"Why is Hawaiian care so efficient? No one really knows. "

Intriguing article by Gardiner Harris, "In Hawaii’s Health System, Lessons for Lawmakers", New York Times, (October 16, 2009) (available online here) What do you think? Remember this: Hawaii's top three medical providers are adopting electronic medical records — years ahead of most mainland counterparts.

But perhaps the most intriguing lesson from Hawaii has to do with costs. This is a state where regular milk sells for $8 a gallon, gasoline costs $3.60 a gallon and the median price of a home in 2008 was $624,000 — the second-highest in the nation. Despite this, Hawaii’s health insurance premiums are nearly tied with North Dakota for the lowest in the country, and Medicare costs per beneficiary are the nation’s lowest.

Hawaii residents live longer than people in the rest of the country, recent surveys have shown, and the state’s health care system may be one reason. In one example, Hawaii has the nation’s highest incidence of breast cancer but the lowest death rate from the disease. Why is Hawaiian care so efficient? No one really knows.

Meaningful Use definition begins to firm up

The Health IT Policy Committee gave its final recommendations on "meaningful use" to the Department of Health and Human Services' Office of the National Coordinator last Thursday. The meaningful use workgroup had tweaked its original recommendations because of the 700+ comments received.

Paul Tang of the Palo Alto Medical Foundation, chairman of the meaningful use workgroup, said the revised recommendations include a faster timeline for giving patients access to information. Access to electronic health information will be counted in 2011, he said, and real-time access within personal health records was moved to 2013 from 2015. The recommendations also went to an "adoption year" approach in which 2011 is considered the first year. An organization must meet the 2011 standards for its first year of use, the 2013 standards for its third year and so on, even if it first adopts EHRs in 2012, 2013 or 2014. However, to qualify for the full five years of incentive payments, the organization would have to adopt by 2012. Penalties begin in 2015, and Tony Trenkle of the Centers for Medicare & Medicaid Services worried that an organization adopting EHRs in 2014 would have to jump a huge bar in one year to avoid the penalties.

The committee also adopted the broad outlines of the recommendations made by the certification group, which were to focus certification on meaningful use, leverage certification to improve security, privacy and interoperability, improve objectivity and transparency of the certification process, expand certification to a range of software sources, including open source and self-developed and develop a short-term transition plan. Within those high- level recommendations, the workgroup had suggested details, which it will continue to work on. Among them were that HHS should define certification criteria, rather than certification organizations, and that multiple organizations should be authorized to certify. The workgroup recognized industry concerns about opening up the process, but determined that competition would be better and would also help alleviate any bottlenecks that might ensue, co-chairmen Marc Probst of Intermountain Healthcare and Paul Egerman told the committee. They said they intended to accept public comment.

There are many suggestions out there, as the definition solidifies over the next few weeks, I'll keep you posted.

Source: Leslie Cantu, Meaningful Use Definition for Health IT Begins to Firm Up, Washington Internet Daily, Today's News Section (July 17, 2009)

Meaningful Use Comments Set Stage for Next Health IT Policy Meeting

Health IT Policy Committee is meeting next week as they continue to discuss the definition of "meaningful use". There were over 900 comments transmitted to the Office of the National Coordinator. If you want a copy of these comments, you can physically go to the ONC starting July 13.

Some commenters have made their comments available. For example, the Computer & Communications Industry Association agreed that for meaningful use to truly be meaningful, the definition must include administration, not just actual health care. The "nightmare" of today's paper-based system of bills and claims, it said, means "that even when our citizens receive the medical care they need, they cannot understand what treatment they received, what they were billed, what was covered, and what they owe." "Meaningful use" should cover administration "down to the individual practice level," it said.

Source: Leslie Cantu, Meaningful Use Comments Set Stage for Next Health IT Policy Meeting, Washington Internet Daily, Today's News (July 7, 2009)

Public comment on the definition of "Meaningful Use"

The Office of the National Coordinator is accepting public comments until June 26 on the initial definition of "meaningful use" proposed by the HIT Policy Committee's meaningful-use work group. Remember, the definition will determine whether doctors and hospitals will be reimbursed for their use of electronic health records with regard to the stimulus package.

The goal for 2011 is to electronically capture information in coded format, report health information and use that information to track key clinical conditions. Some of the objectives are implementing drug-drug and drug-allergy checks, recording vital signs, providing patients with an electronic copy of the record, providing electronic submissions of reportable lab results to public health agencies, and complying with fair data practices, HIPAA and state laws.

Source: Agencies, Washington Internet Daily, Vol. 10 No. 116, (June 18, 2009)