Government and Regulations

The radiation oncology private practice Cancer Care Group (CCG), which has 13 radiation oncologists serving hospitals and clinics throughout Indiana, notified the HHS Office for Civil Rights (OCR) in 2012 about a security breach after an employee’s laptop bag was stolen. The bag contained unencrypted backup media, with the names, addresses, birth dates, Social Security numbers, insurance information, and clinical information of about 55,000 current and former CCG patients.

Related: A Medical Tower of Babel

An investigation revealed that CCG had been in “widespread noncompliance” with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. It had not conducted an enterprise-wide risk analysis when the breach occurred and did not have a written policy covering the removal of hardware and electronic media containing electronic protected health information from its facility.

Related: Getting Along With Electronic Technology—Safely

The OCR found that 2 issues in particular contributed to the breach: Risk analysis could have identified the removal of unencrypted backup material as a significant risk, and a comprehensive policy about device and media control could have clarified guidance for employees.

The case was recently settled. Cancer Care Group paid OCR $750,000 and will adopt a “robust corrective action plan” to remedy the deficiencies.

Related: The Use of Secure Messaging in Medical Specialty Care

To keep other health care practices from making similar mistakes, HHS offers help for conducting a HIPAA Risk Analysis at http://www.healthit.gov/providers-professionals/security-risk-assessment, with videos and a downloadable security risk assessment tool.

The radiation oncology private practice Cancer Care Group (CCG), which has 13 radiation oncologists serving hospitals and clinics throughout Indiana, notified the HHS Office for Civil Rights (OCR) in 2012 about a security breach after an employee’s laptop bag was stolen. The bag contained unencrypted backup media, with the names, addresses, birth dates, Social Security numbers, insurance information, and clinical information of about 55,000 current and former CCG patients.

Related: A Medical Tower of Babel

An investigation revealed that CCG had been in “widespread noncompliance” with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. It had not conducted an enterprise-wide risk analysis when the breach occurred and did not have a written policy covering the removal of hardware and electronic media containing electronic protected health information from its facility.

Related: Getting Along With Electronic Technology—Safely

The OCR found that 2 issues in particular contributed to the breach: Risk analysis could have identified the removal of unencrypted backup material as a significant risk, and a comprehensive policy about device and media control could have clarified guidance for employees.

The case was recently settled. Cancer Care Group paid OCR $750,000 and will adopt a “robust corrective action plan” to remedy the deficiencies.

Related: The Use of Secure Messaging in Medical Specialty Care

To keep other health care practices from making similar mistakes, HHS offers help for conducting a HIPAA Risk Analysis at http://www.healthit.gov/providers-professionals/security-risk-assessment, with videos and a downloadable security risk assessment tool.

The radiation oncology private practice Cancer Care Group (CCG), which has 13 radiation oncologists serving hospitals and clinics throughout Indiana, notified the HHS Office for Civil Rights (OCR) in 2012 about a security breach after an employee’s laptop bag was stolen. The bag contained unencrypted backup media, with the names, addresses, birth dates, Social Security numbers, insurance information, and clinical information of about 55,000 current and former CCG patients.

Related: A Medical Tower of Babel

An investigation revealed that CCG had been in “widespread noncompliance” with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. It had not conducted an enterprise-wide risk analysis when the breach occurred and did not have a written policy covering the removal of hardware and electronic media containing electronic protected health information from its facility.

Related: Getting Along With Electronic Technology—Safely

The OCR found that 2 issues in particular contributed to the breach: Risk analysis could have identified the removal of unencrypted backup material as a significant risk, and a comprehensive policy about device and media control could have clarified guidance for employees.

The case was recently settled. Cancer Care Group paid OCR $750,000 and will adopt a “robust corrective action plan” to remedy the deficiencies.

Related: The Use of Secure Messaging in Medical Specialty Care

To keep other health care practices from making similar mistakes, HHS offers help for conducting a HIPAA Risk Analysis at http://www.healthit.gov/providers-professionals/security-risk-assessment, with videos and a downloadable security risk assessment tool.

Civil rights laws have barred discrimination based on race, color, national origin, disability, and age. Now, HHS is proposing a new rule that will enhance protections for gender equality, as well as for people with disabilities and those with limited English. It is an “important step,” said HHS Secretary Sylvia M. Burwell, “to strengthen protections for people who have often been subject to discrimination in our health care system.”

Related: AMA Challenges Transgender Troop Policies

Among other things, the proposal mandates that women must be treated equally with men in the health care they receive. Patients also cannot be denied health care or coverage based on their sex, including gender identity; their treatment must be consistent with their gender identity, including access to facilities. Sex-specific health care cannot be denied or limited because the patient identifies as belonging to another gender. For example, a provider may not deny a patient treatment for ovarian cancer, based on the patient’s identification as transgender, where the treatment is medically indicated.

Related: Teaching Everyone to Speak Health Care

The proposed rule will apply to health insurance marketplaces, any health program administered by HHS, and any health program or activity that receives funding from HHS, such as hospitals that accept Medicare patients or doctors who treat Medicaid patients.

Civil rights laws have barred discrimination based on race, color, national origin, disability, and age. Now, HHS is proposing a new rule that will enhance protections for gender equality, as well as for people with disabilities and those with limited English. It is an “important step,” said HHS Secretary Sylvia M. Burwell, “to strengthen protections for people who have often been subject to discrimination in our health care system.”

Related: AMA Challenges Transgender Troop Policies

Among other things, the proposal mandates that women must be treated equally with men in the health care they receive. Patients also cannot be denied health care or coverage based on their sex, including gender identity; their treatment must be consistent with their gender identity, including access to facilities. Sex-specific health care cannot be denied or limited because the patient identifies as belonging to another gender. For example, a provider may not deny a patient treatment for ovarian cancer, based on the patient’s identification as transgender, where the treatment is medically indicated.

Related: Teaching Everyone to Speak Health Care

The proposed rule will apply to health insurance marketplaces, any health program administered by HHS, and any health program or activity that receives funding from HHS, such as hospitals that accept Medicare patients or doctors who treat Medicaid patients.

Civil rights laws have barred discrimination based on race, color, national origin, disability, and age. Now, HHS is proposing a new rule that will enhance protections for gender equality, as well as for people with disabilities and those with limited English. It is an “important step,” said HHS Secretary Sylvia M. Burwell, “to strengthen protections for people who have often been subject to discrimination in our health care system.”

Related: AMA Challenges Transgender Troop Policies

Among other things, the proposal mandates that women must be treated equally with men in the health care they receive. Patients also cannot be denied health care or coverage based on their sex, including gender identity; their treatment must be consistent with their gender identity, including access to facilities. Sex-specific health care cannot be denied or limited because the patient identifies as belonging to another gender. For example, a provider may not deny a patient treatment for ovarian cancer, based on the patient’s identification as transgender, where the treatment is medically indicated.

Related: Teaching Everyone to Speak Health Care

The proposed rule will apply to health insurance marketplaces, any health program administered by HHS, and any health program or activity that receives funding from HHS, such as hospitals that accept Medicare patients or doctors who treat Medicaid patients.

Times have changed, and the “Common Rule”—regulations that protect people who participate in research—is being revised.

Related: Using Quality Indicators to Assess and Improve Human Research Protection Programs at the VA

The regulations, in place since 1991, are followed by 18 federal agencies. The regulations were developed at a time when research was conducted mostly at single sites, usually at universities and medical institutions. Now, however, an increase in multisite studies and advances in technology have “highlighted the need to update the regulatory framework,” according to HHS.

Related: Improving Veteran Access to Clinical Trials

The Notice of Proposed Rulemaking (NPRM) is an effort to reinforce and modernize the regulations. For example, the NPRM advocates strengthening informed consent provisions to make sure individuals have a clearer understanding of the study’s scope, including its risks and benefits, as well as alternatives to participating in the study. The proposal also covers changes in review, such as requiring a single institutional review board, in most cases, for multisite research studies.

HHS is taking public comments on the NPRM through December 7, 2015.

Times have changed, and the “Common Rule”—regulations that protect people who participate in research—is being revised.

Related: Using Quality Indicators to Assess and Improve Human Research Protection Programs at the VA

The regulations, in place since 1991, are followed by 18 federal agencies. The regulations were developed at a time when research was conducted mostly at single sites, usually at universities and medical institutions. Now, however, an increase in multisite studies and advances in technology have “highlighted the need to update the regulatory framework,” according to HHS.

Related: Improving Veteran Access to Clinical Trials

The Notice of Proposed Rulemaking (NPRM) is an effort to reinforce and modernize the regulations. For example, the NPRM advocates strengthening informed consent provisions to make sure individuals have a clearer understanding of the study’s scope, including its risks and benefits, as well as alternatives to participating in the study. The proposal also covers changes in review, such as requiring a single institutional review board, in most cases, for multisite research studies.

HHS is taking public comments on the NPRM through December 7, 2015.

Times have changed, and the “Common Rule”—regulations that protect people who participate in research—is being revised.

Related: Using Quality Indicators to Assess and Improve Human Research Protection Programs at the VA

The regulations, in place since 1991, are followed by 18 federal agencies. The regulations were developed at a time when research was conducted mostly at single sites, usually at universities and medical institutions. Now, however, an increase in multisite studies and advances in technology have “highlighted the need to update the regulatory framework,” according to HHS.

Related: Improving Veteran Access to Clinical Trials

The Notice of Proposed Rulemaking (NPRM) is an effort to reinforce and modernize the regulations. For example, the NPRM advocates strengthening informed consent provisions to make sure individuals have a clearer understanding of the study’s scope, including its risks and benefits, as well as alternatives to participating in the study. The proposal also covers changes in review, such as requiring a single institutional review board, in most cases, for multisite research studies.

HHS is taking public comments on the NPRM through December 7, 2015.

Doctors will have 1 more year – until Jan. 1, 2018 – to comply with Stage 3 meaningful use requirements for electronic health records (EHRs), the Centers for Medicare & Medicaid Services announced.

In its long-awaited final rule, released Oct. 6, CMS also announced simplifications to the program designed to align meaningful use with other incentive programs and shift the overall focus of the programs to make them tools for improving overall health.

The announced changes “will ease the reporting burden for providers, increase simplicity and flexibility, support interoperability and information exchange, and improve patient outcomes,” CMS Acting Principal Deputy Administrator and Chief Medical Officer Patrick Conway noted during an Oct. 6 conference call with the media.

Dr. Conway noted that the final rule reduces the number of objectives from about 20 to 8 to allow doctors to find the measures that are most relevant to their practice. Measures also are better aligned, so that a single measure can allow providers to earn credit across multiple incentive programs.

CMS also explained in a separate fact sheet that it was removing many of the “check box” process measures and enhancing the focus on aspects of patient care, such as clinical decision support, e-prescribing, and information exchange.

The agency also finalized a 90-day reporting period in 2015 for all providers currently active in the meaningful use program. Given that the rule was finalized with fewer than 90 days left in the year, Dr. Conway provided additional clarity regarding the flexibility physicians will have to meet those requirements.

If doctors were using an electronic health record on Oct. 1, 2015, “they actually will not report until the end of February, and if we need to extend that time frame, we would look at that at the end of February 2016,” he said. “So, they still have almost 5 months before the reporting actually occurs.”

Dr. Conway added that even if a provider launched an EHR system after Oct. 1, “the thresholds for the program are not 100%. So, even if they were to deploy it tomorrow [and] use it successfully through the end of the year, they could then report that performance in 2016 and avoid a penalty.”

Providers also can use the exemption process if there have been implementation issues, which CMS reviews on a case-by-case basis.

Stage 2 concerns linger

There was concern that the changes did not go far enough, particularly as they relate to modifications of Stage 2 meaningful use.

“Many of the requirements for Stage 2 proved unattainable,” American College of Cardiology President Kim Allan Williams Sr. said in a statement. “Large numbers of providers either haven’t met them or, after trying and failing, have given up. That is why it is vital that CMS consider participation data from the current stage to see what is working and what isn’t before outlining an upcoming stage.”

By 2018, all providers will have to meet Stage 3 meaningful use requirements, because the earlier stages will no longer be available to help new entrants transition into the program. However, if a provider chooses to adopt the 2018 requirements a year early, they will have only a 90-day reporting requirement.

What about MACRA?

Even with the extended time line, CMS is drawing criticism for progressing with Stage 3.

“We still have some concerns about how the program is going,” Ms. Laura C. Wooster, vice president of public policy at the American Osteopathic Association, said in an interview.

One prime area of concern is the current meaningful use time line’s intersection with the start of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reforms, which will replace the Medicare Sustainable Growth Rate payment system, Ms. Wooster noted.

“Stage 3 begins voluntarily in 2017 and then is required for all physicians in 2018. MACRA begins in 2019, and electronic health record reporting will still be part of the Merit-Based Incentive Payment System.”

She expressed concern that physicians are going to have to make changes for Stage 3 meaningful use in 2018, only to have to make more changes to account for MACRA a year later.

The American Medical Association expressed similar concerns.

“The AMA recognizes that physicians continue to struggle with the meaningful use program,” AMA President Steven Stack said in a statement. “However, we hope the decision by CMS to leave Stage 3 open to additional comment will allow for further improvements in the program and promote technological innovation that supports patient care,” Dr. Stack added.

Given the changes that will come as a result of MACRA, CMS is taking comments on the final rule to help inform future policy on how it and MACRA will align.

gtwachtman@frontlinemedcom.com

Doctors will have 1 more year – until Jan. 1, 2018 – to comply with Stage 3 meaningful use requirements for electronic health records (EHRs), the Centers for Medicare & Medicaid Services announced.

In its long-awaited final rule, released Oct. 6, CMS also announced simplifications to the program designed to align meaningful use with other incentive programs and shift the overall focus of the programs to make them tools for improving overall health.

The announced changes “will ease the reporting burden for providers, increase simplicity and flexibility, support interoperability and information exchange, and improve patient outcomes,” CMS Acting Principal Deputy Administrator and Chief Medical Officer Patrick Conway noted during an Oct. 6 conference call with the media.

Dr. Conway noted that the final rule reduces the number of objectives from about 20 to 8 to allow doctors to find the measures that are most relevant to their practice. Measures also are better aligned, so that a single measure can allow providers to earn credit across multiple incentive programs.

CMS also explained in a separate fact sheet that it was removing many of the “check box” process measures and enhancing the focus on aspects of patient care, such as clinical decision support, e-prescribing, and information exchange.

The agency also finalized a 90-day reporting period in 2015 for all providers currently active in the meaningful use program. Given that the rule was finalized with fewer than 90 days left in the year, Dr. Conway provided additional clarity regarding the flexibility physicians will have to meet those requirements.

If doctors were using an electronic health record on Oct. 1, 2015, “they actually will not report until the end of February, and if we need to extend that time frame, we would look at that at the end of February 2016,” he said. “So, they still have almost 5 months before the reporting actually occurs.”

Dr. Conway added that even if a provider launched an EHR system after Oct. 1, “the thresholds for the program are not 100%. So, even if they were to deploy it tomorrow [and] use it successfully through the end of the year, they could then report that performance in 2016 and avoid a penalty.”

Providers also can use the exemption process if there have been implementation issues, which CMS reviews on a case-by-case basis.

Stage 2 concerns linger

There was concern that the changes did not go far enough, particularly as they relate to modifications of Stage 2 meaningful use.

“Many of the requirements for Stage 2 proved unattainable,” American College of Cardiology President Kim Allan Williams Sr. said in a statement. “Large numbers of providers either haven’t met them or, after trying and failing, have given up. That is why it is vital that CMS consider participation data from the current stage to see what is working and what isn’t before outlining an upcoming stage.”

By 2018, all providers will have to meet Stage 3 meaningful use requirements, because the earlier stages will no longer be available to help new entrants transition into the program. However, if a provider chooses to adopt the 2018 requirements a year early, they will have only a 90-day reporting requirement.

What about MACRA?

Even with the extended time line, CMS is drawing criticism for progressing with Stage 3.

“We still have some concerns about how the program is going,” Ms. Laura C. Wooster, vice president of public policy at the American Osteopathic Association, said in an interview.

One prime area of concern is the current meaningful use time line’s intersection with the start of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reforms, which will replace the Medicare Sustainable Growth Rate payment system, Ms. Wooster noted.

“Stage 3 begins voluntarily in 2017 and then is required for all physicians in 2018. MACRA begins in 2019, and electronic health record reporting will still be part of the Merit-Based Incentive Payment System.”

She expressed concern that physicians are going to have to make changes for Stage 3 meaningful use in 2018, only to have to make more changes to account for MACRA a year later.

The American Medical Association expressed similar concerns.

“The AMA recognizes that physicians continue to struggle with the meaningful use program,” AMA President Steven Stack said in a statement. “However, we hope the decision by CMS to leave Stage 3 open to additional comment will allow for further improvements in the program and promote technological innovation that supports patient care,” Dr. Stack added.

Given the changes that will come as a result of MACRA, CMS is taking comments on the final rule to help inform future policy on how it and MACRA will align.

gtwachtman@frontlinemedcom.com

Doctors will have 1 more year – until Jan. 1, 2018 – to comply with Stage 3 meaningful use requirements for electronic health records (EHRs), the Centers for Medicare & Medicaid Services announced.

In its long-awaited final rule, released Oct. 6, CMS also announced simplifications to the program designed to align meaningful use with other incentive programs and shift the overall focus of the programs to make them tools for improving overall health.

The announced changes “will ease the reporting burden for providers, increase simplicity and flexibility, support interoperability and information exchange, and improve patient outcomes,” CMS Acting Principal Deputy Administrator and Chief Medical Officer Patrick Conway noted during an Oct. 6 conference call with the media.

Dr. Conway noted that the final rule reduces the number of objectives from about 20 to 8 to allow doctors to find the measures that are most relevant to their practice. Measures also are better aligned, so that a single measure can allow providers to earn credit across multiple incentive programs.

CMS also explained in a separate fact sheet that it was removing many of the “check box” process measures and enhancing the focus on aspects of patient care, such as clinical decision support, e-prescribing, and information exchange.

The agency also finalized a 90-day reporting period in 2015 for all providers currently active in the meaningful use program. Given that the rule was finalized with fewer than 90 days left in the year, Dr. Conway provided additional clarity regarding the flexibility physicians will have to meet those requirements.

If doctors were using an electronic health record on Oct. 1, 2015, “they actually will not report until the end of February, and if we need to extend that time frame, we would look at that at the end of February 2016,” he said. “So, they still have almost 5 months before the reporting actually occurs.”

Dr. Conway added that even if a provider launched an EHR system after Oct. 1, “the thresholds for the program are not 100%. So, even if they were to deploy it tomorrow [and] use it successfully through the end of the year, they could then report that performance in 2016 and avoid a penalty.”

Providers also can use the exemption process if there have been implementation issues, which CMS reviews on a case-by-case basis.

Stage 2 concerns linger

There was concern that the changes did not go far enough, particularly as they relate to modifications of Stage 2 meaningful use.

“Many of the requirements for Stage 2 proved unattainable,” American College of Cardiology President Kim Allan Williams Sr. said in a statement. “Large numbers of providers either haven’t met them or, after trying and failing, have given up. That is why it is vital that CMS consider participation data from the current stage to see what is working and what isn’t before outlining an upcoming stage.”

By 2018, all providers will have to meet Stage 3 meaningful use requirements, because the earlier stages will no longer be available to help new entrants transition into the program. However, if a provider chooses to adopt the 2018 requirements a year early, they will have only a 90-day reporting requirement.

What about MACRA?

Even with the extended time line, CMS is drawing criticism for progressing with Stage 3.

“We still have some concerns about how the program is going,” Ms. Laura C. Wooster, vice president of public policy at the American Osteopathic Association, said in an interview.

One prime area of concern is the current meaningful use time line’s intersection with the start of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reforms, which will replace the Medicare Sustainable Growth Rate payment system, Ms. Wooster noted.

“Stage 3 begins voluntarily in 2017 and then is required for all physicians in 2018. MACRA begins in 2019, and electronic health record reporting will still be part of the Merit-Based Incentive Payment System.”

She expressed concern that physicians are going to have to make changes for Stage 3 meaningful use in 2018, only to have to make more changes to account for MACRA a year later.

The American Medical Association expressed similar concerns.

“The AMA recognizes that physicians continue to struggle with the meaningful use program,” AMA President Steven Stack said in a statement. “However, we hope the decision by CMS to leave Stage 3 open to additional comment will allow for further improvements in the program and promote technological innovation that supports patient care,” Dr. Stack added.

Given the changes that will come as a result of MACRA, CMS is taking comments on the final rule to help inform future policy on how it and MACRA will align.

gtwachtman@frontlinemedcom.com

There may soon be a new sheriff at the VA. On Friday, President Obama nominated lawyer Michael J. Missal to fill the inspector general (IG) role permanently.

This long-awaited nomination has been met primarily with deep sighs of relief by both Congress members and VA whistleblowers; the most recent IG, George Opfer, retired in December 2013. Just 4 months later, the “wait-time scandal” broke at VA, and reports of corruption and substandard investigations have since persisted.

Related: VA Falling Behind on Backlog According to the OIG

Linda A. Halliday assumed the position of deputy IG following the resignation of former interim IG Richard Griffin, who stepped down in June amid criticism that he interfered with VA investigations.

Related: VA Hospital Deficiencies Contributed to Marine’s Death

This is not Mr. Missal’s first run at federal investigations. In 2007, Mr. Missal was confirmed by the U.S. Department of Justice (DOJ) as examiner in the bankruptcy proceedings of subprime loan specialist New Century Financial Corp, which was one of the first major collapses of the recent U.S. housing crisis. According to the DOJ, Mr. Missal was tasked to “…investigate any and all accounting and financial statement irregularities, errors, or misstatements,…any possible post-petition unauthorized use of cash collateral by the debtor, and otherwise perform the duties of an examiner.”

Related: VHA Under Harsh Criticism From OIG, GAO

The White House said in a statement, “Throughout these and dozens of other high-profile and significant investigations, Missal’s work and reports have consistently received widespread acclaim.”

There may soon be a new sheriff at the VA. On Friday, President Obama nominated lawyer Michael J. Missal to fill the inspector general (IG) role permanently.

This long-awaited nomination has been met primarily with deep sighs of relief by both Congress members and VA whistleblowers; the most recent IG, George Opfer, retired in December 2013. Just 4 months later, the “wait-time scandal” broke at VA, and reports of corruption and substandard investigations have since persisted.

Related: VA Falling Behind on Backlog According to the OIG

Linda A. Halliday assumed the position of deputy IG following the resignation of former interim IG Richard Griffin, who stepped down in June amid criticism that he interfered with VA investigations.

Related: VA Hospital Deficiencies Contributed to Marine’s Death

This is not Mr. Missal’s first run at federal investigations. In 2007, Mr. Missal was confirmed by the U.S. Department of Justice (DOJ) as examiner in the bankruptcy proceedings of subprime loan specialist New Century Financial Corp, which was one of the first major collapses of the recent U.S. housing crisis. According to the DOJ, Mr. Missal was tasked to “…investigate any and all accounting and financial statement irregularities, errors, or misstatements,…any possible post-petition unauthorized use of cash collateral by the debtor, and otherwise perform the duties of an examiner.”

Related: VHA Under Harsh Criticism From OIG, GAO

The White House said in a statement, “Throughout these and dozens of other high-profile and significant investigations, Missal’s work and reports have consistently received widespread acclaim.”

There may soon be a new sheriff at the VA. On Friday, President Obama nominated lawyer Michael J. Missal to fill the inspector general (IG) role permanently.

This long-awaited nomination has been met primarily with deep sighs of relief by both Congress members and VA whistleblowers; the most recent IG, George Opfer, retired in December 2013. Just 4 months later, the “wait-time scandal” broke at VA, and reports of corruption and substandard investigations have since persisted.

Related: VA Falling Behind on Backlog According to the OIG

Linda A. Halliday assumed the position of deputy IG following the resignation of former interim IG Richard Griffin, who stepped down in June amid criticism that he interfered with VA investigations.

Related: VA Hospital Deficiencies Contributed to Marine’s Death

This is not Mr. Missal’s first run at federal investigations. In 2007, Mr. Missal was confirmed by the U.S. Department of Justice (DOJ) as examiner in the bankruptcy proceedings of subprime loan specialist New Century Financial Corp, which was one of the first major collapses of the recent U.S. housing crisis. According to the DOJ, Mr. Missal was tasked to “…investigate any and all accounting and financial statement irregularities, errors, or misstatements,…any possible post-petition unauthorized use of cash collateral by the debtor, and otherwise perform the duties of an examiner.”

Related: VHA Under Harsh Criticism From OIG, GAO

The White House said in a statement, “Throughout these and dozens of other high-profile and significant investigations, Missal’s work and reports have consistently received widespread acclaim.”

There’s little question that patients should have access to their electronic health records, but what should health care providers charge for copies of the electronic documents? A draft of proposals by the Office of the National Coordinator (ONC) for Health Information Technology aims to help providers determine how to calculate these costs.

Electronic file size was a top issue addressed by the ONC at two recent privacy and security workgroup meetings. The group recommended that electronic file size not be used as a proxy for “pages” in setting patient fees for electronic access. Labor, media, and search and retrieval efforts are more appropriate considerations when calculating costs, said Stanley W. Crosley, chair for ONC’s privacy and security workgroup and a Washington data privacy and health information attorney.

©pandpstock001/ThinkStock.com

“The answers were pretty clear across the board that it really wasn’t a very good proxy,” Mr. Crosley said during a Sept. 28 workgroup meeting. “Really it’s more about labor charge and media charge.”

ONC’s privacy and security workgroup discussed cost considerations for electronic protected health information (PHI) during a Sept. 21 meeting and proposed suggested guidance to the Office for Civil Rights (OCR) at a follow-up meeting on Sept. 28. The workgroup’s recommendations stem from a request by the Obama administration that the U.S. Department of Health & Human Services and ONC collaborate to address barriers that prevent patients from accessing PHI. The president’s Precision Medicine Initiative calls for the OCR to develop additional guidance for health care providers and the public about accessing electronic health information under HIPAA.

Few states have addressed how physicians and other health providers should charge for EHR requests, and requirements differ widely in states that do regulate the activity, Mr. Crosley said during the meeting. Illinois, for example, allows doctors and hospitals to charge 50% of the paper-based per-page fee for electronic records retrieved from scanning, digital imaging, electronic information, or another digital format. Ohio does not distinguish between paper and electronic records and allows providers to charge the same per-page fee for both. Most states base fees for paper records on pages, with some states setting limits on maximum copying costs.

Developing cost guidelines around electronic PHI is more complex than meets the eye, ONC members noted at the Sept. 28 meeting. Questions include how producible format should affect fees, whether the cost of electronic data should be comparable to paper copies, and to what extent labor should be factored into cost. Making matters more complicated are recent federal regulations under the Health Information Technology for Economic and Clinical Health (HITECH) Act that mandate what costs can and cannot not include. The 2013 Omnibus Rule, which made amendments to HIPAA as required by the HITECH Act, gives patients the right to obtain health information copies in the form and format they wish, as long as that form is “readily producible” by the covered entity. Fees cannot include costs associated with searching for or retrieving the requested information, but may include labor charges such as time spent to create and copy the electronic file or the compiling, extracting, scanning, and burning health information to media.

“The interaction of these two points creates some issues for covered entities as well as for the charges being offered,” Mr. Crosley said.

As part of its recommendations, ONC suggests that OCR define search and retrieval and distinguish between search and retrieval costs versus copying and duplication costs. In future guidance, OCR should also provide more precision around calculation of labor, media, and search and retrieval costs as well as provide examples of hypothetical scenarios for clarity, the workgroup proposes. In addition, ONC would like OCR to clarify how to handle more restrictive privacy state laws if patients want a doctor to send a record to a third party. As part of the 2013 Omnibus rule, patients can direct a covered entity to transmit a record directly to an individual’s designee or third party.

The ONC workgroup based its recommendations on a survey of questions provided to a group of health providers, EHR vendors, and patients about cost for electronic PHI. The Sept. 28 suggestions are not formal recommendations, but will be used by ONC as a basis to develop final consideration points for the OCR.

agallegos@frontlinemedcom.com

On Twitter@legal_med

There’s little question that patients should have access to their electronic health records, but what should health care providers charge for copies of the electronic documents? A draft of proposals by the Office of the National Coordinator (ONC) for Health Information Technology aims to help providers determine how to calculate these costs.

Electronic file size was a top issue addressed by the ONC at two recent privacy and security workgroup meetings. The group recommended that electronic file size not be used as a proxy for “pages” in setting patient fees for electronic access. Labor, media, and search and retrieval efforts are more appropriate considerations when calculating costs, said Stanley W. Crosley, chair for ONC’s privacy and security workgroup and a Washington data privacy and health information attorney.

©pandpstock001/ThinkStock.com

“The answers were pretty clear across the board that it really wasn’t a very good proxy,” Mr. Crosley said during a Sept. 28 workgroup meeting. “Really it’s more about labor charge and media charge.”

ONC’s privacy and security workgroup discussed cost considerations for electronic protected health information (PHI) during a Sept. 21 meeting and proposed suggested guidance to the Office for Civil Rights (OCR) at a follow-up meeting on Sept. 28. The workgroup’s recommendations stem from a request by the Obama administration that the U.S. Department of Health & Human Services and ONC collaborate to address barriers that prevent patients from accessing PHI. The president’s Precision Medicine Initiative calls for the OCR to develop additional guidance for health care providers and the public about accessing electronic health information under HIPAA.

Few states have addressed how physicians and other health providers should charge for EHR requests, and requirements differ widely in states that do regulate the activity, Mr. Crosley said during the meeting. Illinois, for example, allows doctors and hospitals to charge 50% of the paper-based per-page fee for electronic records retrieved from scanning, digital imaging, electronic information, or another digital format. Ohio does not distinguish between paper and electronic records and allows providers to charge the same per-page fee for both. Most states base fees for paper records on pages, with some states setting limits on maximum copying costs.

Developing cost guidelines around electronic PHI is more complex than meets the eye, ONC members noted at the Sept. 28 meeting. Questions include how producible format should affect fees, whether the cost of electronic data should be comparable to paper copies, and to what extent labor should be factored into cost. Making matters more complicated are recent federal regulations under the Health Information Technology for Economic and Clinical Health (HITECH) Act that mandate what costs can and cannot not include. The 2013 Omnibus Rule, which made amendments to HIPAA as required by the HITECH Act, gives patients the right to obtain health information copies in the form and format they wish, as long as that form is “readily producible” by the covered entity. Fees cannot include costs associated with searching for or retrieving the requested information, but may include labor charges such as time spent to create and copy the electronic file or the compiling, extracting, scanning, and burning health information to media.

“The interaction of these two points creates some issues for covered entities as well as for the charges being offered,” Mr. Crosley said.

As part of its recommendations, ONC suggests that OCR define search and retrieval and distinguish between search and retrieval costs versus copying and duplication costs. In future guidance, OCR should also provide more precision around calculation of labor, media, and search and retrieval costs as well as provide examples of hypothetical scenarios for clarity, the workgroup proposes. In addition, ONC would like OCR to clarify how to handle more restrictive privacy state laws if patients want a doctor to send a record to a third party. As part of the 2013 Omnibus rule, patients can direct a covered entity to transmit a record directly to an individual’s designee or third party.

The ONC workgroup based its recommendations on a survey of questions provided to a group of health providers, EHR vendors, and patients about cost for electronic PHI. The Sept. 28 suggestions are not formal recommendations, but will be used by ONC as a basis to develop final consideration points for the OCR.

agallegos@frontlinemedcom.com

On Twitter@legal_med

There’s little question that patients should have access to their electronic health records, but what should health care providers charge for copies of the electronic documents? A draft of proposals by the Office of the National Coordinator (ONC) for Health Information Technology aims to help providers determine how to calculate these costs.

Electronic file size was a top issue addressed by the ONC at two recent privacy and security workgroup meetings. The group recommended that electronic file size not be used as a proxy for “pages” in setting patient fees for electronic access. Labor, media, and search and retrieval efforts are more appropriate considerations when calculating costs, said Stanley W. Crosley, chair for ONC’s privacy and security workgroup and a Washington data privacy and health information attorney.

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“The answers were pretty clear across the board that it really wasn’t a very good proxy,” Mr. Crosley said during a Sept. 28 workgroup meeting. “Really it’s more about labor charge and media charge.”

ONC’s privacy and security workgroup discussed cost considerations for electronic protected health information (PHI) during a Sept. 21 meeting and proposed suggested guidance to the Office for Civil Rights (OCR) at a follow-up meeting on Sept. 28. The workgroup’s recommendations stem from a request by the Obama administration that the U.S. Department of Health & Human Services and ONC collaborate to address barriers that prevent patients from accessing PHI. The president’s Precision Medicine Initiative calls for the OCR to develop additional guidance for health care providers and the public about accessing electronic health information under HIPAA.

Few states have addressed how physicians and other health providers should charge for EHR requests, and requirements differ widely in states that do regulate the activity, Mr. Crosley said during the meeting. Illinois, for example, allows doctors and hospitals to charge 50% of the paper-based per-page fee for electronic records retrieved from scanning, digital imaging, electronic information, or another digital format. Ohio does not distinguish between paper and electronic records and allows providers to charge the same per-page fee for both. Most states base fees for paper records on pages, with some states setting limits on maximum copying costs.

Developing cost guidelines around electronic PHI is more complex than meets the eye, ONC members noted at the Sept. 28 meeting. Questions include how producible format should affect fees, whether the cost of electronic data should be comparable to paper copies, and to what extent labor should be factored into cost. Making matters more complicated are recent federal regulations under the Health Information Technology for Economic and Clinical Health (HITECH) Act that mandate what costs can and cannot not include. The 2013 Omnibus Rule, which made amendments to HIPAA as required by the HITECH Act, gives patients the right to obtain health information copies in the form and format they wish, as long as that form is “readily producible” by the covered entity. Fees cannot include costs associated with searching for or retrieving the requested information, but may include labor charges such as time spent to create and copy the electronic file or the compiling, extracting, scanning, and burning health information to media.

“The interaction of these two points creates some issues for covered entities as well as for the charges being offered,” Mr. Crosley said.

As part of its recommendations, ONC suggests that OCR define search and retrieval and distinguish between search and retrieval costs versus copying and duplication costs. In future guidance, OCR should also provide more precision around calculation of labor, media, and search and retrieval costs as well as provide examples of hypothetical scenarios for clarity, the workgroup proposes. In addition, ONC would like OCR to clarify how to handle more restrictive privacy state laws if patients want a doctor to send a record to a third party. As part of the 2013 Omnibus rule, patients can direct a covered entity to transmit a record directly to an individual’s designee or third party.

The ONC workgroup based its recommendations on a survey of questions provided to a group of health providers, EHR vendors, and patients about cost for electronic PHI. The Sept. 28 suggestions are not formal recommendations, but will be used by ONC as a basis to develop final consideration points for the OCR.

agallegos@frontlinemedcom.com

On Twitter@legal_med

Fiscal year 2015 closes today, leaving just hours for the U.S. House of Representatives to pass a stopgap spending bill that would prevent a government shutdown on October 1. To speed the voting process, the House invoked martial law on Tuesday, lessening the required wait time for voting in order to maximize the possibility that the bill would make it to President Obama before the end of Wednesday.

Between the martial law invocation and the bill having already passed through the U.S. Senate, a government shutdown may be unlikely, at least until December 11 when the bill expires. Regardless, VA is ahead of the curve on issuing its contingency plan in the absence of appropriations.

Of the VHA’s 323,621 employees, only 1,080 would be subject to furlough, in recognition of the VA’s obligation to provide high-quality medical care to veterans. The Veterans Benefits Administration (VBA) would see a higher furlough rate (7,824 of 22,111 employees), as would the National Cemetery Administration (1,105 of 1,880 employees) and the Office of Information Technology (OI&T) (3,501 of 7,874 employees). The VA notes that in the event of a prolonged shutdown, it would need to begin furloughing excepted employees in VBA and OI&T, raising the rates even higher. If that becomes the case, the contingency plan will be updated.

This time 2 years ago, the government experienced a similar crisis, resulting in about 800,000 federal employees furloughed and another 1.3 million expected to work without known payment dates. The 2013 shutdown lasted from October 1 through October 16 when an interim appropriations bill was signed. Prior to that, the government hadn’t experienced a shutdown since 1995. With only a short-term spending bill on the table, the threat of a government shutdown will continue to hang over the heads of VA and other federal employees.

Fiscal year 2015 closes today, leaving just hours for the U.S. House of Representatives to pass a stopgap spending bill that would prevent a government shutdown on October 1. To speed the voting process, the House invoked martial law on Tuesday, lessening the required wait time for voting in order to maximize the possibility that the bill would make it to President Obama before the end of Wednesday.

Between the martial law invocation and the bill having already passed through the U.S. Senate, a government shutdown may be unlikely, at least until December 11 when the bill expires. Regardless, VA is ahead of the curve on issuing its contingency plan in the absence of appropriations.

Of the VHA’s 323,621 employees, only 1,080 would be subject to furlough, in recognition of the VA’s obligation to provide high-quality medical care to veterans. The Veterans Benefits Administration (VBA) would see a higher furlough rate (7,824 of 22,111 employees), as would the National Cemetery Administration (1,105 of 1,880 employees) and the Office of Information Technology (OI&T) (3,501 of 7,874 employees). The VA notes that in the event of a prolonged shutdown, it would need to begin furloughing excepted employees in VBA and OI&T, raising the rates even higher. If that becomes the case, the contingency plan will be updated.

This time 2 years ago, the government experienced a similar crisis, resulting in about 800,000 federal employees furloughed and another 1.3 million expected to work without known payment dates. The 2013 shutdown lasted from October 1 through October 16 when an interim appropriations bill was signed. Prior to that, the government hadn’t experienced a shutdown since 1995. With only a short-term spending bill on the table, the threat of a government shutdown will continue to hang over the heads of VA and other federal employees.

Fiscal year 2015 closes today, leaving just hours for the U.S. House of Representatives to pass a stopgap spending bill that would prevent a government shutdown on October 1. To speed the voting process, the House invoked martial law on Tuesday, lessening the required wait time for voting in order to maximize the possibility that the bill would make it to President Obama before the end of Wednesday.

Between the martial law invocation and the bill having already passed through the U.S. Senate, a government shutdown may be unlikely, at least until December 11 when the bill expires. Regardless, VA is ahead of the curve on issuing its contingency plan in the absence of appropriations.

Of the VHA’s 323,621 employees, only 1,080 would be subject to furlough, in recognition of the VA’s obligation to provide high-quality medical care to veterans. The Veterans Benefits Administration (VBA) would see a higher furlough rate (7,824 of 22,111 employees), as would the National Cemetery Administration (1,105 of 1,880 employees) and the Office of Information Technology (OI&T) (3,501 of 7,874 employees). The VA notes that in the event of a prolonged shutdown, it would need to begin furloughing excepted employees in VBA and OI&T, raising the rates even higher. If that becomes the case, the contingency plan will be updated.

This time 2 years ago, the government experienced a similar crisis, resulting in about 800,000 federal employees furloughed and another 1.3 million expected to work without known payment dates. The 2013 shutdown lasted from October 1 through October 16 when an interim appropriations bill was signed. Prior to that, the government hadn’t experienced a shutdown since 1995. With only a short-term spending bill on the table, the threat of a government shutdown will continue to hang over the heads of VA and other federal employees.

The Behavioral Health Equity Barometer, published by the Substance Abuse and Mental Health Services Administration, is a series of data snapshots of the impact of substance abuse and mental illness on American communities. Differences in prevalence of disorders, perceptions of risk, and access to treatment contribute to the variations in burden of care, the authors say, and income, location, and insurance status are “key determinants of disparities” across populations. For example, in 2013, adults with serious mental illness were less likely to receive mental health treatment if they did not have health insurance. And only 6% of Americans aged ≥ 12 years with alcohol dependence or abuse received treatment for the alcohol use within the prior year, whereas 13% of those using illicit drugs received treatment.

Related: Self-Screen for Substance Use

Examining the data is critical, the authors emphasize, to providing the most appropriate and highest quality behavioral health care. Their report provides a unique overview of population-based variations in behavioral health at a point in time. Gathering the data in this way, they say, will help create a mechanism for systematically tracking changes and trends.

Related: Effective Mental Health Interventions

The report is available for download at store.samhsa.gov/product/SMA15-4895EQ.

The Behavioral Health Equity Barometer, published by the Substance Abuse and Mental Health Services Administration, is a series of data snapshots of the impact of substance abuse and mental illness on American communities. Differences in prevalence of disorders, perceptions of risk, and access to treatment contribute to the variations in burden of care, the authors say, and income, location, and insurance status are “key determinants of disparities” across populations. For example, in 2013, adults with serious mental illness were less likely to receive mental health treatment if they did not have health insurance. And only 6% of Americans aged ≥ 12 years with alcohol dependence or abuse received treatment for the alcohol use within the prior year, whereas 13% of those using illicit drugs received treatment.

Related: Self-Screen for Substance Use

Examining the data is critical, the authors emphasize, to providing the most appropriate and highest quality behavioral health care. Their report provides a unique overview of population-based variations in behavioral health at a point in time. Gathering the data in this way, they say, will help create a mechanism for systematically tracking changes and trends.

Related: Effective Mental Health Interventions

The report is available for download at store.samhsa.gov/product/SMA15-4895EQ.

The Behavioral Health Equity Barometer, published by the Substance Abuse and Mental Health Services Administration, is a series of data snapshots of the impact of substance abuse and mental illness on American communities. Differences in prevalence of disorders, perceptions of risk, and access to treatment contribute to the variations in burden of care, the authors say, and income, location, and insurance status are “key determinants of disparities” across populations. For example, in 2013, adults with serious mental illness were less likely to receive mental health treatment if they did not have health insurance. And only 6% of Americans aged ≥ 12 years with alcohol dependence or abuse received treatment for the alcohol use within the prior year, whereas 13% of those using illicit drugs received treatment.

Related: Self-Screen for Substance Use

Examining the data is critical, the authors emphasize, to providing the most appropriate and highest quality behavioral health care. Their report provides a unique overview of population-based variations in behavioral health at a point in time. Gathering the data in this way, they say, will help create a mechanism for systematically tracking changes and trends.

Related: Effective Mental Health Interventions

The report is available for download at store.samhsa.gov/product/SMA15-4895EQ.

More than $38 million in HHS grants for improving coordinated health information sharing across the U.S. bring us another step closer to an interoperable learning health system. HHS announced 20 awardees for 3 health information technology (IT) programs.

Related: The Right Care at the Right Time and in the Right Place: The Role of Technology in the VHA

One program receiving a grant is Advance Interoperable Health Information Technology Services to Support Health Information Exchange, a 2-year cooperative agreement program that supports the efforts of 12 states or state-designated entities, including the Arkansas Office of Health Information Technology, the California Emergency Medical Services Authority, and the Colorado Department of Health Care Policy and Financing.

Related: Dissemination of a Care Collaboration Project

The second health IT program, The Community Health Peer Learning Program, works with communities to identify data solutions and disseminate best practices and learning guides, among other initiatives.

Related: HHS Hails Big Ideas

The third program, The Workforce Training Program, trains incumbent health care workers to use new health ITs in settings such as team-based care, long-term care, and patient-centered medical homes.

More than $38 million in HHS grants for improving coordinated health information sharing across the U.S. bring us another step closer to an interoperable learning health system. HHS announced 20 awardees for 3 health information technology (IT) programs.

Related: The Right Care at the Right Time and in the Right Place: The Role of Technology in the VHA

One program receiving a grant is Advance Interoperable Health Information Technology Services to Support Health Information Exchange, a 2-year cooperative agreement program that supports the efforts of 12 states or state-designated entities, including the Arkansas Office of Health Information Technology, the California Emergency Medical Services Authority, and the Colorado Department of Health Care Policy and Financing.

Related: Dissemination of a Care Collaboration Project

The second health IT program, The Community Health Peer Learning Program, works with communities to identify data solutions and disseminate best practices and learning guides, among other initiatives.

Related: HHS Hails Big Ideas

The third program, The Workforce Training Program, trains incumbent health care workers to use new health ITs in settings such as team-based care, long-term care, and patient-centered medical homes.

More than $38 million in HHS grants for improving coordinated health information sharing across the U.S. bring us another step closer to an interoperable learning health system. HHS announced 20 awardees for 3 health information technology (IT) programs.

Related: The Right Care at the Right Time and in the Right Place: The Role of Technology in the VHA

One program receiving a grant is Advance Interoperable Health Information Technology Services to Support Health Information Exchange, a 2-year cooperative agreement program that supports the efforts of 12 states or state-designated entities, including the Arkansas Office of Health Information Technology, the California Emergency Medical Services Authority, and the Colorado Department of Health Care Policy and Financing.

Related: Dissemination of a Care Collaboration Project

The second health IT program, The Community Health Peer Learning Program, works with communities to identify data solutions and disseminate best practices and learning guides, among other initiatives.

Related: HHS Hails Big Ideas

The third program, The Workforce Training Program, trains incumbent health care workers to use new health ITs in settings such as team-based care, long-term care, and patient-centered medical homes.

Getting the right amount of sleep can be hard for service members, but sleep issues have been a priority for Lieutenant General Patricia Horoho, Surgeon General of the Army, who decided in 2011 to focus on the Performance Triad of health: sleep, activity, and nutrition. Now, the Office of Naval Research is also tackling the problem, starting with a recent workshop, “The Restorative Effects of Sleep,” to cover current research and the impact of sleep deprivation on military personnel.

Related: Sleeping Well After Deployment

The workshop committee is assessing the efficacy of existing treatments for sleep deficiency and operational and training programs for encouraging healthy sleep habits, with the aim of establishing servicewide guidelines on best practices.

Related: Risk of Vehicle Accidents for Returning Military

Workshop speakers included Charles Czeisler, PhD, MD, professor of sleep medicine at Harvard Medical School, and David Dinges, PhD, chief of the Division of Sleep and Chronobiology, University of Pennsylvania. “You have military people who are working 18-hour shifts or participating in night operations and training exercises lasting for hours,” Dr. Czeisler said. “Such a lack of sleep is harmful. We must emphasize how crucial sleep is to health and performance.”

Related: CE Course Helps Practitioners Understand Military Culture

Sleep deficiency has been linked to health issues, including depression, heart attack, and traumatic brain injury. But in an interview with Health.mil, David J. Smith, MD, deputy assistant secretary of defense for Health Affairs, Health Readiness Policy and Oversight, said service members often believe that running on little or no sleep is a “sign of being tough and giving 100 percent.” That view, he adds, “stigmatizes those who don’t work themselves to the point of sleep deficiency as lazy or unmotivated.”

Getting the right amount of sleep can be hard for service members, but sleep issues have been a priority for Lieutenant General Patricia Horoho, Surgeon General of the Army, who decided in 2011 to focus on the Performance Triad of health: sleep, activity, and nutrition. Now, the Office of Naval Research is also tackling the problem, starting with a recent workshop, “The Restorative Effects of Sleep,” to cover current research and the impact of sleep deprivation on military personnel.

Related: Sleeping Well After Deployment

The workshop committee is assessing the efficacy of existing treatments for sleep deficiency and operational and training programs for encouraging healthy sleep habits, with the aim of establishing servicewide guidelines on best practices.

Related: Risk of Vehicle Accidents for Returning Military

Workshop speakers included Charles Czeisler, PhD, MD, professor of sleep medicine at Harvard Medical School, and David Dinges, PhD, chief of the Division of Sleep and Chronobiology, University of Pennsylvania. “You have military people who are working 18-hour shifts or participating in night operations and training exercises lasting for hours,” Dr. Czeisler said. “Such a lack of sleep is harmful. We must emphasize how crucial sleep is to health and performance.”

Related: CE Course Helps Practitioners Understand Military Culture

Sleep deficiency has been linked to health issues, including depression, heart attack, and traumatic brain injury. But in an interview with Health.mil, David J. Smith, MD, deputy assistant secretary of defense for Health Affairs, Health Readiness Policy and Oversight, said service members often believe that running on little or no sleep is a “sign of being tough and giving 100 percent.” That view, he adds, “stigmatizes those who don’t work themselves to the point of sleep deficiency as lazy or unmotivated.”

Getting the right amount of sleep can be hard for service members, but sleep issues have been a priority for Lieutenant General Patricia Horoho, Surgeon General of the Army, who decided in 2011 to focus on the Performance Triad of health: sleep, activity, and nutrition. Now, the Office of Naval Research is also tackling the problem, starting with a recent workshop, “The Restorative Effects of Sleep,” to cover current research and the impact of sleep deprivation on military personnel.

Related: Sleeping Well After Deployment

The workshop committee is assessing the efficacy of existing treatments for sleep deficiency and operational and training programs for encouraging healthy sleep habits, with the aim of establishing servicewide guidelines on best practices.

Related: Risk of Vehicle Accidents for Returning Military

Workshop speakers included Charles Czeisler, PhD, MD, professor of sleep medicine at Harvard Medical School, and David Dinges, PhD, chief of the Division of Sleep and Chronobiology, University of Pennsylvania. “You have military people who are working 18-hour shifts or participating in night operations and training exercises lasting for hours,” Dr. Czeisler said. “Such a lack of sleep is harmful. We must emphasize how crucial sleep is to health and performance.”

Related: CE Course Helps Practitioners Understand Military Culture

Sleep deficiency has been linked to health issues, including depression, heart attack, and traumatic brain injury. But in an interview with Health.mil, David J. Smith, MD, deputy assistant secretary of defense for Health Affairs, Health Readiness Policy and Oversight, said service members often believe that running on little or no sleep is a “sign of being tough and giving 100 percent.” That view, he adds, “stigmatizes those who don’t work themselves to the point of sleep deficiency as lazy or unmotivated.”