Health IT program stocking the shelves

Commission approves 22 products for e-records; standards to exchange data expected next

What's next for health IT

Milestones expected in September from Health and Human Services health IT contracts:

  • Health IT Standards Panel to endorse interoperability standards and implementation guides for exchange of lab results, patient registration, medication history and bioterrorism data

  • Certification Commission for Health IT to publish proposed criteria for inpatient electronic health record

  • George Washington University and Harvard University/Massachusetts General Hospital to complete first annual survey of health IT adoption

  • Contractors developing prototypes for nationwide health information network to provide draft architectures.

Senate bill is tight on 2007 funding

Health IT has attracted many advocates in the House and Senate, but Senate lawmakers are not necessarily putting money behind their words.

Under the Senate Appropriations Committee's version of the fiscal 2007 Labor, Health and Human Services, Education and other related agencies spending bills, the Office of the National Coordinator for Health IT would receive $63.2 million, just $2 million more than was enacted this year.

In the House version, the health IT office would receive $98 million.

Both committees included $11.9 million in transfers under the Public Health Service Act for health IT network development in their budget authority.

Lawmakers also recommended that the Agency for Healthcare Research and Quality, another agency of the Health and Human Services Department, receive $50 million for health IT demonstration projects.

Health IT funding as proposed now will cover the initial goals of current contracts and work, said Karen Bell, acting deputy national coordinator for health IT.

'The question becomes, how much can we grow and recognize that, in addition to what we have, the public and the market have needs in other areas as well,' she said. 'MM

The first low-hanging fruit in health IT is ready for picking. Federal health IT efforts are yielding tangible products with an initial list of electronic health record systems that meet an agreed-upon seal of approval.

The inaugural list of 22 certified systems, which became available last month, represents the first concrete results of contracts the Health and Human Services Department awarded in 2005 through the Office of the National Coordinator for Health IT.

On top of the product certifications, the federal health IT effort is looking for other near-term successes. Collaborative groups are developing interoperability standards and prototypes for a nationwide health information network. They're also evaluating state privacy laws with an eye toward harmonizing them.

In addition, HHS announced a final rule proposed last year that revises anti-fraud and abuse laws so hospitals and others can help physicians acquire electronic health records and prescribing systems. The rule should reduce the risk of small practices investing in new technlogy.

'All of the planning over the last two years is beginning to bear fruit,' said Karen Bell, acting deputy national coordinator for health IT.

Exemptions for IT

The new HHS rule creates exemptions to the so-called Stark laws, as well as to safe habors in the physician self-referral law. Under the exemptions, hospitals may provide hardware, software and training to physicians who refer patients to them (something not currently allowed). Systems purchased via the exemption must be able to exchange health information with other systems.

In fact, the first 22 certified record systems are something physicians and patients can now experience first-hand, Bell said, although a lot of the work under the other health IT contracts build 'a huge pyramid of infrastructure and other work that is going on that won't be as obvious to the American public.'

Products received approval from the Certification Commission for Healthcare Information Technology. The commission developed criteria and a certification process for its CCHIT Certified seal of approval to assure that those electronic health records meet baseline levels of functionality, interoperability and security.

'Volunteers from across the health care spectrum developed CCHIT's criteria and inspection process, ensuring fairness and balance between the interests of diverse stakeholders,' said Mark Leavitt, chairman of the Certification Commission for Health IT.

Product certification is expected to spur electronic record adoption because it lessens the risk physicians and hospitals have faced in investing in health IT, Bell said.

'We've heard many times that a bad electronic health record purchase, or one that doesn't fit the office, or have the functionality that was anticipated, is worse than no electronic health record,' she said.

That's been a major deterrent for clinicians, who often determine they're better off continuing to use paper than making the wrong decision on an e-records system.

The certified products represent electronic health record systems for physicians' offices or outpatient medical facilities. The commission next will develop certification for inpatient or hospital electronic records and then architectures or systems that let providers exchange information. CCHIT will incorporate interoperability standards the Health IT Standards Panel endorses.

George Washington Medical Faculty Associates, a large physician practice in Washington, last year started using the TouchWorks electronic heath record system from Allscripts LLC of Chicago, one of the products certified on the initial list. The system has enhanced patient care and significantly reduced administrative costs, said Stephen Badger, chief executive officer of the practice.

'George Washington Medical Faculty Associates was an early adopter of the electronic health record system, which has transformed our practice,' he said.

The next big milestone comes in September, when the health IT standards group will endorse standards for interoperability and implementation guidelines for early versions of health IT applications.

The Health IT Standards Panel took a first step last month when it identified 90 existing standards that let doctors securely exchange patient data in a nationwide health information network.

To exchange information on different networks, providers need standards on which they agree for interoperability. The Healthcare Information Technology Standards Panel distilled the 90 standards it identified last month from 600 candidate standards, said John Halamka, the panel's chairman and CIO of Harvard Medical School.

The group will further reduce that number as the process seeks the most effective standards for exchanging data in the first health IT uses that the public/private American Health Information Community has prioritized.

'Our next task will be to produce the detailed standards guides that will enable the creation of a secure information superhighway for health care,' he said.

The panel will provide in late September the interoperability specifications to define and support early versions of health IT, Halamka said.

The early versions will focus on the exchange of data for laboratory results, patient registration, medication history and allergies, recommendations for secure messaging and biosurveillance, Bell said.

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