Over the last few years, we have seen large EHR vendors purchase the moderate size EHR vendors, while moderate-size EHR vendors acquire smaller EHR vendors. We can expect to see a further decline in the number and diversity of EHRs as the IT mandates of Meaningful Use 2 and 3 are technically unachievable for all but the most well-endowed EHR vendors.
Along with the decreasing diversity of EHR options, an increasing number of physicians have lost the ability to choose the most important tool in their black-bag, their EHR, as many are now employed by large organizations which tell the physicians which EHR/HIT tools they are allowed to use.
If there was data that “Certified” EHRs, “Meaningful Use,” ICD10 and PQRS mandates had an impact on the cost or quality of healthcare which was commensurate with the IT costs and logistical disruptions, I would be the first to encourage physicians to use the new and proven technology. Unfortunately, we still do not know if “more” HIT is good for the healthcare system and society in general, or if it is only good for the IT industry.
As President Obama’s healthcare reform unfolds in the last years of his administration, critics and supporters alike are looking for objective data. Meaningful Use is a funding program designed to create health IT systems that, when used in combination, are capable of reporting objective data about the healthcare system as a whole. But the program is floundering. The digital systems created by Meaningful Use are mostly incompatible, and it is unclear whether they will be able to provide the needed insights to evaluate Obamacare.
Recent data releases from HHS, however, have made it possible to objectively evaluate the overall performance of Meaningful Use itself. In turn we can better evaluate whether the Meaningful Use program is providing the needed structure to Obamacare. This article seeks to make the current state of the Meaningful Use program clear. Subsequent articles will consider what the newly released data implies about Meaningful Use specifically, and about Obamacare generally.
CVS Health acquires Target’s healthcare biz
CVS Health will pay $1.9 billion to acquire Target’s healthcare businesses, including 1,600 pharmacies and 80 MinuteClinic health clinics.
CVS Health also just opened its Boston-based Digital Innovation Lab, which will focus on developing cutting-edge digital services and personalized capabilities that offer an accessible and integrated personal pharmacy and health experience.
CVS is making big strides to position itself as both a digital innovator and major provider of primary care services. Look for them to continue to build on existing partnerships with regional health systems. What’s next – maybe more integration of its health apps into EMRs, patient portals, and HIEs?
Former hospital CFO sentenced to prison for attestation fraud
Joe White, the former CFO of Shelby Regional Medical Center in Texas, is sentenced to 23 months in federal prison for falsely attesting that the hospital was a meaningful user of EHR. White was also ordered to pay almost $4.5 million in restitution to Medicare’s EHR Incentive program. Continue reading…
In the future, doctors who provide better healthcare will be paid more. When a doctor gives good care, she will get credit. For factors out of that doctor’s control, she won’t be penalized. The patient, too, will be rewarded for taking care of his own health. In short, payments will align with good care, and good care will become more common.
This is the promise of value-based care, which is coming, according to almost everyone. Medicare is pushing it. Private payers are preparing for it.Top providers are tooling up.
And yet, the question lingers — how exactly do we measure quality? Today quality measurement is rigid, periodic, and manual. Here’s a peek behind the curtain of what we measure today — and what’s possible tomorrow.
Judy Faulkner pledges to donate her wealth
Epic founder and CEO Judy Faulkner announces plans to give away 99% of her estimated $2.3 billion wealth to charity. Faulkner joins 136 other individuals and families in the Giving Pledge, which was launched by Warren Buffett and Bill and Melinda Gates to encourage billionaires to give the majority of their wealth to philanthropic causes.
What’s not to like about that? Good to know that if Epic wins the $11 billion bid for the VA’s EHR system, some of the government’s money will eventually trickle back down to charity.
Are EHRs creating disparity in care?
A study from Weill Cornell Medical College looks at “systematic differences” between physicians who participated in the Meaningful Use program and those who did not, noting that the differences “could lead to disparities in care.”
The researchers suggest that providers participating in the MU program may provide higher quality care to their patients as physicians using paper records “have less reliable documentation and weaker communication” between providers and won’t benefit from EHR-enabled quality improvements.
I suspect that physicians relying on paper records would balk at the suggestion that the care they provide is inferior to their more digitally-equipped peers. However, it’s hard not believe that the overall care process would be enhanced if all providers could electronically share critical patient information.
News Flash: Government is wasteful in its spending
The Government Accountability Office releases a report calling for urgent action on federal IT Continue reading…
Following the recession, the Obama administration sought shovel-ready projects.
One unlikely shovel wielding aggregate demand was health information technology. The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 directed 5 % of the stimulus towards digitizing medical records.
Computerization of medical records doesn’t induce the images of public works as building freeways during the Great Depression does, but the freeway is a metaphor for exchange of information between electronic health records with the implication that such an exchange is a public good and so government intervention is justified.
Robert Wachter, voted the most influential physician by Modern Healthcare, sums the optimism and frustration with the electronic health record (EHR) in Digital Doctor – which stands to be a classic.
It was Bush Jr., not Obama, who started the digitization. Seeking bipartisanship after the war in Iraq, Bush was inspired by his closest ally, Tony Blair, who was wiring the National Health Service (NHS) – a $16 billion initiative which has since failed, spectacularly.
Bush founded the Office of National Coordinator of Health Information Technology (ONC) and appointed David Brailer – a physician, quant and entrepreneur – as head. Brailer wanted interoperability so that hospitals shared information. It is because of interoperability that we can use our debit cards in New York and Singapore. The market must agree on a common language, such as the TCP/ IP for the internet, to achieve interoperability.
Patients suffer when systems can’t talk. Were patients, not a third party, bearing the full costs of care – a free market – they might have forced hospital information systems to talk. Rightly or not, healthcare is not a free market and hospitals have little motivation in making cross-talking simpler.
Currently, when healthcare data moves in this country it does it using fax machines and patient sneaker-nets. Automated digital interoperability is still in its earliest stages, mostly it has a history of being actively resisted by both the EHR vendors and large healthcare providers. We, as an industry, should be doing better, and our failure to do so is felt everyday by patients across the country.
The ONC-defined difference between EHRs and EMRs is that EHRs are interoperable. Yet, as I have said before, we have spent almost a billions of dollars and generally gotten EMRs instead of EHRs.
Comments were due Apr 3 for the ONC Interoperability Roadmap for 2015-2020. This was specifically separated out from the overall ONC Health IT Strategic Plan for which comments have closed.
Both of these plans ignore the lessons in execution from the previous strategic plan for health IT from ONC. The current Interoperability Roadmap mentions the “NwHIN” (Nationwide Health Information Network) for instance, and only covers what it accomplished, which are mostly policy successes like the DURSA (Data Use and Reciprocal Support Agreement). NwHIN was supposed to be a network of networks that connected every provider in the country… why hasn’t that happened?
ONC has forgotten what the actual ambition was in 2010. It was not to create cool policy documents. The plan 5 years ago was to have the “interoperability problem” solved in 5 years. The plan 5 years before that was probably to solve the problem in 5 years. Apparently, our policy makers look at interoperability and say “wow this is a big problem, we need at least 5 years to solve it”. Without any sense of ironic awareness that this is what they have been saying for decades, even before Kolodner was the ONC.
Life is tough for physicians in solo and small group practice. The federally mandated introduction this fall of ICD-10 requires physicians and their staffs to learn a new system of coding diseases. “Meaningful Use,” another federal program, requires physicians to install and use electronic health records systems, which are complex and expensive. And PQRS, the Physician Quality Reporting System, is beginning to penalize physicians for failing to report individual data for up to 110 quality measures, such as patient immunizations, each of which takes time to collect and record.
Of course, such requirements are not being imposed solely on solo and small-group physicians. In many ways, they affect all physicians alike. Yet the burdens of complying are disproportionately high for small groups, which cannot spread out the costs of purchasing equipment, hiring employees and consultants, and training personnel over so large a number of colleagues. Hospitals and large medical groups can afford to hire full-time specialists to meet these challenges, but such approaches are not economically feasible for a group that consists of only a few physicians.
Such challenges are not just raining down – they are pouring down on the heads of physicians. Some physicians fear they smell a conspiracy to drive solo and small-group practitioners out of business. And the problem is not just the money. It’s also the time. Many physicians already work long hours and simply cannot afford to shop for such systems, negotiate contracts, and enter data. We personally know physicians who report spending two hours each evening completing records that they did not have time to attend to while they were seeing patients.
I drank the kool-aid early. We installed our first EHR in 1996 with me doing the lion’s share of pushing and pulling. While I’d ultimately turn my back on this passion, I had a number of notable accomplishments before walking down my Damascus road.
- Within a year of implementation, our practice became one of the top installations for our vendor.
- Within 2 years I was elected to the board of our user group.
- Within 4 years I was president.
- In 2003, our practice was recognized by HIMSS as one of the top primary care installations of Electronic Records.
- In subsequent years I lectured around the country (for HIMSS) extolling the benefits of EHR for both quality and efficiency of care.
- As opposed to the experience of other physicians, our practice was not only successful in our implementation, we were in the top 10% in income for our specialty.
- Our quality metrics were also routinely far above national norms.
- In 2012, I was the physician representative for CDC public health grand rounds, discussing the upcoming EHR incentive program: Meaningful Use.
- By 2013, we easily qualified for stage 1 of Meaningful Use, and I happily accepted the financial fruit of my labors.
But the final years were not, as I expected, a triumph. I became increasingly frustrated with the worsening of our EHR by the “features” needed to qualify us for MU1. I also chafed at the way most physicians were meeting this criteria: by abandoning patient-centered care and adopting a data-centered care model. Patients were given useless handouts to summarize “care,” and the data requirement was satisfied. Patient portals gave limited access to information were touted as “patient centered” care, while the product was left unused by most patients, but the data requirement was satisfied.
The rush to implement patient portals to meet Meaningful Use Stage 2 deadlines has focused most attention on getting the technology up and running, and convincing patients and providers to move to shared communication online. Hospitals and health systems have implemented portals with the help of incentives from the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, and patients and providers have been migrating to them at a slow but steady pace.
I am one of the patients eager to see this move to transparency, and have been a user of my health system’s portal from the start. But I’m far from a happy customer and my experience leaves me scratching my head. Sure, I can get online without a problem, and I can read my results.
Recently, I read online that my results were “probably benign (not cancer)” and it would be important to follow up with retesting in six months. This news, delivered with no phone call or follow up from the hospital or my primary care provider, was disconcerting. The specter of cancer was anxiety producing, as it would be for many, especially with no clinical context for interpreting my test results.
I never received human follow up. When finally I reached someone at the hospital to set up an appointment for a retest, I asked about the portal and the message and was referred to the hospital IT Department. Hmmm…I wondered. What does this mean? Is this what patient engagement is all about?Continue reading…