Does Your Doctor Use An EHR?

The latest statistics are out regarding the adoption and use of electronic health records (EHRs). The New England Journal of Medicine published the government sponsored survey report. Check out the article in the NY Times, "Most Doctors Aren't Using Electronic Health Records." (full report - Electronic Health Records in Ambulatory Care -- A National Survey of Physicians).

The article indicates that only 9% of medical practices with less than 3 physicians have adopted an EHR -- while the percentage increases to 50% for those practices with 50 or more physicians. The comments in the article by one physician seem to confirm a recent conversation with Jack Shaffer, health IT specialist, that EHRs don't necessarily improve physician efficiency.

West Virginia native, Dr. Brailer, is quoted in the article:

But the new study is based on a large sampling — more than 2,600 doctors across the country — and a detailed survey, making it more definitive than past research, experts say. The results, they say, also show a strong endorsement of electronic health records by doctors who have them, especially for what the report termed “fully functional” records, which include reminders of care guidelines, based on a patient’s age, gender or medical history.

For example, 82 percent of those using such electronic records said they improved the quality of clinical decisions, 86 percent said they helped in avoiding medication errors and 85 percent said they improved the delivery of preventative care.

“Those numbers are huge and very encouraging,” said Dr. David J. Brailer, the former health information technology coordinator in the Bush administration.

Dr. Brailer also pointed to the 54 percent of doctors without electronic health records who said that not finding an electronic health record that met their needs was a “major barrier” to adoption. In short, they are not satisfied with the existing products, which tend to be designed for hospitals — big customers — instead of small practices.

“What we see is a deficit in innovation, and that is something innovators and the capital markets can address,” said Dr. Brailer, who leads a firm that invests in medical ventures, Health Evolution Partners.

AthenaHealth is also mentioned in the article. Over the last several months I have been thinking about whether a web based service as software approach, like AthenaHealth, might be an method to grow the adoption of EHR usage in West Virginia as a part of the West Virginia Health Information Network.

The report finding that that most doctors are not satisfied with existing technology should give Dr. Parkinson via Hello Health and other health 2.0 innovators a positive sense of opportunity.

WVHIN: Public Comment Period on Proposed Privacy and Security Policies

The West Virginia Health Information Network (WVHIN), West Virginia's health information exchange, has issued proposed privacy and security policies and is seeking public comments on the proposed policies from December 3, 2010 through January 3, 2011. The WVHIN is a public/private partnership created in 2006 under W.Va. Code 16-29G-1 et seq. and is charged with building a secure electronic health information system for the exchange of patient data among physicians, hospitals, diagnostic laboratories, other care providers, and other stakeholders.

The proposed privacy and security policies that are available for review and comment are as follows:

• Patient Consent - General
• Patient Consent - Permissible Purpose
• Patient Consent - Sensitive Health Information
• User Authorization
• User Authentication
• Patient Amendment of Protected Health Information
• Patient Access to Protected Health Information
• Minimum Necessary
• Breach Notification

Pursuant to a press release from the WVHIN on the proposed privacy and security policies:

“WVHIN has been developing our core privacy and security policies that will guide us in our initial health information exchange implementation and pilot for 2011. We expect to have changes to the policies as a result of learning how to improve our operations through testing in the pilot period.“

“The policies have been developed over the past few months by the WVHIN Privacy and Security Committee and legal counsel, and are based upon an established WVHIN Privacy Framework and national best practices recommendations in Health Information Exchange (HIE). The committee is made up of stakeholder organizations including provider groups, state government, and consumer groups. The committee followed a cycle of reviewing and vetting the policies that have resulted in our drafts.”

“We have established a public comment period for the draft policies and would like to invite any member of the public to comments on these policies. Thus, we would like to request your assistance in forwarding this e-mail to any parties you may feel would like to comment on the policies. We welcome all feedback”, according to Business Development Manager Samantha Stamper.

Written comments on the proposed privacy and security policies may be submitted to Samantha Stamper, Business Development Manager by January 3, 2011 at sstamper@wvhin.org.

WVHIN Releases RFP for West Virginia Health Information Exchange

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

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

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

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

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

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

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

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

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

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

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

West Virginia will receive the following funding:

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

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

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

• State Health Information Exchange Cooperative Agreement Program

• Health Information Technology Extension Program

Health 2.0: Stay Focused on the Goals

Ben Heywood, co-founder of PatientsLikeMe, outlines simple (but difficult) goals that those in the health 2.0 space must accomplish. Based on his post I take it that he highlighted these during his keynote address at the second Health 2.0 Northeast conference.

His simple but eloquent message to the health 2.0 community:

I believe we, as the eHealth community, need to focus on two major goals: 1) solve patients’ problems, and 2) create business models that allow us to do #1.

Successful companies must show real and tangible benefits directly to the patient consumer. As one who regularly participates in the health information discussion and debate as West Virginia moves forward with its health information network infrastructure -- I often try to step back and ask, like Mr. Heywood, the simple question, "does this help the patient -- why and how?"

To be disruptive and successful the current crop of creative companies have to show a direct and immediate impact on improving care and quality linked to a reduction in cost or a value proposition that the increase in cost is worth such expenditure.

WVHIN Board Meeting (January 2007)

On Friday the board of the West Virginia Health Information Network (WVHIN) met and covered a variety of topics and continued its efforts to coordinate the creation of a successfully integrated health information system. (Note: The WVHIN board is still in the search phase for an Executive Director).

Topics of the board included the following:

1. A status report on the submission of Interim Report of the West Virginia Solutions Group under Health Information and Security and Privacy Collaborative (HISPC). A motion was made and passed to integrate and continue to carry on the HISPC project work under the auspices of the WVHIN after the project grant is completed in 2007.

2. Update and approval of the WVHIN Bylaws, including a letter from the State Ethics Commission approving the form and substance of the Bylaws and indicating that the Bylaws meet the open meeting law requirements in West Virginia.

3. An update on the pending e-prescribing legislation (Senate Bill 69) introduced by Governor Manchin to address the current restrictions on allowing e-prescribing by physician and pharmacists in West Virginia. There were also a number of e-prescribing presentations providing the details of how such systems will work and current statistics on e-prescribing in West Virginia and nationally.

4. An update on the FCC Broadband Grant application process.

Included in the handout materials for the board meeting was a copy of a recent article appearing in Health Care's Most Wired Magazine by my fellow board member, Sarah Chouinard, M.D. Interesting article (see next post).

Tags: WV, West Virginia, health care, WVHIN

WVHIN Executive Director Wanted

In 2006 I was appointed to serve a four year term as a Board Member of the new West Virginia Health Information Network (WVHIN). The WVHIN was created in 2006 to help guide the state's efforts and oversee the implementation of a private/public interoperable health information system for West Virginia.

Last week I was speaking with Sallie Hunt, Chief Privacy Officer for the State of West Virginia, who has been instrumental in overseeing the initial activities and assisting with the startup of the WVHIN. She advised that they are now in the process of searching for a full time Executive Director. If you are interested in applying for the position or know of someone who might be interested, please contact Sallie Hunt at (304) 558-7000 Ext. 252.

Sallie provided me with the following summary of the Executive Director job description being used by the search committee.

The Executive Director (ED) is the primary executive officer of the WVHIN, reporting to the WVHIN Board of Directors. As such, the incumbent is responsible for assisting the Board to develop the policies and procedures of the Health Information Network (the WVHIN), for implementing these policies and procedures, and for initiating a periodic review of these policies and procedures.

The ED is responsible for the overall administration and management of the WVHIN. This responsibility includes planning and evaluation, policy development and administration, personnel and fiscal management, public education, provider recruitment, business model development, and media and public relations. The successful candidate will have excellent problem-solving skills, be a self-starter, have an entrepreneurial spirit, and be able to function with minimal supervision.

This position will be the "public face" of the WVHIN and, as such, the incumbent will have to have strong speaking, presentation development and writing skills, with the ability to convey highly technical issues in a clear and compelling manner. The incumbent will have to interact regularly with a wide variety of audiences—healthcare providers, potential and existing funders, policy-makers and executive leaders, consumers, and vendors—and will need the skill to drive and balance a multi-stakeholder constituency group.

The ED will be responsible for developing, maintaining, and engaging in a relationship with the vendor directly providing the technology services of the WVHIN. Thus, the incumbent should have contract management skills and preferably the ability to manage a highly technology-dependent project.

Finally, the ED will have the personal qualities that enable him/her to work comfortably in an environment characterized by significant uncertainty. With the possibility of the governance structure changing and ongoing fund development needs, the ED will spend significant time and energy assisting the Board of Directors and other state stakeholders to arrive at decisions that assure the WVHIN a clear strategic direction and long-term viability. The incumbent must be comfortable working with diverse organizations and in maintaining a balance among competing interests. This balance sometimes requires making difficult decisions to keep the project on track.

Tags: WVHIN, WV, Charleston, health care, technology

West Virginia's Statewide Health Information Technology Strategic Plan

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

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

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

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