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Stimulus bill offers docs big incentives for technology, but demands effective use

6a00d8341c909d53ef010537105c50970b-800wiThe 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.

The legislation 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).

Of the nearly $900-billion stimulus package, about $20 Billion would go to Health and Human Services, with $6 billion for the Office of the Secretary of Health and Human Services. Of that $6 billion, $2 billion would be for the Office of the National Coordinator (ONC) to support information technology.

The package also authorizes the Medicare Trust Fund to offer physicians financial incentives starting in 2011 to adopt and use certified electronic health records  (C-EHRs). The incentives – in the form of a 75 percent increase in Medicare Part B fees — could add up to more than $40,000 per physician over a five-year period. But the payments would come only after physicians prove they effectively used the EHRs. In essence, the government says it won’t pay for equipment that never gets used.  Physicians that haven’t adopted EHRs by 2016, will face financial penalties starting at 1% and escalating to 3% of Medicare Part B fees.

It looks as if there will be a new set of certification criteria for "qualified electronic health records" that meet the new features defined in the bill. Given the dollars involved, providers will want to adopt products that meet the bonus criteria. To do so, they must understand what is a “qualified record” and what it means to “effectively use” one.

The legislation defines a qualified electronic record as one that:

  • Includes patient demographic and clinical health information, such as medical history and problem lists
  • Has the capacity to provide clinical decision support; allow physician order entry; capture and query information relevant to health care quality; and exchange and integrate electronic health information with other sources.

The legislation leaves some of the ability to define meaningful use of the certified EHR up to the HHS regulators, but it requires the participating providers to submit clinical quality measures and be “connected for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination."

The bonuses for adoption and use break down to about $15,000 the first year and declining each year to about $2,000 in the fifth year, with a maximum payout of more than $40,000.

This economic stimulus bill offers real incentives for effective adoption of electronic systems designed to improve care. Physicians have meandered toward EHR adoption. It is inconclusive whether the slow uptake is due to reluctant physicians, lack of a business case for adoption of HIT, or insufficient system capabilities to improve care and save time.

Starting next year, we may finally get the answer. With the stimulus, the economy hopefully will get a significant jolt, and health care may reap a massive improvement boost as well.

Dr. Haughton brings over 20 years of experience in health care research and clinical application to DocSite as a physician, engineer and adolescent cancer survivor. As CEO and Chief Medical Officer, he is responsible for research initiatives and applications involving patient workflow and clinical care as well as corporate health. 

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  1. I agree with Raindrop Technique. Since there are types and types of doctors there will be types and types of opinions.
    I’ve read a post above about e-mails vs. phones that illustrated just that.

  2. The stimulus package/plan might do wonders for health care but unfortunately, looking the comments above, has been met with diverse opinions. At the end of the day, we just hope it will do better than harm.

  3. A doctor at a computer keyboard as part of his/her practice is a very expensive secretary, whether measured in lost opportunity or diluted productivity. Have your EMR, but not in real time. A doctor’s staff needs to be at the box, not the doctor. It also needs to advance the practice of the doctor or it will be a bomb.
    As far as the consumer, most patients are only occasional patients. Hopefully they have lives. Uopefully they have not turned their healthcare into their hobby. Hopefully it will not be addicting like reading this blog. They will rarely access this monster. Ultamately it must serve the physician.
    All information must be easy to locate. My hospital’s present system hides information from the doctor. The doc doesn’t even know it is there. The nurses enter all this stuff but do not talk to the doctor. They massage the hell out of the computer. Once it is “documented” they have served their master, but not the patient, not the doctor.
    And hopefully it will be filtered for errors, for there are many of those in patient records. Some how not everything should be logged as factual when it is in error, such as whether or not an appendix is out or a gallbladder. Allergies must be real, not imagined or embellished or speculated based on feared crossreativity, etc. We wrestle with our own accuracy at the local level. Let’s magnify that to a national level. Messy.

  4. The stimulus bill seems to be not only good for the economy, but good for health care, as well. Although the term ‘bonus’ has received a negative connotation throughout this whole process, an incentive for physicians is something that has been needed for much time. Graduating medical students have been raised and live in a generation in which e-mails are more frequent than letters and search engines trump the library in trying to find the latest research developments. Therefore, it is not only timely for this technology use; it is necessary. I agree with your view that this bill’s language in describing a “qualified record” and its “effective use” can leave a bit too much power in the hands of HHS regulators who determine this. By doing this, it offers more than enough room for those regulators to determine loopholes that will leave money out of the hands of physicians and into no one’s hands. Doing that would leave the money nowhere near stimulating the economy.
    That brings up another interesting point: Is $15,000 in the first year sufficient? For physicians just finishing their residency, who may decide to open their own practice, is that enough for them to implement an Electronic Health Record (EHR) system in the manner required by the government? Besides the few gray areas in this section of the bill, I do share the same opinion with you that this little change may benefit health care immensely, in the future. Not only will it allow for more cost-effective logs of treatment, with the possible review of these EHR’s, there may even be more successful remedies as a result.
    An interesting thing you mentioned was that $20 Billion of the $900-billion stimulus package will go towards Health and Human Services, while $6 billion of that will be going towards the Office of the Secretary of Health and Human Services. What will happen to the other $14 Billion of that $20 billion? Although the mention of a bonus is great, this does not help those new physicians who may not have the capital to employ the system, but may be penalized if they do not. While I completely agree that EHRs are necessary and will reduce the costs of health care dramatically, I do concur with you that I would like to see if a jolt in the economy would increase EHR use.

  5. The stimulus bill seems to be not only good for the economy, but good for health care, as well. Although the term ‘bonus’ has received a negative connotation throughout this whole process, an incentive for physicians is something that has been needed for much time. Graduating medical students have been raised and live in a generation in which e-mails are more frequent than letters and search engines trump the library in trying to find the latest research developments. Therefore, it is not only timely for this technology use; it is necessary. I agree with your view that this bill’s language in describing a “qualified record” and its “effective use” can leave a bit too much power in the hands of HHS regulators who determine this. By doing this, it offers more than enough room for those regulators to determine loopholes that will leave money out of the hands of physicians and into no one’s hands. Doing that would leave the funds nowhere near stimulating the economy.
    That brings up another interesting point: Is $15,000 in the first year sufficient? For physicians just finishing their residency, who may decide to open their own practice, is that enough for them to implement an Electronic Health Record (EHR) system in the manner required by the government? Besides the few gray areas in this section of the bill, I do share the same opinion with you that this little change may benefit health care immensely, in the future. Not only will it allow for more cost-effective logs of treatment, with the possible review of these EHRs, there may even be more successful remedies as a result.
    An interesting thing you mentioned was that $20 Billion of the $900-billion stimulus package will go towards Health and Human Services, while $6 billion of that will be going towards the Office of the Secretary of Health and Human Services. What will happen to the other $14 Billion of that $20 billion? Although the mention of a bonus is great, this does not help those new physicians who may not have the capital to employ the system, but may be penalized if they do not. While I completely agree that EHRs are necessary and will reduce the costs of health care dramatically, I do concur with you that I would like to see if a jolt in the economy would increase EHR use.

  6. Thanks for all the great comments. Many veins of thought: 1) Lots of Money in the Bill, 2) EMRs have been and will be a work in progress. 3) Seniors and others with chronic diseases need help with finances and care. 4) Primary care physicians need help with finances and care. 5) The bill is good. 6) The bill is bad.
    Since writing the post 2 weeks ago, the Stimulus bill has now passed. It does offer the $40K + bonus for “effective use” of a “qualified EHR” (DISTINCT FROM CURRENT DEFINITIONS OF EMRS / EHRS) – The bill specifically targets FIVE AREAs (which by the way are the evidence-based areas associated with HIT and care improvement): 1) Patient Info / History and Problem lists (Structured Data); 2)Clinical Decision Support. 3) Quality Reporting (performance measurement) 4) Ordering (including prescribing) 5) Interoperability (exchange and integrate with other sources).
    All of the above can ENHANCE workflow and health by saving time and improviing care. There is no push in the bill to completely change office workflow – there is a push to enhance patient care.
    The days of the $40K EMR are numbered. Here’s a prediction: most physicians will spend no more than $10K each over a 3 or 4 year period (2010 – 2013) to acquire and use a qualified system – leaving an increase of dollars flowing into primary care – a great stimulus. What do you think?
    – John Haughton MD, MS

  7. As some commenters have noted, there is a huge unacknowledged gulf between the reality (what is available) and the fantasy (what could be) when it comes to HIT and HIT standards. The large risk here is that the $20 B will be wasted on feeding the fantasy instead of supporting needed tranformation of what we really do have into what we really need.
    Best,
    Don

  8. 25% of all US Bankruptcies filed today are by senior citizens.
    Does anyone here think elder people are dying because they may not have enough money?
    Its not because seniors do not have an EHR. The issue is purely economics and the politics of redistributing wealth. I agree with the man above who wrote we need an EHR that truly is debugged and not something that runs on a Windows.
    And “Ok” to another good fellow! Mentioning computers as a means of communication, you are exactly correct without giving credit to Professor Licklider (MIT, 1960) – it was he who conceived the communication platform paradigm and ran some of the first trials discussing it as a “man-computer symbiosis”, “Enable men and computers to cooperate in making decisions and controlling complex situations without inflexible dependence on predetermined programs” .
    Consider what is at stake here; the health of our people and the cost of defragmenting a healthcare system that our people depend on. Is it worth the taxpayer money to create an EHR that is extensible, valuable, scalable, efficient, symbiotic and something that will last for decades? Considering what we’ve spent in Iraq or the Bank bailout I’d say one trillion dollars in development and implementation costs over 10 years is a great investment. How much is one life worth then multiply that times many millions. We can estimate the number of lives we can save with improvements in safety and quality and around that come up with a number but ask yourselves , how much is a life really worth?
    Lets try the cost of millions of years of evolution – IS THAT NUMBER BIG ENOUGH FOR YOU?
    Can I get an RFP on that?
    Why not shoot the moon on this one and build a national treasure? And why not turn the project over to DARPA. Real thought leadership and focused scientific discipline toward application is needed , not commercial hucksterism. We need work product not more horse crap and spy ware loaded products designed as operating systems with registry keys and com-ports left unprotected for the purpose of crowd control.
    Best regards,
    Cal
    25% of all US Bankruptcies filed today are by senior citizens.
    Does anyone here think elder people are dying because they may not have enough money?
    Its not because seniors do not have an EHR. The issue is purely economics and the politics of redistributing wealth. I agree with the man above who wrote we need an EHR that truly is debugged and not something that runs on a Windows.
    And “Ok” to another good fellow! Mentioning computers as a means of communication, you are exactly correct without giving credit to Professor Licklider (MIT, 1960) – it was he who conceived the communication platform paradigm and ran some of the first trials discussing it as a “man-computer symbiosis”, “Enable men and computers to cooperate in making decisions and controlling complex situations without inflexible dependence on predetermined programs” .
    Consider what is at stake here; the health of our people and the cost of defragmenting a healthcare system that our people depend on. Is it worth the taxpayer money to create an EHR that is extensible, valuable, scalable, efficient, symbiotic and something that will last for decades? Considering what we’ve spent in Iraq or the Bank bailout I’d say one trillion dollars in development and implementation costs over 10 years is a great investment. How much is one life worth then multiply that times many millions. We can estimate the number of lives we can save with improvements in safety and quality and around that come up with a number but ask yourselves , how much is a life really worth?
    Lets try the cost of millions of years of evolution – IS THAT NUMBER BIG ENOUGH FOR YOU?
    Can I get an RFP on that?
    Why not shoot the moon on this one and build a national treasure? And why not turn the project over to DARPA. Real thought leadership and focused scientific discipline toward application is needed , not commercial hucksterism. We need work product not more horse crap and spy ware loaded products designed as operating systems with registry keys and com-ports left unprotected for the purpose of crowd control.
    Best regards,
    Cal

  9. My husband was in the doctor’s lounge and got infected by the fear that they are going to “make us” get EHR. So I decided to spend some time actually reading the bill. That’s no small task and I can say that I have not read it completely and comprehensively. But at a glance it seems like a plan to study and promote the development of EHR with an incentive to apply it. Actually it seems to me like a nod to the fact that EHR are very much a work in progress but there needs to be some standardization and collaboration if they are going to come close to realizing their potential.
    The bill text is a monster at 680 pages. If you find the PDF bill text, in my copy the Health info tech part starts on p.434.
    Of course, execution is everything but I think this could be a positive thing.

  10. This stimulus package is NOT going to fix a healthcare system where patients are no longer responsible for their health. EMR is great but how is that really going to fix the entire healthcare system?
    They eat their hot dogs/burgers/fries and large coke then swallow down their statin and H2 blocker. When their glucose level is too high – they drink another coke and take their metformin and their anti-hypertensive meds.
    Money thrown on to force EMR is not really going to change how health care is delivered…And this package wants to do that as well.
    The least expensive way for patients to get care is prevention – exercise, vegetables, fruit, lean meat and dairy!

  11. I do think the economic stimulus/recovery plan will do wonders for health care around the nation. I just hope it will go on smoothly so positive results will be achieved.

  12. While a move to EMR is a necessity to reduce medical costs for the country, I don’t believe that providing purely financial incentives for individual doctors is going to bring about the desired change. So many doctors are already operating as small business owners so going through the selection, procurement, integration and ongoing maintenance of an EMR system is going to be both time consuming and expensive, much more so than the $40K in incentives.
    How many doctors are going to be a position to effectively wade through the sea of EMR systems to find one that will integrate as painlessly as possible with their clinical activities. By my judgment, not that many. At the same time, what happens when a particular system fails to meet expectations or fails outright; is the doctor paying someone to be on the phone to work through the technical issues? How much support is the doctor going to receive as just one small user of a product?
    In my mind, a far better solution and use of the funds would be for a centralized application commissioned by the federal government. Every doctor would have to pay to use it, but could at least be talking to an “interested party” when it did not work. On top of, it some economies of scale might be achieved with a centralized system.

  13. Just ask your friendly neighborhood physician how much he/she really has to pay for an EMR?
    Ask him/her if he/she can have someone pay 85% of the cost for him/her and then he/she gets these “grants” from the government to the tune of 40k over the next few years….
    Then ask them if they feel dirty when they lie in bed at night….

  14. Omitted in the “stimulus” bills is EHR using very secure, patient-carried EHR smart cards. They are well-proven, safe, easy to use, effective and in wide use in the EU. The French card system gets especially high marks.
    But why ask our EU friends for a proven system when we can waste $20B screwing around for years with web-based systems that are so insecure that Americans will never agree to their use?
    Privacy fears drove the EU to adopt EHR smart card systems. As said, they’re ultrA-secure and the PATIENT control them.

  15. A lot of notes being posted — but don’t forget to post a note to your senator or representative

  16. This bill is the first nail in the coffin of solo and small group primary care offices. It also will send a message to students NOT to go into medicine, just when we will be faced with a severe physician shortange in the next 5-10 years.
    EMRs do not save money, increase quality, or decrease errors. In fact, they kill workflow, are costly to impliment, and bring in new data-entry errors.
    Al

  17. Didn’t mean to say that email will solve all the problems, but it’ll make it easier to communicate with half your patients who are computer literate, giving you more time with the others. Every bit helps.

  18. I would LOVE to replace phone calls to my patients with email. Unfortunately, nearly half my patients do not have computers. The highly tech-literate blog readers of the world need to remember that a lot of poor and/or older patients would be completely left out of these changes. That’s a lot of patients.

  19. Its interesting that physicians still mostly use the phone to communicate with patients, instead of email, which is more efficient, probably more effective, and cost saving. One problem has been that ordinary email is not secure, but there are on line communication services such as http://www.housedoc.us, that are HIPAA compliant, free and easy to use. The cost savings could be considerable.

  20. I am pro an EMR stimulus package but I have concerns what the end goal is. If it is to ask offices (especially primary care) to manage additional data then the net impact of 40k will be a loss. As anyone who is using their emr can testify the idea of transmitting data to ncqa poses challenges that will require additional staffing and project oversight. Will the money for an EMR cover these costs? Probably not and that will leave me in a situation that taxes my already overburdened office.
    Perhaps before we talk stimulus packages towards EMR purchases we should fix the primary care reimbursement issue or we might very well end up pushing more primary care offices out of business.

  21. Seems like a waste of tax money. If EMRs were reliable, user-friendly, improved (or at least did not impair) workflow and improved quality of care, the government would not have to offer me a carrot or beat me with a stick to get me to use them. I have owned a PC for 20 years — I simply know what works!

  22. As many others have pointed out technology is only really a communication and reporting tool and not the goal itself. Many people have long advocated for CMS to use its purchasing power to ensure that people on medicare and medicaid receive patient centered, high quality, effective care. Hopefully they can combine this with the medical home model(based on episodes of care) instead of the perverse procedure based system we currently have but that is another topic.
    Do systems that have EMR’s already provide higher quality more cost effective care (like the VA) and is technology the reason they do or is an EMR simply reflecting something deeper (resources, owning both the patient and the insurance side of the house which allows the organization doing the EMR implementation to capture savings vs the insurance companies)in those systems?
    One critical question is what is the goal? How do we provide patients/consumers and providers with high value data with the least disruption to their workflow? What data is already captured that they would be able to make clinical decisions on? Labs? imagining? RX’s? Demographics?
    I recommend a step-wise approach to change based on a health record banking model and high value data streams that already exist and are easy to capture and share. For example.
    1) leverage e-prescribing by feeding back the information to providers to let them know it was filled, Allow break the glass access so every doc in every ER could quickly see a patients current med list (with access and audit trails) 2) Lab results – both the patient and providers would see them (just as you see a credit card transaction in both the store, visa and your own account) and include patients in clinical alerts 3) Imaging – higher bandwidth requirements so perhaps you would start with the radiologists results first 4) Master Problem list and 5) Demographic information
    All of this information could also be kept both online in scattered data marts or on smart card so that the patient simply swipe the card and give a provider access to make deposits and with-drawls of information from their account.
    Round 2 – Web 2.0 Empower the patients with mobile apps since 95% of all care happens at home. For example. Include a mobile app for patients to pop up their meds and allow them to track if they take them. Integrate at home monitoring device results (glucose, BP, nike running ) into a patient section of the wellness record. Add quality measures that are customized to each patient.
    None of this requires a certified “EMR” nor even a “PHR” and encourages the private sector to participate and allows providers to engage for low or no coast. (similar to getting a merchants account with Visa using a federated model) simply the rules to exchange the data and portals that allow you to aggregate it on the fly.
    Certification for the full fledged EMR”s is important even critical but rather then creating complex interface rules and engines that require everyone’s EMR to have everything start with a distributed model of information for the 80% of docs who don’t have one yet.
    It even comes with a business model (pay per transaction) and allows patients full access to their information (like your bank statement). Sorry I over-generalized but this is a blog not a white-paper.
    S Reynolds, A4H

  23. As much as the Healthcare Blog and Health 2.o dislike the EMR “mandate” coming out of Congress (as I do), I have a hard time accepting the hypocrisy.
    What appeared to start as a venue to share ideas (THCB) has morphed into a way for select individuals to garner consulting gigs. What makes the “owner” – Matt Holt, etc above the frey, take your shots at Washington, big EMR vendors, however until you offer a concrete solution that saves monies, improves outcomes and delivers what you espouse you are no better than the present vendors.
    To utilize the guise of Health 2.0 as a way to generate income based on the fact that you have consulted in this area but not actually practiced anything makes me and others suspect as to what your true motivations are.
    Sorry, Matt and company but not all of us are that gullible and do work of a living int he trenches not a consultant parasites.

  24. To control the pain we must first go to the doctor because we can give him what is appropriate and what we need, such as oxycodone that I take is a medicine used to counter the pain of my back pain for years, but This was the prescribing doctor, I take it in moderation because I read in findrxonline.com is a pill that causes anxiety, and if you can not control it can affect your nervous system, we must always know what the physician and thus avoid setbacks …

  25. To begin with, I deeply respect John Haughton, M.D. and his groundbreaking work to empower his fellow physicians by educating them in the use of EMRs and disease registries (see docsite.com for details). I have interviewed him, and he makes solid sense to me.
    Still, I would like to respectfully point out that the stimulus package offers “negative” as well as “positive” incentives for doctors and hospitals, though OMB (Office of Management and Budget) may regard these incentive as positive for government.
    In his article in the February 1 New York Times Sunday Magazine, David Leonardt, a Times economic writer, spells out his concept of the agenda behind the Obama administration’s $20 billion for subsidizing electronic medical records to the tune of $15,000 per doctors initially up to a maximum of $40,000 for doctors using qualified and certified EMRs.
    My reading of the Leonardt article and his appraisal of the views of Peter Orzag, new head of OMB, and what Obama and his health care teams is,
    One, initially investing heavily in EMRs for doctors and hospitals, to the tune of $15,000 per doctor up to a maximum of $40,000 over the next few years.
    Two, within five years, restricting Medicare payments only to those doctors and hospitals who have EMRs,
    Three, using Medicare-acquired data, to pay doctors and hospitals, at the prevailing rates in the least expensive part of the U.S., e.g. the same in urban centers as rural America.
    Four, stopping or reducing Medicare payments for expensive treatments that don’t work, as determined by a federal comparative effectiveness research institute using EMR-generated Medicare data.
    I may be over-reading or overstating the government’s EMR strategy, and I would be glad to be corrected, but I don’t think so. Data-mongers and policy wonks in government may regard this IT agenda as “positive” for themselves, hospitals, and doctors, because it potentially contains costs, rationalizes care, and stamps out “uwarranted” regional variations.
    But most doctors and hospitals will receive this agenda as “positive.”
    Among other things, it ignores socioeconomic differences between big cities, with their teeming, diversified, and often health illiterate populations, and the northern tier of states, which tends to have a more homogeneous and more educated populations, and it has the government, through its plans for a Comparative Effectiveness Comparative Research Institute, or CERC, likely to be pronounced “CURSE” by doctors, dictating what works and doesn’t work without any real knowledge of what’s transpiring between doctors and patients on the ground.
    I may be wrong,always a strong possibility, about the government’s EMR agenda, or what Leonardt imagines it to be, but I think it is unworkable. For more of my thoughts on this, see medinnovationblog.blogspot.com “The Big Fix,” February 2.

  26. I am a proponent of EMR/EHR. However, how did we come up with this 20 biliion dollar figure? This reminds me of being a homeowner and asking several vendors for bids on work. Some contractors gave me written estimates which broke down the costs so I sould see how much time theyt needed, materials, permits etc.
    Others, just threw out a figure, always rounded off to say a thousand or five thousand for example. I would ask by what freak of math did all of your estimates come out so nice and even instead of say 879 or 4789 or some other researched figure.
    In other words, is 20 billion being pulled out os someone’s rear or is there an actual breakdown of what this will cost in manhours, capital equipment, supplies and the final install?
    Is this too much to ask?
    For that matter, what other countries ahve a system that can be just purchased turn key which has already been proofed and used by consumers and doctors?
    Finally, would we be more comfortable just asking a user friendly company in IT like Apple to see what they can offer instead of a Windows based system which we know will have bugs and need V2.0 before the final install?

  27. There are many reasons why physicians in general (excluding pathologists, radiologists, intensivists, anesthesiologists,large multi-specialty groups)) have not yet embraced healthcare information technology. I refer interested readers to http://www.medscape.com/viewarticle/570116 for Blake Lesselroth’s unique take on the barriers to full clinician adoption of HIT and how to overcome some of them.
    George D Lundberg MD, Former Editor in Chief, The Medscape Journal of Medicine and eMedicine (and JAMA).

  28. Technology in the health care industry can make everyone’s live better and more efficient.

  29. Sean -Great comment
    “Enhancing the doctor-patient relationship, the foundation of delivering effective care, has rarely been the focus of health IT. Neither has been capturing and analyzing data that can have a positive impact on clinical outcomes.”
    Here’s our vantage point – better and easier care is the answer. If it saves time and improves care people will adopt the system.
    Yes, interoperable, intelligent integrated systems make it a reality, and in fact are the types of systems that have care improvement evidence supporting their use.
    The Stimulus package details push hard in that direction, incenting use of systems with features shown to improve healthcare. Execution will be the key – the details of the certification process will dictate how quickly we move in the care improvement direction.
    John
    (by disclosure and background, my day to day work is at DocSite, where we offer a web-native point of care decision support system that works in paper and electronic offices with or without an EMR and offers four main functions: Decision support, Performance Reporting, Recall / Outreach (Safety net lists) and Team Communication through information exchange.)

  30. My colleagues from Univerity of Pennsylvania(Dr.Ross Koppel) and Drexel University (Dr.Scot Silverstein) are pioneers in publishing on effective use of HIT systems and downsides of NOT doing so.
    I am a daily user of the largest HIT system in the world = DoD’s AHLTA. In it’s current form it is a disaster of monumental proportions which the DoD readily admits and is trying desperately to rectify.
    Dr. Rick Lippin
    Southampton,Pa

  31. The market is saturated with hundreds of EMR/EHR/PHR systems. Most of them are inefficient systems that disrupt physicians’ work flow, adding little value to delivering better care. This is more than mere lack of insight on behalf of software engineers and points to a more important barrier to smart health IT design where the needs and changing requirements of third parties (i.e. insurance companies) often supersede that of patients and doctors. As a result, most health IT systems end up being clunky billing machines, focusing mostly on capturing data that satisfy the needs of payers and regulators, not providers and patients. Enhancing the doctor-patient relationship, the foundation of delivering effective care, has rarely been the focus of health IT. Neither has been capturing and analyzing data that can have a positive impact on clinical outcomes.
    I think practical health IT should be Intelligent, Integrated, and Interoperable. Intelligently designed systems prioritize the needs of patients and providers. An electronic platform with well-integrated features ensures a consistent and smooth operator experience. Interoperability stands as a prerequisite to deriving real societal value from health IT and facilitates health information exchange among networks of patients and providers.
    I call this the three “eyes” of practical health IT design.

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