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Washington Debrief: Health IT Provisions Included in 21st Century Cures Bill Passed by the House

December 5, 2016
by Leslie Kriegstein, Vice President of Congressional Affairs, CHIME
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Health IT Provisions Included in 21st Century Cures Bill Passed by the House

Key Takeaway: Last week, healthcare took center stage yet again as the House of Representatives passed a significant piece of legislation that will greatly impact health IT.

Why It Matters: The 21st Century Cures Act, a bipartisan piece of legislation largely focused on medical research and changing the approval process for new drugs and medical devices, contains several health IT-related provisions, including directives that aim ensure patients are accurately linked to their medical records.

The bill also addresses interoperability and improved transparency of the EHR certification process. CHIME issued a statement in support of the bill, which the Senate is expected to take action on early next week.

A crosswalk of the health IT provisions from last week’s House-passed bill, the 21st Century Cures legislation that first passed the House in July 2015, juxtaposed to those approved by the Senate Committee on Health, Education, Labor and Pensions (HELP) are represented in a table here. The legislation provides the Department of Health and Human Services (HHS), the Office of the National Coordinator for Health Information Technology (ONC) and the Government Accountability Office (GAO) a number of directives with specific deadlines, many of which are outlined here.

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Trump Nominates Dr. Tom Price to Lead HHS, Seema Verna to Head CMS

Key Takeaway: President-elect Trump tapped Representative Tom Price, M.D. (R-GA) as his choice to serve as the Secretary of the Department of Health and Human Services (HHS).

Why It Matters: Dr. Price has been a proponent of important reforms to the Meaningful Use program, including pushing for a 90-day reporting period and expanding opportunities to obtain a hardship exemption.

CHIME issued a statement last week pledging to work with the incoming leadership team at the Department of Health and Human Services. The President-elect also announced Seema Verma, MPH, to lead the Centers for Medicare and Medicaid Services (CMS.) Verma brings extensive experience working within Medicaid, including for the state of Indiana, the home state of Vice President-elect Mike Pence.

Meaningful Use Comparison Cheat Sheet Chart

Key Takeaway: Come 2017 there will be three sets of Meaningful Use requirements. 

Why it Matters: Struggling to makes heads or tails of the various and changing sets of Meaningful Use requirements?  CHIME has you covered.  Check out our new comparison chart that compares the three sets of different requirements.  For Medicaid providers, unfortunately the most aggressive set of requirements adopted under Stage 3 are still intact.  CMS has finalized significant changes for Medicare hospitals, however, which will provide substantial relief and flexibility.  For instance, computerized physician order entry (CPOE) and clinical decision support (CDS) while mandatory for Medicaid providers, is no longer a requirement for Medicare hospitals and will not be required under MIPS.  CIOs should also be aware of the different reporting periods.  CMS has adopted a 90-day reporting period for Medicaid providers and Medicare hospitals in 2016 and 2017 but has not yet adopted this for 2018, something CHIME continues to push.  However, CMS has adopted a 90-day reporting period for the Meaningful Use section of MIPS (known as Advancing Care Information) for 2017 and 2018. Moving into the new year, CHIME will continue to advocate for synchronization across programs and greater flexibility all around. Want to chat MACRA? Drop us an email – we want to hear from you.

Quality

Cyber

Key Takeaway: Office for Civil Rights (OCR) issues cyber warning.

Why it Matters: On November 28, 2016 OCR issued a listserv announcement warning covered entities and their business associates about a phishing email that disguises itself as an official communication from the Department. The email prompts recipients to click a link regarding possible inclusion in the HIPAA Privacy, Security, and Breach Rules Audit Program, and directs individuals to a non-governmental website, marketing a firm’s cybersecurity services. The phishing email originates from the email address OSOCRAudit@hhs-gov.us and directs individuals to a URL at http://www.hhs-gov.us. This is a subtle difference from the official email address for OCR’s HIPAA audit program, OSOCRAudit@hhs.gov.

As our readers know, OCR is gearing up for the second round of audits. They have notified select business associates of their inclusion in the Phase 2 HIPAA audits.  For more information on the HIPAA Phase 2 Audits visit their website.

Telehealth Addressed in House and Senate Last Week

Key Takeaway: Telehealth proposals continue to garner interest from lawmakers in the House and Senate.

Why It Matters: Lawmakers continue to explore ways to overcome obstacles impeding the expansion of access to telehealth services and reimbursement despite pushback from the Congressional budget office.

In the House, in addition to the telehealth provisions included in the House-passed 21st Century Cures bill, the National Defense Authorization Act (NDAA), contains provisions that will impact the Department of Defense’s (DoD) telehealth policies. The bill passed by the House last week instructed the DoD to enhance access to and the use of telemedicine within 18 months of enactment as a means to improve access to care and improve communication between patients and their providers. The bill suggests services including secure messaging and home health monitoring via tablets, computers and other devices for evaluation, diagnosis and treatment supervision. A provision in the Senate version of the bill that required a provider using telehealth services to be licensed where they are practicing not necessarily where the patient is located was removed.

The Senate, last week, voted 97-0 to pass legislation that would require the Department of Health and Human Services (HHS) to examine potential uses of telehealth to address workforce areas in underserved and rural areas. The Expanding Capacity for Health Outcomes (ECHO) Act (S. 2873) would provide the foundation to expand a small telehealth program meant to connect specialists with rural health facilities. Representative Michael Burgess (R-TX), a physician, introduced the companion bill last June, but the House has yet considered the legislation.


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EHR-Compatible Pharmacist Care Plan Standard Opens the Door to Cross-Setting Data Exchange

September 14, 2018
by Zabrina Gonzaga, R.N., Industry Voice
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Pharmacists drive information sharing towards quality improvement

Pharmacists work in multiple environments—community, hospital, long term care, clinics, retail stores, etc.—and consult with other providers to coordinate a patient’s care.  They work with patients and caregivers to identify goals of medication therapy and interventions needed, and to evaluate patient outcomes.  Too often, pharmacy data is trapped in a silo and unavailable to other members of the care team, duplicated manually in disparate systems which increases clinical workloads without adding value.

To address these issues, Lantana Consulting Group and Community Care of North Carolina (CCNC) developed an electronic document standard for pharmacist care plans—the HL7 Pharmacist Care Plan (PhCP). The project was launched by a High Impact Pilot (HIP) grant to Lantana from the Office of the National Coordinator for Health Information Technology (ONC).

Before the PhCP, pharmacists shared information through paper care plans or by duplicative entry into external systems of information related to medication reconciliation and drug therapy problems. This documentation was not aligned with the in-house pharmacy management system (PMS). The integration of the PhCP with the pharmacy software systems allows this data to flow into a shared care plan, allowing pharmacists to use their local PMS to move beyond simple product reimbursement and compile information needed for quality assurance, care coordination, and scalable utilization review.

The PhCP standard addresses high risk patients with co-morbidities and chronic conditions who often take multiple medications that require careful monitoring. Care plans are initiated on patients identified as high risk with complex medication regimes identified in a comprehensive medication review. The PhCP is as a standardized, interoperable document that allows pharmacist to capture shared decisions related to patient priorities, health concerns, goals, interventions, and outcomes. The care plan may also contain information related to individual health and social risks, planned interventions, expected outcomes, and referrals to other providers. Since the PhCP is integrated into the PMS or adopted by a software vendor (e.g. care management, chronic management, or web-based documentation system), pharmacist can pull this information into the PhCP without redundant data entry.

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The PhCP allows pharmacists for the first time to share information with support teams and paves the way for them to support value-based payment. The project goals align with the Center for Medicare & Medicaid Services’ (CMS’) value-based programs, which are part of the Meaningful Measure Framework of improved care team collaboration, better health for individuals and populations, and lower costs.

Scott Brewster, Pharm.D., at Brookside Pharmacy in East Tennessee, described the PhCP as a tool that helps them enhance patient care delivery. “From creating coordinated efforts for smoking cessation and medication utilization in heart failure patients, to follow up on recognized drug therapy problems, the eCare plan gives pharmacists a translatable means to show their value and efforts both in patient-centered dispensing and education that can reduce the total cost of care.” (The eCare plan reference by Scott Brewster is the local term used in their adoption of the PhCP).

The pilot phase of the project increased interest in exchanging PhCPs within CCNC’s pharmacy community and among pharmacy management system (PMS) vendors. The number of vendors seeking training on the standard rose from two to 22 during the pilot. Approximately 34,000 unique care plans have been shared with CCNC since the pilot launch.

This precedent-setting pilot design offered two pharmacy care plan specifications: one specification is based on the Care Plan standard in Clinical Document Architecture (CDA); the other standard is a CDA-on-FHIR (Fast Healthcare Interoperability Resources). The latter specification directly transforms information shared using the FHIR standard into CDA. FHIR is straight forward to implement than CDA, so this is an appealing option for facilities not already using CDA. The dual offerings—CDA and CDA-on-FHIR with lossless transforms—provide choice for implementing vendors while allowing consistent utility to CCNC.

What’s on the horizon for the pharmacy community and vendors? With the support of National Community Pharmacists Association (NCPA), the draft standards will go through the HL7 ballot process for eventual publication for widespread implementation and adoption by vendors. This project will make clinical information available to CCNC and provide a new tool for serving patients with long-term needs in the dual Medicare-Medicaid program and Medicaid-only program.  This is a story about a successful Center for Medicare and Medicaid Innovation (CMMI)funded project that started out as a state-wide pilot and is now rolling out nationwide as Community Pharmacy Enhanced Service Network (CPESN)USA. 

The PhCP is based on a CDA Care Plan standard that is part of ONC’s Certified EHR Technology requirements, so it can be readily implemented into EHRs. This makes the pharmacist’s plan an integral part of a patient’s record wherever they receive care. 

Adoption of the PhCP brings pharmacies into the national health information technology (HIT) framework and electronically integrates pharmacists into the care planning team, a necessary precursor to a new payment model and health care reform. In addition, receiving consistently structured and coded pharmacy care plans can augment data analysis by going beyond product reimbursement to making data available for, utilization review, quality assurance and care coordination.

Troy Trygstad, vice president for Pharmacy Provided Partnerships at CCNC, described the strategic choice now available to pharmacists and PMS vendors. “Fundamentally, pharmacy will need to become a services model to survive. Absent that transformation, it will become a kiosk next door to the candy aisle. The reasons vendors are buying into the PhCP standard for the first time ever is that their clients are demanding it for the first time ever."

The move to value-based payment will continue to drive the need for pharmacists, as part of care teams, to provide enhanced care including personal therapy goals and outcomes. Sharing a medication-related plan of care with other care team members is critical to the successful coordination of care for complex patients.

Zabrina Gonzaga, R.N., is principal nurse informaticist and director of health informatics at Lantana Consulting Group and led the design and development of the PhCP standard. 

Email:  zabrina.gonzaga@lantanagroup.com

Twitter: @lantana_group

 


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Health IT Now Pushes for Information Blocking Regulation, Says Administration “Must Uphold its End of the Bargain”

September 13, 2018
by Rajiv Leventhal, Managing Editor
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The executive director of Health IT Now, a coalition of healthcare and technology companies, is again criticizing the Trump administration for not yet publishing any regulation on information blocking, as required by the 21st Century Cures Act legislation.

In an op-ed published recently in STAT, Health IT Now’s Joel White wrote, “More than 600 days after the enactment of the Cures Act, not a single regulation has been issued on information blocking.” White added in frustration, “Health IT Now has met with countless officials in the Trump administration who share our commitment to combat information blocking. But those sentiments must be met with meaningful action.”

The onus to publish the regulation falls on the Office of the National Coordinator for Health IT (ONC), the health IT branch of the federal government that is tasked with carrying out specific duties that are required under the 21st Century Cures Act, which was signed into law in December 2016. Some of the core health IT components of the Cures legislation include encouraging interoperability of electronic health records (EHRs) and patient access to health data, discouraging information blocking, reducing physician documentation burden, as well as creating a reporting system on EHR usability.

The information blocking part of the law has gotten significant attention since many stakeholders believe that true interoperability will not be achieved if vendors and providers act to impede the flow of health data for proprietary reasons.

But ONC has delayed regulation around information blocking a few times already, though during an Aug. 8 episode of the Pulse Check podcast from Politico, National Coordinator for Health IT Donald Rucker, M.D., said that the rule is "deep in the federal clearance process." And even more recently, a bipartisan amendment to the U.S. Senate's Department of Defense and Labor, Health and Human Services, and Education Appropriations Act for Fiscal Year 2019 includes a requirement for the Trump administration to provide Congress with an update, by September 30.

White, in the STAT piece, noted a June Health Affairs column in which Rucker suggested that implementation of the law’s information blocking provisions would occur “over the next few years.” White wrote that this is “a vague timeline that shows little urgency for combating this pressing threat to consumer safety and stumbling block to interoperability.”

Health IT Now is not alone in its belief that the rule should have been published by now, nor is it the first time the group is bringing it up. Last month

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By the end of this year, ONC’s implementation and interpretation of data blocking will also be published and available for comment, as was the case with the TEFCA proposed rule. The TEFCA final rule is also anticipated by the end of 2018.

HOWEVER…there’s still time to prepare for TEFCA and the data blocking regulation, and final rules for both in the coming months will set concrete timelines, and for TEFCA it will be interesting to see how ONC reacts to stakeholder comments, internal and external.

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