Tag Archives: health IT

HHS Just Announced Beacon Awards of $220 million

Surprised not to see Massachusetts on the list, but exciting nonetheless… Here they are:

Community Services Council of Tulsa, Tulsa, Okla. – $12,043,948

Leverage broad community partnerships with hospitals, providers, payers, and government agencies  to expand a community-wide care coordination system, which will increase appropriate referrals for cancer screenings, decrease unnecessary specialist visits and (with telemedicine) increase access to care for patients with diabetes.

Delta Health Alliance, Inc., Stoneville, Miss. – $14,666,156

Focus on achieving improvements for diabetic patients by electronically linking isolated systems and practices for care management, medication therapy management and patient education.

Eastern Maine Healthcare Systems, Brewer Maine – $12,749,740.

Expand community connectivity, including long-term care, primary care and specialist providers, to existing Health Information Exchange and promote the use of telemedicine and patient self-management in order to improve care for elderly patients and individuals needing long-term or home care.

Geisinger Clinic, Danville, Pa. – $16,069,110

Enhance care for patients with pulmonary disease and congestive heart failure by creating a community-wide medical home, promoting Health Information Exchange and extending Geisinger’s proven model for practice redesign  to independent healthcare organizations throughout region.

HealthInsight, Salt Lake City, Utah – $15,790,181

Improve Diabetes management performance measures by increasing availability, accuracy and transparency of quality reporting, leverage Intermountain Healthcare’s strategies to reduce health systems costs throughout the region, and improve public health reporting.

Indiana Health Information Exchange, INC., Indianapolis, Ind. – $16,008,431

Expand the country’s largest Health Information Exchange to new community providers in order to improve cholesterol and blood sugar control for diabetic patients and reduce preventable re-admissions through telemonitoring of high risk chronic disease patients after hospital discharge.

Inland Northwest Health Services, Spokane, Wash. – $15,702,479

Focus on increasing preventive services for diabetic patients in rural areas by extending Health Information Exchange and establishing anchor institutions in close proximity to remote clinics that will promulgate successes in health IT supported care coordination.

Louisiana Public Health Institute, New Orleans, La. – $13,525,434

Reduce racial health disparities and improve control of diabetes and smoking cessation rates by linking technically isolated health systems, providers, and hospitals; and empower patients by increasing their access to Personal Health Records.

Mayo Clinic Rochester, d/b/a Mayo Clinic College of Medicine, Rochester, Minn. – $12,284,770

Enhance patient management and, reduce costs associated with hospitalization and emergency services for patients with diabetes and childhood asthma and address reduce health disparities for underserved populations and rural communities.

Rocky Mountain Health Maintenance Organization, Grand Junction, Colo. – $11, 878, 279

Enable robust collection of clinical data from health systems, providers, and hospitals in order to inform practice redesign to improve blood pressure control in patients with diabetes and hypertension, increase smoking cessation counseling, and reduce unnecessary emergency department utilization and hospital re-admissions.

Southern Piedmont Community Care Plan, Inc., Concord, N.C. – $15,907,622

Improve care coordination for patients with diabetes, heart disease, hypertension, and asthma by engaging patients and providers in bidirectional data sharing through a Health Record Bank, empowering patients and family members to participate in self-management through patient portals, and expanding access to care managers to facilitate post-discharge planning.

The Regents of the University of California, San Diego, San Diego, Calif. – $15,275,115

Expand pre-hospital emergency field care and electronic information transmission to improve outcomes for cardiovascular and cerebrovascular disease, empower patients to engage in their own health management through web portal and cellular telephone technology, and improve continuity of care for veterans and military personnel through the Veterans Affairs/Department of Defense Virtual Lifetime Electronic Record initiative.

University of Hawaii at Hilo, Hilo, Hawaii – $16,091, 390

Implement a region-wide Health Information Exchange and Patient Health Record solution and utilize secure, internet-based care coordination and tele-monitoring tools to increase access to specialty care for patients with chronic diseases such as diabetes, hypertension, and obesity in this rural, health-professional shortage area .

Western New York Clinical Information Exchange, Inc., Buffalo, N.Y. – $16,092,485

Utilize clinical decision support tools such as registries and point-of-care alerts and reminders and innovative telemedicine solutions to improve primary and specialty care for diabetic patients, decrease preventable emergency room visits, hospitalizations and re-admissions for patients with diabetes and congestive heart failure or pneumonia, and improve immunization rates among diabetic patients.

Summary of Massachusetts Health IT Plan

Overview

The Massachusetts Health IT Draft Plan was released for public comment in January 2010 and the commenting period is now closed. The plan outlines high-level statewide goals and strategies for achieving improved health outcomes and reduced costs through the use of interoperable EHR systems and health information exchange (HIE). The document sets up governance structures and policy priorities for the planning for use and implementation of federal HI-TECH funds. Currently MA has been awarded ~$25mil, $14mil to MeHI for regional extension centers (RECs) and $10mil to MeHI for HIE. After the MA HIT Plan is adopted, the HIT Council is responsible for the governance structure and MeHI is the Project Management Office (PMO).

The HIT Plan was created in response to a number of MA statutes, including Chapter 305, MA 201 CMR 17:00, and Executive Order 504. The original plan was publicly announced in Jan 2009, but withdrawn due to the announcement of the HITECH Act portion of ARRA. The HIT Council and MeHI contracted Deloitte to update the plan to correspond with the HITECH Act and Meaningful Use regulations.

The tentative milestones lay out an aggressive plan in line with federal meaningful use requirements.

Tentative Milestones

Target Year Key Milestone Examples
2010
  • Develop HIT Strategic Plan
  • Establish PMO
  • Develop Governance structure with decision-making processes
  • Convene Ad-Hoc Workgroups
  • Produce Program communication plan
  • Initiate Vendor Management and contractual agreements
  • Submit the HIE operational plan including sustainability, privacy and security, etc.
  • Develop Certification Program IOO
  • Provider funding alternatives
  • Oversee the REC Operational Plan
  • Establish Medicaid Partnership
  • Recruit approximately 25% Priority Providers for REC
  • Coordinate Workforce development activities
  • Select HIE Vendor(s)
2011
  • Recruit approximately75% priority providers for REC
  • Establish Patient Engagement baseline
  • Provide Certification Program statewide HIE
  • Pilot Operational HIE (clinical)
  • Ensure REC Priority Providers achieve stage 1 meaningful use
  • Provide Initial Population Health Reporting (local)
2012
  • Ensure Operational HIE comleted with governance structure in place
  • Provide Consumer Engagement survey
  • Ensure the Integration of EHRs to operational HIE
2013
  • Ensure REC Priority Providers achieve stage 2 meaningful use
  • Develop Expansive Population Health Reporting (local, state, national)
2014
  • Pilot Interstate HIE Interoperability
  • Re-Certify IOOs
  • Perform Privacy and Security Audit
2015
  • Meet Chapter 305 requirement of implementing EHR systems in all provider settings and integrating those systems through a robust HIE Interstate
  • Complete HIE Interoperability
  • REC Priority Providers achieve stage 3 meangingful use
  • Provide Consumer Engagement survey
  • NHIN pilot if available

Statutory Overview

  • Chapter 2008 passed in August 2008
  • MA Legislation Chapter 305 formed the HIT Council
  • The HIT Council was charged with creating a statewide HIT Plan and updating it annually. Plans must be approved by the council and the MA Technology Collaborative Board
  • HIT Council Members – (look this up), includes Karen Bell
  • Background – contracted BCG to create plan which was completed by Jan 2009, right when the Stimulus bill & HITECH Act were released, so plan was pulled back. Deloitte was contracted to create updated plan which was released Jan 2010
  • “Community-Based Approach” – inspired by Mass eHealth Collaborative’s 2004 EHR deployment in 3 communities with attempted interoperability, supported by $50mil MA BCBS grant
  • MA Plan adopts opt-in HIE and anytime opt-out (which is different than many other states which are opt-out)

MA HIT Plan – Table of Contents

  • Executive Summary
  • Introduction
  • Establish Multi-stakeholder governance
  • Establish a Privacy Framework to Guide the Development of a secure HIT environment
  • Implement interoperable electronic health records in all clinical settings and assure they are used to optimize care
  • Create a local workforce to support HIT related initiatives
  • Monitoring success
  • Path forward

Discussion

  • ARRA
    • Regional Extension Centers (RECs): Provided ~$14mil to MeHI (the MA regional extension center) for implementation of regional extension centers in MA ($625mil total, and ~$100mil given out so far)
    • Health Information Exchange (HIE): Provided $10.6mil for HIE funds to MeHI (again, the state-selected entity), to create the plan (and no one knows where the plan will take us)
  • Carol Rodenstein, MeHI Program Director
  • HIT Council Members
    • JudyAnn Bigby, MD, Secretary of HHS Massachusetts
    • Deborah A. Adair, Director of Health Information Services and Privacy Officer, MGH
    • Meg Aranow, VP & CIO, Boston Medical Center
    • Karen Bell, MD, Sr. VP of HIT Services, Masspro
    • Lisa Fenichel, MPH, eHealth Consumer Advocate
    • Jay Gonzales, Secretary of Administration and Finance, Massachusetts
  • Median practice size in MA is 3 physicians
  • Masspro has a lot of experience with small practices and workflow issues associated with EHR implementation
  • End of April, governor is inviting governors from entire country, all 50 HIT coordinators, all 50 Medicare reps, all 50 Mecaid reps, and others to bang heads re: conference
  • Health care is the largest employer in Mass, employing ~450k workers with $29bil in revenue in 2005.
  • Small practices aren’t going away…will lead to the rise of the IPAs
  • Health delivery will look a lot different in 2015

High Level Policy Goals:

  • Goal 1: Improve access to comprehensive, coordinated, person-focused health care through widespread provider adoption and meaningful use of certified EHRs
  • Goal 2: Demonstrably improve the quality and safety of health care across all providers through HIT that enables better coordinated care, provides useful evidence-based decision support applications, and can report out data elements to support quality measurement.
  • Goal 3: Slow the growth of health care spending through efficiencies realized from the use of HIT.
  • Goal 4: Improve te health and wellness of the Commonwealth’s population through public health programs, research, and quality improvement efforts enabled through efficient, reliable and secure health information exchange processes.

Strategies to Accomplish these  Goals:

  1. Establish multi-stakeholder governance
    1. The components of the proposed governance structure are:
      1. These organizations: HIT Council, MTC, MeHI
      2. 6 Ad Hoc workgroups: Clinical Quality and Public health, consumer engagement, education, and outreach, Privacy and security, regional extension center, HIE, workforce development
    2. Estimated that this will be >= 90% private funded
    3. HIT Council oversees governance structure
    4. MeHI is acting Project Management Office
  2. Establish a privacy framework to guide the development of a secure HIT environment
    1. ONC’s 6 Privacy Principles: Individual Access, Correction, Openness and Transparency, Individual Choice, Collection, Use and Disclosure Limitation, Data Quality and Integrity
    2. Commonwealth’s privacy and security framework will focus on four key areas: Compliance with policies and standards, Secure HIE technology, Process for certification, Consent management
    3. Privacy/Security rules based on the following previous rulings:
      1. Federal: HIPAA, HITECH Act, FISMA, MITA, HITSP, NIST 800 Series, Privacy Act of 1974
      2. State: Chapter 305, MA 201 CMR 17:00, and Executive Order 504
  3. Implement interoperable health records in all clinical settings and assure they are used to optimize care
    1. MA  has officially adopted the goal of meaningfully used EHR in all physician practices by January 1, 2015
    2. MA will provide direct assistance to ~2500 providers to achieve Meaningful Use by contracting with Implementation Optimization Organizations (IOOs)
    3. To ensure adequate funding – 1) promote a loan program, 2) endorse use of state funds, 3) provide support to providers to receive Medicare incentives
    4. Build an effective REC program for the Commonwealth focusing on: individual & small group practices, public and critical access hospitals, community health centers and rural health clinics, other clinics serving the underserved
  4. Develop and implement a statewide HIE infrastructure to support care coordination, patient engagement, and population health
    1. HIE Priorities: administrative simplification, e-prescribing, electronic laboratory ordering, electronic public health reporting, quality reporting, prescription status, coordination of care/clinical summary exchange
    2. Will continue to support PHR’S currently supported by MA providers and payers
    3. This effort will be lead by MeHI
    4. Existing HIE Initiatives in MA: Northern Berkshire eHealth Collaborative, Newburyport, SAFEHealth, CHAPS, and NEHEN
    5. MeHI has selected a hybrid HIE model (as opposed to centralized or federated) which will use both centralized and distributed data repositories, allowing the majority of the data to stay at the site of collection
  5. Create a local workforce to support HIT related initiatives
    1. High demand and low supply right now for health IT employees
    2. Estimated through 2016 that 64k new health care jobs will be created in the Commonwealth
    3. Development of training programs using federal dollars focusing on implementation, project management, practice management, and data management. Programs will intentionally seek out unemployed persons.
  6. Monitor success
    1. Quality measurement program for REC, HIE, and Workforce Development programs
    2. Indicators selected for reporting will fit into the objectives of the high-level goals of the MA HIT Plan
    3. The HIT Council is responsible for selecting the indicators

Health IT Update – Feb 22

1. Health IT in Developing Countries – a 9-yr history and its future – open to all Harvard community members as part of the Harvard Kennedy
School of Government lunch seminar

2. Global Health Technologies Coalition: Advancing Innovation to Save Lives – useful website with lots of information on technology innovation – http://www.ghtcoalition.org

3. MIT Sloan Bioinnovations Conference – March 12 – see event details below…

4. PHAT/Health Underground Networking Event w/ AthenaHealth’s Jonathan Bush – April 1 (website coming soon)

——————-

Save the Date!
MIT Sloan BioInnovations 2010 Conference: The New Age of Opportunity
http://web.mit.edu/bbc/bioinnovations/2010/

Friday, March 12, 2010
9:00 AM – 4:00 PM
Boston Marriott Cambridge (next to Kendall Square T-stop)

Register before March 1 for Early-Bird Discounts:
http://www.acteva.com/booking.cfm?bevaid=197535

Keynote Speakers:

Peter Wirth, Esquire
Executive Vice President, Genzyme Corporation

Dr. Robert Langer
M.I.T. David H. Koch Institute Professor

Matthew W. Emmens
Chairman, CEO, and President, Vertex Pharmaceuticals

Panels:

Healthcare Reform
Emerging Markets
Bringing Innovation to Market
Connected Healthcare

BioInnovations is a premier gathering of nearly 300 healthcare pioneers from a broad range of industries; from bio-pharma and medical devices to healthcare providers and non-profits.

Highlights from President Obama’s First State of the Union Address

President Obama delivered his first State of the Union Address last night. The Presidential blog at www.whitehouse.gov/blog has an excellent summary of all the initiatives Obama announced and the entire 90 minute video. The full script is also available at http://www.whitehouse.gov/the-press-office/remarks-president-state-union-address.

I am going to highlight just a few initiatives that are particularly important to me:

  • 3-year federal budget freeze – Beginning in 2011, Obama has called for a 3-year federal budget freeze that applies to everything but defense, Medicare/Medicaid, and Social Security. He claimed that without true health reform, it would be impossible to freeze spending on health.
  • Financial reform package – use the Stimulus bank bailout money that banks are repaying to go towards funding small business loans; create a small business tax credit; eliminate all capital gains taxes on small businesses (the latter 2 received bipartisan clapping while imposing a fee on large banks to repay the stimulus bailout is not supported by republicans)
  • College Financing Reform – this one is big! “To increase college access and completion, the Administration will make student loans more affordable by limiting a borrower’s payments to 10 percent of his/her income and forgives remaining debt after 20 years – 10 years for public service works. We will also make permanent the American Opportunity Tax Credit. The President urges the Senate to pass the American Graduation Initiative, which invests more than $10 billion over the next decade in reforming our nation’s community colleges, promoting college completion, and moving toward the President’s goal of having the highest proportion of college graduates in the world by 2020. The President is also asking colleges and universities to do their share to make college affordable for all Americans cutting their own costs.”
  • Health IT – despite all the political action surrounding health IT right now (and a good amount of talk for and against it), this was not mentioned at all
  • Nuclear Power Plants – FINALLY the government is going to pave the way to open up some more power plants, after a 30-yr hiatus
  • Changing the way the government does business – The administration is going to continue with lobbying reform, increasing government transparency, and creating a public “earmarking” database so that the public can see what budget amounts have been earmarked for certain purposes. To see how serious this administration is about transparency, check out http://www.data.gov. For a very specific example, I have been able to call into every workgroup meeting and download the materials related to the Office of the national Coordinator’s work on meaningful use and the HITECH Act. Here’s the schedule: https://singularityblog.wordpress.com/2010/01/11/upcoming-hit-policy-standards-committees-workgroup-meetings/
Also, a few quotables:
  • And what the American people hope -– what they deserve -– is for all of us, Democrats and Republicans, to work through our differences; to overcome the numbing weight of our politics.  For while the people who sent us here have different backgrounds, different stories, different beliefs, the anxieties they face are the same.
  • It’s because of this spirit -– this great decency and great strength -– that I have never been more hopeful about America’s future than I am tonight. Despite our hardships, our union is strong.  We do not give up.  We do not quit.  We do not allow fear or division to break our spirit.  In this new decade, it’s time the American people get a government that matches their decency; that embodies their strength.
  • To recover the rest, I’ve proposed a fee on the biggest banks. Now, I know Wall Street isn’t keen on this idea.  But if these firms can afford to hand out big bonuses again, they can afford a modest fee to pay back the taxpayers who rescued them in their time of need.
  • Now, let’s clear a few things up. I didn’t choose to tackle this issue to get some legislative victory under my belt.  And by now it should be fairly obvious that I didn’t take on health care because it was good politics. I took on health care because of the stories I’ve heard from Americans with preexisting conditions whose lives depend on getting coverage; patients who’ve been denied coverage; families –- even those with insurance -– who are just one illness away from financial ruin. After nearly a century of trying — Democratic administrations, Republican administrations — we are closer than ever to bringing more security to the lives of so many Americans…Here’s what I ask Congress, though:  Don’t walk away from reform.  Not now.  Not when we are so close.  Let us find a way to come together and finish the job for the American people.  Let’s get it done.
  • for the first time in history –- my administration posts on our White House visitors online.  That’s why we’ve excluded lobbyists from policymaking jobs, or seats on federal boards and commissions.But we can’t stop there.  It’s time to require lobbyists to disclose each contact they make on behalf of a client with my administration or with Congress.  It’s time to put strict limits on the contributions that lobbyists give to candidates for federal office. With all due deference to separation of powers, last week the Supreme Court reversed a century of law that I believe will open the floodgates for special interests –- including foreign corporations –- to spend without limit in our elections. I don’t think American elections should be bankrolled by America’s most powerful interests, or worse, by foreign entities.  They should be decided by the American people.  And I’d urge Democrats and Republicans to pass a bill that helps to correct some of these problems.
  • In the end, it’s our ideals, our values that built America — values that allowed us to forge a nation made up of immigrants from every corner of the globe; values that drive our citizens still. Every day, Americans meet their responsibilities to their families and their employers. Time and again, they lend a hand to their neighbors and give back to their country. They take pride in their labor, and are generous in spirit. These aren’t Republican values or Democratic values that they’re living by; business values or labor values. They’re American values.

Health IT Ontology

2 weeks ago I solicited help to put together this Health IT Ontology (see Components of HIT…a start). This post is the result of 6 rounds of edits. The new name, I think, better represents the goal of defining all the entities and relationships within the domain of health IT. Click on the image below to see it full size.

Health IT Ontology

Following are the top-level categories:

  • Health Information Technology
    • Clinical Information System
    • Hospital/Clinic Management
    • Consumer-Oriented Technologies
    • Public Health & Biosurveillance
    • Reference
    • Research
    • Regional & System-Level HIS

The initial motivation behind this was to determine where ART-focused EMRs sat in the scope of HIT, but what I expected to be a trivial exercise quickly became a difficult task. Health IT is an extremely complex and expansive domain and every item in this heirarchy could be broken down into even smaller pieces (similar to EMR/EHR). My goal for this diagram was to cover the breadth of health IT more than the depth. It is certainly possible that there are some oversights, in which case I would love to hear from you.

I welcome your thoughts, criticisms, and suggestions on the HIT Onthology. Using social media (esp. Twitter and Aardvark) was so successful this time around that I plan to pursue more online collaborative projects in the future.

Many thanks to everyone who contributed, and a special shout out to Jacob Sattelmair, Janette Heung, blog commenters, Richard Thall and Eddie from Aardvark, and the score of Twitterers who provided very valuable feedback!

Components of HIT…a start

UPDATE: The final output of this project, HIT Ontology, can be found in this blog post: https://singularityblog.wordpress.com/2009/07/20/health-it-ontology/

Health information technology (HIT) is a broad and extremely complex field, and I want to visualize it. I’m going to need your help to do it. But first it needs defining…

HIT could simply be defined as any information technology utilized within the healthcare industry vertical, but that would be too inclusive, because that means a MySQL database is considered HIT because it is sometimes used in a hospital. Brailer & Thompson, former ONC Secretary and former HHS Secretary respectively, define it as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making” (Thompson & Braile, 2004). The line between HIT and health informatics is fuzzy and we’ll ignore it for now.

With this definition, I tried to create a hierarchical list of the types of health IT software. I want the list to be comprehensive in breadth and don’t care quite as much about depth (3 or 4 levels should be sufficient). There are dozens of ways to structure this list and probably hundreds of items I missed. This is a work in progress, so please leave a comment and let me know what you would change/add/remove. I’ll keep updating it until everyone feels good about it. After that comes the visualization…

HIT Categorization Hierarchy – Take 5

  • Clinical
    • EMR/EHR
      • Ambulatory
      • Specialty
      • Anti-Retroviral Treatment (ART) Focused (common in areas with high HIV/AIDS & TB prevalence)
    • eRx (CPOE)
    • Clinical Decision Support
    • Digital Imaging & Archiving Systems (e.g. PACS)
    • Medical Devices & Equipment
    • Clinical Document Management
    • “Personalized Medicine”
  • Hospital/Clinic Management
    • Physician Office Management Information System (POMIS)
    • Hospital Management Information System (HMIS)
    • Accounting
    • Patient Billing
    • Claims Processing
    • Human Resource Management
    • OR Scheduling
    • Appointment Scheduling
    • Lab/Pharmacy Management
  • Public Health & Biosurveillance
    • Public Health Reporting
    • Diesease Surveillance Networks (e.g. CDC Biomonitoring and Environmental Public Health Tracking Network)
    • Vital Registry (Birth, Death, & Marraige Records)
  • Consumer-Oriented Technologies
    • Personal Health Devices (e.g. WAN-enabled weight scale, phone-enabled glucose monitor, etc.)
    • Personal Health Applications (i.e. exercise & weight tracking)
    • Patient Portals
    • Personal Health Records (PHR)
    • Health-centered Social Networks (Patients Like Me, 23andme, etc.)
  • Medical References
    • Drug references (for docs and patients)
    • Medical references (like WebMD, also for docs and patients)
  • Research
    • Genomics
    • Medical data warehousing
    • Clinical Trial Recruitment, Management, etc.
  • Regional & Systems Level Health Information Systems
    • Vitals Registration
    • Health Information Exchange (HIE)
    • National Health Information Network (NHIN)

A special thanks to the Twitterers that have already helped me on this: @chadosgood, @oneofthefreds, @ChristineKraft, @ePatientDave, @MedC2, and my good friend Jake. And a shout out to Sam Adam’s HIT Primer on his blog, IT (R)EVOLUTION, that helped get me started.

A few other helpful sources:

OpenMRS Implementers Meeting in Boston

Follow me on Twitter @paynejd to receive links to SlideShare during the conference. I will post a summary when the conference is complete.

Here’s the agenda:

Introduction Hamish Fraser
What is OpenMRS? Burke Mamlin
OpenMRS Example: AMPATH, Kenya Burke Mamlin
OpenMRS Example: Rwinkwavu, Rwanda Hamish Fraser
OpenMRS Example: South Africa/Zimbabwe/Mozambique and OASIS Chris Seebregts
OpenMRS Example: Millennium Villages Project Andrew Kanter
OpenMRS Features Darius Jazayeri
OpenMRS Vision Hamish Fraser

In addition, there will be several panels in the afternoon.