Government Mandating Electronic Health Record for Almost Every American by 2014

Stimulus funds are being used as Medicare and Medicaid incentive payments to encourage early adoption by medical providers of electronic health records — language in the stimulus bill calls for “the utilization of an electronic health record for each person in the United States by 2014.” These electronic health records (EHR) will follow each American from birth to death, and include information about each person’s race, ethnicity and medical history. Also by 2014, ObamaCare, signed into law on March 22, 2010, mandates that almost every American must prove to the IRS that he or she is enrolled in a government-approved health plan, giving the federal government the authority to oversee the medical decisions made between doctors and patients and giving the feds access to patients' EHRs. Absent of proof of government-approved insurance, the IRS will impose a "penalty" of 2.5% of income by 2016 or $695 a year, whichever is greater. Note that this initiative calling for an EHR for every American suspiciously came before any bill was sponsored in Congress to overhaul health care and mandate that every American purchase health insurance.

VA Expands Program to Bring Electronic Health Records to the Home

October 13, 2010

GHIT - The Veterans Affairs Department plans to expand its use of information technology and telecommunications – including mobile and landline phones and video conferencing – to deliver health care to aging veterans and others who suffer from chronic conditions, according to senior telehealth official.

In fiscal year 2010, VA recorded 300,000 health care encounters in 36 specialty areas with the assistance of telehealth technologies, according to Dr. Adam Darkins, VA’s chief consultant for telehealth services, who spoke at an Oct. 12 innovation conference sponsored by West Wireless Health Institute, a wireless medical technology non-profit researcher.

The VA has now begun to analyze data from these programs as part of a long-term goal to change the location of care from the hospital to where the patient is, he said. The plan is ultimately to, “extend the electronic health record into the home.”

“No evidence suggests that the best way to manage chronic conditions is in the hospital or office because they return again,” Darkins said. Prime treatment targets include diabetes and hypertension in older veterans or traumatic brain injury suffered in battle by younger veterans in Iraq and Afghanistan.

Among the VA’s major telehealth programs, the Care Coordination Home Program, which has 48,000 participants nationwide, enables senior veterans to continue to live at home instead of in an assisted living facility unless symptoms demand that a physician intervene.

So far, the program has reduced by 47 percent the number of days of facility provided medical care, Darkins said. The technology has also lowered costs by reducing or avoiding the time spent in assisted living facilities. Over the next two years, VA plans to increase participation in this program by 100 percent.

A companion effort, the VA’s Clinical Video Tele-health Program, uses video conferencing so patients can consult with a specialist from the office of their primary physician in VA community clinics. This program has 75,000 participants, most of whom reside in rural areas and have mental health conditions and need rehabilitation support. VA is about to pilot Internet video conferencing in the patient’s home as part of this effort.

The Defense Department is also testing mobile health applications to extend patient management of healthcare for active service members.

One of its findings is that patients prefer to use their own phones as telehealth devices. Forty percent of the participants in a recent test of an application to send patients messages about their diabetes management did not even use the smart phone provided to them.

“We early on decided that we’re going to do mobile health on patients’ preexisting cell phone,” said Dr. Col. Ronald Poropatich, deputy director of the U.S. Army Medical Research & Materiel Command and Telemedicine & Advanced Technology Research Center. “If you give them an extra device, they’ll leave it at home.”

Many current veterans are under 30 years old and have grown up engaging with friends and family over the Internet, said Tom Tarantino, legislative associate for the Iraq and Afghanistan Veterans of America.

“It’s jarring to be thrown into an industry when they come for health care that’s not anywhere near in patient engagement to what they’re used to,” he said.

Military Health System Lays Out Five-year IT Plan

January 20, 2010

GHIT - For the first time in over a decade, the Military Health System last week finalized a strategic plan for information management and technology.

The five-year plan emphasizes collaboration among the armed services, Tricare the services’ health plan organization, the Joint Chiefs of Staff, the MHS chief information officer, and other Department of Defense health-related offices.

It is MHS's first formally adopted IM/IT plan since 1999, according to MHS CIO Chuck Campbell.

The plan places heavy emphasis on two goals: redesigning the MHS IT architecture and delivering a robust electronic health record.

"Our architecture must enable responsive and reliable solutions and rapid delivery of new capabilities," the plan states. "Our EHR needs to be intuitive, aggregate data for each patient over time and across providers, operate in all care settings, and allow sharing of information with our health partners."

MHS's IT architecture strategy, adopted in late 2008, revolves around adoption of a service oriented architecture (SOA), a business plan for introducing information management improvements in unison. The SOA would allow new software services to be more easily adopted by MHS and is also designed to hasten congressionally-mandated interoperability between DoD and Department of Veterans Affairs medical records systems.

The two departments are also under a presidential mandate to develop a joint virtual lifetime electronic record which would incorporate medical as well as other beneficiary records.

The strategic plan also includes two second-tier goals, dubbed the Personal Health Agenda and Enterprise Intelligence.

“Our Personal Health Agenda will provide beneficiaries access to their own medical records, enable virtual visits, and allow them to complete online transactions such as appointing and medication refills," according to the plan. "Enterprise Intelligence will enable seamless sharing of knowledge and transfer of best practices, closing the gap between what we know and what we practice."

The plan also included goals for improved governance to "enable effective and efficient use of resources" and "get products to users faster.”

"I see this plan as the road map that will guide the organization," said Campbell, "and I am excited about putting forth a strategy that commits key resources to critical initiatives."

VA and DOD Move Closer to Single e-health Record

June 5, 2009

GHIT- The Defense and Veterans Affairs departments are on track to meet a Sept. 30 deadline to develop a single electronic health record through which they can share patients’ medical information, according to the executive in charge of that program.

Both departments have recently made moves to ensure that the core capabilities for the interoperable health record will be in place by then, said Rear Adm. Greg Timberlake, program director of the DOD/VA Interagency Program. He spoke yesterday at the Government Health IT conference.

For example, he said, DOD awarded a contract in April to expand CliniComp’s Essentris systems for an inpatient module for DOD’s AHLTA EHR, which had mainly been an outpatient and population health application. DOD plans to roll out the module to its hospitals through 2010.

VA already has its Veterans Health Information Systems and Technology Architecture (VistA) outpatient and inpatient clinical medical record system.

“It [the interoperable EHR] has to be consistent with the nationwide health information network model, with the federal health architecture, and well-defined standards that can be accepted between the two departments and then out with the rest of the nation,” Timberlake said.

VA also has made improvements and expanded the availability for electronic questionnaires and self-assessment forms, said Joseph Gardiner, acting director for the VA/DOD Health Information Sharing Directorate at the Veterans Health Administration, who also spoke at the conference. The expansion of the forms and questionnaires will have to be added to AHLTA, as well as a capability by both to receive the information, he said.

The existing Bidirectional Health Information Exchange, developed incrementally by both departments since 2004, will be incorporated into the shared EHR. It provides an interface that connects the departments’ individual clinical data repositories so physicians can exchange readable data in text on pharmacy and allergy data, lab and radiology results, vital signs and patient histories.

In the future, VA and DOD have agreed to collaborate on the development of a virtual lifetime electronic record that would include health, benefits and personnel data. It would use a common services approach that would allow for single sign-on to authorize users, and would also provide identity management and records portability.

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