Category Archives: Government IT

Rhode Island Awards Bid To Build First-Ever Statewide EHR

July 31, 2007

The Rhode Island Department of Health has awarded a three-year, $1.7 million contract to EDS to design, implement and manage the country’s first statewide electronic health record network, Healthcare IT News reports (Pizzi, Healthcare IT News, 7/30).

The contract could last up to seven years if the state uses all four of the optional one-year extensions, Government Health IT reports.

EDS will use InterSystems’ health care software to build and integrate the system.

The network, called the Rhode Island Health Information Exchange, will consolidate state residents’ health data and provide authorized hospitals, physicians, pharmacists and other health care providers with access to the health records (Wakeman, Government Health IT, 730).

The EHR network will be “developed with strict adherence to patient-consent policies and in conjunction with industry best practices with regard to security and privacy standards,” according to a press release (Providence Business News, 7/30). In addition, residents must give permission before their records are stored on the network.

The health data exchange is expected to go live in summer 2008 (Government Health IT, 7/30).



Federal IT Group To Study Secondary Uses of Health Care Data

The American Health Information Community Consumer Empowerment Workgroup on Wednesday said they would continue to study the policy issues related to secondary use of health care information, Healthcare IT News reports.

Karen Bell, director of HHS’ Office of IT Adoption, said now is the time to tackle the issue because electronic health record adoption still is low and personal health records do not yet contain much clinical information. “I think we are recognizing that we’re not even close to finding all the answers on this,” Bell said.

Charles Safran of Harvard Medical School testified before the work group on secondary uses of health data. “We believe there is tremendous value in secondary use of health information,” he said, adding, “It’s so important to national health, but we need to have better guidelines on how this information should flow.”

Guaranteeing the privacy of health data is key to winning public trust, and the technology has outpaced policies and procedures so far, Safran said. He added, “The public is woefully unaware to what is happening to their data.”

July 13, 2007 iHealthbeat

Nancy Davenport-Ennis, co-chair of the work group and executive director of the National Patient Advocate Foundation, said the group initially will focus on determining who owns the data. She added that the group should look into how to regulate a violation of stewardship over the data, how to protect consumers and how to provide incentives to consumers who make lifestyle chances based on the data collected.

In addition, the Agency for Healthcare Research and Quality recently requested information on the idea of national stewardship over the secondary use of data (Manos, Healthcare IT News, 7/12).


Experts: US electronic health records still a way off

By: Grant Gross 7/06/2007

U.S. President George Bush’s administration gets high marks for its vision in pushing electronic health records, but the U.S. is far from implementing a national health IT system, according to an author of a government report released Thursday.

Although the U.S. could see significant benefits from more use of IT in the health-care industry, including fewer deaths from medical errors, more work needs to be done to create standards for electronic health records and other health IT initiatives, said David Powner, director of IT management issues for the U.S. Government Accountability Office (GAO).

The U.S. government still faces an “enormous challenge” in getting electronic health records to patients, Powner told the U.S. House Committee on Government Reform.

Asked to grade the Bush-created office of the National Coordinator for Health Information Technology, Powner gave the office an “A” for leadership and vision but an incomplete grade for implementation. In January 2004, Bush called for the U.S. health-care industry to embrace electronic health records, with the records available to all U.S. residents by 2014.

Powner’s report to the committee called for the Bush administration and the U.S. Department of Health and Human Services to push for health IT standards that don’t yet exist. “Otherwise, the health care industry will continue to be plagued with incompatible systems that are incapable of exchanging key data that is critical to delivering care and responding to public health emergencies,” Powner wrote.

The Bush administration is working toward setting standards, said Dr. David Brailer, the national coordinator for health IT in the U.S. Department of Health and Human Services. Next week, Brailer’s office will announce a federal government partner to harmonize health IT standards, he said.

In addition to standards, the cost of implementing electronic health records, and a lack of technical expertise, is holding up adoption at many small health-care facilities, Brailer told the committee. While existing research has sent “mixed signals” on the ability of electronic health records to cut costs, health IT can “save lives, improve care and improve efficiency in our health system,” he said.

Part of his office’s job is to convince health-care providers and patients of health IT’s benefits, Brailer added. Some health-care providers have been slow to adopt electronic health records because they’re paid per patient visit, and they aren’t paying the bills, he said. “It is against the financial interest of many providers to improve quality or to improve efficiency, because we pay by volume, and greater efficiency and quality, by definition, reduce volume,” he said.

Committee member Jon Porter, a Nevada Republican, said he plans to introduce legislation in the next couple of weeks that will require electronic health records for people using U.S. government health insurance coverage. With about 9.5 million members on the federal health plan, the requirement would push adoption to the private sector as well, Porter said.

Porter repeated concerns that the lack of electronic health records is adding to medical errors. “We are so far behind in our technology, we are costing lives of many Americans,” he said.

In 1999, the Institute of Medicine, a nonprofit health analysis organization, issued a study saying between 44,000 and 98,000 U.S. residents die each year due to medical errors.

Continue article here:

Government Technology: Miracle Cure?

Jun 1, 2007, By Shane Peterson

It was just a few years back that open source software started sneaking into technology departments.

Not much was known about the software, and CIOs, long accustomed to buying established software packages written and supported by well known vendors, were leery of software produced by a nebulous affiliation of programmers scattered across the globe.

Talk about a reversal of fortune: These days, open source software is downright fashionable. CIOs know it, and public- and private-sector enterprises of all types gladly run open source applications in server rooms and on front-line staff workstations.

History seems to be repeating itself, except now the world of medicine is the stage.

Slow Going
Health-care costs put a heavy strain on federal, state and local government budgets. Medicare and Medicaid especially wolf down huge sums of money.

The federal government is the nation’s largest purchaser of health care, according to the president’s 2008 budget, accounting for approximately one-third of U.S. health-care spending.

States, too, spend considerably on health care. In Texas, for example, health and human services funding consumed 34 percent of the state’s total budget for the 2004-2005 budget year, according to Texas Medicaid in Perspective, Sixth Edition, a report released in January 2007 by the Texas Health and Human Services Commission.

To help trim health-care costs, the Office of the National Coordinator for Health IT was created in 2004 to jump-start health IT activities in the federal government, and between the federal government and the private sector.

“Health IT” is a loose term for efforts to modernize the U.S. health-care system’s methods for collecting, using and sharing patient information and other medical data. Federal officials and industry experts have long recognized that the medical sector has not fully experienced the technology revolution that’s hit other sectors of the U.S. economy.

Observers cite the fragmented nature of medical information systems as the primary reason the medical sector runs at the rear of the technology-adoption pack. Physicians’ information systems don’t talk to hospitals’ systems, which don’t talk to clinics’ systems, which don’t talk to pharmacists’ systems.

Each of these segments uses its own version of a patient’s health record, and a significant goal of health IT is creating the technology infrastructure to support one electronic health record (EHR) per patient that any hospital, clinic, physician or pharmacist can access when providing health-care services to that patient.

Regional health information organizations (RHIOs) and health information exchanges (HIEs) sprouted to start the difficult work of creating information systems to link hospitals, clinics and physicians within clearly defined geographic regions.

The terms RHIO and HIE are often used interchangeably, and the two entities perform the same function, according to the Healthcare Information and Management Systems Society (HIMSS), a health-care industry membership organization focused on coordinating health IT use in the U.S.

There are less than 14 RHIOs currently funded and/or operational in the United States, according to the HIMSS HIT Dashboard, while there are approximately 137 HIEs, though the majority of these lack funding or are stuck at the conceptual stage.

Open Source Medicine
Other interested parties also launched their own projects to stimulate health IT, but these efforts seek to extend open source applications and technologies to the world of medicine.

Continue here:

Medicare Payment Cuts Could Hinder Doctors’ Health IT Adoption

June 05, 2007

The threat of Medicare physician payment cuts would prohibit physicians from investing in health IT, according to Cecil Wilson, chair of the American Medical Association board, United Press International reports.

The Sustainable Growth Rate formula, which determines how much Medicare pays physicians for services, calls for a 10% cut in 2008. Congress for the past five years has stepped in to overrule the formula but so far this year no bill to do so has been introduced.

If the rate reduction goes through, about one in three physicians will decrease the number of Medicare patients they accept, and more than 25% of doctors will stop accepting Medicare patients altogether, according to an AMA survey of almost 9,000 physicians.

The payment cuts also will affect patients who are not Medicare beneficiaries, Wilson said. If physicians cannot invest in technology, such as electronic health records, they will have difficulty measuring, and thus improving, the quality of care they provide, according to UPI.

AMA said Congress should reverse the cuts and add a 1.7% increase to reflect rising practice costs for doctors. Congress in the short term should finance the reimbursement increase by eliminating the 12% gap between what the government pays for patients in traditional Medicare and the higher rate paid to Medicare Advantage plans, Wilson said. In the long term, Congress should eliminate the Sustainable Growth Rate and begin tying physician reimbursements to increased medical costs, he said (Pierce, United Press International, 6/4).

Article here:

Some cautious of additions to IRS health IT ruling

By: Joseph Conn / HITS staff writer

Story posted: May 17, 2007 – 9:54 am EDT

Initial reactions to the long-awaited decision last week by the Internal Revenue Service to join HHS and the CMS in clearing a path for hospitals to subsidize healthcare information technology systems to affiliated physicians were overwhelmingly positive.

But in the passing of a few days and with sober reflection, not everyone sees the new IRS policy as an unalloyed good thing.

Healthcare lawyer Andrew Blustein, a partner with Garfunkel, Wild & Travis, Great Neck, N.Y., while joining the early voices saying the IRS ruling is “wonderful news,” also urged caution. “It’s a major step forward, but people need to realize there are some additions (in the ruling) that may not fit their particular program.”

HHS and the CMS last summer issued safe harbors to the federal anti-kickback law and exceptions to Stark laws prohibiting inducements for referrals in separate documents totaling more than 70 pages. Hospitals can qualify for the HHS and CMS dispensations by providing under specific conditions subsidized electronic medical-records systems and support to physician practices.

After the HHS and CMS rulings, attention turned almost immediately to the IRS. Not-for-profit hospitals were cautioned by their lawyers that IT contributions to for-profit organizations such as physician practices, though legal under the new Stark and anti-kickback modifications, could still jeopardize hospitals’ tax-exempt status.

By November 2006, the American Hospital Association sent a letter to Lois Lerner, director of the exempt organizations division at the IRS, asking for a broad ruling favoring the IT subsidies. Lerner’s response came last Friday in a two-page “field directive” memo she sent to two department directors under her division.

It said: “We will not treat the benefits a hospital provides to its medical staff physicians as impermissible private benefit or inurement in violation of section 501(c)(3) of the code if the benefits fall within the range of health IT items and services that are permissible under the HHS EHR regulations and the hospital operates in the manner described below.”

The IRS conditions were:

  • Hospitals must enter into health IT subsidy agreements with physicians receiving IT items and services.
  • Hospitals and physicians must comply with HHS rules.
  • “The health IT subsidy arrangements provide that, to the extent permitted by law, the hospital may access all of the electronic medical records created by a physician using the health IT items and services subsidized by the hospital.”
  • “The hospital ensures that the health IT items and services are available to all of its medical staff physicians.”
  • “The hospital provides the same level of subsidy to all of its medical staff physicians or varies the level of subsidy by applying criteria related to meeting the healthcare needs of the community.”

The key provisions of the HHS and CMS policies dovetailed, but the IRS memo outlines some unique features, according to Blustein.

Complete article here:

HHS Promulgates New Regulations to Facilitate Adoption of Health Information Technology

On August 1, 2006, the U.S. Department of Health & Human Services (“HHS”) promulgated final rules (“Final Rules”) that will permit hospitals, physician practices and certain other organizations to donate electronic prescribing (“e-prescribing”) and electronic health records (“EHR”) technology and supporting services to physicians without violating either the federal physician self-referral (“Stark”) law or the federal health care program anti-kickback law (“AKL”). Both Final Rules are a result of the Congressional mandate in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (“MMA”) for the creation of a Stark law exception and an AKL safe harbor that would enable entities (such as hospitals) to encourage and assist physicians to embrace the use of e-prescribing technology. In promulgating the Final Rules,

HHS elected to go beyond e-prescribing, providing immunity for the donation of EHR technology and services under certain circumstances, as well.

I. The Final Rules

The Stark law exceptions and AKL safe harbors established by the Final Rules

are considerably more protective than was originally contemplated in the

October 11, 2005 proposed rules (the “Proposed Rules”). Among other things, the Final Rules allow for a broader range of qualifying donors and recipients; cover a more extensive range of technology; and replace a possible cap on the value of the donated e-prescribing or EHR technology with a recipient cost sharing provision for EHR.

A. E-prescribing

The e-prescribing exception and safe harbor are nearly identical, protecting donations by a hospital, physician group practice, Medicare Part D Prescription Drug Plan (“PDP”) sponsor, or Medicare Advantage (“MA”) organization of hardware, software, information technology (including internet connectivity), and training and support services that are necessary and used solely to receive and transmit electronic prescription information, provided that several conditions are met. For example: (1) the donor may not limit or restrict the use or compatibility of the donated technology or services with other e-prescribing or electronic health information systems; (2) the technology and services must be capable of being used for any patient regardless of payor status; (3) the donation of the items and services cannot be conditioned on an agreement by the recipient to do business with the donor; and (4) the decision to make the donation – including the amount and nature of the items and services – must not be determined in a manner that takes into account the volume or value of referrals or other business generated between the parties. Significantly, HHS did not impose a limit on the value of e-prescribing technology that may be donated to an eligible recipient.



The Final Rules also establish a new regulatory Stark law exception and AKL safe harbor for the donation of EHR technology and services. The most significant aspects of this exception and safe harbor are discussed below.

1. Donors

In comparison to the Proposed Rules, the Final Rules expand the types of entities that may donate EHR items and services. Under the Stark law exception, donations may be made by any entity that furnishes “designated health services.” Under the AKL safe harbor, the donor may be (1) any individual or entity that provides covered items and services and seeks reimbursement, either directly or through reassignment, from any federal health care program, or (2) any health plan. This generous definition encompasses hospitals, group practices, physicians, nursing and other facilities, pharmacies, laboratories, oncology centers, community health centers, and dialysis facilities, among others.

2. Recipients

The Stark law exception protects items and services donated to any physician. The AKL safe harbor protects donations to any individual or entity engaged in the delivery of health care, such as physicians, group practices, physician assistants, nurse practitioners, nurses, therapists, audiologists, pharmacists, nursing and other facilities, community health centers, and laboratories.

3. Protected Items and Services

The Final Rules protect “information technology” (e.g., internet connectivity and maintenance) in addition to the software and training services (e.g., help desk) covered under the Proposed Rules. Software must contain, or link to, an e-prescribing component. (Protection is not afforded to the donation of hardware, however.) Unlike the e-prescribing Final Rule, EHR items and services must be necessary and used predominantly (rather than solely) to create, maintain, transmit or receive the EHR of the donor’s or physician’s patients in order to be protected. Although it is not clear what regulators will consider to be “necessary and predominant,” Preamble commentary indicates that software packages may include, depending on the circumstances, functions related to the care and treatment of individual patients, such as patient administration, scheduling functions, billing, and clinical support. Expressly excluded, however, is any technology used primarily for personal business or business unrelated to the recipient’s clinical practice or operations.


4. Interoperability

Under the Final Rules, which abandon the pre- and post-interoperability distinction

contained in the Proposed Rules, donated EHR technology must be interoperable with other e-health systems at the time of its donation in order to be protected.

“Interoperable” is defined as software able to (1) communicate and exchange data accurately, effectively, securely, and consistently with different information technology systems, software applications, and networks, in various settings, and (2) exchange

data such that the clinical or operational purpose and meaning of the data are preserved without alteration. Software is “deemed” interoperable if a certifying body recognized by HHS has certified the software no more than 12 months prior to the date

of donation. In notices published in the August 4, 2006 edition of the Federal Register,

HHS (1) recognized certain ambulatory EHR criteria developed by the Certification

Commission for Healthcare Information Technology that may be used by certifying

bodies to deem technologies interoperable and (2) promulgated interim guidance for entities that want to become recognized EHR certifying bodies.

5. Cost Sharing

The Final Rules require the recipient physician to pre-pay a minimum of 15 percent of the donor’s costs. Neither the donor nor a related party may finance the physician’s payment.

6. Selection of Recipients

EHR donors may not directly take into account the volume or value of referrals or other business generated between the parties when determining whether, and the extent to which, a particular recipient is provided EHR. The Final Rules, however, list various selection criteria that donors may use without triggering the volume or value or other business generated standards. For example, donors may consider such practice specific criteria as the total number of prescriptions written, practice size, number of hours worked by the physician, and the physician’s overall use of automated technology.

II. Conclusion

The Final Rules reflect an unprecedented degree of coordination between CMS and OIG, resulting in consistent treatment of health information technology donations under the Stark law and AKL. This coordination reflects the government’s desire to remove impediments to the adoption of important, but expensive, software and related information technology that will enhance patient care and safety and reduce medical errors while simultaneously protecting federal health care programs from fraud, waste and abuse.

The Final Rules are scheduled to be published in the Federal Register on August 8, 2006, and will become effective 60 days thereafter. Although the exception and safe harbor for EHR donations will sunset on December 31, 2013, the e-prescribing provisions are indefinite.