“In America, innovation doesn’t just change our lives, it’s how we make a living,” he said. “Our free enterprise system is what drives innovation. But because it’s not always profitable for companies to invest in basic research, throughout history our government has provided cutting-edge scientists and inventors with the support that they need. That’s what planted the seeds for the Internet. That’s what helped make possible things like computer chips and GPS.”

In 2009, Obama signed the American Recovery and Reinvestment Act into law, supporting healthcare IT innovators for developing and healthcare providers for adopting healthcare IT. Many observers have said without this support, the healthcare industry would not make it over the tipping point to health information exchange.

[Read more about ARRA funding for healthcare IT.]

The Obama Administration has faced a steep uphill battle with Republicans over the federal deficit, and he took the issue head on in his speech, siding with Republicans in the need for fiscal responsibility. As in the past, he nodded toward keeping programs that could help to lower costs in the future. For healthcare, this means the advancement of healthcare IT to lower costs and increase quality of care. It also means retaining grant programs such as the Beacon Communities, state HIE exchanges and accountable care organization pilots – all funded as part of the Accountable Care Act.

“I recognize that some in this Chamber have already proposed deeper cuts, and I’m willing to eliminate whatever we can honestly afford to do without,” he said. “But let’s make sure that we’re not doing it on the backs of our most vulnerable citizens. And let’s make sure what we’re cutting is really excess weight. Cutting the deficit by gutting our investments in innovation and education is like lightening an overloaded airplane by removing its engine. It may feel like you’re flying high at first, but it won’t take long before you’ll feel the impact.

Obama called for the expansion of America’s infrastructure, including high-speed wireless connection in rural areas. “Within the next five years, we will make it possible for business to deploy the next generation of high-speed wireless coverage to 98 percent of all Americans,” he said. “This isn’t just about a faster internet and fewer dropped calls. It’s about connecting every part of America to the digital age. More broadband access means patients will be able to have face-to-face video chats with their doctors.”

[See more ways the digital age has improved patient care.]

Obama said America has made great strides over the last two years in using technology and getting rid of waste. “Veterans can now download their electronic medical records with a click of the mouse,” he added.

Justin Barnes, chairman emeritus of the Healthcare Information and Management Systems Society’s EHR Association and vice president of government affairs at Greenway Medical, has been closely tied with advising the White House and Congress on healthcare IT since 2003.

“This is the eighth year in a row that healthcare IT has been a part or prominent part of the president’s State of the Union Address,” Barnes noted following the speech. “While the debate will certainly continue on exactly how we go about creating and implementing policy, it was very encouraging to hear the increased vigor supporting additional investments in innovation around biomedical research and information technology.”

Despite a rousing speech, the proof will be in the policies, Barnes said. “That is certainly what keeps many of us engaged to collaborate and help educate while watching out for how these policies can effect care providers, patients, hospitals and all of us as taxpayers. I believe we all have the common goal though to create a smarter, more sustainable healthcare system in America.”

HealthcareITNews
January 26, 2011

A patient shows up at the emergency room unconscious and unable to give a history. Another patient arrives at his primary care physician’s office 3 days after an emergency room visit, and the primary doctor has received no information. A specialist sees a third patient for a consultation and receives none of the critical records needed to help her make the consultation efficient and effective. These scenarios and many others like them, unfortunately, are all too commonplace. The consequences of incomplete information at the point-of-care can be inconvenience, inefficiency, increased costs, and adverse, even life-threatening outcomes for patients.

The major reasons for lack of sharing health information include the fragmented nature of the United States healthcare system and the fee-for-service business model, a model that does not include financial support for health information exchange. Further, most health information technology (HIT) programs are not interoperable, that is, they do not speak to each other.

Health information exchange (HIE), in its current definition, is the electronic sharing of health-related information between disparate partners, based on nationally recognized standards for interoperability, privacy, and security. Without sharing, silos of information persist, physicians function with incomplete information, and tests are unnecessarily  repeated. Information-sharing is particularly important for care coordination of care for older with complicated conditions; chronic disease management; natural disaster and biosurveillance response; and care for a mobile military, veteran, and civilian patient population.

Recognizing these obstacles to sharing, the federal government has taken an active role in promoting HIE as a key component of healthcare reform. In this article, we will describe the
current landscape of HIE in the United States, how different parties are trying to expand it, current obstacles to the expansion, and the future possibilities.

THE HITECH ACT AND HIE
In 2004, President Bush set the goal of an interoperable electronic health record (EHR) system for all Americans by 2014 and established the office of the national coordinator for HIT (ONC). Initial progress towards the goal was slow until the passage of the American Recovery and Reinvestment Act (ARRA) of 2009, which included the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act funded multiple federal programs to promote the adoption of HIT, particularly EHR systems and HIE at the local, state, and national level.

The basic building block for this national strategy is the EHR, which inputs, processes, and stores digital health information for hospitals and outpatient practices. Health information organizations (HIOs) are the organizations that provide the governance,technology infrastructure, and security to exchange health information. A regional health information organization (RHIO) is simply an HIO that covers a defined geographic area, such as a city, region, state or multi-state area. HIOs have the ability to collect and aggregate health data from multiple organizations and electronically share information with EHRs.

The HITECH Act included a Medicare and Medicaid reimbursement program for eligible professionals who use certified EHRs and demonstrate “meaningful use.” Stage 1 meaningful use included the general objectives of e-prescribing, structured data collection, quality reporting, clinical decision support, patient engagement, security assurance, and HIE. HIE is necessary to provide a hospital discharge summary, electronically exchange key clinical information among providers, report quality measures to Medicare/Medicaid or states, perform medication reconciliation, transmit electronic immunization data to immunization registries, and submit electronic syndromic surveillance data to public health agencies.

Currently, most HIE occurs as part of an existing HIO. HITECH funded a new option for statewide and interstate exchange known as the State Health Information Exchange Cooperative Agreement Program, discussed in a later section.

CONNECTING PRACTICES, HOSPITALS, AND CITIES
Approximately 234 HIOs exist in varying operational stages, according to a 2010 study by eHealth Initiative, a not-for-profit organization that has conducted annual HIO surveys since 2005. Seventy-three HIOs claimed to be operational (exchanging some type of health data), and 18 claimed to be sustainable (no federal funding in the past year, operational status, and receiving revenue equal to or exceeding costs). More than half of the HIOs offered the following core services: clinical messaging (electronic test delivery of lab and radiology results, medication data, outpatient visits, and emergency room visits), EHR connectivity, clinical documentation, and alerts to physicians. Fewer than half of the HIOs survey offered the following newer advanced services: e-prescribing, Web-based EHR-HIE combination, public health reporting, telemedicine, medication reconciliation, emergency room use data, transcription, voice recognition, business analytics/intelligence, value-based reimbursement (pay for performance), credentialing, research, clinical decision support, consumer portal, claims clearing house, care coordination, and picture archiving and communication systems.

HIOs such as HealthBridge, located in Cincinnati, Ohio, and Indiana Health Information Exchange,located in Indianapolis, Indiana, are performing well financially and have the support of the medical community. On the other hand, failures such as the Santa Barbara County Care Data Exchange have dissolved primarily due to lack of perceived value by the healthcare community.

In 2010, the State HIE Cooperative Agreement Program funded (via $548 million) 56 states, eligible territories, and qualified state designated entities. The overall goal was to promote standards based statewide and interstate information sharing to meet meaningful use, particularly where none exists currently. Statewide HIE will need to be interoperable with existing HIOs, significant data providers and users (such as Medicaid), and the Nationwide Health Information Network (NHIN).

The NHIN is a collection of standards, protocols, and services that enables the secure exchange of health information over the Internet. Instead of being a specific network, it is actually a “network of networks” connecting disparate healthcare organizations, to include HIOs, federal agencies, and integrated networks. The NHIN primarily will provide a means for large civilian and federal health organizations, to include HIOs, to share information securely. As an example, MedVirginia is sharing information with the Social Security Administration via the NHIN to expedite disability determinations.

WHERE’S THE MONEY?

HIE participation for any given healthcare provider is fundamentally a business decision. The expected net benefit to the provider must be positive so that expected benefits exceed expected costs. These benefits can be monetary in nature, accruing through efficiencies in running a practice or a clinic, or through better use of a reimbursement mechanism. They also can be non-monetary, yielding superior health outcomes through better case management while not affecting the bottom line for the business.

Potential models include monthly or annual pricing on a per physician basis (subscription model), pricing on a per-transaction basis, or some combination of the above (for instance, a monthly fee plus per-record usage cost). Approximately half of the operational HIOs charge physicians a user fee as well as an additional fee to create an electronic interface between an EHR and the HIO. Participants must be willing to collaborate, rather than compete, in data exchange and must be willing to pay operating costs. Organizations must have enough participants to create a “network effect” (enough customers to make it worthwhile) and create subsequent economies of scale to be successful.

One of the more immediate benefits for physicians to participate in information exchange would be to comply with meaningful use objectives as part of the Medicare and Medicaid EHR reimbursement program. Very few HIOs can meet all pertinent meaningful use objectives at this time, however.

Participation in successful HIOs likely will mean access to an increasing number of administrative and clinical tools such as business analytics, telemedicine, clinical decision support, centralized credentialing, research opportunities, and a variety of reports.

According to the latest eHealth Initiative survey, many HIOs report reduced staff time spent handling or filing lab and radiology results and handling prescription issues. Another potential benefit would be creating one EHR-HIO interface to receive results, as opposed to multiple EHR interfaces to outside labs,hospitals, and imaging centers.

NUMEROUS TECHNICAL AND FINANCIAL OBSTACLES
Physicians may object to any change in workflow, user fees, and EHR interface charges to participate in HIE. They may believe that the benefits accrue more to others, such as payers and state and federal governments.

The most commonly reported obstacle for HIE is a long-term sustainable business plan that does not depend on federal funding. HIOs must have the trust of multiple partners that traditionally have been competitors in the market place. HIOs must provide services that have perceived value to a wide audience, such as clinicians, hospital executives, and practice managers. The lack of widely proven return on investment may cause some clinicians to choose faxes and mail over electronic sharing.

HIE also is impeded by a lack of a universal patient identifier that would greatly improve retrieval of the correct patient record. Another administrative obstacle for all HIT initiatives is privacy and security. HIOs will store voluminous data for thousands of patients that can be breached without adequate protection. Further, depending on the state, patients will need to sign an opt-in or opt-out agreement to allow record sharing. HIE participation could raise new legal issues regarding responsibility for reviewing all pertinent information on a patient.

For electronic record-sharing to take place, data standards need to be developed and adopted. The current document standard is known as a continuity of care record or continuity of care document. Both are XML-derived patient summaries that are similar to a problem summary list but are in a format that can be both generated and read by most EHR systems.

ALTERNATIVES ARISE
Although the government approach currently favors HIOs and statewide health exchanges, other models have been proposed. Some favor an approach called health record banking. This approach is consumercentric and particularly appeals to privacy advocates. Each consumer (patient) would directly control who can access his or her account. Patients would authorize their providers to “deposit” and “withdraw” information from their secure online personal health information. It has even been suggested that the consumer would bear the cost of a nominal subscription fee. To date, however, patients have shown little inclination to adopt electronic personal health records, even though several systems are now available for free from organizations such as Google and Microsoft as well as health insurers.

Another proposed option is to use a nationwide electronic messaging system that already exists, such as Surescripts. Surescripts is the primary messaging system between physicians and pharmacies used in this country for the transmission of electronic prescriptions. Surescripts proposes becoming a health information service provider that offers the ability to exchange clinical messages and patient encounters over a standards-based network between providers. The company plans to offer this service in 2011 and support it by a subscription fee.

Additionally, the government recently has proposed a simpler alternative to HIOs called the DIRECT Project. In this option, which could be available as early as 2011, physicians will be able to push encrypted clinical messages between healthcare partners. Pilot tests will be under way in early 2011, and further details are forthcoming.

THE FUTURE OF HIE

Some see the role of the HIO as an “infomediary” or information-hosting organization that reuses data for more than clinical medicine, such as public health and research purposes. Several HIE vendors are planning to add Web-based EHRs, practice management systems, and business analytics to allow for fully integrated clinical and financial functions. A few HIOs are offering services such as transcription, credentialing, reporting (public health, quality and pay for performance), and patient access to health data through a portal and personal health records. In spite of approximately a dozen successful HIOs, HIOs remain expensive and complex.

Further, the viability of the new State HIE Cooperative Agreement Program is uncertain. States will be required to charge for HIE use, and it is unknown how this requirement will be viewed by data providers and users.

If you haven’t already done so, you will need to make a business decision whether to purchase a certified EHR to receive federal government reimbursement. As part of that decision and as an aid to achieving meaningful use, you also should determine how you will share medical information in the future. Ascertain whether you can use an existing HIO, a new statewide HIE, or a simpler solution such as the DIRECT project or the SureScripts network.

The degree of uncertainty regarding both EHRs and HIE is substantial, but so are the potential benefits to you and your patients. Mature and successful HIE is a rarity today but likely will be standard operating procedure in the foreseeable future.

2010 Advanstar Communications Inc..

Source:  Modern Medicine.com
View Full Article: http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=700603&pageID=1&sk=&date=

QHN researches, acquires, and deploys cost-effective shared IT products and services that are essential to the success of western Colorado’s high performing healthcare communities. Currently, QHN supports more than 75% of medical providers in Mesa County and surrounding areas by connecting them to the HIE system. The numerous community participants include hospitals, physicians, surgical centers, emergency departments, pharmacies, extended care facilities, home health services, public health, hospices, and many others. More than 550 physicians currently use the system to help improve their care of patients. QHN helps facilitate the delivery of the right medical data to the right place at the right time with the goal of reducing costs, increasing efficiency and improving patient outcomes. QHN’s HIE has been recognized as a national leader and is a member of the Colorado Beacon Consortium.

QHN’s quality improvement efforts, which are focused on improving care transitions and care coordination within and between medical neighborhoods, is making a difference for all patients served by area providers. With the IT support of QHN, “patients are now being served by multiple providers, in multiple health care settings with confidence,” notes Amy Davis, MD, Medical Director of the Marillac Clinic, which provides medical services to low-income populations in Mesa County.

Beyond its original base in Grand Junction, QHN services have expanded successfully over the past year to support and incorporate other western Colorado medical communities in Montrose, Delta, Gunnison and Aspen. Initial results show that the adoption of QHN’s HIE tools is growing at a fast pace in order to securely share clinical information. This expansion plan for western Colorado has been facilitated by funding from area providers and from the generous support of the Colorado Health Foundation. Their support validates the vision of QHN’s founders and improves the ability of area physicians to deliver high quality care.

“QHN delivers an efficient, reliable and low cost clinical exchange solution for hospitals and doctors. Our community is pleased to be an early adopter of this quality improvement initiative,” said David Ressler, CEO of Aspen Valley Hospital (AVH). “We see a high value in providing our area physicians with timely access to complete patient information at the point of care. It helps them better serve their patients.” Similarly, David Hample, CEO of Montrose Memorial Hospital (MMH) said, “We recognize that patients benefit from the timely exchange of clinical information among all health care providers in our regional area. We want to improve patient satisfaction and reduce costs: and, our connection to the QHN HIE helps us do that.”

Using Axolotl’s Elysium Exchange, QHN will continue to expand into new medical neighborhoods to enhance electronic and technological capabilities, maintain exceptional privacy and security standards, and help providers and patients work together to improve outcomes and reduce costs. “A central tenet of QHN’s growth and high rate of adoption is an abiding respect for local leadership coupled with the provision of high quality support and guidance from QHN,” emphasized Jane Foster, QHN Clinical Director.

QHN is one of four local organizations comprising the Colorado Beacon Consortium. The consortium is one of 17 health IT pilot communities receiving grants, funded by the American Recovery and Reinvestment Act of 2009 (ARRA) to serve as a national model for the broad use of healthcare IT. “The Colorado Beacon Consortium’s mission is to optimize the health and quality of life for all members of the community through the meaningful use of health information technology, and improve the cost-effectiveness and quality of their health care regardless of personal means or coverage status,” said Dick Thompson, CEO of QHN.

Since its inception, QHN’s live operations have delivered nearly 7 million patient clinical results to regional medical providers. The network supports more than 120,000 server requests monthly from greater than 130 participating organizations. In addition, QHN provides HIPAA compliant transfer of over 500,000 electronic prescriptions to pharmacies in western Colorado on an annual basis. Their services are anticipated to grow exponentially over the next few years.

 December 01, 2010

For further Quality Health Network information contact:

Dick Thompson, CEO 970-248-0033
Christina Beck, Marketing & Communications 720-289-2565

View Source

“We are taking initial calls now and are already meeting with small practices,” said Monica Arrowsmith, director of the REC at Purdue.

Todd Rowland, M.D., executive director of HealthLinc, a HealthBridge partner, said “Achieving federal incentives for meaningful use will take time, so it is important to get started.” HealthBridge has several hundred practices already committed.

Here are answers to some questions about RECs as they open for your business.

What exactly is a REC?

Across the country, these centers will serve defined geographic areas to support at least 100,000 primary care physicians and providers (small practices and those serving safety-net populations) to achieve meaningful use of EHRs for nationwide health information exchange.

What can a REC do for me – and what can’t it do?

RECs cannot give you money to purchase an EHR, software or hardware. Also, you can receive federal incentive dollars only if you achieve all 25 meaningful use criteria by specified deadlines.

However, the RECs can help you maximize available funding through direct, on-site support so you can:

• Select the certified EHR product that best meets your needs
• Enhance and expand your use of an existing EHR
• Implement an EHR within federal timelines
• Enhance workflow, maximizing your system to improve quality of care
• Avoid common mistakes and check all the boxes to qualify for incentives
• Comply with legal, regulatory, professional and ethical requirements to protect privacy and security of patient information

Why should I have an EHR system?

While there is little consistent evidence EHRs improve quality or cost, the real promise of EHRs is:

• Practice operations will be more efficient.
• Patient records will be accessible to you anywhere, anytime.
• Medical errors and redundant costs will be reduced.
• Integration of evidence into care practices will be accelerated.

Should my patient referral patterns determine which REC I use?

You should not alter your referral patterns in any way for EHRs or RECs because by 2012, all health information exchanges in the state (currently five) must be able to exchange data with each other. So, no matter where you refer patients, their medical records should be accessible.

See the HealthBridge 19-county target area in the map here.

What do I need to do to get started?

Find information about the Purdue REC here; you’ll need to complete a short survey to get started.

Find information about HealthBridge Tri-State here; an “Interest Form” is available on the site.

Do I have to pay for REC services?

The RECs charge some fees, but they cost far less than other consultants since RECs are non-profit and supported by federal grants. The Tri-State REC does not charge to assist practices already using EHRs attain meaningful use.

I’m a specialist; can the RECs help me?

RECs will provide education to all health care providers about health information technology, EHR and information exchange, as well as process redesign, workforce support and quality improvement.

Will the RECs direct me to certain vendors?

RECs are moving through a vetting process right now to develop a list of preferred vendors that will enable them to offer group discounts on proven, certified products. Vendors are responding to a Request for Proposal issued in early May.

What if I already have an EHR, can a REC help me?

Yes, the REC will assist you to reach the maximum benefit from your EHR system.

What amount am I eligible to receive for reaching meaningful use?

Each eligible professional may qualify for incentives up to $44,000 for Medicare or up to $63,750 for Medicaid (not both) over the next few years for meeting meaningful use of health information technology.

For background on RECs, see the March 8 and April 5 issues of ISMA Reports on the ISMA website.
 

CAeHC’s weekly Webinars provide presentations from national subject matter experts speaking on a variety of topics related to the development and operation of HIE. According to CAeHC, HealthBridge is one of the largest and most financially successful HIEs nationwide.

Founded in 1997, HealthBridge serves 28 hospitals throughout Cincinnati and its surrounding areas. Through its clinical messaging system, the HIE delivers more than three million clinical results (laboratory, radiology, transcription and ADT) to more than 5,200 physicians every month, according to Hepp.

Hepp said that the Cincinnati-based HealthBridge began using a subscription model-based enterprise approach and was built off loans. Since HealthBridge began in a time when grants were not readily available, Hepp said that HealthBridge formed a disciplined approach to develop methodologies to show financial returns in the HIE’s early stages.

The loan notes will be paid off by 2012, according to Hepp.

HealthBridge is internally funded with 97 percent of revenues from fees with a 5-8 percent annual return for the last five years, according to Hepp. Its business model shows that 65 percent of its revenue comes from health systems, 15 percent from laboratories, 3 percent from grants, 12 percent from external HIE services and 5 percent from transcription and billing revenues.

Although Hepp acknowledged no one single financial silver bullet for HIEs, he highlighted a few key financial lessons that HealthBridge experienced since its formation:

•Align costs with benefits received;
•Starting with a messaging metaphor is highly recommended to get various content providers participating in a HIE;
•Treat American Recovery and Reinvestment Act of 2009 (ARRA) funding the same as capital;
•Use ARRA money to buy-down future costs;
•Look for cheaper and easy solutions (ex: CCHIE and HealthLINC connected using HL7); and
•State HIE’s are fine but local governance builds buy-in.

CAeHC weekly Webinars archives and information can be accessed through the organization’s website.

HealthImaging.com

Indianapolis Business Journal
J.K. Wall -  jwall@ibj.com
Sat. March 07 – 2009

Grab a partner and dance. Fast.

The stimulus bill passed last month essentially sets a five-year time line for doctors to start using electronic medical records and for states to figure out how to exchange those records from doctor to doctor.

That has prompted Indiana businesses and not-for-profits that deal in medical records to look for partners to help them meet the challenge and capitalize on the opportunity.

The potential market is substantial. Even before the stimulus bill, the U.S. health care information technology industry spent $28 billion annually. The stimulus bill provides incentives that could pump $31 billion more into the market over the next decade.

Full story

Physicians Can Earn Tens of Thousands in IT Incentives, But They Must Act Quickly to Achieve the Biggest Benefit and Avoid Penalties.

Over the next decade, the federal government is projected to spend more than $35 billion on Medicare and Medicaid bonuses to physicians, hospitals and others that adopt certified electronic health records. Because of the Medicare penalties that eventually will apply to nonadopters, however, the net spending level will be only about $20 billion over 10 years.

Full story