Category: Uncategorized

Next Steps for Interoperability

Dec 23, 2008• 9

By JOHN HALAMKA

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
similar features.

Should we wait for something better that has more interoperability?

Do
you drive a car? Why? It pollutes, costs a lot, and generally is not
very efficient in traffic. You’d be much better off asking Scotty to
beam you up via the transporter. Should we eliminate all cars, planes
and trains until the transporter is invented? The same can be said of
EHRs and health information exchange.

An EHR We Can All Agree On

Dec 23, 2008• 6

By Eric Novack

This is a modified post from one I wrote in Nov of 2007. I report this as a part owner of a small business whose costs are increasing every year while revenues are decreasing.

Therefore, I present to you all the new, improved EHR: Effective Hourly Rate.

With the absurdity of bailouts and the apparent transition from a constitutional republic to an elected monarchy, let’s see if the powers that be require us to ‘move from a 20^th century economy to a 21st century economy’— by making the change from the worthless concept of ‘wages and tips’ on the W-2 to the concept of ‘total compensation’.

Should I suspect that both parties will be unable, and unwilling, to make such a tiny change in reporting that would benefit the people of the United States with real, you know, information.

The EHR should be given to all employees of all companies. What it will consist of is simple: all of the total compensation divided into what that rate would be on an hourly basis.

Let’s give an example:

JSK on Health IT in 2009

Dec 23, 2008

By Matthew Holt

Savvy stuff, of course. Go read.

The Connected Medical Home: Health 2.0 Says “Hello” to the Medical Home Model

Dec 22, 2008• 21

By David Kibbe & Joe Kvedar

The concept of participatory medicine is taking hold, fueled, at least in part, by what we see as two complementary forces, these being the patient-centered medical home (PCMH) and Health 2.0. Health 2.0 is very much a grass roots phenomenon, dominated by a small but significant group of patients who are testing the hypothesis that the wisdom of the crowd can rival the wisdom of physicians. The PCMH is a concept, not new, but gaining tremendous traction in the provider sector now as a best-try effort by some providers to be truly patient centric in their approach. The two should be complementary and mutually self-supporting. One might even suggest their respective champions should be collaborating right now, when the scent of health reform is in the air in our nation’s capital. But they are not. Lets examine why and explore ways in which to create a natural bridge between these two concepts and their champions.

The medical home concept was first introduced by the American Academy of Pediatrics in the 1960s. But several factors are now converging to update this original concept for today’s health care environment. The growth in chronic illness, the emergence of new reimbursement models designed to improve quality and control costs (e.g. pay for performance), and the greater availability of monitoring and messaging technologies have providers, payers and patients taking a fresh look. This is a good thing, in that it is an effort by organized medicine and large corporations to get into the reform conversation.

But the aspects of the medical home that are getting the most airtime are largely focused on rounding out office staff, adding new roles that take work away from the physician so that the physician can tend to more patients, and taking a population view of the patient panel. This vision is idyllic, but several challenges suggest that as conceived it will be tough to get it out of the womb.

Prop 8 still reverberates, and bigotry is still with us

Dec 21, 2008• 20

By Matthew Holt

There’s a pretense from the ~~anti~~ (whoops!) pro-Prop 8 diehards that somehow this is not about them hating gay people. Rick Warren says that, as did Mike Huckerbee said when he ended his (clearly losing) conversation with John Stewart on The Daily Show. Frankly I’d be happier if they just came out and admitted it.

In a portrayal of one of the most unpleasant sounding families I’ve heard about in some time, the LA Times has a couple of juicy quotes. And the unpleasant family and their equally unpleasant pastors essentially come out and say it.

The Bible is very, very clear . . . that that kind of perversion will not get people into heaven," Abel said. "They’re fallen people, broken people, hurting people."

SNIP

Brooklyn and her family believe that gay activists have unfairly painted Proposition 8 supporters as "hate-mongers and bigots."

Hmm…who’s painting who?

But I’m always amazed that while caring so much about what happens in the afterlife, the fundamentalists among us are so determined to ruin other people’s lives in this space-time continuum.

CODA: The ridiculousness of the “resting on what the Bible says” position is of course best revealed in this classic, which ended up being used in a memorable scene in The West Wing.

Weighing in on the New FDA Commissioner

Dec 21, 2008• 1

By MERRILL GOOZNER

Patient
advocacy groups, most of them drug industry-funded, have asked
President-elect Barack Obama to appoint a Food and Drug Administration
commissioner who won’t cave in to pressure from lawmakers or the news
media, according to the Wall Street Journal.

It is news to me that the news media has much say about decisions at
FDA. There are reporters who highlight problems, especially safety
problems, in the nation’s food and drug supply. And there are reporters
who highlight every study suggesting the next miracle cure is just
around the corner. Large news organizations like the New York Times
have both. For every Gardiner Harris, there is a Gina Kolata. The news
media are megaphones. They are not, to use someone else’s phrase, the
decider.

Vioxx and Avandia didn’t come to light because of the press or angry
legislators on Capitol Hill. What consumers and patients, legislators
and the press learned about the lethal side effects of those drugs was
due to diligent researchers like Steve Nissen and Eric Topol and
courageous whistleblowers inside the FDA like David Graham. Ditto for
most of the other safety scandals that have plagued the agency in this
decade.

That said, patient advocates who are worried that the agency under a
more safety-conscious commissioner will somehow abandon the search for
faster cures should know that their views are well represented inside
the transition team. Josh Sharfstein, the Baltimore health
commissioner, formerly on Rep. Henry Waxman’s staff, who took up cause
of making pediatric cold medicines safer, may be leading the effort.
But his co-conveners include Greg Simon, who heads a group called . . .
da da . . . Faster Cures (not industry-funded, according to Simon). The
other team leader is attorney Alta Charo from the University of
Wisconsin, whose expertise is primarily in bioethics, not drug safety.

Cool Technology of the Week

Dec 20, 2008• 5

By John Halamka

In my experience, social networking applications gain marketshare by being first to innovate and then spreading virally.

I
was an early adopter of Facebook but delayed joining Twitter, a
microblog that enables me to post instant blog entries via SMS from my
Blackberry.

Over the past 60 days, I have seen an incredible
rise in Twitter use among my colleagues and have now joined the ranks
of folks who "Tweet" their blogs. You’ll find me at http://twitter.com/jhalamka

Here’s what I do to use Twitter :

Conservatives Need to be Part of Health Care Reform

Dec 20, 2008• 3

By Robert Laszewski

Stuart Butler, Vice President of Domestic Policy at the conservative Heritage Foundation has an op-ed in Thursday’s Washington Times, “Four Steps Can Heal Health Care.”He makes some very valuable points and proposes four steps toward reforming the health care system most people—liberals and conservatives —could agree on:

Making sure every working family has access to an affordable private health plan
that could include state-based default plans with agreed upon minimum
benefits and premiums subsidized through reinsurance pools that spread
any adverse risk over the broad private market.
Encouraging insurance exchanges not unlike those envisioned by Democrats but at the state level where Stuart sees these exchanges avoiding “endless Congressional micromanagement.”
Reforming the existing federal tax preferences for health insurance by capping the value of these tax breaks as a means to encourage more efficient plans and raise revenue to help pay for premium subsidies
Redesigning the Medicaid and SCHIP programs
by giving states the ability to streamline these programs and free-up
funds to expand the help the low-income people get for health
insurance—including vouchers to purchase private coverage.

California transplant surgeon acquitted

Dec 19, 2008• 1

By Sarah Arnquist Roozrokh

A jury acquitted a San Francisco transplant surgeon Thursday of criminal charges
related to his alleged actions during an attempted organ harvest nearly three years ago in a small town on California’s central coast.

In what’s thought to be the first case of its kind in the United States, prosecutors accused surgeon Hootan Roozrokh of ordering excessive amounts of painkillers to hasten the death of a potential organ donor.

The not-guilty verdict relieved the
transplant community, which feared the case would have chilling effects
on the public’s willingness to donate organs and surgeons’ willingness
to participate in the rarer type of donation done in this case, called
donation after cardiac death or DCD.

The Medicare Ponzi Scheme

Dec 19, 2008• 21

By Eric Novack

Just today, our next President spoke out against the largest investment swindle in US history. The alleged behavior of Bernard Madoff may have cost investors up to $50 billion.

“In the last few days, the alleged scandal at Madoff Investment Securities has reminded us yet again of how badly reform is needed when it comes to the rules and regulations that govern our markets. … And if the financial crisis has taught us anything, it’s that this failure of oversight and accountability doesn’t just harm the individuals involved, it has the potential to devastate our entire economy. That’s a failure we cannot afford.” — Barack Obama Dec. 18, 2008

What did Madoff do? He lured investors with big returns, and used the “profits” as a means to encourage additional investment by investors, while luring new ones.