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Washington Debrief: NHIT Week in Review

September 24, 2013
by Jeff Smith, Director of Public Policy at CHIME
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CHIME Celebrates NHIT Week with Policy Retreat, Senate Briefing

Twelve CHIME CIO members traveled to Washington last week to set objectives for future CHIME public policy efforts and to meet with Senate staff to talk about Meaningful Use timing. Over the course of a two-day retreat, CHIME Public Policy determined key areas of focus and is working on an action plan for the next several months. Collaborating with partners in federal agencies and on the Hill will continue to drive much of CHIME’s work in Washington, but new efforts are under way to get more CHIME CIOs involved with standards work. Several recommendations are in development and will be presented to all CHIME members during the Fall Forum, pending CHIME Board review.

Many CIOs who participated in the Public Policy retreat also met staffers from two prominent Senate committees and staff from several offices to discuss the timing for Meaningful Use in 2014. Two panels of CIOs took Senate staff through the process of EHR implementation, from beta-testing to EHR optimization. CHIME CIOs said it takes several months to train users and redesign workflows to incorporate new technology. CHIME has indicated previously to Senate staff that there is not enough time before July 2014 to implement 2014 Edition EHRs and ensure Meaningful Use program success. Last week, CHIME delivered letters, signed by more than 40 CHIME members in four states, echoing similar concerns to their senators. CHIME has called for a 12-month extension to the MU reporting window, which has subsequently been echoed by a half dozen provider organizations, including the AHA, AMA and AAFP.

Senators from the Finance and Health, Education, Labor & Pensions committees are openly considering a recommendation to HHS that would ask for a 12-month extension. If you are interested in supporting this cause, please contact Jeff Smith at jsmith@cio-chime.org

Senator Reintroduces Bill to Include Behavioral Health Providers in MU

In the wake of the recent tragic mass shooting– this one close to our nation’s capital – Senator Sheldon Whitehouse (D-RI) reintroduced the Health Information Technology Extension for Behavioral Health Services Act of 2010 (S 3709) to improve these types of care. It’s now called the Behavioral Health Information Technology Act (S 1517). Sen. Whitehouse hopes to include professionals that provide substance abuse treatment, behavioral healthcare and mental healthcare in the Meaningful Use incentive program to encourage the adoption and meaningful use of electronic health record technology.

According to the CMS website, Eligible Professionals (EPs) under the Medicare and Medicaid EHR Incentive Programs include:

  • doctor of medicine or osteopathy;
  • doctor of dental surgery or dental medicine;
  • podiatrists, optometrists and chiropractors;
  • nurse practitioners, certified nurse midwives and dentists;
  • and physician assistants who furnish services in a FQHC or Rural Health Clinic that is led by a physician assistant.

“The Behavioral Health Information Technology Act would… Expand eligibility for Medicaid meaningful use incentive payments to include community mental health centers, mental health and substance abuse treatment facilities, psychiatric hospitals, licensed psychologists and licensed clinical social workers,” according to Sen. Whitehouse’s press release.

ONC Rolls Out New Patient Consent for eHIE Website

Do patients constantly ask about their rights under HIPAA? Does your front desk have a difficult time explaining privacy rules to patients? As health information exchange technology continues to evolve, ONC has launched a website to educate patients about what they are calling “meaningful consent.” The website will detail consent options for patients and explain who can or cannot access or send their patient records. Another section of the website answers common questions on state and national laws for privacy and security.

ONC’s website states that consent decisions should be:

  • Made with full transparency and education.
  • Made only after the patient has had sufficient time to review educational material.
  • Commensurate with circumstances for why health information is exchanged (i.e., the further the information-sharing strays from a reasonable patient expectation, the more time and education is required for the patient before he or she makes a decision).
  • Not used for discriminatory purposes or as a condition for receiving medical treatment.
  • Consistent with patient expectations.
  • Revocable at any time.

CHIME’s Consent Policy workgroup will review this information and include it in their recommendations.

Privacy and Security Tiger Team Seeks Input on Disclosures Rules

Since publication of the May 2011 Proposed Rules on Accounting for Disclosures, significant implementation has gone forward on many aspects of the HITTECH Act, while leaving open questions on certain provisions affecting HIPAA. To address this gap, the HIT Policy Committee’s Tiger Team has scheduled a Sept. 30, 2013 virtual hearing to explore many of the questions raised in the proposed rules. Witnesses for the Tiger Team, chaired by Devon McGraw/Center for Democracy and Technology, include patients, vendors, business associates, providers and payers. Beginning September 23, ONC will issue a blog that invites the public to provide input.

Under proposed rules, covered entities and their business associates must provide information regarding disclosures of an individual’s protected health information (PHI) made through an electronic health record. Responses, including CHIME’s, pointed to various problems with the May 2011 proposed rules. This included the lack of clarity as to what constituted a Designated Record Set (DRS) and the request that only information gathered through a certified EHR be expected to populate an Access Report for purposes of the rule; requests for more discussion around the “type of protected health information disclosed;” and retention of the 60-day timeline for responding to Accounting for Disclosures rather than 30 days. CHIME’s response also called for withdrawal of the proposed rules and further consultation with stakeholders, a process that begins shortly

FDA Releases Final Rule on Unique Device Identifiers

On Friday, the Food & Drug Administration (FDA) issued a final rule establishing a unique device identification system for tracking medical devices. The rule consists of two main parts, describing how manufacturers of medical devices must apply unique identifiers and how a publicly-searchable database will serve as a reference catalogue for all devices that have an identifier. According to the final rule, FDA expects to implement the regulation over the course of seven years, beginning with high-risk medical devices. After it’s fully implemented, the UDI system rule is expected to:

  • Enhance the ability to quickly and efficiently identify marketed devices when recalled.
  • Improve the accuracy and specificity of adverse event reports and provide a foundation for a global, secure distribution chain, helping to address counterfeiting and diversion.
  • Offer a clear way of documenting device use in electronic health records and clinical information systems.

Washington observers note that Stage 3 Meaningful Use would be a prime target to insert UDI standards and protocols into the electronic health record. For more on the UDI final rule, click here.

Public Policy Briefing: A Demonstration of Electronic Consent Management across Settings of Care

Consent policy varies by jurisdiction and personal health information (PHI) type. As health information exchange becomes more prominent, the issue of consent becomes a more daunting challenge. Healthcare professionals have traditionally managed sensitive privacy disclosures using paper consent forms and printed or photocopied patient records. The technology challenges for privacy and confidentiality are magnified by a complex regulatory environment. To help find solutions, the Office of the National Coordinator for Health Information Technology established the Data Segmentation for Privacy workgroup.

Participate in a demo of privacy disclosure exchanges hosted by representatives of organizations involved in the workgroup's pilot program:

  • Learn about the Ultra-Sensitive Privacy Disclosure (USPD) method for exchanging health information.
  • Hear about open specification and other transport protocols.
  • Understand what ONC is considering in order to enable consent management across care settings.

To register for the Public Policy briefing on eConsent management, click here.

Edited by Gabriel Perna


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