Donald Rucker decides to take helm at ONC as National Coordinator for Health Information Technology

Former Siemens chief medical officer Donald Rucker, MD, has decided to take the helm at the Office of the National Coordinator for Health Information Technology, in accordance to media reports.

A directory for the Department of Health and Human Services that lists workers now involves contact information for Rucker, who most recently was chief medical officer at Premise Health, a worksite health and patient engagement company. He also served at the institute of Ohio State University’s Wexner Medical Center as chief operating officer of the IDEA Studio and clinical professor of emergency medicine and biomedical informatics. Donald Rucker has decided to take helm at ONC as National Coordinator for Health Information Technology.

There has been no formal declaration from the Department of Health and Human Services or the White House on the Rucker appointment, and agency officials weren’t available for comment. Additionally, a spokesman for the Office of the National Coordinator for Health Information Technology refused to comment on news reports about the Rucker appointment, referring a query from Health Data Management to HHS.

A spokesperson for HHS claimed that the agency is “not commenting on personnel at this time.”

“He has engaged in our Health IT Policy work during my tenure, but I have not worked directly with him,” DeSalvo said. “His background surely seems to make him well qualified, and I’m excited that the ONC team will have a leader so early in the Administration so they can press on with their significant work.”

John Glaser, presently senior vice president for population health at Cerner, was CEO at Siemens Health Services during the Rucker's career there, and lauded his choice for the ONC position. "Don has a diverse and extensive career in healthcare IT," Glaser says. "He has in-depth knowledge of the care practice, technology and policy challenges we confront as we advance the capability of the technology to make better health and healthcare. He is a great choice."

Rucker also has practiced emergency medicine at the Kaiser in California; Beth Israel Deaconess Medical Center in Boston, where he was the 1st full-time emergency department attending physician; and at the institute of University of Pennsylvania’s Penn Presbyterian and Pennsylvania Hospitals.

In regard to his medical experience, Rucker brings to the National Coordinator position a powerful technology background. He came to OSU from Siemens Healthcare USA, where he served as chief medical officer for thirteen years and led the team that designed the computerized physician order entry workflow that was installed at Cincinnati Children's Hospital and which was honored in the year of 2003 with the HIMSS Nicholas Davies Award for the best hospital computer system in the United States.

At practice management and clinical systems services vendor Datamedic, Rucker is acknowledged with co-developing one of the 1st Microsoft Windows-based electronic health record (EHR) systems. Recently, he served terms on the board of commissioners of the Certification Commission for Healthcare Information Technology.

 

Health IT Standard eDOS integrates EHR Interoperability and Savings

A health information technology standard for lab tests could make better the EHR interoperability and decrease costs.

Officials from the Office of the National Coordinator for Health Information Technology (ONC) and American Clinical Laboratory Association (ACLA) claim that a lesser-known health IT standard for ordering laboratory tests and services both enables EHR interoperability and the capability to generate cost savings.

The Laboratory Test Compendium Framework established by Health Level Seven International (HL7) involves an electronic Directory of Service (eDOS). The standards developing organization has iterated on the framework over the some past years with the support of the ONC Standards & Interoperability Framework.

In the year of 2015, HL7 issued a guide for implementing the framework and the eDOS service. Now, ONC and ACLA are touting the framework’s potential to make lab test ordering more efficient and less expensive.

AHA: ONC interoperability standards advisory requires more specific information

The American Hospital Association is emphasizing the Office of the National Coordinator for Health IT to give more particular data on the features and metrics it has utilized to assess the readiness of standards and implementation specifications in its draft 2017 Interoperability Standards Advisory. ONC interoperability standards advisory requires more specific details.

In accordance to ONC, the advisory is meant to serve as a “coordinated catalog of standards and implementation specifications” to be utilized by industry as a single, public list to meet interoperability requirements focused explicitly on clinical health information technology. Although, AHA would like to see higher detail in how ONC distinguishes mature from emerging standards.

“The consistent utilization of mature standards is necessary to solving the interoperability issues facing our nation,” wrote Ashley Thompson, AHA’s senior vice president for public policy analysis and development, to National Coordinator for Health IT Vindell Washington, MD.

In specific, AHA needs to see ONC prioritize outreach to organizations conducting maturity assessments so that upcoming versions of the ONC Interoperability Standards Advisory (ISA) can involve this reference. The association also suggests that the agency utilize the ISA to make publicly present the feedback it get on the adoption experience of standards and implementation specifications.

Moreover, AHA recommends that the 2017 ONC Interoperability Standards Advisory also involve data on actual standards use in the real world, and not merely adoption.

As an outcome, AHA asserts that the draft 2017 ISA must assess the victorious use of the included standards, not merely adoption, in case to rightly evaluate the capability of a standard to support interoperability.

Additionally, AHA suggests that ONC support the work of private-sector steps that are educating stakeholders about the availability and readiness of the proposed standards, particularly as they pertain to interoperability.

“The majority of the standards involved in the Draft 2017 ISA don’t show whether a test tool is present to determine conformance to the standard or the implementation specification,” claims the letter. “Positive outcomes from conformance testing will add confidence that a standard is all prepared to support the interoperability requirements of providers.”

An ONC spokesman stated that the agency doesn’t respond to written comments, like those from AHA, however it does review them and they will assist to inform the final advisory.

 

Small, remote and critical approach hospitals lag in interoperability

While the remote, small and critical approach hospitals are closing the proposed gap in electronic health record (EHR) adoption regarded to their higher urban counterparts, they’re lagging behind in acquiring the interoperability, in accordance to the Office of the National Coordinator for Health IT.

At the day of Wednesday’s joint meeting of the Health IT Policy and Standards Committees, ONC depicted an update on EHR adoption and interoperability deployed on an analysis of 2015 American Hospital Association Annual Survey–IT Supplement information.

The information indicates that small services are struggling when it comes to the interoperable exchange and utilization of electronic health data.

In accordance to the brief, rural hospitals have less than half the amount of engaging in all 4 domains of interoperability—electronically finding, sending, receiving and integrating data—in comparison to suburban and urban hospitals (15% vs. 34%, respectively).

Small hospitals also lag behind medium and huge hospitals in acquiring these skills (18% vs. 34%, respectively). Furthermore, CAHs had primarily lower amounts of engaging in the 4 domains of interoperability, compared with services that aren’t CAHs (17% vs. 30%, respectively).

“Among smaller, rural and critical approach hospitals, we discovered that they had primarily lower amounts of electronically sending, receiving, finding, and integrating data,” Vaishali Patel, a senior ONC advisor, informed the committees.

At the similar time, while the rate or percentage of hospitals electronically sending, receiving and finding vital clinical information grew significantly nationwide between the years of 2014 and 2015, Patel told that the electronic availability of outside data at the point of care and usage of that data for clinical decisions was very low among several rural/small hospitals and CAHs.

In accordance to Patel, from 35% to 39% of rural or small hospitals and CAHs had electronic data available from outside providers/sources vs. 46% for whole federal non-acute care hospitals. She also claimed from 41% to 46% of rural or small hospitals and CAHs basically utilized electronic information got from outside contributors or sources, compared with 53% of all federal non-acute care hospitals.

Nevertheless, Patel further added that remote or small hospitals and CAHs are closing the proposed gap in the electronic health record adoption. “There have been key increases in EHR adoption amongst these hospitals,” she stated. “For instance, critical approach hospitals’ basic EHR adoption amount has grown four-fold from the year of 2011. As it regards to the gaps in interoperability, it might be that we will have to detect this over time to see how this evolves. And, it might be that as EHR adoption increases few of these gaps might get narrow over time. But, that is something that sustains to be seen.”

 

ONC Issues the Educational Videos on HIPAA Rights for Sufferers

The Office of the National Coordinator issued the videos to better clarify HIPAA rights for patients, ensuring individuals understand how to access their data.

In an effort to better educate individuals on HIPAA rights for patients, the Office of the National Coordinator (ONC) issued a series of videos that explain the rights patients have to access their health information.

Additionally, ONC disclosed a Patient Engagement Playbook, designed to help providers, practice staff, hospital staff better engage with patients through health information technology (health IT).

“Many people are not completely aware of their right to access their own medical records under the Health Insurance Portability and Accountability Act (HIPAA), including the right to access a copy when their health information is stored electronically,” ONC’s Chief Privacy Officer Lucia Savage, J.D., said in a statement. “The videos we issued today highlight the basics for individuals to get access to their electronic health information and direct it where they wish, including to third party applications.”

Hospital EHR Adoption of Basic Networks Tops 83 percent, CEHRT 96 percent

Most hospitals are utilizing the certified EHR technology, but certain types of hospitals still lag behind in EHR adoption and use.

Certified EHR technology is in place at most hospitals with basic EHR technology adoption also reaching an all-time high, in accordance to new data issued by the Office of the National Coordinator for Health Information Technology.

The latest data brief made present on the HealthIT.gov Dashboard puts the percentage of hospitals with CEHRT at 96% in the year 2015, down nearly a full percentage point from 2014's figure of 96.9%. Hospital adoption of basic EHR technology, meanwhile, rose from 75.5 percent in 2014 to 83.8 percent in 2015. All told, since 2008 hospital adoption of the latter rose by nearly nine times, from 9.4 percent to the current figure.

Leading the way in adoption were Maryland (95%), Nevada (94%), Washington (94%), Wyoming (94%), Massachusetts (93%), Virginia (93%), Utah (93%), Arkansas (90%), and New Mexico (90%).

This ONC data once again needs clarification as to the different between the types of EHR technology. A handy chart accompanying the data brief shows how basic EHR with clinician notes stacks up to comprehensive EHR. Other than supporting advanced directions, the former does everything the latter does for electronic clinical information.

Certified EHR adoption 'almost universal' in acute care hospitals

The recent data on EHR adoption indicates almost all non-federal acute care hospitals are utilizing the certified EHR technology. In accordance to the National Coordinator for Health IT, 96% of hospitals had this technology as of the year 2015, which it deems as "almost universal."

Here are 3 more statistics on EHR adoption.

1. The 2015 amounts of certified EHR adoption are similar to those of the year 2014, demonstrating the adoption of this technology has hit a plateau.


2. Small, rural and critical access hospitals yet have lower amounts of EHR adoption than all hospitals.


3. Moreover, psychiatric and children's hospitals have primarily lower basic EHR adoption rates than general medicine hospitals, at 15% and 55%, respectively.

API task force suggestions acquire narrow approval

By a vote of 13-10, the Health IT Policy and Standards committees has approved final suggestions from a task force on application programming interfaces (APIs), but only after an amendment was involved to satisfy dissenting opinions among members.

Meaningful Use Stage 3 needs certified electronic health records to provide an API through which patient information can be viewed, downloaded and transmitted to a third party. APIs, which permit a software program to access the services offere by another software program, are seen as the enabling technology for patients to gain access to their healthcare information that may be held in multiple provider EHR systems.

The API task force presented its final recommendations during a joint May 17 HIT Policy-Standards Committee meeting that generated a spirited debate, primarily around the development of private sector endorsement or certification of API-enabled apps. At issue was the task force’s recommendation that the Office of the National Coordinator for HIT not need centralized certification or testing of the plethora of health apps expected to be generated as a result of widespread adoption of open APIs in healthcare.

Task Force Discusses Healthcare Interoperability Standards

The Interoperability Experience Task Force pinpointed huge issues to healthcare interoperability, like a deficiency of standardization and strict regulations.

In a recent meeting of the Interoperability Experience Task Force, healthcare stakeholders recognized the top challenges to healthcare interoperability, involving the data availability and accessibility, the requirement for data sharing and format standards, and a lack of supportive regulations and policies.

The Health IT Policy Committee and HIT Standards Committee’s task force met previous week to discuss the most significant needs for interoperability and pinpoint where the industry should start to make better. The task force was made to advise the Office of the National Coordinator for Health Information and Technology.

Through the meeting, the task force discovered that one of the biggest challenges to healthcare interoperability is the large volumes of health data and a lack of workflows to handle the information. The task force reported that many industry stakeholders are overwhelmed by the amount of patient data and EHR data, which can hinder care coordination and timely care.

CMS Atlast declares Comprehensive Primary Care Plus risk based payment model

The CMS (Centers for Medicare and Medicaid Services) initiated a latest risk-based Comprehensive Primary Care initiative on the day of Monday to speed up the shift toward value-based reimbursement with a concentration on health IT and chronic care management.

As CMS authorities see it, the optimal utilization of health IT, concentration on data and a robust learning system will assist the practices to make the essential changes in care delivery to make better the care of patients.

The 5-year, Comprehensive Primary Care Plus, or CPC+, begins in the day of January 2017 and will involve up to 5,000 practices and 20,000 physicians in an assumed twenty regions.

It pays the active participating physicians under the 2 tracks. Both offer practices up-front incentive payments the physicians will either keep or repay deployed on their proposed performance on utilization and quality metrics, CMS claimed in a news release.

Furthermore, both the tracks will “align with the Office of the National Coordinator for Health IT priority to make sure the electronic health data is present when and where it matters to clients  and clinicians,” according to CMS.

Under 1 track, physicians will be capable to deliver care outside of the conventional face-to-face office visit, CMS claimed.

For the proposed initiative to work, Medicare is joining hands with commercial and state health insurance policies. CMS is choosing regions for CPC+ where there is enough interest from various payers to encourage participation by area practices, CMS asserted.

CMS will step into a Memorandum of Understanding with payers that align objectives for payment, information sharing, and quality metrics.

Under the rule of Track 1, CMS will pay the practices a monthly care management fee in addition to the fee-for-service payments under the authority of Medicare Physician Fee Schedule.

Track two is a hybrid framework that permits for larger flexibility in how practices deliver care outside of conventional office visits. This motivates doctors to concentrate on health results instead of the volume of visits or tests, CMS stated.

The hybrid design or model pays practices a monthly care management fee. Although, rather than getting the complete Medicare fee-for-service payments for evaluation and management facilities, physicians will get decline Medicare fee-for-service payments and up-front comprehensive primary care payments, CMS stated.

Under the proposed Track 2, physicians will also offer more comprehensive services for sufferers with complicated medical and behavioral health requirements, involving a systematic assessment of their psychosocial requirements and an inventory of resources and supports, CMS stated.

Vendors for Track 2 practices will sign a formal Memorandum of Understanding with the CMS that mentions their commitment and devotion to motivating the enhancement of health IT abilities. This is primary to the practices' success and aligns with the Office of the National Coordinator for Health IT priority to make sure that electronic health data is available.

CPC +develop on a 2012 Comprehensive Primary Care Initiative.

"Motivating primary care is crucial to an efficient healthcare system," stated Patrick Conway, CMS deputy administrator and chief medical officer. "By reinforcing the primary care doctors and clinicians to spend time with sufferers, serve patients' requirements outside of the office visit, and improved coordinate care with specialists we can sustain to make a healthcare system that results in healthier individuals and wiser spending of our healthcare dollars."

The modern primary care initiative has 5 key components: Services are approachable through enhanced in-person hours and 24/7 telephone or electronic approach; high-risk sufferers get proactive care management services to improve results; comprehensive physical and mental care involves preventative services; care is coordinated, involving specialty care and community services; and patients get follow-ups on time after emergency room or hospital visits.

CMS will agree to the payer proposals to combine with CPC+ through the day of June 1.

CMS will admit the practice applications in the determined places from the day of July 15 through the September 1, 2016.

CMS's target, under the Affordable Care Act, is to move the health network from quantity of care to quality of care.

In the day of March 2016, the agency assumed that it had met the target – eleven months ahead of schedule – of tying 30% of Medicare payments to quality and value through alternative payment models by the year 2016. The Administration's next target is tying 50% of Medicare payments to alternative payment models by the year 2018.

Legislation's policy for HIT rating network gets thumbs down

An intended rating methodology to assess the abilities of EHR systems is getting mixed opinions from stakeholders.

If the Senate health committee has its path, the federal government soon will develop a star-rating system for EHRs deployed on 3 critical criteria—security, usability and interoperability.

Although, the policy is not getting great marks from industry groups like the EHR Association and Healthcare Information and Management Systems Society. In fact, many in the industry claims the private sector is better complimented to make those types of assessments.

Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, is blunt about it—it deserves 2 enthusiastic thumbs down.

The intended legislative policy for a HIT rating network is a “terrible and misguided” concept, Tripathi states.

“The market is already doing this, and it is a much great place to do it,” he claims. “Every comment I have observed from industry is that it is a bad concept. The government is merely not equipped to do it with the type of complication and nuance that is going to be needed. For me, the problem is they will not do it well enough, and it has the potential to have insidious impacts on innovation.”

On the day of February 9, the Senate committee unanimously passed the Improving Health Information Technology Act (S. 2511), which involves provisions for a government-sponsored HIT rating network.

Those who established the legislation claims the intent is to assist contributors make more informed purchasing decisions in choosing EHR products and vendors. Under the proposal, the Office of the National Coordinator for Health IT will serve as the designated agency for publishing the criteria and methodology that will be utilized to determine the rating network.

The rating system, to be handled by a “development council” that will be composed of representatives from accredited certifying bodies, testing laboratories and ONC, would provide systems a 1-, 2-, or 3-star rating.

Additionally, the legislation provides the Secretary of Health and Human Services the authority to decertify vendors’ HIT products if they acquire a 1-star rating and do not make better their score; these vendors will have an opportunity to establish a corrective action policy, but will require acting on it and making better their rating.

Under the measure, EHR vendors are needed to report on the performance of their products every 2 years. Those that fail to report their performance would be termed to fines and potential decertification. The fines accumulated would be utilized to create a “revolving user compensation fund” to assist the offset costs of purchasing latest certified HIT for consumers whose products were decertified.

“I cannot conisder a government agency making yelp ratings for EHRs."

“Overall, we seek the proposed rating system to be duplicative—EHR assessment information is already presently available from private firms, as well as through the Office of the National Coordinator for the certification program of Health IT,” claims Leigh Burchell, chair of EHRA and vice president of government affairs for Allscripts. “We recommend instead that it would be more effective to utilize programs and resources already in place—like ACB surveillance, the Open CHPL and funding relevant research through AHRQ—to make certain that the market has the data required to make smart buying decisions.”

John Halamka, MD, CIO of Boston’s Beth Israel Deaconess Medical Center claims that the EHR rating system is the mere provision of the Senate’s Improving Health IT Act to which he objects. “I can’t consider a government agency making Yelp ratings for EHRs. The Health IT Standards Committee particularly pointed out that this is not a suitable role for government,” contends Halamka, who serves as vice chair of the HIT Standards Committee.

In accordance to Eric Helsher, vice president of client success for Epic, the EHR vendor gave feedback to the Senate committee that a government-led rating network would be “duplicative, more expensive and less effective” than what private firms such as KLAS and HIMSS Analytics presently provide.

“We recommended they look to making that kind of private data more available to the contributor community and also make CMS’s existing information on Meaningful Use and EHR certification more intuitive,” Helsher offers. “The latter is publicly present now but not easily utilized.”

Similarly, HIMSS discusses that such a rating system is not essential because private sector groups are already evaluating EHRs. “Instead of establishing a new rating system, consideration should be provided to leveraging these private sector attempts,” the group told the committee in a letter it submitted previous month.

The HIMSS letter also stated that a rating system deployed on user feedback would “introduce excess subjectivity, if not suitably weighted in the star rating methodology.” As the group points out, EHR consumers “don’t always have thorough understanding of what is executed by the product as opposed to the atmosphere in which the product is being utilized.” The rating system “should be highly deployed on objective measures with few grounding in existing certification criteria,” HIMSS emphasizes.

Nevertheless, the Senate is moving forward with a government-sponsored HIT rating network—the brainchild of Sens. Bill Cassidy, MD (R-La.) and Sheldon Whitehouse (D-R.I.), who in the month of October 2015 launched the idea in the Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, which has now been incorporated into the Improving Health Information Technology Act bill.

Calling it “an unbiased rating system” for HIT products, Cassidy stated that the TRUST IT Act provisions would “help strengthen accountability and improve transparency” in EHR networks. “This bill aids to make interoperability by preventing data blocking, and making a business incentive through the rating program to make sure that all networks work together to seamlessly share data for patient care,” claims Cassidy in a statement he released after the unanimous approval of the act by the committee.