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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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CommonWell Officials: Carequality Connection Now “Generally Available” for Members

November 16, 2018
by Rajiv Leventhal, Managing Editor
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CommonWell’s executive director said this latest step “breaks down another interoperability barrier”

Connection capabilities to the Carequality framework, by members of the CommonWell Health Alliance, are now “generally available,” according to officials who made an announcement today.

CommonWell, a trade association providing a vendor-neutral platform and interoperability services for its members, announced in August that it had started a limited roll-out of live bidirectional data sharing with an initial set of CommonWell members and providers and other Carequality Interoperability Framework adopters. This marked a key step in a collaborative effort to increase health IT connectivity across the country by enabling CommonWell subscribers to engage in health data exchange through directed queries with Carequality-enabled providers, and vice versa.

In just the first two weeks of a few CommonWell-enabled providers being connected, Jitin Asnaani, CommonWell Health Alliance executive director, said there were more than 4,000 documents bilaterally exchanged with Carequality-enabled providers.

Since then, by leveraging the technological infrastructure built by CommonWell service provider Change Healthcare, members Cerner and Greenway Health successfully completed a focused rollout of the connection with a handful of their provider clients, who have been exchanging data daily with Carequality-enabled providers, officials stated today.

Now, since the connection went live in July, officials noted  that CommonWell-enabled providers have bilaterally exchanged more than 200,000 documents with Carequality-enabled providers locally and nationwide.

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“We are proud to break down yet another barrier to interoperability by making this much-anticipated connection available to our members and their clients,” Asnaani said in a statement today. “This increased connectivity will serve to empower providers with access to patient health data critical to their healthcare decision-making.”

In December 2016, CommonWell and Carequality, an initiative of The Sequoia Project, announced connectivity and collaboration efforts with the aim of providing additional health data sharing options for stakeholders. Officials said that the immediate focus of the work between Carequality and CommonWell would be on extending providers’ ability to request and retrieve medical records electronically from other providers. In the past two years, teams at both organizations have been working to establish that connectivity.

Together, CommonWell members and Carequality participants represent more than 90 percent of the acute EHR market and nearly 60 percent of the ambulatory EHR market. More than 15,000 hospitals, clinics, and other healthcare organizations have been actively deployed under the Carequality framework or CommonWell network.

Carequality is a national-level, consensus-built, common interoperability framework to enable exchange between and among health data sharing networks. It brings together electronic health record (EHR) vendors, record locator service (RLS) providers and other types of existing networks from the private sector and government, to determine technical and policy agreements to enable data to flow between and among networks and platforms.

CommonWell Health Alliance operates a health data sharing network that enables interoperability using a suite of services aiming to simplify cross-vendor nationwide data exchange. Services include patient ID management, advanced record location, and query/retrieve broker services, allowing a single query to retrieve multiple records for a patient from member systems.

Following the August announcement of the limited bi-directional data sharing capabilities, Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative said, “This is the ‘golden spike’ moment, connecting the two big railroads, like when AT&T and Verizon finally got connected. This is building that bridge.” Tripathi, who also directly observes and participates in conversations with Carequality and CommonWell, added, “It will take a while for all of the production sites and different vendors to get up and running. That will probably take a couple of years. But you have to have the bridge to connect them to begin.”

One key element in this progression is that currently, EHR giant Epic is not a member of CommonWell, despite other major EHR vendors pushing Epic in that direction. “Because sharing among Epic customers is already universal, when CommonWell connects to Carequality, the entire Epic base will become available, creating instant value for most areas of the country,” a recent KLAS report on interoperability stated.

Interestingly, Tripathi noted in August that once there is “general availability” of the data sharing services for all Carequality and CommonWell members, the competition factor will become less important. “It makes both networks more valuable,” Tripathi said at the time.

It appears as if that “general availability” time has now come. “Thanks to the CommonWell-Carequality connection, our patients can have access to their medical records regardless of the EHR a health care facility uses,” said David Callecod, president and CEO of Lafayette General Health, a Cerner client located in Lafayette, La. “When data is made readily available, providers can make diagnostic and treatment decisions more quickly, and patients can recover sooner. Better data means better communication with our patients and providers, better care and better outcomes. This is a very powerful tool!”

Officials also noted that with the connection officially in production, additional CommonWell members, including Brightree, Evident and MEDITECH, are in the process of subscribing to the connection and taking it live with their provider clients.


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Advancements in Healthcare: Interoperability, Data Exchange, and More

Tuesday, December 4, 2018 | 3:00 p.m. ET, 2:00 p.m. CT

Micky Tripathi, President and Chief Executive Officer of the Massachusetts eHealth Collaborative, is one of the most well-informed and well-respected healthcare IT leaders in the U.S. Tripathi has an inside look at the most significant interoperability trends that are happening nationwide and will discuss varying interoperability and data exchange efforts fit together in the bigger picture of U.S. healthcare.

Tripathi will also discuss the future of data exchange, advancements of standards such as FHIR, the reality of information blocking challenges, and more in this latest Healthcare Informatics webinar, which gives a high-level view on the many market forces that impacting nationwide interoperability.

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Epic Lowers App Orchard Program Fees, Introduces New Low-Cost Tier

November 1, 2018
by Heather Landi, Associate Editor
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Verona, Wis.-based Epic plans to lower program fees for health IT developers participating in its App Orchard program, and will launch a new entry-level program tier, called Nursery.

Epic announced the App Orchard updates at its App Orchard conference last week at its Verona headquarters, according to reporting from Politico published Oct. 26.

In an email statement, Brett Gann, App Orchard director, confirmed the company is reducing and simplifying the costs associated with participating in the app developer program. The three tiers of the program will see program fee reductions ranging from 33 to 80 percent as part of the update, Gann said.

Epic launched its App Orchard in 2017 as an online marketplace for third-party developers with 13 applications.

To date, more than 350 companies in the healthcare industry participate in Epic’s app developer program, where they have access to hundreds of application programming interfaces (APIs), documentation, testing tools, individual technical support, training, conferences, and integration with the Epic community, Gann said,

Gann also said the program updates announced last week at the annual App Orchard Conference in Verona will “engage a broader community of developers and increase access to APIs through simplified and reduced costs.”

The updates will help drive healthcare innovation as interested developers have the opportunity to build on top of Epic’s health record platform, using emerging industry standards such as FHIR (Fast Healthcare Interoperability Resources), Gann said.

Epic also announced a new program tier, Nursery, that will enable early-stage startups to enroll in the app developer program to access Epic’s public API documentation, tutorials, and sandboxes. Early-stage startups also will have access to FHIR, SMART on FHIR, and CDS Hooks, Gann said.

Enrolling in the Nursery program tier will cost participants $100 per year, Gann said, and when a company is prepared to go to market with its product, it may graduate to one of the other three tiers.

Nursery members will have access to Epic’s FHIR sandboxes, classroom and online learning opportunities, and the ability to engage with the online community of Epic, health system, and vendor developers and experts.

In addition to the program fee reductions, as part of the update, Epic will offer new program benefits to participants in the other three tiers, such as additional training opportunities, developer events, support services, sandboxes, and program accounts.

Gann also said Epic has simplified the pricing model for API-based integrations, eliminating the minimum fees, and reducing the cap. “It’s our expectation these updates will be a price reduction for nearly all program members,” he said.

Some developers, particularly smaller developers, have complained in the past that the fees to participate in the vendor app store are too steep.

Earlier this year, Politico reported the experiences of Rick Freeman, CEO of Interopion. Freeman told Politico that a family planning questionnaire app he developed for HHS’s Office of Population Health could have cost him up to $750,000 to run on Epic or Cerner for a year.

As reported by Politico in its October 26 report, in response to the program updates, Freeman said he is “very happy with the changes.”

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