EHR Meaningful Use Video from HHS

EHR Meaningful Use Press Conference from HHS

What is NHIN Direct?

What is NHIN Direct?
What is the NHIN Limited Production Exchange?
How do they work together?
What about CONNECT?

If you have questions about ONC’s efforts to create a comprehensive infrastructure for secure health information exchange, you won’t want to miss the next NHIN University class -

NHIN 103: ONC Initiatives for Health Information Exchange and their Continuing Evolution – on Monday, April 19!

By participating in this class, students will become familiar with:
* The core elements of the ONC’s Nationwide Health Information Network (NHIN) program
* The NHIN Limited Production Exchange and the capabilities supported today
* The FHA CONNECT solution and how this solution can be used by adopters today
* The NHIN Direct project to expand the NHIN specifications and how this project complements the other NHIN initiatives

Register Now for NHIN University!
________________________________

NHIN 103: ONC Initiatives for Health Information Exchange and their Continuing Evolution (NEW TITLE!)
DATE: Monday, April 19, 2010 TIME: 1:00 – 2:30 pm ET

FACULTY:

* Douglas Fridsma, MD, PhD – Acting Director, Office of Standards and Interoperabilty, Office of the National Coordinator for Health IT (ONC)
* Rich Kernan – NHIN Specification Factory Lead (Contractor), ONC
* David Riley, BS, PAC – CONNECT Initiative Lead (Contractor), Federal Health Architecture, ONC
WEBINAR: https://nationalehealthevents.webex.com/nationalehealthevents/onstage/g.php?t=a&d=669956907

AUDIOCONFERENCE: (866) 699-3239 or (408) 792-6300 (Please join the event with a computer system first and follow the audio instructions on the screen.)

ACCESS/EVENT CODE: 669 956 907

ATTENDEE ID: You will receive this number when you join the event first with a computer connection.

If you are not available to attend, the webinar will be recorded and posted to the NeHC website – www.NationaleHealth.org/NHIN-U – following the class.

Healthwise, Inc. CEO Comments on HL-7 InfoButton Standard

January 28, 2010

The Info-Button Standard: Bringing Meaningful Use to the Patient

By DON KEMPER, CEO HEALTHWISE

“Regardless of the U.S. administration’s “meaningful use” requirements, if health information technology (HIT) is to become meaningful for patients, it must include the prescription of information and tools to help each patient better manage his or her own care.

Ask patients what they want from HIT systems, and they will tell you three things:

- “Tell me my diagnosis, what will happen, and what I can do myself to better manage the problem.”

- “Tell me my medical tests results and what they mean to me.”

- “Tell me my treatment options, and help me participate in the treatment decisions.”

The soon-to-be-finalized HL7 International Context-Aware Information Retrieval standard (nicknamed the HL7 “Infobutton” standard) makes it far easier for providers of electronic health records (EHRs) and personal health records (PHRs) to deliver just what the patient wants. And that is what will put the meaning into meaningful.

Using the HL7 Infobutton Standard for Information Prescriptions

The HL7 Infobutton standard has been widely adopted since 2007. It facilitates the delivery of a set of standardized information about the patient, the provider, and the activity of a specific care encounter or moment in care. An Infobutton manager (or equivalent) accessed by an EHR application can then pull from that set the information it needs for any relevant use case. In most cases the Infobutton has been used to bring up decision support information for the clinician.

This same HL7 standard can also be used to trigger relevant, helpful patient education orders or “information prescriptions”—for the patient. While the knowledge request can be triggered by the click of a button, the button click is not always necessary. The information prescriptions can be automatically generated, based on the context of the patient’s particular moment in care, for presentation in a handout or secure message, or on the personal health record (PHR).

In an EHR, a clinician triggers a knowledge request to a content provider. (A knowledge request differs from a query, because it returns tailored, targeted, and relevant information instead of the overabundance of documents with varying degrees of relevance that a standard query might deliver.) The content provider responds with a list of patient information prescriptions appropriate for that patient and that specific care encounter.

In the PHR, the request can be launched by the patient or automatically triggered by a scheduled appointment, a preventive service that is due, a medical test report, or any other clinical event. The content provider responds with relevant Web-based consumer health content.

By having both synchronous and asynchronous triggers, systems can generate relevant, helpful information at every point in the health care continuum. In all cases, the knowledge request and response protocols are defined by the HL7 Infobutton standard. This minimizes development effort and provides a single consumer content integration solution for both HIT developers and content providers.

Download the full white paper: “Getting Patients to Meaningful Use: Using the HL7 Infobutton Standard for Information Prescriptions (PDF)”

As chairman and CEO of Healthwise Mr. Kemper is a passionate advocate for raising the quality of patient engagement in health care. By prescribing prevention, self-management, and decision-support tools relevant to each patient’s needs, clinicians can engage and motivate their patients to become active partners in their health and wellness.

Mr. Kemper co-authored Information Therapy: Prescribed Information as a Reimbursable Medical Service with Molly Mettler. The Ix book lays out both the concept and the practical details of how
information prescriptions will become a core and expected part of health care.

More information about Healthwise can be found at http://www.healthwise.org/”

Government Releases First EHR “Meaningful Use” Criteria

As reported in Healthcare IT News, “The government delivered on Wednesday the long-awaited definition of meaningful use of electronic health record technology, and it came wrapped in about 700 pages of proposed regulation.

[1] Objective: Use CPOE
Measure: CPOE is used for at least 80 percent of all orders

[2] Objective: Implement drug-drug, drug-allergy, drug- formulary checks
Measure: The EP has enabled this functionality

[3] Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT®
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.

[4] Objective: Generate and transmit permissible prescriptions electronically (eRx).
Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

[5] Objective: Maintain active medication list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.

[6] Objective: Maintain active medication allergy list.
Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.

[7] Objective: Record demographics.
Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data

[8] Objective: Record and chart changes in vital signs.
Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.

[9] Objective: Record smoking status for patients 13 years old or older
Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded

[10] Objective: Incorporate clinical lab-test results into EHR as structured data.
Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.

[11] Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
Measure: Generate at least one report listing patients of the EP with a specific condition.

[12] Objective: Report ambulatory quality measures to CMS or the States.
Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule.

[13] Objective: Send reminders to patients per patient preference for preventive/ follow-up care
Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over

[14] Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules
Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3.

[15] Objective: Check insurance eligibility electronically from public and private payers
Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP

[16] Objective: Submit claims electronically to public and private payers.
Measure: At least 80 percent of all claims filed electronically by the EP.

[17] Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request
Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours.

[18] Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)
Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information

[19] Objective: Provide clinical summaries to patients for each office visit.
Measure: Clinical summaries provided to patients for at least 80 percent of all office visits.

[20]  Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically.
Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.

[21] Objective: Perform medication reconciliation at relevant encounters and each transition of care.
Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care.

[22] Objective: Provide summary care record for each transition of care and referral.
Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals.

[23] Objective: Capability to submit electronic data to immunization registries and actual submission where required and accepted.
Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries.

[24] Objective: Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice.
Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically).

[25] Objective: Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities.
Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary.

Healthcare IT Savings Wishful Thinking?

http://www.healthcareitnews.com/news/health-it-savings-estimates-are-wishful-thinking-say-harvard-researchers

New Harvard study questions whether investment in healthcare IT actually improves hospital efficiency, cost-savings, and quality.

My take is that it is too early to get a definitive answer.  We are in the infancy stages and won’t be able to measure any significant ROI until we have critical mass of physicians and hospitals adopting robust electronic health records and engaging in electronic healthcare information exchange.

101 Ways To Use Twitter In Your Hospital

Great blog entry from LPN to RN.net Blog on use of Twitter in hospitals.

http://www.lpn-to-rn.net/blog/2009/101-ways-to-use-twitter-in-your-hospital/

SCRUM and AGILE Software Development Methodology

I’m hearing more and more about the use of SCRUM and Agile software development techniques in healthcare.

http://scrummethodology.com/scrum-user-stories/

Many of the NHIN components are being generated using these methodologies which depart from the past waterfall approach of long builds followed by testing and long deployment cycles.

In the SCRUM and AGILE Software Development Methodologies, small, quick builds are developed to the user for feedback and rapid iterative prototypes over time.

Software is build in SPRINTS with releases as quick as every couple of weeks.

Watch for future posts.

National Healthcare Information Technology Week

BRIEFING ANNOUNCEMENT

Health Care Information Technology Showcase and NHIN Presentation

When:
Thursday, September 24th, 10:00 am – 2:30 pm

Where:
Room 325 Russell Senate Office Building, Delaware and Constitution Ave., NE, Washington, DC 20510

RSVP:
Register now

Cost:
Complimentary for registered attendees

Please join us for our annual Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics” Health Care Information Technology Showcase and NHIN Presentation on Capitol Hill, Thursday, September 24th, 10:00 am – 3:00 pm., Room 325 Russell Senate Office Building, Delaware and Constitution Ave., NE, Washington, DC .

On Monday the Senate unanimously renamed the beautiful and historic caucus room “The Kennedy Caucus Room”. The event is open to the public and will be widely attended.

There will be more than 30 interactive tabletop displays by government, industry and academia.

Lead Members of Congress including: Senators Kent Conrad (D-ND); Sheldon Whitehouse (D-RI); and Representatives Patrick Kennedy (D-RI); Allyson Y. Schwartz (D-PA); Tim Murphy (R-PA) and David Wu (D-OR) are anticipated to address an assembled audience at noon.

Jean-Philippe Linteau, Senior Trade Commissioner and Commercial Counselor of the Canadian Embassy will deliver remarks following the Members of Congress.

DHHS Deputy Assistant Secretary for Minority Health, Garth Graham, M.D. will be on hand to discuss the Health Information Technology for Underserved Populations (HIT-UP) initiative.

In addition, key federal agency officials including: Vish Sankaran, Program Director, Federal Health Architecture, Office of The National Coordinator for HIT; Jim Borland, Social Security Administration Special Advisor for Health IT; and Lieutenant Commander Steve Steffensen from TATRC; will lead a presentation of the National Health Information Network and CONNECT efforts.

Four projects being demonstrated are:

*Wounded Warrior: The Department of Defense, Department of Veterans Affairs, Indian Health Service and Social Security Administration will demonstrate the ability to share a soldier’s health record throughout the continuity of care as well as during the disability determination process.

*Biosurveillance: The CDC, state health organizations and other private entities will demonstrate ways mandated public health case reporting can be enhanced using NHIN-enabled health information exchange, yielding opportunities to blaze new trails regarding knowledge of infectious and chronic diseases as well as injuries, ultimately yielding an ability to reduce morbidity, mortality and healthcare costs.

*Long Term Disability Determination: The Social Security Administration and MedVirginia will demonstrate how access to electronic health records can dramatically speed the process of collecting the evidence required to make disability determinations.

*Cancer Research: The National Cancer Institute (NCI) will demonstrate how information can be exchanged using a caBIG(r) caGrid service and CONNECT to link research and care delivery – ultimately advancing research and supporting healthcare decisions.

Once again this year the HIT Technology Showcase will be integrated into the activities of “National HIT Week” September 21st – 25th.

The Thursday, September 24th program will also be webcast live courtesy of www.NextGenWeb.org and rebroadcast via www.Internet2.edu

The Technology Showcase schedule for September 24th is:

10:00 am – HIT Technology Showcase Opens to the Public 12:00 pm – Lunch remarks by Members of Congress & Federal Agency Leaders (Box Lunch Available) 12:30 pm – Demonstration of NHIN / Federal Health Architecture
1:00 pm – Tabletop Displays Resumes
3:00 pm – Showcase Closes

The session is part of a 2009 series of educational programs on behalf of the Capitol Hill “Steering Committee on Telehealth and Healthcare Informatics.”

The Steering Committee has convened more than 130 widely attended educational sessions and healthcare technology demonstrations since 1993 for Members of Congress, congressional staff, key federal agency officials, industry professionals and the general public.

In May of last year, the Healthcare Information Management Systems Society (HIMSS) Foundation launched the Washington-based “Institute for e-Health Policy” www.e-healthpolicy.org to provide educational and research opportunities for public and private sector stakeholders impacted by e-health policy decisions. The Institute is continuing operation and management of the Capitol Hill HIT briefing series.

*PLEASE NOTE: PER CONGRESSIONAL RULES, THIS EVENT IS CATEGORIZED AS A “WIDELY ATTENDED EVENT OPEN TO THE PUBLIC”. IF YOU’VE RECEIVED THIS ADVISORY FROM A COLLEAGUE RATHER THAN DIRECTLY FROM THE INSTITUTE FOR E-HEALTH POLICY, YOU CANNOT USE THE ONE-CLICK LINK ABOVE TO REGISTER FOR THIS BRIEFING. THAT LINK CAN BE USED ONLY BY THE PERSON WHO ORIGINALLY GOT THE ADVISORY FROM THE ALLIANCE.

If you have any problems or questions, please contact Wayne Humphries at (703) 562-8870 or e-mail us at info@ehealthpolicy.org.

Special Thanks to Our Early 2009 Sponsors

* Agency for Healthcare Research and Quality (AHRQ)
* Alaska Federal Healthcare Access Network (AFHAN)
* American Health Information Management Association (AHIMA)
* American Hospital Association (AHA)
* American Medical Informatics Association (AMIA)
* American Telemedicine Association (ATA)
* Army Telemedicine and Advanced Technology Research Center (TATRC)
* Association of Clinicians for the Underserved (ACU)
* AT&T, Inc.
* Blue Cross Blue Shield Association (BCBSA)
* Cisco Systems, Inc.
* College of Healthcare Information Management Executives (CHIME)
* Commonwealth Fund
* Continua Health Alliance
* eHealth Initiative (eHI)
* Harris Corporation
* Healthcare Information and Management Systems Society (HIMSS)
* Inland Northwest Health Services (INHS)
* INRange Systems, Inc.
* Institute of Electrical and Electronics Engineers (IEEE-USA)
* Internet Innovation Alliance (IIA)
* Internet2 Coalition
* National Library of Medicine (NLM)
* New York Presbyterian Hospitals
* Northrop Grumman
* Perot Systems
* RCHN Community Health Foundation
* RTI International
* Rural Health IT Corporation
* Science Applications International Corporation (SAIC)
* TriZetto
* Verizon Foundation

Honorary Steering Committee
Co-chairs are:

Senators
Kent Conrad (D-N.D.)
Mike Crapo (R-ID)
John Thune (R-S.D.)
Sheldon Whitehouse (D-RI)

Representatives
Eric Cantor (R-VA)
Rick Boucher (D-VA)
Bart Gordon (D-TN)
Allyson Y. Schwartz (D-PA)
David Wu (D-OR)

The Steering Committee coordinates many activities with the U.S. House of Representatives’ 21st Century Health Care Caucus, co-chaired by Reps. Tim Murphy (R-PA) and Patrick Kennedy (D-RI), and is supported by more than 20 major organizations in the healthcare and health information technology (HIT) communities, including trade associations, government agencies, universities and corporations.

Special thanks to NextGenWeb and Internet2 for recording and archiving webcasts of today’s program on their sites. An archived version of the webcast will also be available on the Institute’s web site .

The Congressional Luncheon Seminar Series is a project managed by the Institute for e-Health Policy, a subsidiary of the HIMSS Foundation, a not-for-profit corporation organized and operated exclusively for charitable, scientific or educational purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code of 1986. The goal of the Institute is to promote education and research within the Washington, D.C. metropolitan area for key decision-makers and other stakeholders.

Capitol Hill Steering Committee on Telehealth and Healthcare Informatics Institute for e-Health Policy | Neal Neuberger, CISSP, Executive Director 4300 Wilson Boulevard, Suite 250, Arlington, VA 22203 703-562-8870 | www.e-healthpolicy.org

Healthcare IT Effectivness

Dr. Bumenthal’s latest thoughts on the need for more research on the effectivness of healthcare IT. Unfortunately, its a catch 22. Many CEOs/CIOS won’t invest in healthcare IT until more solid ROI numbers are available; but until we place healthcare IT into production, its difficult to measure its impact on outcomes. Some effectiveness can be tested in the lab, and through Congressional Special Interest Projects and SBIRS overseen by U.S. Årmy TATRC and others.

http://www.fiercehealthit.com/story/blumenthal-more-research-needed-health-it-effectiveness/2009-09-21

Personal Health Record (PHR) Confusion

Great article on confusion over the PHR Term. With the advent of the NHIN, HIE, Microsoft HealthVault, Google Health, and RelayHealth, along with traditional medical journals maintained by the patient. the PHR can mean many things to many people.

http://chilmarkresearch.com/2009/09/09/time-to-kill-the-phr-term-part-1/

http://chilmarkresearch.com/2009/09/10/time-to-kill-the-phr-term-part-2/