IT for Healthcare

House Passes HIT Bill

Super busy the last few days, so while I see lots to write about, I just don't have the time to explore those themes like I want to.  I'll have to make some time for it this weekend!  Here's something brief, though, that I think is pretty important to give attention to:

House passes health IT bill

Over opposition from a substantial number of Democrats regarding privacy issues, the Health Information Technology Promotion Act of 2006, modified in the eleventh hour, passed the U.S. House of Representatives on Thursday afternoon.

The vote on H.R. 4157 was 270-148.

The bill would set an Oct. 2010 deadline for the conversion from the International Classification of Diseases 9th Edition, or ICD-9, codes to ICD-10 codes, a deadline that was extended during negotiations over a final draft of the legislation last night by one year to Oct. 1, 2010.

It also includes a provision calling for to legislative relief from federal anti-kickback and Stark physician-self referral laws for hospitals to assist physician office practices with investment in health information technology.

Have a great weekend.

Feedback: EHR "Not Ready For Primetime"

This reader response was posted on modernhealthcare.com today in response to a piece that we linked to and discussed here yesterday.  An excerpt:

I could not agree more that EHRs are unlikely to bring even 10% of the expected benefits and at probably at least double the largest cost estimate. This is especially true of the small or solo physician groups. Frankly in my solo practice, we are much less likely to lose records or overlook test results because of the very small size of our operation.

There's such a wide variance of opinion in the medical community that I hate to characterize any particular viewpoint as prevalent. . . but I hear/see this sort of anti-EHR stance often enough that I wonder what the real motivation is and I wonder how to change the minds of those who are determined to hold out against adoption.  On a personal level, I'm actively looking for a physician who has implemented EHR (not that easy to find in our neighborhood) and that I can connect with and be comfortable with.  I imagine I'll be looking for a while but I think it's that important.  I've heard it said by others who know more than I but I think that's what it's going to take - a grassroots movement by consumers (patients) who insist that their healthcare be a 21st century endeavor.  I wouldn't do my banking at an institution that didn't have computerized records, why would I trust my life to such an institution?  Anyone out there have an opinion on this??  I'd love to hear what others are thinking on this.

EHR and CCR: The Interoperability Standard of the Future?

We went to a CME seminar this morning sponsored by Lake Hospital Medical Staff Education Committee.  There were several EHR vendors present, including our colleague Jack Rugan from Misys.  Jack introduced us to the Director of AAFP's Center for Health Information Technology, Dr. David Kibbe, MD.  While discussing EHR, interoperability, and the future of HIT, Dr. Kibbe mentioned CCR as the real "gold standard" of the future where interoperability is concerned.  In the past, we've touched on the CCHIT certifications and mused about the impact those certs will have on the market.  I've heard others mention CCR compliance before but never anyone of Dr. Kibbe's standing.  Needless to say I was intrigued and decided it was time to learn more about this communication standard and its applications.

From the AAFP's Center for HIT website:

The ASTM Continuity of Care Record (CCR) was developed in response to the need to organize and make transportable a set of basic information about a patient's health care that is accessible to clinicians and patients. It is intended to foster and improve continuity of care, reduce medical errors, and ensure a minimum standard of secure health information transportability. Adoption of the CCR by the medical community and IT vendors will be a great step toward achieving interoperability of medical records (one of CHiT's guiding principles).

Dr. Kibbe has put together an informative FAQ page on the subject, as well.  I've heard it said (or rather read it) that HL7 seems to be less and less relevant these days.  Our conversation earlier today seems to reinforce that, though perhaps Dr. Kibbe would disagree with that assertion.  As he says:

There is nothing quite like the ASTM CCR. It does not compete with HL7 or NCPDP or any of the existing standards, in large part because the ASTM CCR standard is all about clinical content rather than message format, and it can accommodate itself with messaging standards, such as HL7 and the HL7-CDA.

As always, we will continue to watch these issues play out and keep you updated on what we learn.  The following links are for more CCR-related resources.

ASTM International Commttee E31 on Healthcare Informatics
ASTM New Standard Specification for CCR
Essential Similarities and Differences Between HL7 CDA/CRS and ASTM CCR
Policy Statement of the AAFP Regarding EHR and ASTM CCR Standard

That's a bunch of information but the next time someone mentions CCR you won't be stuck saying something like, "Yeah, I love Have You Ever Seen the Rain!"

And by the way, Misys announced in February that Misys EMR 8.0 is a CCR-compliant product.

EHR "Gospel" Not Necessarily So

I'm ambivalent about this brief piece at modernhealthcare.com.  The author of It Ain't Necessarily So: The Electronic Health Record and the Unlikely Prospect of Reducing Healthcare Costs (Health Affairs), Jaan Sidorov, is cited as a skeptic when it comes to the value of EHR.

I certainly agree that the much-touted financial benefits of EHR are likely overstated.  Ultimately, the point made in this article - a point I have highlighted before and will continue to reinforce - is that EHR is a tool that makes good things possible.  Without buy-in from the providers - and everyone else in the care environment - results won't keep pace with expectations.  Part of the problem is how to get buy-in without making claims that catch the doctors' interest.  The healthcare community is notorious for its IT lag; a rational case for adoption is obviously a difficult sell. 

A perfect example is the point about malpractice premium savings:

"We (at PMSLIC) have not found reason to give a discount on the premiums that we charge just because there is an electronic health record present," Sidorov said. "I am aware of one physician-led insurer that does give a discount, not for an electronic health record, but for the electronic health record and all the things that should accompany an EHR," including hardware and infrastructure options as well as remote data storage, he said.

I've heard this myth many times and repeated it once or twice - until I did the research and saw the same thing: no one (or very few) is actually giving any such discount.  The point: I don't ever mention this, even in casual conversation, because it's clearly not accurate.

Having said all that, I think "debunking articles" like Dr. Sidorov's cut both ways.  I'm all for full-disclosure, I just worry that it will give already recalcitrant doctors more ammunition in avoiding the inevitable adoption of clearly valuable IT solutions.  But that's just my IT-biased $.02.

More CCHIT. . .

From Health IT Strategist:

The Certification Commission for Healthcare Information Technology gave the IT world a peek Monday at possible new criteria for the second round of testing of ambulatory electronic health-record systems.

. . . If approved, the new criteria will be added to the many dozens of criteria already in use by CCHIT judges in their current, first round of certification testing, which began earlier this year and yielded a first batch of 20 EHR systems to receive certification last week.

Testing under the current set of criteria will continue in three more rounds of quarterly testing, if need be, which are scheduled to run through early next year.

Most of the new criteria for testing of ambulatory EHRs, which won't go into use until May 2007, have been on what CCHIT Chairman Mark Leavitt called the "road map," or long-term plan, for some time.

Click through to read more about the proposed new criteria and the future of CCHIT.

Link

Tennessean.com: Frist Praises Push to Create e-Medical Records Network

Government continues to back efforts to drive adoption of HIT; this time the Senate's only surgeon has sponsored the Wired for Health Care Quality Act.  If passed into law, the Act would "promote electronic medical record exchanges nationally — something he says could be a medical breakthrough that not only improves quality of care but also reduces costs and waste."

The article goes on to describe a couple of different RHIO-type networks being developed in Tennessee.  An interesting quote:

"The total value of a health-care network for all users far exceeds the cost to build and to operate," said Dr. Daniel Winship, a consultant on the project. "Everybody believes that; nobody can prove it."

They also can't figure out who's going to pay for, from my experience.  Clearly there are still hurdles to overcome financially.

IOM Endorses ePrescribing

A recent press release and online report from the Institute of Medicine urges healthcare providers to adopt electronic prescribing (and other IT) solutions by 2008 to improve the quality of care in the US and reduce the number of deaths from prescription errors.

Co-chair of the IOM committee that authored the report, J. Lyle Bootman:

Our recommendations boil down to ensuring that consumers are fully informed about how to take medications safely and achieve the desired results, and that health care providers have the tools and data necessary to prescribe, dispense, and administer drugs as safely as possible and to monitor for problems.  The ultimate goal is to achieve the best care and outcomes for patients each time they take a medication.

It warms my heart to see stories like this.  The more reputable institutions get behind HIT and push, the greater the rate of acceptance. . . and that's good news for everyone.

ModernHealthcare.com Article

HIPAA's Demise?

Just an unsubstantiated bit that I saw at HIStalk but coupled with a few articles I've seen about the fact that there have been very few HIPAA legal actions taken it makes one wonder:

"I was speaking with a DC attorney who gave me interesting information about HIPAA. He said that the Bush administration is not allocating any resources to enforcing HIPAA. There have been no lawsuits for any violations. As a result, he said many large hospitals are starting to ignore the security provisions. Nobody cares about HIPAA any more."

CIA Link to Software Vendor Involved in NHIN Prototype Raises Questions

This is a lengthy piece at modernhealthcare.com but one worth reading.  The complex issues raised are indicative of the future debates looming as EHR, RHIO, NHIN, etc. . . continue to gain traction and come up against issues of patient privacy.  I'll summarize here but I recommend taking the time to acquaint yourself with this in more detail - it will be a recurring theme.

• Initiate Systems makes a software application used in healthcare to link patients to their reccords by running a probabilistic matching algorithm.
• The software is currently used by RxHub to check patient eligibility for drug benefits and by SureScripts, whose "data-transfer network is fast becoming a de facto standard for e-Rx linking between clinicians and pharmacies."
• Initiate also worked recently with the Veterans Health Administration to augment their patient identification system.
• Initiate Systems' software is used by MA-SHARE, a Boston-based RHIO that is participating in an HHS prototype of the NHIN.
• Initiate received "Series E" funding in February from In-Q-Tel, a venture capital firm founded in 1999 by - and still financed by - the CIA.
• All relationships, while not exactly publicized, were fully disclosed by both In-Q-Tel and Initiate Systems

So the software created and sold by Initiate Systems is used to sift through patient data and find connections between patients.  The average American's greatest concern about the creation of a national information exchange network for their health data is privacy.  The CIA is involved.  That seems like a scenario that could create some ripples. . . and it has.

Dr. Deborah Peel, chair of the Patient Privacy Rights Foundation "called the CIA connection 'outrageous,' noting that it simply doesn't pass the sniff test. 'Who doesn't believe if the CIA puts up that money, they won't have access?' Peel said. 'I'm still not satisfied.'"  Meanwhile, the folks in charge of almost all the principle players - with serious stake in how this relationship is perceived - don't seem concerned:

• Mark Overhage, with Indiana Health Information Exchange: "I don't worry much about the support Initiate has received. . . Initiate doesn't have access in any way."
• John Halamka, CEO of MA-SHARE: "I don't have specific concerns that the CIA would use this to compromise the privacy of health records. . . The Initiate algorithm is simply a generic way to take a whole set of information and filter through it."
• Rob Cronin, Director of Corporate Communications for SureScripts: "We use various technologies to deliver our services, but the makers of those technologies never have access to our systems and data, period."
• Daniel Garrett, VP and Managing Director of Computer Sciences Corporation (lead contractor in the MA-SHARE-NHIN prototype): "[It] is something I would definitely ask my team to take a look at, but what I think would come back is that it's software that's being imbedded and they (Initiate Systems) don't have access (to medical data)."

I'm ambivalent on this.  On the one hand, this is exactly the sort of thing that gives rise to statements (by Dr. Peel) that "[i]f privacy is not fully protected, we won't be building anything except the most valuable mother lode of information for data mining on Earth."  When people feel that their information is at risk, they aren't going to get behind a NHIN.  That won't make it any easier to implement.  So I say, perception-wise, this is - or at least could be - problematic.

On the other hand, many of the folks I've heard talking about this on the "patient advocacy" side seem a bit shrill.  Someone will always be there to point out that the sky is falling; it's easy to enumerate all the ways that bad things can happen.  And they aren't wrong.  Bad things can happen but it doesn't mean they will and it doesn't mean we should stop progress to avoid them.

In this instance, I think this is a bit of a tempest in a teapot.  But please click through, read the story, and tell us what you think.

CCHIT Announces First Round of Certified Products

As promised, here's the list of certified EMR/EHR Vendors and Products as announced by CCHIT today:

Allscripts (HealthMatics Electronic Health Record 2006) Allscripts (TouchWorks Electronic Health Record 10.1.1) Cerner Corporation (PowerChart 2005.02) Companion Technologies (Companion EMR v8.5) eClinicalWorks (eClinicalWorks Version 7.0 Release 2) Emdeon Practice Services (Intergy® EHR v3.00) e-MDs (e-MDs Solution Series 6.1) Epic Systems (EpicCare Ambulatory EMR Spring 2006) GE Healthcare (Centricity® EMR 2005 Version 6.0)

JMJ Technologies (EncounterPRO® EHR 5.0) McKesson (Horizon Ambulatory Care Version 9.4) MCS-Medical Communication Systems (mMD.Net EHR 9.0.9) MedcomSoft (Record 2006 (V 3.0)) Medical Informatics Engineering(WebChart 4.23) Misys Healthcare Systems (Misys EMR 8.0) NextGen Healthcare Information Systems (NextGen EMR 5.3) Nightingale Informatix Corporation (myNightingale Physician Workstation 5.1) Practice Partner (Patient Records 9)

Not too many surprises here.  It will be interesting to see how each vendor tries to parlay this pioneer-status into marketing capital. . . and whether it will work with the providers out there yet to adopt.