Tag: HIT

HITECH in High Gear

Feb 24, 2011

By DAVID BLUMENTHAL, MD

We’ve known for years that health information technology can improve health care. But until recently, the implementation rate among providers has been low, except for a few early adopters.

In the last two years, however, there has been a significant upward inflection in the adoption rate. For primary care providers, adoption of a basic EHR increased by half from 19.8 percent in 2008 to 29.6 percent in 2010.

And with HITECH Act programs now in full swing, it looks clear that adoption and use of health information technology will go into high gear. Already, 81 percent of hospitals and 41 percent of office physicians are saying they intend to achieve meaningful use of EHRs and qualify for Medicare and Medicaid incentive payments.

A recent edition of the American Journal of Managed Care (AJMC) helps us understand why the accelerated move to EHRs is so important. This special issue devoted to health information technology presents perspectives on health IT from a wide range of stakeholders—providers, policymakers, and patients. Contributors include representatives of private companies and public agencies, managed care organizations and academic medical centers, medical educators and a medical student—confirmation that the potential of health IT is compelling for a broad spectrum of Americans.Continue reading…

HIMSS11 Update from the Chairman

Feb 21, 2011• 4

By C. MARTIN HARRIS, MD

As the Chairman of the board of HIMSS, the Health Information Management Systems Society, which is the largest information technology organization in the world, I’ve been very busy at our annual conference in Orlando, Fla.

As I move through this enormous venue, talking to as many of our 30,000 attending members as possible, I can’t help but think about how much work we all have to do in the coming years.

As healthcare and IT professionals, we are privileged to live at a moment in history when the work we do, the product of our shared passion, the professional discipline to which we devote so much of ourselves, is taking its place as the central catalyst of a transformation in healthcare that is in many ways, unprecedented.

Whereas previous breakthroughs in medical technology, such as the invention of the X-ray or the discovery of antibiotics, have obviously been profound, and powerful; I can think of none that ever impacted the entire medical practice model.

And that is exactly what the technology-driven transformation of healthcare is poised to deliver.Continue reading…

HIMSS11 Live: Meaningful Use

Feb 21, 2011• 2

By NEIL VERSEL

What can be said about “meaningful use” of electronic health records that hasn’t already been said? Actually, plenty, if the events leading up to Monday morning’s official opening of HIMSS11 are any indication.

Last week, HIMSS honcho Steve Lieber told me in an interview at his Chicago office that most of the confusion about Stage 1 meaningful use has subsided, but that there still was plenty of “uncertainty” about the future. As in, uncertainty about the transition from Stage 1 to Stage 2 of the federal EHR incentive program and uncertainty about leadership, as national health IT coordinator Dr. David Blumenthal prepares to return to Harvard in April. (Yes, it is April. Blumenthal apparently spilled the beans to former Sen. Dave Durenberger a few weeks ago.)

“Everybody’s real clear on Stage 1,” Lieber said. The uncertainty is about future stages of meaningful use, particularly in the transition from Stage 1 to Stage 2. The fact that there will be a new national coordinator is another source of uncertainty, but it just means that there could be further refinements to existing regulations.

Vendors seem anxious to see the Stage 2 regulations so they can begin modifying and recertifying their products to help customers meet the next round of requirements. (Yes, everything will have to be recertified to meet Stage 2 criteria.)

The College of Healthcare Information Management Executives (CHIME) late last week formally asked for more time to transition from Stage 1 to Stage 2 because it’s unclear if many physicians and hospitals are even ready for the first stage. “CHIME believes that it would not be prudent to move to Stage 2 until about 30 percent of (eligible hospitals and eligible providers) have been able to demonstrate EHR MU under Stage 1,” says CHIME’s comment letter. “We believe this approach would strike a reasonable balance between the desire to push EHR adoption and MU as quickly as possible, and the recognition that unreasonable expectations could end up discouraging EHR adoption if providers conclude that it will be essentially impossible for them to qualify for incentives.”Continue reading…

The Safety of HIT-Assisted Care

Jan 31, 2011• 1

By JOHN HALAMKA, MD

I was recently asked by an Institute of Medicine committee to comment about the impact of healthcare information technologies (HIT) on patient safety and how to maximize the safety of HIT-assisted care.

“HIT-assisted care” means health care and services that incorporate and take advantage of health information technologies and health information exchange for the purpose of improving the processes and outcomes of health care services. HIT-assisted care includes care supported by and involving: EHRs, clinical decision support, computerized provider order entry, health information exchange, patient engagement technologies, and other health information technology used in clinical care.

There are two separate questions:
1. What technologies, properly used, improve safety?
2. Given that automation can introduce new types of errors, what can be done to ensure that HIT itself is safe?

To explore these topics, let’s take a look at Health Information Exchange (HIE). What HIE technologies improve safety and how can we ensure the technologies are safe to use?

Defining a Maturity Model for HIEs

Jan 30, 2011• 1

By JOHN MOORE

Before entering the convoluted healthcare IT sector, I had worked in the manufacturing sector both as an IT analyst and in corporate strategy for Europe’s second largest enterprise software company. In those many years I learn quite a bit about not only how to effectively deploy large enterprise software systems (SAP, PeopleSoft, i2, PTC, SSA, Dassault Systemes, etc.) but how to create models that would guide clients in a methodical manner in IT adoption. A common model used was the five stage Maturity Model, which was originally developed at Carnegie Mellon University.

The beauty of the maturity model is its simplicity and focus on process change. This proved very effective in educating all stakeholders within a manufacturing company, from the C-suite on down, as to how they needed to think about their internal processes, the technology they were preparing to deploy and the final end-point that they should strive towards. But one should not look at maturity models as completely static for the technology does change overtime and subsequently what is possible.

PCAST HIT Report Becomes a Political Piñata

Jan 23, 2011• 3

By VINCE KURAITIS, JD

The PCAST Report on Health IT has become a political piñata.

Early Feedback on PCAST

Like many of my colleagues, I was taken aback by the release of the Report in early December 2010 — I didn’t know quite what to make of it. Response in the first week of release after Report was:

Limited. The first commentaries were primarily by technical and/or clinical bloggers. The mainstream HIT world had remarkably little initial reaction to the Report.
Respectful of the imprimatur of “The President’s” Report and noting some of the big names associated with the report (e.g., Google’s Eric Schmidt and Microsoft’s Craig Mundie.)
Focused on technical and/or clinical perspectives around two broad themes.
- The vision is on target: “extraordinary”, “breathtakingly innovative”.
- These guys didn’t do all their technical homework. The range varies, but the message is consistent.

Today’s POV on PCAST

What a difference a six weeks makes.

The Office of the National Coordinator for Health IT (ONC) requested comments on the Report. The comments were due by January 19 and a number of influential organizations have already made their comments public.

After having read 10 early commentaries submitted to ONC, I’ll (admittedly subjectively) divide them into 3 schools of thought:

1) PCAST is a frontal attack on mainstream clinical, technical, and economic stakeholders in existing U.S. health IT. While there are some good ideas in the report, almost all of them are already in the works. Bury PCAST ASAP.

Obtaining Meaningful Use Stimulus Payments

Jan 23, 2011• 4

By JOHN HALAMKA, MD

Many clinicians and hospitals have asked me about the exact steps to obtain stimulus payments.

On January 3, 2011, CMS began registering clinicians for participation in meaningful use programs. Every region of the United States has Regional Extension Centers which can help answer any questions. Here’s an overview of the steps you need to take.

1. Choose between Medicare and Medicaid programs. If you qualify, Medicaid offers greater incentives and does not require you to achieve meaningful use before stimulus payments begin.
a. To qualify for Medicaid, 30% of your patient encounters must be Medicaid patients. (20% for pediatricians)
b. To qualify for Medicare, keep in mind that meaningful use payments are made at 75% of Medicare allowable charges for covered professional services in the calendar year of payment, per the payment maximums below:

Year 1 $18,000
Year 2 $12,000
Year 3 $8000
Year 4 $4000
Year 5 $2000

Thus, a total of $44,000 is available at maximum, but could be less if your allowable Medicare charges are less than

Year 1 $24,000
Year 2 $16,000
Year 3 $10,667
Year 4 $5333
Year 5 $2667

Updates on Proposed Stage 2 and 3 Meaningful Use Criteria

Jan 21, 2011• 6

By VINCE KURAITIS, JD

The Health IT Policy Committee has published proposed Stage 2 and 3 Meaningful Use Recommendations and they’re open for public comment until February 25.

I’ll share a couple of particularly useful and well written analyses and commentaries by colleagues.

Health IT guru and thought leader Dr. John Halamka writes about The Proposed Stage 2 and 3 Meaningful Use Recommendations.

This is a great article to get a thumbnail overview of all the proposed recommendations. John lists 38 criteria and provides a quick commentary on how challenging he sees each of them. (Keep in mind that he’s CIO at one of the most HIT-advanced health systems in the country — your definition of “easy” and his might not be alike.)

It caught my eye that the more challenging criteria generally are ones involving inter-organizational health data exchange, care coordination and care management. See his comments on the following criteria: 7, 17, 20–21, and 23–34.

Dr. Halamka concludes:

…areas of concern are chemotherapy automation, recording patient communication preferences, judging clinician performance based on patient adoption of PHRs, EMAR implementation, maturity of HIE capabilities, widespread rollout of longitudinal care planning, and public health readiness.

Ready, Set…ACO?

Jan 14, 2011• 19

By JONATHAN BUSH

Happy New Year, everyone! 2010 was certainly action-packed, and 2011 promises the same.

I hear a lot of thunder about getting ready for ACOs.

This isn’t a crystal ball forecast, but I see hospitals spending tons of capex on new HIT from old-fashioned “software-based” companies, and it seems like the EMR is the new “pavilion.” I see hospitals buying medical practices using arrangements that are certain to require the hospital to subsidize doctor income. [For another take: Paul Levy on ACO.]

These two major waves are explained by clients and prospects alike as “readiness for ACO.”

I have three thoughts:

Don’t worry. We at athenahealth will do our part. If and when ACO payment models emerge, you won’t need to buy a new “module” from us in order to get payment. We will go get you that money the same way we are getting you the “Meaningful Use” stimulus payments, the P4P money, and the plain old health care reimbursements that we have always delivered. The changes to our technology and service needed to accomplish all that will be on us.
Don’t turn blue holding your breath waiting for the big bonus opportunity. The fundamental underlying principle of an ACO is that you will get a bonus in exchange for lower utilization. If that bonus is bigger than what you’d get from the utilization, then why would Medicare pay it? If that bonus is LESS than what you are getting now, why would you do it?
I have met newly elected Republican lawmakers of late and few of them are thinking that money will be saved with this approach. As with other aspects of health reform law, they appear to be eager to… well, let’s just say…scrutinize the mechanics closely.

None of this is certain and there will be exceptions to all the rules anyone tries to write.

This leaves one thing certain.

Do NOT make multi-year investments that depend upon ACO actually happening.

So as far as ACO goes, pay as you go.

With me?

Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997. He blogs regularly at THCB and at the athena blog where this post first appeared. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School. He blogs regulary at the athena blog, where this post first appeared.

Failure is Not an Option

Dec 30, 2010• 78

By MARGALIT GUR-ARIE

2010 is drawing to an end amongst a flurry of activities in the Health IT field. In a few short days 2011, the year of the Meaningful Use, will be upon us and the stimulus clocks will start ticking furiously. In addition to the yearlong visionary activities from ONC, December 2010 brought us two landmark opinions on the future of medical informatics. The first report, from the President’s Council of Advisors on Science and Technology (PCAST), recommended the creation of a brand new extensible universal health language, along with accelerated and increased government spending on Health IT. Exact dollar amounts were not specified.

The second report from the Institute of Medicine (IOM) is a preliminary summary of a three-part workshop conducted by the Roundtable on Value & Science-Driven Health Care with support from ONC, and titled “Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care”. The IOM report, which incorporates the PCAST recommendations by reference, is breath taking in its vision of an Ultra-Large-System (ULS) consisting of a smart health grid spanning the globe, collecting and exchanging clinical (and non-clinical) data in real-time. Similar to PCAST, the IOM report focuses on the massive research opportunities inherent in such global infrastructure, and like the PCAST report, the IOM summary makes no attempt to estimate costs.

Make no mistake, the IOM vision of a Global Health Grid is equal in magnitude to John Kennedy’s quest for“landing a man on the moon and returning him safely to the earth” and may prove to be infinitely more beneficial to humanity than the Apollo missions were. However, right now, Houston, we’ve had a problem here:

The nation spent upwards of $2.5 trillion on medical services this year
Over 58 million Americans are poor enough to qualify for Medicaid
Over 46 million Americans are old enough to qualify for Medicare
Another 50 million residents are without any health insurance
The unemployment rate is at 9.8% with an additional 7.2% underemployed
This year’s federal deficit is over $1.3 trillion and the national debt is at $13.9 trillion