Information therapy measures in rule for electronic health records

Advocates for a discipline known as information therapy are taking credit for some of the requirements in the Health and Human Services Department's recent proposed rules for digital health records.

Doctors and hospitals who can show meaningful use of health information technology under the HHS rule can quality for a portion of $17 billion in incentive payments under the economic stimulus law.

Under HHS' proposed rule,  doctors and hospitals would have to provide an electronic copy of medical records to patients who request them within 48 hours. The providers must achieve that goal 80 percent of the time.

The rule would also require doctors to send reminders for preventative care or followup care to at least 50 percent of their patients older than age 50.

Those were among provisions promoted by the Center for Information Therapy and the Information Therapy Action Alliance that have been included in HHS' proposed regulation, said Jennifer Covich, interim chief executive officer for the nonprofit eHealth Initiative, which took over operations of the information therapy alliance in December.

“This is a significant development for information therapy,” Covich said today. “It is a step in the right direction. I think people understand the concept that patients need access to information.”

Getting medical information to patients at the right time and place, preferably in an automated fashion, are key principles of information therapy, which has been a discipline for about 10 years.

Other information therapy provisions in the HHS proposal include requirements for patients to have timely electronic access to their medical records, discharge information and clinical summaries, Covich said.

One information therapy proposal that did not get included in the proposed regulation would have required that patients be provided with patient-specific information about their condition at the time of the visit, Covich said.

For example, for a patient just diagnosed with diabetes, this could be in the form of an automated printout of facts and information about diabetes care that the physician provides to the patient in the office.

Often, doctors give patients information on their diagnosis verbally, and patients forget details and important points about what to do to care for themselves. “Patients need basic information at the point of care, and that does not always happen,” Covich said. “We want it built into the system and built into electronic health records so that it happens automatically.”

The information could be in an electronic or paper form. It is particularly important in cases of care for chronic conditions or when a caregiver is providing followup care to a child or elderly person, Covich said.

While the information therapy advocates did not succeed in including that provision in the 2011 quality measures, there are indications that HHS will add more quality measures for the 2013 meaningful use standard, she said.

HHS published its proposed rule on meaningful use, along with a separate interim final rule on certification of electronic health records, on Jan. 13 after initially releasing the proposals in draft form on Dec. 30, 2009. The meaningful use rule included 25 quality measures, including requirements that doctors and hospitals use computerized order entry forms and maintain a record of patients who are obese. The public has 60 days to comment on the proposals.

The Center for Information Therapy was founded by Josh Seidman in 2001, who dissolved the organization when he left in November 2009 to become an adviser to the HHS Office of the National Coordinator for Health Information Technology. The national coordinator has been leading the development of the meaningful use regulations. The Information Therapy Action Alliance, also known as the Ix Action Alliance, which was a program of the center, made an agreement with the eHealth Initiative nonprofit organization to be absorbed into that group