Why Clinical Groupware May Be the Next Big Thing in Health IT
Clinical Groupware is intended for use by groups of people and not just
independent practitioners or individuals. It is not the same thing as
an electronic health record, but may share a number of features in
common with EHRs, such as e-Prescribing, decision support, and charting
of individual visits or encounters, both face-to-face and
virtual. Neither is Clinical Groupware bloated with extra features and
functions that most providers and patients don’t need and, with good
reason, don’t want to pay for.
Dear Mr. President, please
accept my heartfelt congratulations for recognizing health information
technology (IT) as one of the most promising targets for public
investment at this crucial moment.
As a (formerly practicing)
doctor, I’d diagnose our economy on the verge of a Code Blue, and our
healthcare system with a more chronic but equally threatening
condition. You’ve recognized how these two illnesses interrelate, with
spiraling healthcare costs damaging business competitiveness and job
losses threatening healthcare coverage. If I may offer a second
opinion, I concur 100% with your decision to apply the chest paddles
now, charged with $20 billion of investment.
Microsoft Health Vault’s leader Peter Neupert has a wonderful blog post
that makes two important points
really well. One message is that health
care reform is about the outcomes, not the technology. We should think
expansively about which technologies to invest in, based on the results
we want to get.
The other message is the economic stimulus package is different than
the reform effort. It is moving at hyper-speed through Congress, and it
may be difficult for staffers and other advisors to sort through and
incorporate what may seem like opposing Health IT views against a
backdrop of traditional ideology and extremely forceful special
A health care Marshall Plan — $50 Billion stimulus to get
electronic health records (EHRs) in every doctor’s hands or $50,000 to
each physician -– what an incredible marketing job. Detroit, are you listening? Stop whining to Congress that you need a
bailout. Tell them you want to be the new alternative energy Manhattan
Project, get the money, and then keep building SUVs and flying around
in corporate jets. To Congress, Daschle, and Obama, please don’t do this. Our industry,
health care, combines the worst of the Big Three automakers with the
worst of the hubris, dishonesty, and failure of the public trust of
Wall Street. Please do not bail us out.
An Open Letter to the Obama Health Team
It seems likely that the Obama administration and Congress will spend a
significant amount on health IT by attaching it as a first-order
priority to the fiscal stimulus package.The easy solution would be to spend most of the health IT funds on
EHRs. The EHR industry has made it easy by establishing a mechanism to
“certify” EHR products if they incorporate certain features and
The economic stimulus bills are a great step forward for health information
technology and medicine.
The two bills,
“HR1” and “S1,” continue to barrel down the legislative track and
continue being amended, but as currently written they create real
incentives for adopting certified electronic health records – upwards
of $40,000 per physician starting in 2011.
emphasizes rewarding designs that improve care and create a path for
certification of records with added functions, such as decision
support, order entry, connections to other systems and reporting on
quality measures. The bill focuses on implementation by tying the
physician bonuses to proven, effective use. The stimulus package also
formalizes the Office of the National Coordinator for Health
information Technology (ONC).
Today’s economic crisis has highlighted our need for breakthrough
improvements in the quality, safety and efficiency of health care. The
nation’s business competitiveness is threatened by growing health care
costs, while at the same time our citizens risk losing access to care
because of unemployment and the decreasing affordability of coverage.
Meanwhile, the quality variations and safety shortfalls in our care
system have been well documented.
There are some folks in Washington who have made statements that we
should delay investments in EHRs because current vendor products lack
the functionality needed to support a coordinated healthcare system.
Others have said that we lack the standards or security framework to
implement interoperability. Here are my thoughts.
Take a look at
the successes in Massachusetts and New York with commercial EHR
products. We’ve implemented eClinicalWorks, which includes decision
support, e-prescribing, administrative transactions with payers,
clinical summary sharing across the community, and quality measurement
(all the National Quality Forum high priority measures). It’s
web-based, using a service oriented architecture in a cloud computing
environment. By implementing this product at BIDMC, we’re meeting all
the payer guidelines for delivering appropriate, coordinated, high
value care. Vendor products from Epic, Allscripts, NextGen, GE,
Meditech, eMDs, MedSphere, and other CCHIT certified vendors have
Like the Institute of Medicine’s (IOM) 2001 counterpart report,
“Crossing the Quality Chasm,” a new report from the National Research
Council of the National Academies
is complex, full of new ideas assembled from multiple disciplines, and
is likely to have seminal importance in framing public policy from now
on. “Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions”
was released last month in draft, but there is so
much to comment on that I think it’s wise to begin with a quote from
the committee that sums up the central conclusion:
In Washington, Healthcare Information Technology policy planning is
accelerating at a pace that is faster than at any time in history (at
least my 30 years in healthcare IT). Over the past few days, the House Ways and Means Committee completed the Health Information Technology for Economic and Clinical Health Act (HITECH), as part of the American Economic Recovery and Reinvestment Plan. At the same time, the House Appropriations Committee has completed a bill
that is not meant to stand alone. It outlines $2 billion in funding for
the programs authorized by section 4301 of the Ways and Means Committee
I read with interest a recent article by my favorite health care reporter, Joe Conn, who has long time interest in the commercial success of the VistA Electronic Health Record system developed by the VA.
VistA has an incredible, well described impact on the clinical and
system peformance of the VA. Given its availability through the Freedom
of Information Act, it can and should seriously be considered as a
potential solution for government-based health care information
technology. I mean, why not? The several billion dollars already
invested, and the several billion dollars already wasted on
alternatives, would hopefully help the new administration come to their
senses to realize the development of a common platform for all
government related health IT would make good business sense.
Freenomics is a term coined in Silicon Valley to describe a free web
service paid for by other revenue sources (usually advertising) –
Google searches, Yahoo mail, Wiki lookups, YouTube videos are all
examples of free services paid for by other revenue sources. Applying
this business model to EMRs is groundbreaking. An ad-based EMR that
maintains a robust, professional, full-featured offering challenges how
we think of the EMR business.
By JOSEPH KVEDAR Connected health is the use of messaging and monitoring technologies to
bring care to where the patient is, when the patient needs it. This
approach has enormous opportunity to increase quality while lowering
the overall cost of care. Early returns on this approach are quite
encouraging. We are starting to weave connected health into the fabric
of our health care system, with good results.
The Technology Hype CycleWhy Bad Things Happen to Good Technologies
Fresh on the heels of my recent bar coding epiphany
comes another “unintended consequences” article. It turns out that the
whipsawing that accompanies the adoption of new technologies is
completely foreseeable, the “Why doesn’t this thing work right?” phase
is as predictable as the seasons. You can chart the course of virtually any
health information technology on the Hype Cycle curve. In the case of
computerized provider order entry (CPOE), the trigger was the
development of the technology in the 70s and 80s (the first CPOE system
was implemented at El Camino Hospital during Nixon’s presidency). The
Peak of Expectations was turbo-charged by the research in the 1990s by
Bates demonstrating its value in one highly unusual organization
(Brigham & Women’s Hospital), working with a homegrown system. The
apogee was the endorsement of CPOE by the Leapfrog Group in 2002.
A Transparent Health Record
Transparency, in the form of a complete, patient-centered and
accessible health record is a policy principle that can drive the next
wave of health care innovation. Investing exclusively in institutional
EHRs will further stifle efficiency, innovation and improvement.
Web-based clinical summaries (CCR+DICOM+PDF) that are available for
patient control foster patient-centered care, clinical collaboration,
and research, and must be included in health care reform if we are to
effectively improve provision of health care for patients and
Fact or Fiction: Electronic health records save money
Of all the initiatives endorsed by outgoing Secretary of Health Mike
Leavitt, few are likely to be met with as much agreement as the need for wider adoption of electronic
health records (EHR). While there is general agreement on the need for
this technology investment—both presidential campaigns included EHR in
their health platforms—the cost ramifications are still up for debate.
Will electronic health records reduce costs? There are compelling
reasons to answer both “yes” and “no.”
Google Health and the PHR: Do Consumers care?
Google Health’s unveiling last week and Microsoft’s HealthVault
launch last October are important milestones in the evolution of Health
2.0. Both of these heavyweights have the resources and potential to
improve the health consumer’s customer experience. What’s missing from all of these conversations is the elephant in
the room: Do consumers really care about having online personal health
This post is to help a non-technical audience
untangle some of the confusion regarding health data exchange
standards, and particularly come to a better understanding of the
similarities and differences between the Continuity of Care Record (CCR) standard and the CDA Continuity of Care Document
(CCD). But what I’m most interested in is getting beyond the
technical, political, or economic positions and interests of the
proponents of any particular standard to arrive at some principles that
demonstrate in plain language what we are trying to achieve by using
such standards in the first place.
— citizens, patients, caregivers, “consumers” — are early adopters of
social media in health,
compared to other industry stakeholders
including providers, plans, payers, and suppliers such as pharmas and
medical equipment companies. This is but one of many findings in my report, The Wisdom of Patients, which was published yesterday by the California Healthcare foundation.