With the impending comment deadline for Meaningful Use (MU) fast approaching, many organizations, from CHIME to AHA to AAFP and others are asking for some form of relaxation of MU criteria in the final version. Now it is not to say these concerns are not justified, it just may be that they are misplaced for the vast majority of those who currently do not use an EHR, small physician practices and clinics. It is within these small practices, which are really just small businesses, that the majority of patient care occurs and where possibly the biggest benefit may be derived in the use of EHRs. It is also here where we may find the highest adoption hurdles, and those adoption hurdles are not so much about MU criteria, but more about productivity losses in adopting an EHR.
This past weekend I spent some time with a nurse who works in a primary care/pediatrics clinic in Vermont. There facility, part of a network of several clinics, recently adopted and went live with a new EHR system (about 18 months ago). According to the nurse, this EHR, from one of the big names in ambulatory systems, has been a complete disaster for the clinic. Productivity is way down, countless glitches have occurred, whole system crashed during a recent upgrade and the list goes on. For 2009, this clinic, which has been in operation for a few decades, had its first ever loss last year, the year they went live with this EHR. The clinic puts the blame squarely on the EHR, which has severely constricted their ability to see patients and as all readers know, clinicians get paid for seeing patients, not trying to use a complex and difficult to use EHR.
It is stories like this that concern me.
This is a clinic trying to do the right thing, trying to use an EHR in a meaningful way (note, did not say meaningful use) and they are struggling. Yes, they do want to deliver the best patient care, but at the end of the day, they, like any business have bills to pay. They are losing money far in excess of what HITECH Act incentives will provide. This story is, unfortunately, not unique, though few EHR vendors will come clean on the productivity hit to a practice. Maybe instead of guaranteeing that their application(s) will meet MU criteria, EHR vendors should guarantee that the productivity hit of using their solution will not exceed HITECH incentive payments. Now that would be an interesting value proposition.
Thanks to Michael Jahn of Jahn & Associates for the MU cartoon.
John Moore is an IT Analyst at Chilmark Research, where this post was first published.
The patient paid for the work but not the record of the work. I prepare it so I can interact with the patient’s insurance company and so I can defend myself from the patient. I do not need a record for anything else. The patient can make their own record. I will give them anything they paid for, like test data and labs, and my recommendations. However, my written opinion is mine. I own it, created it, stored it. Maybe I should sell a license for it like a software vendor.
MD as HELL, you do make a point that I brought up several times and never got a clear answer. Is the documented thought process, particularly in assessment and plan, really the doctor’s intellectual property? If so, should the sharing of medical records be limited to hard data only (vitals, procedures, test results, meds and diagnosis)?
Here is my suggestion to all physicians commenting here or just reading and agreeing, or disagreeing.
The Government has asked for input on their proposed EHR certification model. Why not submit your comments, so the Government gets an idea of the prevailing concerns out there?
You cannot affect change unless you make your voice heard.
The comments are public, thus cannot be ignored.
Here is the URL for commenting. You have until 5/10/2010.
http://www.regulations.gov/search/Regs/home.html#submitComment?R=0900006480ab9d0e
I agree with Janowitz and MD as Hell. President Obama promised to work with Republicans to reform healthcare. The health care bill is designed to provide health care to tens of millions who lack it and ban insurance companies from denying medical coverage on the basis of pre-existing medical conditions. Most people would have to get insurance by law, including poor and middle-income Americans. Subsidies will not help those that are already financially strapped, who are one step away from losing their homes because they lost their jobs.
President Obama wants to create a “commission” with authority to force savings in Medicare, and is seeking the deletion of items sought by individual senators. Does his vision of a commission resemble David Brailer’s vision for creating the commission, CCHIT? God help our country!!
President Obama is obsessed with his vision of “health care reform”. I agree that the President’s tactics to circumvent parliamentary proceedings and ignore the Constitution will cause the President to be impeached.
President Obama is employing techniques learned only in Chicago: Al Capone had a leading role in the illegal activities that lent Chicago its reputation as a “lawless city”. That reputation has only intensified with other countries referring to Chicago as “Crook County”. It does not help that former Rep. Governor George Ryan and former Dem. Governor Rod Blagojevich were both tarnished by scandal, and both arrested on Federal corruption charges. “Pay to play” schemes to obtain personal gain through the corrupt use of authority in Illinois, and especially in Chicago, are a common every day event. Ryan was convicted on Federal corruption charges and he entered a Federal prison on November 7, 2007, to begin a 6.5-year sentence. Blago was impeached and his trial date has been set for June 3, 2010.
If President Obama is forced to step down, he can always apply for a job as a lobbyist at HIMSS.org. He will be following the footsteps of Tom Daschle and Tommy Thompson, who are now successful HIT lobbyists receiving millions of dollars in Federal grants. The Executive Order for the universal adoption of EHRs will forever be known as “Lead and Prosper”.
President Obama has turned a blind eye to the corruption that began in his own backyard, in Crook County, IL—home to HIMSS.org and CCHIT.org. I, too, was one of millions of Americans seduced by Obama’s promises of healthcare reform. There is widespread corruption and solicitation of bribery in Illinois, so it does not surprise me that HIMSS.org and CCHIT.org have been successful in not only pursuing their agenda for universal EHR adoption, but have done so successfully with lack of FDA oversight.
Margalit, can you please clarify by what you mean by “the government” in your statement below?
“The Government has asked for input on their proposed EHR certification model. Why not submit your comments, so the Government gets an idea of the prevailing concerns out there?”
Do you mean by those in government who are able to shape policy? Do you mean by Healthcare Czar Nancy DeParle, with lucrative ties to Cerner? Do you mean by HHS National Coordinator David Blumenthal, who received grants from GE (GE is Mark Leavitt’s former boss)? Do you mean by the HIMSS’ EHRVA and HIMSS’ BOD involvement with HHS Policy Committees and HHS Standards Committees?
HIMSS, HIMSS EHRVA, and HIMSS CCHIT have infiltrated the government, beginning with Tommy Thompson and David Brailer. It is admirable to post your comments so they are part of the Federal Register. But until the government removes the HIT vendors from government roles, and stops HIMSS’ infiltration of the government, our concerns will be tossed aside.
Do you mean an Oligarchy? This is what the great President Eisenhower warned about. You can’t have government, by and for the people, when it is run by big business interests.
BTW, the idea of the “revolving door” comes from the Eisenhower period. Their is an idea that this does not exist today, then how do you explain Glen Tulman, Nancy DeParle, Mark Leavitt, David Blumenthal, Tom Daschle, Tommy Thompson, David Brailer, etc., who are still involved with shaping policy in government? Their constant presence is felt at government meetings, with their hands out for mo’ money. This money is not meant for the testing the safety of these devices, it is meant to fatten the bottom line of the big HIT companies.
Why don’t you post my comment to the Federal Register and sign your name to it, if you agree with it?
BlueDog,
By Government, I mean ONC. The current ONC, as run by Dr. Blumenthal and the various committees.
I will be posting my own comments to the Federal Register, but I think I’ll just stick to the point of certification. I don’t believe political comments were requested, and I don’t believe that the Federal Register is the right place to post those.
It is of course your prerogative to believe that the entire system is so corrupted that there is no point in engaging in conversation.
I am not at that point just yet, so I think trying is better than doing nothing.
Thanks, Margalit; I took your advice about commenting. Interesting; they want to know what organization one is from. Wonder how many truthful answers they’ll get.
Margalit,
the Federal Register is precisely the area where these comments should go! All comments and opinions should be posted regarding the corruption and infiltration by the HIT industry. It is not about Patient Safety. There must be transparency in government. I have not had the HIT Kool-Aid, so I plan to post my comments soon. The govt cannot fix the problem unless the corruption and infiltration is exposed and is part of the Federal Register.
It is important for everyone to participate, so that each voice is heard. However, I believe that because the ONC is run by David Blumenthal, and that David Brailer has stated publicly that he was influenced by his underlying at the time (Blumenthal), that many comments will be disregarded. Brailer awarded CCHIT a grant contract of $7.5 million with “minimal standards” set for certification. That was Brailer’s vision…do you think the govt will ever admit they made a mistake regarding CCHIT? ONC is now trying to distance themselves from CCHIT.
Let’s face it, HHS committees are infiltrated by HIMSS BOD, HIMSS EHRVA, and HIMSS task force members. The Standards Committee alone has HIMSS BOD Liz Johnson (Tenet Healthcare) and HIMSS BOD C. Martin Harris, just to name a few.
Charlene Underwood (Siemens) has been involved with the HHS Policy Committee. She was also involved with HIMSS’ first Mideast conference in May 2009 in Bahrain (coincidentally, during the time that the PBS Frontline: Black Money was aired regarding Siemen’ corruption in the Mid East).
These HIT companies are members of the HIMSS EHRVA. And Lisa Gallagher, HIMSS Privacy and Security Officer, has presented public testimony to Blumenthal and the HHS Privacy Workgroup in November 2009. Ms. Gallagher is also a lucrative contractor for CCHIT under Javelin Technologies (the revolving door).
People at HIMSS have not managed to take the Federal Register away from the public, but they are working on it. Make no mistake, they work 24 hours a day to get what they want. You can count on it.
BlueDog,
I am glad you are going to post this to the Register. I have to admit that I don’t follow each person to the extent you do, and what you wrote here is of great concern to me. I did notice for a while that in all these committees and workgroups and semi official bodies, the same names keep popping up, as if there is one little pond of “experts” that get recycled into every new government effort. I guess I should have checked their pedigrees more carefully.
I don’t know, but for some reason Dr. Blumenthal strikes me as being honest….
The national HIT policy has been purchased by HIMSS on behalf of its member organizations. Revisit Robert O’Harrow’s piece in WaPo to dispel any doubt.
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html
Some “honest” people are undoubtedly being used, but who are they? With white collars, Enron and Adelphia executives seemed honest, did they not?
Good point, e-dollar Bill! If you look at the caption under Blackford Middleton’s photo in the WaPo article, it says “courtesy of HIMSS”. And why is that? Because Middleton was HIMSS Chair in 2006!
In the WaPo article, HIMSS worked closely with technology vendors. That is HIMSS EHRVA!
“With financial backing from the industry, they started advocacy groups, generated research to show the potential for massive savings and met routinely with lawmakers and other government officials.”
HIMSS Advocacy/Lobbyist office is located in the Beltway. The research HIMSS generated came from HIMSS Analytics! HIMSS EHRVA has the big HIT companies as its members, who provided financial backing for HIMSS (Cerner, GE, Siemens, McKesson, etc).
Read the link below from HIMSS’ own website. My comments are in parenthesis:
http://www.himss.org/ASP/about_FAQ.asp
“What percentage of HIMSS’ revenues come from vendor firms?
A SIGNIFICANT portion of HIMSS’ revenue comes from vendor and consulting firms. Those funds, however, are used to create education, tools, and resources by and for our members (advocacy, lobbying). In the past year, HIMSS has published more than 200 new resources and hosted multiple education programs, both nationally and regionally through our chapters.” (also used grants and tax-exempt status to host international conferences, which includes the MidEast, when there is less than 12% adoption in the U.S.)
One way to look at it, Margalit, is that everyone in government is somehow connected to HIMSS. Have you ever heard the phrase “Six Degrees of Separation”?
Do you think David Blumenthal does not know that HIMSS is involved with shaping policy at HHS? Do you think that Blumenthal does not know that HIMSS created the EHRVA and CCHIT?
Well, yes, BlueDog, I’m sure he knows all that and maybe more. But does that necessarily mean that he is acting inappropriately?
If the people in this forum knew what it is like to participate in all these committees to support and promote the health care IT interoperability standards they wouldn’t speak so negatively about it.
I spend my nights and weekends with the spirit of contribution to a cause. Time that I should be devoting to my family and myself.
How disappointing it is to have to read such slanderous statements of some great contributors.
The EHR Guy
For all, a clarification on my own position vis a vis EHR technology and safety: it’s very, very important to monitor these tools for their impact on safety. This has been almost completely overlooked for a generation, but I think that is about to end. If we (that is, our government) regulate EHR technology with respect to its compliance with specific standards for messaging and exchange, then we must also consider that it is appropriate to regulate the technology with respect to its effects on safety and errors. This is coming, as the passion and eloquence of some commenters here suggest it should, and I strongly believe that it’s a good thing that it does come.
Kind regards, DCK
Not sure what triggered this post from Dr. Halamka today, but it addresses some of the subjects discussed here.
For the sake of completeness, here it is:
http://geekdoctor.blogspot.com/2010/03/in-onc-i-trust.html
“monitor these tools for their impact on safety”
Dear Dr. Kibbe,
Actually, it is whether these tools are safe from the getgo. Since when is it legal to sell medical devices without FDA approval?
Halamka states: “My advice – trust the ONC folks and Federal Advisory Committees. Join the process. Be open about your opinions. Feel free to disagree with any idea or policy. ”
Of course,he expects us to believe him, especially when HIT vendor shills and HIMSS insiders are holding influential positions, providing educational resources to the lawmakers. Give me a break.
Translating Dr. Halamka’s words above, to the buzz on main street, what he said was, “DRINK THE KOOL-AID.”
Then go shopping for your purple shroud.
Beam me up, Scottie…
Does anybody know if the free ONC government cheese program is distributing free purple shrouds with every EHR? Are these shrouds “certified”?
I would suggest they keep the shrouds, but in the tradition of Dr. Kellogg, substitute yogurt for the cheese.
Wearing the purple shroud in public makes a statement: I’m impacted with EHRs–hence the yogurt cultures.
For those who are not computer addicts, have you met some of these people who proclaim how the silicon universe will save us time, money, and energy, and make us better people? I for one walk away from these interactions and wonder what planet they came from to truly believe this crap!
It’s just another money scam in the end, and the defenders and apologists do not want you to know this. Just watch the attack that will proceed after this comment.
Electronic records have some positive place, I will admit that. But, just use this as an analogy:
Gone to a commercial business of late to purchase something, and it is not on the computer screen, and then watch how it takes 2 or 3 people to wind up problem solving the issue, when the price was on the product from moment one? And the system can’t ring it up as it is not keyed in? Individuality is lost per the silicon age, and in medicine, that is the hallmark of the system, individuality. A word few IT freaks can say, much less understand.
And that is what you want the coming health care deform to provide for you? Think about it!
Start over. Re-examine what works, and proceed from there. You can’t have a rational discussion when someone hangs an ideological statement on every word. You also have to separate the good faith commentary on how to improve existing systems versus debates about whether they should be imposed on private businesses, etc. One can assume the latter comments are not building toward the same enterprise.
A main issue with practices trying to implement these systems is communication/expectation. And again, every one of the discussants leaves out patients and patient access/ease of use as a factor in chasing profits. That’s like redesigning cars but not consulting drivers about innovation.
The subpoena named Blagojevich Obama is something to be expected as the President is asked to testify for the trial of former governor Blagojevich. It was due to the news that Blagojevich was attempting to sell the President’s empty senate seat, without the President’s awareness but rumored to have communications with Blagojevich about the seat. Obama’s still the President of the United States of The US; even if he is subpoenaed to witness on the trial, the challenge that he’d be able to do it is almost none.
This is a set of phrases, not an essay. that you are incompetent