Tag: EHR

An Open Letter to the New National Coordinator for Health IT – Untying HITECH’s Gordian Knot: Part 1

Apr 26, 2009• 19

By DAVID C. KIBBE & BRIAN KLEPPER

KibbeB&Wjpg Congratulations to David Blumenthal on being named National Coordinator for Health Information Technology (ONCHIT). Dr. Blumenthal will be the person most responsible for the rules and distribution of the American Recovery and Reinvestment Act’s (ARRA) nearly $20 billion allocation, referred to as HITECH, designated to support physician and hospital adoption of health information technologies that can improve care.

The job is fraught with difficulties, which Dr. Blumenthal has readily acknowledged. His recent New England Journal of Medicine (NEJM) Perspective, “Stimulating the Adoption of Health Information Technology,” is a concise, clear and honest appraisal of two of these challenges, namely how to interpret and act upon the key terms used in the legislation, “meaningful use” and “certified EHR technology.” Dr. Blumenthal gets to the heart of the matter by identifying the tasks on which the National Coordinator’s success will most depend, and which will foster the greatest controversy.

The country needs Dr. Blumenthal to succeed. The issues are complex and, with huge ideological and financial stakes involved, politically charged.

Should You Keep Your Own Medical Records?

Apr 26, 2009• 60

By RAHUL PARIKH, MD

Over the past 18 months, technology companies are jumping into one the biggest untapped frontiers in IMG_1534-leveled the economy: Health care.

Among the groups taking the leap are Microsoft and Google. Both have launched products called Personal Health Records over the past 18 months.

Both Microsoft Health Vault and Google Health, as they’re called, allow patients to store their own personal health histories online. Like all of their other apps, they are both free to consumers.

Here’s how they work:

1) You create an account (or sign in if you already have an msn or google account)

2) you enter and/or modify you health history and even upload data from devices like blood sugar meters.

3) You can pull records in from medical centers, doctors’ groups or insurers that have agreements with the PHR company.

In general, PHRs have received a lot of good press since they were launched. But a recent story form the Boston Globe has to make you wonder if they’re the right solution.

The story describes a gentlemen named Dave deBronkart (known to many of us who follow health IT as “e-patient Dave,”
a very tech-savvy guy with an interest in online health. Mr. deBronkart decided to transfer his medical records from a Boston hospital to Google Health. When he did, he was shocked to learn he was one very sick man.

According to his hospital records, he had metastatic cancer (he is kidney cancer suvivor), chronic lung disease and an aortic aneurysm.

Funny thing, though. He felt absolutely healthy.

An Open Letter to the New National Coordinator for Health IT: Part 2 – Opening the Aperture of Innovation

Apr 22, 2009• 21

By DAVID C. KIBBE & BRIAN KLEPPER

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One of the important decisions before Dr. Blumenthal and his colleagues at ONC and HHS is whether the national health information network will be one of closed appliances that bundle together proprietary hardware, software, and networking technology, or one of open data exchange and management platforms in which the component parts required to do medical computing can be assembled from different sources. If the former direction is chosen, power and control will be concentrated in the hands of a very few companies. If the latter, we could see an unprecedented burst of disruptive innovation as new products and services are developed to
create the next generation of e-health services in this country.

Separating the data from the devices and applications, and maintaining a certain degree of independence of both from the networks used for transmission, is far more than a technical quibble. It can determine the economics of technology in stunning ways.

Cats and dogs on film–Tullman, Leavitt, Bush

Apr 13, 2009• 2

By Matthew Holt

Anyone who’s been following along on THCB will realize that there’s a huge divide about whether the HITECH act should pay for and dictate a specified, certified type of EMR product use OR pay for data and outcomes and not specify how providers get there. The “cats” support certification and EMR mandating (more or less). The “dogs” think that existing EMRs are often counterproductive and that a mix of other data sources, processes, and patient outreach technologies will get us where we need to in terms of improving outcomes much quicker. And now there’s an extra $20 billion in the mix, just to add some fun.

Rather than write more about that at HIMSS this week I got detailed interviews on film with leading “cats”, Glen Tullman, CEO of Allscripts, and Mark Leavitt, Chair of CCHIT. And then a response from the always highly caffinated dog-lover Jonathan Bush, CEO of AthenaHealth. And no, they don’t agree with each other…..although there is some common ground.

If you’re at all interested in how Health IT & EMRs will play out, these three are must-sees. (I’d view them in the order I took them).

MH Interview with CCHIT head Mark Leavitt. (24:51)

MH Interview with AthenaHealth CEO Jon Bush (23:29)

A Self-Fulfilling Prophecy: The Continuity of Care Record Gains Ground As A Standard

Apr 10, 2009• 23

By BRIAN KLEPPER

Brian Klepper We live in a time of such great progress in so many arenas that, too often and without a second thought, we take significant advances for granted. But, now and then, we should catalog the steps forward, and then look backward to appreciate how these steps were made possible. They sprung from grand conceptions of possibilities and, then, the persistent focused toil that is required to bring ideas to useful fruition.

We could see this in a relatively quiet announcement this week at HIMSS 09. Microsoft unveiled its “Amalga Unified Intelligence System (UIS) 2009, the next generation release of the enterprise data aggregation platform that enables hospitals to unlock patient data stored in a wide range of systems and make it easily accessible to every authorized member of the team inside and beyond the hospital – including the patient – to help them drive real-time improvements in the quality, safety and efficiency of care delivery.”

Kaiser Permanente CEO George Halvorson on reform and life after IT

Apr 8, 2009• 22

By Matthew Holt

George Halvorson is the CEO of Kaiser Permanente, and the driving force behind both the HealthConnect EMR implementation and a national player in the health reform debate. I got to talk to him at HIMSS where he’d just finished giving the Monday keynote. We discussed KP HealthConnect, and the impact it’s having internally (good), why KP is making such a high-profile fuss about it (no, they’re not planning on expanding nationally or internationally), what AHIP and the insurers might face in the future (a choice between Canada and Switzerland), whether chronic care management can work without integration (he says yes), and whether the big guys will cast the smaller insurers adrift. You’ll have to watch for that answer.

Glen Tullman, CEO of Allscripts

Apr 7, 2009

By Matthew Holt

Glen Tullman, Allscripts CEO is one of the more charismatic, opinionated and politically connected players in health IT. I grabbed a few minutes with him at HIMSS 09 on how he’s positioned Allscripts to be a survivor in the coming consolidation, why he likes CCHIT (he’s a happy cat!), if SaaS (and AthenaHealth) is a real threat, and whether his buddy Barrack Obama (for whom he was on the original fundraising committe) is going to whisk him off to DC any time soon….

BIDMC, Google Health and the data transfer problem

Apr 1, 2009• 15

By Matthew Holt

e-Patient Dave on the real world issues of moving data around in health care. The punchline—claims-based data without dates is not very useful, which requires those using the aggregators (Google health et al) to do a whole lot more work.

A really, really important article. Go read.

For whom the HITECH Bill Tolls?

Mar 17, 2009• 18

By MARGALIT GUR-ARIE

As part of a sweeping effort to address the woes of the current US economy, the government has placed $19 billion on the table for HIT, aimed at containing healthcare costs and creating new jobs. The ultimate instruments for implementing this HITECH bill are America’s physicians and there is much confusion and apprehension in the physician community regarding the net effects of this bill on doctors in particular and healthcare in general. The HIT stimulus effort will not reach its stated objectives without voluntary adoption by our doctors. The government and the HIT community must find a way to draw physicians all over this country into the process of defining and implementing the stimulus package.

In very broad terms, interoperability standards will be defined, Electronic Health Records (EHR) technologies will certify compliance with the standards and physicians will be provided financial incentives to acquire, and meaningfully use, those EHR technologies. The assumptions are that use of these standardized EHRs will reduce costs by reducing medical errors, reducing duplication of tests, improving quality of care and encouraging evidence based clinical decisions. Jobs will be created as the EHRs are deployed across the nation. Experts are already at work “on the Hill”, in the White House, in the boardrooms of HITSP, NIST, CCHIT and other acronym organizations. Technology vendors are feverishly doing their part, from creating websites devoted to the HITECH bill, to making products available at Wal-Mart, to sudden revelations that HIT is really their main business. Everybody is actively involved in making this bill a success. Well, maybe not everybody.

Health Affairs is all about IT

Mar 10, 2009• 6

By Matthew Holt

Most of the Health care geek squad is in DC as I write, at a press conference conducted by Health Affairs which has an entire issue out today about IT in health care. Here’s the table of contents. And for those of you who don’t have a subscription, well here are four articles for free including those from David Brailer and John Halamka.

As you might guess KP’s HealthConnect is featured prominently with academic articles about the impact of its installation on physicians & the system (office visits down 25%) and patients (they love it).

There’s lots and lots more, including an article that makes stars of nerdy docs Jay Parkinson, Danny Sands and Ted Eytan—if “star” is the right word for this rarefied environment. (Oh, and somehow Bob Coffield got in there too!) My early tweetings on that one (which is the only one I’ve read so far) were captured and blogged by e-Patient Dave. Converting tweets into a blog post and making it make sense may be the new art form. Be warned that despite the words “Facebook & Twitter” in the title, this is about using Health 2.0 tools for patient to physician communication not about the social networking side of Health 2.0. Still I guess there’s room for another article in the next Health Affairs about that.