ONC chief pushes for HIE 'rules of the road'

WASHINGTON – Healthcare providers need health information exchange to be fully automated and easy to do in order to scale up sharing of patient data to improve care, according to Farzad Mostashari, MD, the national coordinator for health information technology.

Some steps for preparing data for exchange are still often almost hand-coded, such as vocabulary mapping, value sets and quality measures, he said.

[See also: HIE as a verb: ONC wants to move quickly on data exchange]

The development of rules of the road to govern the nationwide health information network (NwHIN) could promote that automation by detailing the policies and technical standards that organizations that want to perform exchange activities would meet to foster trust in their services.

“This is what we’re expecting people to be able to use for meaningful use. This is what needs to be able to enable meaningful use stage 2 pretty quickly,” Mostashari said at the May 24 meeting of the advisory Health IT Standards Committee. Health information exchange is a critical part of meaningful use Stage 2.

“Whether it’s moving from the information exchange trust that is based on first-name basis and resulting in point-to-point sharing to a more scalable approach where once conditions for trusted exchange are met, there can be assurance that it just works,” he said.

[See also: NwHIN Exchange set to 'stand on its own' this October]

Middleware might also be developed to support policies and evolving technical implementation guidance as governance and exchange matures.

The Office of the National Coordinator for Health IT seeks feedback on rules of the road and conditions for trusted exchange that can help it develop a notice of proposed rulemaking. ONC published a request for comments May 15 and has reached out to its advisory health IT committees for the expertise of their members. Public comments are due June 14.

The NwHIN standards, services and policies enable secure health information exchange over the Internet. Until now participants have been typically large providers and federal agencies. NwHIN participants can share complex health queries with multiple participating organizations at the same time instead of just one-to-one exchange.

ONC wants to open NwHIN to many more participants. Current participants enter into data use agreements, which can be expensive and time-consuming for legal departments to complete.

John Halamka, MD, committee co-chair and CIO of Beth Israel Deaconess Medical Center, said, “We have the technical ability to do exchange, but our legal teams are very backed up.” Instead, he suggested, government and stakeholders need to work together to come up with something workable.

He compared it to the way electronic health records are certified. An organization could be certified as an NwHIN validated entity (NVE) to be a trusted steward of data and an exchange member, according to the ONC request for comments.

“At that point, it is no longer the responsibility of state governments or local entities to do these binary, bi-directional point-to-point, one-off type of agreements before hospitals can trust each other to share data about patients they share in common,” Halamka said.

He envisiions the result being some kind of certification program with clear standards and criteria by which an individual organization can join local, regional and national networks.

ONC has acted now because there has not been national guidance. States and other large groups have begun to develop potentially conflicting governance approaches to health information exchange and there needs to be a consistent trust baseline.

Mostashari described the goal as “if I’m working with a nationally validated NVE and I want to communicate with another provider who also is working with an NVE, I have confidence that there is no need for negotiations between those two around the conditions for interoperability or for conditions for trust or around business practices.” 

ONC has assembled a list of 16 conditions for trusted exchange (CTEs) that are a starting point for discussion for rules of the road. They include conditions for:Safeguards to protect confidentiality, availability and prevent disclosure and unauthorized accessInteroperability that focus on the technical standards and implementation specifications needed for exchanging electronic health information Business practices in operations and finance that NVEs would need to adhere to support trusted exchange.

[See also: Standards panel seeks advice on data exchange]

Blind movie critic Tommy Edison educates the masses

Tommy Edison knows you've got questions about blind people � because people have been asking him those questions all his life.

Like: Do you see stuff in your dreams?

And: How do you count your paper money?

And: Do you think you could hit a golf ball?

Actually, that last one was a question Edison had and decided to answer, along with the others, in a online video series he calls "The Tommy Edison Experience." The videos are shot and edited by his buddy Ben Churchill, a documentary filmmaker, and share a website with a series called "Blind Film Critic."

Yes, a blind guy reviews movies. In fact, Edison � who works as a traffic reporter for a Connecticut radio station � became mildly famous for his pithy reviews about a year ago. His web traffic spiked after master critic Roger Ebert mentioned him online, Edison says.

With the attention, came the questions �starting with how a blind man can appreciate movies.

"I like strong characters in a good story and I like a few laughs," Edison says in a phone interview. Lots of dialogue helps.

But in between going to movies and reporting on traffic tie-ups (using police scanners and calls from listeners), Edison is just a regular forty-something guy who has been blind since birth. The point of the "experience" videos, he says, is "to show sighted people how I live and how I do things," educate a bit and have some fun.

So Edison has answered questions about his:

�Dreams: "I don't see in my dreams. It's all smell, sound, taste and touch," he says.

�Money: In one video, he buys a beer and has to ask the cashier to name the bills as he takes his change so he can line them up in order. Every blind person needs a system, he explains, because U.S. paper currency is not differentiated in a way blind people can detect (though it soon will be, say advocacy groups for the blind).

�Golf game: It's pretty good - for a blind guy. (He hits a ball after a few lessons).

�Travel style: He's an able-bodied guy, but has to explain to an airport employee (repeatedly, with impressive good humor and politeness) that he doesn't need a wheelchair to get through a terminal.

�Celebrity curiosity: If he could see three celebrities, he'd choose singer Tom Waits ("I've got to see the face that goes with that voice"); actress Angelina Jolie ("I keep hearing how beautiful she is") and Jay Leno ("the devil himself," says the Conan O'Brien fan). He's also curious about the Muppets.

Edison doesn't speak for all blind people. But it's nice to have someone out there answering the kinds of questions many blind people get all the time, says Eric Bridges, director of advocacy at American Council of the Blind. "People are naturally curious," he says. "And humor is the greatest device to sort of cut the tension and put people at ease."

The videos seem "very positive and informative," says Chris Danielsen, director of public relations at the National Federation of the Blind. Social media creates opportunities for many blind people "to get our own stories out," he says.

For Edison, that means sharing his reviews of Cabin in the Woods and The Hunger Games (he didn't love either) and answering the question: "Can you open your eyes?" The answer, as he demonstrates in one video, is yes, he can. "Next time," he promises, "I'm going to show you how I perform surgery."

Panel advises against PSA cancer screening

Doctors should no longer offer the PSA prostate cancer screening test to healthy men because they're more likely to be harmed by the blood draw � and the chain of medical interventions that often follows � than be helped, according to government advisory panel's final report.

Even after studying more than 250,000 men for more than a decade, researchers have never found the PSA to save lives, according to the U.S. Preventive Services Task Force, a panel of doctors that advises the government on cancer screenings and other ways to avoid disease.

Yet the PSA can cause harm.

That's because the PSA, which measures a protein called prostate-specific antigen, often leads to unnecessary needle biopsies for men who don't actually have cancer. Even worse, those biopsies lead many men to be treated for slow-growing cancers that never needed to be found and that are basically harmless, says task force chairwoman Virginia Moyer, a professor of pediatrics at Baylor College of Medicine in Houston.

Because doctors today often can't tell a harmless tumor from an aggressive one, they end up treating most men with prostate cancer the same, says Otis Brawley, chief medical officer of the American Cancer Society, which takes a neutral stand on the PSA.

Treating harmless prostate tumors can't possibly help men, however. It only increases the odds of making them impotent or incontinent, Moyer says. Treatment can even be deadly: One in 200 men who have prostate surgery die shortly after the procedure, she says.

The recommendation, first released as a draft in October, applies to healthy men of any age, although not for those who already have been diagnosed with prostate cancer.

The panel didn't consider cost in its deliberations, Moyer says. Federal legislation requires that Medicare must continue to pay for the PSA, Brawley says. Private insurers usually follow Medicare's example.

In the future, Moyer hopes doctors will simply stop mentioning the PSA when men come for office visits. If men ask for the test, or if doctors still want to offer the PSA, Moyer says she hopes physicians will discuss both the risks and benefits of screening. Although the task force aims to help doctors by issuing recommendations, physicians aren't obligated to follow its recommendations, Moyer says.

Yet Moyer agrees that men desperately need a better test. More than 28,000 men die of prostate cancer a year.

Unfortunately, there are no other better tests with which to replace the PSA, such as rectal exams, ultrasounds or variations on the PSA, says Ian Thompson, chairman of urology at the University of Texas Health Science Center at San Antonio and a spokesman for the American Urological Association, which recommends the PSA for men over 40. Thompson supports some of the task force's recommendations, such as its call to do away with mass prostate cancer screenings in shopping malls and parking lots.

But Thompson says the task force went too far in rejecting the PSA completely. He notes that death rates from prostate cancer nationwide have dropped 30% to 50% since PSA testing became widespread in the early 1990s. In its recommendations, published in Monday's Annals of Internal Medicine, the task force said it's unlikely that screening alone could have reduced death rates so quickly. Some experts note that treatments also have improved.

Thompson also says he doesn't want to go back to the "bad old days" before screening, when doctors found prostate cancer only after it had become incurable. And because many men are used to getting PSAs, Thompson says, some might not realize their doctors have stopped performing the tests.

"A patient might presume they've had their PSA tested, then come back five or 10 years later with back pain," only to learn they have prostate cancer that's spread to their spine, Thompson says.

Terry Dyroff, 66, says he first realized the risks of prostate screening five years ago. He developed a life-threatening bloodstream infection called sepsis after his PSA results led to a needle biopsy, and he was hospitalized for three days. Though such infections are rare, Dyroff says one such experience was enough; he hasn't had a PSA since. "At my age, if I developed prostate cancer, I'd rather not know," says Dyroff, of Silver Spring, Md. "And if I did know, I probably wouldn't do anything about it."

Organization sends health info via mobile phones

The Mobile Alliance for Maternal Action (MAMA) celebrates one year of working with local organizations to send timely and culturally sensitive health and wellness information to new and expectant mothers in 22 countries via mobile phones.

MAMA is a $10 million three-year partnership that addresses the 360,000 maternal deaths and 3.1 million newborn deaths that occur each year. It is a collaboration between the U.S. Agency for International Development (USAID), Johnson & Johnson, the United Nations Foundation and BabyCenter. It operates through a secretariat hosted by the mHealth Alliance.

The organization is due to launch nationally in Bangladesh in July, and South Africa will preview its services in May at the GSMA-mHealth Alliance Mobile Health Summit in Cape Town.

Subscribers to the service register by indicating the expected due date or birthday of their recently born child and receive weekly health messages and reminders during the pregnancy and up to the child’s first birthday. Messages include everything from proper nutrition, breastfeeding, vaccinations and referrals to local health resources.

Maternal and infant death rates remain high, and 99 percent of them occur in developing nations. Most of these deaths are preventable with relevant information and care.

“By using available technology and credible health information, the world has the knowledge and the opportunity to stop millions of deaths to moms and babies each year,” said Kirsten Gagnaire, Global Partnership Director at MAMA.

More than one billion women in low- and middle-income countries own mobile phones. Mobile health messages can inform, dispel myths, highlight warning signs and connect pregnant women and new moms with local health services.

In Talent Hunt, Some Businesses Offer Health Benefits For Same-Sex Couples

Enlarge The White House/Getty Images

Reaction to President Obama's bombshell that he now supports gay marriage ran the gamut from profound to lighthearted.

The White House/Getty Images

Reaction to President Obama's bombshell that he now supports gay marriage ran the gamut from profound to lighthearted.

President Obama's pronouncement last week in favor of same-sex marriage has no legal effect on employers' decisions on whether to offer benefits to workers' domestic partners.

But some advocates say it could reinforce a decade-long trend toward coverage.

Last year, a little more than half of employers offered health benefits for domestic partners, according to a nationally representative sample of about 3,000 employers surveyed by benefit consultant Mercer. That's up from a little less than one-third in 2010.

The biggest factors driving that change are employers' views on whether such benefits help them attract and retain desirable workers.

 

"Employers started doing this because they felt they needed to be competitive in the labor market, just like with other benefits," said Paul Fronstin of Employee Benefit Research Institute, a think tank in Washington D.C. "I don't see that changing."

The Village Voice newspaper in New York is credited with being the first private employer to offer workers domestic partner benefits in 1982. In 1995, Vermont became the first to offer coverage to state workers.

"There's been a steady growth for a long time," says Joan Smyth, a partner at Mercer. In the early days, some employers worried that adding coverage for domestic partners could make their costs skyrocket by attracting people with higher-than-average health risks, she said, but it didn't turn out that way.

The District of Columbia and almost half of states currently offer benefits to domestic partners or same-sex spouses of state workers, according to the advocacy group Human Rights Campaign.

Same-sex partners of federal workers are not eligible for coverage under the Federal Employees Health Benefits Program because the Defense of Marriage Act, passed in 1996 and signed into law by President Bill Clinton, defines marriage as a legal union between a man and woman, the FEHB website says.

That law is being challenged and may well end up before the Supreme Court. The Obama administration has said it will not defend the statute.

The proportion of companies offering coverage varies widely by region and industry. In the Mercer survey, coverage of same-sex partners was most common in the West, with 79 percent of large employers offering such benefits. It was least common in the South, at 28 percent.

Among manufacturing firms, for example, the coverage rate ranged from a high of 96 percent for pharmaceutical companies to 18 percent for machinery and heavy equipment makers.

Public sector jobs had a lower rate of coverage, averaging 26 percent across state, county and municipal workers, the Mercer survey found.

While Smyth at Mercer doesn't think the president's pronouncement will sway employers, the Human Rights Campaign's state legislative director Sarah Warbelow has a different take. "Hearing the president supports this as well makes this even easier for corporations to get on board," says Warbelow, adding that 58 percent of Fortune 500 companies currently offer domestic partner benefits. Some of those companies limit those benefits to same-sex couples, while others include domestic partners of opposite sexes.

No 'bubble' for healthcare IT, analysts say

NASHVILLE, TN – Leading financial analysts scoffed at the notion of a healthcare IT “bubble” that could slow the pace of mergers and acquisitions this year. Speaking on a panel called “Financing The Deal” at the Nashville Health Care Council, they predicted that 2012 M&A activity would be brisk, though not superheated.

In the health IT sector, there’s currently a glut of buyers and not enough companies to acquire. There are many non-healthcare players like Lockheed-Martin wanting to buy healthcare IT companies – and many suitors for a limited number of clinical decision support companies. “There are still a lot of great opportunities for technology-enabled healthcare companies with a demonstrable ROI,” said David Jahns, managing partner at Galen Partners.

[See also: All in a week's work]

The analysts agreed that deal-making this year won’t be dampened by uncertainty surrounding the future of healthcare reform. If anything, there’s greater pressure to make deals this year in advance of possible post-election efforts at tax reform.

“There’s still a stable financing environment despite the upcoming election and the events in Europe,” said Jon Santemma, global co-head of healthcare investment banking at Jefferies & Company. “Valuations are down in some sectors like nursing homes and home health, which makes them good deal-making opportunities this year. And we anticipate a lot of deals this year involving private-pay companies.”

There’s still about $350 billion in private equity “overhang”, which sets the stage for some rapid-fire M&A this year. “I look for a lot of activity in the mid-market private equity arena, with a lot of possible deals in the $200 million to $800 million range,” added Santemma.

[See also: Health IT M&A activity down in 2011, value up]

According to Irving Levin & Associates, hospital M&A reached a 10-year high last year, when 86 deals were completed. “I look for hospital transactions to increase,” said Ravi Sachdev, managing director at J.P. Morgan. “The attitude we’re now seeing is, ‘If I can’t be No. 1 or No., 2 in my service area, I want out’.”

Panelists were reluctant to make long-range forecasts. “Five years ago, who would have predicted that you’d have payers acquiring HIEs?” said Jahns. “But that’s exactly what’s happening now.” The panel members agreed that one long-term trend is rock-solid: a lot of money will continue to flow through America’s healthcare system – enough money to allay dealmakers’ concerns about declining state and federal reimbursements.

As for overseas deals, look for increased activity in telemedicine in 2012. China and India have been quick to harness the potential of telemedicine. And as one panelist quipped, “It’s easier for U.S. telemedicine companies to operate in China than across state lines.”

Computing cluster speeds targeted treatments for childhood cancer

AUSTIN – Cloud-based research technology launched by Dell last year for the Translational Genomics Research Institute (TGen) is gearing up for what's billed as the world’s first precision medicine clinical trial for pediatric cancer.

James Coffin, vice president and general manager, Dell Healthcare and Life Sciences, says the eight-teraflop supercomputer, billed as the "kids cloud," will drastically reduce the time required to identify personalized treatments for children participating in the trial program – kids who have no time to spare. In turn, that acceleration can help open the trials up to participation from more children.

The Human Genome Project "took $3 billion and 10 years" to sequence the first genome, he points out. "A year ago, it took about nine months and cost about $400,000 or $500,000 to do a full genome."

And recently, says Coffin, "we just ran a test for a full genome for a patient, and got all the the results and made a clinical decision for the patient to the tumor board in less than five days."

Dell has "done a lot of work to retune the codes and make them run really fast on this platform," he says. "Just three months ago, the analysis of 25 million bases – there's usually about 500 or 600 million bases you have to do to kind of do this whole genome sequence – and 25 million bases took about 48 hours."

Now, that time is down to six hours.

"There's an inflection point in genomic science right now, where we have these new, next generation sequencers that are coming out over the last six months from companies like Illumina and Life Technologies, and then we have very very fact computing, and new processors coming out from Intel," says Coffin.

"I've been talking about personalized medicine for 13, 14 years, since before the human genome project happened, saying that this is the future of medicine," he adds. "It's here now."

Oncologists from the Neuroblastoma and Medulloblastoma Translational Research Consortium (NMTRC) and biomedical researchers from TGen will use Dell's computing and collaboration cloud to seek out and ID treatments for pediatric cancer patients based on the specific genetic vulnerabilities of each specific tumor.
 
First announced in November 2011, Dell’s team has completed the high performance computing cluster that will serve as the cloud’s computational foundation and basis for a private cloud, officials say. When equipped with Dell’s PowerEdge M420 server technology, TGen can analyze comprehensively a patient’s tumor RNA profile seven times faster than was previously possible. Time, of course, is a precious commodity for kids with cancer.

"With this particular population of children, with pediatric neuroblastoma, you've essentially got one shot," says Coffin.

With the dedicated computing cluster in place, Dell will begin to connect the biomedical researchers sequencing and analyzing patient tumors at TGen in Arizona with oncologists providing treatment to patients participating in the trial at 11 medical centers, officials note, adding that the new cloud will eliminate the need to express mail hard drives containing tumor and diagnostic images and genomic sequencing data between locations.

[See also: Slideshow: Advances in personalized medicine.]
 
With just one new treatment for pediatric cancer approved by the FDA since the 1980s – compared with 50 treatments approved for adult cancer in the same period – pediatric oncologists have often been forced to rely on adult-sized treatments, leading to some toxic side effects that are often as harmful to children as the cancer itself. More targeted treatments can aim right for the specific vulnerabilities of each child’s tumor, leaving healthy cells untouched.

"We're really making progress and figuring out what the cocktail is for them very quickly," says Coffin. "We're able to go full genome sequence on them and really get all the information we think we need. It's a very different game."

In the coming years, the hope it that this approach can not only be "a model for all cancer" but "a way to treat all disease," says Coffin. "Understanding the biological and genomic pathways of these things is the way you need to treat everything going forward."

He adds that "this is one of the reasons I'm so passionate about healthcare IT. This is the kind of thing health IT can do to change the world. I don't think health IT gets enough credit for what it does. This is a perfect example: you can't do this without health IT."

No 'bubble' for healthcare IT, analysts say

NASHVILLE, TN – Leading financial analysts scoffed at the notion of a healthcare IT “bubble” that could slow the pace of mergers and acquisitions this year. Speaking on a panel called “Financing The Deal” at the Nashville Health Care Council, they predicted that 2012 M&A activity would be brisk, though not superheated.

In the health IT sector, there’s currently a glut of buyers and not enough companies to acquire. There are many non-healthcare players like Lockheed-Martin wanting to buy healthcare IT companies – and many suitors for a limited number of clinical decision support companies. “There are still a lot of great opportunities for technology-enabled healthcare companies with a demonstrable ROI,” said David Jahns, managing partner at Galen Partners.

[See also: All in a week's work]

The analysts agreed that deal-making this year won’t be dampened by uncertainty surrounding the future of healthcare reform. If anything, there’s greater pressure to make deals this year in advance of possible post-election efforts at tax reform.

“There’s still a stable financing environment despite the upcoming election and the events in Europe,” said Jon Santemma, global co-head of healthcare investment banking at Jefferies & Company. “Valuations are down in some sectors like nursing homes and home health, which makes them good deal-making opportunities this year. And we anticipate a lot of deals this year involving private-pay companies.”

There’s still about $350 billion in private equity “overhang”, which sets the stage for some rapid-fire M&A this year. “I look for a lot of activity in the mid-market private equity arena, with a lot of possible deals in the $200 million to $800 million range,” added Santemma.

[See also: Health IT M&A activity down in 2011, value up]

According to Irving Levin & Associates, hospital M&A reached a 10-year high last year, when 86 deals were completed. “I look for hospital transactions to increase,” said Ravi Sachdev, managing director at J.P. Morgan. “The attitude we’re now seeing is, ‘If I can’t be No. 1 or No., 2 in my service area, I want out’.”

Panelists were reluctant to make long-range forecasts. “Five years ago, who would have predicted that you’d have payers acquiring HIEs?” said Jahns. “But that’s exactly what’s happening now.” The panel members agreed that one long-term trend is rock-solid: a lot of money will continue to flow through America’s healthcare system – enough money to allay dealmakers’ concerns about declining state and federal reimbursements.

As for overseas deals, look for increased activity in telemedicine in 2012. China and India have been quick to harness the potential of telemedicine. And as one panelist quipped, “It’s easier for U.S. telemedicine companies to operate in China than across state lines.”

N.Y. man defrauds Medicare of $70,000 in medical device reimbursements

BOSTON – Michael McKay, 32, of Saratoga Springs, N.Y.. pleaded guilty in district court on May 11 for forging physician’s chart notes to make Medicare or private carrier claims qualify for reimbursements for bone growth stimulator medical devices.

According to the Office of the Inspector General (OIG), between 2008 and 2010, McKay collected $70,000 in false Medicare claims.

District Judge Denise Casper has scheduled McKay’s sentencing for Sept. 6, 2012. McKay faces up to 10 years in prison, to be followed by three years of supervised release; a $250,000 fine; asset forfeiture and restitution.

Had the case proceeded to trial the government’s evidence would have proven that between 2008 and 2009 McKay was a territory manager for a company that manufactured and distributed bone growth stimulator medical devices, according to the OIG. McKay’s territory included New York, Pennsylvania and Ohio.

The device that McKay sold was intended to assist patients with bone fractures that did not heal properly, according to the OIG. Medicare has specific guidelines describing when it will pay for this device for one of its beneficiaries. Many private insurance carriers follow these guidelines as well. McKay often received orders for patients that did not satisfy these guidelines. When this happened, McKay forged the patients’ medical records to make it appear as though the order met Medicare or private payer guidelines.

McKay altered physician’s chart notes, changing the dates of patient visits and inserting false diagnoses, officials from the OIG said. McKay also created phony medical chart notes, describing patient visits that did not occur.

The medical device company fired McKay after it discovered his fraud, OIG officials said. After that, McKay’s supervisor and another territory manager, Derrick Field, concocted a scheme in which McKay continued to submit orders from doctors in his former territory, but he submitted them through Field.

Field, who was also convicted for healthcare fraud in a similar scheme, submitted the orders to the device company and split the commissions with McKay. McKay continued to forge patients’ medical records even after he was fired by the company for this conduct, according to the OIG.

Two new directors join Allscripts board

CHICAGO – Allscripts on Wedenesday, named two independent members to its board of directors. The board had been left decimated last month after its chairman Phil Pead was fired and three board members resigned in protest after a turbulent quarterly meeting.

Allscripts moved quickly to name a new board chairman – Dennis Chookaszian, a member of Allscripts' board since September 2010, formerly chairman and CEO of CNA Financial Corporation.

[See also: Web First: Q&A with Allscripts CEO Glen Tullman]

Now, Allscripts has named Paul M. Black, former chief operating officer of Cerner Corp., and Robert J. Cindrich, former senior vice president and chief legal officer for the University of Pittsburgh Medical Center (UPMC), as directors, effective immediately.  Black will serve on the board’s compensation committee and Cindrich will serve on the board’s audit committee. The Board is now set at seven directors.

"We are pleased to add two new independent directors of such a high caliber," said Chookaszian. "Paul and Robert bring an outstanding combination of operational, governance and healthcare industry experience, which make them excellent additions to our Board. We believe their contributions and insights will be invaluable as the Company executes on its plan to deliver value for our customers, drive long-term growth and build shareholder value."

"Allscripts has well-respected solutions, a broad and unique client base, and a compelling vision for an open, connected, community-based, individually coordinated level of care," said Black. "I’m optimistic about the market opportunity before us and looking forward to collaborating with the board and management to execute the company’s plan to enhance the client experience, improve healthcare outcomes and deliver value for customers, team members and shareholders."

[See also: Allscripts in skid mode as shares plunge, chairman ousted]

"Allscripts has an exciting opportunity to build on its leading position in the growing market for healthcare information technology," added Cindrich. "Having spent years with one of the largest and most respected integrated delivery networks in the world, I believe I can bring a unique client perspective to management and the board. I look forward to working with my fellow directors and drawing upon my experience to help the Board and management team implement the Company’s strategic plans."

Black currently serves as operating executive of Genstar Capital, LLC, a private equity firm, and as senior advisor at New Mountain Finance Corp., an investment management company. Prior to joining Genstar, Black spent more than 13 years with Cerner and retired as its chief operating officer in 2007 after helping build it into a $1.5 billion company. He also served as chief sales officer and is credited as instrumental in the company’s double-digit organic growth. Prior to Cerner, Black was with IBM from 1982 to 1994 in a number of senior sales and professional services leadership positions.

Black was most recently elected to the board of directors of Haemonetics Corporation, a global healthcare company dedicated to providing innovative blood management solutions. He also serves on the boards of Saepio, Inc., Truman Medical Centers, and Genstar portfolio company, Netsmart Technologies. He has served as a director with several New Mountain portfolio companies.

Prior to UPMC, Cindrich served as a judge of the United States District Court for the Western District of Pennsylvania for 10 years. Prior to that appointment, he was active as an attorney in both government and private practice. His government practice includes serving as chair of the Pennsylvania Legislative Reapportionment Commission, 1992-93; United States District Attorney, Western Pennsylvania District, 1978-81; and Assistant District Attorney, Allegheny County, 1970-72. While in private practice, he served as defense counsel in business and commercial litigation.

Cindrich currently serves as a director of Mylan Inc., a leading generics and specialty pharmaceutical company. 

Allscripts’ incumbent directors, including Black and Cindrich, will stand for re-election at the annual meeting of stockholders on June 15. Stockholders of record as of the close of business on April 24, 2012, will be entitled to vote. Information on all director nominees can be found in the company’s proxy statement, which has been filed with the Securities and Exchange Commission and will be mailed to all stockholders of record.

[See also: Allscripts: Debacle or silver lining?]

TEDMED Thursday: Sex, 'Poo Tea' And ALS

TEDMED

Caltech's Frances Arnold says, "I have fun forcing molecules to have sex."

It takes more than a convoy of fire engines and an evacuation of the Kennedy Center first thing to stop TEDMED.

I heard conflicting reports about what happened this morning, but the show went on � a few minutes late � once D.C.'s bravest were satisfied we'd all be safe.

After a snappy tune from the @songadaymann (Jonathan Mann), Caltech's Frances Arnold made sure everyone was really awake by telling us what a blast her lab work is: "I have fun forcing molecules to have sex."

In nature, she said, "proteins aren't designed, they're evolved." That's where sex comes in to mix up genetic material. "Sex is an innovation-generation machine," she said.

 

And in the lab she's speeding that process up by shuffling genes artificially � and doing it smartly she hopes � by figuring out which elements have a fighting chance of producing proteins that actually work and maybe even do something useful.

Later on, I heard more than one person suggest that it would have been helpful to have a session on the risks and ethical implications of work like this.

In the afternoon, Emory's Jonathan Glass and Nick Boulis dove headfirst into the realm of risk, arguing that the current system of regulation is holding back progress in the search for treatments for amyotrophic lateral sclerosis. It's time, they say, for regulators such as the Food and Drug Administration to let patients take bigger risks when the alternative is looming death.

The researchers are interested in speeding up access to stem-cell treatments, even though both acknowledged there are big unanswered questions about their safety and effectiveness. But as Glass summed up, "This is an emergency. The house is on fire."

Finally, back to the morning session for one of the more provocative talks. University of California, Davis' Jonathan Eisen urged everyone to get to know their personal microbes: We're all colonized from head to toe. The mass of microbes each of us carries around, in fact, is greater than the mass of our brains, he said.

Some microbes help us, and others can hurt us. Miscommunication between our bodies and the microbes that live with us may make us sick. Fixing that snafu could make us well.

Some old-time vets, Eisen said, already use a concoction called "poo tea," a diluted mixture of fecal matter from a healthy animal, to effectively treat sick animals.

But we're only beginning to grasp how microbes affect human health. "We need a full field guide to microbes that live in and on us."

Making Insurance Plans Easier to Understand

Having affordable, quality health insurance is incredibly important. But how can you pick the plan that is best for you and your family if insurance plans are written in words you cannot understand or in type so small you can barely read it? And how can you take advantage of the health benefits you have if you don�t know what your plan covers?

You�re not alone in your confusion. Too many Americans don�t have access to information in plain language to help them understand the health coverage they have.

Now, thanks to the Affordable Care Act, every American consumer will receive an important new tool to understand their coverage. Under proposed rules announced today, health insurers and employers who offer coverage to their workers must provide you with clear and consistent information about your health plan.

Specifically, you will have access to two important insurance forms:

An easy to understand Summary of Benefits and CoverageA uniform Glossary of terms commonly used in health insurance coverage

This will include basic information that every person should have, including:

What is your annual premium?What is your annual deductible?What services are NOT covered by my policy?What will my costs be if I go to a provider in my network versus one that is not in my network?

Below is an example of a page from the proposed new form:

These common sense rules benefit from a public process led by the National Association of Insurance Commissioners (NAIC) and a working group composed of consumer advocates, employers, insurers, and other people involved in your insurance and care. As with all changes to health care, we are giving the public a chance to review this proposal and send us their comments before we make the rules final.

But starting in March 2012, if you are one of the 180 million Americans with private health insurance, help is on the way to make sure you understand your health insurance.

And this means you and your family will have an easier time accessing the health benefits you currently have--and you will be able to make a more informed decision about purchasing the coverage you need.

For more information about this announcement, please visit: http://www.HealthCare.gov/news/factsheets/2011/08/labels08172011a.html

If The Health Care Overhaul Goes Down, Could Medicare Follow?

A growing number of health experts are warning of potential collateral damage if the Supreme Court strikes down the entire 2010 Affordable Care Act: potential chaos in the Medicare program.

"The Affordable Care Act has become part and parcel of the Medicare system, encouraging providers to deliver better, more integrated, better coordinated care, at lower cost," says Judy Feder, a public policy professor at Georgetown University and former Clinton administration health official. "To all of a sudden eliminate that would be highly disruptive."

Sara Rosenbaum, a professor of health law and policy at George Washington University, puts it a bit more bluntly: "We could find ourselves at kind of a grand stopping point for the entire health care system."

And it's not just Democrats warning of potential problems. Gail Wilensky, who ran Medicare and Medicaid under President George H.W. Bush, says she doesn't think it's likely that the court will strike down the entire health law. But if it does, she says, "it seems like it takes everything with it, including those aspects that are only very peripherally related to the expansion of coverage."

So why are experts so worried?

 

One reason is that the law changed the payment rates for just about every type of health care professional who treats Medicare patients. Every time Medicare sets a payment rate, it needs to cite a legal authority. And for the past two years, says Rosenbaum, that legal authority has been the Affordable Care Act.

So if the law is found unconstitutional, she says, every one of those changes "doesn't exist anymore because the law doesn't exist."

And the result? "You have agencies sitting on two years of policies that are up in smoke," she says. "Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid. Changes in coverage that have begun to take effect for the elderly, closing the doughnut hole might not happen. We don't know."

And many of those facilities serve not just Medicare patients but the rest of the population, too. Hence, the spillover could affect the health care system as a whole.

That's what has the nation's community of health care providers watching nervously to see what the court does. Many would speak only on background or wouldn't address the subject at all.

One of the few groups willing to address the subject was the American Medical Association. In a statement, the AMA's president-elect, Jeremy Lazarus, says, "With the countless hours of work already done to implement this new law, it is hard to imagine the full impact of it disappearing."

At best, the situation would be legally murky, says Dan Mendelson. He's CEO of the health consulting group Avalere and oversaw health programs for the Clinton administration's Office of Management and Budget.

"In a lot of ways, it's a political never-never land," he says. "We have no idea really what this would look like because we don't have a precedent."

Actually, says Wilensky, there is a bit of a precedent: For the past few years, Congress' inability to fix a glitch in the formula for paying doctors for Medicare has more than once resulted in brief lapses in funding authority.

"So we've had these kinds of smaller-version 'what happens if Congress does or doesn't do something.' This would be much bigger. And it would be extremely disruptive," she says.

Rosenbaum says there could be an even bigger problem: Medicare might be looking at hundreds, if not thousands, of policies that are suddenly null and void. She says it's not at all clear that the agency has the authority to go back to the policies that were in effect before the law was passed.

"This is a conversation that's happening between the Supreme Court and Congress," she says. Medicare officials would "have to sit there and wait to see what Congress wants to do."

What makes it an even bigger potential mess, says Mendelson, is that the health law has fundamentally changed almost every aspect of the way the Medicare program now does business. And undoing that would be almost unimaginably difficult.

"I think it's more akin to Alice in Wonderland," he said. "That we're going down the rabbit hole and nobody really knows what it's going to look like inside."

But in the next few months, they may find out.

GHX acquires UK-based TriSolve

LOUISVILLE, CO – GHX, a supply chain management company, has continued its global expansion with the acquisition of TriSolve Ltd. of Bradford, UK. GHX also recently acquired the France-based Beep-N-Track solution for the upcoming GHX implantable device supply chain solution.

“This acquisition allows us to better serve our European client base, increase utilization of GHX software services and deliver on ambitious three-year European growth plans,” said Bruce Johnson, president and CEO of GHX.

TriSolve provides consultation and hands-on practical help and support with system integration and change management to NHS Trusts and suppliers. As part of the deal, GHX will acquire TriSolve’s employees. TriSolve will continue to work for its existing customer base while expanding its core offerings to the GHX healthcare market.

“Healthcare organizations in Europe increasingly demand a complete Software as a Service solution," said Michel van der Heijden, president, GHX Europe. "This acquisition provides GHX Europe with added capabilities to assist our clients in supply-side initiatives aimed at lowering costs, eradicating inefficiencies and automating processes."

Women's Preventive Services: Seeking Comments

The Affordable Care Act includes important provisions that ensure tens of millions of Americans get recommended preventive care without paying a copayment or deductible. Thanks to the law, people across the country have greater access to mammograms, colonoscopies, and other preventive services that can help them live healthier, longer lives � all without paying an extra penny out of their own pocket.

The law also recognizes the need to take into account the unique health needs of women throughout their lifespan. That�s why the Affordable Care Act ensures more women can get the special preventive services they need to stay healthy.�

On August 1, 2011, the Health Resources and Services Administration within the Department of Health and Human Services adopted Women's Preventive Services: Required Health Plan Coverage Guidelines, which set forth the preventive services � including well-woman visits, support for breastfeeding equipment, contraception, and domestic violence screening � that will be covered without cost sharing in new health plans starting in August 2012. The guidelines followed from recommendations by the independent Institute of Medicine based on scientific evidence.

We understand that some religious organizations have concerns about covering contraception in their employee health plans. Our goal has always been to balance expanding coverage of important preventive services and respecting religious beliefs. That�s why we:

Give religious organizations the choice of buying or sponsoring insurance that does not cover contraception. This option is modeled on a common exemption available in some of the 28 states that already require coverage of contraception.Explored and are open to other definitions of �religious organizations� to ensure organizations that have religious objections to covering contraception can choose whether or not to cover these services.

Now, we want to hear from you. The rule is open for public comment until September 30, 2011. �Written comments are important to the process, allowing all interested individuals and groups a chance to weigh in.� Public comments are the foundation for improvements to regulations.� If, after the comments are received and evaluated, this exemption is modified, its effective date will be aligned with the start of coverage of recommended women�s prevention services on August 1, 2012. We�re looking forward to receiving comments from the American people about this policy and working with all interested stakeholders. We�re committed to meeting our goals of getting women the important health benefits they need and deserve and respecting religious beliefs. You can submit your comments by visiting this page.

Medicare Open Enrollment: Last Week to Review and Compare Medicare Plans

This blog was originally posted on The Medicare Blog.

With housework, doctor appointments, time with family, and job responsibilities, there are always tasks that get left until the last minute. But whether I�m choosing an insurance plan or planning a vacation, I still want to make sure my �I�s are dotted and my �T�s crossed. I want to know that everything�s taken care of � without worry and confusion.

Speaking of insurance, time is running out! If you�ve been thinking about changing your Medicare coverage, the time to act is now. The dates for Medicare Open Enrollment are early this year to allow for a smoother transition to a new plan.� Not only did Open Enrollment start earlier, but it also ends earlier � the last day for you to change your Medicare plan is now December 7.� This gives Medicare enough time to process any change you may make and have you linked correctly to the plan you choose as soon as your coverage starts. That way you can go to the doctor or your pharmacy on January 1 without having to worry about your coverage.���

This year, thanks to the Affordable Care Act, you have better �choices, more benefits and lower costs, and it�s worth it to review them. Our counselors worked with a man in Oregon who has saved more than $600 a month on his prescription drugs between benefits from the health care law and lowering his doses.� $600 a month makes a huge difference in helping him pay other bills, and still put some money into savings.

I know that sorting through your health and drug coverage choices during Open Enrollment can be confusing but you don�t have to do it alone.�

Look around for all the Medicare information out there. We have plenty of resources to help you think about cost, coverage, extra benefits, and convenience when evaluating your plan choices. And visit our Open Enrollment center, where we�ve gathered everything you need online, including a video on how the Medicare Plan Finder works, to walk through your options.�

Medicare�s here to help you, stronger than ever. Take the time this week to review and compare plans. It�s worth it � you can relax later.

Small businesses have new tools in choosing health insurance

We�ve added a new service to further help small businesses find the right health care coverage for their employees.�

In addition to featuring information about new benefits in the law, HealthCare.gov also has a health insurance finder tool, which displays information about insurance plans with estimated base rates, doctor choices, number of applications that were denied, and other details that allow consumers to compare options. And as of today, this insurance tool includes private coverage options for small businesses: http://finder.healthcare.gov/.

Starting today, owners of small businesses with will have access to the following:

Insurance product choices for a given ZIP code, sorted by out-of-pocket limits, average cost per enrollee, or other factors.A summary of cost and coverage for small group products that shows the available deductibles, range of copay options, included and excluded benefits, and benefits available for purchase at additional cost.The ability to filter product selection based on whether they are Health Savings Account eligible, have prescription drug, mental health, or maternity coverage, and allow for domestic partner or same sex coverage.

The new information adds to our site�s unprecedented ability to search and compare coverage options. Today, more than 530 companies that sell small business insurance have provided information on more than 2,700 products in every state and the District of Columbia.

The insurance marketplace is confusing and can be hard to navigate. Even worse, on average, small businesses pay 18 percent more than large firms for the same health insurance policy.� To help make it easier for people � including small business owners � to learn about the law and find coverage options, the health reform law created http://www.healthcare.gov/to make it easier to find a health plan that is right for you and your small business.� HealthCare.gov features a wide range of consumer health information and has received nearly 9 million visits since it was launched.

The new service is just one way the Affordable Care Act is making it easier for small businesses to cover their employees. Employers with fewer than 25 workers can qualify for tax credits of up to 35% to offset the cost of providing health insurance. That credit will increase to 50% in 2014�making the cost of insuring employees more affordable still. To find out more about the tax credit, go here.

We Can’t Wait: Jumpstarting Innovation in Health Care, Reducing Costs

Health care costs remain a significant drain on the budgets of families, businesses, and federal and state governments. The health reform law, the Affordable Care Act, made significant strides in making Medicare more affordable and insurance companies more accountable. Congress is considering other ways to build on this progress, but we can�t wait to do more to help make our health care system more affordable.

In that spirit, the Obama Administration recently launched the Health Care Innovation Challenge. Made possible by the Affordable Care Act, this initiative will invest up to $1 billion in the best projects that doctors, hospitals, and other innovators propose to deliver high-quality medical care and save money. Projects that win this competition will use health care dollars more wisely, help create jobs, and help professionals improve the work they do for patients.

Innovation doesn�t happen in a vacuum and usually doesn�t start in Washington � we need the vision and experience of people who are already proving that our health care providers can and do provide better care and better health at lower cost. So we want to hear from you. Send us your innovative ideas and solutions, and submit a proposal outlining your vision for helping us transform the health care system. We�ll sort through these proposals and help put the best ones into practice.

We�ll work with a wide variety of public and private organizations, including providers, payers, local governments, community and faith-based organizations, and other innovators whose compelling ideas can improve health care for patients. We are also looking for projects that help patients with the greatest health care needs, projects that can be up and running soon, and projects that rapidly hire, train and deploy health care workers.

For example, the Health Care Innovation Challenge could support the use of personal and home care aides to help the elderly stay in their homes or expanding the use of community-based paramedics to provide basic services to individuals in rural communities.

Different communities have different needs and circumstances�some require unique, locally driven innovations. With the Health Care Innovation Challenge, we hope to give providers even more opportunities to make our health care system even stronger.

We look forward to hearing your ideas on how to make this happen. For more information, you can also visit http://innovations.cms.gov/.

Breaking It Down: The Health Care Law & Seniors

The President's health law gives hard working, middle-class families the security they deserve.� The Affordable Care Act forces insurance companies to play by the rules, prohibiting them from dropping your coverage if you get sick, billing you into bankruptcy through annual or lifetime limits, and, soon, discriminating against anyone with a pre-existing condition.

For seniors, the new health care law, the Affordable Care Act, not only means more time with their doctor and important new benefits like free preventive services like cancer screenings and annual wellness visits, but it also means more money in their pocket. The new health care law strengthens Medicare. Already, more than 5.1 million seniors and people with disabilities saved over $3.2 billion in drug costs. That comes to an average savings of $635 per person for seniors caught in the coverage gap known as the donut hole.� And, 32.5 million people with Medicare have received preventive service without a deductible or copay, thanks to the new law.

Here are more ways the law helps seniors:

You get free preventive services. Medicare now covers certain preventive services, like mammograms or colonoscopies, with no cost sharing. You also can get a free annual wellness visit.You get cheaper prescription drugs. If you�re in the donut hole, you will receive a 50 percent discount when buying brand-name prescription drugs covered by Medicare Part D. The discount is applied automatically when you fill your prescription�you don�t have to do anything to get it. These changes are already saving seniors billions of dollars. And by 2020, the donut hole will be closed.�Your doctors are supported to better coordinate your care.� Many doctors, hospitals, and other providers are taking advantage of new programs to help them work better as teams to provide you the highest quality care possible.� They are working to get you the care you need at the time you need it.�The law fights fraud and strengthens Medicare. The Affordable Care Act builds on our efforts to combat fraud and abuse. These efforts are saving billions of dollars in money that was being stolen from people with Medicare. And thanks to these efforts and other improvements, the life of the Medicare Trust fund has been extended.Your Medicare coverage is protected. Under the new health care law, your existing Medicare-covered benefits won�t be reduced or taken away. As always, you will be able to choose your own doctors.

Visit http://www.healthcare.gov/seniors to learn more.

You can also access a print-ready, one pager (PDF- 11 MB) with these points, and there is a brochure available with more details about the preventive services (PDF - 1.22 MB).

SLOW: Privacy issues dog progress on NHIN

WASHINGTON – Privacy issues continue to keep the country's planned nationwide health information network on the slow track, but government and community leaders say it won't be a problem going forward.

Yet things did not go exactly as the Office of the National Coordinator for Health Information Technology planned at a demonstration last month, where 19 cooperative organizations were scheduled to use real patient data to show how interoperability works. Instead, they used fictitious patient records to demonstrate greater depth in capabilities for interoperability than the initial trial run held in September.

The Office of the National, or ONC, held its second long awaited demonstration of interoperability Dec. 15 -16 at the Fifth Annual National Health Information Network Forum in the nation's capital.

Holding up the progress on building the network of networks, officials say, is the finalization of social agreements – how to protect information, and who is liable if there is a breach during the exchange of information.

However, technology experts, software providers, policymakers and regional health organization leaders participating in the December NHIN demonstration all agreed privacy concerns would not be a problem going forward. The technology is ready to go, they said.

It's all about the DURSAs

It's only a matter of time until data use and sharing agreements, or DURSAs, come through. Most regional health information organizations have their own agreements used within their exchanges, but to exchange data outside the RHIO requires a host of lawyers to resolve the untold scenarios that could evolve.

Marc Overhage MD, director of medical informatics at the Regenstrief Institute, one of the organizations participating in the NHIN demonstration, said he sees the December demonstration as a success despite the privacy hold-up.

Overhage is also president and CEO of the Indiana Health Information Exchange, an exchange with 10 million unique patients and nearly 10,000 doctors. The Indiana HIE has not completed its DURSA agreements with communities outside of its network, but Overhage is not surprised. "Everyone who has been involved in this has observed this work takes a long time," he said.

Indiana plans to have its DURSA agreement in place by the end of January.

What is holding up the works? Getting consent from the various custodians of the data, including hospitals, labs, and doctors. "Literally for us, hundreds of parties have to be comfortable with this agreement," Overhage said.

Leavitt's privacy doctrine

As if on cue, with just 36 days left in his tenure, Department of Health and Human Services Secretary Michael Leavitt released a privacy policy at the forum on Dec. 16. The policy is intended as a platform for further discussion, Leavitt said, and focuses on aspects of patient rights, safeguarding of data and HIPAA.

Though some regional health information exchange organizations have been successful in developing privacy agreements for the flow of information, others have not, Leavitt said. HHS also released a toolbox for organizations to use as a starting point for making DURSA agreements.

"Finding the balance between increased access to information and privacy is very important," Leavitt said. "If we don't have it, we won't succeed."

Banking on federal leadership

For some, privacy isn't the only problem. At Wright State University in Dayton, Ohio, Katherine Cauley, director of the Center for Healthy Communities, a participant in the NHIN cooperative, said her exchange is typical of most community RHIOs in the country. There is some local interest, but to most people on the local level health information exchange is still a far-fetched idea - especially for doctors who are wary of costs and initial disruption to workflow.

"Nobody wants to change how they do things. Everybody is worried about legal issues," Cauley said. "Everybody wants data, but nobody wants to go through the processes involved." Cauley believes federal leadership will be the key to moving things forward.

Social Security takes the lead

It looks like the federal government has the same idea. The Social Security Administration announced Dec. 16 it would be the first government agency to use the NHIN. Beginning in early 2009, SSA will receive medical records for some disability applicants electronically through the NHIN gateway.

Despite the obstacles, ONC leaders say the NHIN is making progress, and that progress will continue, they add.
Ginger Price NHIN coordinator for ONC said her office plans NHIN production, though somewhat limited, in 2009.

"The basic bottom line is we're starting simple. And we're starting with the ready, the willing, the motivated and we're starting now," Price told attendees of the forum. "As people get ready to come on board, we'll bring them on."

Standards are key

Jason Colquitt, director of research and outcomes at Greenway Medical Technologies, has been involved with the NHIN effort for years and is a member on Certification Commission for Healthcare Information Technology committees. He claims the NHIN is only as limited as its standards development.

"In my opinion it all falls to the Healthcare Information Technology Standards Panel. That's where the rubber meets the road," Colquitt said. "Many of the standards are already in place, but getting standards as robust as they need to be is the challenge."

Right now, standards have been achieved on a basic level, but to have a fully functional NHIN, they will have to be drilled down to a more refined level of detail. As the NHIN matures, it will require more and more granularity, Colquitt said.
The December demonstration is just one cog in a giant wheel that will continue turning, and already a source of excitement for many providers. "There is value in this level of exchange because we have never done it before," Colquitt said.

 

Do doctors have to be typists to get MU incentives?

WASHINGTON – There's a snag in the proposed meaningful use Stage 2 rule, and it concerns whether or not doctors need to be good at typing. Depending on how the final requirements for Stage 2 play out, they might have to be.

The HIT Policy Committee on Wednesday was divided over a measure in the Stage 2 rule that would allow licensed professionals or scribes to enter data into a patient’s electronic health record on behalf of a doctor.

The difficulty is this: If a doctor doesn’t enter the order, he or she will not be able to see the decision support built into the EHR system that appears at that time. Decision support is supposed to help with the prevention of medical errors and is, according to federal officials, one of the reasons for the EHR incentive program in the first place.

Most electronic health record systems only show decision support once, as the computerized physician order entry, or CPOE, is typed into a system, according to Paul Tang, MD, chief innovation and technology officer at the Palo Alto Medical Foundation and vice chair of the HIT Policy Committee. The problem is, most doctors do not type in their own orders. Nurses often enter medication orders or clerical persons type in hand written physicians’ orders, later to be “signed off on” – or approved on the computer – by the physician, often in groups of multiple orders at the end of the day.

 [See also: Stage 2 MU released at last.]

As the proposal stands now, the physician is required to use his or her personal log-on to open the record, and he or she is the person responsible for the electronic record. The physician is also responsible for approving any information entered by someone representing him or her in a clerical sense. If doctors want to see decision support, which includes warnings about dangerous drug interactions and other health preventative and safety warnings, then the doctor must be the one to type in the information.

Some members of the committee felt the rule was never intended to make doctors into typists. And even if they are good typists, they shouldn't be required to spend their time doing it. It prescribes too much for a doctors’ workflow, and is not what the proposal framers intended.

A serious discussion arose over the CPOE subject, scribes and decision support – labeled by Tang as “the single most important objective of the entire EHR incentive program.”

Last month, the committee discussed if there were other ways a clinician could have something recorded, then take responsibility for it. A physician might want to have a licensed professional enter the CPOE and then have someone else do the clerical task of entering the progress notes. Tang urged the committee to be more specific about who can enter non-CPOE entries.

Some members of the committee were in favor of scribes entering non-CPOEs, some were against, with the major consensus among the group that the physician is ultimately responsible for what is recorded.

Tang was in favor of scribes for some things. “This does not interfere with how ever people want to enter progress notes,” Tang said, “since we don’t have that same need for a feedback mechanism" in that case.

[See also: AHA says 'bar too high' for Stage 2.] 

“My opinion was to let it fall where it falls, and let them decide whether their physicians were less efficient or more efficient" at typing notes, said committee member Judith Faulkner, founder and CEO of Epic. "In some cases they might be, and in other cases they might not be.” 

Gayle Harrell, a Republican state representative from Florida, said the requirement needs to fall where the liability falls. “Liability is the issue,” she said. “It’s going to be difficult to determine who’s the typist.”

“There are two separate issues,” Tang offered. “The accountability for the entire EHR and the accessibility of the information.“

Neil Calman, MD, president and CEO of the Institute for Family Health felt decision support should not be compromised. If a physician doesn’t see the decision support, what good is it? “As long as the decision support appears at the time of authorization, the person who enters the order isn’t really that important,” he said. He added that it is common practice now for physicians to sign off on CPOEs that were typed in by other people.

“I strongly disagree with that,” said David Bates, MD, chief of research for the division of general and internal medicine and primary care at Brigham and Women’s Hospital. If physicians are to see the decision support, they have to see it when they type in the order, he said. “I’ve looked at a lot of different systems, all of them deliver decision support at the time that you’re actually entering the order. I’m fine with having scribes with other things,” he added.

There was some disagreement among the committee over whether or not current certified EHR systems allowed for decision support to appear again after the order is entered. Most of the physicians in the group said it was not possible. At least one said it was. Tang said to make Calman’s idea possible, it would probably require most physicians to have their EHR systems reprogrammed. Not a feasible idea, he said.

The EHR incentive program will not move forward if a doctor has to enter everything into a system, Calman warned. This would be loading doctors with too much work.

Tang also argued, “We want people to do the work at the top of their license,” implying that for doctors, this would be practicing medicine, not typing.

The committee was pressed for time, with only Wednesday’s meeting left to smooth out an entire host of recommendations due to the Centers for Medicare & Medicaid Services by May 7. Tang called for a vote on the CPOE recommendation, with three agreeing with what is written, allowing physicians to sign off on scribes entering non-CPOE data and licensed professionals entering CPOEs, without regard to when decision support may appear in the system.

Five members were in favor of revising the recommendation to require the EHR system to show decision support to every person who enters the data, including again to the physician when signing off. And, four abstained from voting.

“Clearly, we have a split vote," Tang said. “We will have to let CMS know about that.”

CMS is collecting public comments until May 7 on the proposed Stage 2 meaningful use rules. Agency officials say the final rule will be issued some time this summer. Physicians participating in the EHR incentive program would have to comply with Stage 2 rules as early as 2013, depending on when they complete Stage 1. Physicians who do not adopt EHRs by 2015 and use them according to the new rules, will face Medicare and Medicaid reimbursement penalties.

Eclipsys inks deal to acquire Premise

ATLANTA – The Eclipsys Corporation has signed a definitive agreement to acquire all outstanding equity interests of Farmington, Conn.-based Premise, a privately held provider of patient flow software solutions.

The agreement provides for a purchase price of $38.5 million cash, subject to certain holdback escrow provisions and working capital adjustments.

Officials say the transaction has been approved by the boards of directors of both companies and is expected to close within 15 days, subject to satisfaction of customary closing conditions.

"We are finding that hospitals in Connecticut and across the country have been increasingly challenged to do more with less, and that has only intensified with today's economic conditions," said Premise CEO and Chairman Eric Rosow. He said Premise solutions help hospitals "eliminate waste, delays and redundant tasks while proactively planning for patients' needs and optimizing resource allocation."

This is the third acquisition for Eclipsys this year. The Atlanta-based IT company acquired MediNotes, a privately held physician software company based in Des Moines, Iowa, in October and Enterprise Performance Systems, Inc. (EPSi), a St. Louis-based provider of financial solutions for healthcare companies, in February.

Tough new strain of hand, foot and mouth virus hitting U.S.

SAN FRANCISCO�Worried parents are phoning their pediatricians, fearful of the spread of a nasty new strain of hand, foot and mouth virus, a common childhood disease.

It hit Alabama last month, is in Northern California now and may be headed to a day care near you soon.

The hand, foot and mouth virus that usually causes a slight fever and a rash on the palms in toddlers is called coxsackie A16. The new variant, A6, was first reported in the United States in December. It can hit kids and adults hard, causing fingernails and toenails to fall off two to three weeks after the illness has passed.

The variant swept Alabama in March, state epidemiologist Mary McIntyre said. "We've had 15 people hospitalized," she said. Some cases included "severe fevers, seizures, headaches, severe diarrhea and vomiting." The oldest patient was 69.

There is no treatment.

Hand, foot and mouth disease is no relation to hoof and mouth disease, an animal illness.

Nationally, the Centers for Disease Control and Prevention reports that some victims have been hospitalized for severe pain. The virus is highly contagious. Writing on a parent e-mail list, one San Francisco mom said her toddler infected every child but one in her preschool.

Eric Meyerson's 2-year-old son had garden-variety hand, foot and mouth disease this fall. Then a second bout felled the San Francisco boy this week. "He had fever and sores and was complaining that the inside of his mouth was hurting," Meyerson said. The family pediatrician identified the illness as coxsackie A6.

The new variant is "redder and more angry-looking" than A16, said Dan Kelly, Meyerson's pediatrician. The lesions are "fleshy and bigger and can run together so they cover the hands and feet," he said. Most of the children he sees have a fever between 101 and 103 degrees and a rash for three to five days. About 25% of the cases he has heard about are in adults.

The first U.S. cases appear to have arrived in December, said Carol Glaser, chief of the special investigation section of the California Department of Public Health. Doctors didn't know what they were. DNA analysis showed the culprit was A6, which popped up in Finland in 2008 and later in Taiwan. There was an outbreak in Japan in 2011.

Now that word is getting out, Glaser said, she's hearing reports from around the country, including Nevada, New York and Massachusetts.

Better Medicare Products and Services at Lower Cost

For years, spiraling Medicare costs have threatened Medicare beneficiaries and their providers.� And turning to the competitive marketplace seemed to offer little respite. Until now.

On January 1, 2011, the first phase of the competitive bidding program was successfully implemented for nine product categories in nine areas of the country. This means that suppliers of certain medical supplies, such as oxygen equipment, walkers, and some types of power wheelchairs compete among each other to determine the price Medicare will pay for their services to seniors. This in turn sets new, lower payment rates for these pieces of medical equipment and supplies.

Building on that success, the Centers for Medicare & Medicaid Services (CMS) today announced that they are expanding the competitive bidding program to additional areas of the country and also expanding the list of items included in the first round of bidding. All of the product categories selected for Round Two are high cost, high volume items with large savings potential.

This program reduces Medicare spending and beneficiary cost-sharing, and it forces winners of these contracts to compete on quality and customer service. Ultimately, beneficiaries get better products and services, while paying less out of their own pocket. In fact, the Medicare actuary estimates that this program will save more than $28 billion over the first ten years of the program. The $28 billion savings comes from a combination of savings of more than $17 billion in Medicare expenditures, and savings of over $11 billion for beneficiaries as a result of lower coinsurance payments and the downward effect on monthly premium payments. .

For more information about the Medicare DMEPOS Competitive Bidding Program, please visit CMS� Newsroom or go to �www.medicare.gov/supplier.

Doctors Group Tells Patients To Go For Cheaper, High-Value Treatments

Enlarge iStockphoto.com

Got a backache? You can probably skip that pricey scan.

iStockphoto.com

Got a backache? You can probably skip that pricey scan.

The American College of Physicians is urging patients with newly diagnosed diabetes and back pain not to opt for the latest-and-supposedly-greatest.

It's part of a new campaign to steer patients (and their doctors) to what the College of Physicians calls "high value care," and away from expensive tests and treatments that aren't any better � and often are worse.

That may seem like common sense. But it's a departure, and maybe a surprise, to hear a mainline physician group name names when it comes to drugs that shouldn't be first choices � and even steer patients to non-physician competitors.

Instead of highly touted diabetes brands such as Actos, Januvia and Avandia, the physicians' group says, patients with type 2 diabetes should start out on a tried-and-true generic.

"The best first choice usually isn't one of the newer, heavily advertised" drugs, says a new brochure put out by the College in cooperation with Consumer Reports magazine. "It's metformin, a drug that has been around for nearly two decades."

 

"A month's supply of generic metformin typically costs only about $14 compared with about $230 to $370 for Actos and about $265 for Januvia," the brochure points out.

Metformin "lowers blood sugar levels more than newer drugs do," the brochure says. It also reduces "bad cholesterol," while newer drugs don't, and sometimes even raise it.

When it comes to back pain, it's usually not a good idea to get an x-ray, CT scan or MRI, says another new pamphlet that carries the College of Physicians brand.

"If you don't feel better after four weeks or so, it might be worth talking to your doctor about other options," back pain sufferers are advised. Maybe they should see a chiropractor or an acupuncturist, the brochure says.

Steven Weinberger, CEO of the American College of Physicians, says many patients come into doctors' offices with the expectation they're going to get a high-tech imaging study to diagnose their back pain.

"Their neighbor might say, 'When I had back pain I had an MRI, so maybe you didn't get the best care,' " Weinberger told Shots. "We're saying the reflex reaction doesn't represent the best care."

The group plans to put out a series of other pull-no-punches pieces of advice on common conditions.

"In these days of crisis in health care costs," he says, "the medical profession should take its ethical and professional responsibility to do what we can to reduce costs while not compromising care."

Weinberger says that doing the right thing make take courage, "because physicians have financial incentives" to prescribe less cost-effective care, and so do hospitals. So, of course, do pharmaceutical companies.

But Sethu Reddy, the U.S. medical director of Merck, maker of the diabetes drug Januvia, idn't sound too threatened.

"Cost is one factor," Reddy told Shots. "But there are four or five other factors that the doctor has to weigh in. He can't just automatically say that this is the automatic option for every new patient."

Reddy pointed out that, on the very day the physicians' group urged newly diagnosed type 2 diabetics who need drugs to start with metformin, US and European diabetes specialists issued new guidelinesthat are less prescriptive.

"More than any other previously reported guidelines," notes diabetes expert William Cefalu, the new position statement "emphasizes that one size clearly does not fit all."

Big budgets translate to big technology

When it comes to implementing technology, money – and whether you have it ­– really can make a difference. This year there have been some high profile, high-budget implementations that have made big news.

Cleveland Clinic’s plans to open two new, spacious facilities this fall struck a chord with Healthcare IT News readers, who chose it as having the biggest impact on healthcare information technology.

One reason the $634 million facilities will be so roomy is to house all the technology they’ll be using.

The facilities, the Sydell and Arnold Miller Family Pavilion and the Glickman Tower, will house state-of-the-art technologies, including advanced heart and urological, advanced 3-D imaging, robotic interventional surgical devices and a fully computerized communications system.

One Healthcare IT News reader said, “I appreciate their ability to accomplish ‘big news’ producing projects and still provide excellent patient-centered care.”

“Cleveland Clinic has not only pushed its healthcare technology internally, they’ve been very vocal on what they are doing that works,” said Michael Wallace, of the PrimaryData Corporation.

Another big budget item was Kaiser Permanente’s massive electronic health records system, called KP HealthConnect, which had a price tag of $4 billion. HealthConnect is the world’s largest privately funded electronic health record, covering 8.7 million members.

Kim D. Slocum, a HIMSS Fellow and president of KDS Consulting, called it a “groundbreaking success, not just in getting HIT in place, but in using it to improve care.”

 “I believe that the implementation process that Kaiser has gone through can teach many large facilities the rights and wrongs of EMR,” agreed Deborah Smith, RN, of Grand Strand Hospital in Myrtle Beach, S.C.

Medicare Open Enrollment: Last Week to Review and Compare Medicare Plans

This blog was originally posted on The Medicare Blog.

With housework, doctor appointments, time with family, and job responsibilities, there are always tasks that get left until the last minute. But whether I�m choosing an insurance plan or planning a vacation, I still want to make sure my �I�s are dotted and my �T�s crossed. I want to know that everything�s taken care of � without worry and confusion.

Speaking of insurance, time is running out! If you�ve been thinking about changing your Medicare coverage, the time to act is now. The dates for Medicare Open Enrollment are early this year to allow for a smoother transition to a new plan.� Not only did Open Enrollment start earlier, but it also ends earlier � the last day for you to change your Medicare plan is now December 7.� This gives Medicare enough time to process any change you may make and have you linked correctly to the plan you choose as soon as your coverage starts. That way you can go to the doctor or your pharmacy on January 1 without having to worry about your coverage.���

This year, thanks to the Affordable Care Act, you have better �choices, more benefits and lower costs, and it�s worth it to review them. Our counselors worked with a man in Oregon who has saved more than $600 a month on his prescription drugs between benefits from the health care law and lowering his doses.� $600 a month makes a huge difference in helping him pay other bills, and still put some money into savings.

I know that sorting through your health and drug coverage choices during Open Enrollment can be confusing but you don�t have to do it alone.�

Look around for all the Medicare information out there. We have plenty of resources to help you think about cost, coverage, extra benefits, and convenience when evaluating your plan choices. And visit our Open Enrollment center, where we�ve gathered everything you need online, including a video on how the Medicare Plan Finder works, to walk through your options.�

Medicare�s here to help you, stronger than ever. Take the time this week to review and compare plans. It�s worth it � you can relax later.

With Cancer Care, The U.S. Spends More, But Gets More

Enlarge iStockphoto.com

Newer cancer treatment drugs have raised the cost of treatment even more.

iStockphoto.com

Newer cancer treatment drugs have raised the cost of treatment even more.

By now it's hardly news that the U.S. spends more than every other industrialized country on health care. But a new study suggests that at least when it comes to cancer care, Americans may actually be getting decent value.

The study, in April issue of the policy journal Health Affairs, isn't the first to suggest that U.S. patients do better than their European counterparts when it comes to surviving most types of cancer. Other studies have shown that the U.S. approves cancer drugs faster than most nations across the pond.

But this study, by researchers from the University of Chicago and the University of Southern California and partially funded by the cancer drugmaker Bristol-Myers Squibb,actually attempted to quantify what the U.S. gets for the additional money it spends.

And what it found is that for most types of solid tumor cancers, particularly breast and prostate cancer, even after considering the higher costs, U.S. patients experienced greater survival gains than patients in Europe.

 

And those costs did grow. Between 1983 and 1999, the period covered by the study, U.S. spending on cancer care grew 49 percent (in 2010 dollars). By comparison, spending in the 10 European countries included in the study grew by 16 percent. But for patients diagnosed between 1995 and 1999, average survival from time of diagnosis in the U.S. was 11.1 years, while in Europe it was 9.3 years.

"Using conservative market estimates of the value of a statistical life, this study presented evidence that U.S. cancer survival gains are worth more than the corresponding growth in the cost of U.S. cancer care according to the most recent data available for analysis," the study's authors wrote.

There are some significant caveats, of course. One is that that "most recent data" ends in 1999. And, they note, "important changes in cancer care have occurred in the past ten years, including the introduction of expensive new drug treatment and increased use of diagnostic imaging."

So, the authors point out, it will take still more research to determine if today's increased spending is still worth it, and what specific aspects of cancer care are driving the U.S.'s improved survival rates.

IHI puts the spotlight on innovators pursuing better care

CAMBRIDGE, MA – Hospitals, physician practices and health plans across the country are boosting care – and saving millions – by employing quality measures, information technology and plenty of innovation. A new book tells the stories behind the successes.

Maureen Bisognano, president and CEO of the independent, nonprofit Institute for Healthcare Improvement, and Charles Kenney, a healthcare journalist put the spotlight on seven of these organizations in a new book, “Pursuing the Triple Aim.”

[See also: Banner Health earns Stage 7 recognition]

The triple aim they refer to is better care, better health and lower costs.

Some these organizations – Bisognano calls them “pioneers” are pursuing these goals without drivers from the federal government.

“It’s an incredibly dynamic grassroots movement,” said Kenny in a recent webcast that included representatives from the hospitals, physician practices and health plans written about in the book. “It’s growing in a very natural way. There’s no holding these back.”

[See also: Medicaid RACs are ramping up]

Jack Cochran, MD, executive director of the Permanente Foundation, noted that Kaiser Permanente continues to foster “a culture that actually embraces measurement." Leadership is critical, he said. “We must make it very clear why we need to commit to a mission of improvement.”

At Atrius Health, an Alliance of six medical groups in Eastern and Central Massachusetts, Chief Medical Officer Rick Lopez said the leaders are mounting a campaign against practice variation.

Michael O’Connell, vice president at Mount Auburn Hospitals in Cambridge, Mass., which works with Atrius, said his organization has moved from fee-for-service payments to global payments, and to value-based purchasing.

CareOregon is a health plan with 60,000 members. David Labby, MD, its medical director, said CareOregon is looking at ways to move beyond the walls of the office and into the community.

The impetus for the book, said Bisognano, is to show what some innovators have done and perhaps to generate new ideas for improving care.

“As the Triple Aim moves from being largely an aspirational framework to something that communities all across the US can implement and learn from, its potential to become a touchstone for the work ahead has never been greater,” she said.

10 things to consider before purchasing cyber insurance

Data breaches have increased dramatically within the past few years, giving way to new trends within the healthcare space. Given their unpredictable nature, data breaches are hard to budget for, but according to a recent report by ID Experts, one aspect of an overall risk management strategy is becoming increasingly important worth exploring: cyber insurance. 

"Evaluating the need for cyber coverage is not a one-person job," read the report. "Companies should discuss their data breach risks and risk management options cross-functionally, involving leaders from IT, risk management, privacy, compliance, and legal departments. Working together, executives can more accurately quantify risks, evaluate options and develop a cost beneficial analysis to determine if cyber insurance is the right investment for their needs."

The report describes 10 things to consider before purchasing cyber insurance.

1.Assess the risks for a data breach. According to the report, each company needs to evaluate its overall risk of experiencing a data breach, and the sensitivity of its data. Some factors to consider, it continued, includes the applicable rules and regulations, the amount and type of data that a company handles, the prominence of its brand, and the use of mobile devices and number of third-party contractors with access to sensitive data.

2.Determine the financial resources available. In 2011, the Ponemon Institute reported that cyber crimes cost organizations between $1.5 million and $36.5 million per data breach, the report notes. "When considering data breach risk management options, organizations should determine if they have the financial resources to cover network downtime, legal fees, forensics investigations," it reads. Additionally, it's important to keep in mind the costs associated with identity monitoring and recovery services, regulatory fines and penalties, and expenses stemming from a class-action lawsuit.

3.Understand current insurance coverage. Most organizations hold general liability insurance or property insurance that provides coverage for tangible property only, such as like replacing stolen laptops, according to the report. "However, the liability policy may not cover the cost of a hacker intrusion that results in the breach of customer data," it reads. Traditional policies, it continued, also don't overtly cover first-party breach notification costs. "These gaps could leave an organization responsible for the full cost of a data breach response. Cyber insurance can be used to help cover those costs."

[See also: Data center help to cost CMS $28M.]

4.Evaluate policy options carefully. Typically, cyber insurance provides coverage for liability for data breaches, remediation costs to respond to the breach, and regulatory and legal fines and penalties. "However, the limitations on the coverage can vary widely based on the carrier, the type of industry, and the company's risk profile," the report reads. In turn, the terms of a cyber insurance policy may restrict the way an organization responds to a data breach. "For instance it may cover credit monitoring services for a breach of protected health information," for which, it continued, it's useful to monitor a patient's medical identity.

5.Perform a risk assessment. Performing a comprehensive privacy and security risk assessment can help an organization identify, evaluate, and mitigate gaps in its security and privacy program, according to the report: "Lessening those gaps can reduce breach risks and lower exposure if a breach does occur." Having a risk assessment on file, that's third-party documented, can help speed up the underwriting process and may even lower insurance premiums. 

Continued on the next page.