Budget Discussed on the Hill

Key hill staffers, a leading HIT administration official, and the Vice President for eHI, spoke to a packed room at the Capitol Hill Steering Committee on Telehealth and Healthcare Informatics lunch session on February 6th. The speakers focused on the President’s FY 2009 HIT-related budget and future legislative possibilities.

According to P. Jon White, MD, Health IT Director, the health IT budget at AHRQ for FY 2009 is $44.8 million the same as FY 2008 with $7.5 million in grants. Dr. White explained that AHRQ’s four broad goals are to improve medical management, provide engineered clinical knowledge, deliver patient-centered care, and enable quality measurements.

Some of these goals are accomplished through grants and contracts. For example, the National Resource Centers for Health IT are helping the healthcare community deal with the information age. The Centers provide direct technical assistance and consulting services to AHRQ projects.

AHRQ awarded 5 contracts in 6 states to support State and Regional Demonstration projects. These projects are in place to support statewide data sharing and interoperability activities on a state or regional level.

AHRQ’s report to Congress included information on a joint CMS and AHRQ electronic pilot program to support the adoption of new electronic prescribing standards. The pilot was conducted in 5 sites in 8 states to test initial standards to see if the standards were ready to be adopted. As reported to Congress, the pilot program showed that the initial standards were already capable of supporting e-prescribing.

Christine Bechtel, Vice President of Public Policy, eHealth Initiative presented an overview of the FY 2009 Budget request. The request for $66 million for the Office of the National Coordinator for Health IT is an increase of $5 million over FY 2008 but still significantly less than last year’s administration request for $114 million. Overall, the HHS budget would decrease by 2.1% under the President’s budget proposal.

The proposed ONC budget would establish a successor to AHIC, develop standards and implementation for health IT through HITSP, make efforts to ensure appropriate Federal privacy and security protections for electronic health information, support state consensus efforts to address patient protections, develop the NHIN at $26 million, and certify Health IT products through CCHIT.

On the Senate side, Dana Halverson, Health Legislative Assistant for Senator Kent Conrad (D-ND) Chairman of the Senate Budget Committee, started by telling the attendees that the Senator wants to thank Neal Neuberger for the time and effort he has spent over the past 16 years to coordinate and develop the sessions and technology demonstrations for the Steering Committee.

Looking ahead, she said, although the legislation “Wired for Health Care Quality Act” to establish an interoperable health IT system did not pass in 2007, the goal in 2008 is to bring the legislation up again and to deal with the privacy issues.

Katie Oppenheim, Health Legislative Assistant for Senator Mike Crapo (R-ID,) said the Senator is very involved in telehealth and wants to see the program Telehealth Idaho broaden and expand resources to keep helping the people in the rural areas in the state to improve their access to healthcare.

Jordanna Levinson, Health Legislative Assistant for Senator Sheldon Whitehouse (D-RI), reported that DEA has made progress on regulations lifting the federal prohibition against electronic prescriptions for certain medications classified as scheduled drugs.

According information released by her office, the Senator is happy to see DEA acknowledge the need to move forward with new rules and is going to watch the situation closely over the next several months to make sure that this process stays on track. However, the officials at DEA report that they can’t predict how long the approval process will take since both OMB and the Department of Justice are required to review the proposed rule.

She also mentioned that the Senator is very actively involved in other HIT issues. Three bills (S 1451, S 1455, and S 1471) were introduced last year. The Senator wants to see the establishment of a public corporation to advance HIT that would spin off into the private sector, a bill to fund quality grants, and another bill to deal with reimbursement reform.

On February 7th, Senator Whitehouse (D-RI) spoke on the Senate floor concerning HIT issues and reported that the RAND Corporation estimates that a national interoperable HIT system could save $81 billion per year. He believes that we must not only develop a national interoperable secure HIT infrastructure, but we must also invest properly in quality and prevention, and at the same time, address how we will pay for this system.

He emphasized that health IT adoption alone will not stop our huge healthcare costs but we have to do something because more American families are bankrupted by healthcare, doctors are furious, and the paperwork is choking the system.

The Rhode Island Quality Institute has made a great effort to reduce the number of hospital-acquired infections. Similar efforts are ongoing in Washington State and in Utah. The Senator said “we need to get behind all of these state and local efforts.”

The Senator explained that when his state started the ICU reform, he talked to the Hospital Association. They estimated a $400,000 cost per intensive care unit but as much as $8 million could result in savings, a 20 to 1 payback. The Senator said the problem is that all the savings go to the insurers, so as a result, reform is very much an uphill battle.

On the House side, Mike Quear, Staff Director, House Science and Technology Subcommittee on Technology and Innovation, was very pleased to see the science workforce bill (HR 1467) pass the house but wants to see the bill move through the Senate. He said several changes have to be made to get healthcare professionals to embrace health IT. One of the barriers is the lack of trained workers in the field, and secondly, software developers work alone and don’t always design the appropriate needed healthcare systems. Quear emphasized that Congressman David Wu wants to see practitioners not only trained to use technology but also to develop products that fit the needs.

In another legislative effort, Chairman Bart Gordon (D-TN) of the House Science and Technology Committee introduced (HR 2406) on October 2007 to authorize NIST to increase efforts to support the integration of the healthcare information enterprise. Quear said, “NIST would still support AHIC and not circumvent AHIC 2.0.” Efforts are also underway to work on additional targeted bills to deal with privacy and the payment system.

Nandan Kenkeremath, Professional Staff, House Energy and Commerce Committee, raised some concerns as to how providers and patients should deal with specific information in electronic medical records. One of the questions is how will providers deal with genetic information in their actual practices? Will providers need prior patient consent in order to use genetic information in every case? Using genetic information is a very complicated issue. One of the solutions is to separate out specific medical information, but if the information is separated out and moved around in electronic records, then more medical errors may result.

Information in records that can help researchers also presents problems to providers. Medical researchers sometimes find that non-identifiable information can be vital for their use in their studies. However, is it always necessary to get a release for non-identifiable data? If the consent is needed, how do we inform patients on the need for the research so that they will give their consent?

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).

The next session at noon on Wednesday March 5th, will discuss “HIT Projects to Improve Access for Low Income Persons and the Uninsured: Safety Net Providers Step up to the Plate”. The briefing will take place in the Senate Russell Building, Room 385. For more information, contact Neal Neuberger, President, Health Tech Strategies LLC, at (703) 790-4933 or email nealn@hlthtech.com.

VA FY 2009 Budget Request

The Secretary of Veterans Affairs, Dr. James B. Peake, reported that the President is seeking $93.7 billion in FY 2009 for the Department. The budget requests $2.4 billion for the Department’s IT program. This is $389 million (19% above the 2008 budget) and reflects the realignment of all IT operations under the control of the Chief Information Officer. The VA will expand the telehealth program to improve access to healthcare for veterans living in rural and remote areas. In 2009, the Department expects to treat 5.8 million patients which is an increase of 1.6% over 2008.

Highlights for the FY 2009 budget request include:

• $26,260 billion for acute care which includes inpatient acute hospital care, ambulatory care, and pharmacy services. The VA is expecting to fill 126 million prescriptions in 2009
• $3,861 billion for mental health to support inpatient and outpatient mental health programs
• $1,455 billion for the purchase and repair of prosthetics and sensory aids
• $4,820 billion for long term care to provide care in the least restrictive and clinically appropriate setting and to provide veterans with care closer to where they live. The VA is requesting $762 million or a 27.6% increase in non-institutional care
• $1 million for the Office of Rural Health to do studies on the current status of VA rural health programs and to develop policies and programs to meet the needs of rural health veterans
• $93 million to support the cyber security program to enhance data security
• $284 million to develop and implement the Veterans Health Information systems and Technology Architecture. This includes a health data repository, a patient scheduling system, and a reengineered pharmacy application. These applications are directly tied to programs which are intended to enhance or replace existing programs

HIT Planning Grants Available

HRSA, Office of Health Information Technology announced on February 06, 2008, that FY 2008 Health Center Controlled Networks funds are available. This funding will help the networks of health centers do planning activities to lead to HIT adoption. The estimated funding is expected to be $600,000 for 4 awards. The average size of each award is not to exceed more than $125,000. The grant application deadline is April 15, 2008. Public and non-profit organizations including faith-based and community-based organizations are eligible to apply.

Planning activities for EHR adoption can include:

· Conducting HIT readiness assessments
· Doing workflow analyses
· Using due diligence to select a vendor
· Doing business planning and market place assessments
· Determining specific network HIT functions
· Doing system upgrades to be able to join a network or to launch a HIT initiative
· Developing telehealth services
· Doing the initial stage of collaboration with partners

Some possible HRSA funding can include:

• If a network of health centers are ready to purchase an EHR system, but needs funds to help do an EHR readiness assessment and help with the procurement process, then funds may be available
• If funding is needed o upgrade systems to be able to join an existing network
• If an existing network of health centers wants to from a HIE with other state partners and needs funding to do a market assessment, establish a MOA with potential partners, or engage in marketplace and business planning, then funds might be available
• If an established network of health centers wants to develop clinical telehealth services to expand access to, coordinate, and improve the quality of healthcare services in the network

A pre application conference call will be held on March 12, 2008 at 2 pm. The call in number is 800-857-6258, and the pass code is 2058611. The replay number is 800-327-0221. For more information, go to www.grants.gov or contact Judy Oliver 301-594-4465, or email joliver@hrsa.gov.

FY 2009 Budget Request for HHS

On February 4th, Secretary Michael Leavitt detailed the President’s FY 2009 HHS budget request. The HHS FY 2009 budget request outlays $737 billion which is a net increase of $29 billion over the estimated outlays for FY 2008.

Key budget highlights are:

• $66 million for the Office of the National Coordinator for Health Information Technology, an increase of $6 million over FY 2008. The funding establishes the AHIC as an independent and sustainable public-private partnership, supports the development of health data standards, finds solutions for privacy and security in electronic health information exchange, and supports the testing of standards and services to exchange health information across geographic borders
• $40 million for the Office of Civil Rights an increase of $6 million over FY 2008. The budget includes an additional $2 million to improve critical HIPAA compliance and enforcement operations. OCR provides policy support to HHS and is an active participant in the development of standards for a national health information infrastructure. OCR is improving patient safety by establishing and enforcing confidentiality protections under the PSQI Act of 2005
• $29.5 billion for NIH. This is the same as FY 2008. These funds will enable NIH to continue to pursue cross-cutting research and continue to refocus programs for translating clinical research results into clinical practice. In FY 2009, NIH estimates it will support a total of 38,257 research project grants, including 9,757 new and competing awards which are approximately at the same level as FY 2008
• $5.9 billion for HRSA, a decrease of $992 million below the FY 2008 request. The HRSA budget request emphasizes direct medical care and expansion of the Health Centers program. In addition, HRSA will focus on placing health professionals in medically underserved areas. The budget request for HRSA reduces funding for rural programs by $87 million from FY 2008. A PART assessment found that there are programs similar to other HHS programs that provide resources to rural areas. The request for telehealth is $7 million
• $336 million for AHRQ a $9 million decrease from FY 2008. Funding is maintained for comparative effectiveness research, development of new research tools, and to provide transparency on healthcare quality and costs. The budget also supports patient safety by investing in health IT and includes $32 million to support a variety of patient safety activities such as developing a network of patient safety databases.
• $711.2 billion for CMS in mandatory and discretionary outlays, a net increase of $32.7 billion over the FY 2008 level. $3.8 million is included in the budget request to help to further adopt health IT by continuing a demonstration project. The demonstration project provides financial incentives for up to 1,200 physician practices to adopt certified EHR systems. Starting August 1, 2008, approximately $1.1 billion will be provided to Quality Improvement Organizations to start the next three year contract cycle. In the 9th SOW, clinical care efforts will focus on four major themes to include prevention, patient pathways, patient safety, and quality of care complaints.
• $8.8 billion for CDC and the Agency for Toxic Substances and Disease Registry, a decrease of $412 million from FY 2008. The request includes $50 million which is an increase of $16 million for BioSense the human health surveillance system. The funding would help CDC implement connections with emerging Regional Health Information Organization and Health Information Exchanges to implement case-based surveillance. The budget also includes $7 million for continued real-time lab reporting. The CDC budget for Health Information and Services includes $284 million for health statistics, health marketing, and public health informatics. The informatics program requests $71 million which is the same as FY 2008 to continue defining the needs for public health information systems, and to design information systems and software to expand the capabilities of public health
• $2.4 billion for FDA, a net increase of $130 million over FY 2008 with $291 million in the budget to ensure the safety of medical devices. This is an increase of $7 million over FY 2008
• $4.3 billion for the IHS. The budget request includes $58 million for Public Health Nursing to provide for health screenings, home visits, chronic disease care and case management. The budget targets funding for healthcare for Indian people living in isolated areas on or near reservations that do not have ready access to services outside the IHS system. The budget does not include funds for the Urban Indian Health Program
  

The Health Information Initiative promotes Federal efforts to implement health IT systems and products to meet recognized interoperability standards and to increase the transparency of healthcare costs and quality. HHS achieved a Green progress rating for the Initiative in FY 2007. This rating recognizes accomplishments such as developing recommendations for Federal agency health IT capital investment activities, and for providing draft contracting language requiring that as health IT systems are acquired, implemented, or upgraded, standards recognized by the Secretary be implemented.

Rural Health Research Studies Funding

HRSA announced funding for the “Targeted Rural Health Research Grant Program”. The funding will be used to support rural health research studies on a selected number of topics. Grant recipients will conduct policy-relevant research on rural health services as they relate to rural health clinics, public health workforce, oral health, and HIT implementation. HRSA will provide funding during FY 2008 for approximately $750,000 to fund up to 5 new awards. The maximum amount per award is $150,000, and the funding will be for an 18 month project and budget period.

Eligibility is open to any public, private, and non-profit organization. ORHP also funds a 5 year Rural Health Research Center Cooperative (RHRC) agreement which will be competitive again in FY 2008. While the applicant pools for RHRC and the Targeted Rural Health Research Grant program generally do not overlap, applicants may apply for both programs.

The rural health research areas to be funded include:

• Rural Health Clinics in terms of finance, utilization, and service mix
• Frontier Health Services Delivery
• Emergency Medical Services
• Rural Health Leadership
• Allied Health Workforce
• Public Health in terms of finance, HIT, and coordination

The application for the grant program became available on February 1, 2008 with the grant application due April 02, 2008. The projected award date is September 1, 2008 with the project end date to be August 31, 2010.

For more information, go to www.grants.gov or contact Erica C. Molliver at emolliver@hrsa.gov.

NRHA's Health Policy Institute

The attendees at the NRHA 19th Annual Rural Health Policy Institute 2008 held on January 28th and 29th came to Washington D.C. to learn about Federal agency initiatives and to meet with Senators and Representatives to discuss critical health needs in rural areas. According to Tim Fry, Government Affairs Manager, National Rural Health Association, healthcare issues are not at the top of the agenda due to all of the other issues our country faces such as the war, energy policies, and the economy.

Marcia Brand PhD, Associate Administrator, Bureau of Health Professions, announced that Tom Morris is now the Acting Director for the Office of Rural Health Policy. She recounted how ORHP worked on several programs with several agencies. For example, the ORHP staff discussed interpretive guidelines with CMS, communicated with SAMHSA on mental health research, collaborated on a special project with the HIV/AIDS Bureau to coordinate care, and worked with the VA to help rural veterans. In addition, the staff at ORHP worked on quality issues and opportunities, focused on HIT models, highlighted workforce needs, and expanded research on rural pharmacy issues.

Dr. Brand mentioned several meetings that will take place in the next few months. The National Advisory Committee on Rural Health and Health Services will meet February 20-22, 2008 in Washington D.C. to discuss new programs. The Bureau of Health Professions will hold a meeting February 25-27, 2008 to bring grantees together to discuss national health professions education and workforce needs, plus an All Advisory Committee meeting will be held in May.

The major NRHA 2008 Policy Institute goals are to have Medicare provide key rural provisions, achieve proportional representation on MedPAC, protect the physician fee schedule from devastating cuts, provide adequate funding for the rural health safety net, and provide the means to train future rural health professionals.

NRHA Policy Institute presented their 2008 legislative and regulatory agenda at the meeting so that Congress, Federal regulatory agencies, the White House, States, and the healthcare industry will be able to address the issues.

The NRHA legislative and regulatory agenda includes areas related to telemedicine and telehealth include:

• Reimbursement for telehealth should be made based upon medical effectiveness and utilization and not upon particular delivery programs or locations. The NRHA supports Medicare reimbursement for telehealth consults using store-and-forward technology


• Medicare should reimburse telehealth when it is provided by licensed or credentialed provider otherwise eligible for Medicare reimbursement


• Telemedicine payments should provide for delivered services including a technical fee to help facilities cover costs associated with the technology used


• Regional and National Telehealth Resources funded by the Office for the Advancement of Telehealth should be supported and expanded


• Federal and state funding needs to address strengthening and integrating emergency medical services with rural healthcare services and providers. Federal funding needs to support innovative demonstrations, improved training, research activities, telehealth, address preventive health, and provide personnel recruitment for rural and frontier areas


• NRHA supports expanding the Universal Service Program to more appropriately fund telehealth


• The NRHA supports the VA’s efforts to increase care for rural veterans through telehealth systems especially for sub-specialty care as in the case of mental health services. NRHA supports full funding for the Office of Rural Health in the VA

NRHA supports other technology issues related to rural health:

• Federal agencies should support providers, state EMS, and state offices of rural health through policy development, data systems, appropriate curricula, and access to grans


• Congress should require vendors of information systems used in rural communities to incorporate national standards for HIT into their systems


• Federal and state government should provide for the infrastructure and policy framework needed to allow for regional networks


• Liberalization of the Stark Laws should be considered to allow rural hospitals to serve as the hub for a rural network


• Existing and new funding mechanisms need to be put into place. Funding should be provided to support the expansion, upgrading and/or renovation of rural health facilities, including HIT and ambulance services


• A strong public health infrastructure should be developed with access to advanced communications systems and technologies to serve rural communities in the event of a bioterrorism event, for disease surveillance, and to better manage public health emergencies.


• NRHA wants to see proportional rural representation on all federal healthcare related commissions, task forces, and advisory groups


• Funding needs to be provided to support demonstrations, and to perform comprehensive evaluations of state efforts to expand access to oral health services to rural and frontier populations
  
  For more information, go to http://www.nrharural.org/ or email Tim Fry at fry@nrharural.org.

SBIR PHS 2008 Solicitation Available

The PHS 2008-2 Omnibus Solicitation for SBIR/STTR grant applications for NIH, CDC, and FDA recently opened. NIH is interested in numerous topics addressing new technologies. In general, there is interest for small research companies to develop software and hardware, biosensors, monitoring systems to be used at the point-of-care, telehealth and ehealth technologies, medical devices, to do research in biomedical informatics, new tools to analyze clinical trial results and transmit the data, new imaging capabilities, virtual reality applications, assistive technologies to use for the disabled, effective databases to collect extensive medical information, plus develop other technologies for other applications.

These SBIR/STTR topics focus on telehealth, ehealth, health IT and other closely related technologies:

• The National Institute of Biomedical Imaging and Bioengineering seeks telehealth software and hardware to use in situations with broad applications as well as in specific focus areas


• The National Institute on Drug Abuse wants to see the development of ehealth software and hardware to promote the efficacy and safety of clinical trials being done to study substance abuse. NIDA wants to see ways that telemedicine can be used to disseminate drug addiction research findings to primary healthcare providers. NIDA is also interested in the development of an electronic drug abuse treatment referral system


• The National Institute of Nursing Research seeks telehealth technologies to improve patient outcomes. NINR wants to be able to assess traumatic injury severity at remote sites and transmit this information to acute care settings, be able to communicate vital signs and symptoms for home-based clients to healthcare providers in distant locations, and be able to tailor care for diverse patients in a wide variety of settings. The NINR is seeking biological and behavioral monitoring devices for patients at-risk living in underserved populations in rural and frontier areas


• The National Institute of Mental Health seeks technology to enable neuroscientists to electronically interact with colleagues and provide data at a distance. NIMH is also interested in developing capabilities to monitor and analyze the behavior of children using video or telemetry systems


• The National Cancer Institute is looking for ways to better use telemedicine and remote imaging for early cancer detection, screening, and diagnosis in underserved communities. NCI’s Center to Reduce Cancer Disparities is looking for communication technologies to help professionals deal with health literacy


• The National Heart, Lung, and Blood Institute is interested in health IT to be able to adopt and implement asthma clinical practice guidelines. NHLBI wants to see research done to better develop information systems to coordinate patient management, use point-of-care devices to monitor patients, plus help patients adhere to medical regimens

Go to http://grants.nih.gov/grants/funding/sbirsttr1/2008-2_SBIR-STTR-topics.doc for complete information on all of the topics. The closing dates for 2008 submissions are April 5, August 5, and December 5. For more information on the program, go to http://grants.nih.gov/grants/funding/sbir.htm (NIH Office of Extramural Research).