The new National Governors Association panel — set up to address the variations in state laws that hamper a more uniform rollout of e-health regulations — is not shying away from some tough issues. At its second meeting recently, the State Alliance for e-Health gave the green light for its task forces to continue explorations of interstate licensure of physicians and other health professionals, liability, malpractice insurance, and privacy related to e-health.
Reporting to the alliance on its Health Care Practice Task Force's work, Holly Miller, M.D., chief medical information officer of University Hospitals in Cleveland, said, "Nationally it is quite clear that we are driving toward the goal of standardization of care. And so the discussion became clear that we really see no reason not to have interstate medical licenses."
The alliance approved the task force's plan to report in the next few months on an examination, at minimum, of licensure differences in the physician, pharmacist and nursing professions and to identify states' definition of medical practice.
The alliance, co-chaired by Tennessee Gov. Phil Bredesen and Vermont Gov. Jim Douglas, was created with a contract from the federal Office of the National Coordinator for Health Information Technology (ONCHIT). Its purpose, among other things, is to build consensus on harmonization and develop guidance on state policies, including model laws. Its 20 members include high-ranking state officials and health policy experts from around the country.
The alliance's practice task force will also study case law and opinion on liability issues arising from electronic exchange and will assess current practices that may result in malpractice challenges.
Among a host of liability issues, said Miller, are questions such as, "When an electronic health record is impacted in a healthcare delivery system, and there is an untoward or unexpected consequence that is negative and impacts patients, who is liable? Is the physician? Is it the in-house health information technology expert that has implemented the system? Or is it the vendor?"
Howard Burde, another taskforce member and an attorney with a focus on HIT, said another question before the task force is whether — given the indications HIT use can reduce adverse events and costs — liability insurance costs should be reduced for practitioners using technology, perhaps creating another incentive for adoption?
Although the task force will explore mechanisms to enable practice across state lines, said Burde, it will also look at how that might undercut existing systems of quality oversight and enforcement, specifically from the state boards of medicine.
Miller indicated that all these questions can impact many areas, since e-health is evolving and is now considered to include: clinical informatics and telehealth services, information exchange among physicians to physicians and physicians to patients, transmission of stand-alone or implanted medical devices over the internet or over the telephone into electronic health records or a physician's office, and even a variety of currently offered virtual visits and remote second opinions.
A second alliance task force, focusing on information protection, plans to determine the categories of major state health privacy protection laws, identify the rationale behind each and determine relevance, "with an emphasis on an individual's health."
By this fall, the group expects to create resources for states to implement its recommendations, including examples of situations, model laws and tool kits. The task force will look at protecting information primarily about mental health and substance abuse, HIV and other communicable diseases, genetic information and disability.
A third task force, which was still forming, will focus on e-health in programs for state employees, public health, Medicaid and the state children's health insurance programs (SCHIP).
The alliance has a contract of up to three years and it will meet quarterly. Its three taskforces will meet monthly.
Kathryn Foxhall is a contributing writer based in Hyattsville, Md.
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