July 2008 — Vol. 3, No. 7

In This Issue

• Moving Health IT Ahead in Georgia
  Rhonda M. Medows, MD, FAAFP
• Vermont Makes Steady Progress Toward Statewide HIE
  Gregory Farnum
• Statewide Groups in Massachusetts Focus on Health
  Chuck Parker
• Honoring Recipients of HIMSS State Advocacy and Leadership Awards
• News Briefs
• Already There… Implemented Health IT

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The Digital Office is a monthly online newsletter published by the Healthcare Information and Management Systems Society (HIMSS).
Copyright© 2008 by the Healthcare Information and Management Systems Society.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission. Contact HIMSS Publications at 230 E. Ohio St., Suite 500, Chicago, IL 60611; 312-915-9237; jlofstrom@himss.org
HIMSS Healthcare Information Systems Initiative
Patricia Wise, RN, MSN, MA
Colonel, USA Ret'd
Vice President, Healthcare Information Systems, HIMSS
For more information on the HIMSS ambulatory initiative, contact Mary P. Griskewicz, MS, FHIMSS, Senior Director, Ambulatory Information Systems, HIMSS, mgriskewicz@himss.org or 203-421-8317
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Senior Manager, Corporate Communications, HIMSS
jlofstrom@himss.org/312.915.9237

Moving Health IT Ahead in Georgia

Rhonda M. Medows, MD, FAAFP

For this special issue on state health IT activities, the Digital Office talked with Rhonda M. Medows, MD, FAAFP, who is Commissioner of the Georgia Department of Community Health. She was appointed by Gov. Sonny Perdue in December 2005. She leads a $10 billion agency responsible for the purchasing, planning and regulation of health care for over 2.4 million Georgians. Dr. Medows practiced medicine at the Mayo Clinic in Jacksonville, Fla. before joining state government in Florida in 2001.

Dr. Medows also received the 2008 HIMSS State Advocacy Award, which was presented to her in June at HIMSS Advocacy Day in Washington, D.C.

Focused on implementing effective health IT programs to benefit both clinicians and citizens in the state of Georgia, Dr. Rhonda Medows brought her expertise as a physician and a leader in state government to the Georgia Department of Community Health, Office of Health Information Technology and Transparency (HITT).  The office is responsible for leading the strategic efforts of the state of Georgia for health information technology (HIT) adoption and health information exchange (HIE). These initiatives will improve health care delivery for providers, health care professionals and consumers.

Read More

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Vermont Makes Steady Progress Toward Statewide HIE

by Gregory Farnum

Vermont Information Technology Leaders, Inc. (VITL), a non-profit public/private partnership, has been making steady progress toward its goal of implementing one of the first statewide exchanges to meet national standards.

VITL’s efforts to develop its HIE began in April 2007 with the launch of a medication history service pilot in two Vermont hospitals. The six-month pilot provided valuable insight into privacy policy development and patient-consent issues, as well as an opportunity to gain experience in interface development. After the pilot successfully concluded, the two hospitals continued to subscribe to the service. VITL has recently added a third hospital as a medication history service customer and is marketing the service to the remaining hospitals in the state.

The next phase of HIE development began in early 2008, as VITL started creating a secure messaging service. VITL has been working with Allscripts, GE Healthcare, and other vendors to develop interfaces designed to HITSP specifications for the delivery of lab results, radiology reports, and other clinical data to physician EHRs. VITL’s data center acts as a hub, accepting data from participating hospitals and routing it to the correct physician practice. Because VITL’s interfaces are standardized, hospitals can transmit data to different brands of physician EHRs over only one set of interfaces.

The secure messaging service has laid the foundation for VITL’s next step, to initiate bi-directional exchange of clinical summaries and other documents between hospitals, primary care physicians, specialists, and other health care providers. This will also be done in compliance with HITSP standards, leveraging the infrastructure investment already made. VITL plans to pilot the HIE in several communities in early 2009, and begin statewide rollout in 2010.

Visit VITL for more information.

Read in Government Health IT how the Health IT Trust Fund in Vermont may increase physician practices' adoption of EHRs by 50 percent in the next five years.

Gregory Farnum is president of Vermont Information Technology Leaders, Inc., in Montpelier, Vt.

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Statewide Groups in Massachusetts Focus on Health IT Ahead

by Chuck Parker

In Massachusetts, multiple organizations are focused on health IT adoption that affect the physician, community health center, and acute care environments:

• MAeHC - Massachusetts eHealth Collaborative - The $50 million-funded initiative to place electronic health records in three communities
• MA-SHARE (Simplifying Healthcare Among Regional Entities) - The RHIO, funded by the National Health Information Network (NHIN), seeks to promote the inter-organizational exchange of healthcare data using information technology, standards and administrative simplification, in order to make accurate clinical health information available wherever needed in an efficient, cost-effective and safe manner.  In addition to MA-SHARE, local health information exchange (HIE) efforts exist with Southeastern Mass., Partners, Worcester, and the Berkshires along with the HIE developed through MAeHC.
• Mass Health Data Consortium - The neutral program that developed MA-SHARE and NEHEN
• Masspro - The QIO and DOQ-IT national lead is focused on practice transformation with technology and improving practice design
• NEHEN - New England Healthcare EDI Network - A secure and innovative electronic-commerce solution for reducing administrative costs in healthcare

Mass. Technology Collaborative and New England Health Institute (NEHI) are focusing direct attention on how to increase the adoption of computerized provider order entry (CPOE) in acute care settings.

In Massachusetts, the legislative body is addressing the lack of state participation in health IT systems. The current bill 2660 will provide funding, from general revenues, for the implementation of healthcare technology. The bill strives to provide an ongoing funding mechanism for at least five years and may extend up to seven years. It will

create a technology council and provide direct funding to practices and programs to speed adoption of EHRs and other cost-saving technology.

Chuck Parker is Vice President/Chief Technology Officer of MassPro in Waltham, Mass.

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Honoring HIMSS Award Recipients
State advocacy and leadership awards presented at HIMSS Advocacy Day

Following is an update on the HIMSS State Advocacy Awards and HIMSS State Leadership Awards presented in June at the HIMSS Advocacy Day.

HIMSS State Advocacy Awards

New York: New York received the HIMSS State Advocacy Award for its efforts to align with the national vision in the passage of the Health Care Efficiency and Affordability Law for New Yorkers Capital Grant Program. Often referred to as the HEAL New York Program, this program will:

• identify and support development and investment in health IT and quality improvement infrastructure at the regional level
• support a statewide interoperable health information exchange through a State Health Information Network.

In April, the New York State Department of Health and Health Research, in collaboration with the New York City Department of Health and Mental Hygiene, was also awarded a $20-million grant from the federal Centers for Disease Control and Prevention to improve the state's public health surveillance and reporting through a state-of-the-art health information exchange, or H-I-E, service. Patient confidentiality is a top priority of this initiative, and all solutions developed will ensure patient privacy and implementation of the highest security standards.

Tennessee: HIMSS also recognized Tennessee as a HIMSS State Advocacy Award recipient. Governor Phil Bredeson enacted legislation in 2007 that prohibits state contracts for the development or purchase of health IT with other states and federal agencies without the plans for such a purchase receiving initial approval from the Commissioner of Finance and Administration. Governor Bredeson is committed to developing new care- and disease-management practices and making better use of health information technology. For example, the Governor’s Volunteer eHealth Initiative is one of five federally funded HIT demonstration projects designed to lay out a national blueprint for improving the quality of health care while reducing costs in the healthcare system.

HIMSS State Leadership Awards

Georgia: Dr. Rhonda M. Medows was appointed by Georgia Governor Sonny Perdue in December 2005 as Georgia’s commissioner of public health. She leads an $11-billion-dollar agency and is also a member of the National Governors Association State Alliance for E-Health, on which she serves on the Health Information Communication and Data Exchange Taskforce. Before her appointment as public health commissioner, Dr. Medows served as the first chief medical officer for the Centers for Medicare and Medicaid Services Region 4 office located in Atlanta.

New Jersey: Herb Conaway, MD, from New Jersey, is a leader in New Jersey’s General Assembly, serving as chairman of the Health and Human Services Committee and as a member of the Appropriations and the Agriculture and Natural Resources Committees.

New Jersey Governor Jon S. Corzine recently signed into law legislation that Dr. Conaway drafted to enhance the quality of healthcare delivered to New Jersey residents through a health IT system. The New Jersey Health Information Technology Promotion Act will establish the state’s first electronic medical records infrastructure and create a Health Information Technology Commission to oversee the development, implementation and oversight of the program. The new law will advance the quality of health care for all New Jersey residents through a secure and integrated medical records system. The result is a comprehensive network to improve patient care, health policies and efficiency in research while cutting administrative costs and increasing our state’s emergency preparedness. 

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News Briefs

National Health IT Week 2008: HIMSS and 35 other associations co-sponsored the seventh annual HIMSS Advocacy Day on June 10-11th in Washington, DC. Close to 300 individuals from 46 states representing a cross section of our industry and society attended HIMSS 7th Annual Advocacy Day! Learn more about recent activities at National Health IT Week by visiting the HIMSS Web site. Read the fact sheet on National Health IT Week.

During National Health IT Week in June, participants came together at the National Press Club in Washington, D.C., during the announcement of the National Health IT Collaborative for the Underserved. Pictured (left to right) are: Barbara Hood, CIO, Community Health Care Association of New York State and HIMSS Community Health Organization Task Force Chairperson; Dr. Neil Calman, Medical Director, Institute for Family Health; Mary Griskewicz, HIMSS Senior Director, Ambulatory Information Systems; and Dave Roberts, HIMSS Vice President, Government Relations.

First National HIT Collaborative for the Underserved Launched: The National Health IT Collaborative for the Underserved was launched on June 12 at The National Press Club in Washington, DC. The Collaborative, formed by the U.S. Department of Health and Human Services Office of Civil Rights, HIMSS, Apptis, Inc., and the Summit Health Institute for Research and Education (SHIRE), was formed to help mitigate health disparities in medically underserved populations through the use of health IT.

EHR Certification Has Strong Acceptance in Marketplace:  The Certification Commission for Healthcare Information Technology (CCHIT) announced in mid-July that for ambulatory (office-based) and inpatient (hospital) electronic health record (EHR) products, both large and small vendors continue to seek out certification of EHR software products, and the market remains open to new entrants. The CCHIT has certified a total of 136 ambulatory products from 93 health IT vendors since 2006, representing nearly 50 percent of the estimated vendors in the ambulatory EHR market. Fifty-five percent of the 47 ambulatory products certified during the 2007 program year, which ended June 30, came from newly participating vendors indicating that EHR market competition from growing, innovating companies continues. Of the companies certified in the 2006 program, almost all chose to maintain their product certification’s three-year term, with 24 percent bringing new products for an updated certification in 2007. Read the complete news release on the CCHIT Web site. Read More.

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Already There…Implemented Health IT

Building the EMR at Graybill Medical Group

It’s been eight years since Graybill Medical Group in Escondido, Calif. first investigated implementing the EMR. This group includes 37 physicians and a total of 45 licensed healthcare providers that include physical therapists and other specialists who deliver care to the patients in three San Diego locations.

The practice rejected implementation of the EMR in 2000 based on the technology system templates available at that time. A review team of three physicians, the practice CEO, director of nursing and Leslie Chapman, the practice director of finance, visited HIMSS in 2003. “We walked through every vendor’s exhibit,” said Ms. Chapman, who led the selection and implementation process for the practice.

After visiting with potential vendors at the conference, Ms. Chapman sent 35 RFPs, received 17 responses, and selected seven organizations to conduct demos for the practice. From that experience, the review team visited three finalists, medical practices that the vendors suggested to see how their particular EMR system product operated.

From those site visits, the practice selected NexGen.

The physicians at Graybill were part of the entire EMR implementation process, a recommendation that Ms. Chapman suggests to any practice. The practice started an EMR Committee open to any physician who chose to attend. For one year, the committee met every Wednesday with the physicians.

“I think you would hear every one of the physicians say it was hard during the implementation process,” said Ms. Chapman. While the practice did lose productivity that first year, it also adapted to the new technology by offering options for data entry. For example, to meet physician preferences, the practice now has about half of its staff using voice recognition with other physicians entering data or using templates.

Graybill Medical Group also has introduced ePrescribing and Picture Archiving and Communication System (PACS) to the practice, two technologies that will improve medical care for the 129,000 patients who annually visit this San Diego medical group.

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