The HIT Transition Weblog

July Grant Roundup

Washington State: $250,000 to Pilot HIE

Arizona: $685,000 in Rural e-Health Grants

Louisiana: Millions More for Electronic Medical Records

Vendor Grants $50,000 to Physicians for EMR in Florida

New Federal HIT Grants to be Announced

Directory of Biomedical and Healthcare Grants

The Health IT Grant Resource Directory

Grant Roundup for June, 2008

Health Care Foundations Unveil $4.5 Million Program

Lawmakers Push for Passage of Health Care IT Legislation

Microsoft Awards $4.5M in Grants to 15 HealthVault Projects

Hospital Tax Breaks Smacked in Health Reform Hearing

Pittsburgh Insurer To Provide $29M To Help Physicians Adopt IT

Washington Health Information Technology Grants

Highmark Moves On HIT Funding for Physicians

HHS Chooses Areas Where Doctors Get Paid for Using EHRs

Health Plan Gets Prestigious Grant To Evaluate Physician Incentives

HHS: Grants for Public Health Preparedness

AHRQ Health Information Technology Programs Update

$1.3 Million to Improve Medical Device Use & HIT

Grants Roundup for March 2008

$25 Million Gift Seeks Match from Physicians, Includes Bleeding Edge IT

CDC Awards $38 Million to RHIOs

$150,000 for EMR/Cardiac Pilot Project

AHRQ Awards Millions for Clinical Decision Support Systems

Community Foundation Grants Hit Record, Health Tech-Heavy

FCC Grants to Expand Telemedicine in the Rural West

Vermont: Tax Health Plans to Pay for Health Tech?

Delta Dental Awards $50,000 to Prove Digital Expands Access

Practices Can Win $290,000 in Medicare Bonuses through EMR Adoption

Grants Roundup

HHS Awards Grant to Secure Health Information Technology

Independent Sector Urges Senate Finance Committee to Include Nonprofits in Stimulus Package

$1.2 Million for eMAR for Aging Patients

Idaho RHIO To Get $500,000 from State, $11.3 Million from Providers

CDC Grant Opportunity Requires EMRs

AT&T Awards HIT Grantto Local Volunteers in Medicine Group

State HIT Grants in Virginia

PacificCare Gives $700,000 for Safety Net HIE

Opportunity: New Federal Rural HIT Grants

The Old Rural Healthcare Bond Refinancing Ploy

Grant Roundup for 12/05/07

"Disruptive Innovations" Entrants Invited to Apply for Grants
The Robert Wood Johnson Foundation is looking for ways to shake up healthcare, and they may have found some. Among the projects invited to compete for funding:

• Project ECHO: Knowledge Networks for the Treatment of Complex Diseases in Remote, Rural, Underserved Communities - University of New Mexico Health Sciences Center
• Instant Birth Control - Planned Parenthood of the Columbia Willamette
• Develop a universal technology framework for registries focused on capturing outcomes data for cardiovascular disease -- American College of Cardiology
• Clinical Research Information Exchange - CRIX International
• Health Futures Markets - New York University
• The EpiSurveyor Project: Lowering the Barriers and Raising the Bar for Data Collection - The Datadyne Group
• Space age medical care for use on Earth - Henry Ford Hospital
• Rethinking What a Health Insurance Package Can Be - Working Today-Freelancers Union

Colorado Trust Awards $3.9 Million: Some Room for CDSS, eMAR?
Grants totaling $3.9 million to help strengthen patient care and safety in hospitals around the state. Supports the Five Million Lives Campaign, an initiative of the Institute for Healthcare Improvement (IHI) intended to build safeguards against hospital-acquired infections, ADEs, surgical errors and other complications of patient care.

Center for Community Health Leadership: $3 Million Grant for Connected Healthcare
Organization sponsored by Misys Healthcare Systems commits $3 million to the 3 million-population Tampa Bay area.

North Dakota Woman Has A Global Impact
This busy lady was over and above her fair share with her work for rural clinics and working with public safety groups. But then the Navajo nation wanted to track diabetes using PDA/blackberry technology...

Your Grant Dollars At Work: Rochester RHIO Goes Live
The upstate New York RHIO, funded by a $4.4 million state grant and $2 million from local businesses, has started training 20 participating physician office's staff members. Cork the Champagne!

Surprise! Siemens CEO Touts "Big HIT" Solution

In an announcement that should surprise no one, Siemens CEO Erich Reinhardt is advising hospitals to go with a single source for their Healthcare IT software, as well as, guess what? their heavy and pricey diagnostic equipment.  Reinhardt's appearance at the Radiological Society of North America (RSNA) annual meeting was covered by Digital Healthcare and Productivity.

Regular readers of this blog should know by now that we don't do off-the-cuff vendor endorsements -- nor do we take pot-shots at particular companies or products.  Unless, that is, one of their executives says something that sounds a bit unwarranted.

I really don't know Siemens product line -- I know some very smart people that work for the company, and have no reason to doubt they are doing a great job at whatever.

Grant Roundup for November 20

$400 in Grants from FCC for Health Networks
Now that's a government putting its money where its spin usually is. A large majority of the 80 organizations who applied are receiving funding. Examples: the Cabarrus Health Alliance gets $6 million; Copper Queen hospital gets $183,000.

Near Space Technology Brings Healthcare To Navajo Nation
Satellite technology to monitor diabetes funded by the U.S. Department of Agriculture's Distance Learning and Telemedicine Grant program.

Local Philanthropy Funds Health IT
Grocery magnate Hannaford Charitable Foundation gives $25,000 to Saratoga Hospital in its campaign for Electronic Medical Records (EMR) and Computer Physician Order Entry (CPOE).

First Health IT Grant Resource Directory Developed
The "HIT GRD" serves RHIOs, HIEs, hospitals, clinics, rural healthcare and HIT software vendors with information on private funding prospects for RHIO and health IT.

Wealth Transfer To Benefit Illinois Communities
We've been explaining the U.S. intergenerational wealth transfer for years now: Over the coming few decades, many trillions of dollars will pass from the largest generation ever to walk the earth to its heirs and favorite charities (we estimate nonprofit healthcare's slice to be upwards of $2 trillion -- with a T). And we're not alone; communities are catching on...

Resource: Dartmouth Atlas of Health Care
Some of the facts and figues for creating the HIT support case.

Centralization, Commercialization Threaten VistA

Back in 2005, when Rep. Steve Buyer (R-Ind.) pushed a reorg of the HIT operations at the Department of Veteran's Affairs, we stood up for the good work the VA had done.  Looks like centralization has done worse than impaired development, it may actually threaten the VistA EHR's open-source model.  A recent decision to farm out the lab system to Cerner is just the tip of the iceberg, according to Fred Trotter's cogent and well-sourced analysis.  Buyer's supposed to be a friend to the vet, being a Gulf War soldier himself.  Maybe he should read Trotter's account before he goes back and offers any more "improvements."

If the Software is Free, How Do the Political Cronies Make Any Money?
Maybe Buyer could talk to Dr. Kolodner over at ONCHIT and find out why and how Free Open Source Software projects work.  Before Kolodner left his long and distinguished VA career to take over David Brailer's position, he talked about a FOSS migration path from VistA.  That's a far cry from "the current VA reorganization, which has local VistA programmers reporting to and paid by a centralized office in Washington, [and] has destroyed the control and influence of local VA hospital administrators over the direction of VistA," according to Trotter.

Even if you don't care about veterans, government mismanagement or intellectual property rights, Trotter's concise account gives some insights into the various FOSS development models.  A good read, and worth forwarding to somebody in Washington.

http://hittransition.com/flashpoint/ad.htm

New Money for Health IT

Mention the word “grant” to almost anybody in healthcare, and they immediately think “federal.” And that’s odd, because the U.S. federal government is responsible for less than 20% of the grant dollars given annually to U.S. nonprofit organizations.

We know (because Mike Leavitt recently reminded us) that unlike nearly everywhere else in the world, American government doesn’t pay for health IT. So why are we still standing here like a row of prairie dogs waiting for peanuts? It’s time to start thinking differently, and start looking to the country’s 50,000 private foundations, Community Foundations and corporate giving programs for money for health IT.

Rather than just repeating that exhortation incessantly to everyone who will listen, we have been doing some of the footwork. Through a two-year research project involving more tedious reading and databasing than I care to remember, we’ve compiled a list of just over 4,000 prospective funders of health IT. And not one of them is the federal government. Read on...

HIT Forums Point the Way for 2008 (Part 1 of 2)

I was fortunate enough to attend two healthcare IT conferences last week; one as a journalist (really!) and the other as an invited speaker and guest.  Officially, I was gathering information at the first conference and sharing information at the second conference.  Unofficially, I was flogging our products and services -- upcoming webinars on Real Time Adjudication, HIT ROI for provider organizations and the Black Swans of Healthcare IT; and our just-released 5-volume set of healthcare IT funding sources.  Nobody seems to have discovered these ulterior motives so please keep my secret to yourself.  Whatever you do, don't forward this email to everyone you know that might care about saving money or avoiding disaster next year!

How the Other Half of One Percent Lives
The Collaborative Communications Summit is a boutique conference for C-suiters.  The concept is to put the event in a tony venue that pampers the executive appetite and bring in a raft of brilliant speakers and those who move and shake the industry. Last week’s CCS topic, “Transforming Healthcare through Health Information Technology,” was enough to pique my interest when I read about it a few months back. When the conference organizers offered us a media sponsorship that included a free press pass, we jumped on it.  I was already going to be in LA to speak at the Blue Cross Blue Shield Association's Blue Health IT Symposium, so I could make the CCS event for the price of a couple nights at the hotel.  How much could that be?

Historically, my conference experience has been more focused on getting in the thick of things with the doers and persuaders than rubbing elbows with the financers and deciders. I’m pretty familiar with the Metro system in DC, the shuttles at O’Hare and the rental car agencies at DFW, but finding my way to CCS’s ivy-cloaked venue, the Peninsula in Beverly Hills, was a different sort of commute. In my more skeptical moments, I fully prepared myself for one of those fly-and-bye junkets we hear about – the execs make an appearance at the keynote, then head for the golf course, spa or shopping district.

It’s good to be wrong sometimes.

The President is a Lot Smarter Than You Think!
No, not that president.  I’m talking about the president of the company – maybe even your company. The CCS sessions were substantive and dealt with the underlying causes of the challenges and dysfunctions facing the healthcare industry, and the ways that healthcare IT can – and cannot – hope to address them.  The event was intimate – all the sessions took place in a single conference room laid out cabaret style with round tables and a raised dais at one end. 

The vendors were there, of course, but held back from the full frontal sales pitches that seems increasingly characteristic of HIT forums as the industry heats up.  Instead we got case studies, policy analyses and trends.  The interactive style remained consistent throughout, which lent a sense of industry gestalt to the proceedings.

Bullets over Bel Aire
Here are some of the things that seemed to emerge from the group mind.

Health IT Grant Roundup

Creative applications of lifesaving health IT

These examples scarcely glimpse at the wide range of creative ways IT systems are beginning to find philanthropic support, often by emphasizing the critical information technology infrastructure backing up telemedicine and other clinical systems.

Remotely Healthy: Monitors Keep Track of Patients from a Distance
Multi-year grant from Health Foundation of South Florida.

Excellus BCBS Expands Partnership with Hospitals to Combat Hospital-Acquired Infections, Save Lives
$5 million expansion of funding for upstate New York hospitals involving infection control (real-time electronic access to infection-related clinical data component). In the GRD see the related Community Health Foundation of Western & Central New York.

Verizon Foundation Provides Funding for Seven South Carolina Nonprofit Programs
Relatively small grant with a portion for connectivity, communications, translation software.

Indiana HIE Receives $1.7 million Grant
The Indiana Health Information Exchange (IHIE) receives $1.7 million from Regenstrief Foundation to support participation of small primary care practices in the RHIO.

Washington Regional Receives $2 Million From Wal-Mart
Nearing completion of an $8 million clinical information system, the grant supports these technology advancements to generate better information and enhanced data, and streamline processes that produce better patient outcomes.

Case Management Technology Could Cure Some of State's Health Care Ills
Joint venture funding confronts electronic chronic care case management.

Missouri Foundation for Health Infrastructure Grants
17 grants totaling $2.484,023 million to area health departments for infrastructure projects including the purchase of equipment supporting information technology, communication services; includes $576,646 to update the building and information technology equipment for Springfield-Greene County Health Department.

Working with legislators:
Hays Medical Center Receives $500,000 Federal Grant for Telemedicine, Connectivity
"We're very fortunate, Kansans are," said Jodi Schmidt, chief development officer at HMC. "Our congressmen are great about helping us go after federal funds for these sorts of things." Federal grants for these and related projects have totaled about $4 million over 10 years, the most recent (October, 2007) being the largest.

Effective Coattails:
Palo Alto Medical Foundation Receives $1.2 Million Grant for New Diabetes Management Study; Trial Will Evaluate Online Disease Management
Funds a solution developed by several partners including iMetrikus, Epic Systems, Palm and Sprint that will automatically upload blood glucose readings to patient's electronic health record

http://hittransition.com/flashpoint/ad_rhio2.htm

Allscripts Exec Drinks CCD Koolaid, Sees RHIOs Dry Up

"The more important fundamental laws and facts of physical science have all been discovered, and these are now so firmly established that the possibility of their ever being supplanted in consequence of new discoveries is exceedingly remote.... Our future discoveries must be looked for in the sixth place of decimals." – Albert. A. Michelson, German-born American physicist, 1894.

There was so much interesting stuff in Joe Conn's article in Modern Healthcare last week, I nearly had to flip a coin to figure out what to say about it.  Okay, yeah, it's something of a coming-out story for HIMMS' Electronic Health Record Vendors Association (EHRVA), and sure, they've decided to all go ahead and adopt the Continuity of Care Document (CCD), which is the compromise clinical summary standard worked out by the proponents of the competing standards developed by HL7 and ASTM, and, great, they're expecting CCD to be a part of the next round of CCHIT requirements. 

And CCD is, of course, better than a herd of ezras, so we have to kick some sand in the face of the holdouts that are for some reason continuing to espouse CCRs for PHRs and the like, a task to which an Allscripts representative dutifully lends his foot.  (Sorry for not expanding all the mynorcas, but I understand a half-million dollars is being spent by ONCHIT to build a HIT lexicon, so I don't want to steal their thunder)

But then this pops out:

Adoption of the CCD standard by EHR vendors would allow providers using different systems to "support transitions of care without requiring a regional health information exchange to be in place," said Dan Michelson, chief marketing officer for EHRVA member Allscripts, in a news release.

(Continued...)

http://hittransition.com/flashpoint/ad_rhio2.htm

HIT ROI and Incentivizing Swampland Development

I was digging around on some RHIO research (there's a new report out from an organization that is trying to corral the RHIOs into something that might begin to look like a National Health Information Network -- or at least look more like each other). I forgot to take my ADD meds today, so I was clicking away, deeper and deeper into hyperspace when I struck upon Mark Frisse's Policy blog.  Now, Dr. Frisse is a heavy hitter in the RHIO universe.  He sits on blue ribbon panels and he speaks to hifalutin conferences and he coauthors important papers, meanwhile holding a leadership position in one of the country's more forward Regional Health Information Organizations.

So, I expected what I usually get when I see such a luminary has a blog: Two or three cursory posts that read like press releases, followed by many months of neglect.

Imagine my suprise when I discovered his posts were personal, thoughtful, insightful and -- get this!  -- recent.  And long.  (He almost makes me look concise.)  But readable.  Unfortunately, he doesn't include a permalink on his blog entries, so you need to go to his October archive and scroll down to find "Building Nirvana Without Draining the Swamp."

His point -- one of them -- is that it's basically futile to talk about return on investment for healthcare IT, or to determine who should pay for it, until we fix the healthcare system itself.  Since Michael and I are doing a webinar on ROI for healthcare IT in a few weeks, I thought I had better read it. (Continued)

CIA to Take Over VA Medical Records

[Okay, this was originally a clever and slightly scary story about the involvement of the CIA in a certain Health IT company (true) that is developing certain identification technologies (again, true) that take advantage of a very sophisticated database technology (absolutely true).

Unfortunately, the author of the story has been unable to substantiate a direct connection between that HIT company and the company that develops the database technology, and it is that second company that is working with the VA.  So, the wry, but somewhat worrisome tone of the original text falls pretty much flat on its face.  The editor regrets the error, and the author is scrambling for some old notes.  I wish him the best.

We don't usually do conspiracy stories.  Maybe this is why.  Hope you like the cartoon, which is still valid, as it concerns only the proven connection between Company A and The Company, as it were. -Ed.]

Nonprofit Hospital Foundations Enjoy Growing Returns

Commonwealth Institute just released a report finding that U.S. healthcare nonprofit organizations (NPOs) -- largely hospital/health system operating foundations -- reported an average return of 10.6 percent in 2006.

According to the 2007 Commonfund Benchmarks Study Healthcare Report, the average return increased from 6.3 percent in 2005 and 8.2 percent in 2004. Oorganizations with more than $1 billion in operating funds reported an average return of 12.2% for 2006, up from 7.2% for 2005 -- the second highest return since the study was started.

Returns averaged over three years have fallen somewhat, due largely to an outlier in 2003 at 14.1%, which has now dropped off the average. The three-year average on NPO healthcare returns now stands at 8.8%.

So, what are nonprofit healthcare organizations investing in to get these returns? Read on...

Rainmakers for Health IT and RHIO

Had a couple calls this week from IT vendors about our RHIO finance report (http://rhio.hittransition.com). Interesting calls. Both wanted to know how to get more involved in their customers' affairs to try to get them off high center and out pounding the pavement for funding. Seems they've been working with RHIOs for over a year now and still haven't seen a check.

"What's it gonna take to move this needle?" was the frustrated question from one. She's with a big software company and not used to sitting on her sales cycle quite so long. The RHIO "hasn't pulled in any funding since the initial grant and now they're running on fumes."

I asked both callers if they themselves had provided any funding. "No, but we haven't been asked" was the approximate reply from both.

The Wal-Mart Effect on Healthcare

Once again, the Mr. HISTalk site has me thinking.  This time, it's a reader's forum post on the possible impacts of Wal-Mart's entrance into the health care delivery market.  A fellow calling himself Art Vandelay lays out some pretty thoughtful possibilities.  His narrative investigates every aisle of inquiry, from the push toward transparency in pricing and wait times to the impact a nationwide, HIT-enabled provider network could have on road warriors strapped with high deductibles and a runny nose.

As a neighbor (the Behemoth of Bentonville is a short drive from Tulsa, close enough that we can hear it breathing at night), I've long been intrigued by the Wal-Mart Effect and the impact it might have on US healthcare.  Not just as an entity, but as a model of monopsony: The dominant influence that a single purchaser (oops -- I almost said "single payer") can have on a market.

Health IT Fundraising Performance

Part 1 of a series on HIT fundraising
See the other installments in the Grants and Funding category.

NOTE: Michael is presenting a webinar, “The Grant Search for Health IT – Resources and Techniques,” on October 2 and 3.

A Brief Intro: Health IT funding topics have become the most-viewed content in our webspace at hittransition.com. We are offering this series to meet a growing demand for “fundraising moxie” among IT administrators. We will proceed as if your institution’s development department or operating foundation has abandoned you or doesn’t exist (maybe you’re a small rural operation), and you’ve got to do it all on your lonesome. Naturally, if we can get cabinet folk onboard, the hospital’s fundraising staff will take over a large part of this work. In any case, you will benefit immensely by knowing the principles involved and where you fit in. This will be a straight-shooting series, no holds barred. When we can point you directly to where the bodies are buried we intend to do just that. So I feel like I need to toss this out right now: Please don’t be offended at my unapologetic use of every tool at my disposal to unearth cash. We speak plainly around here, and this delicate topic will be no exception.

Juicy Carrot for New York Providers

Perhaps $9.5 million seems like a skinny carrot when you're talking about attracting physicians across the state of New York. Be that as it may, much of this new state money for tackling some nagging healthcare problems seems headed for the right places. Independent Health Association, an IPA, and Taconic Health Information Network and Community RHIO (THINC), an IPA-centered health information exchange (and I thought we had a long company name) are getting some of it. The idea is that the state will be able to better manage chronic illness and epidemics if health information is available. A capitol legislative angle, I would say.

Less RHIO Money from Physicians - And this is a good thing?

Physicians were 88% less likely to be cited as a significant source of earned revenues by startup-stage Regional Health Information Organizations than they were a year ago. Physician contributions to RHIO earnings also dropped among more mature RHIOs. The data comes from the annual Survey of Regional Health Information Organization Finance (http://rhio.hittransition.com). Less money for RHIO. So, how is this a good thing?

$31.4 Million in Health IT Grants

The federal Health Resources and Services Administration (HRSA) part of HHS, has awarded IT funding to 46 federally qualified health centers across the nation that serve uninsured and underserved populations. $27 million will go directly to EMR implementation projects at 25 federally qualified health centers, ranging from $460,00 to $1.4 million per center. E-prescribing, physician order entry, PHR, smart cards, HIT adoption planning and RHIOs took the remaining funding, ranging from $100,000 to $300,000 per grant.

In another announcement, the Colorado Health Foundation has awarded $2.5 million in grants to twenty-one groups to improve health IT systems through the foundation's Healthy Connections: Strengthening Care Through Health Information initiative. Among the recipients are nine federally qualified health centers.

2007 RHIO Finance Survey Released

Is RHIO expansion incompatible with commercial viability?  Well, yes and no.  Find out why in our just-released report on the 2007 Survey of Regional Health Information Organization Finance, "Sustainable RHIO Funding and the Emerging Business Model."  We know that you love all the free information we bring you on our blog, news pages, HITSync newsletter, etc., but this one is gonna cost you.  Why?  Because it's worth it, and we need to occasionally charge a fee so we can stay in business and keep putting our shoulders to the grindstone of transforming healthcare through HIT.

State CIOs Invite Bigger Role in RHIO

The organization that represents the CIOs of state governments says its members should take a more active role in their states' Regional Health Information Organizations. This would definitely rate a "Duh Of The Month" here at the HIT Transition Weblog, except that I'd like to take a step backward and say that I'm not entirely sure that it's such a good idea until state governments show more willingness to pay for RHIO development.

According to a Government Health IT article, the National Association of State CIOs (NASCIO) is calling for its members to have a bigger say in how RHIOs develop. “Integrating these regional efforts will become a critical aspect of state CIO responsibility,” states a NASCIO brief. State government CIOs could serve as advisors to represent state health programs' technical interests.

Fine idea... but governments are already more involved in RHIO management than the dollars they offer would seem to justify.

Long Ways from RHIO?

An article in Information Week makes clear that the remaining barriers to the build out of Regional Health Information Organizations (RHIOs) are formidable. It states:

"Santa Barbara serves as a reality check on the U.S. health care system's slow progress toward a real EMR network. The diagnosis: It's worse than you think."

The National Health Information Network (NHIN), envisioned as a meta-network of the regional medical records networks, relies on widespread RHIO implementation and a relatively complete provider membership in order to reach the dream of a truly portable health record and the realization of healthcare cost savings estimated by some to be in the tens of billions annually.

In the two-and-one-half years since the Administration first called for a fully implemented NHIN by 2014, we see that no more than about 10% of physicians are using electronic medical records, and perhaps less than 1% are connected in any way to what could even be remotely called a RHIO. At the same time, eHealth Initiative tells us that there are more than 160 U.S. RHIO projects in one stage of development or another. So what's keeping adoption rates so low?

Two words: data sharing...

RHIO Business Model Evolving

UPDATE: The findings from the 007 RHIO finance survey have been posted at http://rhio.hittransition.com. 

A year ago we conducted the first survey of Regional Health Information Organization finance, and published a 50-page report, Funding RHIO Startup and Financing for Life. Over the past year we have had innumerable phone calls and emails from RHIOs with questions, and from publications -- most recently Most Wired Magazine -- with requests for interviews.

The newest callers want to know, What's happened in the past year? And we should be able to tell them (maybe), because we've just completed the 2007 Survey of Regional Health Information Organization Finance. A full report will be forthcoming in June, but it makes some sense to talk about what we'll be looking for in the new data.

2007 RHIO Finance Survey Opens to Respondents

UPDATE: Findings from the 2007 RHIO finance survey have been posted at http://hittransition.com.

For a second year, Healthcare IT Transition Group is conducting its national survey to learn how Regional Health Information Organizations (RHIOs) are funded. Last year, in the first-ever broad-based study of RHIO finance, some surprising things surfaced, including that a sustainable business model was evolving.

The 2007 survey questionnaire is nearly identical to the 2006 survey, enabling a year-on-year analysis. We have added one new section, however; this year information will be gathered on the purchase decisioning process. From talks with industry leaders following last year’s findings, we learned that vendors were finding the RHIO segment a difficult one in many respects, particularly with regard to the variety and number of stakeholders involved and the lack of historical data in this new sector.

IRS May Allow Non-Profits to Help Docs with HIT

The IRS threw some cold water on non-profit hospitals last year when they advised that new Stark exceptions might still compromise a facility's non-profit status.  The new Stark safe harbors were designed to allow hospitals to assist non-employed physicians with certain healthcare IT investments and technology support.  We didn't think the revisions went far enough, but it did seem to be a move in the right direction.

A Hitchhiker's Guide to the RHIO

REVIEW: Forming a RHIO? Christina Thielst, MHA, CHE. 2006. 47 Pages.

Christina Thielst may be the bravest healthcare administrator in the galaxy. Not because she ran a RHIO – with Dr. David Brailer on her advisory committee (she knew him when) – but because she took the huge risk of trying to boil her experience down into a guide running just under 50 pages.

Thielst (pronounced “Tilst”) has written a white paper, Forming a RHIO?, which attempts to demystify many aspects of RHIO development, from pulling the stakeholders together, through crafting a governance framework and bylaws, to sample policies and budgets. For all its brevity, this is not a thin guide.

Statewide RHIO Envisioned, NAHIT CEO Leads Cheer

At a November 17 conference held in advance of dedicated planning, some of the potential partners in an Oklahoma RHIO expressed a desire to reach out to include the state's many small rural delivery points. Others were content to focus on two urban RHIOs, one for each of the state's major metropolitan areas, Oklahoma City and Tulsa. The conference, sponsored by the Oklahoma Hospital Association, featured as its keynote speaker Scott Wallace, President and CEO of The National Alliance for Health Information Technology (NAHIT) and Chair of the Commission on Systemic Interoperability.

RHIO Finance Whitepaper Released

UPDATE March 29, 2007: The 2007 RHIO finance survey has been opened to respondents. Visit http://hittransition.com/rhio2007 for information and to take the survey.

UPDATE June 21, 2006: We released a new 50-page report on RHIO Finance, available at http://hittransition.com/RHIO_Survey_2006.

When a new species of organization evolves, there are sure to be a lot of different ideas and downright confusion about how they should be built. At a recent conference called to jumpstart planning for a new state RHIO, I heard that favorite cliche, "If you've seen one RHIO, you've seen one RHIO" at least half a dozen times from the dais alone. Well, I'm here to tell you, nonprofit organizations, for all their idiocyncracies, are a lot alike in some critical ways, and you're headed for trouble if you don't get them right. The argument over how RHIOs should be funded was treated by several speakers, including Scott Wallace, President and CEO of The National Alliance for Health Information Technology (NAHIT) and Chair of the Commission on Systemic Interoperability. I thought it was time to address one piece of the finance question head on.

Healthcare IT Transition Group has just released a new whitepaper entitled "The Integrated Path - Incorporating Contributed Revenue in the RHIO Finance Mix: Not Whether but How," available as a free download at

Stark Realities: Better Mind Than Mine

In my post from earlier today, I wanted to site the article from Thomas E Jeffries of Davis Wright Tremain, which red-flagged the proposed Stark relaxations, but I had received it by email and couldn't find a copy on the DWT website.  The site is a rich trove for any HIT policy wonk.  I couldn't quit browsing.  Then, by accident, I found it. 

Here's the link: HHS Offers Cautious Protections for E-Prescribing and EHR Subsidies

Stark Realities: OIG, CMS Offer "Safe Puddles"

"We know, we know," federal officials have been saying for months, "If we want physicians to adopt Electronic Health Records and e-prescribing, we have to make it possible for hospitals to help them out."  That means waiving Stark and Medicare anti-kickback rules which prohibit hospitals from subsidizing physician HIT investments.  "Don't worry," they assured us, "we're working on it."

Drafts of the new rules were published this week by the Office of the Inspector General and the Centers for Medicare and Medicaid Services.  The problem is that they've hemmed in the shoreline of this much-ballyhood and oft-promised safe harbor so much that the PC on your desktop probably couldn't fit into the resulting puddle. (Actually, one rule allows hardware, while the other disallows hardware.  Don't make me go there.)

What's that?  You had a PC there already?  Sorry, that's an upgrade.  And you're going to use it for billing, too?  Not allowed.  You already had a first-generation EHR and this one is better?  You may be in violation....

Models for Master Patient Index

Government Health IT carries a story about successful implementation of Master Patient Index (sometimes referred to as Master Person Index) systems in Canada and New Zealand.

With a single-code Unique Patient Identifer knocked out of the initial HIPAA legislation by privacy advocates, and a reported prohibition against funding such work added to each year's Continuing Budget Resolution, the "index of identifiers" approach seems to be the best approach.

Read about it in Master index pitched as patient ID alternative.

Is Brailer reading our blog?

From Government Health IT:

"I want to see a digital health information infrastructure happen for the people of the Gulf Coast," Brailer said. "We can deliver personal health records that move with [the patients] as they go through care....We have lost the medical records infrastructure" in New Orleans and nearby areas, he said. "It's gone."

Paper records were stored in basements and cannot be recovered, he said.

Health IT to help with care for Katrina victims

Okay, so he didn't have time to read what I posted yesterday.  But it's nice to have the big guys on your side, even if you are way in the back, pushing....

HIT vs Hurricane? Hillary Pumps EHRs

We got the news last week that some pending HIT legislation may be delayed by the priorities imposed by Katrina.  Worse, some are saying the money won't be there either -- the billions going into relief will dry up any incentives or initiatives we might have hoped for.

Sen. Hillary Clinton isn't so sure.  Clinton co-sponsored the Wired For Healthcare Quality Act (S. 1418) and has crossed the aisle to win broad bipartisan support for HIT efforts with her Republican colleagues.  Of the electronic health record, she affirms, “It is not a luxury, it is now a 21st Century necessity.”

EHR - Notes from the Front Lines

I just happened across a remarkable account of a small physician practice in implementing an Electronic Health Record system, published online by the Annals of Internal Medicine.  Battered and bruised from the effort, they would not go back to paper.

Here's a tidbit that's relevant to our standards development work:

Computerization in a world without established standards that link medical data systems is inefficient. When we have a working interface, as we do with our main outside clinical laboratory (which handles about 80% of our laboratory testing volume), the reports come "named," and the individual laboratory results automatically populate flow sheets and letters to patients. Results can be efficiently retrieved and graphed, and trends can be analyzed. Unfortunately, most of the information we receive (such as radiology reports, consultations, and procedure reports) does not come to us in a format that the system can recognize electronically. Our colleagues in integrated delivery systems and the Veterans Administration do not face this problem because most of their clinical data are generated within their system and the interfaces already exist. National standards on the interoperability of medical data systems would be a big step forward for small practices. For now, we may switch referral patterns to hospitals and specialists who will give us information in a form that flows most easily into our system.