Monday, February 1, 2016

#HIMSS16 Las Vegas Here We Come

The 2016 HIMSS Annual Conference & Exhibition is coming up between February 29 - March 4, 2016 in Las Vegas. This is the Super Bowl of health IT and will bring together over 40,000 health IT professionals, clinicians, executives and vendors from around the world. There are some great educational sessions, and the tradeshow floor will highlight the latest in health IT products. Some very interesting keynote addresses from Michael Dell, Sylvia Matthews Burwell, and even Peyton Manning (who has his own Super Bowl to contend with before the conference. With all of the changes in healthcare underway, this year's conference will be sure to keep CIO's and other decision makers in the loop as to what to expect over the next year. Having attended a few of these events in the past I can guarantee this will be worth the investment of time and resources.

This year I am joining a powerful group of healthcare social media experts who will be tweeting, blogging and leveraging all of the top social media platforms to get the word out and bring the latest news and information. The list of luminaries can all be found on Twitter and many have their own blogs as well. Tweet me @ahier and subscribe to whole list of HIMSS Social Media Ambassadors (SMAs) including:

Andrew DeLaO: @cancergeek
Bill Bunting: @WTBunting
Brad  Justus: @brad_justus
Charles Webster: @wareflo
Colin Hung: @colin_hung
Geeta Nayyar: @gnayyar
Glenn Lanteigne: @glennlanteigne
Jane Sarasohn-Kahn: @healthythinker
Janice McCallum: @janicemccallum
John Lynn: @techguy
Linda Stotsky: @emranswers
Mandi Bishop: @mandibpro
Matthew Fisher: @matt_r_fisher
Nick Van Terheyden: @drnic1
Pat Rich: @pat_health
Shahid Shah: @ShahidNShah
Steve Sisko: @shimcode
Tamara StClaire: @drstclaire
Wen Dombrowski: @HealthcareWen

Also be sure to watch the Healthcare IT News website and Updates and Announcements from the HIMSS Conference website, as well as the king of content aggregators in the industry HIStalk. All of the SMA's have a powerful presence on social media and there is already a great deal of buzz for the upcoming event. Symplur provides social media analytics and shows that so far for the month of January the #HIMSS15 hashtag has almost 5,000 tweeters have joined in the conversation, with over 15,00 tweets and an amazing 91 million+ impressions on the web. So get ready Las Vegas, here we come!

Wednesday, January 20, 2016

Senate HELP Committee Releases Draft of Bill to Help Improve Health Information Technology for Doctors & Patients

The Senate HELP Committee has released for feedback a staff discussion draft of the committee’s bipartisan legislation to improve health information technology, including electronic health records. The draft legislation is the result of a bipartisan, full committee health information technology working group announced last April as well as hearings in the committee.

Chairman Lamar Alexander announced the committee will hold an executive session considering bills on biomedical innovation on Tuesday, February 9. At that meeting the committee will consider at least seven bipartisan bills:

  • Bipartisan HELP Committee legislation to improve electronic health records. 
  • The FDA Device Accountability Act of 2015 (S.1622); 
  • The Advancing Targeted Therapies for Rare Diseases Act of 2015 (S.2030); 
  • The Advancing Research for Neurological Diseases Act of 2015 (S.849); 
  • The Next Generation Researchers Act (S.2014),; 
  • The Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act (S. 800); 
  • and Legislation regarding FDA regulation of duodenoscopes.

“The House has completed its work on the 21st Century Cures Act. The president has announced his support for a precision medicine initiative and a cancer ‘moonshot.’ It is urgent that the Senate finish its work and turn into law these ideas that will help virtually every American,” said Senator Alexander. "“The committee has also been working for months on legislation to help achieve interoperability of electronic health records for doctors, hospitals and their patients," he added. This is the discussion draft now released for public comment.

I am impressed with the draft so far. It emphasizes using technology to actually improve care, provide transparency, and empower patients. Information is power and it is good to see that the Senators are including patients and putting them at center of health information exchange. Strong language on information blocking practices will give some teeth to future regulations. Significantly it also combines the HIT Standards Committee and HIT Policy Committee into one HIT Advisory Committee.

Requiring that one EHR product is capable of trusted exchange with multiple other EHR product would be another certification criterion and testing regime that would hopefully address some of the challenges that have occurred in real world exchanges. It is also striking that they are instructing the Governmental Accountability Office (GAO) to conduct a study to review methods for securely matching patient records to the correct patient. Perhaps this will finally do away with the annual provision that Federal funds can not be used to research or create patient identifiers. Overall this draft is a very good start and it will be worth watching as the process plays out in the Senate HELP Committee.

Below is a summary of the legislation provided by the Committee:
  1. Assisting Doctors and Hospitals in Improving Quality of Care for Patients
    1. Reduces documentation burdens by convening public and private stakeholders to develop goals, a strategy, and recommendations to minimize the documentation burden on providers while maintaining quality.
    2. Allows and encourages health professionals to practice at the top of their license, allowing non-physician members of the care team, such as nurses, to document on behalf of physicians.
    3. Encourages the certification of health information technology (HIT) for specific specialty providers, like pediatricians, where more specialized technology is needed.
  2. Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT)
    1. Establishes an unbiased rating system for HIT products to help providers better choose HIT products.
    2. Allows HIT users to share feedback on the user experience of specific HIT products related to security, usability, and interoperability, among other concerns.
  3. Information Blocking
    1. Gives the Department of Health and Human Services (HHS) Office of the Inspector General the authority to investigate and establish deterrents to information blocking practices that interfere with appropriate sharing of electronic health information
  4. Interoperability
    1. Convenes existing data sharing networks to develop a model framework and common agreement for the secure exchange of health information across existing networks to help foster a “network of networks.”
    2. Creates a digital provider directory to both facilitate exchange and allow users to verify the correct recipient.
    3. Requires that HHS give deference to standards developed in the private sector.
    4. Combines the HIT Policy Committee and HIT Standards Committee into the HIT Advisory Committee.
    5. Creates a process for prioritizing the adoption of standards to focus on the most pressing problems faced by the health care community. 
    6. Establishes an initial set of common data elements, such as a standard format for entering date of birth, to facilitate interoperability and streamline quality reporting.
  5. Leveraging Health Information Technology to Improve Patient Care
    1. Requires that certified HIT transmit and receive data from certified physician registries and that registries be certified to transmit and receive from certified HIT
    2. Includes vendors in Patient Safety Organizations to allow for improvements in the safety and effectiveness of HIT.
  6. Empowering Patients and Improving Patient Access to Their Electronic Health Information
    1. Supports the certification and development of patient-centered health record technology so that patients can access their health information through secure and user-friendly software that may update automatically.
    2. Encourages the use of Health Information Exchanges to promote patient access by educating providers and clarifying misunderstandings.
    3. Requires HHS to clarify situations where it is permissible for providers to share patient information by providing best practices and common cases where sharing is allowed.
  7. Encouraging Trust Relationships for Certified Electronic Health Records (EHR)
    1. Supports the secure exchange of electronic health information by certifying that one EHR product is capable of trusted exchange with multiple other EHR products.
  8. GAO Study on Patient Matching
    1. Directs the Governmental Accountability Office (GAO) to conduct a study to review methods for securely matching patient records to the correct patient.

Summary Prepared by the Majority and Minority Staff of the Senate Committee on Health, Education, Labor, and Pensions

Saturday, January 16, 2016

The End of Meaningful Use As We Know It

Meaningful use called and said, "The rumors of my death are greatly exaggerated." Seriously, a careful parsing of acting CMS Acting Administrator Andy Slavitt's comments last week does not lead to the conclusion that meaningful use as a concept is over, but rather that it is being absorbed into Merit-based Incentive Payment System, and this will take some time to accomplish.

On Oct. 6, 2015, CMS and the Office of the National Coordinator for Health IT released the final rules for Stage 3 of the Electronic Health Record Incentive Program and the 2015 Edition Health IT Certification Criteria. Through this rulemaking, the agencies hoped to simplify requirements and add some new flexibilities for providers. They moved from fiscal year to calendar year reporting for all providers beginning in 2015, and they offered a 90-day reporting period for all providers in 2015, for new participants in 2016 and 2017, and for any provider moving to Stage 3 in 2017. They reduced the number of Stage 2 meaningful use objectives from 18 to 10 in 2015-2017, with no change in clinical quality measures. For Stage 3, there will be eight meaningful use objectives (with about 60% of them requiring interoperability).

Meaningful Use Train
They also requested additional feedback about Stage 3 of the EHR Incentive Program going forward, in particular aligning with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which established the Merit-based Incentive Payment System (MIPS) and consolidates certain aspects of a number of quality measurement and federal incentive programs into one more efficient framework. They plan to use this feedback to inform future policy developments for the EHR Incentive Program, as well as consider it during rulemaking to implement MACRA, which is expected to be released in the spring of 2016.

During last week's J.P. Morgan Healthcare Conference, CMS acting Administrator Andy Slavitt said:
"The meaningful use program, as it has existed, will now be effectively over and replaced with something better. Since late last year we have been working side by side with physician organizations across many communities -- including with great advocacy from the [American Medical Association] -- and have listened to the needs and concerns of many. We will be putting out the details on this next stage over the next few months, but I will give you themes guiding our implementation. 
For one, the focus will move away from rewarding providers for the use of technology and towards the outcome they achieve with their patients. 
Second, providers will be able to customize their goals so tech companies can build around the individual practice needs, not the needs of the government. Technology must be user-centered and support physicians, not distract them. 
Third, one way to aid this is by leveling the technology playing field for start-ups and new entrants. We are requiring open APIs [so] the physician desktop can be opened up and move away from the lock that early EHR decisions placed on physician organizations [to] allow apps, analytic tools and connected technologies to get data in and out of an EHR securely. 
And finally, we are deadly serious about interoperability. We will begin initiatives in collaboration with physicians and consumers toward pointing technology to fill critical use cases like closing referral loops and engaging a patient in their care. And technology companies that look for ways to practice 'data blocking' in opposition to new regulations will find that it won't be tolerated."
A careful parsing of his statement does not lead to the conclusion that meaningful use as a construct is over, rather that it is being absorbed into MIPS. The program is designed to shift Medicare reimbursement from fee-for-service to pay-for-performance.

This next year will be very busy as the rules for implementing the program are released. Note that Mr. Slavitt said the meaningful use program as it has existed, will now be effectively over. But meaningful use as a means of measuring progress is still required to receive payments from CMS above the baseline under MIPS.

There has been basic agreement among stakeholders that the EHR Incentive Program as it is currently constructed has achieved the goal of widespread EHR adoption, and laid a strong foundation for interoperability. The recent letter from 31 large health systems (posted on John Halamka's blog) to HHS Secretary Burwell asking them to reconsider Stage 3 Meaningful Use will apply additional pressure for change.

More detail here:

Wednesday, December 16, 2015

Summary of the HIT Policy Committee Report to Congress

Below is a summary of the HIT Policy Committee Report: "Challenges and Barriers to Interoperability" submitted to Congress today:

The Consolidated and Further Continuing Appropriations Act, 2015 was signed by the President on December 1, 2014. It reads in part:

Interoperability.--The agreement directs the Health IT Policy Committee to submit a report to the House and Senate Committees on Appropriations and the appropriate authorizing committees no later than 12 months after enactment of this act regarding the challenges and barriers to interoperability. The report should cover the technical, operational and financial barriers to interoperability, the role of certification in advancing or hindering interoperability across various providers, as well as any other barriers identified by the Policy Committee.

Past Health IT Policy Committee recommendations in the following categories of barriers to interoperability:

  • Lack of universal adoption of standards-based EHR systems
  • Impact on providers’ day-to-day workflow
  • Complex privacy and security challenges associated with widespread health information exchange
  • Need for synchronous collective action among multiple stakeholders
  • Weak or misaligned incentives

Interoperability is defined as the ability of two or more systems to exchange information and the ability of those systems to use the information that has been exchanged without special effort. Although substantial interoperability amongst all stakeholders in American health care has not been achieved to date, there are pockets of meaningful health information exchange developing.

The following new recommendations were developed by the Interoperability Task Force of the HITPC to build upon work that ONC has undertaken to identify solutions to some of the barriers identified within this report, most notably, ONC’s updated version of the Shared Nationwide Interoperability Roadmap (Interoperability Roadmap).

Three Recommendations

Develop and implement meaningful measures of HIE-sensitive health outcomes and resource use for public reporting and payment

HIE-sensitive measures are those which require health information to be exchanged and effectively used in order for the applicant to earn high scores. In order to enhance the strength of incentives that drive interoperability, a set of specific measures should be developed that focus on the delivery of coordinated care, facilitated by shared information across the entire health team (including the individuals and families) and throughout the continuum of care settings. An example of an HIE-sensitive measure would look at medically unnecessary duplicate testing. Payers could provide incentive clout by declining to reimburse for medically unnecessary duplicate testing.

Develop and implement HIE-sensitive vendor performance measures for certification and public reporting

While use of HIE-sensitive quality and value measures for provider organizations may serve as an indirect incentive for vendors to improve their systems, we believe that direct measures of HIE-sensitive vendor performance will bolster market forces behind vendor business practices that promote interoperability. Today, purchasers of EHR systems lack such measures to inform purchasing decisions or to use as a lever to put pressure on vendors to improve. Although vendors have strong incentives to pass the interoperability requirements for EHR certification, this process is “one-time” and occurs in a lab. It has not been shown to translate into interoperability that is affordable or easy to implement in the field.

Accelerate Payment Incentives for Interoperability: Set specific HIE-sensitive payment incentives that incorporate specific performance measure criteria and a timeline for implementation that establishes clear objectives of what must be accomplished under alternative payment models

Payers have existing mechanisms through which to incentivize providers to meet HIE-sensitive outcome measures, and Medicare is the logical payer to lead such efforts (particularly as CMS operationalizes new payment requirements under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). We note that these measures do not require defining interoperability as a new domain of performance incentives as they could easily be incorporated into incentive programs that target dimensions of provider performance that are HIE-sensitive, such as care that is coordinated, high-value, and safe, as well as integrated across the health and social services continuum. For example, a payment policy that denies claims for medically unnecessary duplicate testing for high-cost imaging would require coordination, or at least awareness, of orders and results by all providers involved in the care of an individual patient. Providing a roadmap for specific HIE-sensitive performance measures for future payment incentives, with enough lead time, will motivate and catalyze specific actions to speed the pace of achieving effective health information exchange that facilitates high priority use cases.