RHIO Finance Survey - Stand Up and Be Counted
We recently reported on a study that turned up a scant seven operational RHIOs. eHealth Initiative says there are 66, maybe more. Other estimates range from 30 to 200. Ok, this isn't very helpful to the good folks who are trying to architect a national health information infrastructure. Nor is it awfully useful to vendors trying to get some idea about what the market is going to be short- and near-term. Here's a chance for both the established and the barely-planned RHIOs to be counted. The Survey of Regional Health Information Organization Finance has just been released to respondents, sponsored by HITSync in partnership with WEDI (Workgroup for Electronic Data Interchange). Survey design and analysis is provided by Healthcare IT Transition Group.
The survey team hopes to reach all of the U.S. RHIO and HIE (Health Information Exchange) projects with this effort. Success relies on how many of these projects learn about the survey before it closes on April 17. (The direct survey link to send to colleagues and listservs is http://rhiosurvey.hittransition.com/200603.htm). While the survey focuses on finance, it may be completed by anyone in the organization who is familiar with the stakeholders and how the organization is funded. The highly streamlined web-based survey avoids complex financial questions, and asks for very basic, multiple-choice responses, such as "Who among the following were active participants in financial planning and management during the startup period of the organization?," offering a list of stakeholders to be checked-off. Respondents are asked only to answer those questions relevant to their RHIO's stage of development, and will invest no more than 10 to 25 minutes. Take the RHIO Finance Survey. [ HITSync top ]
Dr. Oth000 Can Remain On Staff Who is this Dr. OTH000? Some say he is just a helpmeet for lazy billers, who won't take the time to look up the real doctor's UPIN. Others say he is an accessory to fraud, who appears far too often on overblown Medicare charges that shouldn't be paid. But providers said that sometimes Dr. OTH000 is the only doctor they can find, and they need to keep him available for that fraction of a percent of claims -- a portion that for one provider totalled hundreds of thousands of dollars a year. We helped make the case to Medicare and their plans to dismiss him were rescinded, just in advance of an April 1 deadline. Our coverage of this issue, and advocacy in behalf of providers, is chronicled in a series of blog entries by Martin Jensen:
Senate Would Reward HIT Adoption and Provider Performance Within the machinations of passing a FY2006 budget resolution, the U.S. Senate last week proposed creating a reserve fund to provide incentives for providers to adopt HIT, and to offer performance-based payments for meeting clinical performance metrics. [ HITSync top ]
NBC Nightly News: Electronic Records Fixed the VA "The film 'Born on the Fourth of July' portrayed VA medical care as many saw it in the years after the Vietnam War" begins an NBC Nightly News story on the rennaissance of the Veterans Health Administration. Back then, VA hospitals were overwhelmed. Today's VA is a model of best practices, and the envy of healthcare IT professionals. The VA's massive renovation, begun during the Clinton administration, owes much of its success to HIT. According to the NBC story, "A big advantage for the VA is electronic medical records. The VA has the largest, and one of the most modern systems in the world. When a VA patient visits any facility in the country, the records are there. Indeed, after Hurricane Katrina, many VA patients received uninterrupted care even as they were forced to move." Watch the NBC video.
The Washington Post this week reported that at the VA, while some problems such as slow benefits processing still linger, improvements in care are due in large part to EMR. In a "state of the VA" speech at the National Press Club, secretary of Veterans Affairs Jim Nicholson credited EHR as one reason the VA has become "a model for our nation... truly one of America's good-news stories." [ HITSync top ]
VistA Expanding South -- and Up
VistA, the free open source EMR software originally developed for use by the VA and recently released for public use, is expanding downward -- south of the border -- and upward -- into space. According to Modern Healthcare, VistA has been installed in 21 Mexican government-owned hospitals, and a Mexico public health official estimates that it will be in place at up to 100 hospitals by the end of 2006. Peter Groen, a recently retired VA technology specialist, said that Mexico could well be the most extensive VistA (Veterans Health Information Systems and Technology Architecture) implementation in the world within three years. The price is right; because of VistA's development program, the source code and documentation are all publicly available virtually free of charge. A number of Mexican companies are expected to collaborate with the VistA Software Alliance, a U.S. vendor group that provides VistA consulting services, to spread the system across South America.
Court Rules on HIPAA: Medical Records Are Private, Except When They're Not
The Ohio Supreme Court ruled this week that medical records are not necessarily private, at least in Ohio, because the state's open records law conflicts with the federal HIPAA law. TheCincinnati Enquirer newspaper brought the suit, seeking to compel the city to release information involved in a dispute over lead paint violations. Public health officials had maintained that HIPAA prevented them from disclosing the addresses of lead poisoning incidents because their lead paint violation citations were partly based on children's blood tests. In the court's ruling, Justice Terrence O'Donnell wrote "Ohio has a long-standing public policy committed to open records... The Cincinnati Health Department and its commissioners have a clear legal duty to make the lead citations available." The court was responding to a suit brought by a newspaper in a "public's right to know" case. The disputed private information is to be published, and will be relatively easily traceable to individual tenant children by their neighbors. Looks landmarky. [ HITSync top ]
Interoperability Will Save Healthcare $78 Billion a Year Citing estimates, National Institute of Standards and Technology (NIST) director William Jeffrey says that "widespread interoperability" would save the U.S. healthcare industry $78 billion annually -- about 5 percent of its total costs. Healthcare spending in the U.S. has topped 16% of GDP. In testimony to the Subcommittee on Environment, Technology, and Standards Committee on Science of the U.S. House of Representatives, Jeffrey noted that adverse drug reactions are killing more than three-quarters of a million Americans every year, resulting in unnecessary costs of $5.6 million annually to every American hospital.
According to "Dr. HIPAA" -- Bill Braithwaite -- in his recent testimony before the House Committee on Energy and Commerce, "In the healthcare industry there has been some confusion about the meaning of the term 'interoperability.'" Braithwaite sketched a good definition of HIT interoperability as assuring "the clear and reliable communication of meaning by providing the correct answer and exact meaning of the shared information as approved by the designated communities of practice... allowing the information to be accurarately linked to related information, further developed and applied by computer systems and by care providers for the real-time delivery of optimal patient care." Okay, got that? Now, go Download Jeffrey's House testimony. Download Braithwaite's House testimony. [ HITSync top ]
ICD Whites of Your NPIs After scarcely catching our breath following the HIPAA implementation, and before we've yet seen the whites of the NPIs, ICD-10 is coming a-whistling up the street. By 2009, the more specific -- and far more complex -- ICD-10 code set is supposed to be fully in place, but you can expect some of the big stakeholders to weigh in for a less ambitious timetable at WEDI's ICD-10 Policy Advisory Group next month.
The American Clinical Lab Association (ACLA) went before Congress this month to testify in favor of delaying ICD-10 implementation. In his testimony, ACLA president Alan Mertz recommended that the implementation period be changed from a two-year phase-in to five years, permitting providers to bill using ICD-9 or ICD-10 standards. The Blue Cross and Blue Shield Association is also lobbying for a three-year delay, and has gone public with it, writing in an official statement that "we have serious concerns about the provision in HR 4157 that requires all providers and payers to switch from ICD-9 to ICD-10 billing codes by October 1, 2009... To complete this course of action responsibly, and allow for these steps to take place, we believe that the transition from ICD-9 to ICD-10 should be planned to occur by October, 2012." [ HITSync top ]
A Qualified Blessing: Bill Gates Says EHR Ok At this month's Microsoft Government Leaders Forum Americas in McLean, VA, Bill Gates noted that Microsoft is working with HHS on electronic health records, but warned that this must all be handled with great care. Gates said that such a system could work with the right management and privacy protections. Goodness knows Microsoft understands all about computers and security!
Federal health leaders got to show off their HIT for Gates at a gathering on March 16. Dr. William Winkenwerder, assistant secretary of defense for health affairs, initiated the meetup between Gates and representatives from the VA, Military Health System and the Bush administration. HITSync is pleased to report that no promises appear to have been made during the meeting with officials from the Indian Health Service, which was held in the Old Executive Office Building's historic Indian Treaty Room. [ HITSync top ]
This week we sent thousands of HIT workers an invitation to participate in the first-ever nationwide Survey of Regional Health Information Organization Finance. There are two simple reasons we did this: It was a good fit for us and it was something that would help the industry. The first reason is irrelevant without the second, so I'll start there.
RHIOs are Real, Right?
We noted the recent study that suggested there were only 7 "fully operational" RHIOs in the US. That might not have been so surprising, but that the organization touted elsewhere as the first RHIO (UHIN) was not included in that list. So is RHIO is, or is RHIO ain't?
The 1RHIO Principle Since Dr. Brailer defined the RHIO as the building block of his vision of a nationwide network-of-networks, our weekly inbox has been full of grant announcements and state initiatives and pilot projects, quite literally from sea to shining sea. RHIOs are favored subjects of conferences and white papers and, inevitably, conventional wisdom. One choice tidbit affirms the differences between the nascent organizations: "If you've seen one RHIO, you've seen one RHIO." Call it the 1RHIO principle.
When we heard that phrase repeated by three different speakers in the course of a one-day conference, it kind of stuck in our craw. First, no one really knows whether 1RHIO is true, because no one has done a systematic study of RHIO organizational models, service offerings or financing. Second, we suspect 1RHIO is not fundamentally true, as organizations with a common mission typically face shared challenges, from engaging stakeholders to forming an organization to funding its operations. Third, we believe that, to the degree that 1RHIO is true, efforts should be made to correct that situation. Successes should be shared and repeated; pitfalls should be shared and avoided.
Many RHIOs to Cross The RHIO folk I talk to are facing some incredible frustrations (call it "failure to launch") and proclaiming some remarkable victories (call it "kumbaya"). And even as we compile and organize these details, we need to keep sight of the eventual big picture -- a health record that follows you, even when you're visiting your daughter in Atlanta, or even when your house is under water. We need to help build and sustain RHIOs because doing so will not just save money, it will save lives.
Even as we help RHIO organizers learn from others' mistakes and benefit from others' insights, the collateral benefit will be in learning that they are not alone. Which is important, because we want them to learn to speak the same language.
We Have Met the Entity, and He is Us So why HITTG? Why is a little upstart consultancy taking on such a critical project? Well, because we can. Our principals have conducted several nationwide surveys in the HIT universe which have been both well-received by constituents and effective in bringing about positive change. We got plenty of help along the way, and we learned a lot from the smart people we worked with.
In terms of this particular problem area, I recognized the danger of setting up regional "silos" back before the current policy had been fully articulated. My partner Michael has a long career of using a common set of proven techniques to help nonprofits of every sector -- cultural, healthcare, social services -- establish important programs and fund ongoing operations. We may not be the only consultancy with deep expertise in both Healthcare IT and nonprofit fundraising, but we are certainly the smallest -- and the most nimble.
A Different Sense of Leverage At HITTG, we try to base our business decisions on Archimedes' Principle of the Lever: "Give me a lever long enough, and a fulcrum strong enough, and I will single-handed move the world." We don't presume to think we can fix the entire healthcare system, but we feel it is our responsiblity to recognize where our skills and talents can do the most good, and to put our efforts to that task. We have designed this study to help RHIOs around the country establish themselves, define services and find sources of funding that work for the long term.
To that end, we engage you in the effort. If you are involved in starting up or running a RHIO, please take our survey. If not, you may know someone who is. Help us spread the word by sending a link to: http://www.hittransition.com/RHIO_Survey_2006
______________________________ Martin Jensen is COO and Chief Analyst at Healthcare IT Transition Group, and serves as co-chair of the WEDI Business Issues and Health ID Card Subworkgroups. His standards development experience includes work with X12 on the 5010 versions of the Claims standard, and in leading multi-organization collaborative efforts. He recently served as team leader for the WEDI/HL7/X12/AFEHCT National Health Care Claims Attachment Survey and is engaged in the 835 Coalition, a national effort to improve the adoption rate of the 835 Remittance Advice transaction.
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