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Tag Archive | "HIT"

NQF Releases Reports on HIT Use

The National Quality Forum (NQF) released two reports this morning related to the effective use of health information technology (HIT).

The report, “Driving Quality—A Health IT Assessment Framework for Measurement,” examines, defines, and organizes the data needed to measure effective health IT use to better understand how health IT tools can improve the efficiency, quality, and safety of healthcare delivery.

NQF’s report on “Driving Quality and Performance Measurement—A Foundation for Clinical Decision Support” details the Forum’s Clinical Decision Support Taxonomy, which is composed of four functional categories that classify and categorize the CDS information necessary for quality improvement: 1) triggers, 2) input data, 3) interventions, and 4) action steps. The NQF CDS Taxonomy provides a foundation for the description of an electronic infrastructure, bridging quality measurement and health IT. Specifically, the taxonomy will enable quality measure developers, clinical system implementers, and vendors to be more effective in developing, sharing, implementing, and evaluating the effectiveness of different approaches to applying CDS aligned with quality measurement.

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Additional Certification Body Announced

The Office of the National Coordinator for Health Information Technology (ONC) recently announed InfoGard Laboratories, Inc. of San Luis Obispo, California as an ONC-Authorized Testing and Certification Body (ONC-ATCB).  This is the third ONC-ATCB authorized.  As noted in a previous post, the Certification Commission for Health Information Technology (CCHIT) and the Drummond Group were the initial organizations qualified to test and certify electronic health record (EHR) systems as capable of meeting the meaningful-use criteria of the federal health IT subsidy program established by economic stimulus.

ONC stated that additional certification bodies are under review.

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HIT Certification Bodies Announced

Yesterday, the U.S. Department of Health and Human Services (HHS) named the Certification Commission for Health Information Technology (CCHIT) and the Drummond Group as the initial organizations qualified to test and certify electronic health record (EHR) systems as capable of meeting the meaningful-use criteria of the federal health IT subsidy program established by the American Recovery and Reinvestment Act (ARRA) of 2009.  At this time, these ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) will be the only two entities that can certify EHRs in the “temporary” certification program outlined by the Office of the National Coordinator (ONC) for Health Information Technology in a recently released rule.  This may be an indication of a relatively small number of entities that will eventually be certifying EHRs and EHR modules as meeting the criteria for meaningful use, but in a statement HHS confirmed additional ONC-ATCBs were under review.

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HIT and Multi-Campus Hospitals

On Tuesday, July 27, 2010, the House Energy and Commerce Subcommittee on Health held a hearing, entitled, “Implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act.”  The hearing focused on the progress and plans for implementation of the provisions of the HITECH Act aimed at nationwide electronic use and exchange of health information since its passage on February 17, 2009, as a part of the American Recovery and Reinvestment Act (ARRA) of 2009.

Several members of the Committee voiced their concern that multi-campus hospitals are not eligible for seperate electronic health record (EHR) incentive payments for each qualifying hospital.

Mr. Tony Trenkle, Director of the Office of E-Health Standards and Services at the Centers for Medicare & Medicaid Services (CMS), addressed the interest from stakeholders that CMS accommodate multi-campus hospitals with a single CMS Certification Number (CCN) to allow each campus within the hospital to receive a separate EHR incentive payment. He stated that CMS carefully reviewed the comments and met with interested stakeholders, including the two largest hospital associations, the American Hospital Association and the Federation of American Hospitals, to hear their concerns with the policy described in the proposed rule. Taking this input as well as the legislative language of the Recovery Act into account, Mr. Trenkle explained that CMS came to the conclusion in its Final Rule that historically, a subsection (d) hospital has been treated as an entire institution and not each campus that is under the CCN.  Therefore, he stated that allowing each campus of one hospital to be considered its own hospital for purposes of EHR incentive payments, but not for other purposes, would inappropriately distinguish EHR incentives from other payment and program participation policies without clear statutory direction to do so.  To avoid this inconsistent treatment, Mr. Trenkle confirmed that CMS must have a consistent definition of a hospital for all policies, including EHR incentive payments, unless otherwise specified by law.  Finally, he noted that more specificity for future stages of meaningful use would be given in subsequent rulemakings.

The multi-campus hospital issue was discussed by several members, both Republicans and Democrats, of the House Energy and Commerce Committee.  Rep. Zach Space (D-OH) stated that numerous hospitals are going to be impacted by the multi-campus hospital regulation, and he specifically noted that the largest hospital in his district stands to lose about $2 million.  He inquired whether it will make it more difficult to adopt the very technology that the law is designed to promote.  Mr. Trenkle stated that the decision is based on existing policy and the provider number is based on how a hospital chooses to organize itself, consistent with the payment policy in other Medicare programs.  He explained that absent clear statutory intent, CMS does not intend to change, but the agency is committed to working with Congress.

In response, Rep. Space introduced a bill (H.R. 6072), co-sponsored with a group of thirty bipartisan Members, including Committee Chairman Henry Waxman (D-CA), Rep. Michael Burgess (R-GA), Rep. Marsha Blackburn (R-TN), and Health Subcommittee Chairman Frank Pallone (D-NJ) that clarifies the eligibility for all qualified hospitals that are part of a larger multi-campus hospital system with one CMS provider number.   The legislation was referred to the House Ways and Means Committee and the Energy and Commerce Committee.  The American Hospital Association voiced strong support for the bill.

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NQF: The Role of Health Information Technology in Quality Improvement

On June 17, 2010, the National Quality Forum (NQF) hosted a webinar focused on the intersection of health information technology (HIT) and quality improvement.

Dr. Marc Overhage, MD, PhD, Director of Medical Informatics at Regenstrief Institute, reviewed the goal of the Health Information Technology for Economic and Clinical Health Act (HITECH) to improve care and the efficiency of care. He stated that the key to HITECH is the definition of “meaningful use.”  He reported that the Centers for Medicare and Medicaid Services (CMS) is close to issuing its final rule that will establish the definition of meaningful use. He speculated that the Agency will soften the definition of meaningful use in the final rule, but that the proposed and final rules will be very similar. He stated that the Agency’s goals in 2010 are data capture and sharing.  In 2013, the goal is increased data use to improve the quality of care and in 2015 CMS intends to focus on substantially improving outcomes for patients.

Dr. Overhage described the incentives established in HITECH to encourage physicians to become meaningful users of EHRs.  He stated that the EHR adoption timeline is constructed in a graduated incentive model and that the Federal government hopes that many providers will adopt EHRs early.  He noted that if providers become meaningful user in 2011 and 2012, they will receive the full incentive payment.

He highlighted the connection between the National Priorities Partnership priorities and the health outcomes policy priorities established in HITECH. He reported that patient and family engagement, population health, safety, and care coordination were common themes. The National Priorities Partnership also identified palliative and end-of-life care and overuse as additional priorities.

Dr. Overhage shared that Regenstrief has established a Quality Health First® Program that uses HIT to drive performance measurement and quality improvement. The program has incorporated a Medicare demonstration program, which allows Medicare providers to participate along commercial providers and provide incentives.  He explained that providers receive incentive payments based upon their own quality improvement, even if they are the worst performing among providers. In 2009, a 5 percent improvement in quality was reported across the 1,000 primary care providers.

He stated that NQF is convening the HIT and Quality Committees to: (1) help build the electronic infrastructure to help automate performance measurement; (2) encourage and harmonize information standards; (3) facilitate coordination between quality and HIT communities; and (4) establish quality measurement and clinical decision support to occur in simultaneous fashion.

NQF will host another webinar on July 16 at 12:00 pm Eastern Time focused on quality and leadership.

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Overview of President’s Proposed Fiscal Year 2011 HHS Budget

Yesterday, President Obama released his proposed Fiscal Year 2011 budget.  We have provided summary highlights of the President’s budget for the Department of Health and Human Services.    

Visit www.hhs.gov/budget for the HHS Budget in Brief and Performance Highlights.


The budget for the Department of Health and Human Services (HHS) totals $911 billion in FY2011, an overall increase of $51 billion over enacted FY2010 levels. Approximately 84% of all HHS spending goes to Medicaid and Medicare entitlements. While the status of health care reform remains in Congressional limbo, President Obama’s budget assumes enactment and anticipates that it will reduce the deficit by $150 billion over 10 years. Additionally, the budget expands access to care with a $290 million increase to community health centers to expand services and capacity. States also receive a boost of $25.5 billion though a six-month extension of its Federal Medical Assistance Percentage (FMAP) payments. The Centers for Disease Control and Prevention (CDC) would see a $133 million decrease due to unobligated funds from the FY2009 pandemic influenza supplemental. President Obama also proposed a $1 billion increase in the National Institutes for Health’s budget with a focus on translational medicine, genomics, and biomedical research.

  • Health Reform. President Obama mentions Congress’ continuing work on health care legislation and outlines a number of enacted policies that move toward reforming the health care system, such as the Children’s Health Insurance Program (CHIP) reauthorization, lowering the cost of COBRA coverage, regulations that protect genetic health information from discrimination, and investments in health centers, health workforce, health information technology, prevention and wellness, and comparative effectiveness research. The President’s budget assumes $150 billion in savings over 10 years, resulting from Congress’ failure to pass comprehensive health care reform legislation. 
  • Health Resources and Services Administration (HRSA). The budget requests $7.6 billion for HRSA, which is an increase of $29 million over FY2010. Beyond the investment made through the Recovery Act in health centers, the President’s budget includes $2.5 billion for FY2011. The funding for health centers is directed to expand service capacity and investments in behavior health services. The President provides $142 million to improve access to care in rural areas, including $62 million for Critical Access Hospitals to conduct research on rural health issues. HRSA will also undertake initiatives related to telehealth.  The budget provides $673 million for the Maternal and Child Health (MCH) Block Grant program, which provides funding to states to improve the health of mothers and children. Healthy Start receives an increase in comparison to its FY2010 level too. The program is funded at $110 million, which will be used to provide grants to communities to implement strategies aimed at reducing infant mortality and improving prenatal outcomes in project areas with high annual rates of infant mortality. The President, again, eliminates funding for health care facilities and construction, the Denali Commission, and the Delta Health Initiative. 
  • Food and Drug Administration (FDA). The budget requests just over $4 billion in total program resources, an increase of $748 million over FY2010. The budget emphasizes the additional $318 million investment in food safety and the $101 million increase above FY2010 (totaling $1.4 billion) for medical product safety. The FDA will work with states to integrate Federal and state food safety inspections and other related activities. The President’s proposed budget includes $450 million to implement the new tobacco control laws established in the “Family Smoking Prevention and Tobacco Control Act.” The newly established FDA Center for Tobacco Products will work with state and local governments to prevent the sale of tobacco to minors.
  • Centers for Disease Control and Prevention (CDC). The President requests $10.6 billion for CDC, an increase of $101 million over FY2010. The budget references the $650 million provided in the Recovery Act for the Communities Putting Prevention to Work Initiative. In FY2011, CDC will continue to provide programmatic support to the communities participating in this prevention and wellness strategies program. The budget also includes $1.1 billion for health promotion, including $20 million for up to 10 large cities to address tobacco use, nutrition, and obesity. The budget requests $715 million, the same level as FY2010, for the Public Health and Emergency Preparedness Program. The President also requests $30 million for the Centers for Public Health Preparedness, which is a consortium of universities and states. The budget maintains the FY2010 level of $102 million for Preventive Health and Health Services Block Grants. 
  • Substance Abuse and Mental Health Services Administration (SAMHSA). The budget requests $3.7 billion dollars for SAMHSA, an increase of $110 million over FY2010. This funding includes $159 million for various services that assist in the transition from homelessness, an increase of $17 million from FY2010. Included within this funding is $70 million for the Projects for Assistance in Transition from Homelessness, an increase of $5 million from FY2010, to fund a formula grant that allows local programs to enact community-based services for individuals suffering from severe mental illness who are facing homelessness. In addition, the budget provides $37 million for Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health). This increase of $12 million will allow for new grants to communities for conducting evidence-based prevention and wellness interventions focused on children. The budget also includes $56 million, and increase of $13 million, to expand the treatment capacity of drug courts.  
  • Office of the National Coordinator for Health Information Technology (ONCHIT). The budget requests $78 million for ONCHIT. This is an increase of $17 million over FY2010. ONCHIT oversees development and implementation of Health IT standards, development of privacy standards for patient protection, development of architecture to advance Health IT adoption, and defines measures of success. These funds, in conjunction with the $2 billion provided by the Recovery Act, will be used in part to fund implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
  • Agency for Healthcare Research and Quality (AHRQ). The budget includes $611 million for AHRQ, an increase of $214 million from FY2010 levels. This significant increase is largely due to a $479 million request for research on health care costs, quality, and effectiveness. This investment represents a $208 million increase over FY2010. $286 million of this research investment is dedicated to Patient-Centered Health Research, focused on outcomes of health services and therapies. In addition, the budget identifies five other priority research areas: (1) prevention and care management, (2) improving patient safety, (3) achieving greater health care value, (4) improving health care through health IT, and (5) cross cutting research on health costs, quality, and outcomes. The Medicare data initiative falls within its scope and is designed to provide the infrastructure for value-based purchasing and CER. The AHRQ budget request also includes $32 million for health IT research in order to develop and disseminate evidence-based tools about how health IT can be used to improve the quality, efficiency, and safety of care. This represents a $4 million increase from FY2010 levels. The President also provides $34 million to reduce and prevent healthcare-acquired infections.
  • Medicaid. Although a state-level program, many local governments are responsible for public hospitals or services that involve Medicaid funding issues; 38% of the Centers for Medicare and Medicaid Services (CMS) proposed net outlays will go to Medicaid. For FY2011, the Federal share of Medicaid outlays is expected to be $271 billion, which is a $4 billion decrease below projected FY2010 spending. This decrease is due to the end of the Recovery Act’s increased match rate. To protect Medicaid access for low-income families and provide additional fiscal relief to states, the budget includes a proposal to extend the temporary increased FMAP by six months. (The temporary increase was provided by the Recovery Act through June 30, 2011.) Additionally, the FY2011 budget proposes a new program to improve Medicaid’s integrity and beneficiary quality of care by requiring states to track and monitor prescription drug billing, prescribing, and utilization patterns that could be a sign of abuse or over-utilization.
  • State Children’s Health Insurance Program (SCHIP). One percent of the FY2011 CMS request will go to SCHIP. The Children’s Health Insurance Program Reauthorization Act of 2009 (Public Law 111-3) reauthorized the CHIP program through FY2013, providing an additional $44 billion in funding over five years (for a five-year total of $69 billion) and created several new initiatives to increase innovation and enrollment in the program.
  • Medicare.  The budget requests $784.3 billion in mandatory and discretionary outlays for Medicare. This is a net increase of $48.3 billion from FY2010 levels; 60% of this request will go to Medicare. The budget emphasizes transforming CMS’ data centered environment focused primarily on claims processing, to one focused on state-of-the-art data analysis and information sharing. The request includes a $371 billion adjustment to reflect the Administration’s best estimate of future Congressional action for physician payments.  Congress must act by March 1, 2010, or physicians will receive a 21% cut. Additionally, the CMS request included $1.1 billion to Quality Improvement Organizations (QIOs) and a $250 million increase for the Health Care Fraud and Abuse Control (HCFAC), which is the largest one-year increase to the program since its creation.  The FY2011 HCFAC funding includes $1.2 billion in mandatory funding and $561 million in discretionary funding, which will support fraud and abuse prevention initiatives. The entire program integrity initiative is projected to generate nearly $25 billion in Medicare and Medicaid savings over 10 years.
  • National Institutes of Health (NIH). The budget increases NIH funding by 3.2% to total $32.2 billion. The President cites the NIH Director’s five areas of research opportunities that are of particular interest, including: (1) genomics; (2) advancing basic science into new and better treatments; (3) biomedical research; (4) using science to advance health care reform; and (5) global health. The President also outlines his cancer and autism research initiatives.



Overall, funding to HHS discretionary programs would be $81.3 billion, an increase of $2.3 billion from FY2010. The FY2011 budget continues to build on the funding from the Recovery Act with an emphasis on health information technology, reducing health care fraud and abuse, strengthening the health care workforce, and improving health outcomes. Additionally, the budget notes the Administration’s commitment to reforming the health care system.

  • Temporary Assistance for Needy Families (TANF). This program provides $17.1 billion annually to states to support low-income working families. The budget extends the TANF block grant, including the Contingency Fund and Supplemental grants through FY2011. It proposes the creation of a Fatherhood, Marriage, and Families Innovation Fund to provide competitive grants to states to conduct and evaluate responsible fatherhood programs that work in conjunction with community-based organizations, as well as demonstration programs, to improve outcomes for custodial parents experiencing barriers to independent living. The budget includes a $2.5 billion legislative proposal for the TANF Emergency Fund, which assists with payments for increased expenditures on employment-related services.
  • Foster Care, Adoption Assistance, and Independent Living Programs. Although foster care programs are funded through states, localities play a leading role in implementation. The budget requests $7.5 billion for the Foster Care, Adoption Assistance, Guardianship Assistance, and Independent Living programs. Of this requested funding, $4.6 billion is for the Foster Care Program. This is a $36 million decrease from FY2010.  The budget suggests that this decrease is partially due to more children being placed in permanent care settings as well as a reduction in the number of foster care children funded by the Federal program because of old statutory income eligibility requirements that have not taken account of inflation. The Recovery Act provided $806 million through a 6.2% FMAP increase through December 2010 for foster care, adoption, and kinship guardian assistance programs. The budget sets forth a legislative proposal to extend the Recovery Act FMAP increase through June 2011.
  • Community Services Block Grant (CSBG). The budget maintains funding for CSBG at $700 million, for formula suballocations to about 1,100 federally-designated public (city) or private nonprofit Community Action Agencies. The funds can be used to deliver a range of services for low-income individuals including the homeless, migrants, and the elderly, addressing employment, education, better use of available income, housing, nutrition, emergency services, and/or health.
  • Social Service Block Grant (SSBG). The budget maintains funding at $1.7 billion.  SSBG gives broad discretion to states over the use of these funds and is used to finance many local government safety net program activities.
  • Low Income Home Energy Assistance Program (LIHEAP)The budget requests $3.3 billion for LIHEAP to help low-income households heat and cool their homes. While this is a $1.8 billion decrease compared to FY2010, the budget also includes $2 billion in mandatory funding to help address changes in energy prices for the number of Americans living in poverty.   
  • Head StartThe budget proposes $8.2 billion, an increase of $989 million, estimated to serve 971,000 children, an increase of 66,500 above FY2008 levels, and will serve nearly twice as many infants and toddlers as FY2008.  The budget also implements various provisions of the Head Start Act of 2007. The Recovery Act invested an additional $2.1 billion in the program.
  • Child CareThe budget lays groundwork for upcoming child care program reauthorization, seeking $2.9 billion in the Child Care and Development Block Grantfor FY2011, an increase of $800 million over FY2010, plus $3.7 billion in the Child Care Entitlement, another $800 million increase. In total, that funding level serves 1.6 million children, up 235,000 estimated for the prior year. The budget proposes that entitlement child care funding programs to be adjusted for inflation in subsequent years. It also foreshadows reauthorization efforts to reform quality standards, professional development, and early childhood education program integration.
  • Strengthening Communities Fund (SCF). The budget eliminates funding for SCF in FY2011. The Recovery Act provided $50 million in FY2009 for the capacity building of faith-based and community-based non-profits to serve low-income and disadvantaged populations. Funding was not provided in FY2010.
  • Mentoring Children of Prisoners. The budget maintains funding at $49 million for grants to entities that provide one-on-one mentoring to children of incarcerated or recently released parents.
  • Teen Pregnancy Prevention. The budget provides $179 million for teen pregnancy prevention programs to address rising teen pregnancy rates. The newly established Office of Adolescent Health (OAH) in the Office of Public Health and Science will oversee the funds and implement the program. $50 million will be used to fund formula grants to prevent teenage pregnancy. The President provides $65 million in Public Health Services Evaluation Funds, which will be used for health care reform activities and evaluation of teen pregnancy prevention programs among other policy initiatives. The President’s budget also includes $183 million for teen pregnancy prevention within the Office of Public Health and Science. The budget includes $22 million for CDC for activities to reduce teen pregnancy through science-based prevention. Direct funding for abstinence education was not provided, although the $183 million to the Office of Public Health and Science could be used for this purpose.
  • Administration on Aging (AoA). Overall funding for AoA is increased by $109 million, to $1.6 billion.  $102.5 million of this funding will be used for a new Caregiver Initiative. This initiative will support services to caregivers, including counseling, training, and respite care ($50 million), services to elderly disabled individuals to assist with routine daily activities ($50 million), and respite care for family members of individuals with special needs ($2.5 million). Also included in the AoA funding is $30 million for the Health and Long-Term Care Programs (previously, the “Choices for Independence” demonstration projects), a decrease of $1 million from FY2010. This program seeks to empower older individuals and their families to make informed decisions about long-term care options. The program encourages seniors and their families to plan for long-term care and to conserve personal resources through community-based alternatives to nursing homes. The AoA budget also includes $828 million for nutrition-related services (an increase of $8 million) as well as $416 million (an increase of nearly $48 million) for home and community based support services.
  • Emergency Preparedness. The budget highlights that the Office of Inspector General (OIG) will continue to monitor the country’s preparedness and response to public health emergencies. The FY2011 budget includes $632 million for the pandemic influenza program. The President requests $5.4 billion for terrorism preparedness. This represents an overall increase above FY 2010 of $284 million. The President requests $4.8 billion for HHS bioterrorism and emergency response. The budget maintains the FY 2010 funding level of $426 million for the hospital preparedness program.

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Capital Thinking Radio Show




Join Kevin O’Neill this week for Capital Thinking as he interviews health care policy experts Julie Black and Kendall Hussey from the editorial team at the capitalthinkinghealthcare.com blog to understand the latest twists in the road to reform. Then, Karen Thiel will share her expertise in the health care IT area and explain the newest rules on Electronic Health Records (EHRs) and their impact on health IT vendors, health professionals, acute care, children’s and critical access hospitals. Then, political analyst Nick Allard is our guest to talk about the fallout from Scott Brown’s election in Massachusetts. All that, plus the latest insider analysis from Capitol Hill and the halls of power in Washington.

Be sure to tune to Capital Thinking Thursdays at NOON EST and 9AM PST.

This episode of Capital Thinking radio was taped live on: January 21, 2010

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