CMA comments on HHS proposal to reduce health IT burden

  The ongoing

Friction between physicians and CMS remain high due to recommendations from almost all physician specialty groups and the AMA.  Because of this physicians have lost confidence in the AMA to initiate changes for the better.

Most physicians are up against the wall in regard to time commitments and dollars, having little time to devote to political matters to sway legislators with education and information. Most of the time physician recommendations are ignored.

Physicians have been labelled as recalcitrant, or even worse. Physician burnout is reaching a significant loss of professional workforce, and has ruined many lives, families and communities.

Now, one office, the HHS Office of the National Coordinator for Health Information Technology (ONC), in partnership with the Centers for Medicare & Medicaid Services (CMS) . is taking action

The draft Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs was led by the HHS Office of the National Coordinator for Health Information Technology (ONC), in partnership with the Centers for Medicare & Medicaid Services (CMS), as required in the 21st Century Cures Act.

The California Medical Association (CMA) this week submitted comments on the proposal, urging HHS to implement strategies that prioritize interoperability and the use of technology to improve patient care.

Among CMA’s recommendations were:

• CMA supports standardizing and automating prior authorization processes to reduce the burden on physicians, as well as improving real-time access to payer requirements for prior authorization.
• ONC should require EHR vendors to design systems that are usable based on the needs of medical practice in order to receive CEHRT approval, and impose penalties when these standards are not met.
• ONC should strengthen CEHRT interoperability standards and utilize enforcement mechanisms to secure compliance from EHR vendors
• ONC should require greater consistency across EHR systems to encourage sharing of clinical data
• Simplify and reduce the quality measure reporting physicians are required to complete for federal programs
• ONC should improve its enforcement against vendors who participate in data blocking or violate other certification requirements and help develop systems that allow for automatic extraction of data measures from EHRs
• ONC should work with states’ existing regulatory standards to promote interoperability between PDMPs and EHRs

CMA also reemphasized its strong opposition to  the proposal to collapse the E/M office visit codes from eight to two for both new and established patients, and disagrees that the added documentation reduction from the code collapse-single payment proposal as envisioned by CMS will be realized.

 comments on HHS proposal to reduce health IT burden

CMA comments on HHS proposal to reduce health IT burden: Physicians are overwhelmed with unnecessary, burdensome regulations that take time and resources away from providing quality patient care.

The Future of Global eHealth -

The Future of Global eHealth -

sources:  healthinformatics.uic.edu/blog/the-future-of-global-ehealth/ 

What is eHealth? 

Electronic health, or eHealth, represents information and communication technologies used by the health sector. These include electronic patient records, remote patient medical care through telemonitoring, and connecting with health practitioners over the phone through telehealth. How did it Start? The Internet There are concerns about the quality of health info patients can access, yet doctors are now realizing the Internet can assist them with their jobs. Patients’ access to internet searches increased their information, which changed their relationship with doctors and created a shift in the patient-provider dynamic. 

How Widespread is eHealth? 

A 2015 World Health Organization (WHO) survey revealed 160 WHO member countries have some form of universal health coverage, and 74% of these countries mention eHealth as a component. 153 countries have legislation protecting a person’s privacy data relating to their electronic health record, and 134 countries have a national eHealth strategy or policy. 

The survey also found that nearly 80% of healthcare organizations in WHO member states use social media to distribute their health messages. Additionally, the survey pinpointed telepsychiatry as the telehealth service that increased the most between 2009 and 2015. How eHealth Can Help Health care systems the world over are facing rising costs, system inefficiencies, access issues, and quality issues. However, these pressures are some of the issues eHealth initiatives aim to solve. These initiatives strive for this goal through many ways. Digitizing personal health information helps build more complete histories. The creation of electronic health records can also make it easy to share patient data between systems. eHealth can also empower patients with their own electronic records and can also be used to implement various telehealth and home health options to improve chronic disease management. The process of adopting eHealth initiatives is not without its core challenges. These include insufficient communication of eHealth goals, concerns regarding system standardization, and a current lack of governance and funding. WHO has also tied the implementation of eHealth to a goal of achieving universal health coverage in remote and underserved communities. However, this takes a lot of work. 

Some of the Challenges Facing Specific Types of eHealth Telehealth 

Telehealth uses information and communication technologies to provide advice and reminders, handle remote admissions, and remotely monitor patients directly and remotely. It allows specialists to see more patients, and it makes it easier for remote patients to get services. It can also help cut costs linked to hospital visits and can lower the number of patients that need emergency transfers. There are several challenges to implementing telehealth. These include insufficient system development funding, inadequate equipment and internet-related infrastructure, a lack of synchronicity between health system priorities, and a lack of regulatory guidance.

eLearning Programs 

These health care training models are conducted online. This helps circumvent potential shortages in necessary instructors, bridges skills gaps amongst some workforces, and makes it possible for isolated care providers to receive needed training. However, there’s a hesitancy to move to less conventional teaching methods, as well as concerns around the existence of suitable eLearning programs. There are also challenges stemming from an HR and funding perspective. Mobile Health This concept utilizes mobile phones, personal digital assistants, and other wireless devices for public health services. It doesn’t require much infrastructure, and it’s cheaper than in-person services. Plus, several low- to middle-income countries still have high cellphone subscriptions. The challenges facing this concept include the cost and functionality of different plan types, as well as insufficient network infrastructure in some places. There are also questions concerning some patients’ digital literacy and the relevancy of the health content. The concept itself is also not always accepted culturally or socially. The Need Ultimately, the key to overcoming these challenges is to treat eHealth as a key part of health planning, and not just as an add-on. After all, a trained workforce proficient in eHealth systems can provide proper leadership and oversight to others. 

How eHealth is Being Used Globally 

While there are several challenges to eHealth program implementation, that’s not stopping countries and regions from investing in the concept. The U.S. has contributed the most, followed by the EU, Canada, Japan, and Latin America. One of the biggest ways eHealth is being used is text messaging. For instance, the Stockholm-based blood donation service Blodcentralen uses texts to retain and build its donor pool. They also send out “thank you” texts every time donated blood is used in patient treatment, something that helps people to continue donating. 

How Some Countries Facilitated the Spread of eHealth 

England contributed £6 billion to eHealth over a 10-year period with an emphasis on regional deployment. The investment yielded positive dividends relating to data sharing and data entry protocols. However, they realized that clinical implementation and regional-centric adoption is tricky. They also learned sharing health records is ineffective. 

Canada created a federally funded organization to establish an eHealth blueprint that allowed for regional governance, the establishment of standards, and a focus on electronic health records, telehealth, public health surveillance, and various health systems. The program helped them focus on funding eHealth-related projects, initiatives, and models. Their approached also revealed insufficiencies with record integration, program standardization, and underfunding. 

The U.S. contributed $30 billion for a host of eHealth-type programs and provided financial incentives for providers who used IT in a “meaningful” way. This program helped to establish Funding Regional Extension Centers to implement this meaningfulness, and it allowed them to acknowledge the need for training, education, and communication to properly adopt eHealth initiatives. Along the way, they learned lessons regarding system connectivity and post-funding support – lessons that can also be learned from observing other countries’ successes and failures. 

Ultimately, as more countries look to eHealth to provide better healthcare, we’re getting a better sense of what does and doesn’t work. What’s clear is that the health sector has plenty to gain from relying on information and communication technology advancements. Early success stories show that comprehensive strategies, good education and training, and careful program monitoring to see what works and what doesn’t are critical to making the most of what technology can offer.

And on the not too distant horizon is the rapid technological advances in satellite launches. The development of the Falcon family of launch vehicles has markedly reduced the cost of rockets using reusable launch vehicles that only require minor refurbishing. The major cost of a reusable platform is only fuel.

The LEO constellation offers much lower latency times for packet comunications.  This requires hundreds of smaller satellites. Several companies are already competing for customers. The time period for completion of such satellite networks can be measured in years, not decades.

Artist rendition of LEO satellite network

Artist comparison of LEO and Geo Stationary Orbit

Telehealth Regulations, U.S. Current State Laws and Reimbursement Policies |

Ten years ago few providers or patients knew much about telehealth. State regulators and medical boards had few if any rules about using tele-health. In fact there were issues surrounding the lack of a physical examination using tele-health.  However because broadband internet has become more available except in rural areas it is possible to talk and view patients in real time.

There are now commercial vendors that offer these services to any providers wishing to adopt tele-health for their practices. Some of these have become public companies.

Zoom can be deemed a HIPAA compliant web and video conferencing service that is appropriate for use in healthcare, provided a HIPAA-covered body completes a business associate agreement with Zoom prior to using the service.  Zoom has already been put in place by many healthcare groups worldwide who use the platform to interact with other providers and communicate with patients. However, in the USA healthcare groups must adhere with HIPAA Regulations. 

Zoom, as a business associate, would need to complete a contract with a HIPAA covered body before its service can be used with ePHI. That agreement – a Business Associate Agreement – acts as a confirmation that Zoom is aware of its obligations in relation to the privacy and security of PHI.

Zoom is willing to complete a business associate agreement with healthcare groups and has ensured that its platform includes all of the required security controls to meet the strict requirements of HIPAA.

In April 2017 Zoom revealed that it had introduced the first scalable cloud-based tele-health service for the healthcare sector. Zoom for Telehealth allows enterprises and providers to communicate simply with other group, care teams, and patients in a HIPAA compliant fashion.

A HIPAA compliance agreement  must be signed by a medical practice with Zoom.com which defines HIPAA security, privacy and confidentiality issues.

Only until recently the rules and regulations governing telemedicine were not well defined by regulators leaving users open to criticism and possible vulnerable to  medico-legal issues.

You will find here the state by state rules at the present day, January 1, 2019.

Physicians should otherwise use their own judgment as to how to use tele-health and instruct patients as to it's limitations and seek direct provider contact. A tele-health portal should have a sign in agreement with instructions,   precautions, and suitable waivers.




















Current State Laws and Reimbursement Policies | CCHP Website

The Disconnect between Doctors and Software Designers

Doctors are asking Silicon Valley engineers to spend more time in the hospital before building apps

• Richard Zane, an emergency room physician, developed a program so that engineers can understand the clinician's workflow before they build their products
• RxRevu is one start-up that shadows Zane on the job.
• In the Bay Area, it's become common for doctors to invite technologists from Google and elsewhere to follow them on the job

As an emergency room physician, Richard Zane often considers how software can help him with patients. The problem is that engineers and doctors are from different worlds.

Zane, who's also the chief innovation officer at UCHealth in Colorado, said that most technologists he's met have never seen the inner workings of a hospital and don't have a deep understanding of what doctors want and need.

"We found that tech companies more often than not had a preconceived notion of how health care worked," Zane told CNBC. They've "gone very far down the path of building a product" without that input, he said.

Zane decided one way to bridge the gap was by inviting in developers from companies to see how he works. For now, that involves monitoring how he uses computers and other software tools to document and make decisions, but keeping them out of the operating environment and away from patient information.

Start up developers are much more inclined toward working with doctors one on one, with their efforts to build better software by attending clinics and surgery to observe.  One possible barrier to this is HIPAA which requires additional permissions and a business associate agreement. Established companies such as EPIC,  CERNER and others have little to gain since they have a huge market share and little motivation to improve their product(s).

Epic Systems, the largest privately-held medical records company, reportedly sends its engineers along to open heart surgeries so they can see how important it is for their software to function in critical situations. Even so, many doctors see plenty of room for improvement when it comes to Epic's user experience.

Physicians need more from their software. In general, they're spending less time with patients, and more on so-called desktop medicine, which involves hours of documentation in front of a computer after a long day at the clinic. Studies find that so much time on administrative tasks related to things like billing is contributing to increased levels of physician burnout.

Zane wants better technology, built with an understanding of how doctors work.

'Your engineers, my clinicians'

Carm Huntress, the founder of a start-up called RxRevu, shadowed Zane and is applying what he learned.

RxRevu, based in Denver, worked with the hospital on a service to help physicians figure out how to prescribe better. The company's software aims to quickly figure out whether certain drugs will interact negatively with each other, if a patient is allergic to a medication or if insurance covers a specific drug. The goal is to help doctors have informed conversations with their patients about their options.

Huntress said one thing he noticed in observing doctors at their desks is that many automatically move their mouse to delete a notification before reading it. He could tell that clinicians were suffering from alert fatigue and might be missing out on important information amid all this noise. Doctors work extremely long shifts and see dozens of patients, so they need to avoid anything that's even more "taxing on their brain," Huntress said.

Despite more than ten years of criticism by users of their software systems, little has changed....

Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout.



Doctors are asking technologists to shadow them before they build apps: Doctors have had enough with software that's not useful, so they're inviting entrepreneurs to shadow them.