The Health Care Blog – Page 425 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Training Day

Apr 6, 2015• 6

By ROSS KOPPEL and STEPHEN SOUMERAI

Dr. Samuels’ day-long training experience is unfortunate, but it’s only the opening chords of a much longer symphony of time commitments required by electronic medical records (EHRs). Many studies document the extra time that EHRs impose on doctors and patients. Research in U.S. hospitals and medical offices suggest that these systems can add a half-hour or much more time to a day. A study by McDonald et al (2013 JAMA Internal Medicine) found EHRs added 48 minutes/day to ambulatory physicians, and Hill et al found that in a large community hospital emergency room 43% of all physician time was spent entering data into the EHR. This almost doubled the time spent caring for patients, and tripled the time needed to interpret tests and records. (Annals of Emergency Medicine, 2014).

Some of that extra time is spent with clunky interfaces and hide-n-go seeking for information that should be immediately available, such as arbitrary or unexpected presentations of data, e.g., having to find a patient’s history by clicking on her current room number, or lab reports that may be arranged by chronology, by reverse chronology, by the lab company, by the organ system, by who ordered them, or by some informal heading, such as “blood work” or “tests” or “labs.” Then there’s the constant box clicking (or what clinicians call “clickarrhea”). EHRs also send thousands of usually irrelevant alerts that desensitize doctors to legitimate clinical recommendations.
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Health Care Ux Design: Crucial But Conflicted

Apr 6, 2015• 5

By ANDY ORAM

The focus on design for health IT at the HxRefactored conference on March 31 raised several tough questions about the hazard-strewn path app developers must travel in that field. My sampling of introductory workshops and afternoon sessions (I unfortunately had the chance to attend only the first day of the two-day conference) brought up many fine design principles, but most of the presenters were general-purpose designers having limited experience in health care. Still, some important distinctions to recognize when entering health IT came up.

One factor making design is so difficult in health care is the vast variety of tasks health care professionals perform. If you’re designing an app to reserve a restaurant table or buy a sweater, how many pathways can a user take? Probably at most a dozen or two. Now think of a hospital ward: one patient whose heart has to be monitored constantly, another who needs regular injections, and yet another whose medication has put her in a delirium that leads her to jump out of bed and wander. Truly, the pathways that a doctor or nurse can take through the health care application verges on the infinite.

Processed Food Wars: Why the Stuff You Buy at Whole Foods May Be Cheaper Than You Think

Apr 6, 2015• 11

By JONATHAN S. FEIT

April 5, 2015, is Easter Sunday, the third day of Passover, and the four month-and-three day mark to the scheduled birth of my first baby (!!!). My wife and I won’t be finding out what we’re having because there are so few natural surprises in this world — why not enjoy the few that we can?

But I’m head-steaming angry today, even amid such beauty and hope for the future of my family, because on a tour of my own mother’s cupboard I found sample after sample of the substance that will be, I predict, the bane of Western health…and beyond, as the worst influences of our processed-food culture spread like a virus around the world to countries that lack or ability to medically intervene into the cardiac diseases and high cholesterol — what the Mayo Clinic calls a “double whammy” — that can be wrought by fake-food.

Let’s not be subtle; let’s name names: the culprits were cake mixes, soup and dip mixes, and even a matzo ball mix (my heart broke that such an innocuous, nostalgic treat could be putrid) sold and/or distributed under the Manischewitz and Goodman’s brands.

How Meaningful Use Stage 3 Got Patient Engagement Wrong

Apr 5, 2015• 4

By JOSEPH KVEDAR, MD

Criteria for Stage 3 of meaningful use of EHRs were released recently and there is lots of controversy, as would have been predicted. One set of recommendations that is raising eyebrows is around patient engagement.

The recommendations include three measures of engagement, and providers would have to report on all three of them, but successfully meet thresholds on two.

Following on the Stage 2 measure of getting patients to view, download, and transmit their personal health data, the Office of the National Coordinator (ONC) has proposed an increase from five to 25 percent.

The second measure requires that more than 35 percent of all patients seen by the provider or discharged from the hospital receive a secure message using the electronic health record’s (EHR) electronic messaging function or in response to a secure message sent by the patient (or the patient’s authorized representative).

The third measure calls for more than 15 percent of patients to contribute patient-generated health data or data from a non-clinical setting, to the EHR.

Radiologists vs. Mark Cuban on Don’t Ask / Don’t Tell

Apr 5, 2015• 72

By SAURABH JHA, MD

https://twitter.com/mcuban/status/583468799145349120

To his credit, Mark Cuban, engaged on Twitter in response to my post.

Mark, I’m sorry I had to leave Twitter abruptly. My wife threatened to kill me and then divorce me – in that order – if I didn’t get off Twitter instantly and get the groceries.

However, I caught the tail end of the Tweets. I’ll do my best to respond.

1. “Why is this contingency all radiologists?”

Mark wondered why everyone on a thread about overtesting were radiologists. It would be a great question if radiologists, who deal with testing, overtesting, limitations of testing, harms of testing, benefits of testing, appropriateness of testing, in other words the science of testing, would be offering advice on financial planning or offering the White House advice on their ISIS policy.

I can do no better than quote @jeffware.

“Exactly Mark – why are the Drs. who specialize in testing trying to explain the dangers of overtesting?”

That was a rhetorical question. But there are some entrepreneurial radiologists who are licking their lips at the epidemic of overtesting. I can hear them say “Mark and acolytes, bring it on.”

To wit, overtesting is better business for us. So our objection is not financially motivated. Let me make this even clearer. The more blood tests and genomic tests the “must prove that I’m healthy” brigade have, more $$$ for radiologists.

Learning From Our Interoperability Failures

Apr 3, 2015• 14

By FRED TROTTER

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.

A Business Proposal for Mark Cuban

Apr 3, 2015• 11

By SAURABH JHA, MD

Businessman and maverick, Mark Cuban recently opined “if you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health.” I’m unsure why he said quarterly, not weekly, daily or hourly. ‘

He further opined that this must be done to “create your own personal health profile and history. It will help you and create a base of knowledge for your children, their children, etc.” I assume etc. refers to grandchildren’s children.

I’m unclear what my grandchildren would gain from knowing my serum free testosterone levels in 2014. That’s a lot of data to enter in ancestry.com. For that matter, the size of my grandfather’s spleen in 1956 probably doesn’t affect the way I think about my mortality. That year he had a bout of Leishmaniasis, which, thankfully, isn’t a problem in Philadelphia.

Cuban further explained “a big failing of medicine = we wait till we are sick to have our blood tested and compare the results to “comparable demographics.”

An Epic Struggle for the Soul of Medicine

Apr 1, 2015• 32

By MARTIN SAMUELS, MD

This week I attended an all day “training” session in a new medical record system. I thought it was interesting that the experience was called “training,” which prompted me to remind myself of a few useful definitions.

Education, from the Latin root meaning a drawing forth, implies not so much the communication of knowledge as the discipline of the intellect; an intra-cerebral process aimed in large part at creating principles upon which new knowledge may be elaborated. Instruction is that part of education that furnishes the mind with knowledge. Teaching is often applied to practice as in “teaching a dog to do tricks.”

Training is an element of education in which the chief characteristic is exercise or practice for the purpose of imparting facility, as in “training for the marathon.” Breeding relates to manners and outward conduct as in “standing when elders enter a room is a sign of good breeding.” Regimentation is the prescription of a particular way of life or thinking usually involving the imposition of discipline. The term, arising from military regiment, is related to the medical usage of regimen, as in “the patient keeps his prescription medications in separate compartments of a plastic container in order to accurately adhere to his regimen.” Propaganda is the systematic propagation of a doctrine, cause or information reflecting the views and interests of those advocating such a doctrine or cause, as in “ACCME is propagating the view that elaborate re-certification maneuvers will improve the lives of patients.”

A cheerful instructor started the session by asking each of us to introduce ourselves and reveal a “secret guilty pleasure.” Mine is to create elaborate cocktails. If only I had had one of my famous Marty’s Beerjitos with me the whole experience could have been much more pleasant. In addition to the instructor, there were several “super-users” in the room to facilitate the process. It was immediately obvious to me that the super-users hovered behind my chair. These friendly young people had correctly identified me a “super-loser.” Had I been litigious I would have reported the experience to our ombudsperson as blatant ageism.

But, alas, they were correct. I was hopeless. Besides, I don’t believe in ombudspeople. I believe one should speak for oneself.

Will Independent Physicians Go Extinct?

Apr 1, 2015• 21

By RICHARD GUNDERMAN, MD and MATT ALBIN, MD

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.

HIT Newser: Big Win for Epic in San Diego

Apr 1, 2015• 5

By MICHELLE RONAN NOTEBOOM

Epic Scores Another Big Win

Scripps Health selects Epic to replace its existing GE Healthcare’s Centricity Enterprise (inpatient) and Allscripts Enterprise (outpatient). The San Diego-based Scripps includes five acute-care campuses, 26 outpatient clinics, and 2,600 affiliated physicians.

No doubt that this is one that Cerner had hoped to win.

Marlin Equity Partners Acquires e-MDs

Marlin Equity Partners acquires ambulatory EMR provider e-MDs. Marlin will merge e-MDs with its existing portfolio company MDeverywhere, a provider of RCM and credentialing services for physicians. e-MD founderContinue reading…