Ohio Health Policy Review

White paper: EHR implementation should be aligned with quality measures

A new white paper from Virginia-based consulting firm Computer Sciences Corp. urges hospitals to consider changing priorities for EHR implementation in order to provide better data for quality measures used for pay-for-performance programs (Source: “Report: Change EHR Priorities,” Health Data Management, April 24, 2009).

“The typical sequence of implementing the inpatient EHR usually places electronic problem lists and physician documentation at the end of the journey, although the medical and surgical core measures rely heavily on information that can be provided by these sources,” according to the CSC report (pdf, 9 pages). “Moving up the implementation of the electronic documentation of the physician history and physical and the electronic problem list (including surgical care and the ED) is worth considering because it would provide a more complete information base for concurrent quality management.”

Rural Ohio patients to receive wireless health monitors

The Visiting Nurse Association of Ohio plans to begin using high-tech monitors to keep track of the health status of rural patients, a move officials say should reduce hospitalizations and emergency room visits (Source: “Grant to help Visiting Nurse Association track health of patients in rural Ohio,” Cleveland Plain Dealer, March 18, 2009).

As part of the $410 billion federal Omnibus bill passed by Congress last week, the VNA has been awarded a $95,000 grant to pay for equipment that will monitor patients’ heart rate, blood pressure, temperature, blood sugar, weight and oxygen saturation every morning. The results are then sent wirelessly to the VNA office, where advanced practice nurses can review the information and take action if needed.

The VNA has been using this type of monitor in other states since 2002.

Insurers worried HIPAA expansion could hurt HIT adoption

The president and CEO of America’s Health Insurance Plan, the insurance industry’s trade group, is warning that language in the economic stimulus legislation that expands HIPPA privacy rules could have the unintended consequence of slowing the adoption of health information technology (Source: "AHIP Concerned with Privacy Provisions,” Health Data Management, Feb. 4, 2009).

At issue are provisions of the Health Information Technology Act that has been inserted in the economic recovery bill and strengthen HIPAA privacy rules by further restricting patient data for payment, treatment and operational functions. According to AHIP CEO Karen Ingagni, however, new marketing restrictions would prevent providers and payers from sending prescription refill reminders and preventive care notices.

Further, Ignani said that requiring covered entities to account for all disclosures of personal health information would discourage use of electronic health records systems because of the intense labor required to document all disclosures of electronic data.

Senate wants privacy safeguards for HIT

Senators and witnesses at a Senate Judiciary Committee hearing Tuesday said that privacy safeguards need to be put in place before Congress makes a large-scale push toward the implementation of electronic health records (Source: “Groups push for health IT privacy safeguards,” New York Times, Jan. 27, 2009).

"If you don't have adequate safeguards to protect privacy, many Americans aren't going to seek medical treatment," said Senator Patrick Leahy, a Vermont Democrat.

The $825 billion stimulus bill that passed the House Tuesday and is now heading to the Senate includes $20 billion for HIT, including the establishment of an Office of the National Coordinator for Health Information Technology.

Included in the bill are privacy provisions such as an extension of privacy requirements to business associates of health-care providers, and a requirement that the U.S. Department of Health and Human Services put out annual guidance on the most effective privacy safeguards. The bill also requires health-care providers to notify customers of any security breaches.

Federal stimulus bill contains comprehensive HIT act

Not only does the latest version of the federal stimulus bill include $20 billion in health information technology spending, it also includes a comprehensive HIT act that is similar to those Congress has attempted to enact for several years (Source: "New stimulus bill contains complete health IT act," Government Health IT, Jan. 19, 2009).

The HIT portion of the committee's bill, which accounts for more than half of the 328-page document, goes further than most of the bipartisan bills of the past to reward doctors and hospitals for using
e-health records and strengthen privacy protections for patients

"As a result of this legislation, the Congressional Budget Office estimates that approximately 90 percent of doctors and 70 percent of hospitals will be using comprehensive electronic health records within the next decade," according to a summary of the bill released by the Ways and Means Committee staff.

Such an increase in electronic health record adoption would be especially remarkable, considering that a study published last year in the New England Journal of Medicine found that only 4% of U.S.
physicians were using "fully functional" EHR systems.

Akron hospital system’s quality initiative combines claims, clinical records

Akron-based Summa Health Network is working with three insurers as part of a new initiative that uses both claims data and clinical records for quality analysis (Source: “Summa Health tightens its grip on data to promote better care,” Healthcare IT News, Jan. 5, 2009).

The hospital system will use special software that enables it and its insurers to compare claims-based data with clinical data. The hope is that incorporating clinical data will give physicians more actionable data for quality improvement.

Summa “understands that clinical data is more comprehensive, accurate, timely and therefore valuable to physicians and, ultimately, their patients," said Tim Roche, co-founder, president and CEO of MDdatacor, maker of the software being used by Summa. "By providing a consolidated view of patient information, MDdatacor and SHN are empowering physicians to promote quality healthcare for all their patients, a significant step in reducing healthcare costs."

Sec. Leavitt: National HIT plan must require interoperability

In an opinion piece in the Washington Post Monday, Secretary of Health and Human Services Mike Leavitt said that investments in health information technology will only be valuable if they enable national information exchange (Source: “Connecting the Medical Dots,” Washington Post, Dec. 22, 2008.

While Leavitt said he is optimistic that adding money for HIT to the stimulus package expected in January “could spur a critical mass of the nation's doctors to finally enter the information age," he warned that, "unless the funds are tied to standards for the interoperability of health IT systems, the expenditure could do more harm than good.”

He said he fears that systems that don’t exchange information will mean “we will only be replacing paper-based silos of medical information with more expensive, computer-based silos that are barely more useful.”

Study: Word-of-mouth still preferred method for finding new doctor

Despite increased efforts by insurers to steer patients to doctors with higher quality and efficiency ratings, most people still rely on word-of-mouth from family or friends when choosing a doctor (Source: “Insurers offer data to sway doctor choice,” Columbus Dispatch, Dec. 20, 2008).

In fact, a study by the Center for Studying Health System Change found that fewer than 35 percent of patients said they consider insurance-company information when choosing a doctor.

"Consumers still trust people in their social networks -- say, family and friends and word of mouth," said Ha T. Tu, senior researcher at the center and lead author of the study.

Critics say health consumers lack access to data

The introduction of high-deductible health plans was expected to usher in an era of informed health consumers, but critics say obtaining data on cost and quality is still too difficult (Source: “In Cincinnati, health care data still lags ‘choice’ shift,” Business Courier of Cincinnati, Dec. 22, 2008).

Insurers promote high-deductible plans as a way to keep costs down for employers and employees by giving consumers an incentive to become engaged in their own care and shop for the most cost-effective treatment. But the information they need is not always readily available, underscoring the need for greater data collection and better means by which to disseminate it.

“The state of transparency is still in its infancy,” said Craig Brammer, senior research associate in public health sciences at the University of Cincinnati. “There have been considerable advances in the last few years. While prior efforts may have been flawed, I think we’re going to see a lot more sophisticated collection and analysis of data in the future.”

Opinion: HIT must be at center of health reform plans

In an editorial published today in Business Week, an Arlington, Va.-based physician and computer scientist argues that achieving real health reform will only be possible if electronic health records are a top priority (Source: “Electronic Records Are Key to Health-Care Reform,” Business Week, Dec. 19, 2008).

“Any potential approach to restructuring health care must include universal electronic medical records so that both patient care and policy decisions are fully informed,” wrote William A. Yasnoff, who is managing partner of National Health Information Infrastructure Advisors, a health information technology consulting firm.

“As the President-elect stated,” he added, “both the quality and safety of health care could be greatly improved if complete electronic medical records were immediately available to physicians.”

A new survey from National Center for Health Statistics may be a source of optimism for Yasnoff and other EHR proponents. The mail-in survey found that 38.4 percent of office-based physicians reported using full or partial EMR systems, not including billing records, in their practices. Of that group, 20.4 percent reported using a system that including e-prescribing, test ordering, viewing lab and imaging results and clinical notes. A similar survey taken in 2006 found results of 29.2 percent and 12.4 percent, respectively.