HIMSS09 Online Daily - Wednesday April 8, 2009

'HITSP is not on vacation,' Chair John Halamka says
HIEs and stimulus funding: Don’t wait; implement now!
Attendees consider how to get a share of the stimulus
Healthcare reform will be incremental, political analyst says
Davies Public Health Award recipients improve outcomes and workflow
Few U.S. hospitals have achieved Stage 7 EHR implementation

'HITSP is not on vacation,' Chair John Halamka says

By Diana Manos, Senior Editor

CHICAGO – The Healthcare Information Technology Standards Panel is "working triple time" on preparing to help providers and vendors apply the stimulus package requirements, according to its chairman.

"HITSP is not taking a hiatus or a vacation," John Halamka, MD, CIO of Harvard Medical School and CareGroup, told attendees of a HITSP Town Hall Tuesday at HIMSS09.

HITSP plans to accomplish everything on its slate for 2009, he said, but will focus over the next 90 days on simplifying its recognized use case work into "lightweight interoperability specifications" that should be easily understood and available online. The new instructions should help users speed their ARRA preparation by removing the context specificity found in the original use cases, allowing for adaptation.

Though "meaningful use" under the American Reinvestment and Recovery Act (ARRA)

has yet to be defined by the next Department of Health and Human Services Secretary, Halamka said it will likely include elements of HHS-recognized HITSP use cases.

“The one thing I can guarantee is quality measurement,” he said. “ARRA has the word ‘quality’ written all over it.”

The Office of the National Coordinator for Health Information Technology will have“ a laser-like focus on quality and efficiency,” Halamka said of conversations he has had with incoming National Coordinator David Blumenthal, MD.

Halamka explained how federal advisory committees will work under the ARRA. The health IT policy committee will become the figurative "new board of directors," replacing AHIC and AHIC 2.0, and at least 13 of the 20 members have been named.

The Standards Committee has 1,000 nominees, with none appointed yet. Its work will involve taking the priorities created by the health IT policy committee and making them "much more granular."

From there, HITSP will take the recommendations and continue in its role as an independent standards harmonization organization, Halamka said.

HIEs and stimulus funding: Don’t wait; implement now!

By Patty Enrado, Contributing Editor

CHICAGO – The HITECH Act, part of the American Recovery and Reinvestment Act, is unclear on the development of health information exchanges, and the deadlines attached to incentives have been reported all over the map.

Regardless, John Halamka, MD, CIO of Harvard Medical School and the CareGroup Health System, sounded the battle cry to a packed room Tuesday morning: “Implement now.”

Unless the health information exchange is up and running and providing meaningful use, the money won’t be there, he told attendees at a HIMSS09 session titled “Achieving Health Information Interoperability by Leveraging Economic Stimulus.”

Halamka advised the audience not to consider the grant and loan program as a business model. It should only be applied to start up an HIE, he said.

“Make a value proposition to stakeholders,” he said. Cost avoidance was a significant value proposition to MA SHARE, Massachusetts’ collaborative regional health information organization, to be willing to pay for the ongoing operational cost.

Mosaica Partners conducted interviews on HIE efforts in various states. Laura Kolkman, Mosaica’s president, said the response to whether the funds would make a difference was “overwhelmingly positive.”

“The way to predict the future is to shape the future,” she said.

Kolkman entreated those interested in HIE activity and funding to plan now, building on existing state foundations such as telemedicine programs, establish private/public partnerships, coordinate with universities and public health departments and support the development of specific programs to help the individual physicians. States should develop a solid approach to managing and auditing how the funds are allocated and spent, she said.

Organizations should look to states for leading practices, she said. A number of states have different models that support their particular communities.

“The time is now to get started doing something,” she said. “Our future, quite frankly, depends on us getting this right.”

Attendees consider how to get a share of the stimulus

By John Andrews, contributing writer

CHICAGO – While the American Recovery and Reinvestment Act represents “a

big bucket of money” for the healthcare IT industry, there are certain issues – like more government control – that organizations need to consider while they ponder how to get a share, HIMSS officials said Monday.

At a session titled “A Strategic Approach to Managing Opportunities and Risks for Health IT in Economic Stimulus,” HIMSS Board of Directors member Howard Burde and HIMSS fellow Charles Christian cautioned HIMSS09 attendees that a generous amount of government funds also means a substantial amount of government intervention.

Burde, a Philadelphia-based healthcare attorney, kicked off the presentation with an informal poll: “How many people have made ARRA their most recent hobby?” Nearly all the hands in the audience went up.

Though the $19 billion allotment has become the most famous number in healthcare since Y2K, the amount is actually part of a larger $147 billion information technology appropriation that includes education and infrastructure. And while the dollars have been set aside, distribution won’t be automatic, Burde said.

“Healthcare will have to do a lot of work before we get access to even a nickel of it,” he said. “There is a great deal of process change that needs to be done – technology is not the answer, but a tool.”

Christian, director of information systems for Good Samaritan Hospital in

Vincennes, Ind., began with the famous “show me the money” scene from the movie “Jerry Maguire.” Then his tone turned serious.

“ARRA is extraordinarily ambitious legislation,” he said. “We’ve been given this largesse and we must do something with it. But there are a lot of pieces that do not fit together terribly well.”

With Uncle Sam in the driver’s seat, the industry will be relegated to a passenger in the vehicle of change and will likely have to sacrifice some of its autonomy, Christian said.

What’s more, he added, more laws mean more enforcement by various federal agencies, including Health and Human Services, CMS, the Department of Justice, and Federal Trade Commission as well as state attorney generals.

Healthcare reform will be incremental, political analyst says

By Richard Pizzi, Editor

CHICAGO – There are good reasons to believe that Congress will pass healthcare reform legislation in 2009, although some “dealbreakers” could derail the process.

Dispensing this political wisdom at HIMSS09 was Charlie Cook, publisher of the Cook Political Report and political analyst at The National Journal Group. Cook spoke at a “Views from the Top” session on Tuesday.

“There is a general consensus in Washington that something needs to happen in the healthcare arena,” Cook said. He noted, however, that Tom Daschle, the former nominee for Health and Human Services secretary, had been the designated “healthcare quarterback,” and without him President Barack Obama could find it more difficult to pass healthcare reform legislation.

“(HHS nominee) Kathleen Sebelius, as a former governor, knows the Medicaid system, but she doesn’t know Congress like Daschle does,” Cook said.

Funding healthcare reform in the current economic climate could also be challenging for Obama, Cook said. In Washington, he said, one makes “new enemies” every time one seeks a new funding source.

Cook also indicated that cutting payments to healthcare providers and instituting a publicly run health insurance program to compete with private insurers would alienate key constituencies, possibly dooming reform.

“Obama has problems on both sides of the aisle,” Cook said. “We will probably see some sort of incremental healthcare reform. It will be less cohesive than you would like, but that’s how things work in Washington.”

Cook said that no president in recent memory has faced the challenges that Obama does, and the pace of economic recovery would determine the Democrats’ fate in the 2010 midterm elections.

Davies Public Health Award recipients improve outcomes and workflow

By Patty Enrado, Contributing Editor

CHICAGO – The Cherokee Indian Hospital in North Carolina and the New Jersey Dept. of Health and Senior Services each implemented healthcare IT to improve population health outcomes in their communities and the work processes to support that improvement.

For their efforts, they were awarded the HIMSS 2008 Nicholas E. Davies Public Health Awards in June.

The New Jersey Dept. of Health and Senior Services’ IT team designed and implemented a patient-centric, Web-enabled, standards-based, PHIN-compliant system that enabled integrated electronic lab reporting, extensive case and outbreak management and administrative flexibility.

“At the end of the day, the main purpose of a public health application is having fully integrated workflow processes for case management,” said Simi Octania-Pole, director of data management.

The system was well designed, but it was recognized for the outcomes it achieved, including improved timeliness and response of notifiable disease reporting and follow-up, minimization of underreporting, improvement in data quality by enhancing communication and report completeness and empowerment of system users. Ongoing training, a steering committee representing all stakeholders, adherence to standards and collaboration between public health and IT staff were critical to the system’s success, she said.

The Cherokee Indian Hospital leveraged the Indian Health Services’ Resource Patient Management System Electronic Health Record, or RPMS EHR, to achieve better outcomes of its population. While the system was designed by the hospital, Commander Michael Toedt, MD, noted, “It’s how you use the EHR that is critical.”

The hospital created linkages to non-RPMS systems such as VISTA imaging. “Functionality is important,” Toedt said.

The hospital developed a strategic plan and set target goals, which were measured by the reporting functionality. The hospital saw a 47 percent improvement in tobacco screening, 10 percent in breast cancer screening and 79 percent improvement in domestic violence screening, among other measures.

Few U.S. hospitals have achieved Stage 7 EHR implementation

Dave Garets, President and CEO, HIMSS AnalyticsBy Chelsey Ledue, Associate Editor

CHICAGO – Only .01 percent of hospitals in the U.S. have reached a Stage 7 electronic medical record – none until the middle of 2008.

Three panel members and winners of the Nicholas E. Davies Organizational Award of Excellence offered their experiences with implementing a Stage 7 EMR at the session “Hard Lessons: Stage 7 and Davies Award Winners Define Success” Tuesday at HIMSS09.

A Stage 7 implementation includes a paperless system and the ability to share interoperable patient data and analyze clinical data for performance, improvements and clinical decision support.

“The hard part is doing something with it,” said Dave Garets, the session’s moderator and president and chief executive officer of HIMSS Analytics. “At a Stage 7, you have everything, what are you going to do with it?”

Kasier Permanente officials learned that funding for the project should be planned for at least five years, and preferably 10.

The interfaces to legacy systems are also more numerous, complex and expensive than one might think, said Andrew Wiesenthal, MD, SM, associate executive director of The Permanente Federation.

“You won’t have advantages until you have everyone up and running on the system,” said Thomas Smith, chief information officern of the NorthShore University Health System.

Smith said NorthShore did a few things wrong the first time. Having a backup data center is important, he said, because ongoing user engagement is a priority and order sets should be taken care of.

Although EMR implementation is a hard task, Eastern Maine Medical Center in Bangor, Maine, saw an 88 percent increase in productivity in the medications process, saved $1.3 million in blood costs and saw an 8 percent reduction in lab tests, said Catherine Bruno, FACHE, the hospital’s vice president and chief information officer.

“Surprises” in implementing an EMR in the three organizations included the amount of training needed, complexity and cost of a truly redundant information center, whether it’s worth getting rid of all paper documents, and the legal reaction to an EMR.

“The simple stuff can bite you,” Wiesenthal said. “If you strive for perfection, you won’t get anything but.”