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D.C. Report: Final Rules Flexibility, HIE and HIT State Roundup

July 19, 2010
by Sharon Canner
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Final Rules Offer Greater Flexibility for Incentive Program. With great fanfare early last week, HHS Secretary Kathleen Sebelius flanked by new CMS Administrator Donald Berwick, National Coordinator for Health IT Dr. David Blumenthal, and Surgeon General Dr. Regina Benjamin, unveiled final rules for the Medicare and Medicaid meaningful use incentive program along with the certification criteria and standards. HHS received over 2,000 comments including those from CHIME. A key criticism was the “all or nothing” approach that would have excluded even the most EHR-enabled hospitals. Rather than the proposed 25 core objectives for eligible professionals (EPs) and 23 for hospitals, the final rule calls for 15 objectives for hospitals and 14 core objectives for hospitals. Further, providers are required to choose five other objectives from a menu set of 10 additional objectives.

Overall reaction to the Final Rules has been fairly positive. Said CHIME President and CEO Richard Correll, “It’s definitely time to begin a coordinated effort to implement electronic health records by providers nationwide.” American College of Cardiology president Ralph Brindis said the changes "will make it easier for physicians to comply and encourages practices to begin implementation." Former CMS Administrator Mark B. McClellan, MD, PhD, Director, Engelberg Center for Health Care Reform and Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution, said, “These regulations provide a promising foundation for encouraging the effective use of health information to improve patient care. With coming payment reforms, these incentives will give doctors and hospitals needed support for improving health care quality and efficiency,” The American Hospital Association statement, however, expressed concern that the Rule would adversely affect rural hospitals and worsen the 'digital divide' in health care as well as impose unreasonable timeframes for EHR adoption.

StateWatch. As more focus shifts to state implementation, CHIME will report developments of HIE/HIT happenings around the nation.

Missouri and Washington. After almost a year of discussions with providers, insurers, legislators and privacy experts, Missouri has completed the strategic and operational plans for its Health Information Exchange. Missouri Statewide Health Information Organization (HIO) is the non-profit that will govern the state HIE. To implement its plan, the state is receiving $13.8 million from the ONC. Washington state also submitted its HIT Plans to ONC last week. The state hopes that the plans will be approved by the ONC before September 30, 2010.

Kansas already announced two weeks ago that it is implementing its HIE. Four organizations in Kansas--Kansas Hospital Association, Kansas Medical Society, the Kansas City Bi-State Health Information Exchange and Wichita Health Information Exchange--will work with the Kansas Department of Health and Environment to develop the state HIE. The focus is threefold: improving quality of healthcare, while reducing costs and protecting patient privacy.

Georgia Department of Community Health is collaborating with the Morehouse School of Medicine to help doctors in low income areas adopt EHRs. The Department expects to assist over 5,000 hospitals, doctors, and providers in selecting and using new EMR systems. While they will not pay for the systems itself, funds will cover training of health information technology professionals.

Indiana. A partnership has formed between the Michiana Health Information Network and the Indiana University School of Medicine at South Bend. This ensures that the medical students graduating from this school will not only have a deep understanding of health information exchange, but also proficient knowledge regarding electronic health records. The first two years at the medical school will include introductions, demonstration and case studies of the systems. The students will then work with these systems during their clinical clerkships in their final two years.

Washington, D.C. Dr. Richard Katz of George Washington University Hospital in Washington DC is developing a method by which cellphones can be used to treat chronic conditions, such as diabetes. The project is being conducted collaboration with Howard University Hospital’s diabetes clinic and the patient population of inner city diabetics. Patients can enter their blood sugar measurements directly from their internet enabled cell phones to their online personal health record. In this way, their condition is monitored daily. Patients can also receive immediate text instructions via their phone, if the measurements deviate from the normal levels. This method of diabetes treatment provides a “two-way” interaction between patient and provider, and removes any geographical barriers to healthcare access. Dr. Katz and his team are currently researching ways to make this provision more personalized and user friendly and enable a larger patient population to take advantage of it.