Arizona Health-e Connection Blog

Health Information Technology Extension Program - Give us your thoughts!

Part of the HITECH Act portion of the American Recovery and Reinvestment Act of 2009 (ARRA; Federal Stimulus) seeks to establish a new program of technical assistance and education to health care providers - with the goal of facilitating "meaningful use" of electronic health records.  This program is called the Health Information Technology Extension Program, and it is partially modeled on the concept of the decades-old USDA agricultural extension service and the more recent (though also decades old) US Dept of Commerce manufacturing extension program.  The thought is to take nationally-recognized best practices and education and disseminate it to the "front lines" of implementation - in this case to health care providers - while also providing technical assistance. 

Technical assistance can include evaluation and selection of an electronic health record system for those that don't have one, as well as helping those that already have an EHR achieve what the Stimulus Package calls "meaningful use" - which will include implementation and use of a "certified" EHR system, successful use of e-prescribing, participation in health information exchange, and reporting of clinical qualify data to Medicare and/or Medicaid.  The HITECH Act also spells out prioritized groups of providers to receive this assistance, such as public/non-profit hospitals, Federally Qualified Health Centers, providers serving rural or underserved areas, and small primary care practices.  The Extension Program as currently suggested would have both "in the field," multi-disciplinary consultants, as well as subject matter experts in areas such as privacy and security, legal, EHR evaluation, organizational development, economics/business and financing.

So, the Feds have released a draft description of what this program might look like, which we've posted to our website, and you can access here:  Federal Register notice on HIT Extension Program

Because of our organization's mission, and the requirement that any Regional Extension Center be affiliated with a non-profit organization, we have recommended to our Board that AzHeC take the lead on creating the Arizona Regional Extension Center.  What do you think that this Regional Extension Center should look like?  What would make this successful in Arizona?  We want to hear from you for two reasons:  1) to provide feedback by Thursday, June 11th, to the Feds on their draft description; and 2) to design a program that will be successful in Arizona. 

Please either post a comment below, or email us at info@azhec.org (with "HIT Extension Center feedback" in the subject line). Only comments received by Wednesday, June 10th at 12noon will be incorporated into the comment letter to the Feds.  Thanks!!

Highlight: A Not-To-Miss Monday afternoon presentation

Wow, you're in for a treat on Monday afternoon, March 2nd, at the Western States Health-e Connection Summit and Tradeshow when Janet Marchibroda, the Chief Executive Officer of eHealth Initiative delivers a talk on the "Federal Economic Stimulus Package- The Details". 

Janet Marchibroda is the Chief Executive Officer of the eHealth Initiative and its Foundation, both Washington, D.C.-based independent, national non-profit organizations whose missions are to improve the quality, safety and efficiency of healthcare through information and information technology.

Ms. Marchibroda previously served as the Executive Director of Connecting for Health—a public-private sector initiative funded and led by the Markle Foundation and supported by the Robert Wood Johnson Foundation—which is designed to catalyze actions on a national basis to drive electronic connectivity and create an interconnected, electronic health information infrastructure. In addition, she was recognized in 2005 as one of the Top 25 Women in Healthcare by Modern Healthcare magazine and in 2006 for the Federal Computer Week Top 100 Award.

If you want to learn more about eHealth Initiative and what they are doing I have included in this post a link that will download a 23 page executive summary of their "eHealth Initiative Blueprint: Building Consensus for Common Action and eHealth Initiative Consensus Policy".  This document was shared with key Congressional Leaders, President-elect Barack Obama and the Obama-Biden Tranisition Team in December 2008. 

The document provides a guide on how to “enhance health and health care improvement strategies through the use of health IT and health information exchange”.  Great reading for policy wonks like me. The download is in .PDF format.

Executive Summary

Later posts will highlight other presentations scheduled for the conference.

Tips for a successful conference

As a veteran conference attendee, I’d like to share my list of tips for getting the most out of this conference:

1. Read the conference agenda beforehand and plan the important sessions you MUST attend. Plan your sessions and also plan when you will go to the exhibit hall.
2. Stay for the WHOLE conference! Not only will there be a lot to see and hear, but there will be people to meet.
3. If you’re coming from out of town, stay in the downtown Phoenix district (“Arizona’s Urban Heart"). They have lots of great hotels and the nightlife is lively. A recent article on www.azcentral.com tells about “An Eclectic mix of people creates a vital downtown”.
4. Bring a friend or colleague. You’ll each see different things and round out your experience, bringing new questions to be answered and a new perspective.
5. Realize that potential employers, clients and business partners may also be there. This is a networking opportunity and you should take advantage of the situation.
6. Bring plenty of business cards and don’t forget to hand them out. Use the refreshment breaks, breakfasts and reception on Monday to network and hand out your cards.
7. Be an active participant—ask questions, make comments and even contribute answer if you can.
8. Thank the speakers and anyone else you meet that helped plan the event. They’ve worked very hard to create a great conference experience for everyone attending.
9. Take what you learn at the conference and use it to make a difference in your world after you return home.
10. Bring your story to tell others. Each of us has a role to play in the field of health information technology and health information exchanges.

Excitement is in the air...

I don’t know about you, but I’m getting excited about the Western States Health-Connection 2009 Summit and Trade Show.  It seems to me that everything about health information technology is peaking right now.  With President Obama emphasizing electronic medical records and other health care technologies in many of the stimulus packages, I’ve never sensed such a buzz in the air. 

Many of us with connections to health care informatics have toiled for years in the background.  We’ve been working with systems, designing and implementing electronic medical records, working with physicians to digitize their medical records and practices, working to streamline paper and electronic workflows in hospitals, and working with telecommunications to transmit the information back and forth.  And it finally seems like it’s all starting to come together.  

Now, on a sunny day in Phoenix, we have the opportunity to see national experts who will:

•    Update us on rapidly changing national policies
•    Tell us about what’s happening with health information exchanges
•    Inform us about regional efforts in HIT and HIE
•    Show us the best in electronic health records and e-prescribing systems available
•    Give us the scoop on the Arizona and Utah Medicare Personal Health Record pilot
•    Answer our questions on privacy and security in HIT and HIE
•    Talk with vendors and sponsors exhibiting some of the best products & solutions in the nation

Never has an event been more timely than this!  We’ll hear from speakers representing some of the most knowledgeable organizations in the field:  HIMSS, the Markle Foundation, eHealth Initiative, CCHIT, Google Health, PassportMD, NoMoreClipboard.com, AHCCCS, GITA and AzHeC…and that’s only the first day.  Sorry about all the acronyms, but if you don’t know what they mean; you’ll just have to attend the conference to find out!

The second day starts with a bang as Dr. Eric Pan, Senior Scientist at the Center for Information Technology Leadership, delivers the keynote address “The Value of Interoperable Health Information and Personal Health Records”.  Later in the day, there’s a panel discussion with experts from Medicare/Medicaid, California, Colorado, Washington and Oregon sharing about their efforts and highlighting what the western states are doing in this field.

Other presentations include discussions about “The Case of Integration to Enhance EMR/eRX and PHR Adoption", a discussion on the legal aspects of “Personal Health Records Law and Policy” and “Healthcare Privacy and Security Policy Basics".  The day will end with a keynote on “Information Therapy: Prescribing Information to the 21st Century”.

I'm looking forward to meeting you at the summit...

Arizona Health Care Community Discussion - Agenda

The agenda for the December 30 Arizona Community Discussion is available here.

Arizona Health Care Community Discussion

We had an excellent turnout for the Arizona Community Discussion this morning at Arizona State University's Memorial Union.  Many thanks to Julie Smith David of ASU's Center for Advancing Business through Information Technology (CABIT) and our many partner organizations for making this happen on short notice.  The summaries of the discussions will be available shortly, but in the meantime, click here to access some photos and videos!  The next blog will show you the agenda with topics and the partnering organizations!

5th Nationwide Health Information Network Forum: NHIN Trial Implementations: A Path to Production

This week I am fortunate to be attending the 5th Nationwide Health Information Network Forum in Washington, DC.  There were some exciting developments on Monday, with respect to privacy and security in health information exchange.  Here are some of the highlights:

The conference opened with Dr. Robert Kolodner, National Coodinator, Office of the National Coodinator providing a summary of the NHIN Trial Implementations.  Dr. Kolodner introduced the keynote, HHS Secretary Michael Leavitt.

Secretary Leavitt announced HHS's *NEW* Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information. The following eight components make up the new privacy framework and are built around the idea of flexibility and choices.

Individual Access Principle - Individuals should be provided with a simple and timely means to access and obtain their individually identifiable health information in a readable form and format.

Correction Principle - Individuals should be provided with a timely means to dispute the accuracy or integrity of their individually identifiable health information, and to have erroneous information corrected or to have a dispute documented if their requests are denied.

Openness and Transparency Principle - There should be openness and transparency about policies, procedures, and technologies that directly affect individuals and/or their individually identifiable health information.

Individual Choice Principle - Individuals should be provided a reasonable opportunity and capability to make informed decisions about the collection, use, and disclosure of their individually identifiable health information.

Collection, Use, and Disclosure Limitation Principle - Individually identifiable health information should be collected, used, and/or disclosed only to the extent necessary to accomplish a specified purpose(s) and never to discriminate inappropriately.

Data Quality and Integrity Principle - Persons and entities should take reasonable steps to ensure that individually identifiable health information is complete, accurate, and up-to-date to the extent necessary for the persons or entities intended purposes and has not been altered or destroyed in an unauthorized manner.

Safeguards Principle - Individually identifiable health information should be protected with reasonable administrative, technical, and physical safeguards to ensure its confidentiality, integrity, and availability and to prevent unauthorized or inappropriate access, use, or disclosure.

Accountability Principle - These principles should be implemented, and adherence assured, through appropriate monitoring and other means and methods should be in place to report and mitigate non-adherence and breaches.

Secretary Levitt also announced that a usability toolkit would be available in January for Health Information Organizations (HIOs) to use when adopting these principles. 

For more information on this new framework, click here to be re-directed to the HHS HIT website.

Consent in Health IT

Consent.  As surprising as this may seem, in the US, the "Land of the Free and the Home of the Brave," we actually don't ask for the consent to move people's data around as much as it is required in other countries.  Having endured the East German Stasi, Hitler, and other government invasions of privacy, Europe has established stricter laws around the sharing of data.  In fact, a US company has to go to great lengths, via the US Dept of Commerce Safe Harbor route, to show a European nation that it will respect the privacy of an individual (to a greater extent than US law does), before moving its own European personnel data from a European country to the U.S.  In the U.S., we have tended to favor allowing companies - including medical providers and insurance companies under HIPAA -  handling our data without consent (though it may be for specific purposes), and if they don't handle it well, we can go after them.  Essentially, this is an indication of trust in the entities handling the data, and favoring smooth business operations, as opposed to more control by the individual.  I like the following "consent" definition from the European Union Data Protection Directive (referred to as the E.U. Directive):

"any freely-given, specific and informed indication of his wishes by which the data subject signifies his agreement to the processing of personal data about him."

In Arizona, we are in discussions about this issue of consent for Health IT - more specificially as it relates to participation in Health Information Exchange.  Legal Committee Chair Kristen Rosati has outlined consent options in Arizona in a white paper available here: Consent Options for HIE in AZ

A number of states have already enacted statutes related to consent for HIE.  California is going through a very thorough analysis regarding how consent can be viewed differently, based on the HIE context.  They are looking at the following five consent options, weighing each in its value for quality of care, as well as protection of the patient's privacy:  No Consent, Opt-Out, Opt-In with Restrictions, Opt-Out with Exceptions, and Opt-In.  They have, through Committees and forums, reviewed these options as they relate to the following contexts:  E-Prescribing, Lab Results Sharing, Emergency Dept Scenario, and Mental Health Scenario.  They presented these to interested parties on October 28th at an all-day symposium.  You can access the presentation materials at the link below, but keep in mind the "polling" was of participants at the Symposium (thus potentially partial to government or providers), and they will be taking the same subject on a "Road Show" of Town Halls to gain more public input:  California Privacy and Security Advisory Board Symposium

If you are interested in this issue as it applies to Arizona, please contact us at info@azchec.org or 602-288-5130.

Pharmacists, Physicians, and Business cases, OH MY! (Terri Warholak, PhD, RPh, University of Arizona College of Pharmacy)

I was fortunate to attend the CMS eRx conference in Boston this week because I learned something at each session I attended. The following is a list of the highlights.

Learning from experience – the pharmacy perspective

The speakers for this session were a chain pharmacist, an independent pharmacist, and a long-term-care pharmacist. They all agreed that while there were challenges to implementation of e-prescribing in their setting there are benefits to be realized once the initial bugs are worked out of the system.

CHAIN PHARMACY

• The chain pharmacist noted that his people are now dealing with fewer insurance issues because of the benefits checking that takes place before e-Rxs are sent. This is really good news for pharmacists because as a rule we dislike dealing with insurance issues.
• The speakers noted that having more e-Rx sent will help to resolve problems because when e-Rxs are the exception they represent an alternative work flow and consistent training is a problem.
• Some chain stores had problems with their physician matching algorithm such that even after the physician sent eRxs refill requests were faxed. The speakers mentioned that the easiest way to fix this is to alert the eRx vendor and have them log a ticket with SureScripts/Rx Hub. This can then be reported to the chain and the appropriate algorithms can be altered.
• SureScripts/Rx Hub has signs that pharmacists can place in their stores to promote and educate the public about eRx.

INDEPENDENT PHARMACY

• A pharmacy can find out who is e-prescribing their area by going to http://www.surescripts.com/spi/  and typing in their zip code.
• Sometimes when a provider sends an eRx to the pharmacy he/she has can accidentally hit “hold” or “fax” instead. Check these when looking for an e-Rx that the patient says should have been delivered to your pharmacy.

LONG TERM CARE (LTC) PHARMACY

• There are specific LTC enhancements written into the new SCRIPT standards.

Learning from Experience – the Provider Perspective

The speakers for this session were an ED physician and a primary care physician. Like the pharmacists in the previous session, the speakers all agreed that while there were challenges to implementation of e-prescribing in their setting there are benefits to be realized once the initial bugs are worked out of the system.

• It may take time to prescribe a new Rx but refills is where a provider can expect to save time with e-prescribing.
• Make sure all physicians in the practice are using eRx
• Make sure all users are trained on the eRx program
• Create handouts for patients to educate them on the new process (include the how what, why, and when)
• Send test prescriptions to a large number of pharmacies before you go live and have then send e-refill requests back
• When selecting an EHR make sure it is CCHIT certified (CCHIT certification will soon be offered to stand alone eRx programs)
• It is important to think about barriers – and to EXPECT them

E-Prescribing – a Business Case

• Rx Hub published a blueprint for e-prescribing last May – it’s worth getting a copy
• For more information, check out these sites:
  • www.GetRxConnected.com
  • www.RxSuccess.com
  • www.SureScripts.com/Safe-Rx
  • www.LearnAboutEPrescriptions.com
  • www.SureScriptsRxHub.com/mediaguide
  • www.thecimm.org

Thanks for this opportunity!

Terri Warholak

Notes from the Breakout Sessions (Laura Carpenter, Carpenter Law Firm)

Thank you, Brad, Melissa and Mindy, for the privilege of getting to attend the National e-Prescribing Conference on behalf of Arizona Health-e Connection and Arizona Pharmacy Alliance.  What an exhilarating day it has been!  Let me take this opportunity to briefly summarize the three break-out sessions that I was able to attend:

• Implementing E-Prescribing:  The Basics
  Each of the 4 speakers made it clear that while e-prescribing is an excellent starting point, they recommend an integrated full electronic health record (EHR) with eRx functionality.  We heard about the benefits, detriments and financial reasons for adopting eRx technology and discussed the MIPPA-mandated eRx incentive payments (and future penalties for failure for to e-prescribe).  Of note, CMS admitted that it has not yet determined the standard for determining how it will determine what constitutes "successful e-prescribing" that will provide for the 2% incentive payment in 2009.  AzHeC will update this blog as soon as it learns what those standards are.
• Privacy and Security Aspects of E-Prescribing
  Of particular interest in this session was hearing the Federal government's perspective on privacy and security policy as described by Jodi Daniel from the Office of National Coordinator for HIT.  It was exciting to hear how Secretary Leavitt places privacy & security of HIT as one of HHS's top 10 priorities - so much that he personally chairs the committee.  Further, Ms. Daniel stated that HHS is promoting a nationwide health information network to mobilize health data from wherever it is located to wherever the patient is being treated through an Internet exchange via standards-based data. 
• Working Together to Implement E-Prescribing
  This fascinating session included perspectives from SureScripts-RxHub, a pharmacist with a ton of eRx experience and an eRx champion physician who had conducted a study on eRx patterns.  It was very educational and uplifting to hear how e-prescribing can positively impact patients' health - and to hear a physician say "I will never go back to the old way!"