EHRs

Screen Shot 2014-06-19 at 11.04.40 AMACO, MSSP, BPCI, HIE, CQM, P4P, PCMH, yadda, yadda, yadda … The litany of acronyms describing changing P&D (excuse me, payment and delivery) models can sometimes numb the senses. But it would be unwise to allow the latest healthcare jargon to lull you into an AIC—an acronym-induced coma, for which I believe there is a new ICD-10 code—because the world might look a lot different when you snap out of it.

Little debate exists that the U.S. healthcare system needs to transition from turnstile medicine to value-based care, from a predominantly fee-for-service payment model to one that emphasizes accountability for population health. This, of course, is not a novel concept, so the biggest challenges relate to how we get there. As many skeptics have argued, the same dynamics have existed before – unsustainable healthcare costs and too little value for our money – so the Talmudic question arises: Why is this era different from all other eras?

  1. EHRs have changed the playing field completely
  2. Reporting of comparative performance is now embedded into the delivery system
  3. We understand the centrality of patient engagement
  4. Today’s incentives reward greater accountability and value

There are some fundamental differences compared to, for example, the environment that existed in the 1990s when some experts believed managed care would change the underlying cost structure of the health care system. A majority of providers now have implemented electronic health records (EHRs) and an increasing number are – or soon will be as a result of Stage 2 “Meaningful Use” – able to exchange clinical data across network and vendor boundaries. The expectation that quality measurement will be used for holding providers accountable has taken root and most health care organizations regularly submit standardized performance data to public and private payers, purchasers and independent accrediting bodies. Providers increasingly recognize that their success in population health management relates to their ability to effectively engage with their patients in collaborative relationships.

Continue reading “Be Prepared: Beyond the Alphabet Soup of Value-Based Care”

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My 87 year-old father broke his hip this past weekend.  He was in Michigan for a party for his 101 year-old sister, and fell as he tried to put away her wheelchair.  The good news is that he’s otherwise pretty healthy, so he should do fine.

Still, getting old sucks.

During the whole situation around his injury, surgery, and upcoming recovery, one thing became very clear: technology can really make things much easier:

  • I communicated with all of my siblings about what was going on and gave my “doctor’s perspective” to them via email.
  • I updated friends and other family members via Facebook.
  • I have used social media to communicate cousins about what is going to happen after he’s discharged from the hospital and coordinate our plans.

All in all, tech has really made things much easier.

This reality is in stark contrast to the recent headline I read on Medscape: “Doctors are Talking: EHRs Destroy the Patient Encounter.”  The article talks about the use of scribes (a clerical person in the exam room, not a pal of the Pharisee) to compensate for the inefficiencies of the computer in the exam room.  Physician reaction is predictable: most see electronic records as an intrusion of “big brother” into the exam room.

To me, the suggestion to use a scribe (increasing overhead by one FTE) to make the system profitable is ample evidence of EMR being anti-efficient.

Despite this, I continue to beat the drum for the use of technology as a positive force for health care improvement.  In fact, I think that an increased use of tech is needed to truly make care better.  Why do I do so, in face of the mounting frustrations of physicians with computerized records?  Am I wrong, or are they?

Neither.  The problem with electronic records is not with the tech itself, it is with the purpose of the medical record.  Records are not for patient care or communication, they are the goods doctors give to the payors in exchange for money.  They are the end-product of patient care, the product we sell.  Doctors aren’t paid to give care, they are paid to document it.  Electronic records simply make it so doctors can produce more documents in less time, complying with ever-increasingly complex rules for documentation.

Continue reading “Personal Tech”

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Three related columns in HealthcareITNews caught my attention recently.

The headlines pretty much say it all:

1. Satisfaction with HIE solutions drops.

2.  Vendors missing boat on HIE needs.

3.  CommonWell names 3 biggest HIE hurdles.

Over the years, I’ve written more than a few HealthBlog posts on the topic of health information exchange (HIE) and why I feel so strongly that most of the initiatives currently underway are missing their mark.

As I’ve stated before, during my worldwide travels I haven’t yet come across a country that has accomplished a truly national, interoperable, bi-directional, fully functional HIE.

Those few countries that come close are more like a large American city or small state in size, perhaps mirroring some of the moderately successful regional or state-wide exchanges currently operating in America. Over the years I’ve also watched implosions of national HIE attempts in several countries that have failed miserably despite billions of dollars being spent on the efforts.

Reading each of the articles referenced above, I once again reach the conclusion that what I have been evangelizing as a better model for HIEs still rings true.

Continue reading “Cracking the Code on Health Information Exchange. Is It Time to Wipe the Slate Clean and Start Anew?”

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The dude writes:

“I’m looking into a new EMR for our just incorporated small group practice. I’m diligently doing my Google  research. Frankly, I’m not  at all impressed by the quality of the information I’m finding out there.  Both the professional and the customer reviews I’m finding leave a lot to be desired.

The tone of many of the reviews I’m reading makes me wonder how reliable and objective they are.  A suspicious number of customer reviews are blandly positive, as if they were written by a corporate drone in a cubicle somewhere. They’re full of industry buzzwords and  praise: “Met all of my expectations ” and “is everything I could ask for in an EMR system.”

I’ve read enough patient and restaurant reviews online to know that reviews generally fall into two categories: angry customer and  worshipful.  The former almost always outnumber the latter by a margin of 4:1  But not here. Here its the other way around! The tone of the professional reviews also seems strangely subdued.

At least one popular review site (Software Advice) appears to take a direct commission from EMR vendors for each referral. They say this doesn’t impact them and that they’re objective, but this clearly biases them in my mind. What resources do people recommend?

And why doesn’t THCB run user reviews???

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Today, academic medicine and health policy research resemble the automobile industry of the early 20th century — a large number of small shops developing unique products at high cost with no one achieving significant economies of scale or scope.

Academics, medical centers, and innovators often work independently or in small groups, with unconnected health datasets that provide incomplete pictures of the health statuses and health care practices of Americans.

Health care data needs a “Henry Ford” moment to move from a realm of unconnected and unwieldy data to a world of connected and matched data with a common support for licensing, legal, and computing infrastructure. Physicians, researchers, and policymakers should be able to access linked databases of medical records, claims, vital statistics, surveys, and other demographic data.

To do this, the health care community must bring disparate health data together, maintaining the highest standards of security to protect confidential and sensitive data, and deal with the myriad legal issues associated with data acquisition, licensing, record matching, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Just as the Model-T revolutionized car production and, by extension, transit, the creation of smart health data enclaves will revolutionize care delivery, health policy, and health care research. We propose to facilitate these enclaves through a governance structure know as a digital rights manager (DRM).

The concept of a DRM is common in the entertainment (The American Society of Composers, Authors and Publishers or ASCAP would be an example) and legal industries.  If successful, DRMs would be a vital component of a data-enhanced health care industry.

Giving birth to change. The data enhanced health care industry is coming, but it needs a midwife.There has been explosive growth in the use of electronic medical records, electronic prescribing, and digital imaging by health care providers. Outside the physician’s office, disease registries, medical associations, insurers, government agencies, and laboratories have also been gathering digital pieces of information on the health status, care regimes, and health care costs of Americans.

However, little to none of these data have been integrated, and most remain siloed within provider groups, health plans, or government offices.

Continue reading “Could Digital Rights Management Solve Healthcare’s Data Crisis?”

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Matthew Holt
Founder & Publisher

John Irvine
Executive Editor

Jonathan Halvorson
Editor

Alex Epstein
Director of Digital Media

Munia Mitra, MD
Chief Medical Officer

Vikram Khanna
Editor-At-Large, Wellness

Joe Flower
Contributing Editor

Michael Millenson
Contributing Editor

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