The chronic care work group of the American Health Information Community will recommend to the federal information technology advisory panel when it meets next week that it should take off the back burner a so-called "use case" that would lead to the setting of interoperability standards and certification criteria for secure messaging between providers and patients with chronic illnesses.
Work group members complained at a meeting held Tuesday that AHIC, which was created by HHS Secretary Mike Leavitt in 2005 to advise the government on healthcare IT policy, has twice considered the chronic-care, use-case recommendation, and twice put off acting on it in favor of other priorities.
A use case is a patient-care scenario to which healthcare IT can be applied.
Karen Bell, a physician who serves as the director of healthcare IT adoption at the Office of the National Coordinator for Health Information Technology at HHS, said the chronic-care, use-case recommendation "didn't reach the top of the list" of requests to AHIC, which has "very limited capacity to develop use cases."
Last year, AHIC recommended only three use cases be developed despite multiple recommendations from what are now its seven work groups. The blessing of AHIC for a use case focuses the attention of the Healthcare Information Technology Standards Panel, created under an HHS contract, to identify and harmonize data-transmission standards to carry out the task specified in the use case. And work by the HITSP now can lead to the development of criteria for testing and certification of IT systems in the use of those standards by another federally funded organization, the Certification Commission for Healthcare Information Technology.
AHIC passed over the chronic-care, use-case recommendation again this year, but Bell said it "will be put on a road map for later on down the line."
For several work group members, however, further delay just isn't good enough, including physician Eric Larson, the executive director of the Center for Health Studies at the Group Health Cooperative in Seattle. Larson said that based on his experience at Group Health, "I always thought that it (secure messaging) was a precondition for our other pieces of work. I feel almost passionately strongly that whoever made the decision not to include this needs to rethink it."
Work group members will send three other recommendations to AHIC Tuesday asking that HHS Secretary Mike Leavitt should:
- Work with the CMS to develop demonstration projects to assess the value of remote-care monitoring in patients with chronic illness through Medicare Advantage plans.
- Conduct a study of the use and reimbursement under Medicare of "store and forward technology" in Alaska and Hawaii and have the secretary make recommendations of expanding its use beyond those states. In contrast to live, interactive telemedicine, where the patient and physician are linked together by technology at the same time, store-and-forward technology refers to circumstances in which a providerperhaps a family physicianmight store information from a patient encounter. Then that provider would forward that information electronically to another provider, a specialist, for example, to be reviewed by that second provider at a later time. Typically, recommendations by the specialist would then be sent back to the primary-care physician also using store-and-forward technology.
- Consider expanding the scope of the Medicare definition of a treatment "setting" beyond the current definition of a face-to-face encounter with a patient in the doctor's office to include telemedicine environments where services and treatment are provided by physicians not in physical proximity to their patients. The secretary also should analyze the legal implications of any change in the definition on existing Stark anti-kickback laws.
Larson warned that a legal minefield awaits anyone wishing to alter the setting definition and the annals of the inspector generals office at the CMS might be a good place to look up multiple case histories of Medicare fraud.
"The current legal structure got there for a reason," Larson said. "This is not a simple topic."
The warning clearly frustrated fellow work group member Craig Barrett, chairman of Intel Corp., who also serves as one of 18 AHIC members.
"How do we get around this?" Barrett said, adding that it used to be required that a technician come into the presence of a personal computer or a network facility to make needed repairs, but with the computer connected to the Internet, that isn't the case anymore.
"Can you just imagine this discussion going on 10 years ago that to get money out of your bank you had to go to the bank to have a face-to-face transaction to eliminate fraud?" Barrett asked.
HHS attorney Amy Hunsberger said changing the definition of setting might be done administratively. "The secretary does have some authority to add to originating sites" of care, Hunsberger said. However, she added, "Maybe legislation to give the secretary greater discretion would be in order." New legislation could take several years, so Hunsberger recommended adding language to the annual update to the physician fee schedule under Medicare.What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.