HIPAA, HITECH & HIT :: Fox Rothschild LLP

If your hospital is being raked over the coals in the media for alleged fraudulent billing, it’s understandable to want to set the record straight. However, releasing patient information without consent is not the wisest approach. 

California’s Shasta Regional Medical Center and its parent company Prime Healthcare Services have come under fire for aggressive Medicare billing practices, arising out of the unusual frequency of claims for a rare third-world malnutrition condition known as kwashiorkor, which they reported at a rate over 70 times the state average. The story was reported by the Center for Investigative Reporting’sCalifornia Watch, who quoted a patient and her daughter who came forward upon learning that she had been assigned this diagnosis during a hospital stay.  The patient signed a waiver allowing California Watch to review her hospital records, which indicated she was treated for kidney failure, but her doctors made no mention of kwashiorkor or malnutrition.  The kwashiorkor diagnosis resulted in an estimated $6,755 increase in the hospital’s Medicare DRG payment. 

Faced with embarrassing publicity, a lawsuit and potential federal and/or state regulatory action, Prime Healthcare went into damage control mode.  The Los Angeles Times reports that when the local newspaper, the Redding Record Searchlight, contacted Shasta Regional for comment prior to publishing California Watch’s allegations, the hospital’s CEO and Chief Medical Officer paid a visit to the paper’s editor with the patient’s chart, which they discussed with him in detail.  They also divulged information about her treatment to the LA Times reporter, who reports that the patient and her daughter never authorized these disclosures.            

The Times reports that the hospital CEO Randall Hempling defended his decision by stating: "As far as we're concerned, the patient gave that permission when she gave her records to California Watch and was quoted on the record. . . . That waived her privacy." 

As the Times accurately noted, a patient who discloses PHI to a media representative or any other recipient does not waive his or her rights to additional disclosures.  California Watch reports that the FBI is now looking into the unauthorized disclosure of the patient’s records along with the billing irregularities. 

Moral for covered entities: Resist the temptation to reveal patient information without proper authorization, even to defend your reputation in the face of disputed allegations. HIPAA protection is not like the attorney-client privilege which can easily be waived by a single disclosure -- patients still control their PHI and can choose to whom, and for what purpose, they disclose that information.

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 We all know how those year-end deadlines sneak up on us and how there never seems to be enough time to get everything done. Well, here’s some welcome news – The feds have decided to play Santa and give us a little more breathing room this season.

HIPAA 5010 Transition

CMS is transitioning its electronic transaction standards from Accredited Standards Committee (ASC) X12 version 4010A1 to ASC X12 version 5010. These standards regulate the transmission of certain health care transactions among covered entities including hospitals, physician practices, health plans and clearinghouses. Although this description may sound like impenetrable technobabble, CMS considers  the upgrade necessary to increase transaction uniformity, support pay-for-performance methods and streamline reimbursement transactions, particularly with the coming exponential expansion of diagnosis codes under ICD-10.  CMS summarizes the improvements as follows:

“Version 5010 of the HIPAA standards includes improvements in structural, front matter, technical, and data content (such as improved eligibility responses and better search options). It is more specific in requiring the data that is needed, collected, and transmitted in a transaction (such as tightened, clear situational rules, and in misunderstood areas such as corrections and reversals, refund processing, and recoupments). Further, the new claims transaction standard contains significant improvements for the reporting of clinical data, enabling the reporting of ICD–10–CM diagnosis codes and ICD–10–PCS procedure codes, and distinguishes between principal diagnosis, admitting diagnosis, external cause of injury and patient reason for visit codes. These distinctions will improve the understanding of clinical data and enable better monitoring of mortality rates for certain illnesses, outcomes for specific treatment options, and hospital length of stay for certain conditions, as well as the clinical reasons for why the patient sought hospital care.

Finally, Version 5010 also addresses a variety of currently unmet business needs, including an indicator on institutional claims for conditions that were “present on admission,” and accommodating the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1.”

Level I Compliance was required by December 31, 2010, meaning that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing. Level II Compliance is due by: December 31, 2011, and all covered entities must be fully compliant on January 1, 2012. Level II compliance means that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards.  

In a notice posted on December 14 on Medicare Learning Network as MLN Matters® Number: SE1137, CMS' Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement with respect to any HIPAA covered entity that is not in compliance on January 1, 2012 with the Version 5010 standards until March 31, 2012. Importantly, this is only a 90-day delay on the enforcement of the transition, including fines. Claims not submitted under the 5010 standards on or after January 1, 2012 may not be paid, unless CMS has accepted a transition plan. Modern Healthcare reports that most physician practices are relying on their clearinghouses to convert claims into the new format, or assuming that an updgrade in software will meet all the new standards.

If you don’t know your practice’s status regarding 5010 compliance, contact your clearinghouse or practice management system vendor as soon as possible to avoid an unanticipated interruption in your revenue stream.

Extension of HITECH Meaningful Use Stage 2 Deadline

Physicians who met the Stage 1 Meaningful Use criteria to qualify for the HITECH Act’s subsidies in 2011 will get another year to meet the Stage 2 criteria, according to a HHS notice . Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, HHS Secretary Sebilius announced that HHS intends to allow eligible providers to adopt health IT in 2011, without meeting the new standards until 2014. The final Stage 2 meaningful use criteria will appear in a Notice of Proposed Rulemaking scheduled to be published in February 2012.

The HHS press release also linked to a CDC survey that indicated that physician use of electronic records had doubled in the past two years. The reprt shows that in 2011, 57% of office-based physicians used EMR/EHR systems, ranging from 40% in Louisiana to 84% in North Dakota. Over half intended to apply for the HITECH incentives. In Pennsylvania, CDC reports that  50% of office-based practice use some EHR, and that 47.5% planned to apply for HITECH funds.

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Need to educate the public about health information technology? How about an animated cartoon? According to an article entitled When Health IT Meets Bugs Bunny in Information Week Healthcare,  ONC is seeking bids from contractors to produce short animated films explaining the concepts in plain English. In the RFP, ONC noted:

"Although the widespread use of health IT by consumers has seemed a distant reality for many years, we have finally reached a level of activity and interest at which it is necessary to engage the public directly in a conversation about health IT and encourage people to use it to take a more active role in their own health and healthcare… The average person needs to know what changes are taking place on a national level, and what they will mean for him or her personally."

This would not be the federal government’s first foray into the world of animation – anyone remember “Duck and Cover”?  

Despite the growth of social media and the popularity of online health resources (second only to pornography according to internet lore),  the public is lagging behind the industry in understanding and adopting electronic health technology, due to a variety of legitimate concerns about security (i.e., the breach of Google Health’s database and the service’s subsequent shut-down) as well as the time-consuming nature of manual input. There have been some successful initiatives, such as the Department of Veterans’ Affairs MyhealtheVet web site with its Blue Button function that allows veterans to download their health data and share it with their families and physicians. A recent Markle Foundation survey cited by ONC indicates that a majority of both the public and physicians support the ability of patients to download their personal health information online and share information electronically with doctors.

It may take Bugs and Daffy, Mickey and Goofy, or SpongeBob and Squidward to explain the benefits of HIT to the average healthcare consumer. Let's hope these efforts reduce confusion and encourage participation, and maybe get a laugh or two in the process.

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Looking to buy or upgrade your scheduling, billing and collection software? Want to make sure what you’re buying meets the latest HIPAA electronic standard transaction criteria and is able to handle the new ICD-10 codes? Shopping for an Electronic Health Record (EHR) system that includes a practice management component and will qualify for HITECH subsidies? The American Medical Association and the Medical Group Management Association have published a toolkit that will walk you through the process.

The toolkit includes a directory of software vendors, a sample RFP, a sample vendor survey, a practice management system criteria checklist and a buyer’s guide to practice management systems. All but the buyer’s guide are only available to AMA or MGMA members.

The buyer’s guide suggests a five-step process:

• Establish an assessment team
• Analyze the patient and claims revenue cycle
• Identify software functionality and features
• Conduct a vendor survey and identify vendors you will consider
• Request and review formal proposals from selected vendors

This package may help physician practices make sense of the confusing world of practice management systems before they make a significant financial commitment.

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Buried in the 906 pages of the healthcare reform bill signed into law on March 22 are a number of changes that will have an impact on health information technology. Among the changes are standards which, when implemented, will reduce or eliminate the need to submit paper attachments with claims, a pet peeve of many healthcare providers. The inability of most electronic systems to accept required attachments digitally has discouraged many providers from fully implementing electronic claims submission.

Section 1104 of the Act tweaks HIPAA’s administrative simplification provisions by requiring the Secretary of Health and Human services to adopt standards for health care transactions which enable point-of-care eligibility determinations; minimize the need for paper attachments to claims submissions; describe all data elements (including reason and remark codes) in unambiguous terms, require that such data elements be required or conditioned upon set values in other fields, and prohibit additional conditions (except where necessary to implement State or Federal law, or to protect against fraud and abuse). 

The Secretary is directed by Congress seek to reduce the number and complexity of forms (including paper and electronic forms) and data entry required by patients and providers.

Health plans will be also required to adopt “unique health plan identifier” numbers by 2012.

Health plans will need to certify their compliance with the new standards by 2015. Penalties for noncompliance begin on April 1, 2014.

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Pennsylvania, get ready for another acronym: "QUICKSTEPS" (Quality Improvement and Care for Kids through Electronic Programs).  This is the state’s new five-year pediatric EMR initiative, funded by the U.S. Department of Health and Human Services through the Children's Health Insurance Program Reauthorization Act, or CHIPRA. Using $10 million in federal grants, the state’s departments of Insurance and Public Welfare will partner with seven health systems throughout the state to “implement testing and reporting on pediatric core measures of quality, promote the use of health information technology in children’s health care delivery while demonstrating the impact of the pediatric electronic health record.” The seven systems participating in the pilot program are:

•     Children’s Hospital of Philadelphia

•     Geisinger Health System

•     St. Christopher’s Hospital for Children

•     Penn State Hershey Medical Center

•     PinnacleHealth System

•     Pocono Health System

•     West Penn Allegheny Health System

The program’s goal is the increased transferability of health information for pediatric patients across different health care providers and social service agencies, to improve the quality and coordination of care.

For more info, see http://www.portal.state.pa.us/portal/server.pt?open=18&objID=771853&mode=2

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On November 2, 2009, the Texas-based Drummond Group Inc. announced in a Press Release that it will submit to become a certifying body upon the release of the Office of the National Coordinator for Health Information Technology (ONC) requirements for certifying bodies for Electronic Health Records (EHR).  ONC is currently working on the scope and definition of "meaningful use" for EHR, expected to be finalized in early 2010. Along with these new policies on meaningful use of EHRs, ONC announced plans to expand the number of EHR certification agencies to support the new initiative. 

Currently, the only approved EHR certification agency, since 2004, is the Certification Commission for Health Information Technology (CCHIT).

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This is the seventh installment in a series of blog posts that relate to the governance concerns surrounding developments in HIPAA, HITECH and HIT.

For a number of months this series has been emphasizing the importance of establishing a credible and knowledgeable liaison at the governing body and/or senior administrative level to articulate and educate the diverse stakeholders about the new challenges and initiatives in HIPAA and HIT. The liaison should be a champion and advocate for a rational and comprehensive approach for HIT.

The increasing complexities and costs of new IT systems and the need to demonstrate their “meaningful use” has greatly raised the stakes in this area for hospitals. Errors or false starts in HIT and the financial consequences of HIPAA violations under HITECH can be materially injurious to the organization’s finances, public image, internal stability and quality of patient care. It can also cause the loss of potential subsidies from HITECH.

Often the IT leader at a hospital does not have sufficient standing or skills set to serve as the champion. It was not the principal reason that he or she was hired. In such a case the governing boards should recruit either a knowledgeable board member or a senior staff person to serve this function.

The article on October 20, 2009 by Molly Merrill, Associate Editor of Healthcare IT News, adds further confirmation of the need for a qualified IT champion.

Ms. Merrill wrote that a new survey, conducted by Ponemon Institute and sponsored by San Jose, California-based LogLogic, shows that IT practitioners believe their organizations are lacking when it comes to protecting patient information. Moreover, Ms. Merrill continues, “[a]ccording to the study, 61 percent of [IT] practitioners believe their organizations don't have enough resources to meet privacy and data security requirements – and 70 percent think senior management doesn't consider it a priority.”

Ms. Merrill quotes the survey as concluding the following:

Without resources and support from senior management, preventing the loss of data may be very difficult. We recommend that organizations pursue a strategy of assigning accountability for the protection of electronic health information, appropriate technology to prevent the insider threat (such as DLP [data loss protection] solutions) and senior management buy-in for the necessary resources to get the job done right. [Emphasis supplied]

This survey underscores the frustrations and challenges that are present for the majority of IT leaders at hospitals. They may lack the standing within the organization to make a meaningful impact on senior management and the governing boards. Even if they hold a high level position within the organizations and are highly proficient in their jobs, they may lack be sufficient champions to interpret their complex world to their senior management and governing boards. It is incumbent on these organizations to identify a champion who possesses the skills to absorb and interpret the complex IT world for stakeholders who have limited knowledge of the subject.

[To be continued in Installment 8]

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[Installment 6 - Governance Considerations from HIT for the Board and Other Hospital Stakeholders]

On August 4, 2009 the Associated Press reported at http://www.usatoday.com/news/health/2009-08-04-electronic-medical-records_N.htm that Sac-Osage Hospital, a 47-bed hospital in rural western Missouri, “is borrowing nearly $1 million to pitch its paper medical charts and purchase a state-of-the-art electronic health records  [EHR] system. The hospital is hinging its survival on what it hopes will be a $3 million windfall of federal incentives for hospitals that go digital.”

This survival strategy for Sac-Osage Hospital is hazardous because there is an inherent risk in the hoped-for windfall in 2011 under the economic stimulus law. As the AP report goes on to states: “The risk lies in the federal government's ultimate definition of what constitutes a ‘meaningful use’ of electronic records.”

As I reported in my fifth blog post on July 28, 2009, health providers will have to meet minimum prescribed standards (the meaningful use) for their EHRs if they are to benefit in the future from the federal economic stimulus package under the HITECH Act to recoup a portion of the heavy costs that they will incur to implement their EHRs programs. 

The bet that Sac-Osage Hospital says it is making by borrowing to invest in EHRs is the highest - the very survival of the hospital. Its Board and Administration have clearly made the determination that other possible alternatives for capital financing and investment by the hospital will not have the monetary potential return of the HITECH windfall. It is somewhat sobering that Sac-Osage Hospital bases its financial survival plan not on more effective delivery of healthcare or new treatment modalities but on digitalization of its health records. However, a positive by-product of EHRs and the demonstration of “meaningful use” that will be needed to realize the fruits from HITECH of an investment in EHRs presumably will be fewer medical errors, a more efficient healthcare delivery system and a higher quality of care.

Unfortunately for Sac-Osage Hospital and other health providers seeking to benefit from the HITECH windfall, the landscape for qualification could change markedly over the next two years. As technology evolves, the expectations as to what constitutes meaningfully use may rise. Sac-Osage Hospital and other small rural hospitals will also be competing for a share of HITECH money with larger and more well-financed institutions that are much further advanced with EHRs. 

Other challenges can come not just from the crystallization of “meaningful use” but also the enactment of the health reform package that is looming ahead. The package itself may directly or indirectly affect how EHRs are to be generated and used, thereby impacting programs for implementing HIT. 

Hopefully, the substantial majority of hospitals are not in a mode that their survival depends on the stimulus money from implementing EHRs. However, the Boards of health care providers cannot afford false starts and mistakes if they are to meet the meaningful use standards of the HITECH Act on a timely basis. These matters must be appropriately analyzed and monitored continuously at a high level in the hospital, with committed Board oversight. 

 [To be continued in Installment 7]

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[Installment 2 - Governance Considerations from HIT for the Board and Other Hospital Stakeholders]

This is the second in a series of blog posts that relate to the governance concerns surrounding HIPAA, HITECH and HIT.  It is, however, not the second posting that I had originally planned. A front-page article on May 25, 2009 in the New York Times by Pam Belluck, entitled “Hospitals Using Internet to Interact with Public,” prompted me to write on this topic as part of the series. 

In her article Ms. Belluck stated, “Faced with economic pressures and patients with abundant choices, hospitals are using unconventional, even audacious, ways of connecting directly with the public.” She then reports that hospitals are using Twitter and transmissions from the operating room to communicate with the public on surgical results and YouTube to actually show surgery.  

This is seen by Ms. Belluck as a controversial approach to publicizing new procedures, to compete and attract patients and to stimulate contributions. In this day and age of increasing regulatory activity and heavy penalties for violations of HIPAA and state healthcare privacy and security rules, the Twitter practices should be subjected to careful scrutiny at the highest level by the governing bodies of hospitals.   The image of the hospital and its own sense of what are proper and acceptable marketing practices, the risks of legal or ethical violations from unwarranted communications, and the impact on publicity policies can be undermined by the uncontrolled actions of individuals.  The concept that the results of a complex surgical procedure can be meaningfully compressed into a rapid-fire, 140-character disclosure to the world can be somewhat perplexing.

The practice of using Twitter from the operating room to report on results is very risky and has serious implications for patient privacy. It may be a violation of existing laws or the general right of an individual to privacy.  It is always possible or even likely that the identity of a patient may become public, directly or indirectly, especially if the Twitter communication relates to a novel procedure. It is one thing to have a patient knowingly participate in publicity on YouTube and quite another to have someone send a Twitter message from the operating room while the patient is still recovering from anesthesia.

It is of equal concern that there is no control over the Twitter communications from the operating room. Anyone could make the transmission, which can be premature, totally erroneous and/or misleading.  It is a circumstance in some ways similar to the situation that judges are confronting from jurors who are sending Twitter or e-mail messages on the proceedings from the courtrooms of widely-publicized cases while the trial or jury deliberations are going on. Some judges are even prohibiting all electronic devices from being brought into the courtroom or jury deliberation room. In the case of the operating room there is the additional factor of the possibility that electronic transmissions from Twitter or e-mails may adversely affect or interfere with the normal operation of surrounding medical equipment.

The matter goes further. Will there be additional communications from the Tweeter or the hospital if the patient later develops complications or even dies? If the next patient who undergoes the same procedure does not fare well, will that be communicated through Twitter or other means to avoid misleading the public? How will the hospital control Twitter activity if it chooses to endeavor to do so? 

These questions and others should be properly considered at a high level in the hospital, with board oversight, in order to avoid or mitigate liability, maintain the hospital’s reputation for candor and transparency and avoid the adverse publicity of regulatory violations and penalties.  It is likely that the board should require that the hospital’s code of ethics address in greater detail how and when, if at all, electronic communications relating to patient procedures are communicated to the public and the nature of the patient consent that will be required.

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Introduction to Intellectual Property

As my initial entry to this blog, I would like to provide a high-level overview of U.S. Intellectual Property ("IP”) law. This overview will provide background information on the various areas of IP. Future entries will consider how the various aspects of IP effect and are affected by HIPAA/HITECH and the electronic patient record initiatives. The basic components of IP include: patents, copyrights, trademarks and trade secrets.

Patents

A patent is essentially a grant from the federal government conveying to the owner the exclusive right to prevent others from making, using, offering for sale, selling or importing the patented invention. It grants these monopolistic powers for a limited period in exchange for full and complete disclosure of invention to the public.

Note that a patent does not convey an absolute right to practice the invention. For example, a patent on an improvement to a product does not invalidate any existing patent on the underlying product, which may be owned by a different inventor. Thus, hypothetically, an inventor holding a patent on a five-legged chair could still infringe a patent to a four-legged chair held by another inventor.

In order to be patentable, the subject matter must be new, useful and non-obvious. U.S. patent law provides certain “statutory classes” of patentable subject matter. These include: processes/methods, machines, articles of manufacture, compositions, and certain business models (a.k.a., “business methods”).

Examples of patentable subject matter in the healthcare, pharmaceutical and biotechnology arenas include: compounds, intermediates, compositions and methods of making these, diagnostic kits, methods for isolation/purification of compounds, methods for analysis, methods for treatment/use, screening methods, improvements to known compositions, improvements to known methods, combinations of active ingredients, microorganisms. cell lines, cellular compositions, viral isolates, vectors or cloning/expression vectors and DNA/RNA promoters, synthetic oligonucleotides, signal sequences, expressed sequence tags (ESTs), proteins, monoclonal antibodies/hybridomas, isolated antigens/vaccine compositions, methods for isolation/purification of biological materials, methods for cloning/protein production, methods for diagnosis, methods for treatment/use, screening methods, and transgenic animals/plants.

Patentability of “business methods” may also be of significant issue in this blog as the era of HIPAA/HITECH and electronic patient records unfolds, and as computer user interfaces, processing software, database structures and other aspects of electronic patient record generation, processing, storage and retrieval are developed.

Trademarks

A trademark is any word, symbol or device used to identify one’s product and distinguish it from the products of others. Trademark rights are available “appurtenant to use” – that is - to be valid, a Federally-registered trademark must be in use in interstate commerce. Also, an active trademark should be policed by its owner, as allowing a trademark to be infringed or diluted by another’s unauthorized use may lead to effective loss of the trademark. 

In the U.S., a person may apply for a Federal trademark registration by filing either an intent-to-use or an actual use trademark application. If an intent-to-use application is filed, a Statement of Use identifying actual use in interstate commerce will need to be filed before the trademark will be registered as active.

U.S. trademark law, particularly with respect to the court cases (i.e., “case law”), is particularly voluminous (i.e., “lots of it”). It would be easy to devote entire blogs to discussions of trademark case law. We’ll defer further discussion here for a future entry.

Copyrights

A copyright is the right that the government gives an author of any original work of expression to  exclude others from copying or commercially using the work of expression without proper authorization. Examples include books, poetry, plays, songs, catalogs, photographs, computer programs, advertisements, labels, movies, maps, drawings, sculpture, prints and art reproductions, game boards and rules, recordings. 

Copyright protection is easy to obtain by filing a form with a sample of the work and a small fee. Authors of copyrighted works should include an appropriate copyright notice on the work. 

Applying for Federal registration of a copyright is required prior to filing a lawsuit for copyright infringement in a U.S. Federal District court.

U.S. copyright may very well operate as a speed bump on the road to HITECH, electronic patient records, and government-run universal healthcare. We will particularly address copyright issues in one or more future blog entries.

Trade Secrets

A trade secret is any information, design, device, process, composition, technique or formula that is not known generally and that affords its owner a competitive business advantage. Reasonable measures to maintain the secret must be made so as to obtain relief against those who wrongfully obtain the information.

These are traditionally the basic components of IP law. Additionally, Internet-related issues are increasingly tied to other IP – such as domain name dispute resolution where the complainant owns a trademark to the domain name. 

My next entry will discuss potential patent issues with respect to HIPAA/HITECH and electronic patient records.

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The Joint Commission released a Report today titled "Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future" that, among other things, emphasizes that health information technology ("HIT") will be key to hospitals' viability in the future.  According to the Report, HIT will play a significant role in enhancing health care quality and safety.  More specifically, the Report recommends that hospitals adopt integrative technologies across their facilities and systems, and find competent consultants to provide technology and investment guidance.  Ultimately, the Report concludes that HIT is the inevitable way of the future for health care. 

In light of the release of the Report, I will be monitoring whether the Report will ultimately impact the Joint Commission's Hospital Accreditation Standards in the future.  Interestingly, the introductory page of the Report specifically states that the Report does not intend to describe new Joint Commission requirements for health care organizations, nor does it intend to suggest that new requirements will be forthcoming in the future.  However, it is certainly possible and imaginable that the adoption and use of HIT may be woven into any number of Elements of Performance in future versions of the Joint Commission's Accreditation Standards. 

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Health information technology (HIT) bills continue to abound in Congress.   Recently, House bill (HR 6898) was introduced by House Ways and Means Health Subcommittee Chair Pete Stark, which includes proposed penalties for providers who do not adopt HIT by a certain date.  A similar House bill (HR 6357) was introduced by Energy and Commerce Committee Chair, John Dingell, but does not include penalties.  Now, House Speaker Nancy Pelosi is promising that there will be a “good” Democratic HIT bill ready early in the next Congressional session. The word is that congressional staffers are working on a draft even as I write this post, and that it will likely incorporate components of the Stark and Dingell bills. 

Yet, with the upcoming change in administration, and other pressing national issues taking priority, it is tough to predict which one (if any) of the several HIT bills that are currently pending, or any future bills that may be introduced in the next session, will actually become enacted law.  Nonetheless, providers should stay abreast of how proposed HIT legislation is progressing because funding opportunities that also are likely to become available for eligible applicants (i.e., providers) may need to be seized within a certain time frame.  If a deadline is missed, then the only "bills" that may be left are those for implementing HIT that has become standard, or mandated.

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As Election Day rapidly approaches, I thought that it would be interesting to note the presidential candidates' views on health information technology.  In short, both Barack Obama and John McCain appear to support and include health care IT adoption as a major part of their health care reform plans.

I have visited and reviewed each candidates' respective websites, and noted that McCain's plan includes general support for the rapid deployment of 21st century information systems and technology that would allow doctors to practice across state lines.  Obama's plan specifically includes allocating $10 billion annually for five years to help physicians and other health care providers adopt health IT.  The Obama-Biden plan also notes that a study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies.

To read more about the McCain-Palin Health Care Plan, click here.

To read more about the Obama-Biden Health Care Plan, click here.

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Heartland Institute, a Chicago-based think tank published a "scathing critique of the government's efforts to promote healthcare information technology," reports Healthcare IT News.
In its August 2008 edition of Health Care News, Heartland's analysts call the ONC- Coordinated Federal Health Information Technology Strategic Plan 2008-2012 "poorly conceived" and argue that "any plan for changing the healthcare system is better coming from the private sector rather than government . . ."

Greg Scandlen, Director of Consumers for Health Care Choices at the Heartland Institute, further claims that "[a]ny system that is imposed today will be obsolete in five years," and that "[t]he federal government is woefully incapable of changing or eliminating outdated rules and regulations. So we will be stuck for all time with whatever they come up with today."

However, I think that Heartland does not address the fact that the myriad of incompatible standards that have been developed for HIT, privacy, and agreements in connection with health information exchange has also slowed progress.  And, as hundreds and maybe thousands of entrepreneurs and innovators across America "roll out new approaches, try them out, refine them based on experience, and repeat the process," we continue to be left with disjointed systems and vacuums for emerging standards. 

In short, we might not have the time and luxury of allowing market forces to reach their final determinations when the economic and clinical benefits of implementing coordinated systems for health information exchange are needed now.   As such, a centralized coordinator and gatekeeper, such as ONC, may potentially optimize the process -- if done right -- and so, cooperation between the private and public sector could be key to quicker progress.

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The Los Angeles Times reported today about MEDPEDIA.com,  the website currently being developed by Internet entrepreneurs, together with doctors, researchers, and other medical professionals in order to create what is hoped (by them) will be largest body of health information on the Internet.  The information being gathered for the website is of the nature typically confined to academic circles.  The team working on Medpedia hopes to make that information understandable and available to consumers.  The LA Times indicates that Medpedia is "[m]odeled on the on-line encyclopedia Wikipedia, but [will be] written and edited only by trained professionals." 

The website lists Harvard Medical School, Stanford School of Medicine, and the [University of California] Berkeley School of Public Health as some of the organizations that will be assisting in building Medpedia's comprehensive medical clearinghouse.  The official launch of www.medpedia.com is scheduled for the end of 2008, but the website currently contains additional information about what is to come.    

Medpedia is just another example of how health care providers and Internet companies are experimenting with unique and helpful on-line tools to respond to the health IT momentum and a push to use such technology to empower patients.

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Today, the Office of the National Coordinator for Health Information Technology (ONC) released a comprehensive Strategic Plan for advancing health information technology (HIT). The Strategic Plan is intended to serve as a guide to coordinate the federal government’s health IT efforts to achieve nationwide implementation of an interoperable health IT infrastructure throughout both the public and private sector. 

Dr. Robert Kolodner, National Coordinator for HIT, stated that the Strategic Plan "[e]stablishes the next generation of HIT milestones to harness the power of information technology to help transform health care in this country.’’ ONC also notes that objectives, strategies, and milestones have been established for each goal and portray the totality of what must be done across the federal government to:

• address privacy and security concerns;
• achieve an interoperable health IT architecture to ensure reliable data exchange;
• accelerate IT adoption; and
• foster collaborative governance. 

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