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Tuesday, August 13, 2013

Meaningful Use to become a "political football"?

From Government Health IT's

"5 nagging questions about meaningful use Stage 2"
3. Will MU become just another political football? Hatch and company being Republicans and the Obama administration being decidedly not, some observers are afraid that meaningful use may end up impeded by the gridlock that seems to define so many other debates in the nation’s capital these days. And yet the gridlock, one could say, only reflects the fact that there are no easy answers concerning how to move forward. “If the existing meaningful use deadlines and eventual outcome milestones get extended, critics of the Obama administration get to point to yet more healthcare dollars spent on Obama's watch with too little to show for it,” one observer noted. “If Meaningful Use doesn't get extended, hasty implementations could lead to a series of embarrassing headlines and, in a worst-case scenario, HIT-triggered preventable patient deaths.”
Well... got me reaching again for Photoshop.

Again, given the angry political fixation on "ObamaCare" (now in full throat at many congressional recess Town Halls), I'm just not seeing much significant headway across the next year or two for the anti-HIT crowd. There will, of course, be smoke (e.g., the rapidly molding "REBOOT" and its progeny), but no fire. NERF football, this is, IMO. If that. Maybe badminton would be a more pithy metaphor.

That's not to argue that there are no glaring problems with HITECH.


Mostashari's departure creates concern among mHealth advocates
Eric Wicklund - Editor, mHealthNews

The impending departure of Farzad Mostashari, MD, the nation's National Coordinator for Health IT, caught everyone by surprise – none more so than mHealth advocates.

Mostashari announced on Tuesday, August 6, that he will leave the ONC this fall after four years in the office and two as its leader. His departure comes at a time when the ONC is in the midst of a study of the nation's healthcare IT system, a crucial issue facing the mHealth industry as it awaits federal direction on the regulation of mobile medical apps.

"A leadership change at ONC will come at an awkward time for the timely completion of the FDASIA 618 committee work and sorting out the confusion over the regulation of mobile health and clinical decision support software," said Robert McCray, president and CEO of the San Diego-based Wireless Life Sciences Alliance.  "For the sake of consumers and patients we urge (Health and Human Services Secretary Kathleen Sebelius) to quickly identify a knowledgeable replacement with consensus-building skills and a desire to unleash the power of technology in healthcare, including self care."

The FDASIA 618 committee was created by the Food and Drug Administration Safety Innovation Act of 2012 and charged with reviewing the nation's HIT regulatory framework. The committee's study is expected sometime this fall, at which time the HHS will work with the ONC, FDA and Federal Communications Commission to draft a report for Congress that outlines a proposed strategy for regulating health IT, including mobile technology.

mHealth advocates say Mostashari's departure will create transition issues in the ONC that may affect its participation in the FDASIA study. In addition, it comes as another regulatory agency, the FCC, searches for a new leader to replace the departed Julius Genachowsky...
Mobile portends to be a huge component of Health IT going forward, one rife with special problems. We will need competent and steady hands at the helm here.



But, looking ahead...

As if the turbulence of July 2013 on healthcare IT wasn't bad enough, last week things got arguably worse.

First, Farzad Mostashari, director of the Office of the National Coordinator (ONC) for Health IT at the Department of Health and Human Services, announced he is resigning, staying on just long enough for a replacement to be found.

Then, one of ONC's major projects of 2013, a strategy by CMS and ONC to promote interoperability in an industry that desperately needs it, made its underwhelming debut, overshadowed as it was by Mostashari's resignation, which hit during the same 24-hour news cycle.

How underwhelming was the ONC/CMS plan, itself a response to comments on an earlier request for information? Highlights of the initiative related to health information exchange tell the story:

  • Accelerating Interoperability and Electronic HIE through Payment Models Require electronic HIE in all advanced payment models and Medicaid waivers
  • Extend Center for Medicare & Medicaid Innovation (CMMI) efforts
  • Include Long-term care and post-acute care (LTPAC) and Behavioral Health (BH) in State Innovation Models (SIM) grants
  • Direct incentives for LTPAC and BH providers
  • Explore additional reimbursement codes for care coordination via telehealth, e-visits, radiology queries, and Evaluation & Management
  • Require electronic HIE standards as regulatory requirements for quality measurement and conditions of participation
  • Extend Regional Extension Center (REC) support
  • Extend Stark and Anti-kickback exceptions for donations of EHR software
The RECs are doing fine work, and it's all well and good for CMS and ONC to want to extend support for their work in the hopes of moving health IT interoperability forward and provide necessary training, but that will require Congress to act to extend that funding...
There will be no more REC funding. Period, IMO. I have opined at length across prior posts on the short-sightedness of this (and I no longer have no personal dog in that fight, having retired from my REC), but Congress is not going to appropriate any more REC money.

Scott continues, to conclude:
...the dog days of summer 2013, a good time for healthcare CIOs to take a break if they can, if they believe that things will turn around when they return in September. Meanwhile, I do wish ONC and HHS leadership all the luck in the world. Losing Mostashari now is the last thing they need.

One of the more notable failures of the short-lived REC era. If they're doing anything of substance (or anything at all) in the Beltway on behalf of the ONC Regional Extension Centers, it must be a closely held secret.

The 10 RECs (out of 62) who bought into this scheme seem to have gotten played. Probably with taxpayer money.

"2014 brings a perfect storm of regulatory compliance issues for family physicians that, we fear, may derail health information technology (IT) adoption and substantially interfere with our shared progress toward achieving better care for patients, better health for communities and lower costs through improvements to the health care system."

- AAFP Board Chair Glen Stream, M.D., M.B.I., AAFP Proposes Revised Meaningful Use Stage Two Compliance Timeline



apropos of my August 4th post:


More to come...

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