Health IT Law Blog : Health IT Law Blog : Post & Schell: Law Firm : HIT & Electronic Health Records

 Via Democrat and Chronicle (Rochester):

The New York state Department of Health and a public-private partnership called New York eHealth Collaborative, or NYeC (pronounced "nice"), recently announced plans to spend $129 million in state and federal money to create a statewide network for electronic medical records, to be complete in 2014. Like the highways, they envision the network as a public utility that will allow medical providers anywhere in the state to view — with your permission — a list of your medications, any allergies and any recent X-rays or other tests that could help guide your care. The e-records network would be the largest in the country, dwarfing networks of other states and the Veterans Administration.

The planned statewide network, called Statewide Health Information Network for New York or SHIN-NY, is intended to serve more than 200 hospitals, thousands of medical practitioners and up to 20 million patients a year.

You can read more about NYeC here.
 

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The Chesapeake Regional Information System for our Patients (CRISP) went live this month connecting three hospitals, three radiology centers and two private companies in Montgomery County, Maryland during the initial stage of this health data exchange.  According to The Washington Post, all 48 hospitals in Maryland plan to join CRISP by 2012. The exchange will allow hospitals, physician practices, hospitals, clinics, labs, radiology centers, and other health care institutions to share information electronically.

Via the Post:

The Maryland Health Care Commission designated CRISP to oversee the state's effort to create a secure exchange for electronic health information within the state. More than 300 such exchanges are in development throughout the United States as part of a larger effort to develop national exchange standards and best practices. More than 20 organizations were involved in CRISP's development, including doctors, insurance companies, hospitals and consumer advocates, who helped structure the network in a way that will protect patient privacy in accordance with applicable law.

The funding for the network came from a patchwork of state and federal grants. In 2009, Maryland allocated $10 million from a fund that insurance companies pay into to reimburse hospitals for the network's start-up costs. The state health-care commission received an additional $9.3 million in federal stimulus money that covered the cost of the exchange's rollout. In April, a division of the U.S. Department of Health and Human Services that promotes the adoption of information technology gave CRISP $5.5 million to help 1,000 primary care physicians use electronic health records more effectively.

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On June 7, 2010, Maryland's Lt. Governor Anthony Brown announced that the Office of National Coordinator for Health IT approved Maryland's State Health IT plan, allowing the state to move forward to implement a functional health information exchange (HIE).  According to the Washington Business Journal, ONC will release $25 million in ARRA funds to Maryland, to be used in connection with the state's HIE:

Proponents of the exchange say it will cut costs and improve health care quality by streamlining the transfer of electronic health data between hospitals, physicians and patients.

The Chesapeake Regional Information System for our Patients, the nonprofit tasked with implementing the exchange, has already begun work with $10 million in state money. The federal approval leaves the plan's funding "fully unrestricted," said CRISP Program Director Scott Afzal, allowing them to broaden the goals of the exchange and engage more hospitals. Much of their work lies in finding health care providers to sign on to the exchange when there is no state or federal legal requirement to do so, according to Afzal.

'We have to show a value proposition to connect,' he said.

The project is estimated to cost roughly $20 million, although it will be scoped to available funding.

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On April 13, 2010, the Wall Street Journal published two fascinating articles on health information technology issues.  In "Can Technology Cure Health Health Care?" author Jacob Goldstein examined the complexities and major risks of adopting electronic medical records.  Goldstein also suggested a few high-level policies necessary to combat such risks, including designing the software with patient care in mind (rather than focusing on billing and other administrative tasks); customizing the software to fit the unique needs of one's organization; and taking the time to implement the EMR in a carefully crafted, staged manner. 

The last recommendation seems to be indeed crucial to a successful EMR implementation, but it will likely put many healthcare providers trying to capitalize on HITECH incentive payments in a peculiar situation.  Such providers must carefully balance their need to achieve "meaningful use" in a short time frame, while preventing as many disruptions to patient care as possible.

In "Breaking Down the Barriers," Laura Landro examined the state of regional health organizations (RHIOs) and health information exchanges (HIEs). While RHIO/HIE's are still rare, the number of such electronic patient data exchanges grows every day.  In fact, according to the Journal, the number of RHIO/HIE's increased by 57% since last year.  Such exchanges are also likely to benefit from HITECH Act funding distributed by HHS. 

There is an interesting nexus between these two articles:  interoperability and exchange.  A successful widespread adoption of EMR technology seems to depend upon different EMRs talking to each other, and different - including competing - healthcare providers exchanging patient information.  While EMRs may only marginally improve patient care in each individual hospital, they are likely to have a far greater impact as part of a nationwide health information exchange.

"Can Technology Cure Health Care?" Wall Street Journal (April 13, 2010).

"Breaking Down the Barriers," Wall Street Journal (April 13, 2010).

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HHS Secretary Kathleen Sebelius, appearing with Labor Secretary Hilda Solis, announced the Obama administration will release almost $1 billion set aside in the stimulus bill in order to aid implementation of health information technology.

Secretary Sebelius announced $386 million in grants to advance widespread adoption of EHRs at the state level, including for health information exchanges (HIEs).  HHS also awarded $375 million to 32 nonprofits for Regional Extension Centers which assist providers in updating their medical record systems and train workers on such new technologies.

Secretary Solis announced around $225 million to support 55 job-training programs in 30 states which is expected to train around 15,000 people in the health records technology.

The Obama administration expects to help more than 100,000 health-care providers set up electronic medical records for their patients by 2014.

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Dr. David Blumenthal, the National Coordinator for Health IT, gave an update on the Obama Administration's efforts to define "meaningful use" and to further adoption of EHRs nationwide.  Blumenthal did not reveal any new details regarding the upcoming regulations on meaningful use, reminding his audience of the upcoming "notice of proposed rulemaking in late 2009 with a public comment period in early 2010."

Meanwhile, according to Government HealthIT, the next meeting of the HIT Policy Committee, which will meet on October 27 and 28, will focus on how to map meaningful use objectives to medical specialties as well as small practices and hospitals.

Speaking at the 81st annual American Health Information Management Association convention in Grapevine, Texas, Dr. Blumenthal stated that he expects 50,000 health information management (HIM) jobs to be created as the U.S. moves from the paper-based to the digital system of healthcare.  AHIMA's CEO, Linda Kloss, noted that the interest in HIM careers has "exploded" during the last year.

Much more news after the jump.
  

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The State of Maryland awarded $10 million to support the Chesapeake Regional Information System for our Patients (CRISP), a newly created health information technology exchange organization.  Some of  the biggest players in Maryland's health care industry, including Johns Hopkins, MedStar and the University of Maryland Medical System are going to participate in CRISP. 

According to the Baltimore Business Journal:

Funding will come from the hospitals that will receive a slight increase in the prices they can charge patients and federal stimulus money.

The news comes as health care officials and lawmakers champion electronic medical records as a way of reducing health care costs. They argue that electronic medical records will reduce costs by hopefully eliminating unnecessary tests and reducing errors by allowing doctors to quickly access patients’ medical records.

State health insurers plan to provide incentives to hospitals, which include a lump sum payment or increased reimbursement, to adopt electronic health records.

"Maryland awards $10M for health IT exchange," Baltimore Business Journal (August 5, 2009).

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eHealth Initiative, an affiliation of organizations devoted to improving the quality, safety and efficiency of healthcare through information technology, released its 2009 survey on Health Information Exchange (HIE), titled "Migrating Toward Meaningful Use: The State of Health Information Exchange."

The survey found many positive trends in the expansion of HIE's in the United States, including:

• the number of operational HIE initiatives (e.g., exchanges transmitting live data among stakeholders) has increased by nearly 40% since 2008;
• positive impact on physician practices by improving efficiency without disrupting care (e.g., quicker access to test results, reduced staff time spent searching for results and performing other administrative functions);
• reduction in costs associated with, inter alia, reduced staff time spent on searching for test results and performing other clerical functions, as well as reduction in duplicate tests and medical errors; and
• steadily growing number of initiatives are exchanging data, with almost universal increases in the type of data exchanged.

The survey also found that "initiatives identified 'addressing privacy and confidentiality issues' as the most pressing challenge they face, surpassing 'developing a sustainable business model'."

eHealth Initiative's press release, which includes a more detailed summary of the survey, can be found here.

"Migrating Toward Meaningful Use: The State of Health Information Exchange," eHealth Initiative Study (July 22, 2009).

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