We congratulate Bill Childs for his imminent receipt of yet another HIT industry accolade. The 50-in-50 award, rightfully conferred this evening,  will appropriately adorn his home’s mantel, sharing space with last fall’s CHIME Lifetime Achievement Award. Of course, he’s far from resting on his laurels as he has been networking throughout the HIMSS ‘11 this week. You might run into him at our Booth (#3070, see photo) where you can discuss in detail any one of the eight topics he’s summarized so far here on the blog.

Today wraps up his series with the 9th and 10th issues he sees as paramount to HIT/HIS market in the upcoming year. So, without further blabbing, here’s Bill -

9. Sharing of patient medical information outside the traditional walls of provider organizations

ARRA requires the sharing of patient information on a patient-directed guideline to other need-to-know (with permission) entities. The rules are complex and even ominous when it comes down to specific permissions. Enter CHIN’s and a whole host of other secured operating systems. At this time, providers, vendors, states, and the federal government either have a hand out or a hand in (or both!) in developing rules and ways. Some participants do not add value to the solution. Security issues can and will bite the hand that feeds them in this process. Buyer Beware!

10.  Adoption of social media capabilities

The world is becoming one giant social network. Danger lies in the unknown. Social networks have been developed for all kinds of healthcare maladies, procedures, and other specialties. Several CIO’s have recently reported an increasing demand for application and system help in healthcare social media. This is just another area fraught with security issues when it comes to disclosing patient information.

Thanks, Bill and again, congratulations. We’re VCS grateful to and proud of you.

So, if you sidle up to Bill at HIMSS or catch him after a future keynote speech, you have 10 topics upon which to strike up a conversation, add your opinion, or merely joust ideas with the godfather of HIS/HIT.

However, if reading HIT/HIS insight is more your cup of tea, you can delve into VCS’ resource library, its on-line newsletters (still available in hardcopy at HIMSS ‘11), and archives.

For a creative, literary jaunt  read Jeanette Borzo’s “visualization” of an EMR’d physician’s office circa 2015 at The Medical Blog.

HIMSS ‘11 is only three days away. Today, Bill Childs’ third and fourth topics address the federally-mandated propulsion behind Meaningful Use of electronic health (medical) records, and the security that must be ensured so as to allay patients’ fears about personal data being breached.

Take it away, Bill -

3. Accelerated Movement Toward Meaningful Use

More and more CIO’s are beginning to wonder if they can satisfy Meaningful Use (MU) criteria in order to reap all the incentives and avoid all the penalties. Far too much remains unfinished. Dollars are often scarce or unavailable, and attaining MU exceeds many organizations’ resources. However, getting incented to make dates will be less stringent than getting penalized for missing dates. Both providers and their vendors are rushing to meet deadlines, but not all vendors can meet the needs of all their customers and not all providers can afford or manage the requisite, obligatory tasks to attain meaningful use. However, few refute that automating healthcare will produce more benefits for patient and, ultimately, provider.

4. Information Systems’ Security Issues

ARRA, HIPAA 5010, the HITECH Act and a whole host of existing and new rules and regulations are inundating Information Systems departments with (in many cases) ominous portents. At a recent I.S. Security conference hosted by Southern California HIMSS, several provider I.S. security officers detailed their efforts of trying to keep up. Their top laments? Budgets were inadequate. They were getting a mere 2% to 6% of the total I.S. budgets but needed more like 10%, which most never expected to get. Addressing proliferation and subsequent encryption of hand held and remote devices plus demands from physician groups clogged security teams’ “TO DO” lists. But the entire list reached far beyond those two issues.

Take the liberty to comment below.

Tomorrow:  Implementation and integration of new technology including devices, procedures, and the cloud demand Information Systems Support; and Dealing with reduction in elective procedures and Medicare & Medicaid reimbursement

What’s that low thrum? It’s the sound of the “meaningful use” definition” fading in the distance as healthcare providers now scramble away to put pieces of the EHT compliance puzzle into position. But wait! What’s that shrieking bleat ahead? “EHR PRIVACY,” the next issue du ARRA. The DHHS-convened Tiger group will command the headlines and attract legitimate attention over the next few months especially as the public comment period for proposed modifications to the HIPAA Privacy & Security Rules ends September 13, 2010.

The latest from the Tiger Group’s progress is succinctly captured by Modern Healthcare.com and Healthcare IT New.com. Follow these links to learn the most recent developments.

Tiger Group's EHR Privacy Conundrum: Modern HealthCare News

Privacy and security recommendations approved: Healthcare IT News

Below are two links to substantive accounts of the latest MU evolution. The first, released yesterday, is an explication by HHS National HIT Coordinator Dr. D. Blumenthal & CMS deputy administrator M. Tavenner. Given tables summarize new Core and Menu Set objectives.

The second link takes you to HISTalk’s Inga, who had by early morning today, compiled a straight-forward contrast, sort of a “then-and-now,” as regards MU after yesterday’s announcement by HHS.

You’ve probably spent the last 24 hours squinting at as many websites & sources as we have. Trying to keep you up-to-date while avoiding information overload & repetition, the blogmasters extend what we’d like to call a representative sample of our latest research done for you by our agents in the field.

Meaningful Use Regulation for EHR

Inga's Comparison

The recently published PriceWaterhouseCoopers Health Research Institute report, Ready or Not: On the Road to the meaningful use of EHRs and health IT, has circulated through the blogmasters desk, and in our continuing effort to keep you informed, we’ve produced the following abstract…

After surveying 120 CIO’s and another handful of healthcare executives, the PwC report adds heft to the impact of the ARRA’s Meaningful Use (MU).

The report makes many keen assertions including:

• “Health systems will need to transform the way they deliver care, so they can sustain performance and grow revenue in the future.”
• Successfully achieving meaningful use “hinges on closer integration with key constituents” (physicians, health insurers, patients).
• Health systems that already have connected with physicians, patients, and health insurers around MU are “more likely to be applying for government incentives” than those that haven’t. But only half of respondents expected to apply for incentives in 2011. (By 2014, 90% expect to be applying).
• Health systems that have included patients in the planning are “more confident about meeting MU standards.”
• “Implementing MU can enhance hospital-physician alignment.”
• Most health systems are failing to connect with health insurers around MU.
• 80% of CIO’s are more than concerned about meeting MU requirements by deadlines. (An American Hospital Association survey reports that 55% of hospitals expect to incur penalties.)
• “The benefits of achieving MU outweigh the challenges.” Those benefits include improve healthcare quality, disease management, coordination of care, improved alignment with physicians, increased productivity, market advantage, and improved alignment with payers.

But PwC identified four barriers to attaining MU: Lack of MU standards clarity, shortage of skilled IT staff, vendor readiness, limited capacity of existing infrastructure . . .

and proffered five benchmarks to achieve compliance: Establish governance, balance compliance against competing priorities, forge new public-private ventures, make the patient the purpose, collaborate with physicians and health insurers.

Interested in what happens now with healthcare reform? All the fervor has died down and we’re on to the next top issue (Arizona anyone?), but when will we start see the effect... Well, on July 1^st of this year people who have been unable to get health insurance because of preexisting conditions will be able to purchase subsidized coverage via a national high risk pool. On September 23^rd insurers will be banned from dropping people if they develop an illness, the dependent coverage age will extend to 26, no child will be denied because of a preexisting condition, and there will be no annual or lifetime limits. For more details read this, but in 2014 the entire law should be phased in.

That’s a brief synopsis of what’s going to happen in the coming months as a directive straight from the Patient Care and Affordability Act, but what else is going to be indirectly affected? One thing I keep reading is about the number of physicians practicing medicine. It was hard enough to practice with CMS issues, malpractice concerns, and hospital struggles…will the new law make it better for physicians to practice medicine in this country? What about the HITECH push, how is that effecting doctors?

What do you think?

More Reading:

Glamour Answers Pressing Questions

An Employer's Guide to Healthcare Reform

I Have to Buy...or else.

By: Bill W. Childs

I had the honor of meeting with David Blumenthal at HIMSS last week along with selected CIO’s, physicians, and vendor representatives. Our discussions centered on the costs and benefits of the ARRA and Meaningful Use criteria.

My Concerns:

1. Time lines for ARRA, Meaningful Use, HIPAA 5010, and ICD-10 are too tight. Some providers (with anywhere from one to ten facilities)who have been working on these efforts for years, can easily reach meaningful use criteria. However, there are many large and small providers who will not be able to meet the time lines as established.  “Too many guidelines; too little time”.
2. The cost of these efforts is beyond the ability for 80% of providers. It will take a great deal to implement and prove the needed requirements to reach meaningful use and history shows that it will cost much more than most people expect.
3. There is not enough industry experienced talent to get these projects implemented. As an industry observer for more than 30 years, I can already see providers hiring bodies that are not talented enough to get the job done. Implementing these systems is a very difficult task, and many of the most talented are already on the assignment.

My Peers' Concerns (in addition to those listed above):

1. The board and “C” suite lack of understanding the full impact of the effort (time, cost, talent, change, security, and interactions with entities not under their control).
2. The cost of sustaining these Herculean efforts.
3. The cost and effort to report to all of the new agencies and on all of the new data requirements.

My session with Blumenthal was enlightening. Not only were some of my concerns confirmed, but I was also made aware of other aspects to be apprehensive about.  Here is one silver lining though: The effort and direction is a good thing. HIT, if built properly, implemented properly, and maintained the right way with updates as necessary, is the only technology introduced to healthcare delivery systems that has the potential to reduce costs and eliminate errors, thus improving quality.

What are your major concerns? What efforts and ideas would you like to applaud? 

By: Mary Ann Ciccone

As part of ARRA, Medicare and Medicaid will provide reimbursement incentives to physicians and hospitals who become “meaningful users” of EMR. This effort will begin in 2011 and end by 2015 at which time all providers will be expected to utilize EMR. Changes will be implemented in stages and include data sharing, compliance with HIPPA and state laws, evidence based order sets, the engagement of patients and families, and care coordination. The final draft recommendations that will define meaningful use were published by the ONC for Health IT in December 2009. Eligible facilities and providers can incorporate these guidelines into projects currently in progress to meet the requirements.  

The result of following the meaningful use guidelines for all stages will be improved and more efficient patient care through the use of disease prevention and reduction of medication errors, greater communication between providers, efficiency in meeting reporting mandates and claims submissions, and lower healthcare costs.

 The recommendations for Stage 1 are listed below.

Source: HHS website for meaningful use.

Just in case you haven’t been able to find it one of the other dozens of sites publishing the link here is the HITECH: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology and here’s how you get paid (warning 556 pages).

Mr. HISTalk summarized the finer or most relevant points here. And over at HealthcareITNews.com “Stakeholders have mixed reviews on proposed requirements” while Government HealthIT profiles groups that aren’t happy with the definition.  

We all knew it’d be a mixed bag right? What do you think of the proposal? Have you (are you) going to read it or will you just look for an effective summary? Let us know what your thoughts and questions are in the comment section.