OPM, VA push standards from the purse

'Our greatest challenge is the lack of automation outside' the Veterans Affairs Department.

'VA's Robert Kolodner

Rick Steele

Agencies plan to leverage purchasing power as an incentive for insurers and health care providers

The administration's biggest ally in getting doctors' offices and hospitals to use electronic health records just might be under its own control.

The Veterans Affairs Department and the Office of Personnel Management have the ability to give the administration's goal for most Americans to have an electronic health record by 2014 a huge push forward by requiring more than 10 million patients to use health IT.

Through the web of VA hospitals and medical centers connected across the country and the federal employee health benefit contractors, such as the BlueCross BlueShield Association, the administration is seeing how they can use the power of the purse to require electronic health records.

In fact, OPM recently asked insurance carriers to describe their health IT capabilities as part of its strategy to move Federal Employees Health Benefits program (FEHB) contractors to standardized electronic health records.

Developing standards

'We're collecting information from our carriers to identify the leaders and best practices and promote those among plans that are not so far along,' said Dan Green, deputy associate director for employee and family support policy at OPM. 'Our role as a purchaser of private plans is to support the move to developing the standards, certification and interoperability among systems.'

Though Green wouldn't share the results of the OPM questionnaire, interviews with health IT experts reveal an insurance industry that has largely adopted its own standards but is unable to link to networks used by other sectors of the health industry.

Private health care providers still are woefully behind; physicians' offices use software for scheduling and billing functions, but patient health records largely are still on paper.

OPM, with its 8-million-member FEHB, believes it can move insurers to modernize by making it part of their contract requirements. OPM officials said, however, that it's too early to conclude what those standards will be for hardware and software.

'OPM is committed to using its position as the largest purchaser of employee health care benefits to contribute in the expansion and use of electronic health records, e-prescribing and other HIT-related provisions,' OPM director Linda Springer said at a hearing before the House Government Reform Subcommittee on the Federal Workforce and Agency Organization.

David Brailer, the national coordinator of health IT within the Health and Human Services Department, echoed Springer's wish to push electronic health records through the procurement process.

'We want to use all the purchasing power we have and bring private-sector players together to line up behind certified [IT] products, to line up behind standards and to line up behind the adoption of certain technologies,' Brailer said.

OPM also urged contractors in the April 19 FEHB Program Annual Call Letter to undertake six steps to align with HHS' health IT initiative, which seeks to create a nationwide interoperable infrastructure, by:
  • Adopting systems based on the Federal Health Architecture standards

  • Highlighting provider directories to indicate individual provider health IT capabilities

  • Linking disease management and quality initiatives to health IT systems for measurable improvements

  • Providing incentives for the adoption of health IT by providers and facilities in FEHB program networks

  • Encouraging contracted pharmacy benefit managers to provide incentives for taking part in e-prescribing and health IT efforts

  • Ensuring compliance with federal requirements to protect the privacy of individually identifiable health information.

In the letter, OPM said it will 'consider progress in the implementation of health IT as an integral component in our assessment of carrier performance.'

OPM eventually could require the six steps for any insurance provider that hopes to win a FEHB contract.

VA's Veterans Health Information Systems and Technology Architecture (VistA) has improved the sharing of patient information at that agency, but VA still can't easily obtain patient medical records when veterans seek care at non-VA facilities, such as doctors' offices and hospitals. Those records, which include X-rays, laboratory tests, diagnoses and other patient data, are either stranded on incompatible computer systems or still on paper.

Adopting electronic systems

'About 40 percent of our 5 million veterans' seek health care outside the VA system, said Dr. Robert M. Kolodner, VA's acting chief health informatics officer. 'The health care institutions and the personal health records held by patients are islands out there.'

Until private-sector health care providers and insurance companies adopt electronic health record standards, VA must depend on doctors to mail'or patients to hand-carry'those records to VA facilities.

'Our greatest challenge is the lack of automation outside' VA, Kolodner said. 'We have to request medical records the way it is done by everybody else. There's often not cross-connectivity, and the rest is paper-based.'

Many of the large health insurers already deploy internal health information systems similar to those sought by OPM. Companies such as Kaiser Permanente, which has its own network of doctors, health care facilities and labs, transmits electronic health data across closed LANs and WANs that don't fully link with outside systems.

Kaiser Permanente officials said the company is focusing on adopting systems based on Federal Health Architecture standards. The company recently launched an online patient system that lets patients access their electronic health records from their home PCs using a secure password, said Laura Marshall in Kaiser's National Communications and External Relations Office.

'Patients can not only make appointments, but they can refill prescriptions, view lab results and even e-mail their doctors,' she said.

Users can also review the results of past doctor visits, including diagnoses and physicians' directions for care.

'Trying to get organizations like BlueCross BlueShield plans to make such a big move, there's an understandable reluctance to be first,' says David St. Clair, CEO of MEDecision Inc. of Wayne, Pa., a company that develops health management IT systems.

While OPM's letter asks insurance providers to create incentives for the adoption of health IT, some insurance providers aren't ready to tackle that task.

Officials at the BlueCross BlueShield Association weren't prepared to comment on OPM's letter or other aspects of the OPM program.

Streamlining operations

'It's an area we've been working on, but there's still some reorganization on where we stand on some of these questions,' said Jackie Fishman, a BlueCross BlueShield spokesperson. 'It's premature for us to give a clear picture of where we are.'

Part of that reason might be the lack of clear industry standards, St. Clair said.

'There are a number of standardization bodies such as HL7 and ANSII that have been in use for years,' St. Clair said. 'You have processes set up by the very big insurance companies to find out how they can cooperate amongst themselves to streamline operations between physicians and doctors to make it easier for the [sharing of patient information].'

Those IT systems, however, still remain largely 'within the walls of the payers,' he added.

Private health care providers'especially small and independent physicians' offices'don't have the technology to handle electronic health records in the office, much less exchange electronic health records with insurance carriers and the government.

'Somewhere around 60 percent of physicians are in small and medium-sized offices with one or just a few doctors,' said Dr. Joseph Heyman, a trustee at the American Medical Association. 'The standards aren't there yet; some doctors are afraid they'll buy the wrong system.'

Because most doctors' offices have only a patchwork of low-grade software from various vendors, the challenge and expense to interface would be great, Heyman added.

'They'll have to convert their systems or buy some sort of interface so they can use one database with all their systems. That's an expensive situation,' he said.

John Guerra is a freelance writer in North Beach, Md.

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