News and information useful to Cleveland-Marshall College of Law students, faculty and staff.

Pew/AMA/MedStar Report on Improving Electronic Health Record Safety

Graphic of Electronic Health RecordThe Pew Charitable Trusts, American Medical Association (AMA), and MedStar Health National Center for Human Factors in Healthcare recently released a report on “best practices and model test cases to guide rigorous safety assessments of EHRs.”  Ways to Improve Electronic Health Record Safety reports federal EHR certification requirements (see 45 C.F.R. 170) “do not address circumstances in which customized changes are made to an EHR as part of the implementation process or after the system goes live,” and there are no “requirements and guidance on how to test clinician interaction with the EHR for safety issues.”  These challenges “can fail to prevent – or even contribute to – patient harm.”  The report includes a multidisciplinary expert panel’s “recommendations on how to advance usability and safety throughout the EHR software life cycle” and “criteria detailing what constitutes a rigorous safety test case and the creation of sample test case scenarios based on reported EHR safety challenges.”  For more information, see the 8/28/18 Pew Charitable Trusts article Better Testing of Electronic Health Records Needed to Protect Patients and AMA Improving Electronic Health Records page (navigation: AMA > Delivering Care > Digital Health Leadership > Adoption & Scale of Digital Health Solutions in Practice).

ONC Request for Information on Electronic Health Record Reporting Program

Graphic of Electronic Health RecordThe U.S. Office of the National Coordinator for Health Information Technology (ONC) recently issued a Request for Information (RFI) seeking “input from the public regarding the Electronic Health Record (EHR) Reporting Program….  Responses will be used to inform subsequent discussions among stakeholders and future work toward the development of reporting criteria under the EHR Reporting Program.”  Written or electronic comments must be received by 5pm 10/17/18.  The EHR Reporting Program was established by the Section 4002 of the 21st Century Cures Act (Pub. L. No. 114-255 Title IV, § 4002, 130 Stat 1159, 12/13/16; codified at 42 U.S.C. § 300jj-19a).  The ONC is part of the U.S. Department of Health and Human Services Office of the Secretary, and it supports “the adoption of health information technology and the promotion of nationwide health information exchange to improve health care.”

Ohio’s Application for PPACA State Innovation Waiver Denied

CCIIO logoOhio’s application for a State Innovation Waiver under section 1332 of the Patient Protection and Affordable Care Act (PPACA) was recently denied. Ohio was specifically seeking to waive the “individual mandate.”* Per federal guidelines (see 45 C.F.R. 155.1308(c)), the application was reviewed by the U.S. Department of Health and Human Services and the U.S. Department of the Treasury (hereinafter “the Departments”). The Departments found the application to be incomplete, as communicated to the Ohio Department of Insurance in a 5/17/18 letter from Randy Pate, Director of the Center for Consumer Information & Insurance Oversight (CCIIO) and Deputy Administrator of the Centers for Medicare & Medicaid Services. Specifically, the Ohio application did “not include a description of any program implementing a waiver plan for providing coverage that meets section 1332 requirements,” and did not include a description of the reason Ohio was seeking to waive the “individual mandate.” [See requirements detailed at 42 U.S.C. 18052 and 45 C.F.R. 155.1308(f)(3)(iii).] The CCIIO oversees the implementation of PPACA provisions related to private health insurance, including Section 1332 State Innovation Waivers, which permit a state to “pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.” After the Departments make a preliminary determination that a State Innovation Waiver application is complete, they provide for a public notice and comment period, and make a final decision on the application within 180 days.

*The “individual mandate” was originally codified at 26 U.S.C. §5000A and 26 C.F.R. 1.5000A-2. The Tax Cuts and Jobs Act (Pub. L. No. 115-97, 131 Stat. 2054, 12/22/17; text not yet available – see Section 11081 of H.R. 1, 115th Cong., 2017) repealed §5000A and eliminated the penalty associated with the individual mandate, beginning in 2019. However, no changes were made to the statutory language that established the mandate. For more information, see The Individual Mandate for Health Insurance Coverage: In Brief, by the Congressional Research Service.

Free Webinars on Public Health and the Judiciary

PolioVaccinePosterCDCWellbeeThe U.S. D.H.H.S. Centers for Disease Control and Prevention (CDC) and the Network for Public Health Law (NPHL) are sponsoring three free webinars on Public Health and the Judiciary.  The first webinar – When Public Health Goes to Court:  Judicial Structure and Functions – will be 1pm-2:30pm EST, Thursday, February 5th, 2015.  This webinar will will look at the structure and essential functions of the state and federal court systems (including administrative courts), explore the Tribal court system, and examine the role of court watch programs in addressing public health issues.  Speakers will be Judge David T. Emerson, Douglas County Superior Court, Georgia; Lorre Cuzze, JD, MPH, Law Clerk, State Court of Dekalb County, Georgia; Tina Batra Hershey, JD, MPH, Assistant Professor, University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management; and Kerri McGowan Lowrey, JD, MPH, Deputy Director, Network for Public Health Law – Eastern region.  CLEs are available for some attendees.  Register here.

The two upcoming webinars in this series will be Public Health in the Courts and The Court and Public Health Emergencies.  Details will be publicized as they become available.  In the general materials on the need for these webinars, the CDC and NPHL recognize that the US court system has a substantial impact on public health.  “The courts have been instrumental in establishing the evolving reach and boundaries of government involvement in public health since the 1800’s.  The Supreme Court’s landmark 1905 decision in Jacobson v. Massachusetts recognized the judiciary as both an enforcer of governmental public health policies, and an arbiter of the conflicts between individual liberties and public interests that arise from governmental public health action.  Because of the critical role that the U.S. judicial system plays in advancing public health goals, it is essential that public health practitioners, legal counsel, and other partners understand how the court system works and how courts are involved in public health matters.”

Above image is a 1963 CDC poster, featuring “Wellbee,” a CDC symbol of public health.

International Health Statistics with OECD iLibrary

OECD iLibrary Health Statistics is the OECD’s (Organisation for Economic Cooperation and Development) premier online information source for the global health information. This database offers CSU researchers access to worldwide data on health status, health care resources, non-medical determinants of health, demographic and economic references, and much more. [Note that this OECD database is listed in the Schwartz Library’s list of databases, not under the Law Library.] Here’s a sampling of statistics available from OECD iLibrary Health Statistics that will give you a flavor of the information depth of this resource –

  • Total expenditure on health per capita
  • Government social spending per head
  • Old age social spending
  • Public unemployment spending
  • Causes of mortality
  • Prevention and public health services
  • Alcohol and tobacco consumption
  • Obesity rates