Sen. Tom Harkin (D-IA) has put a halt to what appeared to be smooth sailing for Marilyn Tavenner to officially take the helm of the Medicare program. At a budget hearing Wednesday, Harkin said he wants answers on why funding for wellness is to be cut from the federal budget.

Harkin told the Associated Press earlier this week that he temporarily put a hold on the full Senate vote to approve Tavenner until an ongoing discussion is established on prevention funding. It is not clear when he would “lift” his hold, and his office failed to respond to inquiries from Healthcare IT News.

Tavenner, who has temporarily been heading CMS since 2011, faced a confirmation hearing April 9 and was unanimously vetted for the position by the Senate Finance Committee on April 23. She has wide bipartisan support, and a full Senate vote was expected to take place soon. CMS has not had an official administrator for the past six year.

“I am beyond upset,” Harkin told Department of Health and Human Services Secretary, Kathleen Sebelius at the April 24 HHS appropriations hearing. “You don’t know how angry I am about this.”

Harkin, chairman of the Subcommittee on Labor, Health and Human Services, and Education said he has spent the better part of two decades promoting disease prevention and wellness in America. He helped to write prevention measures into the ACA, which included – for the first time – a federal budget for preventing disease, the Prevention and Public Health Fund.

[See also: Tavenner draws wide bipartisan support at senate conafirmation hearing.] 

“The Prevention Fund works,” Harkin said. “Thanks to this funding, more children are being immunized. More people are quitting smoking. More communities are fighting chronic disease. More people are being screened for hepatitis C,” he said at the hearing.

“Raiding the prevention fund to figure out how we pay the bills just perpetuates our unique costly American sick care system. I’m sorry to say that this administration just doesn’t seem to get it,” Harkin said.

Particularly disturbing to Harkin is the proposed elimination of the Racial and Ethnic Approaches to Community Health (REACH) program, which Harkin calls “a staggering success.” The program was funded at $54 million in 2012, but has been cut completely from the proposed fiscal 2014 HHS budget. Harkin said he plans to propose another bill this year that would continue to allocate funding to the REACH program and other wellness programs. 

Sebelius told Harkin the Obama Administration is also concerned about prevention, but has chosen to put the funding into ensuring every American has access to a medical home and health insurance, which includes disease prevention education. Federal funding is also proposed to support other wellness movements, such as First Lady Michelle Obama’s obesity prevention program, and efforts to eliminate food deserts and tamp out tobacco use.

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 The panel, which included Mark Vanderwerf, vice president and director of eHealth and OEM for Nonin; Jerry Wang, director of engineering and quality assurance for A&D Medical; Andy Sallee, vice president of business development for Alere Connect; and Simon Wright, managing director of research and development for Panasonic, pointed out that “design is everything” in telemedicine and mHealth. Products that appeal to the consumer will be accepted by them, and they’ll in turn compel their doctors to embrace telemedicine and mHealth – or lose business.

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Telemedicine is a key enabler for health system transformation. This is the year that healthcare planners everywhere realize telemedicine must be a fundamental part of their plans. We are living longer, but with an increasing burden of chronic disease. Healthcare systems everywhere are stretched to the max trying to deliver quality care that they can pay for.

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South Metro Primary Care, one of the largest primary care independent practice associations in the Denver area, will connect the electronic health records of its 118 primary care providers to the Colorado Regional Health Information Organization HIE.

South Metro Primary Care is one of the 32 Pioneer Accountable Care Organizations in the U.S. It serves some 24,000 Medicare beneficiaries in greater Denver.

Connecting to the HIE will allow more than 100 primary care providers in 26 practice locations to quickly and securely access their patients’ information from hospitals, other provider offices and public health departments, making for more proactive and higher-quality care, officials say.

“We are excited to be at the forefront of connecting healthcare providers to the HIE system to help improve the care coordination for our patients,” said Gerald Brown, MD, SMPC, board president and physician at Internal Medicine Southwest, in a press statement.

“Making the investment to connect was a big decision for the board,” he added, “but we think it’s an important step for our providers and will ultimately benefit our patients.”

Information available to qualified providers through the CORHIO HIE includes lab results, X-ray, MRI and other medical imaging reports, physician transcripts, referral information, hospital discharge reports and newborn screening results.

SMPC will initially focus on connecting their practices utilizing the Amazing Charts and Allscripts EHR platforms, officials say. As the pilot progresses, more than 100 primary care physicians in SMPC on various EHR platforms will be connected to the HIE.

The data provided through CORHIO will help the SMPC providers with care coordination initiatives that are imperative to their goals of accountable and patient-centered care, such as enabling proactive follow up with patients after hospital or specialist visits, helping to prevent medical complications and hospital readmissions.

“Primary care providers and their patients can benefit greatly from the use of health information exchange technology,” said Larry Wolk, MD, CORHIO‘s chief executive officer. “We are pleased to see that primary care providers, including those with the South Metro Primary Care group, are increasingly discovering value in the time-savings and cost-savings that CORHIO’s services provide.”

Moreover, he said, “We know that each time a new physician practice connects to the COHRIO HIE network, it means that hundreds – or even thousands – of patients are receiving higher-quality, better coordinated health care.”

Across Colorado, there are currently 28 hospitals, more than 700 office-based providers, 40 long-term and post-acute care facilities, four behavioral health centers and two large medical laboratories connected to the CORHIO HIE.

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The Canadian Pharmacists Association and PEPID Canada have partnered to offer a bilingual drug and therapeutic knowledge base for healthcare information systems.

CPhA, a nonprofit advocating for Canadian pharmacists, provides a wide range of Canadian, evidence-based drug and therapeutic information in print, online and mobile formats for healthcare professionals. These bilingual databases, with PEPID Canada resources and technology, now have the capability to be integrated into all healthcare information systems.

“We are leveraging PEPID Canada expertise in clinical decision support technology with our bilingual therapeutic and drug information to create integrated resources that are easily accessible,” said James de Gaspé Bonar, Senior Director of Digital Publishing Solutions at CPhA.

PEPID Canada, a provider of drug data and clinical decision support resources, is available on all mobile devices, online or delivered into an existing electronic medical record system. PEPID Canada’s resources include thousands of disease profiles, medical and dosing calculators, drug interactions and allergy checker, patient education information and more.

“This partnership is significant; 50 years of expertise intertwined with cutting edge technology in the hands of healthcare providers across Canada could potentially translate into a quantifiable improvement in patient care and a reduction in errors for all Canadians,” said John Wagner, PEPID Canada chairman.

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The Healthcare Transformation Group – made up of members Geisinger, Intermountain Healthcare, Kaiser Permanente, Mayo Clinic and Mercy – has created a research and development team, to put implementation of a Unique Device Identification System on the fast track.

The team is composed of physicians and clinical researchers from the five healthcare systems that make up the Healthcare Transformation Group, or HTG.

HTG was formed in 2010 as an action-oriented collaboration to share best practices and drive for needed positive change across the healthcare supply chain. The first focused initiative being addressed is the implementation of GS1 Standards. The collaboration among the five health systems evolved as an extension of each member’s involvement in healthcare’s movement toward standards adoption.

[See also: Health systems target efficiency with GS1 Standards.]

The team will advance the goals of the HTG, including the adoption of GS1 standards, and together accelerate the healthcare systems’ work to implement a UDI system. 

A UDI is intended to be used to identify the device, such as cardiac stents, pacemakers and orthopedic joint replacement, through distribution and use.

The R&D team includes:

“We are focused more than ever on the full implementation of a UDI system in our industry,” Drozda said, in a news release. “Clinicians clearly see the value of the adoption of data standards.”

“We also see the clear value and benefits of tracking medical devices and the positive impact this has on our patients and industry,” Rea added, in a statement.

“I don’t think recall is all of it,” Graham told Healthcare IT News, “But I think it’s the easiest example to cite. Unlike a recall of a child’s toy or something, you can just sort of look at it and figure whether you have the right one or not, when you’re talking about an implant that’s inside a patient’s body, they obviously need more information to find out the immediate answer to the question, ‘Does it affect me or does it not affect me?’”

Graham explained that today many implants come with a wallet-sized card with some information about the device. But, some devices do not even have that.

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How are the nation’s top integrated healthcare networks using telemedicine? According to the panel assembled for Monday morning’s Healthcare IT News Breakfast Briefing, they’re all building a better physician.

“I’ve just taken a primary care doctor and turned him into a Super Doc,” offered Jeffrey Benabio, MD, a dermatologist and director of healthcare transformation for Kaiser Permanente in San Diego. “And I can do that with any primary care physician.”

Absent the hammer, the shield, the skin-tight outfit and the phone booth, today’s physician does have the potential to reach new heights through telemedicine. That’s because he or she is becoming a part of an integrated healthcare network that can provide instant access to new tools, resources and experts, thus improving clinical outcomes and reducing wasteful care.

That was the gist of Monday’s session, titled “Connected Care at a Crossroads: How Integrated Healthcare Systems are Using Telemedicine to Coordinate Care.” Moderated by Andrew Watson, MD, medical director for the Center for Connected Medicine at UPMC in Pittsburgh, the panel featured Benabio; Donald J. Kosiak, Jr., MD, executive medical director of Avera eCARE for the Sioux Falls, S.D.-based Avera Medical Group; and Wesley Valdes, DO, medical director of telehealth and virtual medicine for Intermountain Healthcare in Salt Lake City.

In a session punctuated frequently by laughter, the panelists each explained how their networks are using or planning on using telemedicine to improve the experience for both patient and physician. They were challenged by Watson and the packed room to prove why such tools and projects are beneficial, in terms of both clinical outcomes and sustainability.

Their response? Telemedicine brings together disparate resources no matter where they’re located and pushed healthcare to the consumer, no matter where he or she is located. “Where the patient is is where we go,” said Benabio.

“It’s about care coordination, cost avoidance, putting the pieces together and going to the cloud,” added Watson.

For Kosiak, whose network comprises “several tertiary care centers followed by miles and miles and miles of nothingness,” telemedicine enables him to bridge the geographical gaps involved in delivering healthcare – in particular, emergency and intensive care services – across the sparsely populated northern Midwest states. Creating that network allows him to bring a specialist into the conversation when an accident victim in a distant farm community needs immediate help.

At Intermountain, meanwhile, Valdes said the system is making a $25 million investment to create a telemedicine infrastructure in the hospitals, before even thinking of moving out to the remote clinics and care centers. The program’s goal, he said, is to first make the patient’s hospital stay more efficient and cost-effective, then to push care management out beyond the hospital’s walls.

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In a memo to its employees last week, Maine Medical Center, part of the MaineHealth system, said it has suffered an operating loss of $13.4 million in the first half of its fiscal year. The rollout of MaineHealth’s estimated $160 million electronic health record system, which has resulted in charge capture issues that are being fixed, was among several reasons Maine Med’s CEO cited for the shortfall.

“Through March (six months of our fiscal year), Maine Medical Center experienced a negative financial position that it has not witnessed in recent memory,” Richard Petersen, president and CEO of the medical center, wrote in the memo to employees.  MedTech Media, publisher of Healthcare IT News and Healthcare Finance News, obtained a copy of the memo.

In order to bring the medical center to breakeven by year’s end, the health system’s leadership has determined $15 million needs to be saved.

In the memo, Petersen said the operating loss is due to declines in inpatient and outpatient volumes because of the hospital’s efforts to reduce readmissions and infections; “unintended financial consequences” due to the roll out of the health system’s Epic electronic health record and problems associated with being unable to accurately charge for services provided; an increase in free care and bad debt cases; and continued declining reimbursement from Medicare and MaineCare, the state’s Medicaid program.

[See also: CIO Spotlight Episode 2: Barry Blumenfeld, MD.]

Many of the reasons for Maine Medical’s financial woes are similar to those hospitals across the country are facing.

A recovering national economy, continued budget restrictions and restraint and the realization that, while electronic health records may have efficiencies and cost savings over time, the costly transition to EHRs may take years to recoup.

In his memo to employees, Petersen said the hospital has identified many of the hiccups contributing to the charge capture problems and a team of hospital employees and Epic technicians are working to resolve those issues. In the meantime, the remaining roll out of the Epic EHR to the rest of the health system is on hold.

[See also: MaineHealth to go live with new EHR, speech tech.]

To save $15 million by year’s end, Maine Medical is immediately instituting a number of cost-saving initiatives including selective travel and hiring freezes, putting the operating contingency budget on hold and reducing overtime. Petersen appealed to employees to curb discretionary spending and contact management with any cost-saving ideas.

“I’m confident that we’ll confront this test, beat back the issues we face, and reverse this negative financial picture,” Petersen wrote in the conclusion to the memo.

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East Kent Hospitals University NHS Foundation Trust will use Harris Healthcare’s Clinical Integration Platform to create a paperless and mobile clinical environment.

The trust has signed a pilot agreement for 500 licenses, and plans to use the clinical portal to gather patient information from different clinical systems that currently work in isolation. These systems include patient administration, pathology, document management, vital signs monitoring and PACS.

“We have chosen to pilot the use of a clinical portal solution across three clinical specialties with the intention that it provides the technology to enable staff to operate more efficient and paperless clinics in line with the trust’s IT strategy and the government’s challenge to create a paperless NHS by 2018,” said Bob Reeves, head of IT at the trust.

The portal will allow healthcare professionals to access patient data via a real-time, intuitive and comprehensive solution. In combination with Imprivata’s OneSign Single-Sign On the portal will automatically log in to and collect relevant patient information from each of the systems and provide it on one screen. The system will also enable doctors to order standard diagnostic tests quickly and confirm delivery of results.

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Centers for Medicare & Medicaid Services is partnering with Cambridge, Mass.-based analytics firm GNS Healthcare and Health Services Advisory Group to assess CMS quality measures.

GNS officials say the firm will deploy its REFS, or Reverse Engineering and Forward Simulation, dig data analytics and machine learning platform to help determine the impact that quality measures have on the quality of care delivered to patients.

CMS quality measures are collected and reported with the goal of improving patient care. Since the agency has begun to link these measures to value-based incentive payments for providers, it is crucial to gauge their impact.

CMS currently produces a triennial impact report with an assessment of the <a href="http://www.mcknights.com/post-acute-providers-continue-to-improve-on-most-quality-measures-report-finds/article/292192/”>measures, but GNS says it will now substantially advance the process by using REFS, in tandem with cloud-based supercomputing, to analyze the causal relationships between measures and outcomes.

GNS will link data generated by provider reports of quality measures with real world patient outcome data, officials say. Using a high-throughput, data-driven computational approach, REFS will perform trillions of calculations to identify causal and predictive relationships between measures and outcomes, explore links between measures, define important patient subpopulations and identify gaps where new measures are needed to determine the quality of patient care.

“This collaboration is a perfect example of how REFS can use real world outcomes data to determine how to provide high quality healthcare across conditions, settings and populations,” said Carol McCall, chief strategy officer at GNS, in a statement.

“Evaluating these quality measures is a significant challenge, given the size and complexity of the data,” she added. “However, this is a very important challenge. REFS can support CMS by addressing this complexity, in order to create quality standards that have a meaningful impact on patient care.

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