Telemedicine Archives

The Federal Register will publish proposed regulations for the second stage of electronic health record meaningful-use guidelines on Thursday, according to the national coordinator for health IT, Dr. Farzad Mostashari. There had been speculation that the rules might have been released Tuesday or Wednesday.

Mostashari told an audience at an industry conference in Las Vegas that the proposed regulations were sent today to the Office of the Federal Register, according to ModernHealthcare.com. System interoperability will be central to the new regulations, he said during an education session at the Healthcare Information and Management Systems Society (HIMSS) conference, ModernHealthcare reported.

"We have done whatever we can to increase the flexibility and decrease the burden of these regulations," Mostashari said, according to the report.

A final rule is expected this summer.

The National Institute of Standards and Technology is going straight to the source -- health IT vendors -- to create a means for evaluating the performance and usability of electronic health records.

NIST, in a Feb. 14 announcement in the Federal Register, asked companies to send their EHR systems to the agency. NIST will use them to "develop a framework for assessing the usability of health IT systems, EHRs in particular, and performance-oriented user interface design guidelines for EHRs." The institute also wants to review EHR instructions, documentation and error messages.

NIST plans to release its proposed framework in a report to be titled "NIST Usability Guidelines and Evaluation Framework for EHR Systems." Manufacturers will receive updates on information gleaned from the tests, but they will not be identified by name in the report.

Interested vendors should submit a request to participate and a letter of understanding by March 15.

Telehealth will play an increasing role in helping combat veterans receive treatment for post-traumatic stress disorder.

The National Defense Authorization Act, recently approved by Congress, lifts a key restriction against behavioral-health consultations across state lines. The change will give military members at small or rural bases the same access to mental health care as those at large bases with major hospitals, the Army Times newspaper reports.

The act grants a new exemption to a requirement that health care providers be licensed in the state in which their patients are treated, the newspaper says. Gen. Peter Chiarelli, who retired Jan. 31 as Army vice chief of staff, told the newspaper that the measure is "the biggest step forward we've seen in two years . . . We just have to take advantage of it."

The federal government already had exempted state licensure requirements for military health care providers in federal facilities treating patients in other federal facilities. The new exemption includes care provided at any location, including civilian clinics and patients' homes, Army Times reported.

The change could especially benefit National Guard and Reserve troops, many of whom do not live far from military bases.

A population that is on the move will increasingly turn to mobile health applications, predicts a new market study.

The Hampshire, England-based Juniper Research Ltd. projects that mobile networks will monitor 3 million patients by 2016, according to a company news release. The growth will be fueled in part by increasingly more capable smartphones, the company says.

U.S. insurers already offer reimbursement for mobile cardiac monitoring, which makes the monitoring of cardiac outpatients the top remote monitoring field, according to Jupiter. But the analysis projects growth in the monitoring of other chronic diseases, including diabetes and Chronic Obstructive Pulmonary Disease.

Other projections:

• Consumers will download 44 million mHealth and medical applications this year.


• That number will grow to 142 million in 2016.


• Electronic health records will eventually be an important piece of mHealth offerings.


• Smartphone-based patient monitoring will replace expensive specialized remote monitoring systems and drive down mHealth costs.

The nation's health IT czar polished off his crystal ball this week and predicted five major health IT trends for the year. Dr. Farzad Mostashari, national coordinator for health IT, shared the prognostications on his office's Health IT Buzz blog:

• Meaningful use takes off. Mostashari projects that at least 100,000 providers will demonstrate that their electronic health records meet ONC standards for "meaningful use" by the end of the year, enabling them to receive Medicare or Medicaid incentive payments.


• Health information exchanges turn a corner. "ONC efforts are critical," he writes. "Robust policies that protect information and create public trust will galvanize rapid growth and innovation in health information exchange.


• The dots connect between health IT and payment reform. Pay-for-service models lead to higher costs, he argues, just as health IT helps hospitals and practices to move away from traditional pay models. "We are headed toward a virtuous cycle where payment reform improves the business case for using health IT and greater use of health IT improves the chances that new payment models will succeed."


• Consumers take advantage of eHealth resources. Mobile apps and other technological advances make it easier for patients to become more involved in improving their health, Mostashari says.


• Innovation drives improvement. Efforts in 2012 will focus on improving the usability of EHRs, he says.

If you have to sit in traffic, you might as well do something to improve your health.

At the Digital Health Summit during this month's Consumer Electronics Show in Las Vegas, Ford Motor Company promoted mobile health apps enabled by its Sync computer system. Ford announced partnerships with Microsoft HealthVault, Windows Azure and Healthrageous Inc. to develop a prototype system that works with "compatible biometric measurement devices."

Sync "provides easy, voice-controlled access to mobile devices such as smartphones and tablets, and therefore it makes sense to research areas that are important to our customers," said Gary Strumolo, manager of infotainment, interiors, health and wellness at Ford Research and Innovation, in a news release.

Ford thinks cars could be the ultimate mobile-health platform. They're convenient and private, and they can provide "personalized access" to health information, products and services. Accessing health apps will give people something constructive to do when they're stuck in traffic, the automaker says.

BlueMetal Architects of Watertown, Mass., designed the prototype mHealth system. Boston-based Healthrageous compiles information collected from blood-pressure monitors, activity monitors and glucose meters along with "behavioral data" provided by the patient to help people end unhealthy habits, Ford says. Microsoft's programs "translate robotic sensory information" provided by the vehicle into an application with a voice and touch-screen interface.

The system will upload data from the driver to the HealthVault cloud and transfer the information to Windows Azure, which creates graphical reports that the driver can read upon reaching his or her destination.

The topic of health, including electronic records and health information exchanges, is among the top 12 legislative issues state lawmakers will grapple with in 2012, predicts the National Conference of State Legislatures.

States' lawmakers will focus on how to nudge health-care providers toward adopting certified EHRs, the bipartisan group said in a recent news release. Lawmakers also will seek to build health information exchanges that allow providers to access those EHRs, it noted.

"HIEs function like an online file cabinet where your medical record is securely stored, and can be accessed by any doctor or health care professional you visit," the legislative group said. "By mid-year 2012, every state should have Medicaid EHR Incentive programs in place and will be working toward building an HIE by late 2014 or early 2015 as required by deadlines attached to federal cooperative agreements."

The group also noted that the U.S. Supreme Court would hear arguments this spring on the federal health reform law, formally known as the Patient Protection and Affordable Care Act. A ruling is not expected until the summer, so states will have to move forward with health information exchanges and other requirements of the law, the organization said.

Here are the top 10 developments in health IT for 2011, straight from the national coordinator for health IT. Dr. Farzad Mostashari released the month-by-month list Jan. 6 on his Health IT Buzz blog:

• January: Medicare and Medicaid electronic health record incentive programs launched. Since then, "the marketplace of certified products has grown quickly, interest in meaningful use among providers and hospitals is sky-high, and the pace of incentive payments has continued to accelerate," Mostashari said. More than $1.8 billion in incentives had been paid to more than 20,000 health-care providers and 1,200 hospitals as of Nov. 30.


• February: ONC launched Direct Project, providing "a simple, secure, standards-based way for providers and other participants to send encrypted health information directly to trusted recipients over the Internet - a kind of 'health email,'" Mostashari said. Multiple vendors and states are implementing the system.


• March: The Health and Human Services Department, ONC's parent agency, released its National Quality Strategy, a framework to guide efforts to improve health-care, with health IT as a critical component.


• April: The "Summer of Standards" kicked off, a series of standards and interoperability forums to support Stage 2 standards and certification requirements for EHR incentive programs, resulting in consensus being reached on the Consolidated Clinical Document Architecture. Mostashari described the architecture as a "single, broadly supported electronic data standard for patient care transitions."


• June: The Investing in Innovations (i2) program used challenges and prizes to promote innovations in health IT. Several i2 challenges have been launched since, including a call to create applications "activating and empowering patients to improve their heart health."


• July: Health IT training curriculum was released on the open market in July. Employment continued growing in the health IT workforce, which added more than 50,000 jobs between 2008 and 2010, according to the Bureau of Labor Statistics.


• September: HHS' Office for Civil Rights issued its first report to Congress on breaches of protected health information. Breaches now must be reported to HHS, those affected, and in some cases the news media.


• September: ONC formally launched its Consumer e-Health Program, with the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention proposing regulations making it easier for patients to access lab data. More than 250 organizations covering more than 100 million people, including Aetna, the Mayo Clinic and AARP, have "agreed to make health information easily available to consumers," Mostashari said.


• October: ONC's 62 Regional Extension Centers passed their goals to enroll 100,000 "priority" primary-care providers nationwide, and by mid-December had enrolled 116,000 providers requesting help with EHR implementation, including 70 percent of rural primary-care providers.


• November: A CDC survey of office-based physicians showed the percentage of nonhospital-based physicians with a basic EHR doubled from 17 percent in 2008 to 34 percent in 2011, with nearly 40 percent of primary-care physicians adopting an EHR. The proportion of hospitals operating EHRs with the functionality required in the Medicare and Medicaid incentive programs rose from 2 percent to 41 percent, among hospitals eligible for the incentives.

The District of Columbia is shifting away from a formal health information exchange to a less-robust email system for sharing medical data among providers, citing problems with financing and physician compliance as reasons for the shift.

Bids are due Jan. 13 for contractors seeking to build an email platform for D.C. physicians and hospitals to exchange information by the end of June, the Washington Business Journal reported Tuesday. The district can renew the one-year contract for three more years, the newspaper said.

The email system should be able to eventually plug into a nationwide health information exchange, the paper reported.

The D.C. Primary Care Association shut down its D.C. Regional Health Information Organization in October, citing lack of funding, according to the paper. Federal health IT grants that would have gone to the regional health exchange now will go to the email network, to be called Direct Project.

Electronic health records top a list of 10 technologies hospitals need to watch in 2012, according to a report released today by ECRI Institute.

"Technology is increasingly a top management concern, and is no longer confined to clinical and technical decision making. Themes emerging on our 2012 list reflect ongoing impacts of health-care reform initiatives and new technology developments that emphasize patient-centered care," says Jeffrey C. Lerner, president and CEO of ECRI Institute, in a news release. ECRI, based in Plymouth Meeting, Pa., is an independent, not-for-profit organization that focuses on improving health care.

Hospitals need to focus on meeting Stage 2 meaningful-use criteria this year to continue qualifying for federal health IT reimbursements, the organization notes in its report, "ECRI Institute's Top 10 C-Suite Watch List: Hospital Technology Issues for 2012."

The report cites Stage 2 criteria including:

• Increasing the threshold for computerized physician order entry from 30 percent under Stage 1 criteria to 60 percent.


• Requiring that vital signs be recorded electronically for 80 percent of patients, up from 50 percent under Stage 1.


• Recording how the patient prefers to receive communications.


• Enabling Web-based access to inpatient records.

After developing a medical-device integration plan, hospitals will have to determine how they will share the information with health information exchanges, the report notes. "The IT challenges, as well as contractual issues (e.g., with your state or regional health information exchange) related to integration seem unending."

The report is available, with registration, through the ECRI Institute website.