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President Trump, VA Announce New Telehealth Initiatives for Veteran Care

August 4, 2017
by Heather Landi
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The Department of Veterans Affairs (VA) will soon roll out expanded telehealth capabilities, including a new application called VA Video Connect, to provide greater access to health care for veterans, as part of an initiative announced by President Donald Trump and VA Secretary David Shulkin, M.D., on Thursday.

The goal of the initiative is to use telehealth technology and mobile applications in order to connect with more Veterans to provide services where they live, Shulkin said during the White House event announcing the initiative.

The most significant aspect of the initiative is a new regulation that enables doctors to provide health care to veterans anywhere in the VA through telemedicine, regardless of location or state licensing laws.

“We’re expanding the ability of veterans to connect with their VA health care team from anywhere using mobile applications on the veterans’ own phone or own computer,” President Trump said during a White House event announcing the initiative, which a video was posted on YouTube.  “This will significantly expand access to care for our veterans, especially for those who need help in the area of mental health, which is a big request. And also in suicide prevention. It will make a tremendous different for veterans in rural locations in particular. We’re launching the mobile app that will allow VA patents to schedule and change appointments using their smartphones.”

Through VA Telehealth VA can practice over 50 clinical specialties, from tele-dermatology to tele-intensive care. Many of the veterans using telehealth live in rural areas or far away from their closest VA medical facility, according to Shulkin.

The VA has the largest telehealth program in the country and last year, 700,000 veterans received telehealth services through the VA.

Members of Congress have been trying to address geography and licensing barriers to telehealth services, most recently with the introduction of the Veterans E-Health and Telemedicine Support Act of 2017 (VETS Act), which proposed to allow qualified VA health professionals to operate across state lines and conduct telehealth services. U.S. Senators Joni Ernst (R-IA) and Mazie Hirono (D-HI), both members of the Senate Armed Services Committee, called for the expansion of telehealth services for veterans by introducing the VETS Act in 201, and then reintroducing it this past April.

Sen. Ernst, a combat veteran, voiced support for the VA initiative, stating in a press release that the announcement “follows the senator’s efforts to improve telehealth services for veterans through their bipartisan legislation, the VETS Act.”

“The VA’s decision to allow veterans to access care from the comfort of, or closer to, their own homes is necessary to improving quality and timely care for the more than 200,000 veterans in Iowa, particularly those who are disabled or reside in rural communities,” Ernst said.

Other groups pushing for expansion of telehealth services and licensing, including the National Council of State Boards of Nursing, also applauded the new regulation. “The NCSBN commends VA for addressing the important health care challenges facing our nation’s veterans, particularly through telehealth, and appreciates the opportunity to share our views with you," the organization stated a letter. "VA and private sector efforts to expand telehealth as a model of care delivery and recognizes that technological advances can reduce the cost of care, increasing patient access to care and satisfaction and improve health outcomes for veterans across the country,” the organization stated, further noting that the organization stands by the idea that the standard of care for telehealth nursing should be the same as care delivered in person.

The initiative announced on Thursday will expand VA’s telehealth capability in three specific areas.

Shulkin noted that a new federal regulation was required to allow VA doctors to treat patients remotely across state lines. Working with the White House Office of American Innovation and the Department of Justice, the VA be issuing a regulation that explicitly authorizes VA providers, using telehealth technologies, to serve veterans no matter where the provider or the veteran is located in the country, Shulkin said. The “Anywhere to Anywhere VA Health Care” initiative will enable VA to hire providers in major metropolitan areas, where there is an abundance of clinical services and connect them to better serve veterans in rural communities that lack sufficient medical services, Shulkin said.

He specifically cited the example of the need for mental health professionals and suicide prevention services. “That’s one area where we can use that expertise,” Shulkin said.

The VA also is initiating the nationwide rollout of a new application called VA Video Connect. VA Video Connect provides a secure and web-enabled video service that makes it easy for Veterans to connect with their VA providers by video on their own mobile phones or personal computers. VA Video Connect is currently being used by more than 300 VA providers at 67 hospitals and their associated clinics. It will be rolled out to VA providers and Veterans across the country over the next year.

Shulkin also announced the nationwide roll-out of an application to make it easier to scheduled or change appointments with VA. The Veteran Appointment Request app, or VAR for short, is an application that makes it possible for Veterans to use their smartphone, tablet or computer to schedule or modify appointments at VA facilities. The VAR capability is currently available to Veterans at several locations nationwide. During its initial rollout, Veterans used the app to book more than 4,000 appointments with their providers.  Following today’s announcement, VA will continue to roll out the application nationwide – bringing the capability to all VA facilities and clinics.

“What we’re really doing is, we’re removing regulations that have prevented us from doing this.  We’re removing geography as a barrier,” Shulkin said

During the White House event announcing the initiative, Shulkin demonstrated some of the telehealth capabilities, specifically the VA Video Connect to connect with a veteran receiving on-site care in Grand Pass, Oregon. During the demonstration, Shulkin also showed how the video capabilities could connect the veteran with an internal medicine specialists in another city.

During the White House event, which was broadcast on YouTube, Shulkin also demonstrated what he called “the doctor bag of the future,” which included digital diagnostic tools and a notebook computer, the same digital health tools that President Trump’s own personal doctor uses. “We are now able to bring this doctor’s bag into the homes of our veterans, the same technology that is available to President of the United States, and that’s the way it should be,” Shulkin said.

During the event, President Trump also touted what he called “tremendous progress” by the VA in just the past six months to improve health care services to veterans through the use of technology. He specifically cited the upgrades to the VA’s electronic health record (EHR) system through its contract with Cerner to replace the VistA system with a commercial off-the-shelf platform, and the launching a new website that enables veterans to see wait times at both VA and non-VA hospitals.

 

 

 

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Senate Passes Opioid Response Bill with Substantial Health IT Elements

September 18, 2018
by Rajiv Leventhal, Managing Editor
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The U.S. Senate yesterday passed The Opioid Crisis Response Act of 2018, which includes numerous important health IT provisions, by a vote of 99-1.

The bill was originally sponsored by Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.), and includes proposals from five Senate committees and over 70 senators. The House passed its version of the legislation in June and now it’s expected that a committee will be convened to reconcile the differences between the two.

The legislation’s core purpose is to improve the ability of various health departments and agencies—such as the Department of Health and Human Services (HHS), including the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), and the Departments of Education and Labor—to address the opioid crisis, including the ripple effects of the crisis on children, families, and communities, help states implement updates to their plans of safe care, and improve data sharing between states.

There are several key health IT provisions in the legislation, including: enabling the Centers for Medicare & Medicaid Services (CMS) to test various models that provide incentive payments to behavioral health providers for the adoption and use of certified electronic health record (EHR) technology to improve the quality and coordination of care through the electronic documentation and exchange of health information; requiring the use of electronic prescribing for controlled substances within Medicare Part D; facilitating the use of electronic prior authorization within Medicare Part D; and expanding access to telehealth services for substance use disorders.

Regarding telehealth specifically, the Senate version of the bill will allow for payment for substance use disorder treatment services, via telehealth, to Medicare beneficiaries at originating sites, including a beneficiary’s home, regardless of geographic location. It also requires guidance to cover state options for federal reimbursement for substance use disorder services and treatment using telehealth including, services addressing high-risk individuals, provider education through a hub-and-spoke model, and options for providing telehealth services to students in school-based health centers.

Health IT Now's Opioid Safety Alliance—a working group of prescribers, health systems, technology companies, pharmacies and pharmacists, professional societies, and patients advocating for the use of technology to fight illegitimate opioid use—supported the Senate’s passing of the bill. Said Joel White, HITN Opioid Safety Alliance executive director, “We are especially encouraged by the inclusion of commonsense Opioid Safety Alliance-endorsed language in this bill that will remove bureaucratic barriers to vital telehealth services for those suffering from addiction, modernize prescribing practices for controlled substances, and streamline prior authorization claims to improve efficiency while bolstering patient safety. These solutions can make a world of difference both in dollars saved and, more importantly, lives spared."

White did add, however, as Congress convenes a committee to reconcile the differences in the House and Senate-passed bills, lawmakers ought to include the House-passed OPPS Act (H.R. 6082) as part of any final conference agreement, “thereby ensuring that addiction treatment records are no longer needlessly isolated from the rest of a patient's medical history—a practice that has hindered informed decision making and threatened patient safety for too long.”

Indeed, the Senate version of the bill requires HHS “to develop best practices for prominently displaying substance use treatment information in electronic health records, when requested by the patient.”

White also noted, “Additionally, OSA remains concerned about the lack of real-time, actionable data provided to clinicians by states' prescription drug monitoring programs (PDMPs). With lawmakers poised to devote additional resources toward these programs, we should know if taxpayers are getting a return on their investment. We support the inclusion of language that would require an objective study and report on states' use of PDMP technology." 

As stated in the bill, states and localities would be provided with support to improve their PDMPs and "implement other evidence-based prevention strategies.” The bill also “encourages data sharing between states, and supports other prevention and research activities related to controlled substances."

What’s more, another section of the bill reauthorizes an HHS grant program “to allow states to develop, maintain, or improve PDMPs and improve the interoperability of PDMPs with other states and with other health information technology.”

Sen. Alexander, meanwhile, said yesterday he is “already working to combine the Senate and House-passed bills into an even stronger law to fight the nation’s worst public health crisis, and there is a bipartisan sense of urgency to send the bill to the President quickly.”

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Survey: Healthcare Organizations Report Gaps in Disaster Preparedness Plans

September 12, 2018
by Heather Landi, Associate Editor
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As Hurricane Florence churns toward the East Coast this week, disaster preparedness is a timely topic, yet a new survey finds that only 72 percent of healthcare providers believe their organization’s disaster plan is comprehensive enough to cover a variety of disaster scenarios both inside the organization and across the community.

The findings are even more troubling among specialty care providers, such as cardiologists and endocrinologists, who provide critical treatment to individuals with chronic diseases, with just 29 percent reporting that they have a comprehensive disaster plan in place. More than two-thirds (68 percent) of survey respondents were affected by two or more disasters in last five years, according to the survey, yet most respondents doubt their organization’s disaster plans are up to the task.

DrFirst, a provider of e-prescribing and medication management solutions, surveyed 109 healthcare professionals across acute, ambulatory, hospice and home care about disaster preparedness. According to the DrFirst, the results are critical for addressing potential safety issues that affect the health and lives of millions of Americans who are increasingly subject to hurricanes, wildfires, and floods as well as other man-made disasters like digital and criminal attacks.

“The fact that almost 70 percent of the surveyed healthcare providers have been affected by more than two disasters in the last 5 years should be a major wake-up call for the healthcare industry,” G. Cameron Deemer, president of DrFirst, said in a statement. “As we learned in the aftermath of major disasters such as hurricanes Maria and Harvey, natural disasters lead to surging demands for acute and emergency care, especially from the most vulnerable patients who may have been displaced from their homes without medications or critical medical supplies, like oxygen or diabetic testing equipment. We must take measures now to address the critical gaps impacting patient care and safety, such as communication challenges and ready-access to medical records and specialty care providers.”

The survey revealed another key vulnerability—the widespread dependence on disaster communications methods that fail to meet legal requirements for secure communications between medical teams, pharmacies, and patients, according to the survey. Under the federal law known as the Health Insurance Portability and Accountability Act (HIPAA), a patient’s private health information can only be shared with the patient or other providers via secure methods such as password-protected portals and secure messaging.

One-third or more of clinicians surveyed across acute, ambulatory and hospice/home health state that calling by phone is their top method for communicating with pharmacies, EMS units, patients and families, local authorities, and community health providers in times of disaster. Secure messaging and email complete the top three modes of communication.

A striking number of clinicians use regular unsecured text messaging to reach hospitals: more than one-quarter of respondents use this mode to communicate with hospitals during and immediately after a disaster strikes, and 22 percent report using unsecured texting to communicate with patients or their family members. According to the Centers for Medicare and Medicaid Services (CMS), the use of phones for texting of patient health information is only permissible through a secure messaging platform that provides message encryption. Encryption is also required when emailing patient health information.

Healthcare professionals working in hospitals were more aware of the need for secure messaging tools than individuals working in other settings, including specialty care providers. Forty-four percent of hospital-based respondents said that secure, HIPAA-compliant medical messaging is a key requirement of a disaster preparedness plan.

In fact, hospital-based respondents indicated that the only requirements more important than secure messaging were the installation of backup generators in case of power outages (56 percent) and the ordering and maintaining of extra inventory of supplies and medications (52 percent). Yet, specialty providers place the need for including secure messaging at the very bottom of their disaster planning requirements.

Survey respondents also see telehealth is a viable disaster solution, as 45 percent cited telehealth as an effective option to provide care to patients across the community during or immediately after disasters or emergencies. However, more than half expressed concerns that connectivity and other technical issues could impact the reliability of telehealth, and only 27 percent believe their organization has deployed adequate telehealth capabilities.

Another key finding from the survey is that many organizations preparing for an impending disaster still rely heavily on paper, with most advising patients to keep copies of their medical records. Just 40 percent of respondents believe their electronic health record (EHR) has sufficient information available to take care of all patients during a disaster.

 

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CPT Codes Updated to Reflect HIT Advancements

September 6, 2018
by Rajiv Leventhal, Managing Editor
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The American Medical Association (AMA) announced the release of the 2019 Current Procedural Terminology (CPT) code set, with changes reflecting new technological shifts in the industry.

According to the AMA, there are 335 code changes in the new CPT edition reflecting the CPT Editorial Panel and the healthcare community’s “combined annual effort to capture and describe the latest scientific and technological advances in medical, surgical and diagnostic services.”

Among this year’s changes to CPT include three new remote patient monitoring codes that reflect how healthcare professionals can more effectively and efficiently use technology to connect with their patients at home and gather data for care management and coordination. Also, two new interprofessional internet consultation codes have been added to reflect the increasing importance of using non-verbal communication technology to coordinate patient care between a consulting physician and a treating physician, according to AMA.

“The CPT code set is the foundation upon which every element of the medical community—doctors, hospitals, allied health professionals, laboratories and payers—can efficiently share accurate information about medical services,” AMA President Barbara L. McAneny, M.D., said in a statement. “The latest annual changes to the CPT code set reflect new technological and scientific advancements available to mainstream clinical practice, and ensure the code set can fulfill its trusted role as the health system’s common language for reporting contemporary medical procedures. That’s why we believe CPT serves both as the language of medicine today and the code to its future.”

McAneny added that the AMA has urged the Centers for Medicare and Medicaid Services (CMS) to adopt the new codes for remote patient monitoring and internet consulting and designate the related services for payment under federal health programs in 2019. “Medicare’s acceptance of the new codes would signal a landmark shift to better support physicians participating in patient population health and care coordination services that can be a significant part of a digital solution for improving the overall quality of medical care,” she said.

In July, as part of CMS’ proposed Physician Fee Schedule and Quality Payment Program rule, the agency recommended various provisions that would aim to support access to care using telecommunications technology, such as: paying clinicians for virtual check-ins, paying clinicians for evaluation of patient-submitted photos; and expanding Medicare-covered telehealth services to include prolonged preventive services.

New CPT category I codes are effective for reporting as of Jan. 1, 2019. Additional CPT changes for 2019 include new and revised codes for skin biopsy, fine needle aspiration biopsy, adaptive behavior analysis, and central nervous system assessments including psychological and neuropsychological testing.

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