October 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. Commission on Systemic Interoperability Issues Report to Congress
2. Murphy Secures $100 Million for Medicaid Health IT, Anti-Fraud Efforts
3. Brailer's Office Again Fares Poorly in Senate Appropriations Bill
4. N. Johnson Introduces Medicare Pay-for-Performance, Health I.T. Bills
5. Senate HIT Legislation Stalls
6. HIT Scoring Dilemmas
7. HHS Awards First Three NHIN RFP Contracts
8. AHIC Holds Inaugural Meeting
9. HHS Moves to Provide Stark and Anti-kickback Protections
10. ONCHIT Adds Staff
11. AHRQ Grants Support HIT Funding
12. IHI Promising Practice of the Month: 4 Steps to Reduce Surgical Site Infections

 

Commission on Systemic Interoperability Issues Report to Congress
On October 25, the Commission on Systemic Interoperability issued its final report to Congress at a public announcement featuring Dr. David Brailer and a number of Congressional leaders, including Caucus Co-Chairmen Patrick Kennedy (D-RI) and Tim Murphy (R-PA).  The Commission, which was established by the Medicare Modernization Act of 2003, began public hearings in January 2005 and met the statutory requirement of a report within 12 months.  The report focused on three major themes and 14 recommendations.  Highlights of the report include:

• Adoption challenges of getting clinicians and consumers to use healthcare IT to improve the quality and effectiveness of care.
  Using the power of regulation and legislation to adopt incentives and reforms that encourage use of healthcare IT. The Commission calls on the Department (DHHS) of Health and Human Services, and the Departments of Labor and Commerce, to identify workforce needs and possible solutions.
• Interoperability of healthcare data in a way that the data is accessible whenever and wherever approved access is needed.
  Consistent with the goals and targeted efforts of the American Health Information Community (AHIC), the Commission recommends product certification, interoperable data standards, and standard product identifiers and vocabulary. The Commission recommends that the AHIC should make an interoperable drug record for every American by 2010 a priority.
• Connectivity between networks for seamless sharing of healthcare information.
  The Commission recommends Congress authorize DHHS to develop a national standard for patient authentication and identity. The Commission also calls for a federal privacy standard that makes the Health Insurance Portability and Accountability Act (HIPAA) preemptive of state privacy laws; encourages criminal sanctions for privacy violations, and recommends the development of consumer protections against unauthorized access or release of their healthcare data. Finally, the Commission recommends the rapid move to fund and develop the National Health Information Network.

Read the full report from HIMSS on this topic.

Murphy Secures $100 Million for Medicaid Health IT, Anti-Fraud Efforts
At the urging of Caucus Co-Chairman Tim Murphy, the House Energy and Commerce Committee included $50 million for each of two years in new funding for, among other things, health information technology.  The funding was part of deficit-reduction legislation aimed at cutting a net $11 billion from Medicaid.  Under the provision, states can apply for funding to be used to help doctors and hospitals adopt health IT, for reducing fraud and abuse, for improving collections from estates, or for medication management therapies.   

Brailer's Office Again Fares Poorly in Senate Appropriations Bill
A year after surprising health IT advocates by declining to fund the Office of the National Coordinator of Health IT, the Senate passed a Labor-HHS-Education Appropriations bill providing Dr. Brailer's office with only $42.5 million of the requested $75 million budget request.  The bill now needs to be reconciled with the House version, which, at the urging of Caucus Co-Chairman Patrick Kennedy, who serves on the Labor-HHS-Education Subcommittee, included the full $75 million.

The Senate bill did include an amendment to add $10 million for grants to help hospitals and other health care providers implement telehealth solutions. 

N. Johnson Introduces Medicare Pay-for-Performance, Health I.T. Bills
On September 29, the House Ways and Means Subcommittee on Health held a hearing on H.R. 3617, the Medicare Value-Based Purchasing for Physician's Services Act, introduced by subcommittee Chairman Nancy Johnson (R-CT) on July 29, 2005. This legislation would provide a payment update in 2007 and 2008 equal to the Medicare Economic Index (MEI) to practitioners who report certain quality information to CMS.   Practitioners not reporting would receive an update of MEI, less one percent.  Beginning in 2009, practitioners would need to meet pre-established thresholds of quality or pre-established levels of improvement to receive the full MEI.  CMS would select the measures to be reported after a process designed to build consensus.

At the hearing, the subcommittee heard testimony from many in the industry, including Mark McClellan, MD, PhD, Administrator, Centers for Medicare and Medicaid Services (CMS). "We have the ability to vary payment based on the quality and efficiency of care delivered to our seniors under Medicare, and we should use it," said Congresswoman Johnson. "This hearing will offer the Subcommittee an opportunity to hear from witnesses about this important legislation."  A complete listing of witnesses and testimony is available at the committee website.

Johnson also introduced a long-awaited bill on health information technology on October 27.  The Health Information Technology Promotion Act does not provide any financial support for IT adoption or dissemination, but seeks to make the regulatory environment more friendly to health IT.  The bill, drafts of which have been circulating for months, includes provisions to: codify the Office of the National Coordinator for Health IT; create exceptions to anti-fraud statutes for hospitals' provision of health IT to doctors; launch a process potentially leading to creation of a single national privacy standard; upgrade certain standards and coding; study the impact of the recently created American Health Information Community panel; and develop a national health IT plan.

Senate HIT Legislation Stalls
Earlier this month, the Senate tried to pass S. 1418, a bill to enhance the adoption of a nationwide interoperable health information technology (HIT) system to improve the quality and reduce the costs of healthcare in the U.S., by unanimous consent on the Senate floor.  However, some Senators' holds remained unresolved.  Senator Robert Byrd (D-WV) is the latest co-sponsor of this HIMSS-endorsed legislation, which now has 34 senators as co-sponsors. 

HIT Scoring Dilemmas
The Office of Management and Budget and the Congressional Budget Office's methods for scoring the effects of major policy changes lead to errors that "greatly hamper or prevent Congress from adopting policies that would maximize economic growth and personal prosperity," former House Speaker Newt Gingrich and Peter Ferrara, senior fellow at the Institute for Policy Innovation and director of policy for the Free Enterprise Fund, wrote recently in a Wall Street Journal opinion piece.   Permitting drug prescribing over the Internet and maintaining electronic medical records "would save the Feds billions and save lives as well," they stated. However, in their view, federal scorers only counted the costs of launching the technologies and not the amount of money that would be saved, "So nothing has happened," Gingrich and Ferrara wrote.  "Federal scoring methodologies must be revamped to achieve the most accurate results possible." Gingrich and Ferrara conclude, "Without such reform, Washington will be hopelessly blocked from adopting the pro-growth solutions necessary for the 21st century."  

HHS Awards First Three NHIN RFP Contracts
HHS Secretary Michael Leavitt awarded three of four strategic National Health Information Network (NHIN) contracts for standards harmonization, EHR certification, and privacy & security.  The team of ANSI, HIMSS, Booz Allen Hamilton, and ATI were awarded the "ONCHIT 1" contract, also known as Standards Harmonization.  A collaborative effort of 18 industry organizations joined forces to craft the winning response.  The standards harmonization entity - Healthcare Information Technology Standards Panel (HITSP) - launched on September 27 and 28 in Washington, D.C.  Open to all interested stakeholder organizations, more than 80 entities have joined in this collaboration thus far.  John Halamka, MD, the CIO of CareGroup Health System in Boston, serves as the HITSP Chairman.  During its September meeting, the Panel ratified a charter and elected a 17-member volunteer Board.

The Certification Commission for Health Information Technology (CCHIT), created 18 months ago by industry groups AHIMA, HIMSS, and NAHIT, was awarded the "ONCHIT 2" contract.  CCHIT is charged with creating a certification process for electronic health records.  CCHIT's initial Use Cases define the end results expected from interoperable HIT systems; provide a framework for thorough, credible, yet realistic and cost-effective certification testing; and ensure that strategic HIT initiatives deliver real-world improvements in the quality, safety and efficiency of healthcare while securely protecting the privacy of health information.   Chaired by Mark Leavitt, MD, CCHIT's current focus is on ambulatory care.  The certification criteria will be published by year's end and product certification begins in 2006.

The Health Information Security and Privacy Collaboration (HISPC), a new partnership consisting of a multi-disciplinary team of experts and the National Governors Association (NGA), was awarded the privacy and security contract. The HISPC will work with approximately 40 states or territorial governments to assess and develop plans to address variations in organization-level business policies and state laws that affect privacy and security practices which may pose challenges to interoperable health information exchange. Overseeing the HISPC will be RTI International, a private, nonprofit corporation that has been selected as the HHS contract recipient.

AHIC Holds Inaugural Meeting
HHS Secretary Leavitt convened the first meeting of the AHIC on October 7. Two themes emerged during the meeting: (1) the clear relevance of EHRs to the overall quality and delivery of healthcare in the U.S.; and (2) the pivotal role HHS expects an interoperable healthcare system to have on public health promotion efforts, disease prevention, and bio-surveillance.  In his opening statement, Secretary Leavitt implored the commissioners and audience to focus on the progress of HIT, not just the promise.  As a public-private entity, AHIC serves as the focal point for development of a comprehensive health transformation roadmap.

The Secretary and David Brailer, MD, presented the Community Commissioners with some major breakthrough areas in which HIT can produce tangible value for the consumer and healthcare community within two or three years:

• Consumer Empowerment
• My Personal Health Record; My Medication History; My Health Record Locator; and My Registration Information
• Health Improvement
• E-Prescribing; Quality Monitoring and Reporting; Chronic Disease Monitoring; Immunization Records; and an Employee Empowerment Tool
• Public Health Protection
• Emergency Information Network; Bio-surveillance and Pandemic Surveillance; Adverse Drug Event Reporting and Notification

The Commissioners thoroughly discussed the breakthrough areas and approved the development of a Breakthrough Work Group on Consumer Empowerment.  AHIC also called for briefings by government and private sector representatives on the status of e-prescribing and quality monitoring.  Long-term goals and additional Breakthrough Work Groups will likely be established to review chronic disease monitoring and bio-surveillance. 

HHS Moves to Provide Stark and Anti-kickback Protections
In a speech at the George Washington University in Washington, D.C., Secretary Leavitt announced two proposed rules that are attempting to provide exceptions to the Physician Self Referral Regulation (Stark Regulation) and a new safe harbor under the Anti-Kickback Act for health IT.  CMS and the HHS Office of the Inspector General (OIG) are responsible for the Stark Regulation and Anti Kickback Act Regulation, respectively.  Each has given the healthcare community 60 days to provide comment.

Stark Regulation Exception: As required by the Medicare Modernization Act, CMS released a proposed rule that creates an exception to physician self-referral prohibitions for activities associated with electronic prescribing.  Responding to industry requests, CMS has also written proposed exceptions for sharing EHR software and training services directly related to EHR implementation.

Anti Kickback Act Safe Harbor: Also required by the Medicare Modernization Act, OIG has proposed a safe harbor to protect organizations that provide hardware, software, or IT and training services associated with electronic prescribing.

ONCHIT Adds Staff
The Office of the National Coordinator for Health IT (ONCHIT), which recently announced a new structure, has announced the interim managers who will lead the ONCHIT until recruitment for permanent staff is completed.   The interim officials are:

• Dr. Robert Wah, acting deputy national coordinator;
• Dr. Karen Bell, acting director, Office of Health IT Adoption;
• Dr. John Loonsk, acting director, Office of Interoperability and Standards;
• Dana Haza, acting director, Office of Programs and Coordination; and
• Jodi Daniel, acting director, Office of Policy and Research.

According to the announcement, ONCHIT now is beginning to recruit full-time senior managers. Information on the announcements for the positions of deputy national coordinator, director of health IT adoption, director of interoperability and standards, director of programs and coordination, and director of policy and research was posted online on October 11.

AHRQ Grants Support HIT Funding
The Agency for Health Research and Quality (AHRQ) has announced over $22.3 million in HIT grants.  The 16 grantees were selected from a group of AHRQ grantees who received planning funds in 2004.  The current grants are to implement those plans for HIT systems to improve the safety and quality of healthcare.   Eleven of the 16 grantees are in small and rural communities. 

IHI Promising Practice of the Month: 4 Steps to Reduce Surgical Site Infections
The prevention of infections among patients who've undergone surgery is a big priority for the Centers for Medicare and Medicaid Services and hospital accreditor JCAHO. When health care providers follow a series of interdependent steps patients are much less likely to develop infections at the site of their surgical incisions. Read how the Institute for Healthcare Improvement's 100,000 Lives Campaign is helping hospitals across the country take the infection complication out of surgical procedures. 

 

 

The House 21^st Century Health Care Caucus thanks the following organizations for their contributions to this newsletter:

HIMSS (Healthcare Information and Management Systems Society) is the healthcare industry's membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology and management systems for the betterment of human health.  HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems' contributions to ensuring quality patient care.  On the web at www.himss.org. (Items 1-2, 4-8)

The Institute for Healthcare Improvement (IHI) is a not-for-profit organization leading the improvement of health care throughout the world.  Founded in 1991 and based in Boston, MA, IHI is a catalyst for change, cultivating innovative concepts for improving patient care and implementing programs for putting those ideas into action.  Thousands of health care providers participate in IHI's groundbreaking work. To find out more, go to www.ihi.org. (Item 10)