Health Archives

The Food and Drug Administration may have to bulk up on information technology if the House signs off on surveillance measures in a food safety bill the Senate passed Tuesday.

Three months after enactment of S. 510, FDA would have to create an online search engine that allows people to find helpful information on every recalled food, such as whether the recall is ongoing or completed.

Within two years, FDA's parent agency, the Health and Human Services Department, would have to report to Congress on new IT needed for identifying food contamination risks and collecting data from foreign governments, industry, labs, consumers and other sources, according to the bill. HHS officials also would have to detail their progress on building an electronic system that can flag indicators of health risks from the data gathered.

Similarly, the Centers for Disease Control and Prevention would be required to upgrade surveillance machines with better tools for obtaining data on disease exposures; enhancements for matching illnesses with specific foods; and mechanisms for sharing anonymous, aggregated data with the public more quickly.

Lawmakers now will reconcile differences between the House bill, H.R. 2749, approved in July 2009, and the Senate version. The Senate bill, which had been in the works for years, was prompted by several high-profile food scares, including outbreaks of salmonella in tomatoes, spinach tainted with e-coli, contaminated imports from China and the biggest beef recall in U.S. history.

Senate Majority Whip Richard J. Durbin, D-Ill., who spearheaded the legislation, said: "This bill will have a dramatic impact on the way the FDA operates - providing it with more resources for inspection, mandatory recall authority and the technology to trace an outbreak back to its source."

The White House blog and Twitter feed this week promoted a Thursday MTV town hall meeting featuring President Obama and students by asking teens to tweet questions about jobs, energy and other issues weighing on their minds. But the moderators on MTV's website, which was live-streaming the televised event and posting comments, didn't seem to get the whole "youth" theme.

Staged as a forum to get out the vote -- the webcast looked more like an uncensored free-for-all, or a Tea Party rally. Here is a sampling of the comments that appeared on the MTV site:

• "#askmarijuana Dear President Obama, What are your thoughts and views on legalizing marijuana for medicinal purposes in all states ?"
• "Why is the middle class suffering more than any other group right now? I worked 2 years very hard to get you elected. Now I"M being audited!"
• "#askjobs Will the President help push for passage of the Equal Employment for All Act (H.R. 3149)? Credit checks are discriminatory especially so for older Americans. This is a real job creation program. Are you aware of it and that it's been stuck in Committee for the past year?"
• "How are you going to push for Universal Health care? And how do you think that it is not a violations of our rights as Americans? Personally I feel like it is unconstitutional, how can you argue that it is not?"

For the Health and Human Services Department, Health IT is all about knowing the end result.

"It's not about the technology, it's about knowing what you want to get out of it," said Dr. Farzad Mostashari, deputy national coordinator for programs and policy at the office of the national coordinator for health IT at HHS.

As part of health care reform, more emphasis will be placed on available and developing technologies, Mostashari said during a panel discussion on Aug. 16 and hosted by Government Executive. Rather than focus on intangibles, "we will be able to look at actual outcomes," he said, such as did a patient's blood pressure improve.

Mostashari gave an example from his time as assistant commissioner for the primary care information project at the New York City Health Department. In New York, they developed a system that told the provider the quality of health care provided by analyzing results, which, he said, was keeping "the eye on the prize."

With more than 2,400 Web pages, the federal "dot gov" space is full of little-known and interesting tools. The Agriculture Department, for example, comes to the rescue of all those in need of quick nutrition information.

My Foodapedia, a project of the Center for Nutrition Policy and Promotion, is a quick and easy way to find the estimated calorie content and food group category of your bagel and cream cheese breakfast. For example, a regular size plain bagel weighs in at 365 calories. Cream cheese adds an additional 68. The whole thing is a 4 oz. serving of grains. Users can choose the approximate serving size from a drop-down menu.

The tool, though not an exact reflection of every last calorie, does offer options. A search for "apple" reveals choices as varied as Apple Jacks cereal and Waldorf salad. It also allows comparison in case users need to decide between a banana and a handful of Pringles chips.

Engineers, scientists and at least one lawmaker are pushing like never before to resuscitate a legislative agency that once provided Congress with technological expertise.

In an era of supposed government transparency, with allegations that even scientists are attempting to cover up research on global warming, an objective, authoritative Office of Technology Assessment is of utmost importance, advocates say.

Several lawmakers, particularly House member and physicist Rush Holt, D-N.J., have repeatedly rallied for appropriations to revive the office that Congress dismantled to save money in 1995. The counterargument against funding has always been that other agencies, such as the Government Accountability Office or Congressional Research Services, could provide the same services.

Now that belief may be changing, says Francesca Grifo, scientific integrity program director at the Union of Concerned Scientists, who will testify on Wednesday before the House Legislative Branch Appropriations Subcommittee. Holt also will testify in support of restored funding.

"We've decided to make it a priority issue," Grifo said in an interview with Nextgov on Tuesday. Her group is releasing a letter of encouragement signed by 30 organizations, including the American Civil Liberties Union and the United Auto Workers. "It seems a little counterintuitive but, if you look at our current fiscal situation, OTA saves money," she said, explaining that if lawmakers have sound technical advice when they make policy decisions, "you'll waste less money."

Established in the early 1970s, the office was responsible for providing Congress with early evaluations of the potential costs and benefits of new technologies and new applications of existing technologies.

Grifo's organization estimates that the office cost Congress about $20 million annually but, since its extinction, the federal government has squandered billions of dollars on failed systems, including virtual fences to guard the U.S-Mexico border and baggage screening equipment.

A sample of reports produced shortly before its demise shows that the office already was on top of many innovations at the forefront of today's legislative agenda.

One 1995 report referenced the potential for tracking the efficacy of medical treatments with electronic health data - a controversial issue in the ongoing debate over healthcare reform. "Because large amounts of electronic data now can be collected and manipulated, there has been increased emphasis on using existing data, often in the form of insurance claims databases, to evaluate health care technologies," the research stated. "Data gathered from events occurring in a wide range of practice settings have become viewed as a tool for looking at effectiveness-- average outcomes achieved by average doctors and patients."

In a report entitled "Bringing Health Care Online: The Role of Information Technologies," the office found that electronic patient records, portable computers, automated data capture and computer networks "can potentially improve the quality of health care" by "enhancing clinical decision support and by improving data for assessing the effectiveness of health services and the performance of health care providers and insurance plans."

Another 1995 report probed the ramifications of electronic surveillance, concluding, "If major problems arise in meeting the needs of law enforcement, they will likely arise as a result of institutional difficulties in dealing with a diverse, highly entrepreneurial industry made up of a large number of telecommunications companies offering many new innovations and features, with the number of players steadily increasing."

Do you know a federal manager who recently took risks to push through a bold idea, policy or program that uses technology to make government work better or improve public services? If so, we'd like to hear your story by nominating your colleague for a Nextgov Award.

The Nextgov Award program, developed in partnership with O'Reilly Media Inc. and TechWeb, will recognize government executives who stepped outside their comfortable confines to think and manage differently. They acted boldly to push through an innovative program, policy or new management practice that relied on technology to move government in a new direction, to challenge employees to think and work differently, and that ultimately improved the lives of citizens.

We know there are many managers who have done just that, and we want you to tell us about them by nominating them for a Nextgov Award. The deadline is March 12, but we suggest you don't wait. Visit the nomination page and spend just a few minutes filling out the form. We'll tell the stories of the winners later this spring on Nextgov.

A panel of respected judges will make choose the winners, who will be honored at a luncheon on May 27 at the Gov 2.0 Expo at the Washington Convention Center in Washington, D.C. The expo is co-sponsored by O'Reilly Media Inc. and TechWeb, and Nextgov is the premier media sponsor.

Nextgov has launched the Nextgov Awards, an inaugural program to recognize federal managers who have shepherded a program, policy or management practice that is not only innovative, but bold and brave.

Yes, we know, there are a lot of awards programs in government. But when we asked federal managers and industry executives what is missing, they told us unanimously: No awards recognize federal employees who took on risks -- personal, political and otherwise -- and boldly acted to see their idea to fruition. Or if their idea died, at least they took on entrenched bureaucratic interests in an attempt to make government better through the use of technology.

We invite you to visit our awards page to learn more and to nominate someone who fits the criteria. The technology isn't the reason for the award, but the bold idea must rely on it in some way. And we encourage you to tell us a story about the individuals you nominate. We want you to wow us because we know there are dozens of stories of federal employees trying to improve government and the lives of citizens, but they are up against big odds. Yet, they have acted bravely and with resolve to bring about change. We want to know about them, the drama they faced and the results they achieved. And, of course, the technology they used.

The winners of the Nextgov Awards will be honored at a luncheon at TechWeb's Gov 2.0 Expo in May. (Nextgov is a TechWeb partner for the event.) We'd love to see you there.

More to come.

The Social Security Administration, bogged down with a backlog of disability claims and oncoming onslaught of baby boomer paperwork, is trying to expedite processing by paying medical providers $15 to submit applicants' records electronically.

"We are experiencing a significant increase in the number of initial claims for disability insurance benefits and Supplemental Security Income payments on the basis of disability, and we expect this trend to continue," states a Jan. 11 Federal Register notice. "The increasing volume of claims, coupled with the backlog of disability cases in the hearings process, underscores our need to process cases more efficiently by using advanced technologies."

The agency usually makes more than 15 million requests a year for patient records from providers to determine the severity of disability applicants' medical conditions. Waiting for the information can take months.

Social Security officials said they determined that $15 is a reasonable reimbursement rate for the cost of transmitting medical records through a secure data exchange system but said they will periodically review and adjust the rate as technologies advance.

"By using health IT, we will be able to request and receive medical information within minutes, rather than the days or months it may take to receive medical evidence by traditional methods," which are largely paper-based, labor-intensive and manual, the notice states.

Health information technology advocates say new federal requirements for hospitals to become eligible to receive electronic health record incentives set the bar too high.

Many hospitals are only about half-way toward meeting the criteria for acceptable use of health IT to qualify for federal incentive payments by 2011, according to a new survey from CSC, a technology vendor that sells health IT systems.

"Many hospitals report they have the required capabilities but they are not in active use," state the findings that were released this week. "Readiness is highest in the areas of privacy and security protection."

Meanwhile, some physicians who have analyzed most of the 556-page proposal say the timeframe for the government's goals is probably unrealistic.

On the penultimate day of 2009, the Health and Human Services Department issued preliminary guidelines dictating what hospitals and medical professionals must do by 2011 to receive part of the nearly $20 billion in stimulus funding allocated to encourage the use of e-health records.

This fall, before the official guidelines were out, CSC asked executives at 58 hospitals nationwide to describe their readiness for the basic criteria, including deployment of a certified product, routine use, standards adoption, quality of care reporting and privacy and security protection.

The survey found large holes in hospitals' electronic quality of care reporting and noted that most hospitals do not routinely use e-health records. Health IT is supposed to increase the ease and accuracy of measuring outcomes by allowing hospitals to pull results from records automatically, in real-time and without transcription errors.

A proposed rule announced Dec. 30 defines meaningful use as complying with specific procedures -- including the reliance on certified technologies -- in ways that enhance the coordination of care, engage patients and families, and ensure privacy. A typical 275-bed hospital that makes meaningful use of certified electronic health records, as defined by the department, could be eligible for up to $6 million in bonus payments during the next five years.

The conditions for meaningful use of e-health records will become more specific and stringent during the next few years. The first stage requires providers to electronically capture health information in a coded format to track medical conditions, exchange that data with other professionals to coordinate care and report quality of care statistics. In 2011, participants must report the results of their efforts, including quality of care measurements, to the Centers for Medicare and Medicaid Services.

The Health and Human Services Department on Wednesday set preliminary terms dictating who will and will not get billions of dollars in stimulus funds for buying electronic health records systems.

One proposed rule outlines criteria for the e-health records incentive program, including the core concept of "meaningful use" of e-records technology. Medical professionals who make "meaningful use" of e-records by 2011 or 2012 will be eligible for up to $44,000 in Medicare payments spread out over five years.

The proposal would define "meaningful EHR user" as a medical professional or hospital that complies with specific measures, including the use of a certified technology in ways that improve the quality and safety of health care delivery, reduce health care disparities, engage patients and families, enhance care coordination, improve public health and ensure privacy and security protections.

The rule would phase in the specific measures, based on the present state of technological capabilities and providers' practice experience. HHS officials will demand stricter and more extensive criteria for demonstrating meaningful use over time, as technologies and providers' expertise advance.

The 2009 American Recovery and Reinvestment Act allocated about $20 billion to encourage doctors and hospitals to install e-records systems by 2014. The definition of meaningful use and certification standards have sparked controversy, especially among innovative companies, including Microsoft and Google, who contend that the government's strategy won't work because funding is tied to the adoption of electronic health records, not to management of data by clinicians.

A top Google official argued the administration's plan will result in hospitals and physicians using outmoded databases in the increasingly Web-focused world.

HHS Office of the National Coordinator for Health Information Technology (ONC) also released an interim final rule that sets initial standards, implementation specifications and certification criteria for e-records technology.

Both sets of proposals are open to public comment for 60 days.

Under the Recovery Act, HHS must adopt an initial set of standards for electronic health records by Dec. 31. So, the interim final rule will actually go into effect next month, before the period for comment and refinement is over. A final rule will be issued in 2010.

"These regulations are closely linked," Charlene Frizzera, acting administrator at the Centers for Medicare & Medicare Services, stated in a press release. "CMS's proposed regulation would define and specify how to demonstrate 'meaningful use' of EHR technology, which is a prerequisite for receiving the Medicare incentive payments. Our rule also outlines the proposed payment methodologies for the Medicare and Medicaid EHR incentive programs. ONC's regulation sets forth the standards and specifications that will enhance the interoperability, functionality, utility and security of health information technology."

David Blumenthal, HHS national coordinator for health IT, said in an e-mail update to the public, "Great care was taken in the development of these criteria, with input from the public and federal advisory committees every step of the way." The resulting standards and certification criteria are organized into four categories:

• Content Exchange Standards (i.e., standards used to share clinical information such as clinical summaries, prescriptions, and structured electronic documents);
• Vocabulary Standards (i.e., standard nomenclature used to describe clinical problems and procedures, medications, and allergies);
• Transport Standards (i.e., standards used to establish the communication protocol between systems); and
• Privacy and Security Standards (e.g., authentication, access control, transmission security/encryption) which relate to and span across all of the other types of standards. "