Saturday, May 10, 2008

HIT Discussed on the Hill

Senator Sheldon Whitehouse (D-RI), stopped by the May 7th Capitol Hill Steering Committee on Telehealth and Healthcare Informatics session to discuss his interests in HIT. He has sponsored three interrelated bills to help move HIT forward and one of the bills (S.1455) would develop a private, non-profit National Corporation for Health Information Technology and Privacy.

The Corporation would be tasked with developing a national, interoperable, secure health IT system. According to the Senator, the Corporation would be a central entity that would set up licensing access to networks, establish a pool of capital, and be effective in putting the right incentives in the right place.

The Senator wants to see the model for the Corporation to be based on previous developments in this country. John Kennedy as President, wanted to see this country advance in developing communication satellites, so he established Comsat as a private corporation to carry out that specific mission. When the goals for that program were accomplished, Comsat was phased out.

He continued to say how important it is to establish standards for HIT, provide for significant investment in quality improvements, and change the way that reimbursement is handled. As he explained, today’s physicians are faced with difficult workflow issues, returns for physicians are small and most of the return goes to BCBS and Medicare, plus the fact that the relationship between health insurers and providers can be difficult to manage.

As the Senator said, he wants to see changes made in the near future by solving the problems now and not in ten to fifteen years. This country needs to protect the American healthcare system against dangerous outcomes and let the market behave as the market should.

Elliot Menschik, MD, PhD, President, Hx Technologies Inc made the case that Health Information Exchanges (HIE) driven by business and clinical needs are emerging as a rapid deployment cost effective service and sustainable alternative to RHIOs. Dr. Menschik explained that a business driven for profit HIE would enable choices on what clinical data to share and would be designed around the business needs of the participants. When developing the model, not everyone has to agree on every policy, since different ideas can co-exist as long as the right technology is in place.

According to Dr. Menschik, for profit HIEs are able to provide benefits to the patient, provider, and payer in terms of more efficient streamlined services and lower costs. Both the patient and provider end up with more accurate information on hand so that the provider is better able to diagnose medical problems and provide for more timely intervention in critical medical situations.

Hx Technologies Inc is actively involved in exchanging medical imaging data and is now operating the Philadelphia Health Information Exchange (PHIE) that links unaffiliated even competing medical facilities together and provides for the seamless movement of patient digital medical records. Now providers are able to act upon their patient’s results quickly regardless of where the data may be geographically.

Also, moving imaging rapidly helps the payer and provider have a better relationship with their health plans. By delivering images in real time, health plans do not have to deal with diagnostic uncertainty that can lead to additional imaging and may cause the patient to receive additional radiation exposure. It also has been shown that redundant exams can be costly to employers and insurers.

W. Ob Soonthornsima, Senior Vice President and Chief Information Officer, Blue Cross Blue Shield of Louisiana, reports that Louisiana’s goals to deliver healthcare were changed and shaped by Katrina and Rita. The devastating storms produced a wake up call for the state to redesign and establish an evidence-based quality driven healthcare model. According to the Soonthornsima, collaboration is needed at the local, state, and national level to deliver a quality driven patient centric model of healthcare.

In 2006, the Louisiana Health Information Exchange demonstration project was launched to establish an operating HIE entity. HHS contracted with DHH to develop an HIE that could demonstrate interoperability, clinical information exchange, develop security and privacy models, exchange clinical information, be web-based, and provide uniform access to emergency rooms and primary care providers.

Soonthornisima pointed out that the ongoing activities are to identify strategic partnership opportunities and work with the Louisiana DHH, state Medicaid, and key hospitals to establish an operating HIE. Also, the Louisiana Health Care Quality Forum (LHCQF), a non profit organization formed to promote standards for healthcare quality would play an important part in the process. LHCQF now has four working committees with qualified volunteer stakeholders focusing on quality measures, HIT, patient centered medical homes, along with public outreach and education.

BCBSLA is actively involved in technology and has launched an e-Rx program with over 500 physicians participating. Now the state wants to see wide adoption especially among small to medium size physician groups. This summer, Medicaid is launching a similar e-prescribing program for 500 of the highest prescribing Medicaid doctors.

According to Soonthornsima, the HIE should to set up with the EHR at the center. In addition, the system needs to:

  • House a clinical system EMR containing provider clinical data with information on patients from ambulatory or hospital settings
  • House a computerized-based patient record, with Rx information, physician notes, and lab results
  • Contain claims-based data along with administration data to give a longitudinal view of medical histories, episodes of care, and information on prescriptions
  • Develop a PHR system to provide demographic information, personal and family histories, allergies, medical conditions, risk assessment information, and other personal health management data

As part of the rebuilding in the state, the Louisiana Health Care Redesign Collaboration a private collaboration led by the DHH was formed to develop a blueprint for evidence-based quality driven healthcare and look at the future of the delivery system. Critical components were outlined such as the need for medical homes so that patients will have access to primary and specialized care, and the need for patient centric health records to enable care coordination capabilities.

Barbara Massoudi, MPh, PhD, Health Informatics Program, RTI International, described the progress of the Health Information Security and Privacy Collaboration (HISPC) that began with 34 states and territories. Organizations were subcontracted in each state and designated by the government. Then each state identified a steering committee composed of leaders from state governments and stakeholder organizations.

To accomplish their goals, work groups were set up to examine:

  • The variations in policies that can create barriers to the widespread use of HIEs
  • The existing paradigm for privacy and security protections that do not fully accommodate active consumer participation in HIE
  • Legal and regulatory drivers along with standards
  • How to involve consumer organizations, state, and federal entities in sharing their concerns as they relate to privacy and security for health information and how to achieve broad based acceptance
  • Developing plans to implement changes where feasible
  • Providing for international agreements

The state teams have completed their assessment of the different business practices, policies, and laws within the states. This will help to understand the effects that privacy and security can have on the landscape and how these issues affect the development of electronic health information exchanges.

In further collaboration HISPC has worked with the National Governors Association to develop exchange scenarios in terms of treatments, payments, operations and marketing, RHIOs, research data use, law enforcement bioterrorism, employee health information, public health prescription drug use, and state governance oversight. In addition, regional meetings were held in 2006 in HISPC states as well as in other states, and now there are plans to implement collaborative projects in 42 participating states and territories.

Lisa M. Santelli, Esq., Senior Legal Counsel, Health Plan Affairs, Excellus BCBS & the Greater Rochester Regional Health Information Organization, explained how the Rochester RHIO, a non profit organization provides for the secure exchange for health information but also for timely access to clinical information and improved decision making. The RHIO now provides a community-based Virtual Health Record, EMR light (with e-prescribing), and third party EMR connectivity.

The RHIO uses data from local payers, hospitals, laboratories, and radiology practices, and the system based on affirmative patient consent. Santelli pointed out that the system is successful because there is key stakeholder participation, state government support through the New York State Office of Health Information Technology, Heal NY and NYS HISPC and Axolotl’s Elysium has played an important part. She continued to say that the RHIO leadership is able to navigate stakeholder’s interests, encourage collaboration, and maintain focus. This is never an easy mix but in the case of the Rochester RHIO, it works.

In the next phase there will be full program implementation. In the immediate future, the Virtual Health Record now in the pilot phase will be implemented. Future activities and plans will be to support EMR adoption across the area, develop a patient portal, and go completely electronic. Hopes are that the expansion of information sharing across the healthcare continuum will include long term care facilities and home care agencies.

Continuing Honorary Steering Committee Co-Chairs are Senators Kent Conrad (D-ND), Mike Crapo (R-ID), Sheldon Whitehouse (D-RI) and Representatives Eric Cantor (R- VA), Rick Boucher (D-VA), Bart Gordon (D-TN), David Wu (D-OR) and Phil English R-PA). The Steering Committee coordinates many activities with the House 21st Century Health Care Caucus, co-chaired by Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA).

A special session in collaboration with the American Heart Association and the American Stroke Association will be held on Thursday May 15, 2008 in Room 124 in the Dirksen Senate Office Building to discuss “Innovative Uses of Telehealth in the Treatment of Acute Stroke”. For more information, contact Neal Neuberger, President, Health Tech Strategies LLC, at (703) 790-4933 or email