The primary function of the Office of the Chief Medical Officer will be to infuse a clinical perspective across ONC on all activities which have clinical implications. Activities located in this office will include safety, usability, clinical decision support, meaningful use policy development, and quality including metrics and measurement development. The Chief Medical Officer will report directly to me, and will play a key role in helping ONC satisfy its mission of improving health and health care through health IT.

The Office of Consumer eHealth will continue the work on consumer engagement begun in our Office of Policy and Planning. Creation of this new office provides exciting opportunities for ONC to expand upon the work that is currently underway, including the pledge program and patient-focused challenges. Creation of the Office of Consumer eHealth demonstrates ONC’s strong commitment to enabling patient and family engagement in health care.

These changes are well-aligned with ONC’s strategic priorities, and will position ONC to move into the future with its “eye on the prize” of better, safer health care through health IT with increased efficacy, efficiency and flexibility.  We will undertake a national search for both a Chief Medical Officer and a Director of the Office of Consumer eHealth. Postings for both positions will appear on www.usajobs.gov shortly, and I encourage you to check back often for updates.

Patient Safety Developer Contest to Reduce Medical Errors

Why launch this challenge? Hospitals struggle to increase internal incident reporting and to create effective systems for their quality and risk management staff to complete root cause analyses and follow-up. Additionally, quality and risk management staff cope with reporting fatigue in a paper-based reporting system, affecting reporting frequency and quality. Oftentimes, their limited energy is spent convincing physicians and nurses to report incidents, doing enough of an investigation to fill out the appropriate forms, and sending them to the appropriate agencies—all of which lead to better research and improvement efforts.

Ideally, we would live in a world of optimal care delivery. Physicians, nurses, and care delivery organizations across the country are continuously working to minimize and eliminate errors. But, until this ideal world exists, we need to invest in infrastructure that helps enable better care quality, risk management, and shared learning—all to ensure better care for patients.

Participating in the Patient Safety Developer Contest

We’re looking for passionate innovators to participate in this exciting new developer contest to help the health care delivery community solve these issues. These reporting issues would be partially alleviated through the deployment of an effective software reporting solution. The solution needs to make it easier for any qualified individual to file a report electronically, using Common Formats, but allowing for additional elements and narratives. It must allow the hospital quality and risk management staff to add information from follow-up investigations; submit reports as appropriate to patient safety organizations, the states, or the Food and Drug Administration; and track follow-up activities.

Submit Entries for Patient Safety Developer Contest by August 31, 2012

Applicants are required to submit their entries by August 31, 2012, and will be judged on the effectiveness of their system in facilitating patient safety event reporting including:

• Compliance with the Agency for Healthcare Research and Quality’s common formats;
• Usability and design;
• Ability to integrate with EHRs and other health IT data sources; and
• Application of the Nationwide Health Information Network standards.

The first place winner will receive $50,000. The second place prize will be $15,000 and third prize will be $5,000.

For More Information

Please visit the Reporting Patient Safety Events Challenge website to learn more about the developer contest. In the coming weeks, we will launch a webinar to provide further details for participation. Enter now!

We Want to Hear From You

Have thoughts on this blog post? Do you plan to enter this developer contest? Share your thoughts in the comment section below. We look forward to hearing from you!

For more information on health information technology, visit HealthIT.gov.

The release today of the Request for Information (RFI) on Governance of the Nationwide Health Information Network is a critical step toward enabling trusted and interoperable electronic health information exchange (electronic exchange) nationwide. A common set of “rules of the road” for privacy, security, business and technical requirements will help lay the necessary foundation to enable our nation’s electronic health information exchange capacity to grow. It can also help achieve the Administration’s vision for an electronically connected health system for the 21^st Century that delivers efficient and quality health care for all Americans.

A properly crafted governance mechanism will yield substantial public benefits, including:

• Reduced burden and complexity for exchanging electronic health information;
• Protections for consumers and health care providers; and
• An environment where electronic health information exchange is commonplace and “worry-free.”

The Health Information Technology for Economic and Clinical Health (HITECH) Act (P.L. 111-5) delegates authority for establishing a governance mechanism for the nationwide health information network to the Office of the National Coordinator for Health Information Technology.

RFI Seeks Public Input on Governance Mechanism

This RFI seeks the public’s input on how a governance mechanism would best:

• Provide confidence to patients that their health information is being shared appropriately and securely;
• Reassure providers they are dealing with trusted entities when sending or receiving patient information;
• Promote an open and competitive market for electronic health information exchange; and
• Enable innovation to thrive.

Key Components of the Proposed Governance Approach

The key components of the proposed governance approach include:

• A focus on entities that facilitate electronic health information exchange;
• A set of conditions for trusted exchange (CTEs) in three areas: safeguards, interoperability, and business practices;
• A voluntary validation process for entities to demonstrate conformance to the CTEs and to increase provider confidence that the exchange entities meet these requirements;
• Processes to regularly update and improve CTEs;
• A process to classify the readiness of technical standards and implementation specifications to support interoperability CTEs; and
• Approaches for monitoring and transparent oversight

Public Comment Period

In order to receive the best input from all stakeholders on governance issues to help promote electronic health information exchange, the RFI includes many questions about these proposals. The public comment period closes 30 days after the date of publication in the Federal Register, which we expect to occur on May 15, 2012.

We encourage all stakeholders, including consumers and patients, to provide feedback on these proposals. The RFI can be currently viewed and downloaded at the Office of the Federal Register’s Public Inspection website.

For more information on health information technology and electronic health information exchange, visit HealthIT.gov.

E-prescribing Adoption: Where We Are Today

The nation has witnessed a significant increase in e-prescribing adoption over the last several years. Surescripts, which operates the largest electronic prescribing network in the country, shows data from February 2012 that indicate approximately 401,000 prescribers are on its network. This is an increase in e-prescribing adoption of more than 400 percent since December 2008. Additionally, more than 92 percent  of retail pharmacies are actively e-prescribing, representing a 20 percent point increase from December 2008 (Figure 1).

Figure 1: Active Retail Community Pharmacies on Surescripts Network

E-prescribing adoption has positive outcomes for the quality, safety, and efficiency of health care:

• A 2010 study done by the Weill Cornell Medical College, and supported by the Agency for Health Care Research and Quality, found that physicians make seven times fewer errors when using electronic systems to prescribe than when they are writing prescriptions by hand. [i]
• A 2012 study by Surescripts found that e-prescribing significantly increases the likelihood of first-fill medication adherence (i.e., new prescriptions picked up by the patient) and could lead to $140 to $240 billion in health care savings and improved outcomes over the next 10 years. [ii]

Many factors are responsible for the increase in e-prescribing adoption, including efforts by the public and private sectors to use payment incentives/penalties, stakeholder education, and removal of explicit barriers to enhance adoption of e-prescribing.

State Health Information Exchange: Our Role in Encouraging E-prescribing Adoption

States have enabled and encouraged e-prescribing adoption, using policy levers as well as sponsoring programs. Various state policies and initiatives pre-date the HITECH Act and ONC’s Cooperative Agreement programs, highlighting that—for some states—increasing e-prescribing adoption and use has been a long-time goal.

To date, the State Health Information Exchange (HIE) Cooperative Agreement Program has specifically focused on mobilizing pharmacy participation in e-prescribing. The full benefits of e-prescribing cannot be realized unless pharmacies participate along with prescribers. With this recognition, in the first Program Information Notice to state HIE grantees (released July 2010) [iii], ONC encouraged program grantees to employ various strategies to advance pharmacy e-prescribing adoption.

Though states have and will continue to take multiple approaches to achieve e-prescribing adoption goals, ONC has identified three broad themes emerging from leading states’ e-prescribing efforts:

1) Creating an Environment that Advances e-Prescribing

State policies and regulations have addressed a range of factors relevant to pharmacy adoption of e-prescribing. For instance, Minnesota passed legislation (Statute 62J.497) in 2008 mandating that “all providers, group purchasers, prescribers, and dispensers must establish and maintain an electronic prescription drug program.” Following this mandate, the percent of pharmacies actively e-prescribing in the state increased from 57 percent in 2008 to 90 percent by the end of 2011, according to Minnesota’s data. Additionally, in 2009, North Dakota’s legislature passed Senate Bill 2332, establishing a low-interest loan fund from the Bank of North Dakota to assist health care entities in adopting health information technology and enabling capabilities such as e-prescribing. To date, North Dakota has given out approximately $6 million of the $10 million available and has had nearly a 42 percent increase in active pharmacy adoption from June 2010 to February 2012.

2) Reducing Barriers for Rural and Independent Pharmacy Adoption

Particularly for independent or rural pharmacies, the cost of e-prescribing is often a barrier. Some states have used state appropriations, grants, or revolving loans to help alleviate financial burdens of purchasing software/hardware or paying transaction fees among target groups of pharmacies. For example, Tennessee initiated a partnership with the Tennessee Pharmacists Association to provide up to $675,000 in grants to 124 independent, community pharmacies to offset e-prescribing expenses. As of December 2011, Tennessee reports that 81 (65.3 percent) of the pharmacies targeted by the program are e-prescribing.

3) Setting and Monitoring Goals

States have also leveraged data to assess and monitor their e-prescribing environments, to identify gaps and set goals and priorities for incentive programs and outreach efforts. The Rhode Island Quality Institute’s (RIQI)e-prescribing  efforts include an e-prescribing committee chaired by the state director of health. This committee examined monthly Surescripts data to identify barriers to pharmacy e-prescribing adoption and established actionable, public goals for increasing e-prescribing accessibility and utilization in the state. RIQI attributes its success to consistent outreach to the state’s pharmacy and provider communities. Based on data collected by RIQI, 100 percent of Rhode Island’s retail pharmacies are capable of electronic prescribing as of 2009 and 67.5 percent of the state’s prescribers are currently e-prescribing.

What’s Next?

States continue to break new ground with innovative e-prescribing efforts, including the North Carolina Health Information Exchange’s work to expand an existing “Pharmacy Home” web application to connect it to the statewide exchange. After this expansion, North Carolina’s statewide exchange will be the main aggregator of disparate medication lists, enhancing providers’ ability to reconcile patient medications.

There have been great strides in the adoption of e-prescribing, but our work is not finished. Stay tuned for more updates, and for more detail about state e-prescribing efforts, please visit the State HIE Resources Bright Spots page.

To Learn More

For more information on e-prescribing, health information exchange, and health information technology, visit HealthIT.gov.

We Want to Hear From You

ONC is interested in your feedback. Let us know your thoughts on this blog post by commenting in the section below. Feel free to share a story about how e-prescribing has helped you manage your health or the health of your patients.

[ii] http://www.surescripts.com/news-and-events/press-releases/2012/february/212_eprescribing.aspx

[iii] http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_0_5545_1488_17157_43/http%3B/wci-pubcontent/publish/onc/public_communities/a_e/arra/state_hie_program_portlet/files/state_hie_program_information_notice___final.pdf

Marie DeSisto

Marie DeSisto is an innovator when it comes to electronic health records (EHRs) and improving health care in schools. Thanks to her efforts, school nurses in Waltham, MA, are linked by an EHR system that helps them serve students in ways that go far beyond the basics. Just one example: EHR data on student obesity convinced budget-conscious administrators not to eliminate recess.

In honor of National Nurses Week and National School Nurse Day, ONC talked with Ms. DeSisto about Waltham’s EHRs—how the system was implemented, how it works, and how students and nurses benefit.

ONC:

First tell us a little about yourself and how you became interested in EHRs.

DeSisto:

I’m an RN with a master’s in nursing administration, and I’m also a nationally certified school nurse. I’m director of nurses for Waltham Public Schools. We have about 5,000 students, pre-K through grade 12, in 10 schools. We have a nurse in each school—three at the high school.

I’ve been at Waltham for 12 years, and before that I was a school nurse in another district. We had kind of a homegrown EHR program there, cobbled together by our IT people. I knew what a huge timesaver it could be, and there were all kinds of ways we could use data from a good system to improve health care in schools. So when I came to Waltham, I decided to look for a program that would really fill the bill. We’ve been using our EHR system for 11 years. Every nurse has a computer, and we’re all linked.

ONC:

Any challenges getting your system up and running?

DeSisto:

Cost is always an issue. But we were able to get a grant from the Massachusetts Department of Public Health, called an Essential School Health Service Grant. They didn’t tell us what software we had to get, just gave us some parameters. The system we chose, SNAP, is from a company called Professional Software for Nurses. The company’s trainer was a nurse herself, with experience in a school health room. It helped a lot that she spoke our language.

Another challenge was that some of the nurses were a little hesitant about converting to EHRs. But we had a couple of very enthusiastic early adopters, and they really helped get everybody on board. The whole process only took about two months. To motivate our nurses, we emphasized the timesaving aspect of the system. For example, our accident-reporting system had been burdensome—paper forms in triplicate. SNAP does it with the click of a button. That had a big wow factor, and the accident reports made a big impression on administration. It got us off to a good start.

ONC:

Tell us about how you use your EHR system—some examples of what it can do, or rather what you and your team can do with it.

DeSisto:

Vision screening comes to mind. We do the screenings and refer students for treatment or corrective lenses if they don’t pass. The big thing with our EHR system is that we can keep track of those referrals, and do follow-ups. Our completion rate for referrals jumped from 63 percent to 92 percent when we started using EHRs.

SNAP also helps us keep track of immunizations. Say there’s a concern about a potential problem in your school and the principal wants to know the status of immunizations. It can take hours and hours to check for immunization information on documents students have brought from the doctors, but you can pull it instantly from the EHRs.

We’ve also been using our system to track concussions. There’s so much interest now in sports-related injuries. Our trend data show an increase over the past four to five years. That may be because reporting is better, and people are just more aware. We’re helping parents, students, and primary care providers understand that concussions can have serious implications for learning ability.

The EHRs were very helpful when the H1N1 flu virus was going around. We could quickly track how many kids the nurses were dismissing from school, and the symptoms the nurses were seeing. We reported to the Massachusetts Department of Public Health every day, and they could see the patterns.

Another really useful thing—very practical—has been keeping track of injuries from falls. For example, we saw that a lot of first and second graders were getting hurt in falls during recess. So we worked with the principals to train recess monitors in safety. Our data also showed lots of slip-and-falls first thing in the morning, especially on rainy days. Most of that was staff, and it was taking up a great deal of nursing time. Just installing some carpet cut that down almost 100 percent.

ONC:

Can you give us some more examples of how the EHRs help the school nurses meet the students’ health needs or how EHRs can improve health care in schools?

DeSisto:

We have quite a few students with chronic conditions, like asthma or diabetes. We can do an individual health care plan for these students, with everything on medications, nursing interventions. We can track blood pressure and blood sugar readings, make graphs that show changes, and print those out for parents to take to the doctor. The system also helps us with medications. It tracks how many doses we’ve administered, so we know if the student is forgetting to come in for meds. That’s so important. And we can see when we need to ask the parent for more pills.

The system also gives us nursing assessment templates. Say a student comes in for a headache, the nurse can click on the headache template and it prompts questions such as “Did you have a head injury?”

ONC:

Any other examples of how you’ve been able to use EHR data?

DeSisto:

We have always measured student height and weight, but our EHRs let us put that information to use. Our data showed that 40 percent of students in our district are either overweight or obese. The data documented this problem, and that convinced the superintendent to reinstate health education programs and not to cut recess. I really think if all schools in the country used EHRs, we wouldn’t have a child obesity problem. We could have seen it coming and taken action.

ONC:

What’s on your “wish list” for EHRs?

DeSisto:

We aren’t yet linked with other school districts, and we aren’t linked directly with providers. That would be great. I’d also like to see standardization across the country. For example, we have about 190 students with EpiPens for life-threatening allergies. We send data on EpiPen administrations to the Massachusetts Department of Public Health. Massachusetts is the only state that does that. If everyone did it, think what we could learn by comparing states and regions, and how that would affect health care in schools.

ONC:

Any advice for other school districts that are thinking about implementing EHRs?

DeSisto:

Take plenty of time to check available systems carefully. Make sure that the one you choose links to your district’s administrative software—what they use for attendance and demographics. It should be a one-way link, though; you don’t want any outside access to your students’ EHRs.

Make sure the system is visually easy to use and that it’s intuitive to the way nurses think. It also needs to be flexible, so the nurses can make it work for them. For example, you should be able to log more than one student at a time.

You also have to be very careful about privacy and security. The system has to be password protected, and you should be able to track who is making changes. I can hit a button and see right away who entered a particular statement or number.

ONC:

Any final thoughts?

DeSisto:

I am the Massachusetts director for the National Association of School Nurses (NASN).  NASN is a strong advocate for EHR adoption in school systems and believes it can help improve health care in schools. School nurses work hard to keep students safe, healthy, and ready to learn. A good EHR system supports this work in so many ways. It’s worth every penny.

For More Information

• To learn more about health information technology, visit healthIT.gov

• For more on National Nurses Week, visit the American Nurses Association website

We Want to Hear From You

What did you think of the blog post? How do you feel about EHRs being implementing in school districts to help improve health care in schools? Let us know your thoughts by commenting below.

The number of providers and hospitals trading in their old fashioned paper records for EHRs and taking advantage of the assistance provided by the Medicare and Medicaid EHR Incentive Programs continues to climb each month with hundreds of thousands of additional providers registered and in queue to participate in the EHR Incentive Programs and get paid. Preliminary data show that during the month of April alone, more than 17,000 eligible professionals and 280 eligible hospitals received payments under the EHR Incentive Programs. Since the EHR Incentive Programs started a little over a year ago, a total of approximately 90,000 eligible professionals and 2,250 hospitals—which is 42 percent of all eligible hospitals—have successfully participated in the program!

This success is attributable to the hard work of providers across the country who are diligently using the Stage 1 meaningful use criteria as a roadmap for improving patient care.

Broad and Strong Interest from Primary Care Providers

A lot of hard work is going into the dramatic success of the EHR Incentive Programs. The ONC Regional Extension Center (REC) program is an important vantage point from which we are able to observe strong interest among providers in EHR adoption and registering for the EHR Incentive Programs. For the past two years, 62 RECs across the country have identified primary care providers in priority settings, such as small practices, community health centers, and critical access hospitals, interested in achieving meaningful use and have helped them get there. Collectively, the RECs are now working with 132,000 primary care providers, which is more than 40 percent  of all the primary care providers in the country. REC providers are in every state and include more than 70 percent of the small practice providers in rural settings and more than 75 percent of federally funded health centers. REC staff develop customized EHR implementation plans to help every practice in its pursuit toward achieving meaningful use because they know no two practices are the same, and each practice has its own challenges in making the important transition to EHRs.

Success in Supporting Small Practices to Implement EHR Systems

It’s important to take a moment to consider just how far we’ve come over the last several years in the national movement toward EHR adoption the adoption of basic EHRs has doubled since 2008 from 17 percent to 34 percent in 2011. In addition, the REC program has provided subsidized technical assistance to support small practices, which often have the most difficult time in implementing EHR systems because they don’t have the capital, staff, and expertise that exist in larger organizations. To-date, RECs have had considerable success in getting these small practice providers up and running on an EHR system. Of the 67,000 providers working with RECs who are currently or were recently in small practices of less than 10 providers, 58% or 39,000 have implemented an EHR system that can e-prescribe (helping to reduce medical errors) and generate quality measurement reports (helping providers benchmark and measure a patient’s care outcomes). And, interestingly, while it’s striking that physicians 35 and younger adopting basic EHRs has increased from 24 percent to 52.8 percent between 2008 and 2011, the EHR adoption rates among physicians 65 and older has increased even more rapidly from 8 percent to 23.9 percent during the same time period! RECs will continue to work hard with the remaining providers to help them select the right EHR system so they can adopt and start achieving meaningful use within the next two years.

As part of an ongoing effort to improve how they serve providers’ needs, the RECs are working with ONC to identify the most critical barriers providers face to switching to EHRs so we can continue to work together to develop solutions and best practices that assist in the transition. Experience tells us that among the most common barriers small practices confront are:

1. Which EHR vendor to select;
2. Difficulties in prioritizing adoption among other pressing practice needs; and
3. The need for practice transformation support, specifically related to redesigning workflows.

Tools to address these issues are currently being posted on healthIT.gov, and ONC and the RECs would welcome feedback to help us further improve how we can help providers get there.

Helping Critical Access and Rural Hospitals Adopt and Achieve Meaningful Use

In 2010 and 2011, ONC provided an additional $30M to RECs to help increase EHR adoption rates in critical access and rural hospitals. These facilities are vital to health care access in rural parts of the country. The RECs are currently working with 963 critical access hospitals (CAHs) and 85 small rural hospitals (RHs). These facilities are located in remote areas with even more acute staff, capital, and other resource challenges than other providers, and RECs are helping to identify innovative ways of helping these hospitals with achieving meaningful use.  Memorial Hospital of Layette County  in Wisconsin, for example, is one of these early-adopting hospitals. It is a critical access hospital with less than 25 beds, but also one of the first facilities in Wisconsin to achieve meaningful use and receive payment under the EHR Incentive Programs.   Memorial Hospital began to implement an EHR system in 2007 with the support of a Health Resources and Services Administration Critical Access Hospital Health IT (CAHHIT) grant.  According to Dr. Louis Wenzlow, who leads the Wisconsin REC’s efforts to support CAH/RHs in achieving meaningful use, Memorial Hospital reports more complete charting, enhanced compliance with ordering, and better access to patient records as some of the benefits it has experienced since EHR adoption. And, we’re happy to report the share of hospitals using EHRs has more than doubled from 16 percent in 2009 to 35 percent in 2011!

States Continue to Invest in Medicaid EHR Incentive Programs

The number of providers able to participate in the EHR Incentive Programs will get an additional boost as the remaining states that haven’t launched Medicaid EHR Incentive Programs do so over the course of the next several months. As of May, 44 states have active Medicaid EHR Incentive Programs. At least four more states plan to launch their EHR Incentive Programs by August, while the remaining states anticipate launching shortly thereafter in 2012. States continue to develop their health IT infrastructures in order to facilitate Medicaid providers’ demonstration of meaningful use. Apart from the State Health Information Exchange Cooperative Agreement Program grants administered by ONC to the states for the development of state-level Health Information Exchanges (HIEs), state Medicaid agencies are also requesting federal matching funds to contribute to “standing up” HIEs. States understand that HIEs are essential tools for promoting the timely and secure exchange of health information across physicians, hospitals, specialists, patients, and health care insurers, and therefore, can significantly assist providers in achieving meaningful use.

Hard Work Ahead—Bright Future

While it is exciting to see the progress of so many diverse and varied providers and hospitals across the country, we recognize many are still experiencing challenges with EHR adoption and achieving meaningful use.. ONC and the RECs are collecting and sharing best practices andtools on what is working, and by helping facilitate communication among providers, we at ONC believe we can make it easier for the tens of thousands of other providers who will be achieving meaningful use of EHRs this year and into the future. The path to adopting and meaningfully using EHRs is not always easy for everyone, but it is the roadmap to better health and health care at lower costs. The national transition to EHRs through the EHR Incentive Programs is foundational to building a truly 21^st Century health care system.

We’re seeing great progress, and we’re working with providers and hospitals across the country to keep the momentum going!

For More Information

To learn more about health information technology, visit HealthIT.gov.

We Want to Hear From You

ONC is interested in your feedback! Share your thoughts on this blog post in the comment section below.

Second Anniversary of the Beacon Community Program

This month, we celebrate the second anniversary of the Beacon Community Program by showcasing some of the progress and exciting lessons learned across the program. Throughout the month of May, be on the lookout for activities, announcements, events, and webinars taking place across the country. Activities will range from in-person events hosted by our partners, participation in national conferences, and online webinars and social media activities (#Beacon2yr).

Here are a few topics we will feature:

• Collaboration between Beacon Communities and electronic health record vendors
• Innovation in Southeast  Minnesota on electronic capture of patient reported outcomes
• IT-enabled patient center medical home models for the safety net in New Orleans

These activities will highlight successes and show real health care improvements for patients, providers, and community members like you.

Beacon Community Program: Areas of Focus

Each of the 17 communities in the Beacon Community Program, has its own unique population and regional context, and is actively pursuing the following areas of focus:

• Build and Strengthen Health Information Technology: Technology is the foundation for sustainable health care quality and efficiency
• Improve Care: Technology brings tools and information to the right people at the right time to improve health care and reduce costs
• Test Innovation: Beacons are using innovative, evidence-generating approaches to improve patient and community-centered care

Contact Christina Markle at christina.markle@hhs.gov for more information about Beacon Community Program anniversary activities and announcements, or for more information about particular communities or topics/issues of interest.

For More Information

• Beacon Community Program
• Beacon Community Programs: Lessons Learned
• Videos on the Beacon Communities

We Want to Hear From You

ONC is interested in your feedback. Use the comment area below to share your thoughts on this blog post.

To learn more about health information technology, visit HealthIT.gov.

LTPAC Providers and the Electronic Health Record (EHR) Incentive Programs

With the advent of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, electronic health record adoption by eligible providers has increased.  These important care partners can use health information technology (health IT) to share patient information and coordinate care with LTPAC providers under the EHR Incentive Programs to promote improvements in outcomes.

This highlights the importance of care coordination and the need for systems to support information capture, use, and exchange of relevant, timely care data.

Thus, in order to better understand the health IT needs of LTPAC providers for care delivery and to support transitions of care, ONC’s Office of Policy and Planning will be convening a roundtable of LTPAC experts to engage in a discussion on these issues.

Upcoming LTPAC Roundtable

The LTPAC Roundtable will take place on May 3, 2012 and will include public- and private-sector representatives from LTPAC providers, professional associations, system vendors, consumer advocates, and representatives from related federal healthcare agencies and committees.

The objectives of the roundtable are to:

• Understand the information needs of LTPAC providers, and how these needs could be supported through EHR adoption and health information exchange

• Identify priority EHR functions that LTPAC providers should consider when investing in EHRs that would enable the exchange of health information

Following the Roundtable, a summary report of findings will be published and posted on HealthIT.gov.  We look forward to hearing about your comments on this important effort!

For more information on health information technology, visit HealthIT.gov

——————————————————————————————————————————————-

1. Harvell, J., Dougherty, M. “Opportunities  for Engaging Long Term and Post Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information”  http://aspe.hhs.gov/daltcp/reports/2011/StratEng.pdf at page 12 citing:  Mor, V., Intrator, O., Feng, Z., Grabowski, D.C. “The Revolving Door of Rehospitalization from Skilled Nursing Facilities.” Health Affairs, 2010, 29(1): 57-64.
2. Harvell, J., Dougherty, M. “Opportunities for Engaging Long Term and Post Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information”  http://aspe.hhs.gov/daltcp/reports/2011/StratEng.pdf at page 13 citing:  Medicare Payment Advisory Commission (MedPAC). A Data Book: Healthcare Spending and the Medicare Program. Washington, DC: MedPAC, 2006a. http://www.medpac.gov.

Patients and physicians nationwide are leveraging health information technology to make their health care interaction more efficient and effective without necessarily having to be face-to-face. The use of existing a

Endocrinologist, Dr. Gail Nunlee-Bland shared her story with ONC about several telehealth studies she has done with elderly patients to help improve their diabetes self-management.

To learn more about Dr. Nunlee-Bland’s practice and health IT programs, see Part I of ONC’s interview.

Benefits of Telehealth for the Elderly

ONC:

You recently completed a telehealth program, tell us more about it.

Nunlee-Bland:

This telehealth program was funded by the National Institutes of Health (NIH). The primary goal was to reduce patients’ hemoglobin A1C to less than 7 percent. Patients were provided a laptop, and we had a nurse educator conduct virtual visits with the patients in their homes. They were shown how to use video conferencing, which the elderly patients really liked because they didn’t have to leave the comfort of their home for an appointment. The system was tied to the educational portal so they could review materials online with a workbook that would help them manage their care. Since the elderly patients weren’t very computer-savvy, there was a real need to begin with basic computing education. There appears to be a digital divide regarding age—those over 60-65 are less likely to adopt electronic technology to manage their health. It’s important to have a higher level of involvement with elderly patients, to help them understand the value of computers and technology. They were pretty easily convinced to join the telehealth program once we discovered if they had a computer or Internet access, but there was more work to make sure they were comfortable with the technology because self activation is a factor too.

A total of 47 diabetic patients participated in the study with 26 in the telehealth intervention group and 21 in the control group. The 26 participants who had telehealth visits were 4.58 times more likely to reach the desired hemoglobin A1C target of less than 7 percent.

The remote patient visits were mutually beneficial—the nurse enjoyed the interactions, and the patients could upload their blood glucose readings, weights, and blood pressure measurements automatically, which the patients and the nurses really liked. Remote monitoring seems to be a better model for care. This allows you to see  if the patient is really managing their own care without disrupting their daily lives with an appointment. When they’re at home, they don’t get the “white coat hypertension,” that unexplained increased blood pressure that sometimes happens when they visit their doctor.

We had another component where the cell phone was integrated into the EHR and PHR called the DC CCI Diabetes Cell Phone Projects. We send text reminders to patients’ cell phones so they remember to update their missing health measures like weights or glucose levels. The younger patients liked that. For the older generation, we still had to call them for those kinds of reminders, because they frequently turn their cell phones off unless they’re making or expecting a phone call, so the telehealth program was more suited to them. In that project, they were very compliant with their appointment times so the nurses could obtain their data at that time. I think you have to tailor the technologies to the age group.

ONC:

Were there any surprises?

Nunlee-Bland:

We found most of our patients do have computers or access to the Internet—82 percent have access to a computer with Internet, and 95 percent have cell phones too. I looked at insurance demographics of patients who signed up for a PHR who had either Medicare, private insurance, or Medicaid.…Of the 298 patients who signed up for a PHR, 17 percent of the Medicare population signed up for the PHR, compared to 43 percent with private insurance and 40 percent with Medicaid insurance.  The main reason cited for the lower participation in the Medicare population was lack of internet access and computer skills.

Patient Activation Spells Success

ONC:

Did any personal successes stand out for you?

Nunlee-Bland:

We had one patient who is wheelchair bound involved in the cell phone project. It was harder for him to make a physical trip to the doctor; but, he had his cell phone strapped to his wrist and was an avid user of the mobile health technology. He would answer the questionnaires and was self-motivated, so when we checked the system we always knew his readings were current. His diabetes was well controlled remotely, and we hope we won’t have to treat him for any complications from diabetes in the future.

We correlated participants’ HgbA1cs with their input of blood glucose readings in their cell phones, and as a result, saw a significant drop in A1c versus those that didn’t participate in either the cell phone or PHR project.

For more information on health information technology, visit HealthIT.gov.

Patients and physicians nationwide are leveraging health information technology (health IT) to make their

ONC:

Tell us about yourself and your practice.

Nunlee-Bland:

I’m an endocrinologist specializing in diabetes care, in the diabetes treatment center at Howard University. About 89 percent of our patients in the clinic are African American and roughly 60 percent  of our patients have diabetes. Given most of my patients have multiple health care providers involved with their care, health IT is very beneficial for improving their care coordination.

I started with a grant from the D.C. Department of Health to explore novel health information technologies. We adopted an electronic health record (EHR) that was focused on diabetes, later implementing a personal health record (PHR) to work with the EHR. Certain fields in the EHR automatically populated information in the PHR, allowing key information to flow from the provider to the patients like their medication list, problem list, and diagnoses.  Patients could enter their own information and share information with other providers. In my opinion, the personal health record is a valuable tool for our patients.

The Value of  PHRs And Online Patient Portals

ONC:

You’ve used other health IT technologies. Why do you feel the personal health record is such a valuable tool for your patients?

Nunlee-Bland:

On one occasion, one of my patients was in an emergency room in South Carolina.  He was able to provide his username and password to the ER physician to open his PHR. The PHR contained accurate information regarding the doses of his medications, problem lists, and certain laboratory studies. Too often patients visit  a physician’s office not knowing their diagnoses, or the correct names or doses of medications that they are taking. Patients will say, “I am taking that little white pill for my blood pressure,” but there are thousands of little white pills. Physicians are reluctant to record information that they cannot verify, so access to the PHR provides this verification.

We also have a disease management portal where folks can learn more about their diabetes. This portal is a separate module that can be accessed on our website with a username and password. Our diabetes educators search the web for useful, accurate health information related to diabetes for better self-management of our patients’ nutrition, exercise, medications, and diagnoses; then we link to these websites through the portal. It’s full of valuable information. For instance, a diabetic patient of mine with an insulin pump was eating breakfast at a fast food restaurant.  She was guessing the nutritional value of the carbohydrates in the fast food breakfast, but her guess was  too high. She was making the insulin pump give more insulin than it should, causing her blood sugar to go too low. Later I showed her how she can use the disease management portal to look up the nutritional value of various food items at fast food restaurants so she did not  have to guess anymore. Instead of patients going to the various websites of different restaurants, this online patient portal collects it all for them in one convenient location.

To learn more about Dr. Nunlee-Bland’s health IT programs, visit the Health IT Buzz Blog next week to see Part II of ONC’s interview! For more information on health information technology, visit HealthIT.gov.