Wednesday, April 28, 2010

Roundtable Held on the Hill

Representatives Tim Murphy (R-PA) and Patrick Kennedy (D-RI) Co-chairs of the House 21st Century Healthcare Caucus, hosted a roundtable discussion. The event supported by the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics discussed issues of importance to the healthcare technology and medical community.

Neal Neuberger, Executive Director for the Institute for e-Health Policy, said “It is important to listen to the leaders in the field present their thoughts and ideas as to what is now needed to implement HIT in this quickly changing healthcare environment.”

Representative Murphy in his opening statement explained that today only six percent of hospitals and two percent of physicians rely on electronic health records. Although this will improve with the economic stimulus legislation incentives, there still are legitimate concerns that the guidelines for HIT “meaningful use” produced by CMS are too ambitious and impractical.

He reports that he has heard from physicians and hospitals in his district that say that the initial requirements for incentive payments are too complex and simply unattainable and unrealistic. They feel that small physician practices not able to benefit from the incentives will still need to invest in HIT. This can cost as much as $30,000 and the small practices feel that they will have to spend the money for the system to avoid non-compliance penalties that are to begin in 2015.

Representative Murphy thanked Representative Kennedy for recently introducing the “HITECH Extension for Behavioral Health Service Act” to enable mental health providers to be eligible for federal incentive payments. Representative Murphy is looking forward to helping Kennedy secure passage of H.R. 5040.

Both Representatives realize how important it is to help mental health professionals diagnose and treat patients with complete up-to-date medical histories at their fingertips. For instance, when depression is not treated, the costs of caring for a person with a chronic illness like heart disease can double.

Representative Kennedy in his opening statement praised the health IT landmark funding and the grand design of health reform. Kennedy wants to see the effort made to get not only the dollars out to the communities but also to move forward and enable all of the health reforms help medical and healthcare professionals do their work more efficiently. For the past 16 years, Kennedy has worked hard to transform healthcare so that the system will be able to deliver consistently high quality care more efficiently to the population.

Andrew Urbach, M.D. Medical Director, Clinical Excellence and Service at Children’s Hospital of Pittsburgh has only praise for the hospital’s innovative single integrated electronic medical record initiated and built in 2002.

Dr. Urbach pointed out there are many advantages to the hospital resulting from the use of the EMR system. For example, the system has made it possible for the hospital’s medication error rate to be among the lowest in the county with the error rate dropping over 60 percent from the hospital’s starting point.

He praised the hospital in other ways. The hospital’s medication administration system is complete with order sets, computerized order entry, dose range checks, and bar coding. In addition, the hospital has the capacity to mine data to use for decision making. For example, during the H1N1 outbreak, the epidemic’s ebb and flow minute-to-minute actions were tracked and this data helped to deploy resources wisely.

Today, the hospital campus uses 4,000 computers connected to the system which has resulted in no more searching for charts, no more waiting in line to use a chart, no handwritten errors, and clinical decisions being made without paper data.

After searching for the right system for two years, the Thundermist Health Center located in Rhode Island, switched from a paper medical record to an EMR system. According to CEO Maria Montanaro, the system complete with structured data provides comprehensive high quality primary care. This has resulted in a seamless interface for the integration of comprehensive medical, behavioral health, dental, and pharmaceutical information.

The EMR system also used as a quality management tool helps the Center support evidence-based, population focused outcomes, primary and preventive healthcare, along with effective chronic disease management. As Montanaro explained, “Right now, many EMR systems only support what primary care doctors do now in terms of episodic care not what is needed in the future. This needs to change.”

“Today, the Geisinger Health System an integrated health services organization is improving efficiently and quality by using their EHR system to help over 142,000 people”, reports James Walker, M.D. Chief Health Information Officer at Geisinger.

By using the EHR system, Geisinger has the ability to focus on total processes that are needed to help patients by enabling the team approach to be used when treating patients. To develop the team approach, the data from the EHR system helps the staff coordinate their ideas and information, and this in turn, helps the staff put their ideas to work. As Dr, Walker said, “Getting doctors and teams on the grid and the ability to work with great speed is what improves care.”

Very importantly, the EHR system enables the medical home program at Geisingers to work and the program provides improved care coordination and quality while reducing costs. Since the program was initiated, hospital admissions have fallen by 20 percent and total medical costs have fallen by 7 percent.

The new meaningful use best-practices library referred to as the “Premier Healthcare Alliance HIT Collaborative” was formed to share knowledge and best practices around EHR system according to Blair Childs, Vice President Public Affairs at Premier, Inc. He explained that the HIT Collaborative was set up to help hospitals implement EHRs and to support meaningful use.

The Collaborative was formed with diverse health care organizations participating and today 160 not-for-profit hospitals have joined. The key lessons learned from the hospitals participating in the Premier Healthcare Alliance HIT Collaborative was highlighted in the April 2010 issue of the publication “Health Affairs”

He also discussed the need for “Accountable Care Organizations (ACO)” to exist. The goal for the ACOs is to pay providers in a way that encourages them to work together and to create organizations that are rewarded for providing high quality care. In the case of the ACOs, accountability rests with the providers and they are evaluated on the quality and efficiency of care that they provide.

Professor Latanya Sweeney, Director of the Data Privacy Lab at Carnegie Mellon University, and a member of the HIT Policy Committee, feels that HIPAA alone is not sufficient to protect patients from harm. The Data Privacy Lab at Carnegie Mellon was put in place to create technologies and related polices that are needed while protecting privacy, and at the same time, to allow society to collect and share private information for many purposes.

According to the Professor, with massive data sharing and improved patient care, tension often exists between privacy and utility. However, the reaction to this tension can sometimes harbor a false belief that one must be traded against the other.

Dr. Sweeney thinks that the current approach to NHIN design is making it unlikely Americans will have either privacy or utility. The problem is that there is a lack of architectural direction in the NHIN design and this will allow simultaneous efforts to proceed in different even opposing directions.

As a result, patient information is exposed to various risks and limits benefits. In addition, states and regional organizations are making independent isolated decisions, various competing industry efforts are underway, and national efforts recognized by ONC are inconsistent and problematical.

Eva Powell, Director, Health IT Program for the National Partnership for Women and Children stressed the need for healthcare to be a patient centered system with patient engagement that can guarantee quality and safety. Powell is very concerned about the present payment system. She wants to see payment reform and this means that reimbursement needs to be based on outcomes and quality not volume. A new payment model must be established to improve the coordination of care by using health IT.

Martin Harris, M.D. Chief Information Officer at the Cleveland Clinic pointed out that the Cleveland Clinic uses EMR technology tools in all their hospitals making it possible to concentrate on health and wellness. President Obama recently paid a visit to the Cleveland Clinic to see how the EMR system is used in all of their facilities.

However, as Dr. Harris mentioned there are challenges to face such as the need to align reimbursement so diseases can be managed better, identify the medical devices that need to be used to provide care, and at the same time, guarantee privacy to patients.

Tony Trenkle, Director, of the CMS Office of e-Health Standards and Service reiterated that we need to develop a balanced approach when advising the policy and standards committees. Also, care coordination is supported by data but in order for it to work, we have to address privacy challenges and other issues in a balanced way.

Communities need to come together to recognize the value of HIT, the value of the incentive programs, and the system needs to move towards outcomes. As he said, “This is just the beginning of the road to success and we need to look at the challenges ahead with optimism.”

Farzad Mostashari, M.D. Deputy Director of the Office of National Coordinator HIT, reports that the ONC has been working to get programs such as the Beacon Community Cooperative Agreement Program underway. The plan is to provide funding to communities to help strength their health IT programs. Awards are scheduled to be made soon to 15 qualified non-profit organizations.

ONC is working diligently to get the country involved in the definition of “meaningful use” that will be used to drive payments and establish the infrastructure needed to get physicians to adopt technology. ONC is working on cyber security issues, helping the states develop HIEs, and providing funding and assistance to help establish Regional Extension Centers. The goal is to help 95 percent of the doctors implement an EMR system in their offices.

The next program to be presented by the Institute for E-Health Policy for the Capitol Hill Steering Committee for Telehealth and Healthcare Informatics, will discuss “Policy, Technology, and Research Development in Mobile Health” from 11:30 to 1:30 on May 5th in Room 428 in the Senate Dirksen Building. For more information, email