Free Healthcare IT Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Get all the latest Health IT updates from Neil Versel for FREE!

Late news, literally: A new national HIT coordinator

Karen DeSalvo, M.D.

 

I’m a little late to the party reporting on the naming of a new national health IT coordinator, Karen DeSalvo, M.D. HHS Secretary Kathleen Sebelius announced DeSalvo’s appointment on Dec. 19, two days after I boarded a plane out of the country for a much-needed vacation. I vowed not to respond to any work-related e-mail while away, and I stayed true to my word, so now I play catch-up.

I honestly know nothing of DeSalvo’s work as health commissioner of the City of New Orleans and senior health policy advisor to Mayor Mitchell Landrieu, even though I visited New Orleans twice in the early rebuilding stages after Hurricane Katrina in 2006 and 2007 to report on the state of the healthcare infrastructure. At the time, Ray Nagin was mayor, though Landrieu was Louisiana lieutenant gove

rnor and his sister, Mary, was and still is a U.S. senator representing the Pelican State.

During my visits, I met with several state and local healthcare officials, but never came across DeSalvo. She is the first national coordinator I did not know prior to taking over ONC, so I guess I’ll be doing some catch-up. From her biography, I see her background is in public health, much like her predecessor, Farzad Mostashari, M.D. That signals to me that there will be a continued strong focus on using IT to improve population health, one of the original 2004 goals of the first national coordinator, David Brailer, M.D.

While Stage 1 of Meaningful Use has been about installing EHRs, we should start to see connectivity and interoperability to help manage populations in Stage 2, which is just getting started, with an eye toward producing measurable outcomes in Stage 3, which probably won’t begin before 2017.

DeSalvo remains in New Orleans at the moment. She takes over at ONC Jan. 13. Acting national coordinator Jacob Reider, M.D., will go back to being ONC’s chief medical officer.

December 30, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Poll for new national coordinator is rather laughable

Leave it to those in the ivory tower of Modern Healthcare to screw up something as simple as an unscientific poll about who should be the next national coordinator for health IT.  The poll lists a whopping two dozen names, ranging from the obvious—Dr. John Halamka, Dr. Paul Tang, current deputy national coordinator Dr. Farzad Mostashari—to the dark horse—Dr. Robert Hitchcock of T-System, Paula Gregory of the “Philadelphia College of Osteopathic Medicince” (sic)—and even a few laughable listings.

For one thing, Dr. David Brailer is on the list. The first national coordinator (2004-06) left Washington because he wanted to be with his family in San Francisco. He’s currently running a $700 million equity investment firm and couldn’t possibly want to get back into the political game, could he? Besides, he’s a Republican. Dr. William Hersh, CMIO of Oregon Health and Science University, would make a good choice, but he’s already said he doesn’t want the job.

Another choice is current CMS Adminstrator Dr. Donald Berwick. Dirty politics is about to force him out, and if that happens, you can bet he won’t want to be within 400 miles of Washington. (Hey, that just happens to be the distance to his home in the Boston area.) I’m really steamed about the Berwick situation, and am preparing  a separate post that hopefully will go up tomorrow.

Modern Healthcare also includes Janet Marchibroda, who’s identified as chief healthcare officer of IBM. Sorry, but Marchibroda, former CEO of the eHealth Initiative, left IBM last year. My sources tell me she’s now working at ONC, serving as de facto chief of staff to current coordinator Dr. David Blumenthal. (Blumenthal, as you no doubt know, is leaving in April.)

Missing from the long list of names is Johns Hopkins CIO Stephanie Reel, who won in a landslide the equally informal, unscientific poll that HIStalk ran a couple weeks ago. HIStalk did report, though, that Allscripts effectively stuffed the ballot box. Also not included is Blumenthal’s predecessor, Dr. Robert Kolodner, but he doesn’t want to go back, either.

I’m not going to run another survey here (hey, I doubt I have the readership to make it worthwhile anyway), but I’m curious if people think a non-physician could or should be national coordinator.

March 10, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

My BNET commentary on the Google-HIPAA issue

I’ve got a new outlet for my work, namely the BNET Healthcare Blog. My first post went up today after a couple of weeks of refining and editing—worth it only because the faster I get the hang of BNET’s style, the more I get to post on this big stage.

The subject is the denials by Google and Microsoft that their PHR offerings are not subject to the new HIPAA requirements, even though the language seems clear to me and to several experts I’ve talked to. I specifically quoted Dr. David Brailer in this post, from a conversation we had a couple of weeks ago for a story I wrote on the stimulus bill. Brailer consulted extensively with congressional staff during the legislative process.

I expect BNET to put up another post of mine on Wednesday, hopefully before HIMSS09 ends at 2:30 p.m. CDT.

April 7, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Privacy, please

A weekend trip to Maine for a family wedding turned into a business trip (and a tax deduction) when I was reminded that the 16th National HIPAA Summit and related Privacy Symposium were taking place at Harvard University this week. Since I was flying in and out of Boston, I hesitantly forked over the $150 extortion—er, change—fee to American Airlines and sprung for a hotel room, mostly so I could attend a heated debate—er, “roundtable discussion” (even though the table was not round)—about whether patient privacy rules were effective.

I’m pretty sure it was worth the money. Boston usually is. While in the area, I also got a tour of athenahealth’s Watertown headquarters. I learned that “chief athenista” and new daddy Todd Park is on paternity leave for the next several months, is relocating to the west coast and will come back as a board member only while he dedicates much of his time to some new ventures.

But I digress once again.

The roundtable featured a couple of heavy hitters in the privacy world, namely Dr. Deborah Peel and Dr. Bill Braithwaite, as well as Partners HealthCare System Chief Privacy Officer Karen Grant, Linda Sanches, representing the HHS Office of Civil Rights, and, via telephone, Jodi Daniel, from the Office of the National Coordinator. Given the expense I just incurred, I wrote a story Tuesday about the Peel-Braithwaite debate for someone who actually will pay me, Digital HealthCare & Productivity.

In the interest of getting the news out and getting picked up by this week’s Health Wonk Review, I’m going to give you for free some notes from other Tuesday sessions.

On Friday, HHS released some proposed dates for transitioning to the next generation of HIPAA transactional code sets—otherwise known as ANSI X12 version 5050—as well as to ICD-10 standards for E&M coding. The proposal also includes the the National Council for Prescription Drug Programs standard version D.0 for electronic pharmacy transactions.

The full language is at http://www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp#TopOfPage and will appear in this Friday’s Federal Register to trigger a 60-day comment period, closing Oct. 21.

“This is not a do-over of HIPAA,” said Workgroup for Electronic Data Interchange Chairman James Whicker, who also phoned in to the HIPAA Summit. Whicker, director of EDI and e-commerce at Intermountain Healthcare in Salt Lake City, said that changes are necessary because the current version 4010A1 is more than six years old already and has significant shortcomings.

Among the changes he highlighted:

  • The 835 transaction for remittance advice adds an embedded link to payer URLs for some payment adjustment and denial codes.
  • 834 will allow ICD-10 to report pre-existing conditions and address some privacy concerns
  • 270 and 271 eligibility transactions bring what Whicker called “a significant number of changes and improvements” from the provider perspective. For example, he said, the new code sets clarify instructions for sending inquiries based on whether the patient is the health plan’s primary enrollee or a dependent. If the eligibility date, plan name or benefit effective date for a particular encounter is different from that of the overall coverage, the health plan must report it as part of the transaction. Version 5010 also requires alternate search options for 270 and 271 transactions so a provider can search by member ID, last name only or date of birth to help eliminate false negatives and phone calls, Whicker said.
  • 276 and 277 transactions for healthcare claims status have minor changes addressing privacy concerns over sensitive patient information that is unnecessary for business purposes.
  • Implementation guides will no longer be free when 5010 takes effect.

I personally don’t know what to make of the 5010 news, but I know that there is significant opposition to the proposed Oct. 1, 2011, compliance date for ICD-10. As Whicker spoke, I was reading a press release from the Medical Group Management Association denouncing the idea, and would wager a large sum that the American Medical Association thinks three years and two months is not long enough.

And now back to the privacy debate.

In a separate session, Sanches vigorously defended OCR’s record on HIPAA privacy enforcement, despite the fact the office has not assessed a single civil monetary penalty in the five years the rules have been in effect. “Our enforcement has resulted in changes,” Sanches said, a sentiment also expressed by Michael Phillips, a health insurance specialist in the CMS Office of E-Health Standards and Services regarding enforcement of HIPAA security regulations.

Sanches said most privacy complaints have either been dismissed or resolved with corrective action, while some, as with Providence Health and Services last month, have been settled with with “resolution agreements,” usually resulting in a fine. Sanches described the resolution agreements as “forward-looking,” since they require corrective action even though there is no admission of liability. “We will be monitoring their compliance,” Sanches said of Providence, which agreed to pay $100,000 as part of the deal.

Suffice it to say, OCR still has plenty of critics. Deven McGraw, director of the Health Privacy Project at the Washington-based Center for Democracy & Technology, said that enforcement clearly is lacking. “When you haven’t imposed a single civil monetary penalty, you are not sending a message that you are going to hit people in the pocketbook,” McGraw said during a joint session with Peel.

Those who don’t know Peel well might think she would wholeheartedly agree with this sentiment, but she says the August 2002 HIPAA privacy amendments that created the “treatment, payment and healthcare operations” exemption effectively neutered the rule. “We believe there is nothing for OCR to enforce because there isn’t a privacy law anymore,” she said, arguing that lack of privacy is keeping people from seeking treatment for some conditions, including Iraq war veterans who might suffer from depression or post-traumatic stress disorder.

As for HIPAA security enforcement, Phillips said OCR gets many more privacy complaints per year than CMS does for the security rule, largely because so many violations involve paper PHI and the security rule only applies to electronic information. He said that CMS has received 350 security rule complaints, to date, but, surprisingly, given all the attention paid to laptop theft, only 10 percent have involved lost or stolen devices.

Of those 350 complaints, 248 have been resolved and 102 investigation remain open.
Phillips also discussed the CMS contract with PricewaterhouseCoopers to conduct 10 compliance reviews this year, saying that the audit firm has done six reviews, including the well-publicized critique of Piedmont Healthcare in Atlanta. Phillips said CMS will share information about one of the 10 cases when all the reports are done.

Another conference session focused on the Piedmont case, and I think I will do a story for one of my publication clients in the next week or two. Stay tuned.

And finally, since anything involving David Brailer tends to generate a lot of traffic to this site, I shall call your attention to the following from former U.S. Sen. Dave Durenberger (R-Minn.), who founded and chairs the National Institute of Health Policy and sits on the Medicare Payment Advisory Commission:

DAVID BRAILER a few short years ago was the No. 1 name in American healthcare according to the annual Modern Healthcare survey of important people in the field. His job then was to be President Bush’s “Health Information Czar” to get the medical system moving toward automation and electronic information interchange.

Today he runs Health Evolution Partners out of San Francisco. He says HEP was founded to accelerate the best in the inevitable change taking place in the healthcare market. It will focus on redefining quality, efficiency and accountability of healthcare services to consumers and payers. He has developed a “Purchaser Value Initiative” as well, and raised nearly a billion dollars from CALPERS and from an additional four or five state public employees retirement funds (including Minnesota).

Susan and I enjoyed lunch with David recently at the Buckeye Roadhouse just off CA Highway 101 near Sausalito. David’s no. 1 interest these days is in his family, especially his seven-year old son and year old daughter. I listened to much of a fascinating discussion over elementary education in San Francisco and the merits of various institutions before we got to passion no. 2. How health system entrepreneurs will use the cost-quality-access quandary we face in this country, to innovate our way to better health, medical care and health management services.

Listening to Brailer, you get the impression that there may have been a lot not to like in the Bush administration’s approach to “consumer driven healthcare.” On the other hand, it focused us on a critical reality. Everyone in America is a potential consumer of better health, more appropriate medical services and, someday, good judges of value in the healthcare system. Entrepreneur innovators are doing it right now, and Brailer’s EHP team will help make sure they succeed.

August 19, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Mystery solved

A couple of weeks ago, I e-mailed some friends and colleagues in the biz wondering who originally said that installing an EMR without considering workflow redesign was just automating chaos. I surmised it was likely Don Berwick, David Brailer or Bill Stead.

One response said that, just like with Yogi Berra or Winston Churchill, I could always attribute it to Berwick and people would believe me. As it turned out, it was none of the above—not even Churchill.

In fact, the originator of the quote was Larry Weed. Weed even used the “automating chaos” line in an interview he did with me in 2004. In fact, he’s one of the most quotable people I’ve ever had the privilege of interviewing, which I also did in 2006.

June 17, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: Dr. David Brailer on his new venture and progress in health IT

SAN FRANCISCO—Dr. David Brailer is a very popular man these days. Having $700 million of Other People’s Money to invest, as his company Health Evolution Partners does, tends to do that. At the Health 2.0 Conference today, it took an hour and 15 minutes for him to fend off the suitors and finally sit down with me for this brief but lively podcast about his new venture and about the current state of health information technology in America. I think it was worth the wait.

(Everyone else is blogging this event live. I can’t keep up, so thought I’d try something different.)

Podcast details: Interview with Dr. David Brailer on Health Evolution Partners and progress in health IT. MP3, mono, 64 kbps, 4.5 MB. Running time 9:53.

0:34 Investment strategy
1:05 Surprise since he started the fund
1:40 About the company
2:25 Why he’s not looking at biotechnology
2:55 Health 2.0
3:35 Investing through venture partners
3:45 Assessment of national health IT adoption
4:35 Health IT hasn’t become politicized
5:05 Tough issues still unsettled
6:13 RHIOs
6:50 Shakeout in health IT (and interruption from siren outside the window)
7:50 Advice to people involved in RHIOs
8:08 Personal health records and consumerism

September 20, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.