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Washington Debrief: CHIME, Others Urge Federal Coordination in Health IT Regulation

July 2, 2013
by Gabriel Perna
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Jeff Smith, Director of Public Policy at CHIME

ONC Issues Annual Report to Congress

In an 80-page report submitted to Congress this week, ONC said hospitals and physicians had made “steady increases in the adoption of EHRs and key computerized functionalities related to EHR Incentive Programs’ Meaningful Use criteria…”  The reportcovered major components of HITECH Act programs including Meaningful Use attainment, Regional Extension Center utilization, State HIE progress and workforce development.  While this report is mandated by HITECH, several legislators on the Hill have sought for this information to be made public.  Some of the highpoints include:

  1.  As of April 2013, more than 291,000 professionals, representing more than half of the nation’s eligible professionals, have received incentive payments through the EHR Incentive Programs, the report indicated.  And over 3,800 hospitals, representing about 80 percent of eligible hospitals, and including Critical Access Hospitals, have received incentive payments through this program as well.
  2. As of December 2012, 39 states and territories have operational directed exchange mechanisms broadly available for providers to subscribe to statewide, and nine more states have these mechanisms available in regions or as part of pilots.
  3. 10,384 REC-assisted eligible professionals (57 percent) in health centers have received Medicaid EHR Incentive Program funds to adopt, implement or upgrade (AIU) EHR technology.

The report also detailed barriers to health exchange and health IT adoption, citing cost, productivity loss, staffing and training, and resistance of practice to change workflows.  You can read the full report here.

CHIME Supports CMS Efforts to Align Quality Measures

In comments submitted to the Centers for Medicare & Medicaid Services (CMS), CHIME said that the agency was moving in the right direction in proposing alignment between Inpatient Quality Reporting and Meaningful Use clinical quality measures.  Under the CMS proposal, hospitals would be able to qualify for both programs by submitting CQMs for Meaningful Use.  However, the organization of healthcare CIOs voiced concern over the stark differences between chart-abstracted IQR measures and retooled electronic CQMs used in Meaningful Use.   “It has been the experience of our members that without making the entire record out of structured, discreet data or having mature text recognition software in place, one cannot extract all the data needed on every patient to create accurate quality metrics,” CHIME said.  “Given this reality, we believe that the chart-abstracted measures used in the IQR program and the retooled eCQMs used in Meaningful Use will not be comparable.”  CMS also proposed to allow hospitals to publicly report CQMs for IQR and MU via Hospital Compare.  While CHIME encouraged CMS to keep data submission to Hospital Compare voluntary, they worried that CQM reports generated and transmitted electronically are likely to be inaccurate and incomplete, given the state of current EHRs.  “Thus, reporting eCQMs via Hospital Compare at this juncture could convey misleading information about the quality of a hospital’s performance.  CHIME adamantly believes CMS should commit to CQM harmonization before requiring public reporting of eCQMs.”  Here are access to the full comments.

CHIME Leads Industry Effort Urging Federal Coordination in Health IT Regulation

CHIME joined more than 100 healthcare stakeholder organizations, asking the Obama administration to coordinate various efforts across HHS, FCC and FTC in regulating health IT.  Currently, the FDA has pending guidance on mobile medical applications; a group composed of multi-agency, multi-sector stakeholders resulting from FDASIA legislation; and ONC are all working on components of health IT regulation vis-à-vis patient safety.  CHIME and others asked administration officials to coordinate their various conclusions, rather than issuing them separately.  The letter signatories were concerned that contradictions and confusion would result unless there was more coordination.  “While proper oversight of health IT is critical to ensuring patient safety, such oversight must be implemented in a balanced way that also fosters innovation and encourages adoption of these technologies,” the letter stated.  “We believe that, by working collaboratively, Congress and the Administration can produce a statutory framework for regulation of health IT based on risk while supporting innovation and patient safety.”

‘Big’ Health Data, Transparency Gets Focus during Washington Briefing

The Bipartisan Policy Center (BPC) this week held a briefing that focused on the impact that massive amounts of data could have on healthcare.  From genome sequencing to droves of Medicare claims data, experts agreed that US healthcare delivery could be revolutionized by “big data.”  Senator Ron Wyden (D-Ore.) and Intel executive Eric Dishman set the stage for the event, which will result in a BPC policy brief.  Sen. Wyden focused on the power that Medicare data – especially price data – could have on healthcare if it were liberalized and available to the public.  "Healthcare can be transformed by the mountains and miles of data that are growing everyday, but only if it's accessible," Wyden said.  To this end, Sen. Wyden and Sen. Charles Grassley (R-Iowa) reintroduced the Medicare Data Access for Transparency and Accountability Act (http://www.govtrack.us/congress/bills/112/s756) (Medicare DATA Act), which calls for a database containing Medicare claims and expenditures.  Intel executive Eric Dishman discussed some of the barriers to widespread application of big data to healthcare encounters, citing cost, privacy and security concerns.  He also said a lack of data standardization was a major inhibitor to utilizing big data at the point of care.  And there is also the practical concern of simply organizing and managing the sheer volumes of data that increasingly is available to healthcare providers.  CIOs are in a unique position to share insights to these and related policy discussions on how to tap the promise, overcome the challenges and craft policies that are critical to encouraging innovation and improving health care through big data.

Edited by Gabriel Perna

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