In Smigaj v. Yakima Valley Memorial Hospital Association, the Washington Court of Appeals reversed a grant of summary judgment by a lower court based upon HCQIA immunity.

Although the opinion is fairly lengthy, the key facts with respect to the reversal of summary judgment are as follows:

1.         Dr. Smigaj was preliminarily and summarily suspended because of quality of care concerns;

2.         Her privileges were reinstated subject to a concurrent three month review of her cases;

3.         Dr. Smigaj was again suspended upon the recommendation of the hospital’s Perinatal Quality Assurance Committee (PQAC). The appellate court concluded that the hospital was not entitled to HCQIA immunity because the professional review action failed to satisfy two of the four HCQIA requirements. The court concluded that Dr. Smigaj had been unable to rebut the presumption that the hospital acted in the reasonable belief that the action was taken for the furtherance of quality health care and that it was reasonably warranted by the facts, but the court concluded that the hospital had neither conducted a reasonable investigation, nor provided due process.

A reasonable investigation was not conducted because the PQAC failed to review the external reviewer’s report or discuss the issue directly with the external reviewer prior to the issuance of the suspension, but instead relied upon third party summaries of the report, and it conducted no internal investigation of its own. The hospital failed to provide due process because Dr. Smigaj was not advised that a suspension of her privileges was being considered until after the suspension, did not receive the external expert report until after her suspension, and was not present during any discussion by the PQAC with the external reviewer. This last one obviously suggests that even had the PQAC met with the external reviewer prior to the suspension, that meeting would have been insufficient if Smigaj was not given the opportunity to be present and rebut the report. 

Furthermore, the court was concerned because three members of the PQAC were economic competitors of Dr. Smigaj.

Finally, and for good measure, the appellate court reversed the trial court’s award of attorneys’ fees to the hospital in the amount of $534,415. 

Link:              

MARCH 8-9, 2012: Canada - US Healthcare Technology Summit: Improving Care through Innovation

Thursday evening networking 3/8/12 & Educational Seminar Friday 3/9/12 Doubletree Pittsburgh

As total annual U.S. healthcare costs continue to soar, the role of healthcare and technology has taken over discussions in Washington and on Wall Street – and now Pittsburgh. On March 8 and 9, the Consulate General of Canada in Buffalo and The Canadian Trade Commissioner Service, along with the Western Pennsylvania Chapter, Healthcare Information and Management Systems Society (WPHIMSS) are partnering to present the inaugural Canada − United States Healthcare Information Technology Summit − “Improving Care Through Innovation” – which will be held at the DoubleTree Hotel & Suites Pittsburgh.

The summit aims to foster partnerships and identify opportunities for synergies among Canadian healthcare technology companies and U.S. hospitals, health insurers and healthcare delivery partners, to identify and accelerate the adoption of innovative solutions – ultimately leading to improved outcomes and lowered costs.

The event will kick off on March 8 with professional networking, speakers and an interactive discussion session, while the following day’s events will include educational sessions and a keynote speaker. Representative discussion topics include:
- Surviving the conversion to ICD-10 codes
- Use of SMS/Text Messaging for successful health management
- Health IT Security Concerns & How to Protect Your Data and Patients
- Use of Social Media in Healthcare

To register, visit www.wphimss.org and click on the blue Registration Information button. Registration deadline is Monday, March 5th at 5 p.m.  

In Gargiulo v. Baystate Health Inc., Dr. Gargiulo alleged age and disability discrimination against Baystate Health Inc. and Baystate Medical Center, Inc. She sought production of the evaluations of other residents in her program, but the defendants declined stating state peer review confidentiality statutes. 

The Court reaffirmed that there was no federal common law privileges against production in this situation and that the federal discovery rights trump state peer review protections.

The USPTO is required by the America Invents Act ("AIA") to study and report on ways of providing independent, confirming genetic diagnostic tests where gene patients and exclusive licensing for primary genetic diagnostic tests exist.  In an effort to gather information, the USPTO is hosting two hearings:

1. Thursday, February 16, 2012 at 9 AM, Eastern Standard Time, in Alexandria, Virginia; and

2. Friday, March 9, 2012 at 9 AM, Pacific Standard Time, in San Diego, California.

The public is invited to give testimony at the hearings and/or submit written comments.  For more information, including how to share input with the agency, please access the following link in the Federal Register (77 Fed. Reg. 3748, January 25, 2012): http://www.uspto.gov/aia_implementation/2012-1481_genetic-testing-hearing-notice.pdf.

Although this topic is not related to our mission at Med Law Blog, it is so important locally that we believe it necessary to post, and ask for your tolerance.

On December 27, 2011, Allegheny County mailed new 2012 property assessments to all residential properties within the City of Pittsburgh and the Borough of Mount Oliver. The overall increase in assessed value in the City of Pittsburgh was 46% for residential property owners. On December 30, 2011, Allegheny County issued new commercial assessments to all commercial properties in the City of Pittsburgh and Mt. Oliver.

If you own property within the City of Pittsburgh or the Borough of Mount Oliver, you should be familiar with two key deadlines for filing 2012 Allegheny County property assessment appeals. The deadline for filing informal appeals is January 13, 2012. The deadline for filing formal appeals is February 10, 2012.

Please remember that for City of Pittsburgh and Borough of Mt. Oliver property owners, if formal appeals are not filed by February 10, 2012, the right to challenge the assessed value for the year 2012 will be lost.

·       Informal appeals provide a property owner or representative the opportunity to submit information to a County official--without a City or School District representative present--indicating that the assessment is inaccurate.

·       Formal appeal hearings are conducted by Hearing Officers on behalf of the Allegheny County Board of Property Assessment, Appeals and Review. A City or School District representative is likely to attend the formal appeal hearing and may present information to keep your new assessment unchanged. If you file an informal appeal and you do not have a decision by the February 10th formal appeal deadline, you should file a formal appeal to preserve your rights.

These deadlines affect only the City of Pittsburgh and the Borough of Mount Oliver properties. Properties in the remaining municipalities throughout Allegheny County will receive separate assessment notices with separate appeal deadlines. These assessments are expected to be issued at various times from January to May.

We have handled thousands of assessment hearings before the Allegheny County Board of Property Assessment Appeals, and Review and have consistently obtained favorable results. If you have any questions or would like to discuss particular issues regarding the assessment appeals process, please feel free to contact any of the members of our Real Estate Group listed below:

Irv Firman          412-594-5557        ifirman@tuckerlaw.com

John Vogel         412-594-5622        jvogel@tuckerlaw.com

Gavin Robb     412-594-5654          grobb@tuckerlaw.com

Contributed by: Lee Kim, Esq.

412.594.3915

Thursday evening networking 3/8/12 & Educational Seminar Friday 3/9/12 Doubletree Pittsburgh

The Consulate General of Canada in Buffalo, along with their partner, the Western Pennsylvania HIMSS Chapter, is hosting a Canada - US Healthcare Technology Summit in Pittsburgh, PA.

As total annual U.S. healthcare costs have passed $2 trillion, the role of healthcare and technology has taken center stage both in Washington and on Wall Street.  The U.S. has embarked on a major overhaul of its healthcare system and is seeking to reduce costs and improve patient care utilizing information technology and mobile communications, as well as through the adoption of advanced care delivery and reimbursement models. 

The eHealth Summit’s goal is to foster partnerships and identify opportunities for synergies between Canadian health IT companies and United States hospitals and health Insurers, to accelerate the adoption of innovative solutions leading to improved outcomes and lowered costs. 

Registration details and other details on participation are forthcoming and will be posted here by way of update.

412.594.3915

A vendor of web-based services to help physicians achieve faster reimbursement from payors, reduce error rates, improve collection rates, improve patient compliance and satisfaction, and more efficiently manage clinical and billing information requested an advisory opinion from the Department of Health and Human Services Office of Inspector General ("OIG").  The OIG issued the advisory opinion on November 30, 2011 (No. 11-18).

Specifically, the vendor inquired whether its online service that would facilitate the exchange of information between healthcare practitioners, providers, and suppliers (the "Proposed Arrangement") would constitute grounds for the imposition of sanctions under exclusion authority at section 1128(b)(7) of the Social Security Act, the civil monetary penalty provision at section 1128A(a)(7) of the Social Security Act, as those sections relate to the commission of acts described in section 1128(b) of the Social Security Act, namely, the Federal Anti-Kickback Statute.  The anti-kickback statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a Federal health care program.  This statute is violated where remuneration is paid purposefully to induce or reward referrals of items or services payable by a Federal health care program.  It ascribes criminal liability to parties on both sides of an impermissible "kickback" transaction.  "Remuneration" in the context of the anti-kickback statute includes the transfer of anything of value, directly or indirectly, overtly or covertly, in cash or in kind.  The courts have interpreted the statute to cover any arrangement where one purpose of the remuneration was to obtain money for the referral of services or to induce further referrals.  However, the Department of Health and Human Services has promulgated safe harbor regulations that defines practices which are not subject to the anti-kickback statute due to such practices being unlikely to result in fraud or abuse.

The OIG concluded that although the Proposed Arrangement could potentially generate prohibited remuneration under the anti-kickback statute and that the safe harbors would not apply, the OIG would not impose administrative sections on the vendor under the statutes as referenced above.  While the nature of the Proposed Arrangement is described in more detail below, in brief, Ordering Health Professionals would use the Coordination Service to exchange information with Health Professionals to which referrals can be made.  If the Health Professionals are Trading Partners, then the vendor would perform value-added services associated with transmitting the information.  The vendor would receive payment from either the Ordering Health Professionals or the Trading Partners for transmitting the information and from the Trading Partners for any value-added services provided.  Additionally, Ordering Health Professionals who purchase the Coordination Service Package would receive a discount on their monthly EHR Service subscription fees.  Under the Proposed Arrangement, Transmission Fees paid by Ordering Health Professionals for referrals to Non-Trading Partners would be capped at the total dollar amount of the discount. 

Because the Proposed Arrangement's fee structure could constitute indirect remuneration from the Trading Partners to the Ordering Health Professionals to induce referrals, the OIG concluded that the anti-kickback statute is implicated.

By way of background, the vendor primarily offers the following services: the Billing Service (for automating and managing billing-related functions for physician practices and assisting clients with non-billing related back-office operations), the EHR Service which automates and manages medical record-related functions for physician practices, and the Messaging Service which automates practice communications with patients.  Its typical customer is a physician or physician group that either uses the Billing Service alone or both the Billing Service and the EHR Service, with or without the Messaging Service.  The vendor generates most of its revenues by charging a monthly subscription fee in the form of either a percentage of collections or a flat monthly fee.  In addition, under the Proposed Arrangement, the vendor would offer the Coordination Service as a new service which is intended to facilitate the exchange of information between health care providers, practitioners, and suppliers and to help them keep track of patients receiving services from other Health Professionals.  Only the Health Professionals who purchase the EHR Service can use the Coordination Service to transmit patient information to other Health Professionals in connection with a referral.

Under the Proposed Arrangement, Ordering Health Professionals (primarily physicians) would use the Coordination Service to access an electronic database (the "Network") to identify Health Professionals to which they would like to make a referral.  There would be no cost to Health Professionals to be included in the Network.

The vendor would offer Health Professionals that are interested in receiving referrals through the Coordination Service the opportunity to enter into "Trading Partner Agreements" with the vendor.  There would be no cost to Health Professionals to become Trading Partners; however, the vendor would charge the Trading Partners for services it provides to them.

Health Professionals would not be required to become Trading Partners to receive referrals using the Coordination Service; however, Health Professionals that are not Trading Partners ("Non-Trading Partners") would not be able to customize their Network profiles in the same manner as Trading Partners and would not be able to receive Formatted Orders.

Under the Proposed Arrangement, the vendor would continue to charge Ordering Health Professionals a monthly subscription fee for the EHR Service component of the Coordination Service Package, but that fee would be discounted.  Additionally, the vendor would charge three types of transaction-based fees for referrals made and received using the Coordination Service: (i) a base fee for transmitting the referral (the "Transmission Fee"), (ii) a fee for the work performed by the vendor to record and maintain the Trading Partner's preferences, attach clinical documentation in accordance with those preferences, and facilitate the appointment scheduling with the Trading Partner, and provide "report builder" functionality (the "Functionality Fee"), and (iii) a fee for the work performed by the vendor to verify benefit eligibility and obtain referral authorization (the "Service Fee").

The vendor would charge the Transmission Fee each time an Ordering Health Professional makes a referral using the Coordination Service, but the party responsible for paying this fee would vary depending on whether the receiving Health Professional is a Trading Partner or a Non-Trading Partner.  The Trading Partner would pay the Transmission Fee.  However, Trading Partners that are clients of the vendor would pay slightly lower fees than non-client Trading Partners.  For Non-Trading Partners, the Ordering Health Professional would pay the Transmission Fee which would be the same as the amount that would be charged to a non-client Trading Partner.

The Functionality Fee would be assessed each time an Ordering Health Professional uses the Coordination Service to make a referral to a Trading Partner.  The Service Fee would be assessed each time it is applicable, namely, each time a benefits verification or referral authorization service is required.  The amount of the Functionality Fee would be Fixed and the Service Fee would vary depending upon the level of effort required to provide the related services. 

Based upon the facts presented concerning the Proposed Transaction, as stated above, the OIG determined that the anti-kickback statute was implicated due to the fee structure.  The OIG also determined that the safe harbor provisions for referral services did not apply.  The type of referral service in the Proposed Arrangement is very different from the referral service as contemplated by the safe harbor.  The anti-kickback statute's safe harbor contemplates a referral service that helps beneficiaries make their initial contact with the health care system before a relationship of trust is established with a particular health care provider or supplier.  In contrast, the Coordination Service facilitates referrals through the transmission of information and the actual referrals are made by Health Professionals.  However, the OIG concluded that the anti-kickback statute is not violated because the Proposed Arrangement adequately reduces the risk that the remuneration provided therein could be an improper payment for referrals or for arranging referrals of Federal health care program business for the following reasons:

• The vendor would offer a comprehensive Network within which all Health Professionals could participate and from which an Ordering Health Professional could select a receiving Health Professional.  No payment is required simply to be in the Network, although participants must pay the vendor to obtain certain value-added services.
• The Transmission Fee, the Functionality Fee, and the Service would, both individually and in the aggregate, reflect the fair market value of the actual services the vendor would provide to the Health Professionals.  The vendor's services would provide value that is unrelated to inducing referrals and the fees charged for services provided by the vendor would not vary based on the value of the items or services that a receiving Health Professional might ultimately provide to Federal health care program beneficiaries.
• The use of a "per-click" transaction-based pricing model is reasonable.  The vendor would assess the Transmission Fee each time an Ordering Health Professional makes a referral to receiving Health Professional using the Coordination Service, regardless of whether the patient follows through and actually receives items or services from the receiving Health Professional.  The Functionality and Service Fees would be charged only to Trading Partners and would reflect the work the vendor must perform.  The vendor would charge the Functionality Fee and, as applicable, the Service Fee, each time an Ordering Health Professional makes a referral to the Trading Partner using the Coordination Service, regardless of whether the patient follows through and actually receives items or services from the Trading Partner.
• The fee structure in the Proposed Arrangement would be unlikely to influence an Ordering Health Professional's referral decisions in a material way.  Discounts on monthly EHR Service subscription fees, standing alone, would not induce an Ordering Health Professional to refer to any particular person or entity.  The amount of the Transmission Fee is low (less than or equal to $1.00) and this fee would be unlikely to sway an Ordering Health Professional's judgment regarding which Health Professional to refer to.  Additionally, the amount of the Transmission Fees that could be charged, in the aggregate, to an Ordering Health Professional could be capped at the difference between the Ordering Health Professional's undiscounted monthly EHR Service fee and the discounted monthly fee charged for the EHR Service (as a component of the Coordination Service Package) such that the Ordering Health Professionals would never pay more for the Coordination Service Package than they would have paid for the EHR Service alone.
• The Coordination Service is intended to facilitate the exchange of information between Health Professionals and not to limit the pool of Health Professionals to which an Ordering Health Professional may refer.  Neither freedom of choice nor provider freedom of choice would be compromised under the Proposed Arrangement.
• A Trading Partner's payment of the Transmission, Functionality, and Service Fees to the vendor would not provide the Trading Partner with enhanced access to a referral stream vis-a-vis Non-Trading Partners.  The Non-Trading Partners would not be disadvantaged with respect to, nor precluded from, the opportunity to receive and respond to referrals made through the Coordination Service

In view of the foregoing, the OIG concluded that even though the Proposed Arrangement may generate prohibited remuneration under the anti-kickback statute (if the requisite intent to induce or reward referrals of Federal health care program business were present), the OIG would not impose administrative sanctions under sections 1128(b)(7) or 1128A(a)(7) of the Social Security Act in connection with the Proposed Arrangement.  Therefore, the OIG would not subject the vendor to administrative sanctions in connection with the anti-kickback statute for the Proposed Arrangement.

Link to original OIG Advisory Opinion (No. 11-18):

http://oig.hhs.gov/fraud/docs/advisoryopinions/2011/AdvOpn11-18.pdf

Medicare pay cut averted; Congress OKs
two-month patch

Physicians got a brief reprieve from a 27 percent Medicare pay cut Friday when the U.S. House of Representatives reached agreement with the Senate on a two-month extension of important policies that expire on Jan. 1.

The U.S. Senate last week voted to extend current Medicare payment rates for two months. After first balking at the two-month extension earlier in the week, the House reached an agreement Friday with the Senate to extend the payment rates, as well as the 2 percentage point Social Security tax cut and to extend unemployment benefits. A House-Senate conference committee will convene in January to work on a longer-term agreement.

At a press conference, House Speaker John Boehner (R-Ohio) said the goal is to extend all the expiring programs for a full year, except for the physician payment cut reprieve, which is to be extended for two years.

AMA President Peter W. Carmel, MD, called on Congress to "enact a real and fiscally responsible solution to this sorry cycle of scheduled cuts and short-term patches that compromises access to care for patients and drives up costs for taxpayers. Members of Congress need to use this time to work in a bipartisan manner to provide long-term stability for seniors, military families and the physicians who care for them."

Meantime, the Centers for Medicare & Medicaid Services (CMS) has extended the annual Medicare participation enrollment period through Feb. 14. The previous deadline was Dec. 31.

The effective date for any participation status change during the extension, however, remains Jan. 1, and will be enforced for the entire year. According to CMS, contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are post-marked on or before Feb. 14.

Votes on H.R. 3690. As originally passed by the House Dec. 13 by a vote of 234-193, the House's version of the bill would have provided Medicare physician payment updates of 1 percent a year for two years, followed by a return to the current negative trend line produced by the sustainable growth rate (SGR) formula. But as a result of disagreements over financial offsets and other policy issues unrelated to the SGR, the legislation could not attract a sufficient number of votes to pass the Senate.

On Dec. 17 the Senate voted 89-10 to pass an amended version of the bill that would extend all the expiring policies—including current Medicare physician payment rates—for two months. The rationale for the short-term extension was to avoid disruptions on Jan. 1 and provide time for further negotiations on financing longer-term extensions.

House action on Dec. 20. Following the Senate's action, a significant number of House Republicans expressed strong opposition to the two-month extension, and several relevant votes were scheduled for today. In the most important vote, the House approved by a vote of 229-193 a resolution that disagrees with the Senate and calls for appointing members to a House-Senate conference committee, which is charged with working out differences between the two versions of the bill.

Prior to the House votes today, Senate leadership announced that the Senate would not reconvene over the holidays to engage in further negotiations and votes. In addition, members of the House are departing this evening for the holidays with the understanding that they could be called back to Washington, D.C., on short notice.

At this time, it does not appear likely that the outstanding issues will be resolved before Jan. 1.

Outlook for January. On Dec. 19 the Centers for Medicare & Medicaid Services announced that it would hold claims for 2012 physician services for 10 business days—until Jan. 17—to avoid processing payments at the lower rate. After that date, claims will be processed on a first-in, first-paid basis at the reduced rates until the situation is resolved.

The House currently is scheduled to return to Washington on Jan. 17, while the Senate is scheduled to return on Jan. 23. However, there are reports that the House may move the date of its return up to Jan. 3.

AMA views. The AMA issued strong statements following the House and Senate votes, reaffirming its opposition to any short-term patches to the SGR formula, denouncing the political brinkmanship that left the issue unresolved until Congress was adjourning, and calling for a bipartisan effort to repeal the flawed and disruptive formula once and for all.

Throughout the year, the AMA has been pursuing a strategy to repeal the SGR that was developed in consultation with state medical societies and national medical specialty societies. We continued to oppose short-term remedies that serve to make future cuts deeper and the cost of permanent payment reform increasingly steep.

Throughout the year, bicameral and bipartisan support has been expressed in Congress for permanently addressing the Medicare physician payment crisis. Nevertheless, physicians and their patients once again find themselves confronting uncertainty and instability. It is long past time for Congress to act decisively and protect access to care for senior citizens and military families who rely on TRICARE—they and their physicians deserve better.

The AMA will provide additional updates on the status of the 2012 payment rates as events unfold. With the expectation that Congress will be in recess, we will defer any new grassroots messaging until after the holidays.

New grassroots messages will be available after Jan. 1 or earlier if Congress decides to return to Washington between the holidays. Physicians can always view the AMA's latest grassroots messages and reach their federal legislators by telephone using our toll-free physicians grassroots hotline number: (800) 833-6354.

Topics discussed include the following:

• What is an electronic health record (“EHR") system?
• What types of EHR systems exist?
• What is meaningful use?
• How can healthcare providers and hospitals qualify for incentive payments under the Medicare and Medical programs?
• What are the HIPAA Privacy and Security Rules?
• What is the HITECH Act?
• What is an EHR license?
• How do I negotiate an EHR license?
  • From the vendor perspective
  • From the hospital perspective
  • From the physician practice perspective

http://lawreviewcle.com/cle_mcle_credits-2012-01-18-live-webcast-introduction-to-electronic-health-records.html.

The Commonwealth has sent out notices and forms, however, please contact us at 412-594-5582 if you need assistance determining if your entity is required to make a Decennial Report and/or completing the filing.

For more information:

http://www.hhs.gov/news/press/2011pres/11/20111130a.html

http://www.uspto.gov/about/stratplan/ar/2011/USPTOFY2011PAR.pdf.

The ACO concept is probably misunderstood because there is no generally accepted definition. Many people think of ACOs as the legal entities that will participate in the Medicare Program, but the term is generically being applied to many types of health care delivery systems. Perhaps the simplest definition is one coined by Mark McClellan, who describes an ACO as “an organization seeking per capita improvements in quality and costs.” 

While CMS has been developing the regulations for the Medicare ACO program, generic ACOs are already up and running, and in some cases have been for quite a few years. A recent study by Leavitt Partners indicates that there are 164 identified ACOs across the country. Of those, 99 are primarily sponsored by hospitals, 38 by physicians’ groups and 28 by insurers, and they tend to be developed in higher income and more populated areas of the country. In fact, a majority of the ACOs are identified as being headquartered in only eight states, with California having almost twice as many as the next highest states. 

The Leavitt Partners study reaches the following conclusions:

1.         Dispersion of ACO varies significantly by market;

2.         Certain regions of the United States are devoid of ACOs, i.e. the poorer and rural regions in particular;

3.         Hospitals and hospital systems are the primary backers of ACOs;

4.         Significant investment in the accountable care model exists independent of the Medicare Shared Saving Program; and

5.         The success of different accountable care models is yet unproven.

I think it is fair to state that there is almost universal agreement that higher quality and more efficient care cannot be developed in areas where the major health care providers are primarily compensated on a fee for service basis. It is interesting to note, as pointed out by a recent article in the Pittsburgh Post Gazette that, in an area dominated by a major hospital system and a major insurer, where you would think that integration would yield more efficiencies, the Western Pennsylvania area has the highest number of hospital beds and the highest utilization rate of any of the metropolitan area included in the study reported on by the paper in the December 4,2011 article.

The request seeks the OIG’s “no action” letter on a proposal by which a company will provide consulting and marketing services to physician practices. The services would be designed to review patients’ files and identify opportunities to provide allergy testing and immunotherapy laboratory services. 

The OIG declined to issue a letter stating that it did not identify potential violations of the Anti-Kickback Statute and declined to prosecute. 

Federal courts have previously concluded in Nursing Home Consultants vs. Health Services and Modern Medical Laboratories vs. SmithKline that percentage-based marketing arrangements were suspicious. 

I would suggest that the key issue here is that the service would be one in which the management company would review files and identify potential patients to receive covered services, which should be distinguished from situations in which the physicians identify the patients through the customary practice of medicine and the management or consulting services are provided merely to assist the physician in providing previously identified services or products.

You should also note that the OIG declined to provide any opinion regarding the fact that this process would review protected health information, and constitute a HIPAA violation. Obviously, any situation like this would require a HIPAA complaint business associate agreement. 

Kristen McNiff, MPH, Senior Advisor, Quality & Guidelines Department spoke about the American Society of Clinical Oncology's (ASCO's) health IT initiatives.  The objectives of the ASCO HIT workgroup include providing educational resources assisting the selection and implementation of HIT, identifying and advancing HIT functionality necessary to support cancer care, and representing the oncology perspective in national discussions regarding health information technology and healthcare reform policy.  Resources highlighted include the Oncology EHR Field Guide.  She also spoke of the impact of clinical decision support systems within EHR and the quality oncology practice initiative (QOPI) as it relates to EHR.

Nelita Zytkowski gave a presentation on transforming nursing practice through technology and informatics.  Her presentation focused on the HIMSS nursing informatics initiative.  The position statement can be accessed here. 

Donna DuLong, BSN, FHMISS, PhD student, gave a presentation on preparing the nursing workforce for meaningful use of electronic health records.  She focused on the TIGER initiative and the ONC workforce development programs.  The Health IT Workforce curriculum modules may be accessed at http://www.onc-ntdc.org/.  She also discussed university-based training in health IT.

Anne Ireland, MSN, RN, AOCN, presented on the topic of leveraging electronic health records to transform cancer care.  She spoke about her experience at Fletcher Allen Health Care with regard to the transition to electronic health records.  She also discussed what oncology nurses want in an electronic health record system including usability, evidence-based interventions, decision support, chemotherapy and biotherapy guidelines, survivorship care plans, and more.

Lee Kim, JD, gave a presentation which summarized the legal obligations under the HIPAA Privacy, HIPAA Security, and HITECH Act.  She also discussed meaningful use stage 1, including clinical quality measures as they relate to clinical oncology.

Phil Magistro, Director of Health Informatics for Quality Insights of Pennsylvania, gave a presentation on the regional extension centers, including an overview of the regional extension centers, the status of PA REACH West, PA REACH East, and Medicare and Medicaid EHR incentive programs.  He stated that health care providers who enroll with PA REACH may receive assistance up until the point that they attest for meaningful use and that PA REACH assists health care providers in EHR vendor selection and implementation support.