Tag: EHR

One Day in the Life of a Meaningful User

Aug 17, 2010• 58

By MARGALIT GUR-ARIE

All the laws have been passed and all the final rulings have been published. In the spirit of the times, you went out and got yourself an EHR. You did your due diligence and sat through many hours of vendor demonstrations. In the end they all started to blend together, so you talked to friends and colleagues and accepted the Hospital’s offer to pay a big chunk of your EHR costs if you picked the one they wanted you to pick.

Your biller quit in disgust, but other than that the implementation was uneventful and the Hospital folks helped a lot. After several hiccups, your Medicare payments are coming in regularly now and your office is adjusting well to the new software. The documentation templates leave a lot to be desired, but you type well and when you find some free time you may take a stab at customizing them a bit. Here and there you run into bugs and a couple of times the EHR was unavailable for a good two to three hours. Not sure exactly why. Maybe it was the Internet that was unavailable.

Anyway, if all goes according to plan, you will be retiring in 10 years and your much younger partner will be bringing in someone who is probably in Medical School right now. Everything seems under control. But today is different…

Today is January 2nd, 2011 and you are driving to work. Today has to be meaningfully different and your first patient is waiting in Exam Room 1.Continue reading…

How About “Meaningful Exchange”?

Jul 23, 2010• 8

By JONATHAN BUSH

At last, we have received from Mt. Olympus those much awaited writings….the definition of “meaningful use”!

Oy.

I understand how we got here. I could put myself in the shoes of government decision-makers at every step of the way and see myself doing the same thing. “Step in and help … EMR adoption is too slow and costs are rising too high … the free market isn’t working, so step in.” I get that.

“Make the definitions hard and truly meaningful so that after we are thrown out of office, the social benefit of this program of ours will outlast the pure stimulus effect and create real social change in the health care market.” I get that too.

“Let hospital-owned practices into the mix. Even though we know they have the money, we want their leadership. Also, lots of docs are affiliated with hospitals.” This one was tough for me even though I have a lot of hospital clients that own practices and are growing that business.

“Delay a little to see if we can get more people to our higher standard.” Okay.Continue reading…

If HIT Plan A Doesn’t Work, What’s Plan B?

Jun 28, 2010• 42

By VINCE KURAITIS, JD, & DAVID KIBBE, MD

Pop quiz: Among early-stage companies that are successful, what percentage are successful with the initial business model with which they started (Plan A) vs. a secondary business model (Plan B)?

Harvard Business School Professor Clay Christensen studied this issue. He found that among successful companies, only 7% succeeded with their initial business model, while 93% evolved into a different business model.

So let’s take this finding and reexamine our human nature. In light of these statistics, what makes more sense:

Defending Plan A to your dying breath?
Assuming Plan A is probably flawed, and anticipating the need for Plan B without getting defensive?

We question many of the assumptions underlying HITECH Plan A. We also want to talk about the need and content for Plan B in a constructive way.Continue reading…

Plug Into Meaningful Use, Don’t Try to Build It

Jun 14, 2010• 8

By JONATHAN BUSH

Earlier this month I read in The New York Times (okay, someone read it to me), that hospitals and docs are saying “meaningful use” is just too much, too fast. I have to say, I would sympathize . . . if I didn’t know about the Internet!

If someone told me that the federal government was going to make (or at least ‘encourage’) everyone commute via hot-air balloon by 2011, I’d start to feel edgy right about now. How do you make or buy one? Who sells them? What if the wind blows the wrong way?

This would be my panic—unless I knew about a little-known hot-air balloon service that DEALS with all of it. Like a taxi service. You tell it where you want to go and when and then boom! a balloon shows up piloted, prepped and ready.

Such a quandary exists in the EMR market today. Everyone thinks the government rules mean that meaningfully using electronic health information actually means meaningfully using information you BUILD YOURSELF! They think you have to buy EMRs and servers and program them to meet government rules and then re-program them to meet rule changes. This would give me hives, even if I were a giant health system. Even systems with big budgets don’t have a comparative advantage in programming software!Continue reading…

Reflections from “Health 2.0 in the Doctor’s Office”

May 17, 2010• 3

By WILLIAM SELLMAN, MD, MBA

Will Sellman has commented on a couple of panels at Health 2.0 and been very prescient. Now he’s spent a bit of time to pen his reflections on what happened in Health 2.0 in the Doctor’s Office, which was held late last month in Florida. Will is at Alameda Family Physicians and is Director of Performance Improvement at Affinity Medical Group

Why is there innovation in this sphere?
What problems are we really trying to solve, and how?
Is there any party missing from the discussion?

These are but three of a series of questions I asked myself during and after the enlightening, and perhaps prescient, Health 2.0 conference that took place last weekend in Jacksonville, Florida. But these particular questions are inextricable from one another when applied to the overarching goal of the movement afoot that Health 2.0 supports. I endeavor here to not only answer these questions, but to communicate their relevance to those striving to maximize a fluid patient experience through technology.

While Health 2.0 is, in my mind, a nexus of technology utilization and process revision with respect to health care, it is also a phenomenon that must be considered within the context of the healthcare industry as a whole if it is to be usefully deployed.

Important: Input on consumer ‘Meaningful Use’ requested and required, Apr 20

Apr 15, 2010• 6

By MATTHEW HOLT

Josh Seidman, now running the meaningful use program at ONC, but formerly of the Center for Ix Therapy writes with an important request:

The Meaningful Use Workgroup of the Health IT Policy/federal advisory committee that advises ONC) is holding a hearing on Tuesday, April 20 in Washington (open to the public in person and virtually) on patient/family engagement. This testimony and other public input will be critically important in laying out the foundational steps for the evolution of Stages 2 & 3 definitions of MU for patient/family engagement.

In addition to the hearing itself, we are now inviting public input in advance of the hearing and follow-up to it on the FACA Blog, and we’d love to get as much thoughtful input as possible.

It goes without saying, but I’m going to say it again anyway, that Josh’s shepherding of the meaningful use criteria plus his earlier lobbying of the process from the outside HHS was very instrumental in making the consumer such a big part of phase 1 of the meaningful use criteria. However, you can be assured that there are lots of people wanting to put the brakes on any expansion of the consumer-facing meaningful use criteria.

We’ve just come back form Europe where the Danes showed us that all their citizens already have access to everything we’re talking about in stages 2–3 of meaningful use. So I believe that we should be shooting for the stars here.

BUT unless the Health 2.0 crowd, the ePatients, and the consumer gets into the commenting mix, there are no guarantees. So please take the opportunity to get involved virtually and in reality if you’re in DC next week.

Survey on PHRs: Interesting Data, Wrong Emphasis

Apr 13, 2010• 15

By MATTHEW HOLT

There’s a new study on PHR use out today (although it looks like Brian Ahier ignored the embargo in his good summary! Update–he didn’t, he just posted late PST so it looked like he did. Sorry Brian!) funded by CHCF and done by the (unknown to me) Lake Research Partners. You can follow the Twitter hashtag #phrpoll to see what Jane Sarasohn Kahn and various others think from the live press conference in DC. But I’ve read the data sheet which has the full poll responses, and here are my (admittedly very quick) take.

1) PHR use is apparently at 7% about double from the last time some one asked (Markle, a few years back). It’s still low and it’s an irrelevant number, instead what’s more interesting is where people say they get and they want to get their PHRs from, which leads to…

2) People say they want to get their PHRs predominantly from their doctors and hospitals. Next requested is their insurers. Independent companies (Google & Microsoft were stated in the questions) are only wanted by about 25%, same as employers (q23). Most who have PHRs which deliver data to them now get them from their insurer, although I suspect Kaiser is viewed as an insurer by many people which probably skews that answer.

Get Privacy Right, So We Can Move On Already

Apr 13, 2010• 10

By LYGEIA RICCARDI

A national survey released today by the California HealthCare Foundation shows that 66% of Americans believe we should address privacy worries, but not let them stop us from learning how technology can improve our health care. Amen.

This is particularly heartening news given that the same survey also documents for the first time real consumer benefits from the use of personal health records (PHRs). Seven percent of American now use PHRs, more than double the number in 2008. According to the survey, significant proportions of PHR users feel they know more about their health and health care, ask their doctors questions, feel connected to their doctor, and even take action to improve their health as a result of using a PHR.Continue reading…

Meaningful Use in the Real World — Is the Additional Administrative Burden Worth the Bonus for Small Practices?

Apr 11, 2010• 36

By DAVID C. KIBBE, MD

An article in the April 10, 2010 New York Times entitled “Doctors and Patients, Lost in Paperwork,” brought attention to what may be, in the near term, the Achilles heel of the plan to incentivize doctors for the “meaningful use of EHR technology.” The article cited a study published in the Archives of Internal Medicine this past February, which asked a large cohort of physicians in internal medicine training programs about the time they were spending on clerical work, most of which is documentation in patient charts, both paper and electronic. A stunningly large 67.9% of the respondents reported that they were spending “in excess of 4 hours daily” on documentation, while only 38.9% reported spending an equal amount of time in direct patient care.

Now, I am fully aware that practice in the inpatient, hospital setting is not the same as practice in the office, clinic, or ambulatory care environment. Patients tend to be sicker and require more consistent attention while in the hospital, which often means more documentation is necessary. However, the study and the NYT article point to a real world problem that crosses all medical care settings and impacts physicians and other professional providers of all kinds: the enormous burden of documentation, clerical work, and administrative forms completion that impedes real care giving and makes health care less and less efficient even as we add more and more technology.

Are We Adequately Securing Personal Health Information?

Apr 4, 2010• 14

By BRIAN KLEPPER and DAVID KIBBE, MD

In a discussion about electronic health records (EHRs) a couple weeks ago, one of the Human Resource team members at a prospective client said, “I don’t believe it’s possible to secure electronic health data. It’s always an accident waiting to happen.”

There is some truth to that. More and more, our Personal Health Information (PHI) is in electronic formats that allow it to be exchanged with professionals and organizations throughout the health care continuum. It is highly unlikely that each contact point has the protections to wrap that data up tightly, away from those who would exploit it.

Of course, PHI is among the richest examples of personal data, often with all the key ingredients prized by identify thieves: social security number, birthday, phone numbers, address, and even credit card information. This should give health care organizations considerable pause.

Then consider that, while paper charts contain the same information, electronic files often aggregate hundreds of thousands or even millions of records, information treasures troves for someone really focused on acquiring, mining and making use of the data.