D.C. Report: ONC Education initiative, Congress' Fall Agenda, Medicare Savings Targets, Open Source HIE

ONC Launches New Initiative, Website ONC has began implementation of a promise made in their five-year strategic plan, released earlier this spring, to enable a “learning health system” to understand population measures of health, performance, disease and quality while respecting patient privacy. In an announcement and webinar (.pdf) this week, ONC National Coordinator Dr. Farzad Mostashari, HHS CIO Todd Park, and director of the ONC’s Office of Standards and Interoperability Dr. Doug Fridsma launched Query Health – an initiative to establish standards and protocols that allow:

• Physicians to ask questions of their patient populations and apply that information in near real-time in their clinical setting;
• Public health agencies to monitor trends more quickly and more accurately; and
• Academic researchers to test and develop new understandings of public health and clinical methodologies – all while keeping patient data secure, de-identified and in its database of origin.

“Part of what we’ve been doing is trying to meet legislative mandates to adopt EHRs and building NwHIN,” said Dr. Farzad Mostashari during Tuesday’s unveiling. “But there’s also an expectation that information exchange generates knowledge and learns from the knowledge that it generates.” Dr. Fridsma and Query Health project coordinator Rich Elmore likened the effort to the Direct Project in terms of openness, transparency and an inclusive development processes. “The development will be community-driven and consensus-based,” Fridsma said. “We’ll develop running code, providing it in an open source setting.” HHS CIO Todd Park agreed, saying “We want to move superfast, super iteratively and build on what works.” Three working groups have been established under the S&I Framework and will be holding weekly meetings through next April when pilot and demonstration projects are expected to begin. Query Health is one of two projects underway to investigate the potential of metadata in healthcare.

Also this week, ONC launched a new website, HealthIT.gov, “designed to become the leading national resource on health information technology (health IT) for both consumers and health care professionals,” according to an announcement. For patients, the dual-facing site tries to answer questions about why they should care about health IT and how to use e- health tools and protect their privacy. For providers, the site focuses on the benefits of electronic health records, the Incentive Program and resource to help select an EHR system.

Energy & Commerce Committee Pledges to Focus on FDA, Doc Fix This Fall The US House Energy & Commerce Committee unveiled its fall agenda this week on Capitol Hill. The Republican majority has pledged to focus on improving the FDA regulatory process and explore “solutions to the flawed Sustainable Growth Rate formula,” as part of its health endeavors. Energy & Commerce Chairman Fred Upton (R-MI-6), who also sits on the Super Committee charged with addressing the nation’s debt crisis, said the “doc fix” would be an important part of the fall agenda because, “patient care would be significantly harmed by the scheduled 30 percent reduction in Medicare payments.” As for the FDA piece, Rep. Upton said, “The. U.S. traditionally has been the leader in the medical device industry employing an estimated 420,000 Americans, but the lack of predictability and consistency at FDA currently force research and development, manufacturing and new product approvals to Europe, costing American jobs and limiting U.S. patients’ access to revolutionary new devices.”

Ways & Means Committee Assesses ‘Potential Health Offsets’ Democratic aides on the Ways and Means Committee have identified more than $500 billion (.pdf) in potential savings from the Medicare program for the Super Committee to consider during their upcoming deliberations. The summary took policy options from various sources including MedPAC, the Simpson-Bowles Commission, the Biden Group, President Obama’s Budget as well as options discussed by Rep. Cantor’s Deficit Slides. The biggest drivers of savings on the list include raising the Medicare eligibility age to 67, which would save nearly $125 billion over ten years, according to the Congressional Budget Office (CBO). The list of 25 options cover general Medicare, Medicare Advantage and Part D, and Medicare Part B. For a detailed view of the programs, click here (.pdf).

Development Work Marches on for Open Source HIE Solution, Officials Say Through efforts spearheaded by ONC’s Standards and Interoperability Office, government officials are making headway on CONNECT, an open source software solution meant to support local and national health information exchange. CONNECT uses Nationwide Health Information Network (NwHIN) standards and governance to make sure that HIEs are compatible with other exchanges standing up across the country. On June 11, 2011, the first full release of CONNECT version 3.2 under new development teams was made generally available (GA). Since that time, CONNECT developers held a Code-a-Thon at Johns Hopkins to collaborate, discuss ideas and share best practices on how CONNECT should move forward. This week, CONNECT released version 3.2.1, which developers said was “essentially a bug release.” Some examples of the fixes built into 3.2.1 include correlating multiple responses for patient discovery and more robust policy checks inside the gateway when requesting patient data. ONC officials hope to release a more comprehensive release, CONNECT 3.3, sometime this winter.

CMS Actuary Outlines How HHS Can Get To $10B with Partnership for Patients At the behest of Senators Mike Enzi (R-Wyo.) and Orrin Hatch (R-Utah), officials at the Centers for Medicare and Medicaid Services (CMS) were urged to pinpoint how HHS could save $10 billion over three years through the Partnership for Patients. CMS Chief Actuary Rick Foster delivered an answer this week, but he cautioned that it would be difficult to assess savings and scale best-practices industry-wide, as envisioned in the Partnership. According to HHS, the Partnership for Patients seeks to decrease preventable errors by 40 percent and reduce readmission rates by 20 percent by 2013. Mr. Foster said that reaching the $10 billion goal would be difficult to achieve, but possible – and that such efforts hold significant potential to improve patient care and save money. According to the actuary’s letter, “Considerable evidence suggests that these goals are indeed possible, but we reiterate that achieving consistent improvement across all providers and patient populations will be very challenging, particularly if it must be done primarily through voluntary efforts.” Another issue that makes estimating savings difficult is determining how much could be saved through reduced follow-up visits or added administrative burdens associated with the program.