Congress Archives

As you resolve not to smoke, overeat or work too much in 2012, the website SearchHealthIT issues its list of five health IT trends not to watch in the new year:

• Electronic medical records: EMRs are generally in-house records for tracking patient data and improving quality of care. It's electronic health records, which can be shared among caregivers and accessed electronically by patients, that bear watching, website editor Brian Eastwood writes in a blog post.


• Personal health records: The market doesn't seem to be going anywhere right now, and questions are being raised about privacy.


• Hospital information systems and clinical information systems: Like EMRs, the data compiled by these systems is not easily shared among providers or through a health information exchange.


• Computerized physician order entry: Adoption is low, in part because they're geared toward hospitals, not the physicians using them. They're "slow to adapt to the tablet PCs and smartphones that physicians have more than happily embraced," Eastwood writes.


• Regional health information organizations: While more than 250 of these organizations exist nationwide, the terminology and its acronym (RHIO) appear to be going out of fashion.

Spending by federal government agencies on health IT systems and services will grow from $4.5 billion in 2011 to $6.5 billion in 2016, a new report projects.

At an anticipated compound annual growth rate of 7.5 percent during the five-year forecast period, total federal health IT spending will increase an estimated 44 percent, according to the new GovWin report from research firm Deltek.

The forecast, Federal Health Information Technology Market, 2011-2016, looks at trends that are likely to affect the federal health IT market as well as the expected impact on vendors, systems integrators and federal contractors over the next five years.

Key findings of the report include:

• Technology advances, as well as potential long-term cost savings and better health outcomes, drive demand for mobility, telehealth, informatics, decision support, interoperability and common EHRs.


• Federal agencies possess the most advanced EHRs in the world, however due to their age and legacy architectures and technologies, they are overly ripe for major transformation.


• The federal government is the single largest payer of health care services in the U.S., and as such must transform from a "pay for service" model to a "pay for health" model in order to reduce costs and improve population health outcomes.


• Data security, program integrity, care coordination, political agendas, and the deficit present challenges to federal and nationwide health IT adoption and implementation.

In addition, the HITECH Act and the Affordable Care Act are driving government agencies to adopt health IT. "Agencies will be forced to spend money to save money in the long run by investing in electronic health record (EHR) systems, IT infrastructure modernization for health-related agencies, payment system transformation, and IT to promote advancement in population health," the report says.

GovWin is an industry information service of Deltek, a "provider of enterprise software and information solutions for professional services firms and government contractors."

If you were preoccupied last week with the seasonal imperative to give gifts, you may have missed an announcement, put out by the Office of the National Coordinator, that its gifts come with strings attached.

ONC announced in the Federal Register that it would create databases to track, monitor and assess the performance of individuals who receive grants intended to promote development of an interoperable system for sharing health information.

The "ONC Health IT Dashboard" will assess the progress of providers who receive incentive funds to spur the "meaningful use" of electronic health records as well as providers who participate in other health IT programs, including regional extension centers.

The program will take effect within 30 days, according to the announcement.

While the overall economy may well continue to sputter, the health IT market should be hitting on all cylinders over the next five years, a new industry report predicts.

One slice of the market, federal spending on health IT, is expected to grow from $4.5 billion in 2011 to $6.5 billion in 2016, for an annualized growth rate of 7.5 percent, according to a summary of the report, "Federal Health Information Technology Market, 2011-2016." The market report by Deltek, a Herndon, Va.-based software and information services provider, is available for purchase.

Key findings, according to the summary, include:

• Demand for mobility, telehealth, informatics, decision support, interoperability and common electronic health records will be driven by technology advances, potential long-term costs savings and improved patient outcomes.


• Aging EHRs operated by federal agencies "are overly ripe for major transformation."


• The federal government must transition from a "pay for service" model to a "pay for health" model that emphasizes outcomes.


• Health IT adoption is threatened by data security, program integrity, care coordination, political agendas and the federal deficit.

An industry trade group is proposing that Congress authorize Medicaid coverage for maternal and neonatal care via telemedicine "birthing networks." Medicaid recipients with high-risk pregnancies would be eligible for the program.

The proposal, by the Washington, D.C.-based American Telemedicine Association, encourages adoption of state networks through a "shared savings approach" that rewards participating health-care providers. To encourage state participation, it also recommends that the federal government cover 90 percent of network development costs in the first two years. The birthing network would be modeled after the nearly 10-year-old University of Arkansas ANGELS (Antenatal and Neonatal Guidelines, Education and Learning System) Program, the association says in a press release.

The networks "could leverage telemedicine technologies to more effectively treat major conditions associated with high-risk pregnancies, including pre-term labor, gestational hypertension, mild preeclampsia and gestational diabetes mellitus," the ATA says. The U.S. Department of Health and Human Services would monitor network performance.

The association cites a study it funded, saying birthing networks could save taxpayers up to $186 million over 10 years. The study, by Avalere Health of Washington, D.C., finds that savings would come from less use of hospital and physician services.

Federal stimulus money helped to pump up the value of stocks in 11 health care technology companies by 82 percent since President Obama took office, well above the 51 percent growth in the Standard & Poor's stock index over the same period, according to an analysis by USA Today.

The 2009 economic stimulus bill included up to $30 billion earmarked for health IT spending in the form of incentive payments for health care providers achieving meaningful use of electronic health records. Purchasing and implementing EHRs can be expensive, especially for small medical practices. The incentive cash promotes EHR adoption, an Obama administration priority, by helping practices to recoup some implementation costs.

The benefit to health IT companies has been enormous, according to the USA Today report, which says the $20 billion "boost in companies' value far exceeds the amount spent so far" under the stimulus bill.

The newspaper noted that shares of industry leader Cerner rose 194 percent, or $6.5 billion, as Cerner's clients received $100 million in incentives for achieving meaningful use. Shares of major competitor Allscripts Healthcare Solutions rose by 134 percent, while Athenahealth's stock value doubled.

A new bill introduced in Congress would give Medicare and Medicaid providers limited liability protection for electronic health record errors.

Rep. Tom Marino, R-Pa., says the bill "would create a system for reporting potential errors that occur when using electronic records without the threat of that information being used as an admission of guilt."

The Safeguarding Access For Every Medicare Patient Act, HR 3239, also prevents plaintiffs' lawyers from using EHRs as "an easy source for 'fishing expeditions,'" Marino says in a news release. Health-care providers would be able to correct EHR problems "without having those actions be used to establish guilt," according to the release. It also would limit when lawsuits could be filed, and protect against libel and slander lawsuits.

Marino says his bill reduces fear of expensive lawsuits and thereby promotes EHR adoption by Medicare and Medicaid providers. "Every time a doctor or hospital chooses not to participate because of these fears," he says, "our seniors lose another provider."

To qualify for protections under the bill, providers would have to demonstrate that they are using certified health IT products or meet federal criteria for "meaningful use."

The bill has been referred to the House Energy and Commerce Committee.

An independent analysis of the first round of Medicare incentives paid to medical providers for using electronic health records indicates that about half of the payments went to providers for upgrading existing EHRs.

The findings, by iWatch News, an arm of the nonprofit, nonpartisan Center for Public Integrity, raised questions about whether the $27 billion set aside to compensate health care providers for buying and installing expensive EHRs will stimulate the economy. The incentive program is part of the 2009 American Recovery and Reinvestment Act, the administration's $787 billion economic stimulus plan. The multiyear EHR stimulus is included in the Health Information Technology for Economic and Clinical Health Act, which is part of the ARRA.

iWatch News analyzed the first round of payments -- $75 million in Medicare incentives disbursed to about 320 doctors and hospitals this May. Recipients demonstrated that they had met at least 23 of the 25 "meaningful use" benchmarks required under the program.

The organization interviewed about one-third of the practices and hospital chains that received the initial incentive payments. Of those, iWatch News reported, nearly half had installed their technology before the incentive program was announced. It was unclear whether those results were representative.

The analysis also showed that podiatrists were disproportionately represented among first-round recipients, at 12 percent, although they represent only 1.5 percent of Medicare practitioners.

In a second iWatch News article, Dr. James Christina, director of scientific affairs for the American Podiatric Medical Association, credited a "very directed effort" by the trade association to teach its members about health IT and how to meet meaningful use benchmarks.

iWatch News said it was able to contact seven of the 25 podiatrists who received incentives. Of the seven, five had implemented EHRs after the stimulus was announced.

A bipartisan group of legislators from both houses of Congress have introduced a bill that would issue microchip-embedded smartcards to Medicare recipients and providers, starting with a $29 million investment that supporters say could eventually save up to $30 billion a year in fraud and abuse.

The Medicare Common Access Card Act of 2011 would require Medicare beneficiaries to swipe their new smartcard and enter a PIN when they arrive at the provider's office. After the appointment, providers would have to swipe their own cards into a machine that verifies their identity through fingerprint recognition.

The system would reduce the potential for identity theft, streamline billing and improve billing accuracy, the sponsors say through a website set up by the Secure ID Coalition to promote the bill.

The legislation was introduced earlier this month by Sens. Mark Kirk, R-Ill., Marco Rubio, R-Fla., and Ron Wyden, D-Ore., in the Senate, and in the House by Reps. Earl Blumenauer, D-Ore., Jim Gerlach, R-Pa., and John Shimkus, R-Ill.

The cards would be similar to the common access cards used by the Defense Department to identify its 20 million health-care beneficiaries, Kirk says in a news release.

The enhanced security of smartcard identification will "not only make the identity of America's seniors more secure, it does so in a way that will ensure that Medicare is paying for the services that are actually being provided," co-sponsor Wyden says in the release.

"If you looked at the card carried by every Medicare beneficiary in America you would find their name and their full Social Security number there for all to see," he says. "In an age of identity theft, this is simply asking for trouble."

The bill calls for the Department of Health and Human Services to set up pilot programs in five areas, then assess the results after a year in a report to Congress. Expanded implementation would follow, with additional analysis due from HHS after another year, along with recommendations for expanding and implementing the program nationwide.

The legislation first needs the approval of the Senate Finance Committee. Backers also are hoping that the Congressional Super Committee would include provisions of the law in its recommended debt-limit spending cuts due to Congress on Nov. 23.

AARP supports the measure along with the Secure ID Coalition, a digital security industry group whose members stand to benefit from the legislation.

The Health Information Management Systems Society is asking its members to lobby Congress for a "nationwide patient identity solution" to improve accuracy of patient medical records and reduce errors traced to misidentification.

HIMSS says the problem stems from a 1999 statutory prohibition on developing a "unique health identifier" for patients until a federal law authorizing national standards passes. No such standard exists now.

"Patient-data mismatches remain a significant problem," HIMSS says in its recommendation to Congress. Industry groups estimate that 8 percent to 14 percent of medical records include erroneous information tied to patient identity error, an expensive and potentially dangerous problem to correct, according to the recommendation.

"A technologically advanced nationwide patient identity solution does not mean that every system has to use the same patient identity method but, rather, means national standards and solutions that can be used for exchanging information across systems," HIMSS says.

Health insurance exchanges, large health plans and electronic health record vendors have come up with their own patient ID systems, but there's little to no interoperability, says HIMSS, a Chicago-based not-for-profit advocacy group for health IT and information systems.

"Patient safety, privacy and security depend on getting this core element right, and soon," concludes HIMSS.