HHS's Final Rule on Health Information Technology Sent to House

The House Energy and Commerce Committee has received an executive branch communication from the Department of Health and Human Services.
The assistant office manager at the HHS has transmitted, pursuant to law, [5 U.S.C. 801(a)(1)(A)], the Department's final rule - Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology.
The document (RIN: 0991-AB58) was received by the House on Jan. 15.

Source: Sarabjit Jagirdar, US Fed News

Conn. Hospital Selects eClincialWorks

eClinicalWorks, a market leader in ambulatory clinical systems, announced that Stamford Hospital, serving Connecticut’s lower Fairfield County and a major teaching affiliate of the Columbia University College of Physicians and Surgeons, has selected eClinicalWorks’s unified electronic medical records (EMR) and practice management (PM) solution for its employed and affiliated physicians. In addition to the EMR/PM system, Stamford will use eClinicalWorks’s Patient Portal, Electronic Health eXchange (eEHX), Enterprise Business Optimizer (eBO) and eClinicalMobile – all designed to extend the use of electronic health records beyond the practice’s walls to improve communication and access to real-time information.

The Doc is Logged In

The LA times just had a nice article on IT in the practice.

Wow. I've just taken care of three patients in 12 minutes, and I didn't do it by "churning" them through my office as if it's some sort of factory assembly line. Rather, those patients (their parents, more specifically -- I'm a pediatrician), e-mailed me over a secure network with questions and descriptions of signs and symptoms.

One mother attached a digital photo of a rash on her 3-month-old daughter's face; it turned out be nothing more serious than baby acne (it'll go away in a month or so). Another mom had noticed that her son was missing one of his pre-kindergarten immunizations (she had pulled up his shot records online) and requested that I order it. And the father of a 5-month-old boy told me that his son has been constipated off and on for the last month. I e-mailed him a questionnaire so I could determine whether the family should try something at home or bring the child to the office.

The articles goes on to list some advantages and disadvantages of healthcare IT. Read the article here .

Source: Rahul Parikh, In Practice; The doctor is in and logged on; Let's not pass notes or play phone tag anymore: E-mail and e-records do it better., Los Angeles Times, Health Section, Features Desk, Part E, pg. 1 (July 20, 2009)

Arizona State offers degree in Biomedical Informatics

Arizona State University will offer the first undergraduate degree program in biomedical informatics, beginning in the 2009 fall semester. Biomedical informatics involves the integration of computer and information sciences with basic biological and medical research, clinical practice, medical imaging and public health disciplines. The American Medical Informatics Association foresees 10,000 new jobs being created in the field by 2010. Phoenix employers, including Banner Health, United Health Care and Mayo Clinic, predict a local need for at least 200 new employees in the field within 5 years.

An undergraduate degree in biomedical informatics is also a viable choice for a pre-med program because it provides students with a solid background in life sciences as well as information technology that plays an increasing important role in medical care, said Robert Greenes, chair of the Department of Biomedical Informatics.  For more information about the degree program, see the web site http://bmi.asu.edu/undergraduate/index.php

Washington Hearing on Health IT: Short Synopsis

I read a recent article in the Washington Internet Daily that provided a synopsis of a House Small Business subcommittee on regulations and health care. Witnesses asserted that the Recovery Act's provisions for adopting health IT isn't necessarily a good fit for small practices and specialists. While we disagree, I understand what the witnesses are trying to say. They are asserting that small practices and specialists need something more, but what? The witnesses (people who I don't know, or else I wouldn't keep referring to them as witnesses) urged a broad definition of meaningful use that would essential cover many providers as possible.

David Blumenthal, national health IT coordinator at the Health and Human Services Department, said his office understands "that small practices carry an extra burden." He also said HHS doesn't intend to compel other types of health care providers to adopt health IT. It isn't compelling doctors and hospitals to use health IT, just offering incentives and penalties through Medicare and Medicaid reimbursements.

But that system worries Chairwoman Kathy Dahlkemper, D- Pa. She said she fears doctors will look at the potential penalties on top of already small Medicare and Medicaid reimbursements and decide to turn away from those patients altogether. The $44.7 billion in incentive payments -- up from an original estimate of $20 billion -- should ease the way for those providers to purchase health IT systems, Blumenthal said. The regional extension centers will provide hands-on technical help in implementing the systems, he said. "It's certainly our hope those penalties will never go into effect."

To help small practices meet the start-up costs of adopting health IT, Dahlkemper introduced legislation Wednesday creating a loan program at the Small Business Administration. The SBA would back private loans of up to $350,000 for a single provider and $2 million for a group. The bill authorizes $10 billion for the program.

The committee highlighted many important points, for example, pediatrician's low adoption of EMR, 50+ definitions of "meaningful use" (state-specific), and interoperability. The article does a good job at summarizing the hearing.

Source: Leslie Cantu, Health IT Provisions Don't Address All Situations, Hearing Told, Washington Internet Daily Vol. 10 No. 121 (June 24, 2009)

Why should your IT company know about Security?

Why should your IT company know about Security? Because lawmakers (politicians, judges, etc.) are soon going to require some pretty strict rules about EMR and IT in the clinic.

The stimulus bill included $20 billion to promote adoption of EMR. Adopting EMR promises increased efficiency, lower costs and a reduction of preventable errors. This summer, the Secretary of Health and Human Services will define standards for EMR. Among these standards, I'm pretty sure we're going to see some strong authentication and encryption requirements. (We've been doing this for years, so we're prepared!) The question is, will tougher privacy and security records stunt the efficiency and adoption of EMR?

According to new research co-authored by Amalia Miller, University of Virginia economics assistant professor, Yes.

Ratcheting up the privacy and security of medical records means slower adoption of electronic medical records. "Reducing adoption by more than 24 percent - that's a pretty big effect," Miller said. "It's important to know those costs and have that be part of the policy decision-making process. To decide how much privacy is optimal, we need to quantify the costs and benefits, and those haven't been well quantified.

I personally think its wonderful to have more stringent requirements when it comes to privacy. However, Professor Miller is absolutely correct, we must quantify the costs and benefits of any new requirements.

The issue is, what's more important, speeding up EMR adoption or protecting the actual records? Slowing EMR has substantial costs to our healthcare institution. "How long can we wait?" is the question everyone is probably asking. We have just as much of a public policy concern with slow EMR adoption (since our healthcare insurance costs are so high) as we have with protecting those EMR records.

As long as policy makers are being reasonable in their policy making, I don't see why anyone would really complain about stringent requirements! Why? Because if the requirement is practical, competent IT companies will be able to implement the proper solution. In fact, I highly believe IT companies should ALREADY be taking safety precautions when designing an IT infrastructure. I'm waiting for the first string of these requirements to come forth. I'll keep you posted.

(I won't brag about our credentials in this blog post... maybe next time!)