July 18, 2010

E-health records take off

New rules give push, locals say

By Keri Brenner
The Chronicle

     Now that new federal standards for electronic health records are out, doctors, hospitals and healthcare agencies in the gorge and the state say they have the clarity they need to move forward.
     “We have reached a fulcrum point in the history of health care in our country,” Brian Ahier, health information technology leader at Mid-Columbia Medical Center in The Dalles, wrote this week in a widely quoted online blog piece.
     “The announcement on Tuesday of the final rule establishing Medicare and Medicaid incentive programs for the meaningful use of electronic health records creates a framework for change that will have reverberations throughout the healthcare industry,” Ahier added.
     Ahier, a founding committee member for the local Gorge Health Connect, was one of scores of bloggers, reporters, agency officials and journal editors across the nation to react to Tuesday’s announcement by the U.S. Department of Health and Human Services.
     “This is great news,” said Carol Robinson, Oregon state coordinator for the Health Information and Technology Oversight Committee. “Everyone’s been in this waiting mode for months and months — now there’s clarity.”
     Ahier said the new federal rules will help clear the way for Gorge Health Connect members, who meet this Thursday for an all-day planning session at The Port of The Dalles, to move forward in setting up a network for sharing electronic health records in the gorge.
     “Our goal for phase one is to be able to share five things,” said Laurie Miller, privacy and security officer for Columbia River Women’s Clinic and a Gorge Health Connect committee member. “Those are: lists of medications, allergies, medical histories, past diagnoses and tests that have already been done.”
     David Mack, a retired osteopathic physician and a committee member of Gorge Health Connect, said the group will also work on the larger issue of protecting privacy and ensuring security for patients’ health information.
     “It has to be secure, and it has to be HIPAA- compliant,” Mack said, referring to national health information privacy laws. “It could be done with a pin number and a smart-card, like a credit-card.”
     With Tuesday’s announcement, doctors and hospitals now know what they have to do to prove they are employing “meaningful use” of electronic health records. If they prove it, they can claim bonus payments from the government of up to $44,000 through Medicare or $63,750 through Medicaid.
     “Meaningful use,” according to Robinson, means they are not just typing in medical data into a computer file, but are sharing the electronic health information — such as e-lists of medications, tests that have been done, diagnoses, past surgeries and allergies, for example — with patients, other doctors, hospitals or pharmacies.
     Ahier said the new set of rules is scaled back from a draft proposal issued at the beginning of this year.
     “A major shift is the move away from an all-or-nothing approach, where providers had to meet every single measure to be eligible for payments,” Ahier said. “Instead, there’s now a set of must-have core requirements and an a la carte menu of discretionary options.”
     According to Ahier, “This strategy will enable a great many hospitals and small practices in rural and underserved areas to have a shot at cashing in on incentive payments.”
     Robinson said one example of a core requirement is that physicians and hospitals will have to transmit at least 40 percent of their prescriptions to pharmacies electronically. Originally, that bar was set at 75 percent.
     Similar rules apply to sending lab results and sharing test results with doctors and hospitals.
     Currently, an electronic “firewall” exists among healthcare providers, forcing them to use phones and fax machines — rather than computers — to share records for patients from other providers or other areas. In addition to being cumbersome, that does not work on evenings or weekends, when many doctors’ offices are closed or hospitals might not have staff to phone and fax a patient’s medical records to a hospital in another area.
     As a result, patients could get duplicate tests done or receive medications that have toxic interactions to other drugs they are taking.
     “Electronic health records will improve caregivers’ decisions and patients’ outcomes,” said David Blumenthal, M.D., and Marilyn Tavenner, R.N., in an article posted online Tuesday by the New England Journal of Medicine. “Once patients experience the benefits of this technology, they will demand nothing less from their providers.”
     Blumenthal and Tavenner caution people to have patience, however.
     “The widespread use of electronic health records in the United States is inevitable,” they say. “But inevitability does not mean easy transition.”
     Gorge Health Connect, which launched last fall, is ahead of the game in that most of the major hospitals, clinics and health and community agencies in the gorge have agreed to set aside competitive politics and to cooperate in the electronic networking effort, Ahier said. Over the past year, all the groups who have signed on have met monthly to try to find a way to achieve consensus and agreement, he said.
     Charter members of Gorge Health Connect include: Mid-Columbia Medical Center; Providence Hood River Memorial Hospital; Columbia Gorge Community College; Columbia River Women’s Clinic; Hood River County Health Department; La Clinica del Carino Family Health Care Center Inc.; Mid-Columbia Center for Living; Mid-Columbia Surgical Specialists; and North Central Public Health District.
     “I know the technology is there and it’s possible to do this,” Ahier said.
On the statewide level, Robinson said her group must have a strategic plan in place to send to the federal government by the end of August in order to receive an $8.5 million grant to allow the state to move ahead.
     She estimates that Oregon physicians and hospitals who meet the new “meaningful use’ guidelines could start receiving their incentive payments by late spring of next year.
     “It seems likely that about 5,000 Oregon physicians have sufficient Medicare and Medicaid volumes to qualify for incentive payments, if they meet the other meaningful use criteria, including the use of a certified electronics health records system and engaging in health information exchange,” Robinson said.
     About 65.5 percent of Oregon clinicians use some form of an electronics health records system, certified or not, according to a 2009 survey, Robinson added.
Medicare is the federal health insurance program for seniors aged 65 and older; Medicaid is a federal healthcare program administered by the states for low-income families, pregnant women and children.