July 2005
Mission: to transform the health care system through information and technology to improve patient safety and health care quality, lower costs, and coordinate care.
IN THIS ISSUE:
1. House and Senate Agree on Patient Safety Legislation
2. Senate Committee Passes Major Health IT Legislation
3. "Fair Access to Clinical Trials" Bill Introduced
4. House Government Reform, Ways and Means Hold HIT Hearings
6. HHS Announces Medicaid Advisory Commission Members
7. CMS Seeks Input on Personal Health Records
8. CMS Announces Outpatient Payment Changes
9. AHRQ Begins Effective Health Care Program
10. CCHIT Releases Draft Certification Requirements
11. Public Health Information Network Advances but Continues to Face Challenges
12. NCQA Releases Five New Healthcare Quality Measures
13. Poll: Consumers Accepting E-Records
14. IHI's Promising Practice of the Month: Safety Net Clinical Transformation
House and Senate Agree on Patient Safety Legislation
The House and Senate have agreed on legislation to create new voluntary reporting systems for errors and near-misses so that researchers will be able to analyze the data and recommend policy fixes. Under the bill, passed by the House on July 27, the information in safety reporting systems will be shielded from use in malpractice lawsuits. This agreement resolves more than two years of on-again, off-again negotiations over relatively minor differences between measures passed by both chambers in the 108th Congress. A spokesman for Senate HELP Committee Chairman Enzi said he plans to bring the compromise to the Senate floor as a substitute for S. 544, the Patient Safety and Quality Improvement Act of 2005, that was approved by the HELP Committee in March.
Senate Committee Passes Major Health IT Legislation
On July 19, the Senate Health, Education, Labor and Pensions (HELP) Committee unanimously passed a health information technology bill merging the key provisions of Enzi/Kennedy (S. 1355) and Frist/Clinton (S. 1262).
The "Wired for Healthcare Quality Act of 2005" (S. 1418) authorizes the Office of National Coordinator for Health IT and the RFPs that have already been issued by HHS. It codifies the American Health Information Collaborative, a public-private advisory body intended to help set policy and recommend interoperability standards. The bill includes grants to providers to promote IT adoption, grants to states to establish revolving loan funds, and grants for the development of regional health information networks. It also establishes a process to create standardized quality metrics. The sponsors have also indicated that they intend to add Stark and anti-kickback exceptions for health IT to the bill before it is brought to the Senate floor.
Prospects for full Senate passage appear strong although timing for floor action is uncertain. Caucus co-chairmen Tim Murphy and Patrick Kennedy have applauded the merged Senate bill, which is very similar in many respects to their 21st Century Health Information Act (H.R. 2234), and have called for the House to pass legislation of similar scope.
"Fair Access to Clinical Trials" Bill Introduced
Representative Henry Waxman (D-CA) has introduced a bill that would establish a mandatory federal clinical trials database. The Fair Access to Clinical Trials (FACT) Act (H.R. 3196) would provide public access to the results of clinical studies and would authorize the Secretary of Health and Human Services to impose penalties for noncompliance, including revoking a sponsor's eligibility for further federal funding and imposing civil monetary penalties. Waxman introduced the bill in partnership with Edward Markey (D-MA).
House Government Reform, Ways and Means Hold HIT Hearings
On Wednesday, two different House committees held hearings examining health information technology. Both the House Ways and Means Health Subcommittee and the House Government Reform Subcommittee on the Federal Workforce and Agency Organization examined how they could use their jurisdiction to promote the digitization of health care. Ways and Means Health Subcommittee Chairwoman Nancy Johnson used her hearing to explore themes she intends to address in forthcoming legislation. That bill reportedly includes provisions to codify the Office of the National Coordinator for Health IT and its recent RFPs, create health IT exemptions from anti-fraud statutes, and require HHS to move from ICD-9 coding to the newer ICD-10.
Caucus Co-Chairmen Murphy and Kennedy were invited to testify before the Government Reform panel. Both Congressman Murphy and Congressman Kennedy urged the Government Reform subcommittee to make use of the Federal Employee Health Benefit Program to drive quality improvements and information technology development and offered several specific suggestions.
HHS Seeks AHIC Nominations
The Department of Health and Human Services has published the charter (http://www.hhs.gov/healthit/ahiccharter.pdf) for the American Health Information Community (AHIC) and has called on the healthcare industry to submit nominations for 17 commissioner positions. The AHIC will be chaired by Secretary of Health and Human Services, Michael O. Leavitt, and will advise HHS on specific actions necessary to achieve a common interoperability framework and serve as a forum for a wide range of healthcare industry constituencies.
The AHIC will have an integral oversight role for the four RFPs addressing HIT standards harmonization, certification of EHRs, National Health Information Network prototypes, and privacy and security legislation/regulation. Individuals interested in nominating or supporting a candidate should submit a one-page letter of nomination or support to the Office of the National Coordinator for Health IT (ONCHIT) at onchit.request@hhs.gov by August 5, 2005.
CMS Seeks Input on Personal Health Records
The Centers for Medicare and Medicaid Services (CMS) has issued a request for information that seeks public comment on how best to capitalize on its resources and data for use on personal health records. Several vendors and organizations offer personal health records, including PC-based and Web-based systems, to consumers. According to a memo from CMS, "Giving beneficiaries better, more personalized information to make informed health care decisions is a key component to improving the quality of health care in the nation."
Besides claims information on all Medicare beneficiaries, as of next January, CMS will also have prescription information for its beneficiaries once the Medicare drug benefit starts. The agency issued the RFI to determine what personal health records functions are important to beneficiaries, whether it should provide some services directly to beneficiaries, and what kind of data it should make available to vendors. The agency also wants to find out what pieces of CMS information can be used in personal health records, how often that information should be updated, and what kind of links there should be between the records and electronic health records maintained by physicians.
The RFI asks for comment on whether the agency should certify CMS vendors to ensure that they provide privacy and security safeguards for data. Replies to the RFI are due Aug. 31.
CMS Announces Outpatient Payment Changes
The Centers for Medicare & Medicaid Services (CMS) has announced a new proposed Outpatient Prospective Payment System (OPPS) rule that would give acute care hospitals a 3.2 percent inflation update in Medicare payment rates in 2006 for outpatient services. Sole Community hospitals in rural areas will also receive an additional 6.6 percent payment adjustment. The proposed rule would also support prevention and early detection of diseases by increasing payment rates to hospitals for most screening exams that are covered by Medicare.
AHRQ Begins Effective Health Care Program
The Agency for Healthcare Research and Quality has announced the first phase of research reviews being performed under its new Effective Health Care Program intended to develop evidence on the comparative effectiveness of different treatments and appropriate clinical approaches to difficult health problems. The initial set of reviews will provide science-based information on the effectiveness of interventions, including prescription drugs, to enhance decision-making by Medicare policy makers, beneficiaries and providers.
CCHIT releases draft certification requirements
The Certification Commission for Healthcare Information Technology (CCHIT) has issued its second phase work product. CCHIT is working to create a sustainable mechanism for the certification of health information technology products. The Commission's phase I work product assessed the existing HIT environment. This second phase work product drafts the certification requirements and test procedures and also lays our a roadmap of certification requirements in the future. The Commission will be accepting public comments on the second phase work product through August 11, 2005.
Public Health Information Network Advances but Continues to Face Challenges
The Government Accounting Office (GAO) released a report entitled Information Technology: Federal Agencies Face Challenges in Implementing Initiatives to Improve Public Health. The report shows the progress federal agencies have made on major public health information technology initiatives and also looks at the challenges they continue to face. It specifically discusses the Center for Disease Control and Prevention's Public Health Information Network (PHIN) which is intended to provide the nation with integrated information systems. PHIN's BioSense application is reportedly not found useful by health officials due to limitations in the data currently being collected. The GAO has recommended that Health and Human Services establish clear linkage between the initiatives and the national health care strategy and federal health architecture and encourage interoperability through the adoption of standards for healthcare data and communications.
NCQA Releases Five New Healthcare Quality Measures
The National Committee for Quality Assurance (NCQA) has released specifications for the 2006 edition of its Health Plan Employer Data and Information Set (HEDIS). HEDIS defines how healthcare quality is measured in key areas of clinical care and customer service. NCQA added five new measures including the use off spirometry in the diagnosis and assessment of chronic obstructive pulmonary disorder, ADHD medication followup in children, antibiotic use in adults with acute bronchitis and drugs to be avoided in the elderly and annual monitoring of patients on persistent medications.
From iHealthBeat:
Poll: Consumers Accepting E-Records
A recent survey from research/consulting firm Accenture shows many consumers support the use of electronic medical records. Fifty-two percent of survey respondents reported they would be willing to pay at least $5 per month to have their medical records stored in electronic format. Further, 54% expressed concern over the privacy and security of their paper medical records, while 55% said they believe electronic records are more secure.
Ninety-three percent of respondents supported giving emergency physicians access to their electronic medical records.
The survey, conducted in late March but only recently released, used the Internet-based methodology of Survey Sampling International, Fairfield, Conn. The survey yielded 519 responses from a nationally representative sample group of consumers who have agreed to be occasionally queried about various issues. For more information, visit accenture.com and surveysampling.com.
IHI's Promising Practice of the Month: Safety Net Clinical Transformation
The work of reducing health disparities in the US needs to take place on many fronts, including improving access to primary care in low-income communities. In Rochester, New York, an ambitious effort is underway to insure some of the city's poorest residents, many with chronic health problems, receive highly targeted services without unnecessary delays and hurdles. Underlying the broad effort is the Safety Net Clinical Transformation Project, which has been implemented at five primary care clinics and one mental health clinic. Read more....