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Washington Debrief: Think Tank Develops Health IT Safety Framework

February 19, 2013
by Jeff Smith, Assistant Director of Advocacy at CHIME
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Jeff Smith, Assistant Director of Advocacy at CHIME

Washington Think Tank Develops Safety Framework to Regulate Health IT In developing a regulatory safety framework pertaining to health IT HHS should establish an oversight framework that is administered by a combination of existing private sectors standards and accreditation/certification bodies, Patient Safety Organizations, and federal agencies such as AHRQ and ONC.  These are the recommendations of a report released recently by the Bipartisan Policy Center, a Washington Think Tank.  CHIME joined several other participants in compiling the report, which will help inform a broader debate over the regulation of health IT safety, as well as the recently released ONC Patient Safety Plan.  CHIME member and newly announced CEO Russ Branzell joined Siemen’s John Glaser and other panelists to discuss the report’s recommendations and steps forward.  “The health IT lifecycle is unique and speeding up,” said Branzell.  “It’s a relay race between vendors, implementers, users and patients.  This report recognizes the shared responsibilities that all these stakeholders have in patient safety and it gives policymakers a path towards a framework that enables innovation without compromising safety.”

The report describes an oversight framework that includes the following elements:

·  Agreement on and adherence to recognized standards and guidelines for assuring patient safety in the development, implementation, and use of health IT;

·  Support for the implementation of standards and guidelines as well as development and dissemination of best practices through education, training, and technical assistance;

·  Developer, implementer, and user participation in patient safety activities, including reporting, analysis, and response, while leveraging patient safety organizations (PSOs);

·  Creation of a learning environment through the aggregation and analysis of data to identify and monitor trends, mitigate future risk, and facilitate learning and improvement.

Congress directed HHS to develop such a framework in legislation passed last year.  It is hoped that this report can help inform those discussions during the upcoming year before a final HHS report is delivered to Congress.  The full report can be found on the BPC website, here

House Sees SGR ‘Window of Opportunity’ In what can aptly be compared to Sir. Lancelot’s “endless running scene” in Monty Python’s Holy Grail, the House of Representatives seems to think that 2013 is the year for permanently addressing the doc fix.  A flurry of activity has taken place in the last two weeks and now House Republicans are vowing a permanent fix no later than August.  In comments made tothe American Medical Association recently, Energy and Commerce Chairman Fred Upton (R-MI) said he hopes to have a doc fix bill on the floor by the end of July or the first week of August.  As reported in theWashington Debrief last week, congressional budget scorers revised their estimates of what a permanent fix would cost, lowering the price tag more than $100 billion to $138 billion over ten years.  House leaders see this as a “window of opportunity” because while many lawmakers understand the formula’s flaws, they cannot agree on how to pay for the fix. 

Now that the right people are on board for a fix to the SGR, the daunting process of hashing out details and adding riders to eventual legislation begins.  One idea being floated in a similarly-minded bill would provide $720 million to regional extension centers as they help assist physicians in their adoption of health IT and their adoption of alternative healthcare delivery models identified as representing best practices.  HR 574, cosponsored by Reps. Allyson Schwartz (D-PA) and Rep. Joe Heck (R-NV), would repeal the SGR, while also incentivizing innovative payment and delivery models.  Another idea being talked about in conjunction with an SGR repeal would be to replace CMS’ quality reporting program, such as the Physician Quality Reporting System (PQRS) with registries developed by physician societies.  Proponents of the idea argue that CMS should rely on quality measures submitted through PQRS and physician society-developed registries because some specialists do not fit well into alternative pay models such as accountable care organizations (ACOs) or medical homes.

Spending on Medicare, Medicaid Declines Again – Is Delivery Reform the Cause? Spending on Medicare and Medicaid has slowed significantly in each of the last four years.  Now, economists and policymakers are trying to figure out why.  According to a rash of statements made by administration officials and the non-partisan Congressional Budget, the answer may be, in part, due to changes to delivery and payment reform.  The CBO projects that spending on Medicare & Medicaid in 2020 will be about $200 billion, or 15 percent, less than it projected three years ago.  Part of the slowdown stems from “the recession and the loss of income and wealth” causing people to cut back on healthcare, Douglas W. Elmendorf, the director of the CBO, said. But he added that a “significant part” of the slowdown “probably arises from structural changes in the healthcare system.”  Later in the week, HHS Secretary Kathleen Sebelius said, “There's growing evidence that the slowdown isn't just the result of the ongoing economic recovery, but a reflection of a fundamental transformation in care delivery across the country,” while addressing attendees at the American Medical Association’s advocacy conference.

AHRQ to Study Workflow Impacts of Patient-Reported Data In continuing a string of research on the impacts of health IT on workflow, the Agency for Healthcare Research and Quality (AHRQ) announced plans to focus on patient-reported data.  According to the Federal Register, the AHRQ project “will fill the gaps in the current literature by exploring the influence of sociotechnical factors—for clinicians and their office staff, and for patients—in capturing and using patient-reported information in ambulatory health IT systems and associated workflows.”  The goal of the project is to answer the following questions:

·  How does the use of health IT to capture and use patient-reported information support or hinder the workflow from the viewpoints of clinicians, office staff, and patients?

·  How does the sociotechnical context influence workflow related tothe capture and use of patient-reported information?

·  How do practices redesign their workflow to incorporate the capture and use of patient-reported information?

The study will look at three small practices and three medium-sized practices to identify current workflows related to patient-reported information, and determine the work system factors that influence workflows (barriers and facilitators).  The report will focus on the workflows required to capture, process, and make use of information that patients report to their care providers, the AHRQ announcement said.

Calendar of Upcoming Policy Events

CHIME has several upcoming events and new documents to highlight.  See below for further information.

**SAVE THE DATE** CHIME Public Policy Monthly Briefing: A look at ONC’s Patient Safety Action & Surveillance Plan – February 20, 2103 @ 2pm ET – REGISTER HERE!!

**SAVE THE DATE** CHIME StateNet: HIE 1.0 versus hie 2.0: The Current State of Health Information Exchange – February 27, 2103 @ 2pm ET – REGISTER HERE!!


Recent Public Policy Comments & Policy Documents

CHIME Response to ONC’s Patient Safety Action & Surveillance Plan (February 2013)

**NEW** Summary of HIPAA Omnibus Rule by HPA on Behalf of CHIME (January 2013)

CHIME Comments on Stage 3 Meaningful Use (January 2013)

CHIME Comments on EHR-Generated Inpatient Quality Reporting Readiness (January 2013)

Edited by Gabriel Perna

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