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CVS Health, IBM Partner To Develop Care Management Technology

July 30, 2015 in News

On Thursday, CVS Health and IBM announced they are partnering to bring IBM’s Watson technology to CVS Health pharmacists and practitioners in an effort to improve health care management for patients with chronic diseases, USA Today reports. 

Background on Watson Technology

IBM’s Watson computing system can:

  • Analyze large amounts of information;
  • Develop knowledge over time; and
  • Interpret and evaluate data.

In addition, Watson can access:

  • Health records;
  • Pharmacy information; and
  • Other resources that allow CVS Health employees to help patients and work with primary care physicians.

Details of Project

For the collaboration, IBM and CVS will leverage IBM Watson Health in a way that lets providers and researchers use data and technology collected by the computing system to provide improved health care. The partnership also will use IBM Watson Health Cloud, which collects various data, including information on nutrition, medical history and lifestyle (Calfas, USA Today, 7/30).

Using the Watson technology, the companies aim to develop a system that can:

  • Predict health declines for conditions, such as diabetes, heart disease and obesity;
  • Prevent costly and unnecessary interventions; and
  • Provide more personalized care.

CVS Health CMO Troynen Brennan said the first stage of the project will involve creating and testing algorithms to determine if they improve patient outcomes. He said he hoped to see “realistic interventions” in one to two years (Eunjung Cha, “To Your Health,” Washington Post, 7/30).

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Study: Telemedicine Effective for Providing Talk Therapy to Vets

July 30, 2015 in News

Telemedicine can be just as effective as in-person visits for delivering talk therapy to older veterans with depression, according to a study published in The Lancet, Reuters reports.

Study Details

For the study, researchers divided more than 200 veterans over age 58, who were diagnosed with major depressive disorder into two groups.

Both groups received identical behavioral activation treatment in four to eight one-hour therapy sessions. However, one group received the therapy during in-person sessions, while the second group received care in their homes using video conferencing technology to connect remotely with therapists.

Patients’ progress was measured using questionnaires in which the veterans rated their symptoms. Later on, researchers also used structured clinical interviews to gauge progress.

According to Reuters, patients whose symptoms were reduced by at least half were considered to be responding to treatment (Kennedy, Reuters, 7/29).

The study was conducted between April 1, 2007, and July 31, 2011 (Egede et al., The Lancet, August 2015).

Study Findings

Overall, lead study author Leonard Egede said the talk therapy “works for depression whether you deliver it by face-to-face or [via] the telemedicine approach.”

Specifically, the study found that:

  • After one month, 5% to 7% of patients in the telemedicine group reduced their symptoms by half, compared with 15% on the in-person visit group;
  • After three months, 15% of telemedicine patients reduced their symptoms by half, compared with 19% of in-person visit patients;
  • After one year, 19% to 22% of telemedicine patients reduced their symptoms by half, compared with 19% to 21% of in-person patients; and
  • After one year, 39% of telemedicine patients reported no longer being depressed, compared with 46% of in-person patients.

Egede noted that telemedicine can be helpful for older individuals who face barriers to accessing mental health care, such as limited mobility, stigma and geographic location.

Editorial Raises Safety Concerns

In an accompanying editorial, Charles Hoge, a psychiatrist and senior scientist at the Walter Reed Army Institute of Research, said that therapy delivered via telemedicine could raise safety concerns because there are no professionals on site to help in the event of an emergency.

In an email to Reuters he noted that while telemedicine “can expand patients’ options for receiving needed mental health treatment,” the “most important consideration is ensuring that there are procedures in place to address emergencies, such as if a patient reports intent to commit suicide or homicide” (Reuters, 7/29).

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DOD Selects Cerner Team for Massive EHR Overhaul Contract

July 30, 2015 in News

On Wednesday, the Department of Defense announced that electronic health record vendor Cerner, Leidos, a government systems integrator,  and Accenture Federal have been awarded its EHR modernization contract, FierceEMR reports (Bowman, FierceEMR, 7/29).

Background

In February 2013, DOD and Department of Veterans Affairs officials announced plans to halt a joint integrated EHR, or iEHR system, and instead focus on making their current EHR systems more interoperable.

In August 2014, DOD issued a final solicitation for bids for the Defense Healthcare Management Systems Modernization contract, which was estimated to be worth $11 billion. A team of DOD civilians, military personnel and subject matter and procurement experts evaluated the proposals.

In addition to the Cerner team, other groups competing for the contract included:

  • A team that includes Computer Sciences Corp., a defense contractor and systems integrator, Hewlett Packard, a computer services firm, and EHR developer Allscripts;
  • A team that includes IBM and EHR vendor Epic, which recently unveiled a new advisory group; and
  • A team that includes DSS, General Dynamics Information Technology, Google, MedSphere and PricewaterhouseCoopers (iHealthBeat, 2/24).

Contract Details

The initial two-year contract is worth $4.3 billion. There are two additional three-year option periods and a potential two-year award term, which could bring the contract period to 10 years. In a release, Frank Kendall — undersecretary of defense for acquisition, technology and logistics — said the total contract value is now estimated to be $9 billion.

As part of the contract, the winning group will be responsible for upgrading and managing the health records of more than 9.5 million DOD beneficiaries (Conn, Modern Healthcare, 7/29). DOD officials said the system will be deployed at about 1,000 sites in the U.S. and abroad, including the DOD’s 55 hospitals and more than 600 clinics.

Christopher Miller, the Defense Healthcare Management Systems program executive officer, in a statement, said that the new EHR system will replace up to 50 legacy systems, each of which has its own transition plan (DOD release, 7/29).

Therefore, officials said the system will be implemented over six or seven years. Officials said they will begin deploying and testing the system at eight military facilities in the Pacific Northwest, which are expected to be up and running by the end of 2016 (Modern Healthcare, 7/29).

Reaction

In an emailed statement, athenahealth CEO Jonathan Bush expressed disappointment that DOD did not go with a more open, Internet-based platform. He said, “By partnering with the very same legacy [health IT] system vendors [that] are largely responsible for the current state of disconnected health care, the DOD is making a long slog toward the type of interoperable infrastructure the [Office of the National Coordinator for Health IT] mapped out in its 10-year plan” (athenahealth statement, 7/29).

Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, said, “My biggest worry isn’t that Cerner won’t deliver, it’s that DOD will suck the lifeblood out of the company by running its management ragged with endless overhead and dulling the innovative edge of its development teams.” He added, “There is a tremendous amount of innovation going on in health IT right now. We need a well-performing Cerner in the private sector to keep pushing the innovation frontier” (Tahir et al, “Morning eHealth,” Politico, 7/30).

Todd Cozzens — venture partner and senior adviser at venture capital firm Sequoia Partners — said, “The number one focus of the DOD, the ONC and others should be, not only is this system useful, but can it interoperate” with other vendors’ EHRs. He added that he would not be surprised if the award is appealed (Modern Healthcare, 7/29).

According to “Morning eHealth,” Computer Sciences Corporation, which was on a bidding team with EHR vendor Allscripts, said it would “evaluate its options.” The IBM and Epic bidding team did not comment on the possibility of an appeal.

Meanwhile, John Halamka, CIO at Beth Israel Deaconess, appeared more optimistic, saying, “Cerner is a strong company, which has accelerated its interoperability and cloud hosting efforts over the past few years. Their strategic direction seems well-aligned with DHMSM needs” (“Morning eHealth,” Politico, 7/30).

According to MedCity News, Cerner is unable to comment on the announcement due to a mandatory quiet period that is expected to be lifted on Tuesday ahead of its scheduled earnings announcement for the quarter that ended June 30 (Versel, MedCity News, 7/29).

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Burwell: HHS Not Aware of Any Fraud in Federal Insurance Exchange

July 30, 2015 in News

On Tuesday, HHS Secretary Sylvia Mathews Burwell testified before Congress that her department has no evidence of consumers fraudulently obtaining coverage through the federal online health insurance exchange, Modern Healthcare reports (Dickson, Modern Healthcare, 7/28).

Background

A Government Accountability Office report released  this month found that the federal exchange automatically re-enrolled 11 fake U.S. residents in health plans for 2015, despite ongoing documentation issues with the staged individuals. The initial investigation discovered that GAO officials were able to obtain subsidized coverage for fake applicants in 11 out of 12 applications submitted through HealthCare.gov’s website or the telephone.

A GAO official said during a hearing earlier this month that the agency did not find any proof of an individual fraudulently enrolled in federal exchange coverage outside of their investigation (iHealthBeat, 7/17).

Details of Burwell’s Testimony During a House Education and the Workforce Committee hearing, Burwell said GAO’s investigation is “the only examples (of fraud) that we know of.” 

According to Burwell, in the first quarter of this year HHS removed 117,000 people from the federal exchange and reduced the subsidies of thousands more after they were unable to verify their submitted information. Burwell could not say if any of those individuals were attempting to defraud the system. Further, Burwell said GAO has not issued recommendations to HHS regarding the results of its investigation.

Meanwhile, Senate Finance Committee Chair Orrin Hatch (R-Utah) in a letter to CMS acting Administrator Andy Slavitt requested details on data verification processes for the exchanges (Modern Healthcare, 7/28).

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AHA Urges Congress To Improve Interoperability, Data Sharing

July 29, 2015 in News

Last week, the American Hospital Association sent a letter to Congress urging lawmakers to strengthen policies that will support interoperability and health data exchange, Health IT Security reports.

Letter Details

In the letter, AHA noted that many of the electronic health record systems used by hospitals and health systems:

  • Cost too much and are too complex to be sustainable;
  • Do not easily share data; and
  • Do not provide universal access to infrastructure, such as efficient exchange networks (Snell, Health IT Security, 7/28).

AHA outlined several recommendations aimed at improving interoperability, such as:

  • Conducting more pilots and demonstrations to test standards that support interoperability and ensure standards have clear implementation guidance before being included in federal regulations; and
  • Enacting policy changes that will “hold vendors accountable for the design and marketing of interoperable products” (AHA letter, 7/23).

However, AHA warned against adding additional policy drivers intended to encourage providers to share health data. AHA said such drivers would be unnecessary or even harmful “if they become overly prescriptive or contradict the larger set of payment incentives and quality initiatives in place.”

AHA added, “Similarly, heavy-handed sanctions on providers for failure to share information would be duplicative of the meaningful use requirements to share health information and could have unintended consequences.”

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.

AHA also noted that Congress currently is considering cybersecurity issues and urged lawmakers to keep in mind that the health care industry already has federal statutes and regulations in place that govern information security, such as HIPAA.

AHA wrote, “The AHA strongly believes that improving the infrastructure to support secure data sharing in support of clinical care can be accomplished within the existing HIPAA requirements and the existing framework of cybersecurity policy” (Health IT Security, 7/28).

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CMS Releases FAQs To Clarify Plan To Ease ICD-10 Transition

July 29, 2015 in News

On Monday, CMS released answers to frequently asked questions to help clarify recently announced measures that aim to provide physicians with some flexibility as they transition to the new ICD-10 code sets, EHR Intelligence reports (Murphy, EHR Intelligence, 7/28).

Background

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1.

On July 6, CMS and the American Medical Association jointly announced measures designed to help ease physicians’ transition.

Among other things, CMS said it would:

  • Appoint an ICD-10 ombudsman to help oversee the transition;
  • Establish a one-year grace period in which it will reimburse physicians under Medicare Part B for claims with incorrect ICD-10 diagnosis codes;
  • Extend the flexibility for quality code errors to the Physician Quality Reporting System, Value-Based Payment Modifier program and meaningful use program so physicians and other eligible professionals are not penalized; and
  • Provide a range of online resources — including Web conferences and training documents — to aid providers in the transition (iHealthBeat, 7/7).

FAQ Details

CMS posted a list of 13 FAQs to clarify several aspects of the measures. For example, the agency noted that:

  • The ICD-10 ombudsman will be in place by Oct. 1;
  • The measures do not signify an ICD-10 delay;
  • Submitters whose claims are denied will be notified with an explanation of the rejection;
  • Submitters should follow existing processes for correcting and resubmitting rejected claims (Goedert, Health Data Management, 7/28);
  • The measures only apply to Medicare fee-for-service claims;
  • The guidance does not apply to Medicaid claims, but each state will be “required to process submitted claims that include ICD-10 codes for services furnished on or after Oct. 1 in a timely manner” (EHR Intelligence, 7/28); and
  • The measures do not apply to commercial payers, which “will have to determine whether [to] offer similar audit flexibilities” (Health Data Management, 7/28).
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Precision Medicine Requires Regulatory Reform, Data Analytics

July 29, 2015 in News

President Obama’s Precision Medicine Initiative will not succeed without a regulatory system that can facilitate big data analytics for genomic research, according to a white paper by the Center for Data Innovation and Health IT Now Coalition, Health Data Management reports (Slabodkin, Health Data Management, 7/27).

Background

In February, Obama in his fiscal year 2016 budget proposal asked Congress for $215 million in funding for a precision medicine initiative that centers on the creation of a massive database containing the genetic data of at least one million volunteer participants. Of the funding:

  • $131 million would go toward NIH to recruit at least one million volunteers and analyze their full genetic makeups, as well as expand clinical trials for possible cancer medications;
  • $70 million would go toward NIH’s National Cancer Institute to further study genetic causes of cancers and use study findings to assist with drug development;
  • $10 million would go toward FDA to develop databases to help the agency create the regulatory structure for evaluating precision medicine advances; and
  • $5 million would go toward ONC to help develop interoperability standards and policies to address privacy issues and help with secure data exchange across various systems (iHealthBeat, 2/3).

An implementation plan from NIH is due in September.

White Paper Recommendations

The white paper makes several recommendations to ensure a successful precision medicine program, stressing the importance of public-private partnerships. Specifically, the two organizations recommend that stakeholders:

  • Encourage patient and private-sector engagement because of their shared interest in the way big-data applications can shape health care innovation;
  • Implement strong federal requirements to improve interoperability and data sharing so that genomic and other health data can be accessed and sent across different systems; and
  • Re-evaluate existing privacy and consent laws to account for advances in science and technology.

Joel White, executive director of the Health IT Now Coalition, said, “In order to make full use of [the genomic and clinical] information and taxpayer dollars that are funding the initiative, we need a functional and broad-based data-sharing model that can only be reached through cooperation of both private and public sectors” (Health Data Management, 7/27).

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Practice Challenges Ruling, Defends Firing Over Improper EHR Access

July 28, 2015 in News

A Montana-based eye care center is challenging a ruling that firing a worker for improperly accessing an electronic health record system violates the National Labor Relations Act, FierceEMR reports.

Background on Case

The case involves an employee at the Rocky Mountain Eye Center in Missoula, Mont., Britta Brown, who used the practice’s EHR system to obtain the contact information of 17 coworkers. She then provided information on 12 coworkers to a union representative. Rocky Mountain fired Brown, citing a HIPAA violation and abuse of the practice’s confidentiality agreement.

However, an administrative law judge found that while the practice’s personnel files were kept in a separate software system, it mixed patient and employee contact information in its EHR system because employees entered their contact information into the EHR  system as part of training. The judge also found that Rocky Mountain allowed the EHR system to be used as an employee directory.

In the decision, the judge wrote, “It was generally known that coworkers and supervisors accessed the Centricity system to get employee contact information,” adding, “Employees accessed each other’s contact information for work-related purposes, primarily involving last-minute schedule changes.”

The decision also noted that Rocky Mountain employees no longer enter their contact information into the EHR system and that the practice’s Human Resources Department now handles scheduling changes.

Details of the Challenge

In an Exceptions document filed with the National Labor Relations Board on July 10, the practice argued that the EHR system is a database reserved for patients. The practice noted that Brown accessed records of patients who happened to be employees before turning them over to a third party without approval (Durben Hirsch, FierceEMR, 7/24).

According to the Exception document, under HIPAA’s minimum necessary standard, “employees of a covered entity are not permitted to access a patient’s [personal health information] in the employer’s [EHR] system for personal reasons unrelated to that patient’s care or services” (Rocky Mountain Eye Center Exceptions, 7/10).

Rocky Mountain also argued that Brown never testified that she witnessed or was told it was acceptable to use the EHR system to find patient-employee contact numbers. In addition, it stated there is no evidence the practice allowed such access (FierceEMR, 7/24).

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HHS To Collect Health IT Data on Health Center Controlled Networks

July 28, 2015 in News

Last week, HHS’ Health Resources and Service Administration revealed plans to collect information on health center controlled networks’ progress with data sharing and the adoption of electronic health records, FierceEMR reports.

Details of the Announcement

In a request for comment published in the Federal Register, HRSA said it wants to ensure health center controlled networks effectively implement health IT to help providers achieve meaningful use of EHRs. Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments (Durben Hirsch, FierceEMR, 7/22).

Specifically, HRSA said it plans to collect annual progress reports to determine participants in the Health Center Controlled Networks program are meeting key goals, such as:

  • Adopting quality improvement strategies, such as health information exchange;
  • Providing ongoing support for achieving meaningful use; and
  • Sharing knowledge, resources and data (Federal Register, 7/22).

In addition, HRHS said it will use the information collected to “inform new technical assistance needs” and evaluate how meaningful use funding is progressing.

HRSA is seeking public comment until Sept. 21 and then will submit a request to the Office of Management and Budget (FierceEMR, 7/22).

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ONC Announces $38M in Grants To Bolster Use of Health IT

July 28, 2015 in News

On Tuesday, the Office of the National Coordinator for Health IT announced three new grant programs that awarded a total of $38 million to 20 entities to advance the use of health IT, FierceHealthIT reports. 

Details of Grant Programs

The first grant program — called the Advance Interoperable Health Information Technology Services to Support Health Information Exchange — focuses on expanding the adoption of health information exchange technology, tools and services. The two-year cooperative agreement program dispersed a total of $29.6 million among 12 “states or state-designated entities,” including the:

  • Arkansas Office of Health Information Technology;
  • California Emergency Medical Services Authority;
  • Colorado Department of Health Care Policy and Financing;
  • Delaware Health Information Network;
  • Illinois Health Information Exchange Authority;
  • Nebraska Department of Administrative Services;
  • New Hampshire Health Information Organization Corporation;
  • New Jersey Innovation Institute;
  • Oregon Health Authority;
  • Rhode Island Quality Institute;
  • South Carolina Health Information Partners; and
  • Utah Health Information Network.

The second grant program — called the Community Health Peer Learning Program — awarded $2.2 million to health services research organization AcademyHealth over two years to help identify best health IT practices for population health management in 15 communities (Bowman, FierceHealthIT, 7/28).

The third program — called the Workforce Training Program — provided $6.7 million to seven entities over two years to bolster workforce training by updating materials and ensuring “incumbent health care workers” are using health IT tools across various settings.  The grant recipients include:

  • Bellevue College in Bellevue, Washington;
  • Columbia University;
  • Johns Hopkins University;
  • Normandale Community College in Bloomington, Minnesota;
  • Oregon Health Science University;
  • The University of Alabama at Birmingham; and
  • The University of Texas Health Science in Houston (HHS release, 7/28).
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