LISTA and ADE partnership will work to facilitate digital advocacy, digital literacy,
job creation and economic development in regards to digital empowerment initiatives
Today, Latinos in Information Science and Technology Association (LISTA), the nation’s leading organization of Latino technology professionals and the Alliance for Digital Equality (ADE), a nonprofit organization that provides broadband solutions and broadband related services to underserved and un-served communities, are excited to announce a partnership to facilitate digital empowerment initiatives.
The strategic alliance of ADE and LISTA combines the collective skills, knowledge and experience of two diverse technology-based organizations, enabling them to work together to facilitate digital advocacy, digital literacy, job creation and economic development in regards to digital empowerment initiatives. In particular, the MSI Wireless Technology Act, the Workforce Investment Act, the American Recovery & Reinvestment Act (ARRA), among others.
“We are forming this partnership right now because this is a pivotal time in the race to close the digital divide. Access to affordable high-speed Internet and broadband technology is a stepping stone to the opportunities of economic prosperity,” said Julius H. Hollis, Chairman of ADE. “As we focus on turning our economy around, we must make sure that those Americans currently in un-served and underserved communities are not left behind and further marginalized in this economy.”
“Both LISTA and ADE have worked hard individually to provide and enhance digital empowerment opportunities for communities of color, now as LISTA joins ADE’s Board of Directors we will combine our unique strengths and expand our reach,” said Jose Marquez, President and CEO of Latinos in Information Sciences and Technology Association. “This will strengthen our ability to make a difference. I am very excited to work with the ADE leadership team to further these important goals.”
Together, ADE and LISTA will pursue initiatives in order to increase Latino and African American employment opportunities within American based information sciences, telecommunication, and technology industries. The partners will target project opportunities that make technology applications available to communities of color for educational purposes, for job training and development, and to enable fuller participation in the learning, civic engagement and cultural opportunities afforded jointly or separately by ADE-LISTA utilizing online technologies.
“As part of the LISTA/ADE Partnership, we will conduct a series of surveys of African Americans and Latinos in the tech sector to measure which tech companies are leading the way in corporate responsibility relative to their Latino and African American inclusion in higher management within their company. While Latinos have made strides there are areas in the tech industry we still have little to no representation, boards, upper management and key decision making positions are still scarce at some of the most successful tech companies, we can’t ignore Latinos in high tech anymore, it is just bad business,” said Marquez.
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About Latinos in Information Science and Technology Association (LISTA) (www.a-lista.org)
Latinos in Information Science and Technology Association (LISTA) promotes the utilization of the technology sectors for the empowerment of the Latino community. We are an organization that is committed to bringing various elements of Technology under one central hub to facilitate our partners, members and the community with the leverage and education they need to succeed in a highly advanced technologically driven society. LISTA Mission is to educate, motivate and encourage the use of technology in the Latino community and empowering them to bridge the digital divide.
About The Alliance for Digital Equality
The Alliance for Digital Equality (ADE), headquartered in Atlanta, GA, is a national, non-profit consumer advocacy organization that serves to facilitate and ensure equal access to technology in underserved and un-served communities. The Alliance also serves as a bridge between policymakers and minority individuals in order to help the public understand how legislative and regulatory policies regarding new technologies can impact and empower their daily lives. For more information on The Alliance for Digital Equality, please visit www.alliancefordigitalequality.org
New York, NY, June 14th, 2010 – Latinos in Information Sciences and Technology Association’s President and CEO, Jose A. Marquez-Leon proudly announced today that Federal Communications Commission Chairman Julius Genachowski will deliver remarks on the National Broadband Plan at LISTA’s upcoming 3rd Annual National Tech-Latino 2030 Legislative Forum on Capitol Hill, Washington, DC at 6:00 pm – 8:30pm on Tuesday June 22nd 2010.
“It is a great honor to have Chairman Genachowski address our members at our 3rd Annual National Tech-Latino 2030 Legislative Forum,” said Tony Jimenez LISTA National Board of Directors Chairman. “Chairman Genachowski has been an advocate for the Latino community and understands the critical role broadband plays in developing businesses and improving the economy for all Americans.”
“We are extremely pleased to have Chairman Genachowski address our members at our 3rd Annual National Tech-Latino Legislative Forum,” said Jose A. Marquez Leon. “Chairman Genachowski recognizes the role of the nation’s Latino technology sector and how broadband will help the Latino community continue to develop businesses and our positive impact on the economy of the United States. He understands that closing the digital divide once and for all will give all Americans the chance to achieve the American Dream of financial independence and economic empowerment.”
“Having Chairman Genachowski participate in LISTA’s Tech-Latino Legislative Forum is a testament to the recognized impact Latinos will have in our nation’s high-tech future,” said Danny Vargas. He added, “We sincerely appreciate the Chairman’s interest and dedication to ensuring that the FCC continues to engage all segments of American society and encourages Latinos to take a leading role in not only telecommunications but all aspects of innovation.”
The 3rd Annual National Tech-Latino Legislative Forum will provide Latino IT professionals an opportunity to dialogue with members of Congress about key concerns in the industries of Science, Technology Math and Engineering. It will also provide LISTA an opportunity to continue to raise awareness of the digital divide and how to bridge it, develop ideas on how to stimulate the growth of technology business, and be a catalyst of change in the high-technology and science sectors.
Event Information
3rd Annual National Tech-Latino Legislative Forum is generously sponsored by MicroTech, Capitol Wire PR. Uber Operations, Broadband for America, NTIA, ADE, State Farm, Aetna and Comcast
Date: Tuesday, June 22 2010
Time: 6pm – 9 pm
Opening Reception Venue:
Rayburn House Office Building,
Room B-338, Basement, Washington, DC 20515
To Attend Please Visit: www.techlatino2030.org
About Chairman Genachowski
Julius Genachowski was nominated by President Barack Obama as Chairman of the Federal Communications Commission on March 3, 2009, and sworn into office on June 29, 2009.
Chairman Genachowski has two decades of experience in public service and the private sector. Prior to his appointment, he spent more than 10 years working in the technology industry as an executive and entrepreneur. He co-founded LaunchBox Digital and Rock Creek Ventures, where he served as Managing Director, and he was a Special Advisor at General Atlantic. In these capacities, he worked to start, accelerate, and invest in early- and mid-stage technology and other companies. From 1997-2005, he was a senior executive at IAC/InterActiveCorp, a Fortune 500 company, where his positions included Chief of Business Operations and General Counsel.
Genachowski’s public service spanned broadly across government. His confirmation as FCC Chairman returns him to the agency where, from 1994 until 1997, he served as Chief Counsel to FCC Chairman Reed Hundt, and, before that, as Special Counsel to then-FCC General Counsel (later Chairman) William Kennard. Previously, he was a law clerk at the U.S. Supreme Court for Justice David Souter and Justice William J. Brennan, Jr. , and at the U.S. Court of Appeals for the D.C. Circuit for Chief Judge Abner Mikva. Genachowski also worked in Congress for then-U.S. Representative (now Senator) Charles E. Schumer (D-N.Y.), and on the staff of the House select committee investigating the Iran-Contra Affair.
Genachowski has been active at the intersection of social responsibility and the marketplace. He was part of the founding group of New Resource Bank, which specializes in serving the needs of green entrepreneurs and sustainable businesses, and has served on the Advisory Board of Environmental Entrepreneurs (E2). He also served as a board member of Common Sense Media, a leading non-partisan, non-profit organization seeking to improve the media lives of children and families.
Genachowski received a J.D from Harvard Law School (magna cum laude), where he was co-Notes Editor of the Harvard Law Review. He received a B.A. from Columbia College (magna cum laude), where he was Editor of Columbia Spectator’s Broadway Magazine, re-established Columbia’s oldest newspaper (Acta Columbiana), and was a writer and researcher for Fred Friendly. He was also a certified Emergency Medical Technician who served on the Columbia Area Volunteer Ambulance, and taught cardiopulmonary resuscitation (CPR).
About Latinos in Information Sciences and Technology Association (LISTA)
LISTA (www.a-lista.org) promotes the utilization of the technology sectors for the empowerment of the Latino community. We are an organization that is committed to bringing various elements of Technology under one central hub to facilitate our partners, members and the community with the leverage and education they need to succeed in a highly advanced technologically driven society.
The American Recovery and Reinvestment Act of 2009, commonly known as the stimulus law, has a host of tight deadlines for its myriad health information technology subsidy and IT network development initiatives.
Nearly all of them are timed to help fulfill the ambitious goal set by former President George W. Bush in 2004 and adopted by President Barack Obama last year to make electronic health records available to most Americans by 2014.
Not surprisingly, a federally funded health IT workforce training effort is both part of the overall program and caught up in its mad rush.
“We are moving fast,” said Patricia Dombrowski, director of the Life Science Informatics Center at Bellevue (Wash.) College, which is leading a consortium of community colleges that applied for and won $3.4 million in workforce training grants funded by the stimulus law—covering career paths from information management to IT hardware installation.
Preparations at the college are moving so fast, “We were talking about using roller skates this morning, but we raised our hands,” Dombrowski said. “We knew the time line, so I really feel confident moving forward.”
Last month, HHS’ Office of the National Coordinator for Health Information Technology awarded $112 million of stimulus funds to dozens of universities and community colleges such as Bellevue for various IT workforce training and advanced-education programs ranging from six-month certificates through post-graduate degrees.
The faculties and administrators at those schools will be preparing feverishly for the fall semester and the first influx of what they hope will be thousands of new health IT students and job seekers.
Feeling the need
Boosting employment nationwide was a major goal of the stimulus law, and there is little doubt, according to the government and industry leaders, that tens of thousands of new jobs will be needed if the federal effort to push provider adoption of EHRs is to be successful.
Under the stimulus law, both physicians and hospitals seeking subsidy payments for their IT purchases must use certified EHRs in a meaningful manner. Last December, the ONC and CMS issued rules for certification and meaningful use. In response to thousands of subsequent public comments, both rules are likely to be modified sometime this spring.
The National Center for Health Statistics, part of the Centers for Disease Control and Prevention, estimates there are 308,900 office-based physicians who are not federal employees, who are not working for a hospital’s ambulatory-care program, and who are not radiologists, anesthesiologists or pathologists.
Almost half of these doctors are either in solo practice or work in partnership with just one other physician. According to the latest NCHS data available—the 2009 estimates from its National Ambulatory Medical Care Survey—only 21% of these office-based physicians have a “basic” EHR.
By NCHS definition, a basic system has rudimentary capabilities, including the ability to create patient problem lists and clinical notes and do electronic prescribing. Although it’s not part of the definition, a basic system most likely lacks sufficient functionality to be certified under ONC rules and thus be considered to be an EHR system worthy of reimbursement under the multibillion-dollar stimulus technology subsidy program that is dominating the health IT landscape.
Just 6% of all office-based physicians use what the NCHS defines as a “fully functional” EHR. Such a system might have enough bells and whistles—such as automatic warnings of drug interactions and out-of-range test levels—that a physician using one might reasonably expect to qualify for federal EHR subsidy payments under the stimulus law, based on current drafts of ONC and CMS rules.
But even these advanced EHR systems are likely to require vendor upgrades to meet proposed ONC certification criteria, while many clinicians will still be expected to change their workflows and reporting requirements to fully qualify for EHR subsidy payments under proposed CMS meaningful-use standards.
On average, hospitals are a bit higher up the IT adoption curve than physician offices, but most hospitals are still a long way from where they’ll need to be to achieve meaningful use under the proposed CMS criteria.
Computerized physician order entry is an advanced EHR function in hospitals. According to the CMS proposed rule, to qualify for federal EHR subsidy payments under the Medicare portion of the stimulus law, hospitals must run 10% of their orders through a CPOE system for a 90-day period sometime during the first year of the program, which starts this fall.
Jason Hess, general manager of clinical research at KLAS Enterprises, Orem, Utah, a health IT market research firm, said its latest survey data, validated between October 2009 and February 2010, show only about 16% of hospitals have CPOE systems up and running.
“And if you look at those that are doing 50% of their orders or more through CPOE, it’s 11.3%,” Hess said.
Given the low levels of adoption and use, Hess asked whether it is even “realistic” for the CMS to require that all hospitals have CPOE installed in the first year and “get 10% of orders through CPOE.”
Talk of a looming labor shortage problem is on a lot of IT buyers’ lips, Hess said. Some of the vendors are trying to address the problem by offering remote hosting services for their products, he said, but it remains to be seen whether the software-as-a-service delivery model will catch on fast enough and be used widely enough to make a dent in the workforce shortfall.
Small, rural and community hospitals will feel the stress most severely.
“It’s kind of the Wild West for these folks who say we’ve got to do all the things the big hospitals do,” Hess said.
Help wanted
For starters, thousands of workers will be needed to simply install these EHR systems, configure them to local needs and train clinicians and other healthcare workers in their use. Thousands more will be needed to keep them running and to squeeze the data from them to improve patient safety and quality of care and warrant the multibillion-dollar public investment in them.
Leaders of organizations representing the nation’s office-based physicians and hospitals are concerned their members might not be able do all that will be needed to qualify for EHR subsidies under current ONC and CMS rules, given the gap between their current IT adoption status and the high bar set for them in the December drafts.
On May 3, the American Medical Association, American Hospital Association and Federation of American Hospitals as well as a host of medical specialty societies sent a joint letter to HHS Secretary Kathleen Sebelius, calling for the government to dial back its proposed meaningful-use criteria as well as give them more time to meet its performance targets.
For both physicians and hospitals, time is money. The first “payment year” begins Oct. 1 under the Medicare portion of the EHR subsidy program, through which the bulk of the estimated $14 billion to $27 billion in federal IT reimbursements under the stimulus law is expected to flow.
The healthcare industry has not been caught unawares of an IT labor force shortage, even though the advent of such massive amounts of federal EHR subsidy payments have added a heightened sense of urgency.
Back in 2005, the American Health Information Management Association and American Medical Informatics Association formed a joint committee to try and gin up support for education and training in heath informatics and health information management.
They produced a report, Building the Work Force for Health Information Transformation in 2006. In a case of “be careful what you wish for,” one of that group’s specific recommendations was to seek federal legislation and support for healthcare IT adoption and funding for IT education and training.
The stimulus law, with its buckets of money for EHR subsidies and education was all that, but with tight timelines as a kicker.
What eventually flowed from the AHIMA/AMIA joint effort was a report released in 2008 laying down what the two groups concluded are the core competencies of professionals working with EHRs.
In addition, AMIA is leading an effort to create a board certification program for physicians in medical informatics with the first credentials being awarded in 2013.
AHIMA, meanwhile, supported the design and rollout of the Virtual Lab for EHRs that provides Web-based coursework to more than 125 associate, baccalaureate and post-graduate health information management, or HIM, degree programs.
The latest figures from the Bureau of Labor Statistics pegged the medical records and health IT workforce in 2008 at about 173,000. About two in five HIM/HIT workers were employed by hospitals, with the rest scattered across physician offices, nursing homes, home health services and other outpatient centers.
Despite the current U.S. unemployment rate hovering just under 10%, the highest figures since 1983, job prospects for health IT workers “should be very good, particularly for technicians with strong computer skills” who will be “in particularly high demand,” according to a BLS report. The healthcare industry, it projected, will need another 35,000 of these positions by 2018, a 20% increase.
Dombrowski
Part two of a two-part series
Along with the push to ramp up the use of health information technology in hospitals and doctors’ offices comes the need for a highly skilled labor force to get the job done.
Claire Dixon-Lee is executive director of the Commission on Accreditation for Health Informatics and Information Management Education; the CAHIIM is a division of the American Health Information Management Association that accredits 281 health information management certificate and baccalaureate degree programs at schools across the country. In the past, health information management workers dealt with managing paper records, but their jobs have changed with the times.
Dixon-Lee said that today many AHIMA members are doing the work of IT specialists at their hospitals and physician offices while others can be retrained for these new positions. CAHIIM-accredited programs graduate between 3,000 and 3,500 students a year, of which 600 receive bachelor’s degrees and the rest associate’s degrees, she said.
“Our data show a 95% placement rate, but we aren’t producing them fast enough,” said Dixon-Lee, who cited a 2009 private workforce study commissioned by AHIMA last year projecting the need for anywhere between 12,000 and 50,000 new health information professionals over the next eight years.
Many Modern Healthcare readers who participated in our most recent annual IT survey reported having a tough time recruiting and retaining IT staff. A majority of survey respondents (58%) indicated they’ll need to hire more IT staff in the next 12 months. Meanwhile, 49% of responding executives said they have a hard time hiring or retaining IT workers, most commonly, because of a scarcity of trained personnel, but also because of low wages for IT workers in healthcare compared with other industries.
Officials at the Office of the National Coordinator for Health Information Technology think the demand for workers skilled in health IT will be even greater than the Bureau of Labor Statistics suggests, but perhaps near the upper end of the numbers that Dixon-Lee cited.
“In the aggregate, we have estimated to get to meaningful use by almost all care venues in the country we’re going to need something like 50,000 more trained healthcare workers in these roles than the educational system as it currently exists can produce,” said Charles Friedman, chief scientific officer for the ONC and its point man on ONC-funded educational and workforce development programs. The goal is to have 10,500 new healthcare IT workers trained each year over five years.
“We believe most of the people who can benefit from this program will come into it already possessing part of what they will need to know,” Friedman said. “They will be either IT people who will need to know more about health, or health people who will need to know more about IT. I can’t say what the balance between those two is.”
Friedman said the ONC picked the six “career paths” that the community colleges will train students to take. Those jobs are: clinician/practitioner consultants; implementation managers; implementation support specialists; practice workflow and information management redesign specialists; technical/software support staffers; and trainers.
“We looked at the field as it was evolving, not as it is today, but as we expect it to evolve,” Friedman said. ONC staffers looked at all the activities under the stimulus law and the low EHR adoption rate “and said, OK, what’s going to be necessary to get these practices from paper to electronic, and what roles are needed,” and what is needed to do it properly?
Under the ONC-supported, six-month certificate programs, U.S. community colleges are expected to train 10,500 students a year over five years. For those programs, there will be no certification organization required to look over the shoulder of the 70 community colleges expected to churn out those graduates.
“It’s a bit early to be contemplating that,” Friedman said.
Instead, Friedman said, the ONC has awarded a $6 million grant to Northern Virginia Community College, Annandale, to create and administer a competency examination for graduates of the community college training programs. AHIMA is “very much involved” in the grant, Friedman said.
The individual competency testing program was chosen as an alternative to certification, Friedman said, “to make it very clear this grant award is to assess objectively a certain set of competencies in each examinee who sits for the exam.
“This could evolve in the future into some kind of certification program,” he said.
Community college graduates of the six-month certificate programs won’t be required to sit for the competency exam, “but we hope they will,” Friedman said. Part of the money for the competency testing grant is to underwrite the cost of 20,000 students to sit for the exam for free, he said. “We’re considering this as a pump-priming mechanism to ensure enough sit for the exam to demonstrate its value.”
For the new student certificate holders, “We think it will improve their job prospects. Think of how colleges use the SAT exam to complement a student’s grades to enhance admission. I think in the same way, this exam will be a comparable assessment of a certain set of competencies,” Friedman said.
“For a prospective employer, it will be information above and beyond” the educational program, Friedman said. Data on pass-fail rates from the competency exams could be aggregated and reported back to the community colleges to help them assess their programs, he added.
Back to school
Bill Hersh is a physician and chairman of the medical informatics and clinical epidemiology department at Oregon Health & Science University and a man on the hustle.
The university was a triple winner in the federal workforce grant competition, receiving a total of $5.8 million in funding for three programs—nearly $3.1 million for advanced training to medical professionals in healthcare informatics; more than $1.8 million to develop curricula to be used by community colleges to train healthcare IT workers; and $900,000 to serve as the National Training and Dissemination Center for the curriculum-development program.
Oregon Health & Science has an established, nationally recognized medical informatics program. At any given time, Hersh said, the university may have as many as 200 people enrolled in its postgraduate, 24-credit-hour certificate program and its 52-credit-hour, master’s degree in biomedical informatics program.
About two-thirds of the current enrollment in those programs consists of clinical professionals—with half of that group being physicians—and the remaining third being computer people, Hersh said.
The federal, advanced-education grants will be for scholarships to those programs, Hersh said, with the caveat being that enrollees in the federally funded graduate certificate programs must complete their work in 12 months, whereas in the past, a typical enrollee, who works and goes to school at the same time, often takes longer to complete the same course.
“If they do our graduate certificate program, they have to do it all in a year,” Hersh said, but the trade-off for the rush is, “in essence, people can get a free education.” Tuition for the certificate program is about $12,000. “We have 45 slots per year,” Hersh says. “The people who don’t get funded can still do the program.” It just won’t be subsidized, he added.
Aid recipients under this one-year, advanced educational grant program also must choose from six career paths: clinician/public health leader; health information management and exchange specialist; health information privacy and security specialist; research and development scientist; programmers and software engineers; and health IT subspecialist.
In addition to Oregon Health & Science, eight other universities will share in a total of $32 million in stimulus law funding for university-based, advanced IT education programs. They are: Columbia University; the University of Colorado at Denver’s College of Nursing; Duke University; George Washington University; Indiana University; Johns Hopkins University; the University of Minnesota; and Texas State University, San Marcos.
Along with its graduate-level programs, Oregon Health & Science, as part of its triple-win, will join Columbia, Duke and Johns Hopkins as well as the University of Alabama at Birmingham in sharing ONC grants totaling $10 million to develop curricula to support the six-month, community college IT certificate programs.
The new curricula will cover 20 different content categories, including history of health IT, installation and maintenance of health IT systems, project management, and the use of IT in quality improvement.
“The people who got funded were all experts in informatics who have been doing this kind of instruction,” Hersh said, although none of them has ever developed curricula for community colleges.
To make up for lack of community college experience, each of the contracting universities was obliged to enlist “a suitable number of community college partners,” Hersh said. “In my center, there are four community colleges partners. There are faculty that will work with us as subject-matter experts that will come up with curricula suitable for the community college setting.”
Work on curriculum development by the five universities and their community college partners began almost immediately after the grants were awarded in early April, Hersh said.
The schools have less than four months to complete their curriculum development work before Oregon Health & Science welcomes 400 community college educators to Portland in August for a crash course in the new IT training program outlines.
“It will be a pretty intensive week late that month,” Hersh said. After that, the newly trained faculty will return home and get ready for a hoped-for influx of new IT students. By the end of September, the entire first wave of new IT students is expected to be enrolled.
The participating 70 community colleges will form five consortia, each geographically dispersed, although not every state will have a participating community college. The five consortia will each be led by one community college—Bellevue (Wash.) College; Los Rios Community College, Sacramento, Calif.; Cuyahoga Community College, Cleveland; Pitt Community College, Greenville, N.C., and Tidewater Community College, Norfolk, Va. Grants awarded to these schools could total $70 million over the next two years—$36 million this year and up to $34 million the next.
At Bellevue College, administrators years ago foresaw the looming demand for health IT workers and began developing training programs to meet the industry’s needs. Patricia Dombrowski, director of the school’s life-science informatics center, said the college has graduated about 17 health IT workers a year over the past six years from its 12-month, 30-credit-hour health IT training program.
In 2008, as doldrums beset the Puget Sound IT job market, the college responded by creating a six-month program aimed at providing experienced IT workers from other industries with a background in healthcare IT. The 18-credit-hour program for these IT veterans opened this January with students to spare.
“We could have probably seated 50 or more, but we limited it to 25,” Dombrowski said.
In addition, Bellevue this summer will offer a three-month program for incumbent physician-office practice managers on IT project management and EHR support, she said. “Now we’re ready to scale up” for the HHS-funded training program, Dombrowski said.
Community colleges are not obligated to use the curricula developed by Oregon Health & Science and the other four universities, but all must focus their training programs on the six federally designated career paths. Although no single school is required to offer courses on all six job targets, each consortium must see that all six are covered within their group.
“I doubt we’ll do all six,” Dombrowski said. “We have to see a little more about the curriculum before we make a decision about that.”
Bellevue could get by with just some tweaks to its existing courses and curricula to adapt them to the federal program, Dombrowski said.
“We think we’re spot on and at the very worst, very close, but we have not seen the standard, and we’ve made some suggestions about the ONC accepting the existing curriculum,” she said. If required, “We stand ready to implement the national curricula.”
Bellevue will receive $1 million from the ONC grant to oversee its consortium, which includes seven other community colleges. Each community college, including Bellevue, will receive the same $625,000 in federal grant money to run its training programs and other services. Bellevue’s additional $375,000 will go to administer the consortium.
Beyond providing teachers and course materials, Dombrowski said, Bellevue will offer tutoring and counseling and employment services. The amount of money the ONC is providing “seems adequate to the task,” she added.
Will there be enough time to develop and disseminate the curricula, train educators and be ready for the first day of school by September?
Dombrowski thinks so.
“It’s wonderful in these tough times for people to be able to draw a direct line from training to be put to work,” she said. “The beauty of this is it’s so directly related to people who need work.”
New York, N.Y. – Today Latinos in Information Sciences and Technology Association (LISTA) President and CEO, Jose Marquez-Leon released the following statement in response to the May 24, 2010 letter to the Federal Communications Commission on the importance of broadband adoption and deployment over regulation.
LISTA is pleased to see 74 members of Congress join together and speak with one voice on the importance of broadband technology to transform the communities where we live and work. Broadband technology can revitalize the Hispanic community – providing access to first class schools and job training for high-paying American jobs.
Members of Congress have shown the Federal Communications Commission the importance of broadband – and the importance of focusing on policy goals before implementing net neutrality rules that threaten delay and deter broadband investment. We simply can not afford to keep high-speed Internet out of reach from the communities with schools and businesses that need to be online.
Congress has shown the Commission that there is much work to be done to bring broadband to all of America – I hope they will take the leadership to promote access and adoption with sensible policies that encourage investment, innovation, and collaboration.
As new HIT makes ever greater inroads into the nation’s healthcare system, there is bound to be an expanding array of stories that highlight the advantages HIT brings to patients and doctors alike.
But rather than taking too much comfort as favorable evidence piles up, policymakers should regularly wonder what percentage of the population is still not reaping the benefits.
Take this story from San Francisco. For HIT proponents, it just doesn’t get much better. A single mother with a sick child on her hands uses all available hi-tech tools to get the boy’s situation diagnosed so that, much to his chagrin, he can get back to school without missing a single class.
The story goes on to describe how doctors and patients are communicating via videoconferencing, IM, e-mail, Facebook, and Twitter, and the result, particularly for those patients with EHRs, is a system brimming with convenience, new efficiencies and improved care.
But here’s the question that should nag at policymakers no matter how many of these stories they read: What percentage of the population are we not reaching with all our new tools?
On the one hand, there will never be a time for a definitive answer to that question, because HIT will keep evolving and the healthcare system will have to evolve with it. On the other hand, however, policymakers should already be trying to figure out how to measure, at least roughly, who’s using HIT beyond the healthcare providers who are making the up-front investment.
For purposes of comparison, at least when it comes to patient use of HIT, they might want to take a look at how the “digitizing” of the nation’s school systems has changed or not changed the relationship between parents and teachers. With three kids in school and a veteran teacher for a wife, our admittedly unscientific hunch is that HIT runs the risk of being used much like “Edu-IT” is being used. That is, those who are plugged in general are plugged in when it comes to their children’s education. They access their grades on-line, for example, and they communicate regularly with their teachers via e-mail.
But ask a teacher, and you may well hear the lament that the parents who really need to be more engaged in their kids’ education aren’t using the latest technologies to plug in, and the chances are they won’t be any time soon.
So will the same divide develop as HIT becomes more prevalent? Obviously, there’s no way to know for sure. The question, however, should be one of the first things policymakers think of whenever they read another HIT success story.
EVERY ADVANCE IN healthcare information technology presents a new challenge to a patient’s privacy. The recent initiatives promoting electronic health records (EHRs) and personal health records (PHRs) are no exception. While the use of these records could potentially revolutionize the way physicians treat patients and both patients and physicians manage medical data, they will also put unprecedented amounts of personal information at the fingertips of thousands of third parties. An increased number of individuals with access to health information will only increase the likelihood that, whether inadvertently or purposefully, data security will be breached. The federal Health Insurance Portability and Accountability Act (HIPAA), state health information privacy laws, and state security breach laws all aim to protect an individual’s data from various incidents in which personal information may be compromised. However, the mere existence of these laws does not mean that a person’s health data is necessarily safe. Scores of high profile security breaches have occurred over the past several years, including breaches resulting in unauthorized access to massive amounts of private data at pharmaceutical companies, major data brokers such as ChoicePoint, hospitals, and the Veteran’s Administration. In the dawning era of EHRs and PHRs, physicians, hospitals, insurers, claims processing companies, and various information technology entities must be ready to combat threats to electronic health information. The reality is that many are unprepared.
There is a growing tension between the rapid growth in the use of EHRs and PHRs and the tightening regulation of the security of personal information. In order to effectively navigate the emerging technology and opportunities afforded by EHRs and PHRs, entities conducting business involving such records must be equipped to prevent or mitigate any threat to personal data that may occur, as we will discuss in greater detail below.
Electronic health Records and Personal health Records: Overview and Trends
EHRs are typically defined as clinical patient health records in electronic format that are originated, managed and maintained principally by healthcare providers. They may include information about a patient such as medical history, lifestyle, demographics, any prescription medication, test results, and billing information, and in some instances, they are made accessible to patients.
EHRs have many attributes; if used effectively they can reduce medical errors and costs, as well as increase efficiency. Their advantages range from eliminating confusion resulting from a physician’s handwriting to enhanced searchability, making it easier for a provider to assess possible drug interactions or for a consistent pattern of symptoms. Depending on the platform, another advantage EHRs may offer is accessibility. If they can be transmitted outside of a particular entity’s local information system, they have the potential to be shared with providers and other healthcare entities throughout the world.
PHRs are clinical patient health records in an electronic format that are created by patients themselves, but are maintained by an outside vendor such as an HMO member site or an information technology entity such as Microsoft or Google. They are accessed principally by the patient, but in some formats can be accessed by providers and/or insurers depending on what level of access the patient provides to healthcare entities. PHRs have advantages similar to those of EHRs if a patient grants his or her providers full access to records.
Adoption of EHR platforms has been historically slow. In late 2006, approximately 11 percent of hospitals had a fully implemented EHR system, according to a survey conducted by the American Hospital Association.1 In study by the Healthcare Financial Management Association in 2006, hospitals cited lack of national information standards and code sets, lack of funding, concern about physician usage, lack of interoperability and concerns about privacy as obstacles to EHR adoption.2 Less than 30 percent of office- based physicians reported using EHR systems in a recent study by the National Center for Health Statistics, and only 12.4 percent used comprehensive EHR systems.3 However, the use of EHR systems by office-based physicians has increased over 50 percent in the past five years.4 A wave of recent local, state and federally-sponsored initiatives should help to increase the implementation rate of EHRs. New York State and New York City have been particularly active in encouraging expanded use of EHRs by healthcare providers. At the end of February 2008, Mayor Bloomberg announced that New York City was ready to equip 1,000 Medicaid providers with an EHR system by the end of 2008. Already more than 200 primary care doctors in New York City are using EHRs, and the city says it is on track to reach its goal of 1,000 providers serving more than a million patients by the end of the year.5 Furthermore, Mayor Bloomberg is collaborating with a coalition of House Democrats to help achieve the goal of linking 75 percent of the nation’s health care providers through an e-record system within a decade. On the state level, New York Governor David Patterson awarded $105 million in grants in late March 2008 to 19 community based health information technology projects to help build a statewide EHR system.6 Grant recipients include Regional Health Information Organizations (RHIOs) such as the Bronx Regional Health Information Organization and Brooklyn Health Information Exchange, which facilitate the exchange of health information electronically within a specific geographic area.
Last year, a groundbreaking bill was introduced in the Senate by U.S. Senator Kennedy that, if passed into law, would “recommend specific actions to achieve a nationwide interoperable health information technology infrastructure” and “make recommendations concerning standards, implementation specifications, and certification criteria for the electronic exchange of health information for adoption by the federal government.”7 The “Wired for Health Care Quality Act” would also authorize the Department of Health and Human Services (HHS) to award grants to facilitate the “widespread adoption of interoperable health information technology.”8 Essentially, it would serve to boost implementation of EHRs throughout the U.S. using a common platform. At the time of publication, the sponsors of this legislation were hopeful that the legislation would pass by unanimous consent in the coming weeks.
Various private entities are now offering their own versions of PHR platforms. These platforms would allow consumers to manage and access their health records online. It would also give consumers the option of giving providers and insurers access to their records as well. Microsoft (through its website HealthVault), Google and a variety of HMOs are all developing such platforms, with security and privacy controls tailored to the needs of the consumer. Additionally, the Medical Banking Project, a policy group that focuses on the integration of banking technology, infrastructure and credit with healthcare administrative operations, is also conceiving of a private PHR- type platform, which it calls “consumer-directed healthcare (CDH) platforms.” CDH platforms aim to go a step further than the PHR-platforms offered by Microsoft and Google, as they would not only give a consumer control of his or her health records, but also engage the consumer more fully in the financial aspects of his or her healthcare-related activities. A CDH platform would combine information from an individual’s health plan and personal health accounts such as Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). The main objective of a CDH platform would be “to provide a coordinated link between the healthcare and financial services systems to offer the most comprehensive consumer-directed solution.”9 Such a platform would also benefit from enhanced security from the banks that help to administer CDH platforms. Banks would protect health-related information much as they presently protect financial information.
However, despite the recent surge in EHR and PHR initiatives, efforts still remain highly fragmented. The available EHR and PHR frameworks are driven by different philosophies, potentially compete with each other, and appeal to different types of users, therefore creating different standards for privacy and security. The current lack of coordination between these various frameworks may lead to an increased risk of security breaches, as communication between multiple and possibly incompatible platforms could lead to data leaks and subsequent tampering with records by outside parties. The patchwork of state laws as well as the general lack of regulation in this area beg for federal legislation to set a uniform standard that will harmonize these efforts.
Security Breach Laws, HIPAA and Their Application to EhRs and PhRs
Because private PHRs such as those offered by Microsoft are not explicitly regulated under HIPAA, which governs the use and disclosure of an individual’s identifiable health information, health records created by consumers using these services would not be protected by HIPAA’s privacy and security provisions. HIPAA generally applies to “covered entities”, i.e. providers, health plans and clearinghouses, and breaches in the privacy and security of patient records by these entities result in significant penalties.10 However, when an entity such as Microsoft enters into an agreement with a consumer, it is not subject to the obligations of a covered entity; it would not even need to enter into a business associate agreement, which extends HIPAA protections from a covered entity to its business partners. Thus, without the protection of HIPAA, consumers may be left vulnerable and could potentially shift blame in any privacy breach situation to the providers viewing their PHRs (unless comparable state law protections extended to entities like Microsoft). While publicly-sponsored initiatives such as the ones in New York would be more strictly regulated (as they would be most likely subject to HIPAA indirectly through these public entities” activities as business associates of covered entities as well as other state privacy laws), questions remain about just how secure their EHR platforms are.
The Wired for Health Care Quality Act, described above, would have amended HIPAA so that “an operator of a health information electronic database” would essentially become a covered entity.11 This would have resulted in entities that offer PHR platforms such as Microsoft becoming subject to HIPAA and would create a new class of businesses that would be required to adopt more stringent policies and procedures related to the privacy and security of certain health data. However, at the time of publication, an amendment authored by Senator Leahy significantly altering the privacy provisions of the bill had been accepted by Senator Kennedy in order to “ensure the privacy of individual protected health information.”12 Senator Leahy stated in a recent press release that the amendment would prevent “operators of personal health information databases” from giving sensitive health records “to virtually anyone under the [HIPAA] Privacy Rule.”13 This amendment eliminates the requirement that operators of PHR databases would be automatically covered under HIPAA. Rather, it would require that HHS submit to the Senate recommendations for privacy and security protections for PHRs, including whether it is appropriate to apply certain privacy regulations promulgated under HIPAA to PHRs and “the extent to which the implementation of separate privacy and security measures is necessary.”14
Certain covered entities dealing with EHRs and PHRs must also be prepared for heightened scrutiny of their security policies and procedures related to HIPAA. Earlier this year, the Office of E-Health Standards and Services of the Centers for Medicare and Medicaid Services (CMS) distributed a sample Interview and Document Request list for HIPAA Security Onsite Investigations and Compliance Reviews.15 This list indicates that CMS may request that a covered entity which contracts with CMS produce evidence of policies and procedures that address prevention, detection, containment and correction of security violations as well as other technical documents that address security matters.
Regardless of whether an entity operating an EHR or PHR platform is a “covered entity,” all such entities would be subject to state security breach notification laws (currently enacted in 43 states, the District of Columbia and Puerto Rico) which require disclosure to consumers of any breach in their personal data. Under most states’ laws, “personal information” includes only basic identifying information, but under the amended California security breach notification law, breaches in health insurance information and medical information16 are also covered. Therefore, any entity that has clients or patients who reside in California would be subject to these heightened requirements. The Arkansas security breach notification law also has similar requirements regarding medical information. Regardless of which state security law(s) apply to a particular entity, the increased aggregation of data in EHR and PHR platforms as a result of the initiatives described above will leave more personal data vulnerable to security breaches.
An entity that deals with medical data should be prepared to adapt its policies and procedures to the changes in California law. If the entity has a national presence, it is more than likely to have customers or patients from California. Also, because California was the first state to codify a security breach notification law, and most states followed its lead, one could expect that other states will soon follow its example of including “medical information” in the definition of “personal information.”
The challenges in complying with California’s recently enacted amendments are already apparent. Even an advisory group affiliated with the California Office of Privacy Protection, which assists with the implementation and enforcement of the California security breach notification law, has struggled with formulating recommendations as to how best to comply with the new requirement that businesses and state agencies protect against and notify California residents of security breaches in medical information. Prior to being amended, the California breach notification law and related guidance was geared toward breaches affecting financial information. According to Joanne McNabb, Chief of the California Office of Privacy Protection, a breach of medical information is “a different kind of breach in a lot of ways . . . . The risk it poses is not the same” as a financial data breach.17 The advisory group found that there is not an obvious way to “flag” a person’s medical record in the same way a person’s financial records would be flagged in the event of a security breach. Still, the recommendations are likely to include suggestions that breach notices be as specific as possible, stating what types of records were breached. Pam Dixon, a member of the California Office of Privacy Protection advisory group, said that the amended California law “may drive the debate nationally toward a uniform system like the credit bureaus for medical information.”18
Lack of Preparedness and Increased Enforcement
While entities increasingly adopt EHR platforms and promote the use of PHRs, they may not be prepared to assume the security risks associated with these types of data systems. In a 2008 study conducted by Kroll Fraud Solutions/HIMSS Analytics to better understand the status of patient data security at hospitals, the hospitals surveyed reported an average level of preparedness to deal with a security breach of 5.88 on a one to seven ascending scale.19 Yet the same study indicated that only 56 percent of these hospitals had notified patients whose information was compromised as a result of a security breach.20 13 percent of the respondents to the survey reported that their organization had a security breach in the previous 12 months, with a patient’s name and high level patient information, such as diagnosis, most frequently compromised.21 Also, according to the Government Accountability Office (GAO), in 2004–2005, 47 percent of Medicare Advantage contractors, 42 percent of Medicare fee-for-service contractors, and 38 percent of TRICARE contractors reported experiencing a privacy breach.22 While hospitals and health plan contractors may have policies and procedures in place to combat security breaches, the Kroll survey and the GAO report would seem to indicate that the implementation of such policies and procedures is insufficient.
As healthcare institutions lag behind in their preparedness to deal with data security issues, HHS has stepped up its enforcement efforts to counter noncompliance with HIPAA. In 2007, the total number of resolutions of possible Privacy Rule and Security Rule violations totaled 7,176, compared with only 4,761 resolutions in 2004. Of those resolutions, there were 2,199 investigations in 2007, compared to just 1,392 investigations in 2004.23 HHS is clearly responding to the proliferation of data security incidents that occur with increasing frequency as more health records become digitized and thus susceptible to compromise.
The short history of enforcement of security breach notification laws on the state level has been quite robust. Unlike HIPAA, which puts the onus on a covered entity to come up with its own solution to mitigate a violation of the Privacy and Security Rules, security breach laws mandate disclosure to individuals and, in some instances, to law enforcement agencies. Companies found to have violated a notification law may face civil penalties, injunctive relief and attorney’s fees and costs.
Recommendations for Implementation, Prevention and Response
Businesses that retain individuals’ healthcare data, especially those that interface with EHRs and/or PHRs, should revisit their existing policies and procedures to ensure that they are not only compliant with existing federal and state law, but also to anticipate inevitable changes to the privacy and security regulations and increased enforcement activities. As individuals and healthcare providers become more comfortable with putting personal health information in electronic format, they will expect a heightened level of security to accompany this data. Businesses must be vigilant about protecting this data, as a security incident of any magnitude may cause substantial reputational damage. Providers, insurers, and any other businesses that possess personal health information should consider taking the following measures in order to smoothly transition to a work environment incorporating EHRs and PHRs:
First, an entity should determine exactly what types of data it possesses (if it is a covered entity, it should inventory its protected health information). The entity should also assess whether sensitive information is encrypted and the level of accessibility of such data.
Next, an entity should assess its vulnerability to a security breach. It should look across its organization to identify strengths and weaknesses, i.e. not only should an information technology department be prepared to deal with increases in electronic data and potential security threats, but also departments such as human resources, claims processing, and recordkeeping that view and use individuals’ health information.
An entity should review its physical, technical and administrative safeguards. It should make sure that passwords, encryption, physical locks and barriers allow only authorized personnel access to sensitive data and equipment.
After the steps outlined above, an entity should revise its policies and procedures to reflect any new information gained and processes developed through its own assessment. For example, if the entity determines that it is inadequately prepared to respond to a security breach, it should create or revamp any related guidelines and protocols, such as, with respect to an entity handling medical information of California residents, how to notify a California resident of a breach in his or her medical information.
An entity should periodically train new and existing employees to effectively administer electronic data and comply with rules, regulations and policies and procedures. Existing employees should be required to attend “refresher” courses on policies and procedures related to privacy and security matters.
A business should reevaluate its contracts that include provisions regarding healthcare data and assess what types of provisions it could incorporate into its agreements regarding potential security breaches—how it will coordinate with the other party to prevent and/or notify individuals of security breaches.
Specifically with respect to EHRs and PHRs, providers and insurers should assess whether they wish to develop their own systems, contract with an outside vendor, or try to become part of a state or federal program that facilitates the use of electronic records.
If a provider or insurer does not wish to adopt its own EHR system, it should weigh the risks and benefits of encouraging its patients to utilize a PHR web-based system such as Health Vault. The provider or insurer should be comfortable with uploading patient records to an accessible web site and ensure it obtains necessary authorizations from the patient before transferring health records. The provider or insurer should also be aware of the potential for out-of-date, incomplete or inaccurate records from other providers or insurers to be kept on an individual’s PHR account and plan accordingly for associated risks.
Entities involved with all sectors of the healthcare industry information. should start strategizing now about how they can best coordinate their operations in anticipation of either adopting an EHR or PHR platform or merely interacting with consumers or other entities that use EHRs or PHRs now. Understanding how privacy and security laws affect a business in connection with EHRs and PHRs is crucial, as most healthcare operations deal with patient records at some point or another and will inevitably deal with EHRs and PHRs in the future. Preparedness is key. Making sure your business is in full compliance with existing privacy and security laws and anticipating changes to relevant laws are necessary steps to effectively navigate the increasingly regulated environment of digital healthcare information.
Linda A. Malek is a partner at Moses & Singer LLP, chair of the firm’s Healthcare practice group and co-chair of the firm’s Privacy practice group. Jay D. Meisel is an associate in the firm’s Healthcare and Privacy practice groups. Moses & Singer counsels a variety of entities in the healthcare industry and other industry sectors on matters related to privacy and security. For more information on this topic, please contact Linda A. Malek at lmalek@mosessinger.com or 212-554-7814 or Jay D. Meisel at jmeisel@mosessinger.com or 212-554-7823. For further information about Moses & Singer LLP, please visit www.mosessinger.com.
1American Hospital Association. “Continued Progress: Hospital Use of Information Technology” (2007) at 3.
2Health Financial Management Association. “Overcoming Barriers to Electronic Health Record Adoption” (2006) at 2.
16Medical information may include medical history, diagnosis, policy number, subscriber number, and claims and appeals histories.
17Laura Mahoney. Advisory Group Struggles to Pen Guidance On California’s Medical Breach Notice Law. BNA’s Privacy and Security Law Report. Volume 7 Number 18 (2008).
18Id.
192008 HIMSS Analytics Report: Security of Patient Data (Commissioned by Kroll Fraud Solutions), Apr. 2008, 21.
20Id. at 4.
21Id.at 19.
22Government Accountability Office, Domestic and Offshore Outsourcing of Personal Information in Medicare, Medicaid and TRICARE (GAO-06-676, Sept. 2006).
Moses & Singer LLP ( Disclaimer Viewing this article or contacting Moses & Singer LLP does not create an attorney-client relationship. This article is intended as a general comment on certain recent developments in the law. It does not contain a complete legal analysis or constitute an opinion of Moses & Singer LLP or any member of the firm on the legal issues herein described. This article contains timely information that may eventually be modified or rendered incorrect by future legislative or judicial developments. It is recommended that readers not rely on this general guide in structuring or analyzing individual transactions but that professional advice be sought in connection with any such transaction. Attorney Advertising It is possible that under the laws, rules or regulations of certain jurisdictions, this may be construed as an advertisement or solicitation. )
Local hospitals shut out of federal funding for program; costs pose problem across the board, but benefits outweigh obstaclesPuerto Rico’s private hospitals are pushing for a share of federal funding they say is vital to meet a 2015 deadline for all medical institutions and practitioners around the nation to implement electronic health records (EHRs) under the U.S. Health Information Technology for Economic & Clinical Health Act (Hitech).
Hitech, passed as part of President Barack Obama’s American Recovery & Reinvestment Act (ARRA) last year, calls for the development of a national electronic health-records system throughout the mainland U.S., Puerto Rico and other territories by encouraging the adoption of EHRs through incentive payments to physicians.
Although physicians and medical practices in Puerto Rico are eligible for federal incentives, the island’s hospitals were shut out of the program, leaving them $200 million short of what they expected to get to implement EHRs, hospital officials say.
At stake is a vital modernizatio! n initiative and potential cuts in Medicare payments starting in 2015 if the EHR deadline isn’t met.
Congress left the hospitals in Puerto Rico and the other territories out of the Hitech legislation because it was easier to draft a definition based on just the 50 states and Washington, D.C., according to Puerto Rico Hospitals Association President Jaime Plá Cortés.
“When the Hitech Act was approved, we thought we were in. But we were wrong,” said Plá, adding the congressional record doesn’t shed any light on how and why local hospitals were shut out.
Surprised by the exclusion, island hospitals are lobbying hard for funding to meet a federal requirement that does apply to the island’s medical facilities and practitioners. Plá has taken the case to Capitol Hill during various visits to Washington, D.C.
“Members of Congress agree there is no reason we should be left out,” he said.
“We feel it isn’t fair because we aren’t eligible for the financial aid but do have t! o comply with the law,” said Ashford Presbyterian Community Ho! spital E xecutive Director Pedro González, the incoming Hospitals Association president for 2011.
Resident Commissioner Pedro Pierluisi is aiming to fix the problem through legislation to amend Hitech. His H.R. 1501, or the Puerto Rico Medicare Reimbursement Equity Act of 2009, was co-sponsored by the three stateside Puerto Rican members of Congress— Rep. Luis Gutiérrez, D-Ill., and New York Democratic Reps. José Serrano and Nydia Velázquez—and has been sent to the U.S. House Ways & Means Committee.
“This lack of eligibility apparently stems from an involuntary mistake since Puerto Ricans pay the payroll taxes that finance this program,” said Pierluisi, adding the island Health Department, meanwhile, has received $7.7 million through ARRA for the implementation of EHRs in public medical facilities.
“There is no law that obligates anyone to incorporate EHRs,” said Dr. José Piovanetti, chief medical information officer at the island Health Department.
While no sanctions will be! levied for noncompliance, Medicare-funding cuts will come into play and will increase annually after the EHR incentives run out by the 2015 deadline, he said, noting hospitals with mostly older patients would be particularly hard hit.
EHR implementation at a midsize hospital costs roughly $10 million-$12 million, according to Piovanetti. Even with the federal funding issue unresolved, some local private hospitals are pushing ahead with EHR implementation, including Ashford, which has earmarked more than $2 million for the project.
“We are currently in phase five of six and the project will be completed by early 2011,” González said.
Plá said some hospitals might receive EHR funds through Medicaid, but “the local government is still deciding how the funds are going to be distributed.”
“Only hospitals with at least 10% of patients covered by Medicaid may be eligible for that money,” he said.
Other challenges for EHR implementation
Beyond the federal fundi! ng issue, the island’s medical community faces other significa! nt chall enges in implementing EHRs.
Piovanetti believes Puerto Rico should move quickly toward EHRs, but acknowledged the process poses obstacles across the medical field.
“It requires a change in the whole operation of the institution and the adoption of a new mechanism as well as a new dynamic in the doctor-patient relationship,” he said.
It can take up to two months to implement EHRs in a small practice while the process can extend to nine months in a primary-care clinic, according to industry executives.
The Health Department official said doctors fall into one of three categories in terms of the new system: The adopters, who are young and embrace technology; the sideliners, who will wait and see how the project develops; and the late adopters, who see the system as a headache rather than a benefit and will incorporate it only reluctantly.
“This is normal in a change of this sort. But the mid- and long-term benefits outweigh everything else,” said Piovanetti, adding th! at once widely adopted, people won’t be able to work without EHRs.
A potential problem with an HER system, according to Piovanetti, is that they are designed by technology specialists, not by health experts, which can complicate diagnosis and treatment efforts by doctors.
The Health Department chief medical information officer, however, brushed aside security and privacy concerns, saying EHRs are safeguarded from hackers and dramatically more secure than paper records.
‘Bar set too high’
A big obstacle to the implementation of EHRs in Puerto Rico is that “meaningful use” must be established to qualify for incentives under the Hitech Act, a standard that will be tough to meet, according to Plá.
“Meaningful use isn’t a possibility right now for island or U.S. mainland medical practices. The bar was set too high,” he said, adding the Federal Hospitals Association agrees with his assessment.
According to the Hitech regulations, medical practices should be us! ing EHRs by 2011, exchanging information through EHRs by 2013 ! and empl oying EHRs as a full tool for patients by 2015 to comply with the “meaningful use” standard. If doctors in medical practices don’t comply with 100% of the regulation they won’t receive a cent in federal incentives, Plá said.
Plá said the Puerto Rico Hospitals Association has submitted amendments to the regulations to make Hitech compliance easier, which includes extending the timeframe to implement the system.
“There are practices that will be able to comply with the meaningful-use clause, though many won’t,” Piovanetti said.
“If medical practices wait until 2011 to start the transformation process, there is a high probability they won’t receive any funds because they won’t be set on time,” he said. “Whoever hasn’t started yet is late, for both the meaningful-use compliance and the certification.”
However, the certifier of the correct use of EHRs, the U.S. Health & Human Services Department, hasn’t completed its regulation.
“Most certified providers are transitory ! while the department finishes the regulations,” Piovanetti said.
Despite the challenges, medical-industry officials say the benefits of EHRs outweigh the costs.
EHRs, which integrate the patient information from all health providers and can be exchanged, shouldn’t be confused with electronic medical records (EMRs), which carry patient information offered from one health provider.
“Our patients can be anywhere and, with just the touch of a button, we can assure they will be covered and taken care of correctly,” said Wanda Mims, the top official in Puerto Rico of the U.S. Department of Veterans Affairs, the only institution on the island that currently handles EHRs.
Former Humana President Dr. Víctor Gutiérrez worked for more than 10 years to establish a system that compiles all the clinical data for a patient into a single file.
“Many have long seen this as a logical process so patients and health professionals can have easy access to information and prevent duplic! ation. We wanted quality to go up but costs to go down,” Gutié! rrez sai d. Obama’s inclusion of EHRs in the ARRA stimulus package accelerated the process by making it a priority for medical practices to share information through a national database.
“You are able to look at a full patient profile. For patients, it will prevent any inconveniences in terms of picking up and taking documents from one place to another. It will also lower costs and will help a lot in quality of service,” Gutiérrez said.
Gutiérrez acknowledged the high hardware, software and training costs tied to EHR implementation but argued “there has to be a safe method for data storage and the Hitech Act can help cover these costs.”
“The government is providing us with the power to transform health services to attend to patient’s needs,” said Laura Morales, president of Smart Health, a company that provides health-information systems. She added that the current manual-records process is vulnerable to errors, privacy violations, duplication of prescriptions and treatments an! d is marked by fragmentized information.
For Piovanetti, the adoption of EHRs is also a matter of maintaining the competitiveness of the island’s healthcare system.
“Puerto Rico is too focused on its problems and isn’t looking beyond our coast to see how we rate,” said Piovanetti, arguing that the island lags far behind the medical industries in Europe, Mexico, Canada and other jurisdictions.
According to a study published by the World Economic Forum, Puerto Rico ranks 43 out of 133 in the network readiness index. Countries such as Tunisia, Qatar and Barbados are more technologically ready than Puerto Rico.
“This is a long process and it won’t be easy. There are a lot of people who aren’t technologically advanced,” Plá concluded.
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Following the release of the FCC’s National Broadband Plan yesterday, Chairman Julius Genachowski sat down for an interview on YouTube National Broadband Plan Wrap-Up By Brad
A sampling of online chatter following yesterday’s release of the National Broadband Plan. First up, the Huffington Post:
Among the cornerstones of the plan is a ‘shoot for the moon’ goal of connecting 100 million U.S. households to 100 megabits per second broadband service over the next decade. Goals of this ambition require an unshakable policy foundation that is unequivocally supportive of investment. This means the many rule-makings that likely flow out of this plan must be cohesive in nature—pulling in the same constructive and unifying direction and staying true to the Chairman’s early and firm commitment to fact-based, data-driven decisions.
From Business Week:
If the U.S. military ranked 17th in the world, you can bet that as a nation we would make strengthening our armed forces a national priority. Yet that’s just how the U.S. stacks up against the rest of the world in terms of access to high-speed Internet connections. The vital communications systems that make our economy work and serve as a platform for business innovation and social interactions are second-class. Sadly, many of us have accepted that.
It’s time to overcome our broadband complacency. The national broadband plan sent to Congress on Mar. 16 by the Federal Communications Commission is critical to our economic and national security. Without a plan, we simply cannot compete.
The L.A. Times:
The FCC’s plan calls for a dramatic expansion of affordable, high-speed Internet. A chief goal is to ensure that at least 100 million homes have access to networks that allow data downloads at speeds at least 20 times faster than what most networks now deliver.
The bulk of the recommendation can be enacted by the FCC, such as diverting money from a fund for affordable phone service to rural areas to be used for increasing broadband access.
But Congress would have to act on others, particularly changing rules for federal auctions of federal airwaves to entice some broadcasters to give up their spectrum so the airwaves could be used for wireless Internet access.
USA Today:
FCC Commissioner Mignon Clyburn criticized the recommendation to coax, and possibly force, television broadcasters to give up some airwave spectrum. The plan aims to increase broadband competition by boosting the amount of spectrum for wireless Internet services to 500 MHz from 50 MHz.
She said that “it is certainly possible, if not likely” that the few minority-owned stations likely would be among the first to sell their spectrum. She says she would find a policy that further diminished that number to be “untenable.”
The Wall Street Journal:
The FCC report suggests that 100 million U.S. homes—of a total 112 million—should have “affordable access” to 50 megabit per second Internet service in five years. That’s about 10 times faster than most homes get today. But the plan doesn’t define affordable.
Nor does it offer a specific recipe for its aim. The FCC says it will ultimately propose dozens of new rule changes to enact some of the ideas in Tuesday’s report.
The New York Times:
The broadband proposal, which the agency sent to Congress on Tuesday, “is necessary to meet the challenges of global competitiveness, and harness the power of broadband to help address so many vital national issues,” the agency chairman, Julius Genachowski, said in a statement.
President Obama said the plan recalled the way “past generations of Americans met the great infrastructure challenges of the day, such as building the transcontinental railroad and the Interstate highways.”
Statement from the President on the National Broadband Plan
America today is on the verge of a broadband-driven Internet era that will unleash innovation, create new jobs and industries, provide consumers with new powerful sources of information, enhance American safety and security, and connect communities in ways that strengthen our democracy. Just as past generations of Americans met the great infrastructure challenges of the day, such as building the Transcontinental railroad and the Interstate highways, so too must we harness the potential of the Internet. Expanding broadband across the nation will build a foundation of sustained economic growth and the widely shared prosperity we all seek.
I commend Chairman Julius Genachowski, the Commissioners, and the FCC staff for their hard work in developing the National Broadband Plan.
My Administration will build upon our efforts over the past year to make America’s nationwide broadband infrastructure the world’s most powerful platform for economic growth and prosperity, including improving access to mobile broadband, maximizing technology innovation, and supporting a nationwide, interoperable public safety wireless broadband network.
### FCC Chairman Announces The National Broadband Plan.
What is Broadband?
The term broadband commonly refers to high-speed Internet access that is always on and faster than the traditional dial-up access.
How is broadband different from dial-up service?
Broadband service provides higher-speed of data transmission. It allows more content to be carried through the transmission “pipeline.”
Broadband provides access to the highest quality Internet services—streaming media, VoIP (Internet phone), gaming, and interactive services. Many of these current and newly-developing services require the transfer of large amounts of data that may not be technically feasible with dial-up service. Therefore, broadband service may be increasingly necessary to access the full range of services and opportunities that the Internet can offer.
Broadband is always on. It does not block phone lines and there is no need to reconnect to network after logging off.
Less delay in transmission of content when using broadband.
Goal 1: At least 100 million U.S. homes should have affordable access to actual download speeds of at least 100 megabits per second and actual upload speeds of at least 50 megabits per second.
Goal 2: The United States should lead the world in mobile innovation, with the fastest and most extensive wireless networks of any nation.
Goal 3: Every American should have affordable access to robust broadband service, and the means and skills to subscribe if they so choose.
Goal 4: Every community should have affordable access to at least 1 Gbps broadband service to anchor institutions such as schools, hospitals and government buildings.
Goal 5: To ensure the safety of Americans, every first responder should have access to a nationwide public safety wireless network.
Goal 6: To ensure that America leads in the clean energy economy, every American should be able to use broadband to track and manage their real-time energy consumption.
Inside net neutrality with FCC Commissioner Robert M. McDowell by Hugh Carter Donahue
12.03.2010 kl 22:52 | IDG News ServiceA A A Billions of dollars are at stake in the FCC’s net neutrality rule making, which could mandate rules for broadband Internet access over wireless and wireline networks.
Billions of dollars are at stake in the FCC’s net neutrality rulemaking, which could mandate rules for broadband Internet access over wireless and wireline networks.
To date, network operators decide on their own how to comply with voluntary net neutrality standards, which call for enabling subscriber choice when it comes to sending and receiving lawful content, running lawful applications and services, and connecting devices to their computers, laptops and mobile phones as along as those devices do not damage providers’ networks.
Now, the FCC is evaluating whether to change these voluntary standards into mandatory rules, which would limit broadband network operators’ discretion to do what they want.The FCC is also determining whether to restrict network operators from offering premium service options to content, application and service providers (the so-called non-discriminatory standard) and to compel network operators to disclose network management information so users can ascertain if they are getting the services they are paying for (the network management standard).
Service quality and speed differentiations are increasingly feasible due to technological innovations, and, some argue, desirable because they would stimulate investment. If the FCC were to permit differentiated service quality, network operators could enable content, application and service entrants to take on incumbents more effectively, and network equipment manufacturers could develop new ways to manage traffic and service quality.
The commission wishes to stimulate innovation and investment, and the net neutrality inquiry enables it to address network management technologies and practices and their impacts on Internet content, application and access markets, even though the inquiry formally addresses access.
A crucial part of the FCC rule-making process involves seeking comments from industry participants, public interest organizations and citizens.
For a commissioner’s perspective on these complex issues, Network World asked Hugh Carter Donahue, a communications policy expert and scholar, to pose questions to Federal Communications Commissioner Robert M. McDowell about the net neutrality proceeding.
You were a great proponent of competition in local telecommunications markets earlier on when you worked at Comptel promoting competitive communications services. What similarities exist with your policy views regarding competitive local phone markets and net neutrality?
During my career, I have always tried to find ways to ensure that consumers have choices. That was the goal in my previous job and has been my theme as a commissioner. Specifically, I have sought ways to increase last mile connections. And, looking at the current marketplace, American consumers have more choices in last mile providers now than ever before. As a commissioner, I have made it a priority to encourage the commission to adopt policies that create opportunities for the construction of new delivery platforms. More often than not, I have tried to approach these goals using deregulatory incentives. For example, over the past couple years, the FCC has classified broadband as less regulated “information services” under Title I of the Communications Act. As we move forward with proceedings emanating from the National Broadband Plan, I work towards finding ways to continue this trend.
Why is the Commission initiating a net neutrality rule making now?
Actually, this is a question that would be more appropriately addressed to the chairman since he controls the FCC’s agenda. Nevertheless, I question the need to pursue such a rulemaking. First, thus far no evidence of a systemic market failure in the broadband market has been presented to the commission. For instance, in 2007, the FCC conducted an inquiry into the state of the broadband market, and did not find evidence of a systemic market failure. Furthermore, during that same year, the Federal Trade Commission (FTC) concluded a thorough market analysis and ultimately issued a bipartisan report after an unanimous vote that actually cautioned against the imposition of network neutrality regulations.
Second, pursuant to a congressional directive in the Stimulus Act, the FCC has been developing proposals for a National Broadband Plan. It might have made more sense to analyze and deliberate on the findings from the FCC’s broadband team before jumping right into regulating network management.
Third, both the Department of Justice and the National Telecommunications and Information Administration recently filed comments in the National Broadband Plan proceeding, and neither agency made a case that a systemic market failure exists. To the contrary, DOJ’s comments seemed virtually optimistic regarding the broadband market when it wrote:
Between the ongoing deployment of wireline broadband networks, the geographic expansion of wireless broadband services (hopefully spurred by the availability of additional spectrum to broadband wireless services), and increased transparency, the Department is hopeful that the vast majority of American households will benefit from significant competition in their local broadband markets. Put differently, most regions of the United States do not appear to be natural monopolies for broadband service. – Letter from Christine Varney, Assistant Attorney General, U.S. Department of Justice Antitrust Division, to Marlene H. Dortch, Secretary, FCC, GN Docket No. 09-51, at p.28 (filed Jan. 4, 2010).
Are you concerned that mandating net neutrality would shift the industry focus from pleasing customers to manipulating regulators?
I have many concerns regarding imposing mandatory regulations on the Internet, so it is hard to put one at the top of the list. But, one concern is that the proposed regulations may not necessarily be structured in a way to protect consumers. The U.S. government’s bipartisan policy since the Clinton-Gore administration has been to allow a competitive free market and non-governmental organizations, such as the Internet Engineering Task Force, handle Internet governance.
Broadband providers have the direct connection with the consumers, and it is in their best interest to keep their customers happy. I worry that the proposed rules could set up a “Mother-May-I” regime on top of other unintended consequences we cannot foresee, whereby new innovations could be inhibited by the uncertainty created by net neutrality rules. Consumers could suffer as a result.
What effects do you think mandatory standards will have on broadband network and equipment investment and software programming? Will these standards stimulate or freeze investment and innovation, or turn out to be neutral?
Hundreds of billions of dollars have been invested in America’s broadband networks since the Internet was privatized in 1994. More investment is pouring in over the horizon. New rules, regardless of their context, always invite litigation and, therefore, uncertainty. Capital avoids uncertainty. It is not hard to envision a scenario where new investment is inhibited by new rules. Investors of all kinds told the FCC as much during our Oct.1 hearing on investment in the broadband market.
Turning to network administration, when the commission issued the Network Neutrality Notice, you pointed out that “the public interest would be better served if the debate would focus more on” the dichotomy between “anti-competitive” and “anti-discriminatory” network administration. In your view, network engineers necessarily discriminate and it’s a chimera to belabor discrimination.
The practical effect of the proposed net neutrality rules would be that all broadband providers would have to treat all Internet traffic equally. But, the reality is that the Internet can function only if engineers are allowed to “discriminate,” otherwise known as “network management.” Discriminatory conduct, in the network management space, does not necessarily mean anti-competitive conduct.
Practically speaking, consumers will not tolerate delay or interference when it comes to certain kinds of applications. For example, for users to enjoy online video without interruption or distortion, video bits have to be given priority over e-mail bits. But if traffic must be treated equally, that will have to change and consumers could see a degradation of quality and more delay as a result.
In a voluntary net neutrality regime, how would the roles change for voluntary standards organizations such as the Internet Society (ISOC), Internet Engineering Task Force (IETF) and the Internet Architecture Board (IAB), among others?
Since the early days of the state-run ARPANET, network management and Internet governance initiatives have migrated further away from government regulation. I question whether the government would really be able to replicate the billions of decisions that are made each day in the private sector regarding the Internet. It seems to make more sense that such voluntary standards organizations continue their work in a voluntary regime as they address network issues, including network management.
They should continue to be free of government control and encourage the participation of volunteer engineers, academics and software developers, who act on their own, not on behalf of their employers. The Internet will continue to thrive if these volunteer groups are able to work collaboratively instead of within a government-mandated “top-down” model.
As for the FCC’s involvement, the FCC could act as a partner with these non-governmental collaborative Internet governance bodies, and together we could collectively shine a bright light on any allegations of anti-competitive conduct. This approach could provide the benefits sought by proponents of new rules without the unexpected costs and risks that a new regulatory regime could cause.
If mandated, does net neutrality give incumbent Internet content and application providers disproportionate competitive advantages in terms of lower unit costs and flat rate end-to-end pricing, potentially making it more difficult for new entrants to compete?
The proposed net neutrality rules, as currently drafted, only apply to providers of broadband Internet access service. Some may argue that they were drafted in this manner because there was concern that the FCC lacks jurisdiction over content providers. Regardless, as to why the rules were drafted this way, they have the potential of tipping the scales, which unfortunately could have the end result of harming consumers.
For example, while currently the most common way that services are charged is through flat-rate pricing, that may not continue to be the best (or only) model in the future. And, it certainly may not be a model that benefits all consumers. The proposed rules could create a regime whereby every consumer must be treated the same regardless of their usage. In that scenario, all prices would have to rise to compensate for the costs imposed by heavy users because broadband providers would be locked into a flat rate pricing regime.
The FCC is loathe to let network operators extract service quality pricing from content providers lest so doing lead to walled gardens that erode the public Internet and suppress originator and user innovation and investment. However, the notice indicates the commission could favorably consider varieties of service quality levels for managed or specialized services and applications. Is this a vehicle for industry peace? Do you see this approach developing for retail access services?
Just as the term “net neutrality” means different things to different people, the same can be said for the term “managed services”. Additionally, if some companies view that as a regulatory regime will favor certain services, they could have incentives to focus more of their resources on developing such services at the expense of other services. Additionally and conversely, if the rules lock in a certain definition for such services, companies could be less creative in the future in developing new technologies.
Switching to wireless, you often point out that open access mandates in 700Mhz auctions constituted the initial steps toward network management regulation of wireless. Will mandating these standards or sustaining them as voluntary standards stimulate or freeze network investment and innovation, or turn out to be neutral?
As an initial matter, I have long advocated application and device portability as well as free and open networks. Consumers want these features, and the market started working on delivering them years before unnecessary, counterproductive and after-the-fact Commission mandates. In the absence of regulatory mandates, U.S. wireless carriers have — and continue to – ring consumers the mobile Internet services they demand.
In 2007, I cast the only dissenting vote against auction rules for the 700MHz band because they included “open access” mandates concerning devices and applications for some, but not all, blocks of that spectrum. I dissented partly because evidence in the record convinced me that new rules were unnecessary. Marketplace forces, otherwise known as consumer demand, were moving network providers in that direction anyway.
I also feared that the open access mandates would undermine the commission’s goal of encouraging entry of new providers into wireless services. I was especially concerned that larger carriers would avoid the nationwide, encumbered spectrum and outbid smaller players for the regional, unregulated spectrum blocks. It gives me no joy to report that my fears proved to be correct — the smaller providers did indeed lose out.
Here’s how: the price for the “open access” C Block was 77 cents per megahertz by population in the license area (known as “megahertz pop”), and it was purchased not by a new entrant, but by Verizon Wireless. On the other hand, the average price of the unencumbered B Block was an unprecedented $2.65 per pop. AT&T Wireless was the largest winner of B Block spectrum. Even the A Block, unencumbered, but which some had argued was “less desirable” because it neighbors with higher-powered broadcast operations and thus might be susceptible to harmful interference, went for an average of $1.13 per pop.
The bottom line is that the smaller unencumbered blocks sold for up to three times more than the larger, more regulated block. Large and small players have already commented that the encumbrance on the C Block had an effect on pricing because bidders put a premium on the clean spectrum. Acting in an economically rational manner, large incumbents outbid many smaller players in smaller blocks. Smaller players had nowhere else to go, all while no new broadband provider emerged. In short, the open access regulation not only failed to deliver on what was promised, but it actually harmed competition.Another possible unintended consequence of the open access mandate has recently been brought to our attention. This issue pertains to design and manufacture of equipment for operating in the 700MHz Band. A coalition of A Block auction winners has complained to the FCC because: (1) Verizon Wireless, the C Block auction winner, is allegedly contracting to purchase equipment capable of operating only in the C Block; and (2) AT&T, which won the largest share of B Block spectrum, is allegedly contracting to purchase equipment capable of operating only in the B and C Blocks. These A Block auction winners argue that their customers will be left without viable and widely operational equipment options. They have requested that the FCC suspend the authorization of any equipment not capable of operating over all commercial 700MHz Band spectrum.Here again, it appears that the encumbrance on the C Block may be having an effect on equipment design and purchasing decisions.In order to mandate net neutrality, the commission employs a rationale to regulate telecommunications services, which entail no information processing, as a means to regulate Internet services, which depend on information processing. This seems anomalous. This approach will not survive judicial scrutiny, your comments indicate. Why?
Since 2002, the Commission has continued on a path of classifying broadband services as less regulated information services under Title I of the Communication Act. As such, proponents of net neutrality rules have had to argue that the commission has jurisdiction to impose these rules through its ancillary authority under Title I — rather than directly through Title II. But, some question whether the commission can use its ancillary authority for network management regulations.
That specific jurisdictional question is currently before the U.S. Court of Appeals for the District of Columbia in the Comcast/BitTorrent case. Oral arguments have already been held in that case, and it will be interesting to see how the court rules regarding the commission’s ancillary jurisdiction. If the court rules that the commission does not have jurisdiction, the proposed rulemaking will be on a shaky legal foundation.
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