August 3, 2009

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HealthInfoNet to Go Live in Pilot Phase; Blumenthal Touts Advantages of Electronic Exchange

More than 300 people gathered in Portland on Friday, July 31st to hear David Blumenthal, M.D., the top health information technology official in the Obama Administration, and to celebrate the announcement that Maine's nonprofit HealthInfoNet network will "go live" this summer making Maine the nation's largest statewide electronic health information Exchange (HIE) using clinical data.  Only Delaware and Vermont have similar statewide exchanges in operation.

The announcement, which was widely covered by the news media, coincided with the visit by Dr. Blumenthal who was the keynote speaker at the annual Hanley Leadership Forum Friday in Portland.  Later in the day, Dr. Blumenthal visited the Maine Medical Center emergency room to see first hand how the new system will be used by medical care teams.

Under development for the past five years, HealthInfoNet will allow physicians quick and efficient access to key clinical information they need to provide the best possible care for their patients.  Electronic exchanges such as HealthInfoNet will be critical in connecting the rapidly growing number of providers using electronic medical records and other systems.  As the system expands its reach across the entire state, an estimated $50 million per year in healthcare costs is expected to be saved as physicians and other caregivers order fewer duplicative tests, procedures, prescriptions, and hospital admissions.

Despite a substantial budget shortfall, the State of Maine has included $1.7 million in its 2010-2011 budget to allow HealthInfoNet to go live and to position Maine for federal matching funds that are expected to be available later this year under the American Recovery and Reinvestment Act.  Some $8 million has been raised so far to build HealthInfoNet.  Another $12 million is needed to build out the statewide infrastructure and it is estimated that $6 million a year will be necessary to operate the system.

Beginning this summer, more than 2,000 healthcare providers, including nearly half of the rural and urban hospitals across the state and one-third of practicing physicians, will have access for the first time to HealthInfoNet's secure clinical data repository.  Use of the system will be phased in over the next several months.

Organizations taking part in the demonstration phase include Maine's four largest health care delivery systems (Central Maine Health Care, Eastern Maine Healthcare Systems, MaineGeneral Medical Center, and MaineHealth) as well as an independent, multi-site primary care practice (Martin's Point) and an independent rural hospital (Franklin Memorial Hospital).  The Maine Center for Disease Control and Prevention, which is in the process of developing a statewide public health information system, will be part of the demonstration phase, as well.  This linkage will support the laboratory reporting requirements mandated by law for disease outbreak purposes.

HealthInfoNet has retained 3M Health Information Systems and Orion Health to build and operate the exchange.  In addition, DrFirst, Inc. has been retained to provide coordination in automating electronic prescribing services and access to medication history information in medical care teams.

Organized as a public-private partnership, HealthInfoNet is governed by a volunteer board which includes physicians, hospital leaders, consumers, employers, government officials, insurance representatives, and others.  The Maine Medical Association has endorsed this effort since its inception in 2004 and was one of the first organizations formally voting to support the effort.

Congratulations to the Project Director Dev Culver, Jim Harner, Board Chair David Howes, M.D., and all others involved with the project for getting it this far.  "Having been involved in the CHINS project years ago, which attempted to establish a statewide health information exchange, I know first hand how difficult this was and is," noted Gordon Smith, MMA EVP.  "Given these difficult economic times, and the amount of cooperation required among a host of interests, both public and private, this is a very significant achievement, bordering on the miraculous."  Smith also noted the significant assistance provided by Senators Lisa Marrache and Peter Mills, and former Senator Karl Turner, who remains on the HealthInfoNet Board, as well as the support of the Baldacci administration and the Maine Health Access Foundation. 

For more information on Friday's announcement and on HealthInfoNet, go to  For information on the Daniel Hanley Center for Health Leadership,  visit  The MMA website at also has the press release and fact sheet from the Friday announcement.



HSR Update: Deal Struck with Blue Dog Democrats; House Energy & Commerce Committee Votes Out H.R. 3200

Before heading home for the August recess, the House Energy & Commerce Committee voted 31 to 28 in favor of H.R. 3200 at 9:05 p.m. on Friday, July 31st.  The vote followed days of negotiations with the Blue Dogs and capped a marathon session that began at 10:00 a.m. on Friday.  Five Democrats joined all the Committee Republicans in voting against the bill.

Among the issues of concern to the Blue Dog caucus was the premium subsidy.  The deal requires those with incomes above 200% of the FPL to contribute a greater percentage of their income to premium costs before being eligible for a subsidy.  Those with incomes at 400% of the FPL, the highest qualifying income level, would contribute 12% of their income toward premiums before qualifying for subsidies, rather than 11% as included in the original bill.  The deal also requires the reimbursement rates for the public insurance option to be negotiated with providers, rather than be based on Medicare rates.

You can find more details about the Energy & Commerce Committee negotiations and mark-up on the AMA's web site at:

The Energy & Commerce Committee is the last of three House committees with jurisdiction over health care issues to vote out H.R. 3200 and the three versions of the bill must be reconciled before the bill comes to the floor, expected in September.

Meanwhile, Senate Finance Committee Chairman Max Baucus (D-MT) announced last Thursday that his committee would not mark up health care reform legislation before the August recess.  The Senate Finance Committee still is seeking a bipartisan solution to the health care reform effort and Maine Senator Olympia Snowe (R) remains one of a bipartisan group of 6 Finance Committee Senators leading the negotiations.  With no Finance Committee bill, Senate Majority Leader Harry Reid (D-NV) cannot merge the Senate bills during the recess and this delay likely will push off the reform debate in the Senate beyond September to later in the Fall. [return to top]

Make Hotel Reservations for MMA Annual Session by August 10

The cut-off date for hotel reservations for the Association's Annual Session at the Harborside Hotel and Marina in Bar Harbor is August 10th.  Reservation forms are available from the MMA office and will be contained within the July-August issue of Maine Medicine which should arrive in your mailbox on Tuesday of this coming week.  The meeting begins on Friday, September 11th and concludes on Sunday morning, September 13th.

This 156th Annual Session promises to be one of the best ever.  The theme of the conference is, Personalized Medicine, Translating Science to Clinical Practice.  The Association is partnering with the Jackson Laboratory in presenting the educational programming for the meeting.

With health system reform the major topic in our nation this month and into the fall, this is an important time to be involved and to have your voice heard.  We look forward to seeing you, and hearing from you, in Bar Harbor. [return to top]

Casey Foundation Ranks Maine 12th in the Nation in Child Health and Well-being

In its annual Kids Count report released last week, the Annie E. Casey Foundation ranked Maine twelfth nationally in its efforts to improve the health and well-being of children.  Maine children did worse than the last annual report in six categories measured, while doing better in three.  In a significant finding, Maine's child poverty rate for children under the age of 18 was 21 percent, compared to 25 percent nationally.

Maine lost ground in the percentage of low-birthweight babies, and infant mortality and teen death rates.  Maine children also did worse in the percentage of teenagers who neither work nor go to school and the percentage of children living below the federal poverty line and living in single-parent homes.

For the good news, the death rate improved for children ages 1 to 14 and the teen birth rate declined.  There was also a decrease in the percentage of children who lived in a home where no parent worked full-time. [return to top]

FTC Delays Red Flag Rule Enforcement Again - Until November 1, 2009

The Federal Trade Commission (FTC) has delayed the enforcement date of the "red flags" rule from August 1, 2009 until November 1, 2009, and will provide additional guidance for health care providers and other "low-risk" entities concerning compliance. 

Enforcement of the "red flags" rule, which requires certain businesses to develop identity theft prevention and detection programs, was originally scheduled for November 1, 2008, but following advocacy efforts from the AMA and other associations, compliance was extended to May 1, 2009, and then later to August 1, 2009.

The new compliance date of November 1, 2009 is a result of continued advocacy by the AMA and others who continue to object to the applicability of this rule to health care providers and other professionals.  Since the rule was issued, the AMA has objected to the FTC's interpretation that physician practices are "creditors" when they accept insurance and bill patients after services are provided or if they allow patients to set up payment plans after services have been provided.  The FTC states that this delay is intended to "give creditors and financial institutions more time to review this guidance and develop and implement written Identify Theft Protection Programs."  

You can find the AMA's guidance on the rule on the web at:

The AMA will continue to make the case to Congress and the agency that the FTC should republish the rule so that the AMA has an opportunity to formally comment and state its objections to physician inclusion in the program. [return to top]

Novel H1N1 Vaccination Recommendations

With the new H1N1 virus continuing to cause illness, hospitalizations, and deaths in the US during the normally flu-free summer months and some uncertainty and about what the upcoming flu season might bring, CDC's Advisory Committee on Immunization Practices has taken an important step in preparations for a voluntary novel H1N1 vaccination effort to counter a possibly severe upcoming flu season.  On July 29th, ACIP met to consider who should receive novel H1N1 vaccine when it becomes available.

Every flu season has the potential to cause a lot of illness, doctor’s visits, hospitalizations, and deaths.  CDC is concerned that the new H1N1 flu virus could result in a particularly severe flu season this year.  Vaccines are the best tool we have to prevent influenza.  CDC hopes that people will start to go out and get vaccinated against seasonal influenza as soon as vaccines become available at their doctor’s offices and in their communities (this may be as early as August for some).  The seasonal flu vaccine is unlikely to provide protection against novel H1N1 influenza.  However a novel H1N1 vaccine is currently in production and may be ready for the public in the fall.  The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used along-side seasonal flu vaccine. 

CDC’s Advisory Committee on Immunization Practices (ACIP), a panel made up of medical and public health experts, met July 29, 2009, to make recommendations on who should receive the new H1N1 vaccine when it becomes available.  While some issues are still unknown, such as how severe the virus will be during the fall and winter months, the ACIP considered several factors, including current disease patterns, populations most at-risk for severe illness based on current trends in illness, hospitalizations and deaths, how much vaccine is expected to be available, and the timing of vaccine availability.

The groups recommended to receive the novel H1N1 influenza vaccine include:

  • Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;

  • Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated.  Vaccination of those in close contact with infants less than 6 months old might help protect infants by “cocooning” them from the virus;

  • Healthcare and emergency medical services personnel because infections among health care workers have been reported and this can be a potential source of infection for vulnerable patients.  Also, increased absenteeism in this population could reduce health care system capacity;

  • All people from 6 months through 24 years of age

    • Children from 6 months through 18 years of age because we have seen many cases of novel H1N1 influenza in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and

    • Young adults 19 through 24 years of age because we have seen many cases of novel H1N1 influenza in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,

  • Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.

We do not expect that there will be a shortage of novel H1N1 vaccine, but flu vaccine availability and demand can be unpredictable and there is some possibility that initially, the vaccine will be available in limited quantities.  So, the ACIP also made recommendations regarding which people within the groups listed above should be prioritized if the vaccine is initially available in extremely limited quantities.  For more information see the CDC press release CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1.  

Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups.  However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.  [return to top]

Maine DEP Publishes Chemicals of High Concern List

The Maine Department of Environmental Protection (DEP) and the Maine Center for Disease Control and Prevention (CDC) announce the publication of Maine’s List of Chemicals of High Concern (CHC).  Publishing the list of about 1700 chemicals is the first step toward implementing Maine’s new Toxic Chemicals in Children’s Products law. 

The law aims to make children’s products safer and less toxic.  Maine DEP and CDC have taken the first step, which is to identity and list chemicals known to the government as causing cancer and other health concerns. The CHC list was compiled from existing government lists which identified chemicals that are known to pose specific health threats including those that cause cancer.  Some of the commonly recognized chemicals on the list include:  lead, mercury, formaldehyde, and bisphenol A.

To view Maine’s List of Chemicals of High Concern, go to: [return to top]

H1N1 Summit Scheduled for August 20th at the Augusta Civic Center

This H1N1 Influenza Preparedness Summit is sponsored by the Maine Center for Disease Control and Prevention (Maine CDC), Maine Emergency Management Agency (MEMA), and Maine Department of Education and is set for Thursday,  August 20th at the Augusta Civic Center. 

Experts forecast that the impact of H1N1 may well worsen this fall — when the regular flu season hits or even earlier when schools open.  The goal of this Summit is to help Maine prepare for the fall and to plan for a statewide H1N1 vaccination campaign.

Our goal is to promote vigilance, preparation, and a shared responsibility to mitigate the effects of H1N1 and to offer H1N1 immunization to all people in Maine later this year.

Applications have been submitted for continuing medical education credits for MDs, DOs, Nurses, EMS, Pharmacists, Dentists, and Health Educators.  A health care provider track is being planned. 

Who Should Attend: School Nurses, Other Nurses, Physicians, EMS, and Other Health Care Providers; Local and County Emergency Management Officials; Local, County, and State Government Officials; Public Safety; Home Health and Social Services Agencies; Voluntary and Faith-Based Organizations; Educators; Other Interested Parties.

Instructions: Pre-registration is required and includes lunch and materials.  PLEASE NOTE:  Registration begins at 8:00 a.m. with the conference beginning promptly at 8:30 a.m.  Registrations will be confirmed by email and will be accepted on a first-come, first-served basis until the cutoff date, August 17th, or until the conference is full.  For registration questions, please use the contact info on the left hand side.

Online registration is available through Medical Care Development’s Meeting Services at: and Maine CDC’s website at: [return to top]

Maine Workers' Compensation Board Publishes Revised Medical Fee Schedule

The Maine Workers' Compensation Board has published a revised version of its Rule Chapter 5, Medical Fees; Reimbursement Levels; Reporting Requirements.  The new rule incorporates the work of a "consensus-based rulemakiing" process that goes back to 2008 in which the MMA and several ambulatory surgical facility representatives participated.

The rule updates the Physician's CPT and the Medicare RBRVS and establishes maximum facility fee charges for hospital inpatient, hospital outpatient, and ambulatory surgical centers, as well as maximum charges for professional services.

You can find the proposed rule on the web at: .

The Board has scheduled a public hearing on the rule for 9:00 a.m. on Monday, August 17, 2009 in Room 170 of the WCB Central Office in the Deering Building on the AMHI campus in Augusta.  The deadline for written comments is 5 p.m. on Thursday, August 27, 2009.  Written comments should be directed to John C. Rohde, General Counsel, WCB, State House Station 27, Augusta, Maine 04333-0027.

If you have comments on the draft rule, please contact Andrew MacLean, Deputy EVP at or 622-3374, ext. 214. [return to top]

For more information or to contact us directly, please visit l ©2003, Maine Medical Association