Survey Says: EHR Incentive Program Is on Track

Survey Says: EHR Incentive Program Is on Track

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We continue to see progress in improving the nation’s health care system, and a key tool to helping achieve that goal is the increased use of electronic health records by the nation’s doctors, hospitals, and other health care providers. These electronic tools serve as the infrastructure to implementing reforms that improve care – many of which are part of the Affordable Care Act.

Doctors and hospitals are using these tools to reduce mistakes and hospital readmissions, provide patients with more information that enable them to stay healthy, and allow for rewarding health care providers for delivering quality, not quantity, of care.

The adoption of those tools is reflected today in a release from the Centers for Disease Control and Prevention’s National Center for Health Statistics which provides a view of the Medicare and Medicaid EHR Incentive Program and indicates the program is healthy and growing steadily.

The 2013 data from the annual National Ambulatory Medical Care Survey are encouraging:

  • Nearly 80% of office-based physicians used some type of electronic health record system, an increase of 60 percentage points since 2001 and nearly double the percent in 2008 (42%), the year before the Health Information Technology and Economic and Clinical Health Act passed as part of the Recovery Act in 2009.
  • About half of office-based physicians surveyed said they use a system that qualifies as a “basic system,” up from just 11% in 2006.
  • Almost 70% of office-based physicians noted their intent to participate in the EHR incentive program.

Figure 1. Percentage of office-based physicians with EHR systems: United States, 2001-2013

The report also noted that 13% of physicians who responded said they both intended to participate in the incentive program and had a system that could support 14 of the Meaningful Use Stage 2 “core set of objectives,” ahead of target dates. This survey was performed in early 2013 – before 2014 certified products were even available.

The deadline to begin attesting for Meaningful Use Stage 2 is October 2014 for the earliest adopters of Meaningful Use Stage 1, so more than one in ten physicians decided on their own to participate  Meaningful Use Stage 2 capabilities more than a year earlier than necessary. These are early adopters who recognize the benefits of EHRs.

“From 2010 through 2013,  physician adoption of 7 of the 17 capabilities required for Stage 2 core objectives for meaningful use increased significantly,” according to National Center for Health Statistics health-policy researcher and lead author Chun-Ju Hsiao, PhD. Electronic prescribing through an EHR and adverse drug event/contraindication alerts had the largest increase among the stage 2 capabilities, Hsiao wrote.

In 2013, Meaningful Use related functionalities with the highest adoption rates included capabilities for recording key patient health information and functionalities related to medication management and safety. About three-quarters or more of physicians had these types of computerized capabilities.

Notably, physician respondents to another national survey also noted the clinical benefits in using EHRs, including that they helped physicians access records remotely (81%), and alerted providers of a critical lab value (62%). Most importantly, 78% of respondents said that EHRs “overall, enhanced patient care”.

Overall, we are encouraged to see that physician adoption of EHRs meeting Meaningful Use Stage 2 is increasing significantly and that physicians are recognizing the value of EHRs in the care setting.   The report does also tell us there is more to do and we agree. Fewer than one in three respondents (30%) said their EHR facilitated a communication with a patient via e-mail/secure instant messaging.

At ONC we look forward to continuing to work on key issues such as usability and improving functionalities so we can all see the promise of EHRs and health IT to improve care and eventually health.

Figure 2: Percent of physicians with selected computerized capabilities related to Meaningful Use objectives, 2013

Data Source: CDC/NCHS, National Ambulatory Medical Care Survey, Electronic Health Record Survey. Notes: VDT is “view online, download or transmit”. Data represent non-federal office-based physicians providing direct patient care in the 50 states and the District of Columbia, excluding radiologists, anesthesiologists, and pathologists.

Karen DeSalvo, MD, MPH, MSc. is the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. More information about the Office of the National Coordinator for Health IT and health information technology can be found at www.HealthIT.gov

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98 Comments on "Survey Says: EHR Incentive Program Is on Track"


Guest
Jan 17, 2014

“These electronic tools serve as the infrastructure to implementing reforms that improve care – many of which are part of the Affordable Care Act.”
__

While this is true, I’m sure a lot of critics will point to this as a negative. I’d be touting HIT on its own merits.

Guest
Jan 17, 2014

While it would be rational to conclude HIT will improve healthcare, the data to-date does not allow one to conclude that HIT will substantial decrease the cost of healthcare or improve quality. There are studies showing CPOE and CDS has merit, but the remainder of the HIT initiate is more of a pipe dream, at this time. See: What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology. Health Aff January 2013vol. 32 no. 1 63-68 and Health Information Technology: An Updated Systematic Review With a Focus on Meaningful Use Ann Intern Med. 2014;160(1):48-54-54

Given the recent Robert Wood Johnson Foundation report (Time to Act: Investing in the Health of Our Children and Communities, Robert Wood Johnson Foundation Commission to Build a Healthier America), it appears that the best way to reduce the cost of healthcare is not to invest in HIT but to invest in our communities so as to prevent disease before it happens.

As there are limited resources, we should prioritize interventions that have been proven to work, rather than those that we “think” will work. As most physicians are well aware, that vast majority of new interventions in healthcare usually, (after scientific studies), turn out to be either ineffective or dangerous. Clearly, evidence based medicine should be the standard used throughout the healthcare industry, and it should apply to HIT as well.

Unfortunately, the snowball is rolling downhill and is being pushed ever faster by the politically unstoppable HIT industry. While the HIT proponents espouse a commitment to better/cost effective healthcare, their actions demonstrate that their priority is to their own market share, control of HIT and the bottom line. I fear the battle is already lost.

Guest

It is interesting we never ask is their an ROI on using a phone in health care or even perhaps an exam table.. Wouldn’t it be cheaper to eliminate beds in hospitals? What study has ever shown they add any value? How about hospital administrators now that we are looking at ROI? (joking)

Like HealthIT they are simply the infrastructure that give you the ability to manage your practice and meet your patients needs.. Email and online questions are huge time savers for the patients and increase loyalty. Registries help you find patients who aren’t getting their needs met.. EHR’s allow you to quickly contact of patients when an RX is recalled.

The ability to see and then manage your cases at a population level. There will always be early adopters and laggards in any organizational change and you are correct public health actually is the best ROI we have but there is little profit to be made there so very little investment.

So perhaps it isn’t a battle and an unintended secondary consequence of big companies building market share will be a backbone of data that will give us all the information we need to know where to focus our efforts?

Guest
Jan 17, 2014

“Given the recent Robert Wood Johnson Foundation report (Time to Act: Investing in the Health of Our Children and Communities, Robert Wood Johnson Foundation Commission to Build a Healthier America), it appears that the best way to reduce the cost of healthcare is not to invest in HIT but to invest in our communities so as to prevent disease before it happens.”
__

Yeah, see http://theincidentaleconomist.com/wordpress/poverty-homelessness-and-the-social-determinants-of-health/

“Policy wonks have a terrible habit of focusing on insurance and health system design… This gives short shrift to the “social determinants” of health—upstream factors related to lifestyle, environment, and socioeconomic status—that cannot be corrected by medical interventions. We’re fond of highlighting how much more the United States spends on health services, but an idiosyncrasy that receives less attention is how much less we spend on other social services.”

Guest

Perhaps investing in healthIT will give you the data you need to show where we need to invest. Places like Theda Care rely on both – data to drive interventions at the personal social level and hotspotters also use data to drive change..

It is startling to see how much wider our ratio or medical vs social spending is verus most of the developed world and how much better their outcomes are.. Perhaps health IT can start to include those organizations as partners as well like they are experimenting with in Oregon via their Community Care Organizations (sort of medical home Plus social services)

Guest
bird
Jan 17, 2014

“Doctors and hospitals are using these tools to reduce mistakes and hospital readmissions, provide patients with more information that enable them to stay healthy, and allow for rewarding health care providers for delivering quality, not quantity, of care.”

Really? I would like a little more data on this one? I am skeptical when it comes to data given to me by drug companies concerning there drugs and i am skeptical when it comes to data regarding quality and cost when it come from HIT/govt sources.

Guest
LeoHolmMD
Jan 17, 2014

Agree that quote is completely unsubstantiated. Medical errors may be up, no one is measuring honestly. Of course EHR is moving forward, HHS sanctions are working.

Guest
Jan 18, 2014

Have errors ever been measured honestly? In any industry?

When you get down to it, are critics measurements any more honest?

Guest

In some health care systems like Group Health Cooperative (has had an EHR since 2006 and is owned by its members – employs 900 docs). they have the highest quality at the lowest cost in the region (puget sound health alliance community check-up). google them lots of published research – health affairs and elsewhere

The key wasn’t the EHR on its own but using healthIT to implement the medical home model.. Their payment structure (salaried docs) also allows up to 30% of all primary care encounters to happen via email or scheduled phone encounters.

None of their data goes to a drug company nor do they allow drug companies to deliver ads on the doctors screens like some of the “free” ehrs do.

Guest
bird
Jan 20, 2014

i have always been interested in how they do it, last i read was they have big subsidies and docs see less then 16 per day and make less then 200K. Not feasible in real work medicine unless you work at the VA

Guest
Jan 17, 2014

Checking my pulse. Breathing into paper bag. OK, I can write now.

Adoption of an EMR system centered around using a broken system in a more efficient manner, then reporting “success” by obvious measures (remote access, adoption rates) DOES NOT constitute proof that “meaningful use” works. Obviously doctors will adopt EMR more because we are holding a gun at their head (with “incentives” for adoptions followed by significant penalties for those who don’t).

Having stepped out of the problem-oriented, sickness rewarding, procedure promoting system into a world where healthy patients are better for business, I can say that EMR systems are very far from being good tools for improving care. They have been corrupted by the payment system and by the “meaningful use” criteria. Why do I say this? I tried using them outside of the payment system we are being crushed by and found very little left when there wasn’t need for note-generation, code submission, and meaningful use compliance. There is little left for real patient care. EMR systems have become a vehicle for communication between doctors and those who pay doctors (insurance companies and the government).

OK. I’ve got to pick up the paper bag again.

Guest
LeoHolmMD
Jan 17, 2014

If only we could stop all the “perverse incentives” that HHS continues to design, physicians might be able to improve care. Now that Godzilla has an iPad, things will certainly improve for those being crushed under his rampage. I cant wait to see how much ICD-10 and MU27 improve patient outcomes.

Guest
Jan 17, 2014

ICD-10 conversion alone is gonna be a CusterFluck.

Guest
Eric A, MD
Jan 18, 2014

Not all of us have opted out of our ethical obligation as doctors and opened up direct pay practices with 1000 patients and then toss bombs over the wall at the rest..

Your solution isn’t scalable but yes we all know it is good for your paycheck to no longer treat the most vulnerable in a practice. (how many medicare or medicaid patients do you see? what happened to the other 1000 in your old practice? who picked up the slack for you)

Honestly what EHR did you use? Most of us don’t find it difficult to type (we dictate the clinical encounter and it blows into the chart in a few hours) so it is just the patient instructions usually.

So please stop accusing anyone of being “Corrupted by the payment model” when we all know your goal was to increasing your income by opting out? (Why not go on salary instead like many of us at academic teaching facilities) or work at someplace like Kaiser – no external billing.

Head in a bag or in the sand?

Guest
Jan 18, 2014

Eric:
18 years in practice being paid for Medicare/Medicaid at their rates and doing far less for patients than I am now. As of the first year in my practice, I continue seeing both medicare and Medicaid patients, and I estimate I’ve saved the government at least $500,000 by giving patients access to me so they can get my input on whether or not they need to go to the ER, or as I have followed their daily weights, BP, and other vitals and have kept them out of the hospital. These are things I never had time to do because of the perverse payment model that “encourages” me to give better care by paying me less. In this past year, by the way, I am not yet anywhere near my salary when I worked in the hamster wheel of our payment system.

In my old practice I was only paid when people were sick. Now I am rewarded for an empty waiting room and healthy patients. In my old practice I was rewarded for patients with more serious problems. Now I am rewarded when I keep them small. In reality, the ratio of Medicare patients in my practice is fairly close to that in my old one. True, I have a smaller patient base for now, but I am working to grow it to where the two are comparable in size. Will I be ashamed if I make more money doing it this way? Why should I be? My patients choose to pay me to keep them well and can leave my practice any time they want (I require no commitment). I give them value they can’t find anywhere in the kind of practice I am accuse of “abandoning.” My goal was never to escape the old system; it was to build a legitimate alternative that no longer encouraged spending, sickness, and terrible customer service.d

Shame on me for that.

Guest
bird
Jan 17, 2014

just remember there is a big difference between “monitoring outcomes and improving outcomes” Monitoring outcomes are for someone elses benefit ie insurance etc and improving outcomes are for the patients benefit.

Guest
Jan 17, 2014

“Health IT experts brainstorm with ONC on clinical quality measures”

“Informaticists joined clinical quality experts in a brain storming session this week with new ONC chief Karen DeSalvo, exchanging ideas on developing the “next generation” of quality measures.

Charged with developing new e-clinical quality measures that can work in tandem with accountable care measures, the HIT Policy Committee’s Quality Measures Workgroup offered recommendations to Karen DeSalvo at her first policy meeting…”

http://www.healthcareitnews.com/news/health-it-experts-brainstorm-onc-clinical-quality-measures?topic=29

Should there be ANY outside 3rd party assessment mechanisms? Are “clinical quality measures” feeble (or irrelevant) proxies for health care “quality”?

Guest
pcb
Jan 17, 2014

“Should there be ANY outside 3rd party assessment mechanisms? Are “clinical quality measures” feeble (or irrelevant) proxies for health care “quality”?”

feeble, irrelevant, harmful they are.

Here’s some more info (from a recent THCB post) on what true quality is about:

http://thehealthcareblog.com/blog/2014/01/15/fee-for-service-vs-fee-for-serving/

Guest
Jan 17, 2014

Usability is a big part of the MU2 incentive program. Many EHR vendors are eager to achieve the “Complete EHR Ambulatory” certification from a certified ONC-ATCB, such as Drummond, or CCHIT, authorized to conduct complete and modular EHR testing and certification in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services.

To be able to obtain the ONC certification (and meaningful use funding for their clients) EHR vendors must follow a formal User Centered Design (UCD) process and perform and report summative usability tests of specific areas of their EHR product to an ONC-ATCB.

We have been in contact with a number of EHR vendors that have reached out to the certification bodies, and are currently preparing their submission. In preparing their submission they have discovered that they are missing the usability evaluation portion for the Safety-enhanced design criteria.

Usability testing cannot happen overnight, and it is important that you reach out to your usability partner early so that the required testing can be completed in time for your appointment with the ONC-ATCB.

We recommend that you allow at least 3-4 weeks in your submission timeline for the preparation, conducting and reporting of a summative usability test for EHR 2014 Certification.

Visit out blog site for info and discussion of Usability in Healthcare, http://www.HealthcareUsability.com

Guest
Peter1
Jan 17, 2014

Spending the HIT/EMR money to instead send public health nurses into impoverished areas would do more to reduce medical spending – I’m thinking.

This a people business, not a technology business.

Guest
Policywonk
Jan 17, 2014

“Doctors and hospitals are using these tools [EHRs] to reduce mistakes”

I laughed when I read this. Having been a victim of a medical error CAUSED by an electronic medical record system (the system would not allow the human nurses to administer pain meds to me after surgery), needless to say I am skeptical of this promise. But then, I’m just a study of n=1.

Guest
Jan 18, 2014

@policywonk

Details please. Without naming names, what happened?

This does not sound like a medical error, it sounds like a bad policy. I’m curious to know, how did this story end? Did the nurses refuse to provide pain meds? Were you sent home screaming in agony? Or was there simply a delay in treatment?

Guest
legacyflyer
Jan 17, 2014

Dr. DeSalvo is serving up the KoolAid.

Drink as much as you like!

Guest
Jan 18, 2014

Dr. DeSalvo is defending a program that was put in place by her predecessors. The notion of meaningful use may be a misguided one designed by academics who don’t understand the realities of the system, but that doesn’t make the goal of EHR adoption a bad one. You’re confusing poor execution with a poor goal.

If ONC wants to win this fight they will

A. take steps to prevent EHRs from being turned into high tech torture instruments by reducing unneeded bureaucracy (oxymoron alert: “digital paperwork”) Until they respond to critics, the attacks will only intensify. By saying nothing they will appear clueless and complicit. B. Open up the system to competition by making it possible for new competitors to enter, encouraging solutions to the design problems and sloppy work we’re seeing on the part of vendors. C. Develop safety and regulatory regimes that address some of the early problems we’re seeing. This is not optional. It is necessary. D. Work with Congress and the White house, to develop data portability and compatibility rules that allow information to flow freely. This is as important as net neutrality but completely misunderstood. E. Develop privacy rules that balance the needs of commerce, science and the consumer. Doing A-E will involve paying a political price. Otherwise we get what we pay for.

Guest
Jan 18, 2014

Nice comment. But

“designed by academics”
__

Not true.

Anyone familiar with the way this program was rolled out knows that there was heavy and sustained public input from all stakeholder segments at EVERY step along the way — including many, many practicing physicians.

“develop data portability and compatibility rules that allow information to flow freely”
__

One Comprehensive Data Dictionary Standard. Problem largely solved. From my REC blog:
__

One.Single.Core.Comphrehensive.Data.Dictionary.Standard

One. Then stand back and watch the Market Work Its Magic in terms of features, functionality, and usability. Let a Thousand RDBMS Schema and Workflow Logic Paths Bloom. Let a Thousand Certified Health IT Systems compete to survive. You need not specify by federal regulation any additional substantive “regulation” of the “means” for achieving the ends that we all agree are desirable and necessary. There are, after all, only three fundamental data types at issue: text (structured, e.g., ICD9, and unstructured, e,g., open-ended SOAP note narrative), numbers (integer and floating-point decimal), and images. All things above that are mere “representations” of the basic data (e.g., text lengths, datetime formats, logical, .tiffs, .jpegs etc). You can’t tell me that a world that can live with, e.g., 10,000 ICD-9 codes (going up soon by a factor of 5 or so with the migration to ICD-10) would melt into a puddle on the floor at the prospect of a standard data dictionary comprised of perhaps a similar number of metadata-standardized data elements spanning the gamut of administrative and clinical data definitions cutting across ambulatory and inpatient settings and the numerous medical specialties. We’re probably already a good bit of the way there given the certain overlap across systems, just not in any organized fashion.

Think about it.

Why don’t we do this? Well, no one wants to have to “re-map” their myriad proprietary RDBMS schema to link back to a single data hub dictionary standard. And, apparently the IT industry doesn’t come equipped with any lessons-learned rear view mirrors.

That’s pretty understandable, I have to admit. In the parlance, it goes to opaque data silos, “vendor lock,” etc. But, such is fundamentally anathema to efficient and accurate data interchange (the “interoperability” misnomer).

Yet, the alternative to a data dictionary standard is our old-news, frustratingly entrenched, Clunkitude-on-Steroids Nibble-Endlessly-Around-the-Edges Outside-In workaround — albeit one that keeps armies of Health IT geeks employed starting and putting out fires.

Money better spent on actual clinical care.

I’m still awaiting substantive pushback. There are conceptually really only two alternatives: [1] n-dimensional point-to-point data mapping, from EHR 1 to EHRs 2-n, or [2] a central data mapping/routing “hub,” into which EHRs 1-n send their data for translation for the receiving EHR.

Guest
Jan 18, 2014

CODA to that thought, also from my blog:
__

True interoperability requires a comprehensive data dictionary standard. Without it, information can become “garbled.” That is, altered during sequential transmissions. For example, what if you took these sentences and ran them through Google Translate from one language to another — say, [1] from English to Spanish, [2] then from Spanish to French, [3] then from French to German, [4] then from German to Greek, [5] then from Greek to Swedish, [6] then from Swedish to Portuguese, and [7] then back to English?

1. Verdadero interoperabilidad requiere un amplio diccionario de datos estándar. Sin ella, la información puede llegar a ser “confusa”. Esto es, alterado durante las transmisiones secuenciales. Por ejemplo, ¿qué pasa si usted tomó estas frases y las pasó por Google traducir de un idioma a otro – por ejemplo, del Inglés al Español, a continuación, del español al francés, después del francés al alemán, después del alemán al griego, luego del griego al sueco, luego del sueco al portugués, y luego de nuevo a Inglés?

2. Véritable interopérabilité requiert une vaste série de dictionnaire de données. Sans elle, l’information peut devenir “confus”. C’est, séquentielle modifié pendant la transmission. Par exemple, si vous avez pris ces mots et a traversé Google traduire d’une langue à l’autre – par exemple, de l’anglais à l’espagnol, puis l’espagnol vers le français, puis du français en allemand, puis de l’allemand vers grec , puis du grec au Suédois Suédois Portugais après, puis revenir à l’anglais?

3. Echte Interoperabilität erfordert eine breite Palette von Data-Dictionary. Ohne sie können die Informationen zu “verwirrt”. Dies wird sequenziell während der Übertragung verändert. Zum Beispiel, wenn Sie mir das Wort und ging durch Google übersetzen von einer Sprache in die andere – zum Beispiel aus dem Englischen ins Spanische und Spanisch in Französisch und von Französisch ins Deutsche und Deutsch auf Griechisch, dann aus dem Griechischen ins Schwedisch Portugiesisch nach dann wieder auf Englisch?

4. True διαλειτουργικότητα απαιτεί ένα ευρύ φάσμα του λεξικού δεδομένων. Χωρίς αυτά τα στοιχεία για να “σύγχυση”. Αυτό είναι διαδοχικά αλλαχτούν κατά τη μεταφορά. Για παράδειγμα, αν η λέξη και μου περπάτησε μέσα από το Google μετάφραση από τη μία γλώσσα στην άλλη – για παράδειγμα, από τα αγγλικά στα ισπανικά και ισπανικά στα γαλλικά και από Γαλλικά σε Γερμανικά και Γερμανικά σε Ελληνικά, στη συνέχεια, από τα ελληνικά στα Σουηδικά Πορτογαλικά σε συνέχεια πίσω στα Αγγλικά;
Verklig driftskompatibilitet kräver ett brett spektrum av data dictionary. Utan denna information till “förvirring.” Detta successivt förändras under transporten. Till exempel, om ordet och promenerade mig genom Google översättning från ett språk till ett annat – till exempel från engelska till spanska och spanska till franska och från franska till tyska och tyska till grekiska, sedan från grekiska till Svenska Portugisiska in sedan tillbaka till engelska?

5. Plena interoperabilidade exige uma ampla gama de dicionário de dados. Sem esta informação a “confusão”. Isso mudou gradualmente em trânsito. Por exemplo, se a palavra e me atravessou tradução do Google a partir de uma língua para outra – por exemplo, de Inglês para Espanhol e Espanhol para Francês e de Francês para Alemão e Alemão para o grego, depois do grego para o Português Sueco em seguida, de volta para Inglês?

6. Full interoperability requires a broad range of data dictionary. Without this information to “confusion.” This gradually changed in transit. For example, if the word and I went through Google translation from one language to another – for example, from English to Spanish and Spanish to French and from French to German and German to Greek, then from Greek to Portuguese Swedish in then back to English?

Ouch.

Pull up Google Translate, try it yourself. Pick additional languages. The results can often be quite amusing.

Guest
Jan 18, 2014

Missed numbering one above. Wish we had “edit” functionality.

“Verklig driftskompatibilitet kräver ett brett spektrum ”

Should have been #5

Guest
Joel Hassman, MD
Jan 18, 2014

Um, some clarification from you, sir, don’t you sell or represent EHR materials?

Guest
Jan 18, 2014

You could find out in a heartbeat. I blog about Health IT. Independently and with an unsparing critical eye. Google “REC Blog”

I am a statistician by training and long experience, not an IT geek.

But, in fairness, I DO own an EHR company.

http://ClinicMonkey.blogspot.com

:)

Guest
Joel Hassman, MD
Jan 18, 2014

well thank you! But, you have a personal gain here to some degree, eh? You could retort that I do too, but, it isn’t about profit or personal gain for me, but, making sure the health care process is allowed to provide care, not minimize cost to provide profit elsewhere outside the health care process.

Tell us your opinion about the part of bailing out the insurance industry as part of the bill not read until the last few months. Or, does that benefit you as well???

Guest
Jan 18, 2014

Joel, I was not a big fan of “AHIPcare” as I call it. See my post “Public Optional.”

http://bgladd.blogspot.com/2009/08/public-optional.html

“you have a personal gain here to some degree”

Not by distorting any conclusions I might come to in order to make a buck. No, not at all. My interest is in science.

Guest
Southern doc
Jan 18, 2014

“You’re confusing poor execution with a poor goal.”

But what is the goal? Most physicians have realized that it’s not better, more efficient medical care. Ir’s data collection, and in terms of my patients and my practice, that is a poor goal.

Do you think there is even the slimmest chance of A-E being achieved? The idea of ONC working to reduce the digital paperwork seems pretty fantastical. It seems much more likely that physicians will be stuck with these high tech ( actually pretty low tech by current standards) torture instruments for a long, long time.

Guest
Dr. Mike
Jan 17, 2014

Karen DeSalvo, MD, MPH, MSc. is the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.

That should’ve been at the beginning, not the end of the article, as a warning. Kinda like, “Abandon all hope of finding meaning, ye who read here.”

Guest
MD as HELL
Jan 18, 2014

The computer has been down since Tuesday night. Back to paper.

Ahhh! What a refreshing development. Giving verbal orders instead of CPOE. Writing orders on a chart anywhere in the department instead of going back to the computer at the far end of the dept. Dictating for a transcriptionist instead of Dragon which is really a bad system attached to Meditech.

Things are getting done much faster. Patient stays are shorter. Room assignments for admission are quicker and patients go to their rooms in a shorter period of time.

PACS, the best piece of technology for the clinician, still works.

What was it we were on track for with EHR? Whatever it is (was), it’s not patient care.

Guest
Joel Hassman, MD
Jan 18, 2014

Nice point here, what happens WHEN the system crashes? Does care freeze? Or do clinicians just turn to a dart board to make decisions?

Guest
MD as HELL
Jan 18, 2014

Us 30+ year docs just do what we have always done…provide great care. With no computer I have much more time for either the paitent or for more patients.

If what I do needs to be injected into a computer, someone else who cannot do what I do needs to put it in.

Guest
Jan 18, 2014

What happens when the power in your office goes out?

Do you demand access to your tinderbox and oil lamp?

No, you turn to your backup.

Do you have one?

Guest
Jan 18, 2014

Love it.

Guest
Joel Hassman, MD
Jan 18, 2014

Typical, have to buy more IT products because we have to expect these wonderful technological advancements are going to fail.

Gee, really refutes my earlier comment about HIT being today’s snake oil salesmen. Fits perfectly with working for Obummer.

Guest
Dr. Mike
Jan 18, 2014

What happens when the power in your office goes out?
Do you demand access to your tinderbox and oil lamp?
No, you turn to your backup.
Do you have one?

Wow – missed the point entirely. Why would you want a backup when things run so much better when it crashes?

Guest
Granpappy Yokum
Jan 18, 2014

Against incredibly stiff competition, the original post is the biggest piece of bullshit ever to show up on THCB.

Guest
Joel Hassman, MD
Jan 18, 2014

You haven’t read old posts by Maggie Mahar here, but I guess for current posts, you probably are correct. Oh, but the editors do reveal their agenda by including Rob Reich of The NY Slimes. You should catch the video of Newt Gingrich putting Reich in his place when Reich tried to pin the hopeless War on Poverty on the Republicans!

Guest
Peter1
Jan 19, 2014

“You should catch the video of Newt Gingrich putting Reich in his place when Reich tried to pin the hopeless War on Poverty on the Republicans!”

http://www.politifact.com/punditfact/statements/2013/dec/15/newt-gingrich/new-gingrich-says-poverty-problems-are-tied-democr/

“The poorest states, based on per capita income, are, from first to last: Mississippi, Arkansas, Tennessee, West Virginia, Louisiana, Montana, South Carolina, Kentucky, Alabama, and North Carolina. Of these, exactly half—Arkansas, Kentucky, Montana, North Carolina, and West Virginia—have Democratic governors and three have Democratic majorities in the lower house of their legislature…”

You’re an idiot.

Guest
Joel Hassman, MD
Jan 19, 2014

No, the point of the comment was the fact that most poverty is in major cities, fairly much all run by Democrat mayors and legislatures in those cities. For 50 years in many of those cities, Baltimore one I know well.

So, who is the idiot, one who cherry picks some stats, or, what are equally facts that show a party that talks a great game, but then sacrifices those they use for votes, for decades.

Oh, and my allegiance is to the public, neither party that rule America. Thanks for illustrating the partisan agenda I know is prevalent at these blog threads.

Guest
Peter1
Jan 20, 2014
Guest
Joel Hassman, MD
Jan 20, 2014

You have your resources and stats, P#1, and I have mine.

Let readers decide by researching all the info on their own who is honestly fighting for people who are struggling, and who is just putting on a show for votes each election year.

here is my last reply on this matter,

http://www.wbal.com/article/104941/12/violent-crime-in-baltimore-city-is-acceptable-what

It is what the Police Commissioner said last week, as readers can google “Baltimore City Commissioner and acceptance of murder & Baltimore Sun & 2014” and read more, just for here alone, a bastion of Democrat RULE for 50 years plus now.

Yeah, I am glad I am not in Mississippi, but I bet the Republican leadership there is a bit honest about what they will and won’t do; the Democrats, who by the way were AGAINST desegregation in the South up into the mid 1960s, well, they have suppressed that lie for decades longer, eh? Why did they quit that attitude, or perhaps the better question is, how did they reframe it and get the black vote?

The African American culture is so much improved with Barack Obama in office for 5 years now, eh? Those unemployment numbers alone for males are inspiring, true, P#1?

George Carlin said it best before he died, “the real rulers of this country don’t want an educated, informed public.” And all you apologists and defenders of said rulers continue the spin machine.

And the general public sucks it up!

Guest
legacyflyer
Jan 18, 2014

Bobby Gladd,

“Anyone familiar … this program … knows that there was heavy and sustained public input from all stakeholder segments … including many, many practicing physicians.”

I am surprised by this statement. Some questions:
– Were they really practicing, or were they academic docs and MD MPHs?
– Were they employed or did they accept money from the EHR companies?
– Was their input listened to/acted upon or were they ignored?

I am a practicing physician and I am familiar with the process of “giving input”. Sometimes your input actually makes a difference. Sometimes your input is ignored.

Guest
Jan 18, 2014

“Sometimes your input actually makes a difference. Sometimes your input is ignored.”
__

That’s just life in general.

The activities and entanglements of the various MDs who participated in the public input for the MU program ran the gamut. There’s a public record there.

Guest
Joel Hassman, MD
Jan 18, 2014

No one who is genuinely concerned about health care first and foremost supported the development of “let’s pass this bull, er, bill and find out what’s in it later” Obamacare. But, again, facts and transparency aren’t traits of this administration, eh?

Just like what the EHR/EMR is about too?