ONC Budget Cut by 29 Percent in FY2019 Draft Bill, NIH Gets $1.25B Boost | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

ONC Budget Cut by 29 Percent in FY2019 Draft Bill, NIH Gets $1.25B Boost

June 18, 2018
by Heather Landi
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The House Appropriations Committee released a draft 2019 budget for the U.S. Department of Health and Human Services (HHS) and departments of Labor and Education that proposed slashing funding for the Office of the National Coordinator for Health IT (ONC) by $17.7 million.

Under the proposed budget in the spending bill, released last week, ONC would receive $42.7 million in total funding in fiscal year 2019, or a 29 percent reduction from the agency’s current funding of $60.4 million. The $17.7 million budget cut for ONC is smaller than the 37-percent-reduction previously proposed by the White House, which sought to slash $22 million from ONC’s funding.

A federal spending bill passed back in March maintained ONC’s funding at $60 million through this September, a figure held steady for years under the Obama Administration.

As previously reported by Healthcare Informatics’ last summer, when the House Appropriations Committee released a draft funding bill for 2018 that included a $22 million budget cut for ONC, many industry stakeholders and health IT association groups expressed concerns that cuts to ONC could have an undesirable impact on the industry. The 21st Century Cures Act, passed last December, calls on ONC to perform a number of responsibilities related wide-ranging responsibilities to improve interoperability. But pundits attest that carrying out these functions could become very difficult with a slashed budget.

In a statement, Jeff Smith, vice president of public policy at the American Medical Informatics Association (AMIA), said the organization is “disappointed” in the proposed cuts to ONC’s FY 2019 budget. Smith also notes that the proposed cuts to ONC’s budget appears to be a “continuation of stagnating support for the Office.”

“Whether you look at the burgeoning influence of consumer technology in the medical space, the continued digitization of research, or the numerous aspects of Cures yet to be implemented, ONC has the kind of workload that demands more resources, not less,” Smith stated. “Congress has played an important role in protecting ONC and other parts of HHS from the draconian budget proposals of the White House. Insofar as Cures implementation and interoperability remain important to Congress, so too should fully funding ONC.”

Overall, the House Appropriations Committee’s draft funding bill proposes a total of $89.2 billion for HHS, an increase of $1 billion above last year’s enacted level and $2.4 billion above President Trump’s budget request. The funding bill provides a $1.25 billion boost to the National Institutes of Health (NIH) for a total of $38.3 billion; that’s $4.1 billion above the Trump Administration’s budget request. The House Appropriations Committee increased funding for critical research initiatives, including a $400 million increase for Alzheimer’s disease research, a $100 million increased for the Cancer Moonshot initiative and a $29 million increase for the Brain Research through Application of Innovative Neurotechnologies (BRAIN) initiative.

Additionally, the $1.25 billion increase to NIH includes a $437 million in funding, or an increase of $147 million, for the All of Us research initiative, which aims to create a 1-million-person research cohort; $30 million more in funding to develop a universal influenza vaccine; $15 million more for research on combating antibiotic-resistant bacteria; and $12.6 million for the Gabriella Miller “Kids First” pediatric cancer research initiative.

The legislation expands support for research related to opioids and pain management, as well as for the Down syndrome research initiative established in fiscal year 2018.

The spending bill also proposed cutting the budget for the Centers for Disease Control and Prevention (CDC) by $663 million, to $7.6 billion. According to a summary of the bill, after accounting for the transfer of the Strategic National Stockpile to ASPR and the one-time facilities funding in fiscal year 2018, the legislation provides an increase of $427 million for CDC on a comparable program level. This includes $848 million in transfers from the Prevention and Public Health Fund. The bill also continues the longstanding prohibition against using federal funds to advocate or promote gun control.

The spending also funds the Substance Abuse and Mental Health Administration (SAMHSA) at $5.6 billion , which is $448 million above the fiscal year 2018 enacted level and $2.1 billion above the President’s request. SAMHSA funding includes $3.85 billion to address substance use, including opioid and heroin abuse. This amount includes $1 billion for State opioid response grants, along with funding for programs authorized in the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act.

The Agency for Healthcare Research and Quality’s budget would remain the same at $334 million. The budget request proposes to merge most of AHRQ’s activities into NIH.

The spending bill recommends providing the Centers for Medicare and Medicaid Services (CMS) $3.5 billion for CMS administrative expenses, which is $168 million below the fiscal year 2018 enacted level and $42 million below the fiscal year 2019 request. This funding level is sufficient to maintain core operations and services, the House Appropriations Committee said.

 

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EHR-Compatible Pharmacist Care Plan Standard Opens the Door to Cross-Setting Data Exchange

September 14, 2018
by Zabrina Gonzaga, R.N., Industry Voice
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Pharmacists drive information sharing towards quality improvement

Pharmacists work in multiple environments—community, hospital, long term care, clinics, retail stores, etc.—and consult with other providers to coordinate a patient’s care.  They work with patients and caregivers to identify goals of medication therapy and interventions needed, and to evaluate patient outcomes.  Too often, pharmacy data is trapped in a silo and unavailable to other members of the care team, duplicated manually in disparate systems which increases clinical workloads without adding value.

To address these issues, Lantana Consulting Group and Community Care of North Carolina (CCNC) developed an electronic document standard for pharmacist care plans—the HL7 Pharmacist Care Plan (PhCP). The project was launched by a High Impact Pilot (HIP) grant to Lantana from the Office of the National Coordinator for Health Information Technology (ONC).

Before the PhCP, pharmacists shared information through paper care plans or by duplicative entry into external systems of information related to medication reconciliation and drug therapy problems. This documentation was not aligned with the in-house pharmacy management system (PMS). The integration of the PhCP with the pharmacy software systems allows this data to flow into a shared care plan, allowing pharmacists to use their local PMS to move beyond simple product reimbursement and compile information needed for quality assurance, care coordination, and scalable utilization review.

The PhCP standard addresses high risk patients with co-morbidities and chronic conditions who often take multiple medications that require careful monitoring. Care plans are initiated on patients identified as high risk with complex medication regimes identified in a comprehensive medication review. The PhCP is as a standardized, interoperable document that allows pharmacist to capture shared decisions related to patient priorities, health concerns, goals, interventions, and outcomes. The care plan may also contain information related to individual health and social risks, planned interventions, expected outcomes, and referrals to other providers. Since the PhCP is integrated into the PMS or adopted by a software vendor (e.g. care management, chronic management, or web-based documentation system), pharmacist can pull this information into the PhCP without redundant data entry.

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The PhCP allows pharmacists for the first time to share information with support teams and paves the way for them to support value-based payment. The project goals align with the Center for Medicare & Medicaid Services’ (CMS’) value-based programs, which are part of the Meaningful Measure Framework of improved care team collaboration, better health for individuals and populations, and lower costs.

Scott Brewster, Pharm.D., at Brookside Pharmacy in East Tennessee, described the PhCP as a tool that helps them enhance patient care delivery. “From creating coordinated efforts for smoking cessation and medication utilization in heart failure patients, to follow up on recognized drug therapy problems, the eCare plan gives pharmacists a translatable means to show their value and efforts both in patient-centered dispensing and education that can reduce the total cost of care.” (The eCare plan reference by Scott Brewster is the local term used in their adoption of the PhCP).

The pilot phase of the project increased interest in exchanging PhCPs within CCNC’s pharmacy community and among pharmacy management system (PMS) vendors. The number of vendors seeking training on the standard rose from two to 22 during the pilot. Approximately 34,000 unique care plans have been shared with CCNC since the pilot launch.

This precedent-setting pilot design offered two pharmacy care plan specifications: one specification is based on the Care Plan standard in Clinical Document Architecture (CDA); the other standard is a CDA-on-FHIR (Fast Healthcare Interoperability Resources). The latter specification directly transforms information shared using the FHIR standard into CDA. FHIR is straight forward to implement than CDA, so this is an appealing option for facilities not already using CDA. The dual offerings—CDA and CDA-on-FHIR with lossless transforms—provide choice for implementing vendors while allowing consistent utility to CCNC.

What’s on the horizon for the pharmacy community and vendors? With the support of National Community Pharmacists Association (NCPA), the draft standards will go through the HL7 ballot process for eventual publication for widespread implementation and adoption by vendors. This project will make clinical information available to CCNC and provide a new tool for serving patients with long-term needs in the dual Medicare-Medicaid program and Medicaid-only program.  This is a story about a successful Center for Medicare and Medicaid Innovation (CMMI)funded project that started out as a state-wide pilot and is now rolling out nationwide as Community Pharmacy Enhanced Service Network (CPESN)USA. 

The PhCP is based on a CDA Care Plan standard that is part of ONC’s Certified EHR Technology requirements, so it can be readily implemented into EHRs. This makes the pharmacist’s plan an integral part of a patient’s record wherever they receive care. 

Adoption of the PhCP brings pharmacies into the national health information technology (HIT) framework and electronically integrates pharmacists into the care planning team, a necessary precursor to a new payment model and health care reform. In addition, receiving consistently structured and coded pharmacy care plans can augment data analysis by going beyond product reimbursement to making data available for, utilization review, quality assurance and care coordination.

Troy Trygstad, vice president for Pharmacy Provided Partnerships at CCNC, described the strategic choice now available to pharmacists and PMS vendors. “Fundamentally, pharmacy will need to become a services model to survive. Absent that transformation, it will become a kiosk next door to the candy aisle. The reasons vendors are buying into the PhCP standard for the first time ever is that their clients are demanding it for the first time ever."

The move to value-based payment will continue to drive the need for pharmacists, as part of care teams, to provide enhanced care including personal therapy goals and outcomes. Sharing a medication-related plan of care with other care team members is critical to the successful coordination of care for complex patients.

Zabrina Gonzaga, R.N., is principal nurse informaticist and director of health informatics at Lantana Consulting Group and led the design and development of the PhCP standard. 

Email:  zabrina.gonzaga@lantanagroup.com

Twitter: @lantana_group

 


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Health IT Now Pushes for Information Blocking Regulation, Says Administration “Must Uphold its End of the Bargain”

September 13, 2018
by Rajiv Leventhal, Managing Editor
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The executive director of Health IT Now, a coalition of healthcare and technology companies, is again criticizing the Trump administration for not yet publishing any regulation on information blocking, as required by the 21st Century Cures Act legislation.

In an op-ed published recently in STAT, Health IT Now’s Joel White wrote, “More than 600 days after the enactment of the Cures Act, not a single regulation has been issued on information blocking.” White added in frustration, “Health IT Now has met with countless officials in the Trump administration who share our commitment to combat information blocking. But those sentiments must be met with meaningful action.”

The onus to publish the regulation falls on the Office of the National Coordinator for Health IT (ONC), the health IT branch of the federal government that is tasked with carrying out specific duties that are required under the 21st Century Cures Act, which was signed into law in December 2016. Some of the core health IT components of the Cures legislation include encouraging interoperability of electronic health records (EHRs) and patient access to health data, discouraging information blocking, reducing physician documentation burden, as well as creating a reporting system on EHR usability.

The information blocking part of the law has gotten significant attention since many stakeholders believe that true interoperability will not be achieved if vendors and providers act to impede the flow of health data for proprietary reasons.

But ONC has delayed regulation around information blocking a few times already, though during an Aug. 8 episode of the Pulse Check podcast from Politico, National Coordinator for Health IT Donald Rucker, M.D., said that the rule is "deep in the federal clearance process." And even more recently, a bipartisan amendment to the U.S. Senate's Department of Defense and Labor, Health and Human Services, and Education Appropriations Act for Fiscal Year 2019 includes a requirement for the Trump administration to provide Congress with an update, by September 30.

White, in the STAT piece, noted a June Health Affairs column in which Rucker suggested that implementation of the law’s information blocking provisions would occur “over the next few years.” White wrote that this is “a vague timeline that shows little urgency for combating this pressing threat to consumer safety and stumbling block to interoperability.”

Health IT Now is not alone in its belief that the rule should have been published by now, nor is it the first time the group is bringing it up. Last month

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By the end of this year, ONC’s implementation and interpretation of data blocking will also be published and available for comment, as was the case with the TEFCA proposed rule. The TEFCA final rule is also anticipated by the end of 2018.

HOWEVER…there’s still time to prepare for TEFCA and the data blocking regulation, and final rules for both in the coming months will set concrete timelines, and for TEFCA it will be interesting to see how ONC reacts to stakeholder comments, internal and external.

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