Tag: HIT

Errors of Omission

Jul 22, 2011• 17

By ANONYMOUS MD

I am a rural Family Physician who has been in solo practice for more than 22 years. I am neither a technophobe nor an information technology Luddite. I have been using electronic prescribing for over 6 years and am in the market for an EHR that is net-based, scalable, interoperable and linked to a nationwide patient database.

While I wait, over the years I am seeing more and more patient care that is less co-ordinated and even thwarted by the very health information technology (HIT) that is supposed to increase efficiency. In my opinion, this is leading to decreased information transfer that is wasting precious time and putting patients at risk with errors of omission.

I will give anecdotal and real examples of HIT run amok that I suspect are more common than generally appreciated. Alarmed by the lack of awareness of the potential frequency of these errors, I am writing this hoping that the blogosphere can somehow counter the momentum of an all-powerful HIT cerebrosphere.

1. e-Prescribing (ERX): While mandated alerts about potential drug interactions in this software is often life-saving, it can also be life impairing. There are two reasons for this: 1) at point of care, the warnings are just too darn sensitive and I’m being conditioned to ignore 90 percent of them. I am afraid that this will cause me to click the “ignore” pop-up at the wrong time. For instance, doxycycline and Dilantin have an interaction and a prescription of one in the presence in the other always prompts a warning. When I researched this, I found the plasma concentration of doxycycline is decreased by a clinically negligible amount. 2) at the pharmacy window, the warnings can override physician judgment. A colleague of mine described to me how he prescribed a fluoroquinolone antibiotic to a patient on Coumadin and, aware that there was an interaction, ordered the appropriate follow up testing and dosage modifications. The pharmacist not only refused to fill the prescription, they also did not notify him. Instead, he asked the patient to call the doctor. Two days later the patient was admitted to an ICU with life-threatening sepsis. In both cases, needed prescriptions were omitted.

Interpreting the Draft Insurance Exchange Regs

Jul 19, 2011• 1

By ROGER COLLIER

The Obama administration’s progress—with just a few stumbles—towards health care reform implementation took another major step this past week. In a carefully chosen small business setting—a Washington DC hardware store—HHS Secretary Kathleen Sibelius released draft regulations for the health benefit exchanges called for by the Affordable Care Act.

The exchanges, required to be established for every state, are predicted to serve some 24 million consumers by 2019 (provided that the ACA is neither significantly changed nor found unconstitutional), with the majority receiving federal subsidies to help pay for coverage. So far, a dozen states have enacted bills to create exchanges, while in nine states such legislation has failed.

Responding to strident opposition to the ACA requirements from conservatives and from many business owners, Secretary Sibelius emphasized the flexibility of the draft regulations, which would allow considerable variation among states, give participating businesses considerable latitude in coverage selection, and interpret states’ readiness for exchange operation more loosely than implied by the ACA itself. In describing the intent of the exchanges, she stated that they will “offer Americans competition, choice, and clout.”

Well, maybe, depending on one’s interpretation of the draft regs.

So Many EHRs. So Expensive.

Jul 15, 2011• 15

By MARGALIT GUR-ARIE

There are currently 386 software packages certified by an ONC approved certification body as ambulatory Complete EHRs, which means that the software should allow the user to fulfill all Meaningful Use requirements and possibly qualify the proud owner for all sorts of CMS incentives. There are 204 more software packages which are certified as ambulatory EHR Modules, and a proper combination of these packages could result in a Complete product, which if used appropriately could lead to the same fortuitous results.

There are 423 distinct manufacturers of ambulatory EHRs and EHR modules on the federal list. Most are software vendors, or wannabe software vendors, but a fair amount are facilities that developed an EHR for in-house use and had it certified. These are not really available for purchase. A very large number of listed vendors offer niche products for distinct specialties, such as optometry, oncology, behavioral health, etc. All that said, there is still an inordinate number of EHR “choices”, or so the story goes. By comparison, since we all love car analogies, there are 1,310 individual trims currently sold in the U.S., and around50 car manufacturers overall. If you ask an average citizen on the street to name their top 10 cars, chances are that you will get a Honda Accord, Toyota Camry, a Caddie, maybe a Ford truck, a Beemer, a Porsche and perhaps even a Beetle. You are not likely to hear anything about a Tesla or a Coda and rarely will anybody mention a Scion. Automotive modules are not widely sold for home assembly, so there is no parallel lesson there. One way or another, we manage to find our way when it comes to automobiles.

HIT Trends Summary for June 2011

Jul 8, 2011

By MICHAEL LAKE

This is a summary of the HIT Trends report for June 2011. You can get the current issue or subscribe here.

EMRs in the cloud. There is additional validation this month by MarketsandMarkets that the EMR market has heated with compound annual growth rates over the next couple of years pegged at nearly 20%. Analysts report that EMRs delivered over the Internet are a fast growing segment appealing to small practices. One new example is the Allscripts’ MyWay EMR is being offered by Costco in a hosted version for as low at $499 per physician per month. This could be an emerging market price now-a-days for a low-end hosted or web-based solution. This leaves some room for disrupters underneath to position at a lower price or premium pricing with differentiating services. We saw a similar idea pursued by Sam’s Club and Dell last year without much success.

The AMA also clarified one of its ideas for this Internet EMR market by marrying e-prescribing and registry functions to meet stage 1 meaningful use. DrFirst is the e-prescribing app. DocSite and WellCentive are participating registry-oriented EMRs. It is a welcome new alternative that should get significant market attention.

EMRs and care coordination. Care plans have become the foundation for care coordination. This is one of the lessons learned from a report by eHI. Yet it finds that additional EMR functional support is needed. Oncology patients report they want to collaborate with their physicians. The report tracks two detailed case studies at Taconic IPA and Community Health Center in CT. The EMRs are useful but insufficient to support care coordination. Workarounds are available through increased staffing.

HIT Trends Summary for May 2011

Jun 9, 2011• 1

By MICHAEL LAKE

This is a summary of the HIT Trends report for May 2011. You can get the current issue or subscribe here.

E-prescribing scale and innovation. Surescripts reports dramatic growth for e-prescribing with a third of office-based physicians on its network and 20% of all scripts now going electronically to pharmacies and mail order. Yet formulary and prescription history data are underutilized by practices. This according to a study by Center for Studying Health System Change who finds that while most physicians have access to formularies and about half to medication histories, many don’t utilize it because they don’t see the value or systems are too cumbersome. However, there continues to be innovation in this area. CVS Caremark is piloting electronic prior authorization and Medco released a consumer pharmacy app for Verizon phones that alerts consumers to lower cost alternatives that Medco hopes will be discussed with prescribers. This is a terrific model for supporting the provider-patient dialog around medications. The key is the personalization to the member’s specific benefit information and the application’s ease of use. Perhaps these innovations can help address the utilization issues.

EHR market dynamics. There is also market growth and adoption of EMRs. According to report by Kalorama Research it’s a $15.7B U.S. market in 2010 with predicted market growth of 18%-20% per year for the next two years. California Health Care Foundation is reporting that over half of California’s primary care physicians using an EHR, and of the largest practices, adoption is over 80%. EHR is increasingly a global issue with new reports on the European experience highlighting that 81% of hospitals there have electronic patient records. This is a comprehensive European study of 909 hospitals in 30 countries. Larger public and university hospitals are more advanced than smaller private ones. Nordic countries are leading. Individual spider-charts give readers a summary at-a-glance. Still all is not rosy. England’s National Audit Office reports its National Health Service EHR project is failing.

Coordinating Care Coordination

Jun 7, 2011• 11

By MARGALIT GUR-ARIE

Care coordination is one of the four pillars of Meaningful Use, one of the six NCQA Patient Centered Medical Home (PCMH) standards and one of the main goals of Accountable Care Organizations (ACO). Care coordination, particularly for patients with multiple chronic conditions, is expected to reduce unnecessary repetition of laboratory testing or imaging and the number of avoidable admissions. Other than reducing overall costs, care coordination is also supposed to improve quality of care. According to experts like Joe Flower, “Lack of care coordination is at the core of the mess healthcare is in”, and nobody in their right mind would argue that it is best that medical care remains disorganized and uncoordinated, if it is indeed so. It seems that our fee-for-service, fragmented and fractured (lots of f-words here) health care system is not conducive to care coordination. When patients float around in a sea of hospitals, physicians, nursing homes and other facilities, each care provider gets paid, and is responsible for the piecework performed at their independent entity and nobody is minding the handoff of patients to the next provider of care, and nobody is assembling a comprehensive picture of the entire care process, let alone orchestrating, or coordinating, the progression of patients between stages of care and the overall needs of patients in transit. What would it take then, to see that the bits and pieces of health care we now have, become a safe and affordable continuum of care?

CMS is taking the lead, as it should, in an all-out effort to encourage health care coordination through various carrot-stick initiatives, aligned to ultimately base payment for medical care on value to the patient, as measured on a population level, instead of fee-for-service and no accountability for outcomes. These initiatives fall into three general categories:

Health Information Technology to assist with documentation, information exchange and measurements as required in any coordination effort.
Incentives and penalties for providers based on measures thought to be influenced by care coordination (e.g. preventable hospitalizations, readmission rates, etc.)
Financial and structural encouragement for vertical integration of the delivery system (e.g. ACOs, consolidation, employed physicians, etc.)Continue reading…

NPfIT Blazing the Trail

May 24, 2011• 5

By MARGALIT GUR-ARIE

The National Audit Office (NAO) in the UK has recently published a report evaluating the status of “The National Programme for IT in the NHS” (NPfIT). The program is a very ambitious top down initiative to deploy Health Information Technology across all NHS facilities in an attempt to provide an electronic care record for every patient in the UK. The blunt conclusion of the report states that “The original vision for the National Programme for IT in the NHS will not be realized” and “This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme”. Is this gloom ridden report in any way pertinent to our own quest for an EHR for every patient by 2014? Of course not. We don’t have a Socialist system where the government can decide on a particular EHR product, buy it, contract billions of dollars in services, and force all hospitals and doctors to install it and use it in their facilities on a government dictated schedule.

Instead, the United States Government is building a National EHR, and I find the business model fascinating. No, the Feds did not hire a team of software developers, did not set up a business entity and didn’t even hire a defense contractor to do all these things. Instead, they legislate and engage in a flurry of rule makings which are then applied in quick succession, like giant levers, to the delivery side of our health care system. This is nothing short of brilliant.Continue reading…

Fostering Innovation in Healthcare IT

Apr 18, 2011

By JOHN MOORE

As in most sectors, innovation in healthcare IT (HIT) is by and large incremental. A tweak here and added feature there to some existing application, e.g., what we are seeing today from EHR vendors as they strive to meet meaningful use criteria. Occasionally, we may see a vendor develop something new and novel – one might put porting their EHR application onto an iPad as an example of such – but really, is that innovation or just an attempt to meet existing customer needs by tweaking software to meet the design criteria of a new form factor?

Innovation, true innovation that breaks from existing norms is exceedingly rare. Even in an industry sector such as HIT where we are seeing an unprecedented amount of money being spent, it has been difficult for this analyst firm to find real innovation that gets us excited and thinking beyond the limited constructs that seem to keep this industry perpetually incased, like an insect, in amber. Part of the reason lies with tradition (culture), another part with entrenched interests (existing/legacy IT vendors) and arguably the most important business models.

But that may begin to change as nothing elicits innovation more than a substantial change to core models of doing business. The Center for Medicare and Medicaid Services (CMS) recently released proposed rules for the establishment of Accountable Care Organizations (ACOs), which is a move towards bundled payments. Here in Massachusetts, the Governor announced introduced a bill as well to “expand the use of alternative payments and significantly reduce fee-for-service payments by end of 2015.” It is actions such as these that will open the floodgates ushering in some truly innovative approaches to optimizing the delivery of quality care.Continue reading…

Near Chicago next week? Meet Todd Park!

Apr 18, 2011• 1

If you’re near or in Chicago next Weds (April 27) and you care about health data, applications or innovation, we highly recommend that you get to a Community Forum on the Health Data Initiative. The formal invite & details follow–Matthew Holt

James M. Galloway, MD, Acting HHS Regional Director and Regional Health Administrator, Region V invites you to a community dialogue hosted in Chicago on the Health Data Initiative with Todd Park, HHS Chief Technology Officer. Todd Park joined HHS as Chief Technology Officer in August 2009. In this role, he is responsible for helping HHS leadership harness the power of data, technology, and innovation to improve the health and welfare of the nation.

One of his priority projects, on behalf of Secretary Sebelius, is the Community Health Data Initiative. The Community Health Data Initiative is a public-private collaboration among federal, state, local and private organizations, that aims to make indicators of health available to a broad array of users. Health indicators represent data from populations or groups of individuals that can be used to reflect health trends or differences in health status, cost, quality, and health system performance.

This is an opportunity for public health officials, businesses, academic institutions, providers, hospitals, health plans, and advocates to learn more about the Community Health Data Initiative, in particular, on the use of health and health care data to improve performance. More information on the initiative can be found at http://www.hhs.gov/open/datasets/communityhealthdata.html.

We hope that you can join us in a community dialogue with Todd Park!

When: Wednesday, April 27^th from 2 – 4 p.m.

Where: The MidAmerica Club (inside the Aon Building)
200 E. Randolph, 80th Floor
Chicago, IL 60601

Why: You can help improve the health of our nation and the reach of this program in our community.

RSVP: Space is limited. Please RSVP for this free event by Friday, April 22^ndto Ms. April Dublin at ap**********@*hs.gov or 312-353-1385

Video Collage: KP Center for Total Health

Apr 8, 2011• 4

By MATTHEW HOLT

This week I spent quite a bit of time at the very new and very fancy Kaiser Permanente Center for Total Health in Washington DC. It’s next door to a very large medical office building (110+ docs) in which KP is showcasing its current integrated care model, and how far its come in its mid-Atlantic region. The Center is a pretty fascinating place–part tech and idea showcase and part meeting room. Certainly no other health care organization that I’m aware of has spent so much on a place designed to stimulate the imagination and enhance conversation–under the nose of the folks on Capitol Hill. I won’t get into here whether this is how money should be spent in health care but on balance I’m a fan. (FD KP is a sponsor of the Health 2.0 Conference I co-run). Instead I want to try to give you a feel for the place, and why it fits their vision and what it’s trying to demonstrate.

I took a tour with some colleague journo/blogger types led by the always expressive Robbie Pearl (CEO of the Permanente Groups in N Cal and now DC too–the airlines thank him!) and with Phil Fasano, CIO of the whole organization. Robbie is not shy in voicing his opinions (as you’ll see) and Phil occasionally trots out the voice of caution to reel in Robbie’s vision a tad. It was great fun.

What was also fun was the cocktail party at the grand opening. There I met three of my favorite DC-based ladies in health: Deven McGraw, Regina Holliday & Cindy Throop. So we’ll start with that fun video, and then there’s a whole lot more from the tour of the center after the jump. All these videos are pretty short.

After that fun and games, lets head to the tour. This is a series of videos of me and a few others testing out the displays, and listening to Pearl & Fasano, as well as asking them a couple of pointed questions.

But I’ll take the tour in order….after a quick thanks to Holly Potter, Danielle Cass, Ravi Poorsina & center boss Julie Norris who with a ton of their colleagues worked their butts off keeping hundreds of visitors informed and entertained.

First up, Robbie Pearl on the current state of the KP.org health record and why we shouldn’t have to put up with less; what he called the 19th century state of medicine. And I can assure that is on display in my wife’s OBGYN office every time I visit.Continue reading…