Dear HITCh members,
Decmeber 1, 2007
This e-news update includes the following:
The HITCh meeting at Fall Forum went very well. Tony Rodgers gave a great talk on the transformation of Medicaid through health information technology. His presentation can be found here http://www.ncsl.org/print/health/forum/Rodgers_FF07.pdf.
Health Information Technology and Massachusetts
Health Information Technology leaders in Massachusetts recently held a meeting to discuss HIT efforts in the state. A great issue brief was prepared for the meeting that provides a summary of HIT activities in the state and gives an overview of the policy environment in Massachusetts. The report calls for the formation of a statewide multi-stakeholder public/private governance body and for the creation of a HIT implementation statewide roadmap. The report identifies five major policy issues facing the state:
Funding:
“No existing model to develop the resources to pay for statewide adoption of interconnected EHRs… A creative combination of public and private funding streams, possibly accompanied by appropriate tax and reimbursement incentives, may offer a solution to the funding problem.”
Privacy, Security and Standards:
“Policy is needed to articulate and resolve the patient consent issues surrounding the use, disclosure and sharing of patient medical information while providing consumers with stringent privacy and security protections”
Public Health:
Need to define the role of statewide HIT in the promotion and improvement of public health.
Racial and ethnic disparities, and serving of vulnerable populations:
Due to the way HIT is adopted the potential exists for certain groups (Medicaid and rural patients, the uninsured) to be excluded from the benefits.
Coordination and Governance:
“Coordination of policies and business practices is necessary to achieve interconnected HIT among organizations”
Boston Globe article on the meeting
http://www.boston.com/business/healthcare/articles/2007/12/05/mass_seeks_more_use_of_electronic_medical_records/?p1=email_to_a_friend
Issue brief prepared for the meeting
http://masshealthpolicyforum.brandeis.edu/publications/pdfs/34-Dec07/HIT%20IssueBrief%20Final.pdf
The State of RHIOs
Health Affairs just released a study titled The State Of Regional Health Information Organizations: Current Activities And Financing. The researchers surveyed 138 RHIOs in early 2007. Of these thirty six organization were defunct (26 percent). Of the RHIOs that responded only 20 were exchanging clinical data for a “modest-sized” population. Of these 20 only 15 were focused on data exchange across a range of the patient population (the others had targeted populations such as Medicaid enrollees or the uninsured).
Of the RHIOs exchanging data 12 were considered to be self-sustaining by the researchers. Sustainability for these RHIOs was achieved “through the difficult work of building community support, developing key stakeholders’ interest in clinical data exchange and demonstrating the benefits.” Eight of the RHIOs (40 percent) were heavily dependent on grants, while 9 (45 percent) had never received grant funding. Thirteen received funding through user fees.
The article notes “Whether RHIOs represent small businesses that need viable business models, which requires the ability to generate profits as well as value for participants, or public goods that require public financing is an important unresolved issue. The United Kingdom and other countries approach clinical data exchange as a public good that should be fully funded by the government. Our evaluation of the U.S. approach, which relies more on the small business model, suggests that these organizations’ survival is tenuous at best and that surviving entities have structured their activities around exchanging results of diagnostic tests.” Payers, who are likely to receive financial benefits from health information exchange, and pharmacies, which have valuable clinical data to provide, were both “noticeably absent” from many RHIOs.
E-prescribing has been a hot topic in Washington in the past few weeks. Congress plans to include an e-prescribing mandate in a bill that will block a cut in Medicare payments to physicians scheduled to take effect in 2008 http://www.govhealthit.com/online/news/350139-1.html.
In addition, a work group for the American Health Information Community (AHIC) recommended the Department of Health and Human Services ask Congress for the power to mandate e-prescribing for Medicare physicians. The recommendation included items that need to take place before the mandate should go into effect:
- All pharmacies must be able to accept prescriptions sent electronically. Currently 30% of pharmacies do not have e-prescribing capabilities.
- All prescriptions must be able to be e-prescribed. Currently the Drug Enforcement Administration regulation and some state regulations prohibit e-prescribing for controlled substances
- The Center for Medicare and Medicaid Services should establish incentives for providers and pharmacies to adopt certified EHRs and/or e-prescribing systems.
A draft of the letter can be found here http://www.hhs.gov/healthit/documents/m20071128/letter.html.
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