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Tag: HIT

Will ACO IT Models Be Walled Gardens or Open Platforms?

Will ACO (accountable care organization) IT models be walled gardens or open platforms?  i.e., will ACO IT platforms focus on exchanging information within the provider network of the ACO, or will they also be able to exchange information with providers outside the ACO network? (If the question still isn’t clear, click here for a further explanation.).

One POV: ACO’s Will Need Open IT Platforms

Mike Cummens, M.D., associate chief medical information officer at 750-physician Marshfield Clinic in Wisconsin, is quoted in a recent article in Healthcare Informatics. Dr. Cummens argues for an open ACO IT approach:

There will be an emphasis on transfer-of-care summaries and how to facilitate information sharing across the full continuum of care, he said. “For instance, you will have to work into care management plans the notification of home health agencies,” Cummens added. “In an ACO model, you will have to have methods in place to communicate all this information to providers who are not part of your own organization. People will have an option to see providers outside an ACO, so you will need to be able to transfer care summaries and discharge summaries outside the ACO.”

Also, because patient involvement is a key part of ACOs, the IT infrastructure will have to support patients signing off on their care plans and document their progress toward reaching goals, he noted. That will involve some type of self-management tools and personal health record access to their own data.

Cummens noted that the patient-centered medical home is geared toward an individual practice, and meaningful use metrics are geared toward providers, but ACOs will require managing data across enterprises. “When we visualize this and realize we are dealing with multiple electronic health records, the infrastructure for ACOs really has to ride on top of that,” he said. He sees the need for a new type of system, probably outside the EHR, that can bridge organizations, allow for risk assessment and analytics and reach down into tools for day-to-day management. That’s a tall order.

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HIT Trends Summary for October 2010

This is a summary of the HIT Trends Report for October 2010.  You can get the current issue or subscribe here.

The evolving health information exchange market. The HIE segment was center-stage this month with a game-changing announcement by Surescripts. It will combine its national physician directory and EMR connectivity with apps from its strategic investment in Kryptiq to offer physician-to-physician clinical messaging beginning in December, extending its dominant market position.  As first to market with these functions, it will likely cement its standing as the country’s premiere neutral national network.  It also enables a platform for additional web services from collaborating partners in the future.  We are also reminded this month in Healthcare IT News of the relative dominance of Epic in the IDN and large practice market with the startling statistic that 75% of Wisconsin residents are in the databases of its state user group.  Using Epic tools and with patient consent physicians in the state can see patient information across institutions.  And there’s a story this month that Verizon is expanding its vision as an HIE by adding clinical lab and imaging results to its networking services with leading transcription companies.  These three lenses:  (1) Surescripts as the leading national network; (2) Epic as the leading national EMR; and (3) Verizon as the leading national telecom, exemplify the rapidly changing dynamics in this segment.

EHRs and HIT have become central to transformation of clinical practice. One large driver is the announcement by the insurance commission of the inclusion of HIT as well as wellness and care management as medical expenses for insurers under PPACA.  In the past these areas were generally allocated to the administrative budget of health plans which limited participation.  This will increase payer investment.  A CMS exec, Anthony Rogers, reported to Healthcare IT News on early results of CMS accountable care organization (ACO) pilots.  He noted that practices with EMRs were getting most of the $36M in incentives and said, “If that’s not a business case [for EHRs], I don’t know what is.”   The Patient-Centered Primary Care Collaborative, the organization driving medical homes released two reports this month also highlighting HIT’s role in transformation.  One report looks at best practices to engage patients in a medical home project using HIT.  It’s a compendium of 15 essays by a diverse set of experts on different perspectives about using health IT to engage patients, plus snapshots of two dozen case examples.  The other report focuses on five ways to implement HIT effectively to enable clinical decision support.  And CSC released a roadmap for HIT in ACOs with an elegant six factor model:  member engagement; medical management; clinical information exchange; quality reporting; business intelligence; and  risk and revenue management.

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What’s Your Platform?

We’ve done some heavy dipping into the world of policy recently. In mid-September, I spent a day in Washington, D.C., with friend and advisor Tom Scully meeting researchers, senators, and a congressman.  We heard from “ONCHIT” that “CCHIT”—which, as you know is an “ATCB”—granted us Stage 1 MU!  This is great news for me, mostly because some competitors didn’t get it!  (How’s that for starting a policy blog with some serious ABCs?!)

I met with some amazingly smart and engaged reporters who now (I think, get called “researchers,” since their newspapers can no longer afford them) work for the Henry J. Kaiser Family Foundation or NPR.  They’re the real deal.  They needed much less initial grounding in the problems we try to solve than most of the journalists we meet.  They had taken on board the assumption that the move toward ACOs means less waste (which it could for some) and can get everybody in the clinical supply chain on one system (which has been seen to work at times).

But none of them appears to have considered the idea that there is a relationship between a healthy integrated health information ecosystem and a health information exchange marketplace.  It’s still surprising to me, but precious few people correlate sustainability of any social good with the existence of a healthy marketplace with enough room for flexibility to allow innovation over time.  It’s like the single economic condition responsible for ALMOST ALL of the social progress of this nation since inception, but in health care it’s still kind of a new idea.

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Update on Modular EHR Technology: Harvard’s SMArt Research

ONC awarded four Strategic Health IT Advanced Research Project (SHARP) grants earlier this year to

”…address well-documented problems that have impeded adoption of health IT and to accelerate progress towards achieving nationwide meaningful use of health IT in support of a high-performing, learning health care system.”

One of  these grants was awarded to a Harvard group led by Drs. Ken Mandl and Isaac Kohane, based in Children’s Hospital Boston and Harvard Medical School. This research team is tackling the problems associated with developing an ecosystem of  modular, plug-and-play medical applications, what we have referred to as Clinical Groupware.  (Disclosure: DCK is on the Harvard SHARP grant’s advisory board.)

The research is aimed at creating a “medical apps store” based on the iPhone/iPad model of substitutable applications running on a device or platform. The name of the project, SMArt, stands for “Substitutable Medical Applications, re-useable technology.” The approach could impact both the EHR industry and the federal regulatory and standards process, possibly within a relatively short period, i.e., 1-3 years, so we think it merits your attention.

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Reckless REC Wrecking

The Health Information Technology Extension Program, created and funded by ONC, has completed funding for all 62 Regional Extension Centers (REC), with a grand total of well over half a billion dollars and, predictably, criticism of the program was immediately forthcoming. The RECs are supposedly an impediment to free EHR markets and doomed to failure from the start, which may seem a bit contradictory if you think about it. Anyway, before making further statements and assertions regarding the “recklessness” of the RECs, or the impeding “train wreck” they represent, it may be beneficiary to take a closer look at the program.

Overview

The HIT Extension Program consists of 62 RECs, at least one for each State and territory, and one national Research Center (RC). The stated goal of the program is “to provide outreach and support services to at least 100,000 priority primary care providers within two years”. The individual RECs are supposed to conduct outreach and education campaigns in their respective States and inform physicians on the latest HIT developments and available programs and incentives. The RECs are also chartered to offer support and guidance to physicians selecting and implementing EHRs, particularly Primary Care docs in small practices and in underserved areas. These are the doctors that were left out by the regular market process because they were hard to reach, too expensive to implement and too poor to bother with. While the individual RECs are locally oriented, with feet on the ground in each State and each County, the RC is basically a National forum for RECs to share information and exchange lessons learned.

Funding

Other than a small amount of seed money, RECs are not handed out all those hundreds of millions of dollars of grant funds. RECs are paid for performance. For each physician they touch and manage to recruit, the RECs are paid about $1500. If and when the provider implements an EHR, the RECs receive another equal payment. The last third of the money is handed to the REC if, and only if, the provider achieves Meaningful Use. This arrangement is only in effect for two years. All those who believe that RECs are bound to fail should be reassured by the fact that in that dire case most of the allocated funds will remain with ONC. The RECs are expected to use the ONC seed money and find a way to become sustainable businesses after ONC ceases to support them financially.

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The Next Big Thing for Doctors

By

The Future Just Happened,
by Michael Lewis, 2001

As a consultant to the Physician Foundation, a not-for-profit 501 C-3 Organization representing physicians in state medical societies, as a sometime futurist, and as someone who has written extensively about innovation in Innovation-Driven Health Care (Jones and Bartlett, 2007) and in 1475 blogs in Medinnovation, I have been asked: What is the next big thing for doctors, and how should they react to it?

The next big thing for physicians will be Medicare fee cuts in the neighborhood of 50% by 2020 as mandated by the Affordable Care Act, and the next big clinical innovative response for doctors will be encouraging patients enter their own data, their own chief complaint, and their own medical histories before seeing the doctor to compensate for fee reductions.

Ceding a Traditional Physician Function to Survive Economically

Doctors will have to cede a traditional function – taking a history – to patients to become more efficient to survive. Payers – including Medicare, Medicaid, and private health plans- will demand standardization and restructuring of the medical history to achieve consistency in medical records. Patient-entered information may be disruptive. Doctors will have to change practice flow patterns to adjust to reality of lower pay. The need for greater productivity will drive this change.

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Aneesh Chopra talking Health IT and innovation, SF 12 noon today

Today at 12 noon PST Aneesh Chopra, Federal CTO will be at the Commonwealth Club in San Francisco talking about health care and health care IT. Indu and I saw him last night talking about technology before a big crowd at the Silicon Valley Computer History Museum.

In today’s talk he’s going to be focused exclusively on health care, which means he won’t have to dodge the question on Net Neutrality that he got last night. And even better, if you don’t have a ticket yet you can get one free thanks to the California Health Care Foundation,

I’ve seen Aneesh talk several times. Last night was particularly good in that he really responded well in the Q&A session. Plus he gave several shout-outs to the Health 2.0 Developer Challenge even if he made Indu embarrassed,

So if you care at all about health care and IT, you should come to the Commonwealth Club in downtown San Francisco today. And as an added bonus the entire health 2.0 team down to the Norwegian interns will be there – except for Lizzie who is up at the Health 2.0 NorthWest Chapter Kick off meeting.

Use Emotion to Drive Adoption—Not Rejection—of Health IT

Last week I heard uber marketer Seth Godin speak about the power of fear. Fear is one of the strongest human emotions, based in the core of our brain–the “lizard brain” that evolved prior to our higher order thinking skills. Fear served us well throughout most of ancient history (stay away from the tiger!)–but it’s not always productive in modern day society.

Consumer fears about health information technology (health IT) privacy are a case in point. Surveys show that more than half of consumers voice fears which are, (in my opinion) appropriate, to an extent: risks such as discrimination are real, and public concerns should hold policymakers, vendors, and providers to the highest standard of privacy protection.

The real problem is fear mongering. Debroah Peel, founder of Patient Privacy Rights, has put herself and her organization on the map with sensationalism. As she said in a KTVU report earlier this month: “Anything that’s in there, any information that’s in there, can and will be used against you in the future. It’s very important to know that in the electronic health world…” and, “This is a nightmare. It’s nothing we’ve ever seen before in medicine.”

Extremist statements like this are usually misleading and often just plain wrong.. But a response that focuses on the logical and rational alone doesn’t cut it.  In March Peel wrote an opinion for the Wall Street Journal online called “Our Medical Records Aren’t Secure.”

It got 179 comments. A measured rebuttal by Mary Grealy, President of the Healthcare Leadership Council, got only 4.Continue reading…

Acquisitions Creating White Hot Market for Healthcare IT

Picture 58Since the beginning of 2010 there has been a series of acquisitions in healthcare IT (HIT) market, which  recently culminated in one of the largest, IBM’s acquisition of Initiate.

Triggering this activity is the massive amount of federal spending on HIT, (stimulus funding via ARRA which depending on how you count it, adds up to some $40B) that will be spent over the next several years to finally get the healthcare sector up to some semblance of the 21st century in its use of IT.

But one of the key issues with ARRA is that this money needs to be spent within a given time frame, thus requiring software vendors to quickly build out their solution portfolio, partner with others or simply acquire another firm.Continue reading…

EHR & The Art, Science and Business of Medicine

“The practice of medicine is an art, not a trade; a calling, not a business…”

– William Osler

Picture 111 Dr. Osler was a great physician and a great man. However, in America today medicine may be a calling and may be partly art, but it is also increasingly part science and, for many physicians in private practice, it must also be part business.

This article will attempt to examine the role of Healthcare Information Technology (HIT), and Electronic Medical Records (EMR or EHR) in particular, in the art, science and business of medicine as practiced today, whether by choice or due to political and economic circumstances in 21st century America.Continue reading…

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