Numerous healthcare stakeholders submitted comments on the Health IT Policy Committee's proposed definition of "meaningful use" of electronic health records to the Office of the National Coordinator for Health IT. Here, iHealthbeat.org provides summaries of groups' comments.
There are only a handful of regions in the United States that have the knowledge base, capital access, local leadership, and infrastructure to be the innovative leader in health IT. And Nashville, TN, is a "tremendous contender," said David Brailer, MD, PhD, chairman of San Francisco, CA-based Health Evolution Partners, during the Nashville Health Care Council's forum on health information technology and the economic stimulus held nearly two weeks ago.
It has been awhile since we've heard from Brailer, the former National Coordinator of HIT. He joked how arriving in Nashville on Southwest Airlines was a completely different experience than his last visit when he arrived on Air Force One. Brailer was joined by William W. Stead, MD, associate vice chancellor for strategy and transformation at Vanderbilt University Medical Center, Don E. Detmer, MD, president and CEO of the American Medical Informatics Association, and Dave Goetz, Jr., commissioner for the department of finance and administration for the State of Tennessee.
Jonathan B. Perlin, MD, PhD, who is the chief medical officer and president of clinical services at HCA and was recently named chair of the Department of Health and Human Services Health Information Technology Standards Committee, moderated the panel.
The panel focused on three questions:
How to make the HIT investment in the stimulus package the most effective?
Are the goals realistic?
Will the increased regulation of the HITECH Act stifle innovation?
Brailer echoed a sentiment that I've heard repeatedly. Namely, that adopting HIT is not enough. The technology should be adopted in a manner that changes the fundamental delivery of healthcare by driving quality, efficiency, and transparency. He also expressed concern that Washington may not be able to move beyond financing IT to change the world of care delivery.
“We are pushing health IT instead of pulling it and I think that leads to inefficiencies," said Brailer.
The incentives will get the industry moving in the right direction, he said, but providers may have to wait longer to receive stimulus funding than many people realize. "The money will not be a tsumani but a trickle," he said.
Brailer also said he doesn't believe that having a regulated market will stifle innovation as long as the end objectives allow free play, innovation, and competition.
Stead agreed, saying that a regulated approach can work but it must redefine interoperable information as information that can be reinterpreted as knowledge evolves, separate data from applications so different kinds of computer systems can access it, and limit the use of standard data that has one and only one meaning.
In order to see reductions in cost and improvement in quality, Stead said that the industry has to change the nature of practice itself like coordinating care across the continuum and practicing evidence-based medicine. For the technology to work it has to be "architected so it can support change and adapt to change," said Stead.
When it comes to leveraging health information exchanges, Goetz said that the solutions need to be simple, thoughtful, and meet clinical goals. "We try and build information sources that can then drive value," he said. "We won’t get value without simplification."
And even though Goetz said the goals of the HITECH Act will be difficult to meet, he thinks the healthcare community will find a way to make it work.
Detmer is equally optimistic about the opportunity the stimulus package provides, but he is still not convinced that the rate of change will move more quickly than it is currently moving. "It is a tremendous opportunity," he said. "But workforce and training issues are quite real."
Simply having a good technology isn’t enough to remove the barriers of cost, change, disruption, and risk, said Brailer. "Healthcare entrepreneurs must actually understand how the healthcare delivery system works so they can actually make a change in it.”
The technology is only worth it if you are going to get a 40% to 60% improvement in value, said Stead. The stimulus package offers the healthcare industry a real opportunity to innovate. But to capitalize on that, Stead said, "we have to be willing to stop playing defense around a model that is not sustainable."
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The nation's hospitals have agreed to contribute $155 billion over 10 years toward the cost of insuring the 47 million Americans without health coverage, according to two industry sources. About $100 billion of the savings would come through lower-than-expected Medicare and Medicaid payments to hospitals, the sources told the Washington Post. About $40 billion would be saved by slowly reducing what hospitals get to care for the uninsured, they added. The reductions would probably not begin for several years, after a significant number of people have enrolled in the new insurance programs. The agreement is the latest in a series of side deals that aim to reduce the cost of revamping the nation's healthcare system and to neutralize industries that have historically opposed such reforms.
Group Health Cooperative of Puget Sound is one of the country's few surviving health insurance cooperatives, and it has recently embraced electronic medical records and a collaborative model of primary care. Those innovations have made the Washington state-based Group Health a prototype for a political compromise that could lead to a bipartisan healthcare deal. After a month of brainstorming, including briefings from Group Health executives, the Senate Finance Committee seems poised to propose private-sector insurance cooperatives as its primary mechanism for stoking competition and slowing the growth of medical costs.
It is more important that healthcare legislation inject stiff competition among insurance plans than it is for Congress to create a pure government-run option, White House Chief of Staff Rahm Emanuel said. His comments came as the Senate Finance Committee pushed for a bipartisan deal, and one of the most contentious issues is whether to create a public health-insurance plan to compete with private companies.
Hartford, CT-based St. Francis Hospital and Medical Center, which advertises its cardiovascular program as the largest open-heart surgery center in the state, has temporarily halted all non-emergency cardiac surgeries at the recommendation of state health officials. The decision to suspend the elective cardiac surgery program was voluntary, but comes as the state Department of Public Health investigates the hospital, health department spokeswoman Diana Lejardi said. She said the suspension occurred because of "quality of care issues."
Richard L. Jones Jr. announced that he will be retiring as president and chief executive officer of Warminster, PA-based Abington Memorial Hospital, effective Jan. 31. Jones held those posts for 11 years; he has spent 29 years with the hospital. John Durham, the hospital's board chairman, said the national search firm Witt/Keiffer has been hired to find a replacement.
Television commercials are expected to grow this summer in both numbers and criticism as detailed health bills emerge from Congress and dozens of interest groups, companies, and labor unions tussle over influencing lawmakers. Through June 27, $31 million has been spent for roughly 47,000 TV ads on healthcare this year, says Evan Tracey, president of the Campaign Media Analysis Group, a firm that tracks issue advertising. That's double the roughly $14 million the insurance industry spent in 1993 and 1994 for the famous "Harry and Louise" ads credited with helping kill President Bill Clinton's healthcare drive, but a fraction of the $250 million Tracey guesses will ultimately be spent this year.
If H1N1 re-emerges this fall as many health officials anticipate, hospitals could lose essential portions of their workforce and supplies and support services could be held up as well, warns the American College of Emergency Physicians.
"If the virus follows the pandemic patterns of the 20th century, health care providers should prepare for the potential of higher level of virulence in the fall wave, which occurred in both 1918 and 1957," says the group's new report, which spells out a plan for managing the virus. Cases could occur in early fall, before the vaccine's availability in late October, and continue into the normal flu season.
"If this occurs, the population will not have had available vaccine, and similar patterns of infection are expected, with higher prevalence in children and young adults," the report says.
The College says no emergency department will be exempt from the risks of an H1N1 outbreak. And if transmission rates double from the events of this spring, "over 30,000 cases can be expected over the fall and early winter. Emergency departments could see 150% of normal volume of respiratory complaints."
"Without a vaccine, the best defense the nation will have in reducing transmission would be community mitigation strategies," such as school closures, social distancing, frequent hand washing and requiring people to stay home from work at the earliest signs of illness, the report says. "No area of the United States would be spared from the spread of H1N1."
For hospitals, the college says, "pharmacies may not be able to get additional supplies from distributors . . . supplies of personal protective equipment and other supplies may require stockpiling, and food services could encounter supply problems due to production and delivery. The workforce may be depleted due to infection."
Complicating the scenario is that even though prevalence of disease may be as low as 2%, public officials may discourage the use of public transportation, and adults and parents with sick children will seek care from primary care providers, who "will be overbooked and will be referring patients to the emergency department." The report said.
Among the report's 27 recommendations, most of which list three or more action items, the college advises hospitals to have predetermined lead officers to coordinate preparedness, plan for surge staffing for the entire institution, prepare for supplies of personal protective equipment, and augmented post-mortem and mortuary services.
As of July 2, there were 33,902 cases of influenza in the U.S. including Puerto Rico and the Virgin Islands, and 170 deaths, according to the Centers for Disease Control and Prevention. Wisconsin had the most cases, 5,861, but only four deaths. By contrast, New York state had less than half the cases of Wisconsin, 2,499, but 44 deaths, more than any other state.
Department of Health and Human Services Secretary Kathleen Sebelius said Monday that up to $40 million in grants are being made available for helping children in families who qualify for—but are not yet enrolled in—Medicaid or their state’s Children's Health Insurance Programs (CHIP). This grant announcement is the first cycle of outreach funding under the new Children’s Health Insurance Program Reauthorization Act (CHIPRA) that was signed into law by President Obama in February.
"The grants are not specifically for states," Sebelius said in a teleconference on Monday. "They are for states [along with] local governments, providers, consumer groups, faith-based groups, community outreach organization, and advocacy groups."
The $40 million also will not be allocated on a per state basis, Sebelius added. "It really is based on the opportunities to reach particularly the most underserved population, the most neglected health group and the most creative proposals to tie in with current children's health plans."
While states have been successful in enrolling more eligible children for coverage under their Medicaid and CHIP initiatives, as many as 4 million children still may not be covered. "We'll be focused on targeting populations that historically don't get the care they need," Sebelius said.
All grant applicants will have to demonstrate a strong working relationship with their state's CHIP, she added. The grants will be worth between $25,000 and $1 million. "We expect to see a wide variety of projects from a broad spectrum of applicants."
Colorado Gov. Bill Ritter (D), who participated in the teleconference, said that since 2007, 67,000 more children have been enrolled in Medicaid and his state's CHIP a 27% increase. However, about 180,000 children still remain uninsured in the state.
"In these tough economic times, when Medicaid and CHIP are straining state budgets, it would be easy to pull back on these efforts and even try to create barriers to enrollment as a budget management strategy," Ritter said. "We believe that when times get tough . . . they need to rely even more on safety nets services. It's critical that eligible families know about the services that are available to them."
The new law will provide a total of $100 million for outreach campaigns aimed at reducing the number of low income, uninsured children. The grants will be administered by the Centers for Medicare and Medicaid Services.
