March 2010

NBC/Comcast execs make few guarantees to Franken

In the wake of last month's heated Senate hearing with executives from NBC and Comcast, Sen Al Franken (D-MN) wanted some guarantees that the companies would continue to offer their content online on sites like Hulu.com after the proposed merger. Their responses, however, were a far cry from binding proclamations. While both companies emphasized their commitment to mass distribution of content, they largely argued that broad promises would be unwise in such a rapidly evolving media environment. In other words, "We'll try, but business is business."

It's time to unleash the NHIN

[Commentary] The HITECH stimulus funds have created great buzz in health and health IT. Providers are contemplating electronic medical record (EMR) implementations, vendors are scurrying to be "meaningful use" compliant, and states and others are planning for Medicaid, health information exchange, training and other related services. This environment should be ripe for movement, yet there are numerous signs that the movement that comes will be begrudging and fragmented - not the kind explosive, coordinating movement that has characterized other major information technology advancements like the Internet. Projections for physician adoption rates, the timeframe expressed by the "meaningful use" phases, and the push-back received on the first "meaningful use" criteria all point to such a trajectory. It is time to unleash the NHIN and let it develop into the "killer app" that can actually help draw in participants and make meaningful outcomes attainable.

CMS meaningful use revisions must synch with other regulations

The Centers for Medicare and Medicaid Services has to make sure that changes it makes to the final version of the proposed meaningful use rule mesh with other rules for standards and certification, as well as the recently published proposal for a certification process.

"There really is a dance among the regulations," said Tony Trenkle, CMS director of e-health and standards, at a meeting March 17 of the Health IT Policy Committee, which advises the Health and Human Services Department, and CMS has to keep this interplay in mind as it considers what to incorporate into the meaningful use rule. "The more complexity you build into this process, the more difficult it becomes to launch the program quickly," he said. The combination of meaningful use and the other rules and regulation is important because they lay out the requirements that healthcare providers must accomplish to document meaningful use to qualify for incentives, the functions that electronic health records must be capable of to support meaningful use and the process for an organization to validate the capability of an EHR.

Feds received 2,700 comment letters on meaningful use and standards rules

The comment period on the proposed meaningful use rule and the interim standards final rule closed Monday. On Wednesday, federal officials said they had so far collected some 2,700 comment letters.

Steve Posnack, a policy analyst with the Office of the National Coordinator for Health Information Technology said ONC received 700 comment letters on the standards interim rule. After reviewing them, ONC found that only 300 of them were "relevant," Posnack said Wednesday at a meeting of the HIT Policy Committee. According to Jodi Daniel, director of the ONC Office of Policy and Research, because the standards rule is a interim final rule, there is very little the government is allowed to change, by law. Recommendations can only be acted upon by ONC if they expand on what is already in the rule.

Tony Trenkle, director of the Centers for Medicare and Medicaid Services' (CMS) Office of E-Health Standards and Services said CMS has so far read almost half of the 2,000 comment letters it received on the meaningful use proposed rule, with a few more expected to trickle in over the next few days. Most of the letters were well thought-out, and reflected the need for balance between setting standards high enough for data collection and ease of healthcare IT adoption.

Warning of healthcare IT disaster

In a sobering keynote address at the 2010 World of Health IT Conference and Exhibition, e-Health researcher Enrico Coiera of University of New South Wales, Australia said industry enthusiasts who back, uncritically, national-scale health information technology systems need to prepare themselves for some very bad news.

"We've yet to experience our first health IT plane crash, a health IT failure that claims many lives," Coiera said Wednesday. "But I think that will happen... I think it's unavoidable given what we're doing. We need to do our best to mitigate that."

Coiera titled his talk "The Dangerous Decade," because while he predicts unprecedented growth in healthcare information technology in the immediate future, that proliferation will come with some unwanted side effects -- especially when deployed on a national scale.

"I think over the next 10 years we will build more health IT than we have ever built before," he said. "These systems will be bigger and more complex. The costs and benefits are so large that they will significantly impact national GDP -- people are going to notice it.

"We have no choice but to do this," Coiera continued. "The danger is that health IT is still in its infancy. We are doing things we have never done before."

Letter tells CMS to set more specific EHR goals

To successfully implement the broad use of electronic health records, the Centers for Medicare & Medicaid Services (CMS) needs to make its health goals and targets more explicit, according to public comments submitted by healthcare leaders from 56 organizations on the agency's meaningful-use rule.

The Markle Foundation, the Center for American Progress and the Engelberg Center for Health Care Reform at Brookings were the three organizations that coordinated these comments and submitted them to the CMS in response to several rules governing meaningful use and certification of EHRs. The rulemaking originated from the American Recovery and Reinvestment Act of 2009, also known as the stimulus law, which provided billions of dollars in federal subsidy payments to hospitals and office-based physicians for the purchase of EHR systems. HHS plans to administer the new subsidies beginning in 2011. The goal of meaningful use is to improve healthcare efficiency, safety and quality, not just to adopt EHRs, yet the rulemaking fails to establish a set of clear and measurable goals for achieving the quality metrics it proposes, healthcare leaders stated. Unless these goals are understood by the provider community, compliance with meaningful use will become more of an exercise to fulfill reporting requirements instead of an opportunity to use health IT to improve care, the groups warned.

Internet Access Ignites the Blogosphere

Last week, in very large numbers, bloggers focused on a subject near and dear to their hearts -- access to the Internet.

From March 8-12, the top story in the blogosphere was a BBC survey of more than 27,000 adults worldwide in which four out of five people consider Internet access a "fundamental right." Fully 43% of links in blogs were about this story and a related information graphic that mapped the spread of Internet access around the world. The survey elicited more attention among bloggers than any other story in 2010, other than the devastating earthquake in Haiti, which also received 43% of the links the week of January 11-15, 2010. And since PEJ began the New Media Index in January 2009, there have been just 10 stories in all that have captured more than 40% of links. Bloggers largely championed the idea of online access as a basic right and some called for legislation and programs to expand it. But many also dissected the survey findings closely, and some expressed concern that the question -"To what extent do you agree or disagree that access to the Internet should be a fundamental right of all people?"- was too vague.

States Pressure E-Tailers to Collect Sales Tax

The economic slump is helping rekindle a debate on whether online retailers should have to collect state sales taxes, a question that has pitted the new economy against the old.

A half dozen cash-strapped states are contemplating new laws that would require e-commerce sites to charge shoppers local sales tax on purchases. Proponents of sales tax for online merchants, such as the American Booksellers Association, say it is a matter of fairness to tax online purchases the same as bricks-and-mortar ones. "It isn't the role of government to pick favorites between one group of retailers as opposed to another," said the organization's chief executive, Oren Teicher. Mary Osako, a spokeswoman for Amazon.com Inc., the largest online retailer by revenue, said state-by-state laws are creating a "very complex sales tax regime," and that the company would only support a "simplified system, fairly applied to all business models." Amazon is in favor a national streamlined sale-tax effort that would mandate sales tax collection by out-of-state retailers in 23 states that have voluntarily signed on to the program. "We aren't opposed to collecting sales tax within a constitutionally permissible system applied even-handedly," Osako said.

Tech lobbying soars in 2009

Computer and Internet companies spent well over $120 million last year on federal lobbying efforts, according to the Center for Responsive Politics.

That means the industry has devoted more than $1 billion to federal lobbying over the past decade -- the fourth-highest amount spent by any industry in the center's yearly study. Broken down, the list of the top 20 tech lobbying spenders published this week features a number of expected names. Microsoft tops the list, having spent about $6.7 million in 2009. Google places fifth, devoting more than $4 million to federal lobbying last year, followed by companies like Intel, VeriSign and Yahoo!

Google's fast pipe to Asia almost ready

Google and a group of telecommunications companies are about ready to turn on a fast Internet cable running under the Pacific Ocean from the U.S. to Japan, increasing bandwidth by about 20 percent and giving Google its own connection to Asia.

The Unity Consortium, which consists of Google, Bharti Airtel, Global Transit, KDDI, Pacnet, and SingTel, has nearly completed the testing of the $300 million project. Internet users in Asia will start seeing faster Internet speeds over the next several months from the new cable, which has the potential to create a 7.68Tbps (terabits per second) connection under the Pacific. In return for its investment -- the amount of which was not disclosed -- Google is entitled to 20 percent of the overall capacity for its needs, according to partners involved with the project. Google is one of the largest users of bandwidth on the planet, if not the largest, and invested in the project in 2008 to help satisfy those needs on one of the critical routes for Internet traffic.