming. I’m exhausted just thinking about it.

Seriously, though, I’m confused. Someone please set me straight; seriously.

Meaningful use is now up to the patient? Whether or not I choose to interact with my physician via electronic means determines his/her level of success as gauged by the government?

I’m sure I don’t need to recite the language from the ruling, but I’ll do so for good measure.

In short:

The language isn’t written in an inviting tone, but one that tries to demand respect. It doesn’t say “may’ or “can,” if says “must.”

Is this a Ray Kinsella moment and HHS’ field of dreams?

“If you build it, he (they) will come,” sounds the whispered voice across the sky.

Cue the sound of rustling corn fields blowing in the wind as each of us imagine memories of our happy places where dreams live on forever.

If this gets built, will we all come and play? How can this be a requirement of our physicians? How can their level of success, the quality of the care they provide, be gauged based on whether or not I choose to interact with them via the web? After all, I want healthcare, not a Facebook friend or a Twitter follower. (I’m using obvious over exaggeration to make a point.)

I am all for patient engagement and believe it will increase given time and effort behind it, but forcing me — as a patient — to do something makes me a little less likely to follow so easily along. I’m not a lemming, and I don’t intend to be.

Sure, five percent seems like a manageable number; not that big of a deal. Surely, it’s just a few people, right?

Until next time, when the number increases to 25 percent of the overall patient population then 50 percent then 75 percent and so on until it’s just mandatory.

What might be the most troubling, though, is how this affects physicians and practices. Engaging patients to receive incentives and keep from being penalized becomes a marketing function, not a care function.

I can see it now: Your doctor will start offering club-type discount cards and try to cajole you with attractive terms like, “Sign up today for the patient portal and after you send just one email to your physician, you’ll be receive a $5 credit to your account.”

Or, perhaps the whole thing will have physicians sounding like to cashiers at Target: “Sign up for your patient portal access today and you’ll not only receive a nifty tote bag for your things, but you’ll get 25 percent off of of your next purchase!”

Lastly, I’m reminded of the lines of credit card pushers lining the student union of every college in the U.S. trying to convince our young and inexperienced that credit is the same as cash, don’t you know.

As noted on HealthWorks Collective, meeting this portion of the stage 2 requirement will take everyone in the practice, not to mention the support of those outside it.

But portals can only facilitate access to patient’s information, but it can’t force the participation of people to do something they don’t want. Requiring physicians and their practices to encourage me to engage with my care providers is up to me, and no matter how useful or entertaining, whether I choose to engage is something I commit to on my own terms.

Just because “they” build (read as “require”) it doesn’t mean I’ll come.