Press Release

A year and a half after the American Recovery and Reinvestment Act allocated billions of dollars to help hospitals and doctors purchase equipment to computerize patient medical records, even the most sophisticated hospitals in the country are struggling to qualify for the payments. Eight in 10 hospital chief information officers (CIOs) surveyed by PricewaterhouseCoopers LLP said they are concerned or very concerned they will not be able to demonstrate "meaningful use" of electronic health records (EHR) within the federally established deadline of 2015, according to a report entitled Ready or not: On the road to the meaningful use of EHRs and health IT, published today by PricewaterhouseCoopers' Health Research Institute (HRI). (Download Chartpak and Report HERE - registration required)

PricewaterhouseCoopers' survey of 120 hospital CIOs who are members of the College of Healthcare Information Management Executives (CHIME) found:

• Only half of the hospitals and health system CIOs surveyed say they will be prepared to meet the first set of meaningful use requirements and apply for incentive bonuses in 2011, the first year they are available.
• CIOs interviewed for the report said they also were concerned about meeting later-stage requirements within the specified time frames. These requirements include (1) advancing care processes through decision support; (2) providing and populating patients' personal health records; and (3) improving health outcomes through data-sharing outside their own organizations, such as with insurers, patients and other providers.

The promise of stimulus funding has accelerated EHR adoption and the collection of massive amounts of electronic health data as hospitals and physicians across the country race to meet eligibility requirements. But the existing infrastructure to support meaningful use of EHRs on a national health information superhighway is insufficient, according to the CIOs interviewed by PricewaterhouseCoopers.

"Healthcare organizations are building high-performance race cars to travel back country roads," said Daniel Garrett, leader of the health information technology practice, PricewaterhouseCoopers.  "Furthermore, we found many healthcare providers are mired in the complexity of incentive-rule criteria and may not be working toward longer-term goals for meaningful EHR usage. The bottom line is improved quality of care and patient safety, delivered more efficiently. Government leaders and health organizations need to give consideration to the ultimate goal as they work to finalize and meet guidelines for meaningful use."

According to PricewaterhouseCoopers' report, many hospitals are behind the curve on the path to meaningful use. The biggest barriers include:  

• Lack of clarity and a final ruling hinder meaningful use implementation. Guidelines for system certification were issued by the U.S. Department of Health and Human Services on June 7, but final guidelines for meaningful use criteria are not expected until fall of 2010, leaving many CIOs and their vendors at an impasse. CIOs surveyed by PricewaterhouseCoopers are most concerned about reporting requirements. Ninety-four percent of CIOs said they are concerned they can't meet government requirements about how to report meaningful use, and 92 percent are concerned about remaining lack of clarity in meaningful use criteria.
• Shortage of skilled staff. There is a shortage of professionals in the labor market with the appropriate mix of skills to help integrate information technology usage into clinical, operational and administrative practices. The government predicts a shortfall of about 50,000 qualified health IT workers over the next five years. According to the report, hospitals are scrambling to hire additional staff, including clinicians with IT expertise and business skills.
• Vendor readiness and fallout from consolidation are unclear. More than one-third of CIOs surveyed by PricewaterhouseCoopers said they are concerned or very concerned about vendor readiness overall. In particular, 44 percent of CIOs said they are concerned that the external vendors they rely on in health information exchanges (HIEs) are not prepared for meaningful use implementation. Recent merger and acquisition activity among EHR and IT vendors reflects serious efforts by technology suppliers to better position themselves for rapid deployment of systems and integration support.
• Existing infrastructure capabilities are being questioned. Complex networking capabilities and increased bandwidth are needed to reliably handle the massive influx of data that needs to flow 24X7, and hospital CIOs are concerned about the unknown cost of maintaining back-up plans should the system go down and they have to revert to paper records.

Collaboration Characterizes Early Adopters

According to PricewaterhouseCoopers, one of the keys to successful meaningful use of EHRs is getting buy-in early on from physicians and increasing the involvement of physicians and other clinicians in quality initiatives.

"Nowhere would the meaningful use of EHRs be more valuable than in a hospital emergency department, where it could mean life or death for a patient," added Garrett.  "Emergency department physicians aren't eligible for stimulus incentives but their meaningful use of EHRs is crucial to the hospital and its patients. Hospitals that do not see the path to meaningful use of EHRs as part of a bigger transformational opportunity to improve healthcare quality could be on a long path toward meaningless use."

PricewaterhouseCoopers' CIO survey found distinct patterns of collaboration among hospitals and health systems furthest ahead in achieving meaningful use. The survey found:

• Health systems that have connected with physicians, patients and health insurers around meaningful use are more likely to be ready to apply in 2011 for incentives. They are three times more likely to incorporate patient input, 87 percent more likely to work with health insurers and 63 percent more likely to assist physicians with regard to meaningful use than are those planning to apply for the first time after 2011.
• Health systems that include patients in the planning for EHRs are more confident about meeting meaningful use requirements. Seventy-four percent of CIOs who had involved patients responded that they would be among those applying for stimulus incentives in 2011, compared with 50 percent of all hospitals and health systems surveyed.  Yet, fewer than 20 percent of CIOs surveyed said their organizations are incorporating patient input into meaningful use initiatives.
• Sixty-three percent of CIOs said their organizations are either already working with physicians around meaningful use issues or plan to do so within the next six months. Moreover, an overwhelming 88 percent responded that meaningful use is somewhat or very likely to increase the involvement of non-administrative physicians in quality initiatives.
• Most health systems are missing out on opportunities to connect with health insurers around meaningful use. Only 6 percent of CIOs said meaningful use would improve alignment with health insurers over the next two years, and only 24 percent said it would improve alignment long-term. Academic medical centers appear most unclear about how they will work with health insurers around meaningful use; 81 percent of their CIOs said their organizations either do not plan to work with health insurers at all or do not know whether they will do so, compared with 47 percent among all hospitals.

"Success in achieving meaningful use standards hinges on closer integration with key constituents – physicians, health insurers and patients," said Kelly Barnes, U.S. leader, health industries, PricewaterhouseCoopers. "Meaningful use of EHRs is an ambitious goal that requires significant clinical, operational and cultural changes, and patients need to be at the center of all planning. Healthcare organizations have an opportunity to be listening much more closely to what patients are telling them they want and need, and through meaningful use of EHRs, they can deliver care in a more personalized, coordinated way."

The PricewaterhouseCoopers report outlines five milestones that hospitals will have to meet to achieve meaningful use. These include: Governance and tone set by the top of the organization; a balance among competing priorities; forging new public-private and community partnerships; a decision to make patients the purpose; and collaborating with physicians and payers.

A full copy of the report Ready or not:  On the road to meaningful use of EHRs and health IT is available at http://www.pwc.com/us/meaningfuluse.

Methodology

PricewaterhouseCoopers' Health Research Institute surveyed 120 CIOs and health IT executives, who are members of the College of Healthcare Information Management Executives (CHIME) during the second quarter of 2010. In addition, HRI conducted in-depth interviews with 14 CIOs and health leaders from health systems, health information exchanges, health insurers and regional extension centers.

About PricewaterhouseCoopers' Health Research Institute (HRI)

PricewaterhouseCoopers' Health Research Institute (http://www.pwc.com/hri) is a leading resource for health industry expertise. By providing cutting-edge intelligence, perspective and analysis on issues impacting the health industry, HRI assists executive decision-makers and stakeholders worldwide in navigating their most pressing business challenges. PricewaterhouseCoopers is one of the only firms with a dedicated global healthcare research unit, capitalizing on fact-based research and collaborative exchange among our network of professionals with day-to-day experience in the health industries.

About PricewaterhouseCoopers' Health Industries Group

PricewaterhouseCoopers' Health Industries Group (http://www.pwc.com/healthindustries) is a leading advisor to public and private organizations across the health industry, including payers, providers, academic institutions, health sciences, biotech/medical devices, pharmaceutical companies, employers and new non-traditional market participants in the dynamic healthcare space. PricewaterhouseCoopers has a network of more than 4,000 professionals worldwide and 1,200 professionals in the U.S. dedicated to the health industries.

PricewaterhouseCoopers' Health Industries' clients include 40 of the top 100 hospitals in the U.S. and 16 of the 18 best hospitals as ranked by US News & World Report; all 20 of the world's major pharmaceutical companies; all of the top 20 commercial payers in the U.S.; municipal, state and federal government agencies and many of the world's preeminent medical foundations and associations. Follow PwC Health Industries at http://twitter.com/PwCHealth.

About PricewaterhouseCoopers

PricewaterhouseCoopers (www.pwc.com) provides industry-focused assurance, tax and advisory services to build public trust and enhance value for its clients and their stakeholders. More than 163,000 people in 151 countries across our network share their thinking, experience and solutions to develop fresh perspectives and practical advice.

"PricewaterhouseCoopers" refers to PricewaterhouseCoopers LLP or, as the context requires, the PricewaterhouseCoopers global network or other member firms of the network, each of which is a separate and independent legal entity.

© 2010 PricewaterhouseCoopers LLP. All rights reserved.

SOURCE PricewaterhouseCoopers

Federal regulators are reconsidering the rules that govern high-speed Internet connections. Net neutrality is the idea that the Internet should be like roads and highways — generally open to all traffic.

FCC Commissioner Robert McDowell discusses the commissions recent efforts to reclassify certain broadband services

At an open meeting June 17, 2010, the FCC voted to open a proceeding that seeks comment on three options for redefining the FCC's role in regulating broadband. The FCC is asking for comments on these new proposals

Presentation: PowerPoint
NOI: Acrobat
Genachowski Statement: Acrobat
Copps Statement: Acrobat
McDowell Statement: Acrobat
Clyburn Statement: Acrobat
Baker Statement: Acrobat

The Office for the National Coordinator for Health Information Technology (ONC) is to provide a press briefing related to the Final Rule on the Temporary Certification Program for Electronic Health Record (EHR) Technology. The Final Rule is to be on display at the Federal Register today. The press briefing will be held on Friday, June 18, 2010, at 1:30 p.m. EDT. Remarks will be followed by a brief question and answer segment.

Here is the audio from the Certification Call

WHO:

David Blumenthal, M.D., M.P.P., national coordinator for health information technology
Steve Posnack, director, Federal Policy Division, ONC
Carol Bean, division director, Certification & Testing, ONC

WHAT:

Press briefing on the Final Rule on the Temporary Certification Program for EHR Technology

WHEN:

Friday, June 18, 2010, 1:30 p.m. EDT

WHERE:

Via conference call: 1-800-857-6748

Ed Boyden

Assistant Professor, MIT Media Lab, MIT Brain and Cognitive Sciences, and MIT Biological Engineering

Controlling Brain Circuits with Light

The brain is three-dimensional and densely-wired with billions of heterogeneous computational primitives. Understanding how these elements work in real time to mediate behavior and consciousness, and how they are compromised in neural pathology, is a top priority. We have recently revealed methods for real-time optical activation and silencing of specific cell types in the brain, using naturally-occurring molecular sensitizers such as channelrhodopsin-2, halorhodopsin, and archaerhodopsin. Building off of these molecular tools, we also have created optical hardware and algorithms for systematically testing the contribution of brain regions, cell types, and circuit connections to behavioral functions. We are also working on noninvasive methods of information delivery to the brain. We discuss the application of these technologies to the analysis of neural dynamics, as well as to translation for new treatments for human disease, and eventually towards augmentation of the human condition.

Ed Boyden is the Benesse Career Development Professor at the MIT Media Lab, assistant professor of Biological Engineering and Brain and Cognitive Sciences at MIT, and leader of the Synthetic Neurobiology Group. His group aims to discover principles for controlling neural circuits in order to understand how cognition and emotion arise, and also to enable systematic repair of intractable brain disorders such as epilepsy, Parkinson's disease, post-traumatic stress disorder, and chronic pain. In order to accomplish this, his group invents new tools for controlling and observing the computations performed by brain circuits. He has launched an award-winning series of classes at MIT that teach principles of neuroengineering, starting with basic principles of how to control and observe neural functions, and culminating with launching companies in the nascent neurotechnology space. He was named to the "Top 35 Innovators Under the Age of 35" by Technology Review in 2006, his lab's work was selected to the Discovery Science Channel's "Top 5 Best Science Moments" in 2007, and he was selected for the "Top 20 Brains Under Age 40" by Discover Magazine in 2008, as well as awarded the NIH Director's New Innovator Award and the Society for Neuroscience Research Award for Innovation in Neuroscience. Ed received his PhD in neurosciences from Stanford University as a Hertz Fellow, where he discovered that the molecular mechanisms used to store a memory are determined by the content to be learned. Before, he received three degrees in electrical engineering and physics from MIT. He has contributed to over 200 papers, current or pending patents, and articles, has given over 80 invited talks, and writes a column for Technology Review magazine.

Transcript via http://designfiles.org

Our group is a neuroengineering group. There's an active volunteer program, where there's half-a-dozen people initiating projects. Some of them have initial origins in retirees or or the part of the head. There's unrestricted research, we give people who don't even donate, there's a nice feedback loop that we're excited about.

The tools allow us to understand the brain at a level to understand it. The brain over the last 100 years has been about looking about the molecular scale and so on. There is also an importance about the diseases related to atrophy, poluttion, and different cells or losses, like epilepsy or disorders. One of the most key ideas is that we can do a new generation of treatments that are about targeted neuromodulations. You can target the circuits in the brain, and there's this immeineslsy complicated 3D microcircuit structure. The trends are pointing towards this being increasingly common. More than 100k people have invasive cochlear implants. More than 50k have deep brain stimulators. There's even in adolescents, not even the traditional population. And so on.

So, why control neural activity? We can reprogram the neural computations that underly disorders. If we just give someone a drug, it will bathe the brain in a substance, and that cause problems. The brain is a very cryptic thing. We want to target information in a targeted area in the brain. There's driving activity in technology, so one of the technologies is the little spikes or action potentials in the brain. So, light's nice because you can point at a population in the brain, or selectively. This is useful.

The experiment begins a decade ago where we were trying to find genomic materials for photosynthetic pathways, to convert light to electrical energy, we put them into cells with viruses, and we make cells with a light. Here's a cell that was coated with the sensors, like coating with solar cells. There's all sorts of reactions happening. We can put them into the brain. One of the big things is trying to do this with 3D optical fiber arrays to beam the light in and do patterns. They can do complex and distributed structures. This is doing the hippocampus; it was compromising the ability to form new memories.

One of the examples that we're doing here, one of the PTSD grant, from the DARPA. Can we find targets in the brain that can ameliorate the pathological fear of events that were previously neutral? We're going back to Pavlov and so on, like operant conditioning and pavlovian conditioning, like enducing fear states using a tone. WE're trying to figure out which ones can amiliorate the different sites in the brain, and then we can find which targets might not treat the disorder.

The other thing that we've doing a lot of is new genomic diversity, so that we can mine it for better things. Nature is good at making things. Maybe we can team up with nature, and find interesting stuff, put them into biological systems, and treat them. Insulin, taxixiciln, you name it. Earlier this year, we had this whole diversity of organisms from all over the planet, and look at the genes, express them into neurons so that we can do other things. We can completely turn off the neurons with one method. This was one of the methods to look at more and more ecology populations and samples, and actually came out and get out some scuba diving. We want to mine the genomic diversity, so that we can connect genotype, and the amount of genome data that we're doing. The genotype that we're doing is not at moore's law rate yet, so we can cure stuff.

There's different classes of models in the wild. One of the proteins is sensitive to blue light, some is sensitive to other colors of light. If we can only figure out how to phenotype it quickly. And the ability to cure diseases. A lot of our work is based on more collaborations..

Which is where I want to start thinking about brain coprocessors. If you look bad at the opening slides, we talked about cochlear implants. If you can mine the data, and then use intelligence, and there's two multi-million dollar projects to merge AI with neuroscience, get the information where it needs to happen, and have maximal clinical benefit in the short term. We can figure out where natural intelligence and ai starts to happen. We can train the software on neural computations in the brain, and that's speculative and we haven't figured out how that would work.

The other interesting thing that could happen with this is that the technologies could be used directly - proteins and light - as we expand the genomic and ecological search- if you think about it, gene therapy, which is required to put its genes into cells. One of the things about this is that there are classes of viruses, adenoviruses, lentivurses, that are very safe to use in humans. Adeno-associated viruses (AAV), FDA trials, and there has been no single adverse; there's payload issues sometimes, of course. It's quite inocculouous. One of the things that we did is a pre-clinical study, and with two groups, Bob Desimone, Ann Graybiel. One of the things we did was pre-clinical studies with inocculant parties. So we gave them some of the molecules, and this was the gold standard for neurological psychiatric standing, there was this pre-clinical; we found we can drive neurons over a long period of time. We worked with phenomenologists, for antibodies, and we found no evidence for immune reactions. These are molecules from algae and so on, one of the things we're exploring is how to use these things.

We're collaborating at USC; there's a company he's funded to see if we can do neural disorders- like blindness. And classical disorders are due to loss of photoreceptors, and they are here, gone here. Why can't we just make this back? Why can't the retina produce the photoreceptors again? one of the things that we've done is taken a model of blindness, and the kind of mice that you find in pet stores, and these are similar to the kind of things that happen in humans. And these are going down in long alleys, and over many weeks of training, they come up with strategies, like don't go the same pathway twice. Untreated rd16. Here's a mouse that was blind a few weeks before, and received our light receptors in a single dose, and he can solve the maze just as well as identical rats that could see all their life. That's what we've been up to.