Furthering its
commitment
to health IT

October 31, 2009

BARRINGTON, Ill. -- GE Healthcare has announced the launch of eHealth, a new business unit offering enhanced connectivity to clinicians and patients designed with data privacy and security features to enable health information sharing that can help increase efficiency, reduce error and improve health outcomes. A part of GE's healthymagination initiative to improve quality
and access while reducing cost, the eHealth business tackles one of healthcare's most pressing problems - fragmented clinical information trapped in disparate IT systems across multiple institutions, without the common framework to connect to other care providers and their patients.

"Connecting healthcare systems is challenging," said Dr. Brandon Savage, chief medical officer of GE Healthcare IT. "Wide variations in clinical terminology, patient identification methods and systems architecture makes integrating health information exceptionally difficult. Turning that information into value for the care provider is a second, even more challenging hurdle, requiring deep understanding of care provider requirements and clinical workflows."

The eHealth suite of solutions enables the secure sharing of health information that can help lead to improved care by equipping providers with timely patient data, help reduce costs by eliminating redundant procedures, and empowering consumers to make more informed health decisions by providing health histories and wellness services. By providing infrastructure and clinical support services that support physicians, GE is helping to improve the communication of health information,and helping to reduce life-threatening medical errors, twenty percent of which currently occur due to the lack of immediate access to patient health information1.

"eHealth provides the next level of connectivity," said Jim Younkin, IT Program Director, Geisinger Health System and Project Director, Keystone Health Information Exchange (KeyHIE). KeyHIE utilizes GE technologies to serve 31 counties in central and northeastern Pennsylvania. "More than 345,000 patients have registered for our exchange and those patients have given their healthcare providers at eight hospitals and other regional health facilities timely access to relevant information through a secure connection," noted Younkin. "This, in turn, helps ensure these patients receive optimal care."

GE's eHealth business is delivering value to clinicians and patients in four fundamental ways:
*Patient Health Records - As consumers are increasingly engaged in their healthcare decisions, secure and reliable access to medical histories is critical. LifeSensor® patient health record provides a web-based system designed with privacy and security features that allow consumers to access their health histories and to collaborate with care providers. With LifeSensor, consumers can now better understand and direct their own health and wellness plans and leverage the LifeSensor tools for managing chronic disease, nutrition and fitness to help promote lifelong well-being. LifeSensor patient health record is the result of seven years of development by GE's strategic partner InterComponentWare (ICW) and integrates with GE's Centricity HIE solutions.
*Health Information Sharing - The heart of the eHealth business, GE's standards-based Centricity Health Information Exchange (HIE) infrastructure helps enable clinical data from disparate information systems, including medication history, laboratory results, radiology images and referrals to be shared between clinicians in a secure and private manner, helping physicians gain a more complete picture of a patient's medical history. Today, GE's Centricity HIE solutions are helping states, Regional Health Information Organizations (RHIOs) and healthcare systems aggregate data across information silos.
*Structured Clinician Views - Information is only valuable if it is organized, accurate and logically conveyed. Leveraging a deep understanding of caregiver requirements and workflows, the eHealth Clinical Portal structures and displays information so that it is clear, understandable and useful to the caregiver.
*Robust Patient Identification and Matching - It is essential that physicians and patients trust that clinical information is matched with the right patient. GE's Master Patient Index (MPI) technology provides a comprehensive solution for matching patient records from diverse organizations. This technology helps to ensure that information is accurately matched, and is designed to maintain patient privacy.

"With eHealth, we're working to develop standards-based infrastructure, a ground-breaking suite of collaborative services and clinical decision support tools that will empower providers and patients as never before," said Earl Jones, recently named vice president and general manager, GE Healthcare eHealth.

"Integrating disparate data into a single, accurate clinical picture, turning this integrated clinical picture into insight, and making that insight available to caregivers across offices and institutions in real-time will transform the way healthcare is delivered."

GE eHealth solutions are driving value for customers today by providing customers collaborative charting across institutions, patient medication histories, and centralized services such as physician referral, and laboratory, radiology and image information exchange.

eHealth Business Leader Earl Jones joined GE Healthcare IT earlier this month from GE Water & Process Technologies, where he served as Global Commercial Leader, leading global sales and partnership activities. Prior to this role, Jones served in GE's Corporate Initiatives Group where he led Lean Six Sigma for supply-chain and manufacturing. Jones also served with distinction as a submarine officer in the US Navy.

ABOUT GE HEALTHCARE:
GE Healthcare provides transformational medical technologies and services that are shaping a new age of patient care. Our broad expertise in medical imaging and information technologies, medical diagnostics, patient monitoring systems, drug discovery, biopharmaceutical manufacturing technologies, performance improvement and performance solutions services help our customers to deliver better care to more people around the world at a lower cost. In addition, we partner with healthcare leaders, striving to leverage the global policy change necessary to implement a successful shift to sustainable healthcare systems.

On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009 (ARRA), which, among other things, created financial incentives for physicians and other providers to adopt and utilize electronic health records (EHR) and penalties for those physicians who do not.

Over $60 billion in healthcare funding is included in the HITECH provisions of the ARRA for electronic health records.

• $46.8B for Medicare & Medicaid Incentives to doctors & Hospitals for "Meaningful Use" of certified HIT
• $2B for HIT infrastructure, especially Health Information Exchange (HIE)
• $4.7B for the National Telecommunications and Information Administration's Broadband Technology Opportunities Program
• $2.5B for the U.S. Department of Agriculture's Distance Learning, Telemedicine, and Broadband Program
• $1.1B for Comparitive effectiveness grants from AHRQ, HIH, and HHS
• $1.5B for the Community Health Centers through the Health Resources and Services Administration
• $500M for Loan Forgiveness and Workforce Training
• $500M for Department of Labor for Workforce Training
• $500M for HRSA Workforce Training
• $85M for the Indian Health Service
• $50M for the Veterans Benefits Administration
• $ 25M for Chi ldren's Health Insurance Program Reinvestment Act (CHIPRA)

Meaningful Use of certified EHR Technology:
To take advantage of these incentives you must be able to demonstrate "Meaningful Use" of Healthcare IT.

The EHR must be certified, and you need to use the EHR for:

• ePrescribing
• Sharing clinical data with other certified EHR systems (interopraability)
• Reporting on specified clinical quality measures

Medicare Incentives
 

• Incentives will start in 2011
• Available to all non-hosptial physicians who see Medicare patients
• Eligible physicians can receive up to $44K over a five-year period
• Minimum for Medicare participation: Provider must bill 125% of the total incentive received over the five-year period of incentive distribution.
• Must prove "meaningful use" of an EHR.
• Physicians who have not adopted an EHR by January 1, 2015 will be penalized by reduced Medicare payments.
• CMS has extended full Medicare ePrescribing one full year until the end of 2011

Medicare Incentives Schedule
Year	Eligible in 2011	Eligible in 2012	Eligible in 2013	Eligible in 2014	Eligible in 2015
2011	$18,000	$0	$0	$0	$0
2012	$12,000	$18,000	$0	$0	$0
2013	$8,000	$12,000	$15,000	$0	$0
2014	$4,000	$8,000	$12,000	$12,000	$0
2015	$2,000	$4,000	$8,000	$8,000	$0
2016	$0	$2,000	$4,000	$4,000	$0
Total	$44,000	$44,000	$39,000	$24,000	$0

Medicaid Incentives
 

• Available only to non-hospital based clinicians, including dentists, certified nurse midwives, and physician assistants practicing in rural health clinics or FQHCs
• Medicaid incentives range up to $63.5K over a five-year period.
• Minimum for Medicaid participation: 30% of a clinician's patients must use Medicaid, with the exception of pediatricians, who only need to have 20% of their patients using Medicaid.
• Startup incentive up to $21,000 in state loan funds will be available in year one to ward the purchase of a certified EHR.
• After receiving startup funds, providers who can prove "meaningful use" can receive up to $8,500 annually for an additional five years.
• No penalties have been defined by Medicaid for lack of adoption.

Medicaid Incentives Schedule
Year	Eligible in 2011	Eligible in 2012	Eligible in 2013	Eligible in 2014	Eligible in 2015
2011	$21,000	$0	$0	$0	$0
2012	$8,500	$21,000	$0	$0	$0
2013	$8,500	$8,500	$21,000	$0	$0
2014	$8,500	$8,500	$8,500	$21,000	$0
2015	$8,500	$8,500	$8,500	$8,500	$21,000
2016	$8,500	$8,500	$8,500	$8,500	$8,500
2017	$0	$8,500	$8,500	$8,500	$8,500
2018	$0	$0	$8,500	$8,500	$8,500
2019	$0	$0	$0	$8,500	$8,500
2020	$0	$0	$0	$0	$8,500
Total	$63,500	$63,500	$63,500	$63,500	$63,500

To stay informed, you can always go to the ONC's FACA Blog site for the latest news and updates.

Jim Steinberg, Staff Writer

Posted: 10/29/2009 06:31:16 PM PDT

The push to develop a nationally compatible system of computerized health records will include aid to states and the creation of a new federal extension service patterned after the one created for agriculture nearly a century ago.

Dr. David Blumenthal, who was named in March as the Obama administration's national coordinator for health information technology, outlined some of his early plans at the Southern California Health Care Summit, held Thursday at the Ontario Convention Center.

"Every physician and every health professional will will tell you that information is the life blood of medicine ... It is the source of wisdom and knowledge about what each patient needs," Blumenthal said.

"If information is the life blood of medicine, then health information technology is its circulatory system ... We can't have a successful health c are system without a good circulatory system," added the long-time family practice physician who has been a professor of medicine and health care policy at Harvard Medical School.

In the late 1970s, Blumenthal was a professional staff member on Sen. Edward Kennedy's Senate subcommittee on Health and Scientific Research. He served as chief health advisor to the Dukakis presidential campaign and senior health advisor to the Obama for President Campaign.

Washington's high-tech push is fueled by nearly $20 billion from the American Recovery and Reinvestment Act, which Blumenthal called "historic."

To help hospitals and physicians move into the paperless world of digitalized records, Blumenthal said the government has allocated nearly $700 million to create a nationwide network of "local healthcare geek squads."

Just as the agricultural extension service centers for decades have helped farmers deal with pesticide, crop and land use issues, the new health care extension service would help health providers "not just get computers, not just store the information, but use the information," Blumenthal said.

A goal of these centers will be to help health care providers become "meaningful users" of information technology by 2011 so they can qualify for "$10s of millions of dollars."

The announcement of the first center should be made before the end of the year, he said.

Blumenthal relayed an experience he had with a new digitized record system alerting him to the fact that test he just ordered for a patient had already been performed at the request of another doctor.

"So I saved the patient from needless exposure to radiation, I have the health care system thousands of dollars ... It was clearly a win for everyone. And that's the kind of win, one by one, that can make our health care system one we all want to have for ourselves and our families."

An additional $560 million will be available to help state governments participate in the information flow, Blumenthal said.

Blumenthal said the push for the computerization of medical records will fail if the American public does not have confidence in the security of the system.

Within the legislation creating this nationally directed technology effort are provisions for newly created civil penalties of up to $1.5 million for providers and their business associates who allow a breach of sensitive patient information.

The legislation allows state attorney generals to enforce this provision, he said.

And the federal government is looking at new technologies and sciences that will afford greater security, Blumenthal said.

Thursday's Health Care Summit occurred in the backdrop of the U.S. House of Representatives unveiling a retooled a health care overhaul plan.

Among the conference attendees wary of the plan was C. Duane Dauner, president and chief executive officer of the California Hospital Association.

Dauner said, "We want health care reform, but it has to be fair."

Several provisions of the House plan place California at an unfair disadvantage.

The plan would phase out eliminate geographic variations which allocate more federal health care dollars to high cost of living regions, like the East Coast and West Coast.

And it places a tax on private insurance plans.

As 77 percent of Californians have their own health insurance, and the national average is 46 percent, health care costs will rise disproportionately for the state's residents compared to the national average, he said.

Hospitals do not like the public option as it will be structured on the basis of existing federal reimbursement policies - which are below actual costs, said Richard E. Yochum, president and CEO of Pomona Valley Hospital Medical Center.

On the other hand, for Dr. Faisal Qazi, an Upland neurologist, just getting a public option started is all that matters.

The excessive profits must come out of health insurance, he said.

CBO and the Joint Committee on Taxation (JCT) have just issued a preliminary analysis of H.R. 3962, the Affordable Health Care for America Act, as introduced on October 29, 2009. Among other things, H.R. 3962 would establish a mandate for most legal residents of the United States to obtain health insurance; set up insurance “exchanges” through which certain individuals and families could receive federal subsidies to substantially reduce the cost of purchasing that coverage; significantly expand eligibility for Medicaid; substantially reduce the growth of Medicare’s payment rates for most services (relative to the growth rates projected under current law); impose an income tax surcharge on high-income individuals; and make various other changes to the federal tax code, Medicaid, Medicare, and other programs.

According to CBO and JCT’s assessment, enacting H.R. 3962 would result in a net reduction in federal budget deficits of $104 billion over the 2010–2019 period. In the subsequent decade, the collective effect of its provisions would probably be slight reductions in federal budget deficits. Those estimates are all subject to substantial uncertainty.

The estimate includes a projected net cost of $894 billion over 10 years for the proposed expansions in insurance coverage. That net cost itself reflects a gross total of $1,055 billion in subsidies provided through the exchanges (and related spending), increased net outlays for Medicaid and the Children’s Health Insurance Program (CHIP), and tax credits for small employers; those costs are partly offset by $167 billion in collections of penalties paid by individuals and employers. On balance, other effects on revenues and outlays associated with the coverage provisions add $6 billion to their total cost.

Over the 2010–2019 period, the net cost of the coverage expansions would be more than offset by the combination of other spending changes, which CBO estimates would save $426 billion, and receipts resulting from the income tax surcharge on high-income individuals and other provisions, which JCT and CBO estimate would increase federal revenues by $572 billion over that period.

By 2019, CBO and JCT estimate, the number of nonelderly people who are uninsured would be reduced by about 36 million, leaving about 18 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants). Under H.R. 3962, the share of legal nonelderly residents with insurance coverage would rise from about 83 percent currently to about 96 percent. Roughly 21 million people would purchase their own coverage through the new insurance exchanges, and there would be roughly 15 million more enrollees in Medicaid than the total number projected for Medicaid and CHIP combined under current law. (Under the bill, CHIP would no longer exist in 2019.) Relative to currently projected levels, the number of people purchasing individual coverage outside of the exchanges would decrease by about 6 million, and the number obtaining coverage through employers would increase by about 6 million.

Although CBO does not generally provide cost estimates beyond the 10 year budget projection period (2010 through 2019 currently), many Members have requested CBO analyses of the long-term budgetary impact of broad changes in the nation’s health care and health insurance systems. However, a detailed year-by-year projection, like those that CBO prepares for the 10-year budget window, would not be meaningful because the uncertainties involved are simply too great. Among other factors, a wide range of changes could occur—in people’s health, in the sources and extent of their insurance coverage, and in the delivery of medical care (such as advances in medical research, technological developments, and changes in physicians’ practice patterns)—that are likely to be significant but are very difficult to predict, both under current law and under any proposal.

All told, H.R. 3962 would reduce the federal deficit by $9 billion in 2019, CBO and JCT estimate. After that, the added revenues and cost savings are projected to grow slightly more rapidly than the cost of the coverage expansions. In the decade after 2019, the gross cost of the coverage expansions would probably exceed 1 percent of gross domestic product (GDP), but the added revenues and cost savings would probably be greater. Consequently, CBO expects that the legislation would slightly reduce federal budget deficits in that decade relative to those projected under current law—with a total effect during that decade that is in a broad range between zero and one-quarter percent of GDP. The imprecision of that calculation reflects the even greater degree of uncertainty that attends to it, compared with CBO’s 10 year budget estimates, and the effects of the bill could fall outside of that range.

Those longer-term projections assume that the provisions of H.R. 3962 are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the “sustainable growth rate” mechanism governing Medicare’s payments to physicians has frequently been modified to avoid reductions in those payments, and legislation to do so again is currently under consideration in the Congress. The bill would put into effect (or leave in effect) a number of procedures that might be difficult to maintain over a long period of time. It would leave in place the 21 percent reduction in the payment rates for physicians currently scheduled for 2010. At the same time, the bill includes a number of provisions that would constrain payment rates for other providers of Medicare services. In particular, increases in payment rates for many providers would be held below the rate of inflation (in expectation of ongoing productivity improvements in the delivery of health care). Based on the extrapolation described above, CBO expects that Medicare spending under the bill would increase at an average annual rate of roughly 6 percent during the next two decades—well below the roughly 8 percent annual growth rate of the past two decades, despite a growing number of Medicare beneficiaries as the baby-boom generation retires. Based on the same extrapolation, Medicare spending per beneficiary under the bill would increase by roughly 4 percent per year, on average, during the next two decades—compared with a 7 percent average growth rate (excluding the effect of establishing Part D) during the past two decades.

Oct 29, 2009, By Steve Towns, Editor

Federal Chief Technology Officer Aneesh Chopra challenged state CIOs to work more innovatively and collaboratively on Wednesday, Oct. 28 -- and he ticked off a laundry list of issues where state IT professionals will play a key role in President Barack Obama's innovation strategy.

Speaking at a meeting of the National Association of State Chief Information Officers (NASCIO) in Austin, Texas, Chopra said state and local technology executives should be involved in planning for health information exchanges, smart grids and broadband initiatives. They also should be helping to spur entrepreneurship and ensure that schools can continue to teach in the event of a flu pandemic.

"This is all about a new performance contract," he said. "The president has elevated technology and innovation into the fabric of how we run the gover nment. We have extended an olive branch to state and local government. We want to collaborate."

Get Involved

Chopra urged CIOs to join the process of creating standards for emerging smart grid and electronic health records initiatives. He said the Health IT Standards Committee within the U.S. Department of Health and Human Services planned to hold a public hearing on the subject Thursday, Oct. 29, and would continue seeking public input for two weeks through an online forum.

"We want to exchange data across all health-care actors, and it needs to be secure and frictionless. CIOs need to be involved in writing these standards," Chopra said. "Your health department is getting data from hospitals -- what standard do they use? What format do they get that data in? Is the list of doctors in your state in machine-readable format?

"State CIOs have a meaningful role to play in the health IT debate. Please give me your input on the standard before we lock it down," he added.

Chopra's message was similar on smart grids. He said CIOs should be working with public utilities to ensure that data feeds from smart electricity meters and appliances are publicly available and in forms that encourage the creation of innovative new applications.

"Today, could someone use your data to build an application that tells me when to do my laundry at an off-peak time? Is the data available for someone to build that app?" he said. "How will that data be available, and what rights do citizens have now to use that data?"

More broadly, he said state and local CIOs should be scouring their operations for data feeds that can be made publicly available to spur development of innovative new software and other entrepreneurial activity.

Broadband Plan

States and localities also have a crucial role to play in the development of a national broadband strategy. Chopra urged CIOs to give their ideas to the FCC, which is set to release a national broadband plan in February.

Broadband Internet access can help advance almost any major state and local policy objective, he said. "I promise, if you listen to your governor's priorities, there's a broadband play there -- there has to be. Make sure your voices are heard, and help use paint a vision for what broadband means to our communities."

State IT professionals can be particularly helpful in creating standard formats for data used to create broadband coverage maps.

"Many of you are starting to win grants for broadband mapping. There are numerous ways in which to execute this. Do we have a common agreement on data format? Do we want to have 50 different ways to report that data?" he said. "Let's agree

Pandemic Preparations

Finally, Chopra said continuity of learning recommendations released by the U.S. Department of Education for the 2009-2010 school year have implications for state CIOs.

The recommendations give schools advice on how to continue instruction even if students must be out of classrooms for weeks due to a flu pandemic. Among the proposals are making course materials available online and conducting live class meetings via conference calls or webinars.

CIOs should look for innovative ways to quickly share their state's existing collaboration and remote meeting solutions with school districts, Chopra said.

"Could you flip a switch and make your teleconferencing software available to schools?" he asked. "Have you set up the storefront so that those tools are available without a complicated procurement process?"

 

 

• By Jacob Goldstein

The big health-care bill House Dems backed earlier this year would have blocked planned cuts in Medicare payments to doctors. That provision is not part of the bill Nancy Pelosi rolled out today. But that doesn’t mean it vanished — the Dems just made it a separate bill, also released today. Here’s the  bill; here’s a  summary.

Why bother creating a separate bill? Blocking the pay cuts will cost roughly $250 billion over 10 years. Getting rid of that provision lowers the cost of the big health-care bill. Of course, if the Medicare payment measure passes as a separate bill, the federal government will still be on the hook for the costs.

This whole Medicare-pay-cuts-to-doctors thing is a long-running Washington saga, with frequent last-minute interventions from Congress to block imminent cuts. Under current law, rates are set to decline by more than 20% starting next year.

Even if the House does pass this new bill, it may never make it to the President’s desk; the Senate recently killed its own bill that would have permanently blocked the cuts. At the time, Harry Reid said the Senate would go back to a “one-year fix” — Congress’ standard, short-term band-aid that blocks the cuts for the coming year but doesn’t get rid of the underlying payment formula that keeps making this happen.

KHN's Mary Agnes Carey discusses the latest health reform proposal unveiled today by House Democratic leaders.

Listen to audio interview (mp3) | 

Transcript:

Jackie Judd: Good day, I’m Jackie Judd with Health On The Hill. Breaking News from Capitol Hill. House Democrats have unveiled their bill for health care reform. It’s the product of work of three House committees. Joining me today is Mary Agnes Carey from Capitol Hill. Mary Agnes, what’s the big picture?

Mary Agnes Carey: House Democratic leaders today unveiled their health reform package. They said it will come in at under $900 billion under the next decade. It will increase insurance for 36 million people who don’t have it now. It will have, as we’ve known from previous measures, it’ll have an individual mandate with some exemptions for hardship and so on, and also an employer mandate. But they’ve made some significant changes for small business. They said that small businesses , for example, whose payrolls are under $500,000 would be exempted from the mandate, and then that mandate "> penalty would come in on a gradual basis between $500,000 and $750,000 on payroll. That’s important because a lot of members with small business constituencies said requiring businesses to cover their employees would be a hardship. So that was a major concession. Of course, the public plan, which we’ve all heard so much about, is contained in the House bill. It would be paid for with negotiated rates for hospitals and physicians and for other providers. Again, that was an important change from the prior bill, which would have paid on Medicare rates. House moderates in the Democratic party, as well as those representing rural areas said that our providers need negotiated rates to stay in business, so that was a major change in this bill.

Jackie Judd: And so with all of those changes, do the House Democratic leaders believe that they have the sufficient number of votes to pass this?

Mary Agnes Carey: They’re feeling good about it. They’re feeling confident. They’ll have those 218 votes before they see a House vote, which they said tentatively could occur at the end of next week.

Jackie Judd: And what are the biggest differences - we understand at the moment - between the House version and the Senate?

Mary Agnes Carey: On the public plan, for example: In the House, it will be there and it will be part of the health insurance exchange. In the Senate, Democrats were talking about an opt-out provision for states that would allow governors and state legislatures to say “no, we’ve decided that we don’t want to participate in the public plan.” That’s one of the major differences. Another major difference between the bills is on how they finance it. In the House, they’ve decided to put an excise tax on high-income earners. That definition would be $500,000 for individual people and $3 million for couples. I don’t think you’ll see that excise tax in the final bill that’s in the works in the Senate, and if it is, part of the House package. And also, the House package is going to allow the Secretary of the Department of Health and Human Services to negotiate prescription drug prices for Medicare beneficiaries. In the Senate, Max Baucus, who is head of the Finance Committee, as well as the White House, have cut a deal with the drug industry to limit their exposure on financial issues in this bill and I don’t think you’re going to see allowing the HHS Secretary to negotiate Medicare drug prices, but the House Democratic leaders were not part of those negotiations, so that’s why that provision is in the House bill.

Jackie Judd: And a final question, Mary Agnes. In terms of the time table, does it still seem to be that if there is going to be legislation approved by Congress that it would happen before Christmas?

Mary Agnes Carey: That is absolutely the goal of Democratic leaders in the Senate and in the House. Their very strong feeling is they have momentum on their side; it’s an important issue. Next year, as we all know, we face a mid-term election. It would be very difficult to get legislation of this size done then, so they’re pushing their hardest to have it done this year before they leave for the year.

Jackie Judd: OK, thank you so much. Mary Agnes Carey outdoors on Captiol Hill - we can hear the background there. Thank you so much. I’m Jackie Judd with Health On The Hill.

WASHINGTON, DC -- 10/29/09 -- 8th Annual Smart Cards in Government Conference - Identity and trust were the center of discussion at the 8th Annual Smart Cards in Government Conference, taking place this week through October 30th at the Washington DC Convention Center. From healthcare to more efficient government information system development to Internet security, knowing with whom you are dealing and being able to authenticate their identity online is a top issue for the federal government. And as identity becomes increasingly important in Washington, the importance of smart card technology becomes increasingly evident to policy makers and government IT executives as well.

 

One factor: Personal Identity Verification (PIV) credentials now exceed 60 percent penetration of federal government employees, and agencies are implementing logical and physical access control and other applications, according to GSA's Judy Spencer, chair of the Federal Identity Credential Credentialing Committee in the Federal CIO Council. A key initiative to help achieve government-wide and partner trust and interoperability using PIV credentials is the Identity Credential and Access Management (ICAM) subcommittee, which is within days of receiving final clearance to issue the first of two architecture, use case, and implementation guidance documents.

Another factor is that several members of congress have had their own computers hacked into. That makes it more personal and is helping to generate interest, according to Tom Davis, the retired seven-term congressman from Virginia and director of Deloitte's federal government services business.

Keynote speaker David Wennergren, deputy CIO U.S. Department of Defense and vice chair of the Federal CIO Council, sees the smart card industry at the "epicenter of change" in government's IT future. In his view, the completion of the PIV program and its use as an identity management tool is the foundation for "secure information sharing." His vision is to enable a service oriented approach that decouples data from hard-coded applications. Citing several existing examples, he argued that by making data more available in a services architecture, new capabilities can be implemented more rapidly. He also sees the potential of Web 2.0 and cloud computing in government. The smart card-based PIV credential is essential to making these innovations work effectively together for government, because its two factor authentication provides trust and access control.

Identity presents a similar challenge in healthcare. "One of the challenges we face trying to implement healthcare systems nationwide is, Who is that patient? And, Do we know we have that patient?" said Dr. Deborah Lafky, the security lead in the Office of the National Coordinator for Health IT (ONC). "If all patients had an identity card that we could rely on imagine how much simpler this problem would be."

Lafky also issued a call to action for industry stakeholders interested in advancing smart cards as a technology solution for healthcare. "The single biggest thing that this industry can do is greater outreach to the healthcare industry to show them the vision of what could be if everyone had a trusted identity. I don't think that they have that vision today," said Lafky.

In addition to strong credentials, another critical part of identity management is proving identity. Several speakers agreed that efforts to design more secure identity credentials are far ahead of efforts to define and standardize processes for securely vetting identities. There was a consensus among the presenters that a process is needed for the standardization of authenticating breeder documents used to originally establish an identity. In addition, there is a need to establish levels of identity proofing, corresponding to the four levels of assurance already established by the federal government.

It's not about getting a perfect identity, however, cautioned Brett McDowell, executive director, Katara Initiative. There is a continuum of trust, and we have to work with what we have and make decisions about whether not what we have is enough.

Follow the Smart Card Alliance on Twitter at http://twitter.com/SmartCardOrgUSA. Get up to the minute updates on the 8th Annual Smart Cards in Government Conference, or tweet your own news from the event, using #scgc09. To join the Smart Card Alliance Facebook page, visit http://tiny.cc/zAuQY.

About the Smart Card Alliance

The Smart Card Alliance is a not-for-profit, multi-industry association working to stimulate the understanding, adoption, use and widespread application of smart card technology.

Through specific projects such as education programs, market research, advocacy, industry relations and open forums, the Alliance keeps its members connected to industry leaders and innovative thought. The Alliance is the single industry voice for smart cards, leading industry discussion on the impact and value of smart cards in the U.S. and Latin America. For more information please visit http://www.smartcardalliance.org.

Posted by Aneesh Chopra on October 29, 2009 at 09:52 AM EDT

Today, the Health IT Standards Committee within the Department of Health and Human Services will begin an unprecedented effort to get the public’s view on how our work might "pull forward" the benefits of healthcare information technology (IT).  Specifically, we’re interested in uncovering new strategies to accelerate the adoption of health IT standards.  This effort began with the passage of the American Recovery and Reinvestment Act of 2009, calling for recommendations on standards to promote safe, secure, healthcare information exchange.

“Standards” are really the guardians of quality, consistency, and interoperability.  Without thoughtful, clear and uniform standards, we cannot enable the seamless and secure exchange of electronic health information (or the benefits that accrue to providers and patients from such protected exchanges).

So, while the exploration of technical standards may seem mundane to some, it is foundational to electronic health records (EHRs) and electronic health information exchange more broadly.  In other words, it’s worth paying some attention to, and voicing your opinions.

Our process continues with a public hearing today in Washington, DC. Find out how to participate via phone and webcast here. We are convening four panels of experts with on-the-ground experience in interoperability standards - providers, quality stakeholders, health IT vendors, and a group with lessons drawn outside of healthcare. Thanks to HIT Standards Committee member Judy Murphy for her leadership on this effort.

The public hearing draws to a close this afternoon but we will continue the conversation through an Online Forum over the next two weeks.  Thanks to Committee Member Cris Ross for his leadership on this effort.  Given the breadth of interests, we have arranged a series of Committee Member blog posts to begin the dialogue, starting with HIT Standards Committee Vice-Chair John Halamka's summary of our work to date, which will post on Friday.  We will concurrently enable ongoing discussion threads on the following topics:

1. Proposed Standards (General Discussion)
2. Interoperability
3. Vocabularies
4. Privacy
5. Security
6. Quality
7. Implementation Case Studies (Your Story - the good, bad and
   in-between)

We have also enabled a "voting" feature on submissions to allow you - the public - an opportunity to emphasize points raised in a given post. Our goal is to harness the shared wisdom of our community to inform the work of the HIT Standards Committee in the weeks and months ahead.

The tight schedule of this process is designed to ensure that your ideas inform the HIT Standards Committee at its November 19th meeting.  However, your ongoing feedback on our efforts is also encouraged via written submission or public comment at any of the subsequent monthly meetings of the HIT Standards Committee.

The process of accelerating the adoption of health IT standards will not end this week, this month, or this year. This is an ongoing effort, and your participation will continue to be essential to its success.

Aneesh Chopra is U.S. Chief Technology Officer

Source: CSC's Global Healthcare Group Posted on: 28th October 2009

 

The United States is on the verge of significant health reform today, and the American Recovery Reinvestment Act (stimulus) passed in February made a downpayment on reform by recognizing health information technology (health IT) as one of its key foundational elements.

An evolution is taking place as we move from paper records to electronic ones in parallel with networking the information, or making it ”interoperable”. Eventually we will be able to use the digital information for population analytics and personalized care.

The funding provided in the stimulus legislation is coming in waves to support this evolution. The first covers health information exchange (HIE), followed by incentives for “meaningful use” of electronic health records (EHRs). The states are tasked with playing a key role in securing and coordinating these funds, presenting a tremendous opportunity for visibly enhancing health IT and ultimately, patient care.

States Must Act Quickly

In August, the federal Office of the National Coordinator for Health Information Technology (ONC) issued requests for proposals from states, territories and designated non-profit entities to facilitate widespread adoption and use of EHRs and health IT. ONC views the states as force “multipliers” for its efforts. By October 16, every state and qualified U.S. territory had applied for state-level HIE funds and received preliminary determinations of their portion of the $564 million ONC is making available over the next four years. Once funds are awarded in January, states will have between three and eight months to complete strategic and operational plans for their HIE implementations.

The funds have a “use or lose it” flavor to them since they are only available for four years, and state matching requirements increase every year. There is in fact no matching requirement in year one (this year). In addition to the HIE grants, there is $598 million planned for Regional Extension Centers to help doctors implement health IT and EHRs in their practices and an estimated $45 billion in incentive payments for doctors and hospitals demonstrating meaningful use of EHRs.

While the new responsibilities require states to have high levels of organization, expertise and support, they are literally all over the map on their approach to facilitating health IT and HIE. Some, like New York, have already committed considerable state funding over the past few years. Many others have private or public / private grassroots efforts underway. Still others are conducting pilot programs in specific areas, such as Medicaid or public health. The majority of states, however, have no large scale HIE underway today.

Looking to Successes for Guidance

HIE in Massachusetts and Rhode Island, where the New England Healthcare Exchange Network (NEHEN) has been performing live data exchange since 1997, can provide a model for other states just getting up to speed. NEHEN is multi-stakeholder and public / private in nature – it has been built with investment from hospitals and commercial health plans, as well as from Massachusetts state government. It has used earlier federal grants for seed funding, but not for sustainability. It is standards-based, in terms of the format of the data exchanged and its deployed technology. It has provisions for all sizes of healthcare organizations to participate by providing tiered pricing and hosting / cloud computing options for smaller organizations. And NEHEN includes administrative and payment processing in its exchange, along with clinical information sharing – providing a low-cost replacement for functions its participants are already engaged in, with a clear and immediate return on investment. NEHEN has already proven to its participants that HIE can drop costs from dollars to pennies per transaction.

Key Considerations for States Planning a Health Information Exchange

To qualify for ongoing funding ranging from $4-40 million per state, states must have ONC-approved plans organized around five domains: governance, finance, technical infrastructure, technical and business operations and legal / policy. We recommend that they consider many of the elements NEHEN’s system already has in place and is delivering across Massachusetts and Rhode Island. Also, a shortage of qualified technology partners is predicted as the federal milestones approach, making it essential for states to choose their technology partners – particularly those with the experience and expertise to get health IT and HIE done right – carefully and soon.

Beyond this initial effort, all the pending congressional bills propose insurance exchange or co-operatives to help residents find affordable health insurance. The Commonwealth Connector in Massachussetts, the first statewide insurance exchange, can serve as a model for states as health reform places states in another force multiplier role.

This is an exciting time for advancing both health IT and reform. As part of a global IT company, we are working to transform healthcare with better information for better decisions to be made by patients, doctors, payors, government, and researchers. Amid all the exciting technology, software and hardware, it is important to remember that the reason for all this is to improve the care of patients, improving lives and saving money.

For more information on health information exchange and state HIT grants:

www.csc.com/healthforstates
The Massachusetts Health Connector: Lessons Learned from the Builders of the Health Insurance Exchange: http://www.csc.com/health_services/insights/32538-the_massachusetts_health_connector_lessons_learned_from_the_builders_of_the_health_insurance_exchange
Health Information Exchanges: At the Intersection of Healthcare, IT and Business: http://assets1.csc.com/cscworld/downloads/10_CSCWORLD_DEC08_HEALTH.pdf

Greg DeBor, Partner, CSC’s Global Healthcare Group
Robert Wah, MD, Chief Medical Officer and Vice President, CSC’s North American Public Sector; and former deputy national coordinator for Health IT at the Dept. of HH