Year: 2014

Ebola Offers a Teachable Moment For Health Information Technology

Oct 9, 2014• 19

By ADRIAN GROPPER, MD

The essence of controlling Ebola is surveillance. To accept surveillance, the population must trust the system responsible for surveillance. That simple fact is as true in Liberia as it is in the US. The problem is that health care surveillance has been privatized and interoperability is at the mercy of commerce.

Today I listened to the JASON Task Force meeting. The two hours were dedicated to a review of their report to be presented next week at a joint HIT Committee Meeting.

The draft report is well worth reading. Today’s discussion was almost exclusively on Recommendations 1 and 6. I can paraphrase the main theme of the discussion as “Interoperability moves at the speed of commerce and the commercial interests are not in any particular hurry – what can we do about it?”

Health information technology in the US is all about commerce. In a market that is wasting $1 Trillion per year in unwarranted and overpriced services, interoperability and transparency are a risk. Public health does not pay the bills for EHR vendors or their hospital customers.

Let’s Make Sure “Health” Encompasses “Care”

Oct 9, 2014• 23

By RISA LAVIZZO-MOUREY, MD

For the past several months the Robert Wood Johnson Foundation has been promoting a particular vision– of a Culture of Health in America, where everyone has the opportunity to live the healthiest life possible, no matter their income, or where they live, or work, or play.

With that vision in mind, geriatrician Dr. Leslie Kernisan asks an important question in her Oct 7 Health Care Blog post, “Why #CultureofHealth Doesn’t Work For Me.” She writes: “Is promoting a Culture of Health the same as promoting a Culture of Care? As a front-line clinician, they feel very different to me.”

For physicians treating the chronically ill and patients facing the end of life, good health might seem like a pipe dream. Kernisan and some of her commenters even wonder if the phrase “Culture of Health” could be misconstrued as “blaming the victim.”

UC Davis Pre-Medical & Pre-Health Professionals National Conference

Oct 9, 2014

By AMERICAN RESIDENT PROJECT

Open to students of any level, the conference is the largest pre-medical and pre-health professions gathering at an undergraduate institution, and is the only event of its kind, supporting URM students (underrepresented in medicine, as defined by the AAMC) interested in a career in medicine. More than 8,500 pre-medical and pre-health students from California and beyond will attend alongside deans of admissions from top medical, dental, public health, pharmacy and nursing schools.

The American Resident Project is hosting a panel at the UC Davis Pre-Medical & Pre-Health Professionals National Conference this coming Saturday, Octoer 11th. The panel will feature The American Resident Project Writing Fellows Dr. Marisa Camilon, Dr. Craig Chen and Dr. Elaine Khoong who will discuss what it’s really like to be a medical resident and will be moderated by WellPoint Chief Medical Officer and conference keynote speaker Dr. Sam Nussbaum.

http://www.americanresidentproject.com/

Why ACO Savings Aren’t About Location.

Oct 8, 2014• 21

By TRAVIS BROOME

One of the big questions since the inception of the Medicare Shared Savings Program has been whether the model would only work in regions with extremely high baseline costs. Farzad’s state-level analysis of earlier MSSP results suggested that ACOs in higher-cost areas were more likely to receive shared savings. It’s one of the questions that Bob Kocher and Farzad received in the wake of the op-ed on Rio Grande Valley Health Providers last week.

So we decided to dig into the data.

We’re still waiting for CMS to make baseline costs for ACOs – and the local areas they serve – public. But in the meantime, we linked each ACO to a Hospital Referral Region using the main ACO address provided by CMS – and took a look at the region’s per capita Medicare costs as a predictor of ACO success.

An Open Letter to the FTC on Hospitals and Providers

Oct 8, 2014• 20

By DAVID BALTO

The role of the United States’ antitrust laws are to ensure competition, not to prescribe or favor any particular organizational structure. Yet recent Federal Trade Commission (“FTC”) enforcement actions in the health care provider merger arena have done just that – dictated that if provider groups want to integrate, they can only do so through contractual means, not by merging their businesses. Everyone accepts the proposition that health care integration is essential to improving health care and bending the cost curve. Yet often the FTC has been a roadblock to provider consolidation arguing that any efficiencies can be achieved through separate contracting.[1] But this regulatory second guessing is inconsistent with sound health care and competition policy.

Health care provider consolidation poses some of the most challenging antitrust issues. Particularly challenging are efforts by hospitals to acquire or integrate with physician practices. There is clearly tremendous pressure from both the demand and supply side for greater integration between hospital and physicians. And arrangements between firms in a vertical relationship are treated solicitously by the antitrust laws, because they are typically procompetitive and efficient. Where competitive concerns arise from a merger or alliance, the FTC will ask if there are efficiencies from the relationship and, if so, whether there are less restrictive alternatives to achieve the efficiencies. If there is a less restrictive alternative, the FTC will claim the efficiencies should not be credited. So for example, if the FTC believes that contractual arrangements between doctors and hospitals can achieve comparable efficiencies, the FTC will reject the merging parties’ claimed efficiencies.

THCB Marketplace

Oct 8, 2014

By THCBist

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A Crowdsourced Campaign to Help Patients Access Their Medical History

Oct 6, 2014• 6

LINKED MD in MARKETPLACE

Patient-centric healthcare is all the talk — patients should be able to take an active role in their own healthcare. A big part of that role is the ability to access their entire medical history in one place digitally. Doesn’t that make sense? LinkedMD™ thinks so!

To find out more about the LinkedMD™ app, how you can be one of the first adopters of the new technology and to see our Kickstarter video, click here The LinkedMD Project.

Want to reach a daily audience of 5,000 + of health care industry observers? Post your announcement in THCB Marketplace. Find out how.

Why Health Outcomes Data Should Directly Feed Back To The Frontline

Oct 6, 2014• 3

By JOSHUA LIU, MD

The first time I met one of my staff physicians on Internal Medicine, he told our team he had just one rule:

“Our team must contact the patient’s family physician during the admission, inform him or her of the situation and plan for appropriate patient follow up after discharge.”

If you talk to any hospital physician or family doctor, they would almost certainly agree that this type of integration between hospital and community is essential for reducing avoidable ER visits, readmissions and improving other key health outcomes. Put more simply, it’s just good care.

And so you would think contacting a patient’s family doctor during a hospital admission would be the standard of care – but it’s not. There’s no rule or expectation; rather, it’s just something nice to do.

I’m not here to criticize health care providers who do or don’t act a certain way. I’m sure there are many best practices which some providers do that others don’t, and vice versa.

That said, I don’t think we can deny the harsh truth: It’s no longer about knowing what needs to be done to provide higher quality of care at a lower cost. We know enough answers to begin implementing.

Hospital at Center of Ebola Outbreak Reverses Its Story

Oct 6, 2014• 19

By THCBist

The Dallas hospital at the center of the Texas Ebola outbreak has changed its story.

Last Thursday, the hospital blamed a poorly designed electronic medical record for the failure to diagnose Duncan when he arrived at the hospital’s emergency room with symptoms consistent with Ebola, including a fever, stomach cramps and headache. According to the initial story, a badly designed electronic health record workflow made it difficult for doctors to see details of Duncan’s West African travel. Duncan was sent home. Very bad things happened as a result, as we all know by now.

On Friday, the hospital reversed itself without explanation.

The new statement:

Clarification: We would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient’s travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician’s workflow. There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event. [ Full text ]

In other words: The EMR didn’t do it.

When the EMR story came out Thursday, critics jumped all over it. It did sort of make sense to some people, especially people who aren’t fans of electronic medical records. The idea that a piece of key information could get lost in the maze of screens and pop ups and clicks in a complex medical record sounded plausible.

A lot of other people weren’t buying it:

The swiftness of the hasty retreat led some critics to speculate that Texas Health’s statement Thursday provoked the wrath of EPIC, the hospital’s EMR vendor. Industry critics pointed out that many major EMR vendors, EPIC among them, often include strongly worded clauses in contracts that forbids customers from talking publicly about their products.

After this story was posted, EPIC contacted THCB with a response via email. Company spokesman Shawn Kieseau wrote:

We have no gag clauses in our contracts. We had no legal input or participation in our root cause analysis discussions with Texas Health staff on this issue. Texas Health’s correction is appropriate given the facts in this situation.