The start of 2006 finds a healthcare community facing an ever-increasing demand for services while at the same time finding costs nearly overwhelming. This combined with mandatory industry and legislative pressures have driven all sectors to seek out new and creative solutions. To succeed, technology services will once again be called upon to provide innovative effective solutions that can reduce cost, improve service and ultimately improve the delivery of care. Examples include the development of interoperable health networks, electronic patient records, improved clinical systems and intelligent data mining. In addition, 2005 initiatives such as security and privacy and health cost shifting will continue to be hot topics well into this year. 

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This includes the following key goals:

1. Oversee the coordination of the Department of Health and Human Services' (HHS) health information technology programs.
2. Ensure that HHS health information technology policy and programs are coordinated with those of other relevant executive branch agencies.
3. Oversee the development, maintenance and implementation of a strategic plan to guide the nationwide implementation of interoperable health information technology in both the public and private health care sectors. Known as the National Health Information Network or NHIN, this technology would have the goal of providing useful and appropriate information to guide medical decisions at the time and place of care, improving care delivery and reducing cost.

Sound easy? Consider this. In the overwhelming response to a Request for Information for what would be needed to build the NHIN, standards stood out as the number one roadblock to success. Why? Because even if your provider organization is fortunate enough to have an electronic medical record application, chances are they cannot communicate with other systems external to their implementation. The reason is historic. EMR vendor competition tended to lead software development into focusing on digitizing the patient record and not on interoperability. Conversely, provider organizations while acknowledging the benefits of an electronic record within their organization, has viewed the external communication of such information with apprehension. Privacy issues, considerable cost, data integrity, and loss of control have been often cited. At a time when provider organizations are forced to watch every dollar spent on technology, interoperability with external systems have simply not been a priority.

While the goals EMRs and interoperability with health information networks are not necessarily in conflict, for interoperability to be successful systems must be able to communicate with each other. It is therefore no surprise that much of the work pursued on the NHIN has focused on health information standards.

Fortunately, the news isn’t all bad. For years individual health systems have had the problem of communicating clinical, financial and administrative information electronically between internal disparate vendor applications. Classic examples include best of breed clinical systems passing information to patient financial applications or financial applications communicating with Human Resource applications. As simple peer-to-peer solutions grew to complex EAI applications, agreement on data information standards became necessary. This in turn led to the establishment of numerous standardization bodies to recommend subject domain standards. Key among these are:

• Health Level Seven (HL7) – ANSI accredited organization providing standards and methodologies for the communication of health information in several specific healthcare domains.
• Health Industry Business Communications Council (HIBCC) – ANSI accredited organization providing standards for the exchange of information among trading partners.
• International Organization for Standardization (ISO) – With representation from more than 140 countries ISO provides standards development for the global communication of information.
• Digital Imaging and Communications in Medicine (DICOM) – Provides standards for medical imaging.
• Logical Observation Identifiers Names and Codes (LOINC) – Provides universal identifiers for laboratory and other clinical observations.
• Systematized Nomenclature of Medicine (SNOMED) – Provides standardization for clinical terminology.
• Accreditation Standards Committee X12 (ASC X12) – Provides standards for the communication of electronic data.
• World Health Organization (WHO) – Provides international standards for the classification of diseases

To facilitate impartiality and ensure success, advocacy organizations from both the private and public sector have taken the lead in standards development. Leading the way are the Healthcare Information and Management Systems Society (HIMSS), the American Medical Association (AMA), American College of Radiologists (ACR), the governments Agency for Healthcare Research and Quality (AHRQ), and the American Nurses Association (ANA).

While the establishment of healthcare standards, their supporting bodies and advocacy groups are an important and necessary prerequisite, much more work is necessary for the NHIN to take shape. Issues related to the content or semantics of healthcare data will need to be resolved. This is especially true for clinical information and its management.

Finally, an overall agreement must be achieved on which standards will be used, how will they be implemented, and under what controls. Many believe that this will require the leadership of the federal government similar to the efforts behind the implementation of HIPAA. To this point the ONCHIT has tendered a number of requests for proposals related to healthcare interpretability.  One is specifically focused on the unification of healthcare standards. 

HHS Announces More than 21 Million Beneficiaries to be Covered Under Medicare’s New Prescription Drug Plans
The 21 million far exceeds original estimates of 18 million first predicted. Centers for Medicare & Medicaid Services Administrator, Mark B. McClellan credits among other reasons, especially strong response from employers and unions who are looking for ways to keep the retirees under their current coverage. The number includes more than one million who signed up for new stand-alone coverage within its first 28 days of availability. HHS further breakdown enrollment figures as follows:

• Stand-alone Prescription Drug Plans: more the 1 million
• Medicare/Medicaid: 6.2 million
• Medicare Advantage: 4.4 million
• Retire Coverage: 6.5 million
• Retiree Coverage that ncorporates/supplements Medicare’s coverage: 1 million
• Federal Retirees: 3.1 million

CMS Offers Program to Ensure Smooth Transition of Dual Eligibles from Medicaid to Medicare Part D 
As of January 1, 2006, Medicare’s prescription drug coverage will be open to all Medicare eligibles including current Medicare recipients. As part of the Medicare Modernization Act of 2003, over six million low-income Medicaid beneficiaries referred to, as full benefit eligibles will have their prescription plans moved to the new Medicare Part D Plans.  Full benefit dual eligibles will have until January 1st to enroll in a plan at which time CMS will automatically enroll them in a plan. This action is being taken by CMS to ensure there is no lapse in prescription coverage.  In addition, CMS will also honor eligibles who present at pharmacies but have not yet transitioned by having their claim submitted to a special account that will be monitored by a CMS contractor. In turn the contractor will immediately validate eligibility and facilitate enrollment in a Part D plan.

Legislative Wrangling Over Labor – HHS Bill
The US Senate agreed to pass the fiscal 2006 Labor – HHS appropriations bill on the condition that the House approves a modified defense spending Bill. If approved the Bill will allocate approximately $62 million for the Office of the National Coordinator of Health and Information Technology for healthcare IT initiatives. An additional $50 million will be allocated from the Agency for Health Research and Quality for the development, evaluation and implementation of healthcare technology systems.

HL7 Releases Version 3 Normative Edition 
The standard body Health Level Seven Inc. (HL7) has announced the long awaited release of version 3 Normative Edition 2005. Version 3 is a compilation of dozens of specifications based on the HL7 Reference Information Model or RIM. Historically, HL7 Version 2.x has been considered the primary integration standard for the communication and integration of health information. While Version 2.x is widely adopted, it is hoped that this release will spur the adoption of the Version 3 standard among healthcare providers and vendors within the United States. Key features of the version 3 standard include:

• A focus on semantic interoperability by specifying that information be presented in a complete clinical context that sending and receiving systems understand.
• A focus on universal application.
• Model based specification that provides consistent representation of data across health subject domains.
• Technology Neutral standards allowing implementers the opportunity to use the latest technologies.
• Founded on a development methodology and meta model that assures consistent development and the ability to store and manipulate the specifications in data repositories rather than word processing documents.

RHIO Startups Continue 
The rapid growth of regional health networks continues with announcements of new ventures in Florida, New York and Michigan. In the most recent announcement, CyberMichigan, a division of Altarum Institute, has received a federal grant of $190K to be used on the initial design of MHIN or Michigan’s Health Information Network. Leading the project will be Michigan’s Community Health and Information Technology departments with assistance from a wide group of stakeholders representing healthcare, information technology, insurance, consumer protection and other sectors. 

The rapid appearance of regional health networks have been spurred by a federal commitment to develop a National Health Information Network aimed at linking disparate healthcare information systems to facilitate the sharing and communication of patient information among physicians, hospitals, public health agencies and other authorized users. To achieve these and other lofty health related technology goals, the department of Health and Human Services has established the Office of the National Coordinator for Health Information Technology or (ONC).  

In addition to the federal funding private donors and nonpublic foundations have also recognized the benefits of health networks. One such foundation, the Robert Wood Johnson Foundation, recently announced grants as much as $100K to support participation in health information exchanges.