WV HIT Funding Under HITECH: WVHIN Gets $7.8M and WV REC gets $6M

Health and Human Services Secretary Sebelius and the National Coordinator for Health Information Technology, David Blumenthal, announced the HITECH funding under the ARRA for State Health Information Exchanges (HIEs) and Regional Extension Center (RECs) across the country.

The White House Press Release provides a detailed list of HIEs and RECs receiving grants. Inormation is also available via the HHS News Release, Sebelius, Solis Announce Nearly $1 Billion Recovery Act Investments in Advancing Use of Health IT, Training Works for Health Jobs of the Future.

West Virginia will receive the following funding:

• West Virginia Department of Health and Human Resources in conjunction with the West Virginia Health Information Network HIE Award: $7,819,000

• West Virginia Health Improvement Institute, Inc. REC ward:$6,000,000

More information about the health information technology programs and awards can be found on the Office of National Coordinator HIT Website.

• State Health Information Exchange Cooperative Agreement Program

• Health Information Technology Extension Program

CMS and ONC Issue Rules on Proposing a Definition of Meaningful Use and Setting Standards for EHR Incentive Program

Yesterday the Centers for Medicare & Medicare Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) issued two regulations laying the foundation for improving quality, efficiency and safety through meaningful use of certified electronic health record (EHR) technology.

The two regulations are part of the implementation of the EHR incentive programs for physicians and hospitals enacted under the HITECH provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). CMS issued a proposed rule outlining the proposed provisions governing the EHR incentive programs, including defining the central concept of “meaningful use” of EHR technology. ONC issued an interim final regulation setting forth the initial standards, implementation specifications, and certification criteria for EHR technology.

For more details see the following CMS Press Release. Also, CMS has issued Fact Sheets on the proposed regulations:

• CMS Proposes Requirements for the Electronic Health Records (EHR) Medicaid Incentive Payment Program
  
• CMS Proposed Requirements for the Electronic Health Records (EHR) Medicare Incentive Program
  
• CMS Proposes Definition of Meaningful Use of Certified Electronic Health Records (EHR) Technology

Below are links to complete copies of the rules. Once they are published in the Federal Register I will update with the specific Fed Reg details. Some light reading for the New Year!

Medicare and Medicaid Programs; Electronic Health Record Incentive Program
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
SUMMARY: This proposed rule would implement the provisions of the American Recovery and Reinvestment Act of 2009 (ARRA) (Pub. L. 111-5) that provide incentive payments to eligible professionals (EPs) and eligible hospitals participating in Medicare and Medicaid programs that adopt and meaningfully use certified electronic health record (EHR) technology. The proposed rule would specify the-- initial criteria an EP and eligible hospital must meet in order to qualify for the incentive payment; calculation of the incentive payment amounts; payment adjustments under Medicare for covered professional services and inpatient hospital services provided by EPs and eligible hospitals failing to meaningfully use certified EHR technology; and other program participation requirements. Also, as required by ARRA the Office of the National Coordinator for Health Information Technology (ONC) will be issuing a closely related interim final rule that specifies the Secretary’s adoption of an initial set of standards, implementation, specifications, and certification criteria for electronic health records. ONC will also be issuing a notice of proposed rulemaking on the process for organizations to conduct the certification of EHR technology.

Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology
AGENCY: Office of the National Coordinator for Health Information Technology,
Department of Health and Human Services.
ACTION: Interim final rule.
SUMMARY: The Department of Health and Human Services (HHS) is issuing this interim final rule with a request for comments to adopt an initial set of standards, implementation specifications, and certification criteria, as required by section 3004(b)(1) of the Public Health Service Act. This interim final rule represents the first step in an incremental approach to adopting standards, implementation specifications, and certification criteria to enhance the interoperability, functionality, utility, and security of health information technology and to support its meaningful use. The certification criteria adopted in this initial set establish the capabilities and related standards that certified electronic health record (EHR) technology will need to include in order to, at a minimum, support the achievement of the proposed meaningful use Stage 1 (beginning in 2011) by eligible professionals and eligible hospitals under the Medicare and Medicaid EHR Incentive Programs.

Lorman Medical Records Law Seminar: March 18, 2010

On March 18, 2010 I will be speaking on Medical Records Law at a seminar in Charleston, West Virginia. The seminar is sponsored by Lorman Educational Services. Joining me for the day long seminar will be three very knowledgeable health care colleagues:

• Michael T. Harmon, MPA, CIPP/G, Compliance Specialist for the West Virginia Mutual Insurance Company, a Medical Professional Liability Insurance Company
• Sallie H. Milam, J.D., CIPP/G, Executive Director of the West Virginia Health Information Network and Chief Privacy Officer for the West Virginia State Government
• James W. Thomas, Esq., Manager of the Charleston, West Virginia Business Law Department of Jackson Kelly PLLC whose practice focuses primarily upon health care matters of a business, regulatory and operational nature
  

Additional information about the seminar and how to register can be found at Lorman Educational Services. Following is the full seminar agenda:

8:30 am – 9:00 am			Registration
9:00 am – 9:15 am			Overview
9:15 am – 10:30 am			HIPAA Compliance: Reality and Perspective
			— Michael T. Harmon, MPA, CIPP/G
			Overview Enforcement Complaints Case Examples Summary of HITECH Changes
10:30 am – 10:45 am			Break
10:45 am – 12:00 pm			HITECH Financial Incentives for Implementation of HIT
			— James W. Thomas, Esq.
			Qualifying an Electronic Health Record System Available Financial Incentives
12:00 pm – 1:00 pm			Lunch (On Your Own)
1:00 pm – 2:00 pm			Health Information Exchange in West Virginia: Impact on Patient Records
			— Sallie H. Milam, J.D., CIPP/G
2:00 pm – 2:15 pm			Break
2:15 pm – 3:30 pm			Consumer Driven Health Care: HITECH, Health 2.0, Social Media and Personal Health Records
			— Robert L. Coffield, Esq.
			HITECH Breach Notification Requirements Impact of Health 2.0 and Social Media Technology on the Future of Health Care Development and Adoption of Personal Health Records Discuss the Legal Implications of Emerging Technology
3:30 pm – 4:30 pm			Panel Discussion
			— Robert L. Coffield, Esq., Michael T. Harmon, MPA, CIPP/G, Sallie H. Milam, J.D., CIPP/G and James W. Thomas, Esq.

WVHCA Report: $1.1B Cost Saving from Adoption of HIT

iHealthBeat reports on the release of a new report prepared by CCRC Actuaries for the West Virginia Health Care Authority.

The full report is available via the West Virginians for Affordable Health Care website and is titled, Health Care Financing in the State of West Virginia: An analysis and Projection of the Current System and Potential Transformations, August 2009.

According to the articles, the report indicates that the adoption of health information technology (HIT) and implementation of centralized medical care through medical home concepts could save West Virginia's health care system more than $1.1B in 2014. The estimates in the report used insurance claims data from more that 800,000 West Virginia residents, including data from Medicaid and Mountain State Blue Cross Blue Shield.

More details in the AP article by Tom Breen from the Charleston Gazette and Washington Post, Report: Health strategy could save W.Va. $1B.

The Washington Post article indicates:

. . . In the case of electronic prescriptions, the report estimates an overall savings of $164 million in 2014, including nearly $51 million in savings to private insurers and $42 million in savings to policyholders. . .

. . . The report estimates that a statewide rollout of medical homes would cost about $45 million up front and incur ongoing costs of about $368 million . . .

. . . Estimates suggest that about nine in 10 health care offices still keep everything in paper. As the new report says, up front costs for physicians run from $25,000 to $45,000 and have annual costs thereafter of between $2,000 and $9,000, steep amounts for small practices . . .

UPDATE: Thanks to a reader comment - you can now read the full report. The report is titled, Health Care Financing in the State of West Virginia: An analysis and Projection of the Current System and Potential Transformations, August 2009.

Following is the Executive Summary of the report which contains some very interesting statistics on the state of health care in West Virginia.


Executive Summary

• A cohort model was developed to simulate health care eligibility, utilization and insurance availability of the projected 1,828,538 West Virginians in 2009.
• The model utilizes 8,640 cohorts to represent current insured status, health care utilization, age, gender, and household income.
• The projected average age in 2009 is 40.2 years.
  
• West Virginia is projected to have a population of 1,806,545 in 2019 and the average age is projected to increase to 42.2 years.
• The number of commercially insureds is 757,884 in 2009.
• The number of non-Medicare PEIA insureds is 175,324 in 2009.
• The number of non-dual eligible Medicaid insureds is 321,113 in 2009.
• The number of dual eligible Medicaid/Medicare insureds is 57,118 in 2009.
• The number of Medicare eligible PEIA insureds is 37,784 in 2009.
• The number of other Medicare insureds is 168,571 in 2009.
• The number of West Virginia CHIP insureds is 24,480 in 2009.
• The number of uninsured West Virginians is 286,264 in 2009.
• Health care costs can be defined as charges or as allowed charges. In terms of allowed charges, projected West Virginia expenditures total $13.1 billion in 2009.
• Allowed charges are projected to grow to $24.4 billion in 2019.
• In 2009, the uninsured population is projected to incur $3.2 billion in allowed charges, resulting in bad debt and charity care of almost $900 million.
• Initiative I, Adult Medicaid Expansion, is projected to cost the State of West Virginia $56.8 million and the Federal Government $162.0 million in 2014, while overall health care expenditures will decrease $611.5 million. Low income residents see the majority of the savings, spending $591.5 million less on health care.
• Initiative II, Adult Medicaid Expansion Combined with an Insurance Mandate for Employers and Individuals, is projected to cost the State of West Virginia $56.8 million in higher Medicaid expenditures and $1,004.3 million in insurance premium subsidy. The initiative will cost the Federal Government $162.0 million in 2014, while overall health care expenditures will decrease $2,176.0 million. Low income residents see the majority of the savings, spending $2,212.8 million less on health care.
• Initiative III, Adult Medicaid Expansion combined with an Insurance Mandate for Individuals, is projected to cost the State of West Virginia $56.8 million, $983.4 million in insurance premium subsidy. The initiative will cost the Federal Government $162.0 million in 2014, while overall health care expenditures will decrease $1,634.7 million. Low income residents see the majority of the savings, spending $1,656.2 million less on health care.
• Initiative IV, Medical Home, is projected to save the State of West Virginia $57.3 million in claim expenditures and the Federal Government $199.3 million in 2014, and overall health care expenditures will decrease $642.6 million. Low income residents and insurance companies see the majority of the savings, spending $170.6 million and $173.2 million less on health care, respectively. This initiative requires $45 million of initial costs and a total of $368.2 million of ongoing physician reimbursement per year.
• Initiative V, e-Prescribing, is projected to save the State of West Virginia $16.0 million in claim expenditures and the Federal Government $53.8 million in 2014, and overall health care expenditures will decrease $164.0 million. Low income residents and insurance companies see the majority of the savings, spending $41.9 million and $45.6 million less on health care, respectively. The cost of implementing e-prescribing has not been projected.
• Initiative VI, Electronic Medical Records, is projected to save the State of West Virginia $28.3 million and the Federal Government $98.5 million in 2014, and overall health care expenditures will decrease $317.6 million. Low income residents and insurance companies see the majority of the savings, spending $84.3 million and $85.6 million less on health care, respectively. This initiative requires around $25,000 to $45,000 of initial costs and an annual cost of $3,000 to $9,000 per provider. However, these cost estimates appear to be declining over time.
  

WVHIN Releases RFP for West Virginia Health Information Exchange

Today the West Virginia Health Information Network released a Request for Proposal (RFP) for a statewide Health Information Exchange. More information, including the deadlines, bidder worksheets and a full copy of the RFP are available on the WVHIN website.

Following are sections from the RFP that provide a general overview of the proposed West Virginia Health Information Exchange and a general scope of the RFP:

The West Virginia Health Information Network (WVHIN) is soliciting proposals to provide a statewide Health Information Exchange (HIE) infrastructure platform for physicians, hospitals, other health care organizations, and consumers. The purpose of this Request for Proposal (RFP) is to obtain vendor services and expertise in support of the WVHIN. Details on the scope of work, requirements and deliverables are contained in this RFP. WVHIN reserves the right to use the results of this RFP to obtain services for additional and related work should the need arise throughout the course of this project . . .

. . . According to the eHealth Initiative’s Sixth Annual Survey of Health Information Exchange 2009, there are almost 200 self‐reported HIE initiatives across the country with a substantially increased number of organizations that reported being operational. The impetus for HIEs has increased as a result of the passage of the American Recovery and Reinvestment Act (ARRA) of 2009 and specifically key provisions from the Health Information Technology for Economic and Clinical Health (HITECH) Act. These provisions called for the Office of the National Coordinator (ONC) to create a program to engage in collaborative agreements with states or “qualified” state‐designated non‐profit, multistakeholder partnerships to “conduct activities to facilitate and expand the electronic movement and use of health information among organizations according to nationally recognized standards.” . . .

. . . There are 1.8 million people in the very rural state of West Virginia with a high level of elderly and low‐income people in many of the rural areas. With a geographically dispersed population, access to and coordination of care is a critical issue. To serve this rural population, there is a relatively high number of hospitals with less than 100 beds and a high level of clinics serving the underserved making access and care coordination both difficult and essential. Based on the population profile and the number of small providers, a strong case was made for the need for a statewide HIE, which will help providers overcome communication and geographic barriers to access and coordination of care.

The WVHIN was established in July 2006 by the West Virginia Legislature at the request of the Governor. The WVHIN is a sub‐agency under the West Virginia Health Care Authority. The intent of the legislation was for the WVHIN “to promote the design, implementation, operation and maintenance of a fully interoperable statewide network to facilitate public and private use of health care information in the state”. With this authority, the WVHIN established a multi‐stakeholder board and has been working with stakeholders to develop and implement a state‐level HIE. . .

. . . With this mandate, the WVHIN established a vision to enable “high quality, patient centered care facilitated by health information technology”. The WVHIN mission is as follows: “The West Virginia Health Information Network provides the health care community a trusted, integrated and seamless electronic structure enabling medical data exchange necessary for high quality, patient‐centered care.” Guiding principles have been established around collaboration, facilitation of patient‐centric care, enabled participation by all providers, quality improvement, patient participation, privacy and security, and sustainability.

The WVHIN, along with health systems, physicians, other providers, payers, and consumers, has a unique opportunity to establish a state‐level HIE infrastructure that helps communities and regions share data across organizations. The WVHIN is well positioned to provide a cost‐effective HIE infrastructure that benefits from economies of scale while enabling communities to develop their own unique solutions. As a convener and collaborator, the WVHIN will build bridges between health care stakeholders to launch and fund HIEs. It will help communities address complex issues such as setting standards for interoperable data exchange, addressing liability, setting policies for privacy and security, and exchanging data across state lines. It will collaborate with other health information technology (HIT) and HIE initiatives such as the Regional Extension Center (REC) to be initiated, public health, Medicaid, and others, to leverage collective resources. WVHIN activities are being pursued within the parameters of the West Virginia Statewide Health Information Technology Strategic Plan. WVHIN is one of several participating entities that jointly developed the strategic plan.

West Virginia's Statewide Health Information Technology Strategic Plan

Over the past several months I have been involved with a group in developing West Virginia's statewide strategic plan for health information technology.

The final draft of the West Virginia Health Information Technology Statewide Strategic Plan, September 2009 is now available for review and comment. Additional comments and feedback on the strategic plan are welcome.

The strategic plan is a part of West Virginia's efforts to position itself as a national leader in implementing and adopting health information technology to improve our health care system. The strategic plan will be a part of the the state's efforts to submit applications to the Office of the National Coordinator for Health Information Technology (ONC) for funding under the State Health Information Exchange Cooperative Agreement Program and the Health Information Technology Extension Program: Regional Centers Cooperative Agreement Program, both programs developed under the American Recovery and Reinvestment Act of 2009, Title XIII - Health Information Technology, Subtitle B.

The project has been lead by the Adoption of Health Information Technology Workgroup under the West Virginia Health Improvement Institute. Both private and public stakeholders from across West Virginia have collaborated and provided input into the development of the strategic plan.

Technology: Then and Now

The discussion about health care reform has been front and center lately. Along with the debate comes the discussion and questions about the role technology will (should) play in the reform efforts. I was reminded of a photo I found a few months ago while I was home visiting my dad and looking through some old photo albums with him. 

Although the technology may have changed some from 1978 to 2008 - human nature hasn't really changed that much. Reforming the health care system involves more than implementing technology. Health information technology will not save the system, make health care cheaper or better without changes to the underlying structure of the system of health that we have built. If we continue our health care system with the fundamental flaws that exist without changing the human/process side - adding technology won't help.

Below is a photo of me from Christmas 1978 with the Atari 2600. The second photo of my son with the Nintendo Wii in 2008. Has much change in 30 years? 

HITECH Act Breach Notification Guidance: What Renders PHI Unusable, Unreadable or Indecipherable For Purposes of Breach Notification?

On April 17, 2009, the U.S. Department of Health & Human Services (HHS) issued guidance on the technology requirements to render protected health information (PHI) "unusable, unreadable or indecipherable to unauthorized individuals, as required by the Health Information Technology for Economic and Clinical Health Act (HITECH) which is a part of the American Recovery and Reinvestment Act of 2009 (ARRA).

The April 27, 2009 Federal Register (74 FR 19006),contains the official copy of the regulation, Guidance Specifying the Technologies and Methodologies That Render Protected Health Information Unusable, Unreadable, or Indecipherable to Unauthorized Individuals for Purposes of the Breach Notification Requirements Under Section 13402 of Title XIII (Health Information Technology for Economic and Clinical Health Act) of the American Recovery and Reinvestment Act of 2009; Request for Information

The guidance is effective as of April 17, 2009. However, the guidance will apply to breaches 30 days after publication of the interim final regulations.

HHS's press release on the guidance states:

The guidance issued today provides steps entities can take to secure personal health information and establishes the trigger for when entities must notify that patient data has been compromised. This guidance is related to “breach notification” regulations, which will be issued by HHS and the Federal Trade Commission respectively. The HHS regulations will apply to entities covered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the FTC regulation will apply to vendors of personal health records and certain others not covered by HIPAA. The Recovery Act requires that these regulations be published within 180 days of enactment.
The guidance was developed through a joint effort by the HHS Office for Civil Rights (OCR), Office of the National Coordinator for Health Information Technology (ONC), and Centers for Medicare &Medicaid Services (CMS).

The guidance also seeks public comments on the guidance as well as the breach notification provisions under FTC's new Health Breach Notification Rule and the yet to be releases HHS Breach Notification Requirements for HIPAA Covered Entities and Business Associates. Public comments must be submitted on or before May 21, 2009.

FTC Proposed Health Breach Notification Rule for PHRs and Electronic Health Information

Yesterday, April 16, 2009, the Federal Trade Commission released its proposed Health Breach Notification Rule for Vendors of Personal Health Records (PHRs) and Electronic Health Information.

The official title of the proposed rule is: 16. C.F.R. Part 318: Notice of Proposed Rulemaking and Request for Public Comments Concerning Proposed Health Breach Notification Rule, Pursuant to the American Recovery and Reinvestment Act of 2009.

The FTC is seeking written comments electronically or in paper form. The comments must be submitted by June 1, 2009 and will be placed on the public record and made accessible at the FTC website at: http://www.ftc.gov/os/publiccomments.shtm.

The FTC's press release states:

The Federal Trade Commission today announced that it has approved a Federal Register notice seeking public comment on a proposed rule that would require entities to notify consumers when the security of their electronic health information is breached.

The American Recovery and Reinvestment Act of 2009 (the Recovery Act) includes provisions to advance the use of health information technology and, at the same time, strengthen privacy and security protections for health information. Among other things, the Recovery Act recognizes that there are new types of Web-based entities that collect or handle consumers’ sensitive health information. Some of these entities offer personal health records, which consumers can use as an electronic, individually controlled repository for their medical information. Others provide online applications through which consumers can track and manage different kinds of information in their personal health records. For example, consumers can connect a device such as a pedometer to their computers and upload miles traveled, heart rate, and other data into their personal health records. These innovations have the potential to provide numerous benefits for consumers, which can only be realized if they have confidence that the security and confidentiality of their health information will be maintained.

To address these issues, the Recovery Act requires the Department of Health and Human Services to conduct a study and report, in consultation with the FTC, on potential privacy, security, and breach notification requirements for vendors of personal health records and related entities. This study and report must be completed by February 2010. In the interim, the Act requires the Commission to issue a temporary rule requiring these entities to notify consumers if the security of their health information is breached. The proposed rule the Commission is announcing today is the first step in implementing this requirement.

In keeping with the Recovery Act, the proposed rule requires vendors of personal health records and related entities to provide notice to consumers following a breach. The proposed rule also stipulates that if a service provider to one of these entities experiences a breach, it must notify the entity, which in turn must notify consumers of the breach. The proposed rule contains additional requirements governing the standard for what triggers the notice, as well as the timing, method, and content of notice. It also requires entities covered by the proposed rule to notify the FTC of any breaches. The FTC can then post information about the breaches on its Web site, and notify the Secretary of Health and Human Services.

More information over at info.rmatics blog who appear to have done a quick summary of the proposed rule. I have only had a chance to quickly scan the proposed rule but will add addition comments once I have a chance to read the entire proposed regulations. Comments and thoughts of others are welcomed - please post your comments.