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New AHRQ-Funded Report Provides Snapshot of Electronic Health Record (EHR) Vendor Usability Processes and Practices

May 28, 2010• 15

By MATT QUINN, Special Expert, Health IT, Agency for Healthcare Research and Quality

The usability of EHR systems, while recognized as a critical factor in the successful adoption, safe and effective use of these systems, has not historically received the same level of attention as software features, functions and technical requirements. In recognition of the importance of this issue, the Agency for Healthcare Research and Quality (AHRQ) initiated a series of research activities focused on assessing and improving the state of usability in Electronic Health Record (EHR) systems.

Based on a research gap identified by a multi-disciplinary expert panel formed to recommend and prioritize research and policy actions in this area, AHRQ funded a follow-on project to gain insight into the processes and practices that certified EHR vendors employ during different phases of the product development to make their products usable.

Specifically, AHRQ contracted with James Bell Associates and the Altarum Institute to conduct a series of structured discussions with selected certified EHR vendors to understand their processes and practices with regard to:

One Big Little Change

May 27, 2010• 4

By ROB LAMBERTS, MD

It’s just plain stupid.

Why does the government not allow patients with Medicare part D to use pharmaceutical discount cards? What is the ethical rule broken by making the government pay less? What is the legal reason that the elderly should be prevented from saving money?

I know there are probably reasons having to do with discounts not being allowed that are not extended to all Medicare participants, but isn’t that a little silly? As long as the discount is available to all Medicare participants, why can’t they receive help from the pharmaceutical industry.

I do my best to prescribe the cheapest medications possible. I love the $4 list at Wal-Mart et. al., and I try to never use a brand when a generic would do the trick. But there are times where I have no choice. These newer drugs are sometimes the only choice we have to help control their blood pressure, diabetes, or pain. Without these drugs, we end up with worse blood pressure, worse diabetes, and more pain. What do you think is the consequence of that? More people:

Develop complications of chronic disease poorly controlled.
Are hospitalized for these complications.
Visit the doctor for management and/or treatment.
Have pain.Continue reading…

We’re getting so excited (and Todd Park always is)…about DC

May 27, 2010• 4

By Matthew Holt

The next ten days are going to be very very exciting. It all culminates in Health 2.0 Goes to Washington on June 7 (Monday). But there’s lots leading up to that which is very important for the whole Health 2.0 community and anyone interested in innovation in health care.

Yesterday at Gov 2.0, Sunlight Labs’ Clay Johnson announced the winners of the Design for America challenge. The Visualizing Community Health Data prize (in conjunction with the Community Health Data Initiative) was won by County Sin Rankings and it’s great—even thought THCB/Health 2.0 favorite Regina Holiday’s painting will be the winner in our hearts (and gets a special mention in the announcement blog)

Apples

Today at Gov 2.0 Todd Park is talking at 3pm EST, 12pm PST, and it’s being livestreamed here (have to sign up). Watch for a very interesting pre-announcement about the next iteration of developers. And if you tune in 10 minutes earlier you’ll see Jay Parkinson too. Comparing Todd & Jay’s visible enthusiasm levels will be fun!

Shining a Light on Conflict of Interest in Biomedical Research

May 27, 2010• 2

By NAOMI FREUNDLICH

Last week Francis Collins, the director of the National Institutes of Health proposed important new rule changes for federally-funded investigators that are designed to increase transparency and remove many of the conflicts of interest that abound in biomedical research.

The proposed NIH rules, which are open for comment and expected to go into effect before the end of the year, represent the first time financial reporting requirements have been overhauled since 1995. The rules require investigators to disclose to their institutions all payments they receive from industry above $5,000, as well as any equity position they hold in a company. Research funding, speaking fees, paid authorship and travel expenses all must be part of this accounting. The previous limit was $10,000. The new regulations, which are aimed at reducing or removing industry bias from academic research, also require the academic medical centers to come up with a plan to manage investigator’s conflicts of interest—for example, university officials might insist that an investigator sell stock he owns in a company that helps pay for his research. Institutions will also be required to post all relevant payments (along with names of individual investigators) on a public website.

10 Rules for Good Medicine

May 27, 2010• 38

By ROB LAMBERTS, MD

The recent discussion of the appropriateness of bringing patients back to the office has really gotten me thinking about my overall philosophy of practice. What are the rules that govern my time in the office with patients? What determines when I see people, what I order, and what I prescribe? What constitutes “good care” in my practice?

So I decided to make some rules that guide what I think a doctor should be doing in the exam room with the patient. They are as much for my patients as they are for me, but I think thinking this out will give clarity in the process.

Rule 1: It’s the Patient’s Visit

The visit is for the patient’s health, not the doctor’s income or ego. This means three things:

All medical decisions should be made for what is in their interest, including: when they should come in, what medications they are given, what tests are ordered, and what consults are made.
Patients who request things that are harmful to themselves should be denied. People who ask for addictive drugs or unnecessary tests should not get them. Patients who are doing harmful things to themselves should be warned, but only in a way that is helpful, not judgmental.
All tests done on the patient should be reported to them in a way that they can understand.

An Open Letter to Senator Scott Brown

May 27, 2010• 4

By PAUL LEVY

Dear Scott,

I understand the Senate confirmation process in Washington, DC, and how the appointment of individuals
gets hung up for a variety of political reasons. I don’t particularly like it, but I understand it.

But I don’t understand how with regard to the appointment of Don Berwick as head of CMS, the Medicare agency, this can be the case, as reported recently in the Boston Globe:

Senator Scott Brown, a Massachusetts Republican, has not decided how he will vote, a spokesman said.

That Don Berwick is an internationally renowned expert in health care delivery is not in doubt. That he is an honest, hard-working, and thoughtful person is also clear to the thousands of people in the health care professions with whom he has worked. That his primary focus has always been on reducing harm and medical errors is likewise the case. He is also interested in reducing costs in the health care delivery system when such costs represent waste and inefficiency.

Scott, the issue here is not whether the recently passed health care bill was right or wrong for the country. I respect your opinion on that matter. But that vote has been taken.

In Defense of Paul Levy

May 26, 2010• 20

By ROBERT WACHTER

Paul Levy, the blogging CEO of Boston’s Beth Israel Deaconess Medical Center, found himself in hot water last

month over an inappropriate relationship with a female subordinate. While some of the details of the transgression remain sketchy, I think I now know enough to opine on it. To my mind, Paul has been an extraordinary healthcare leader, and – while the episode represents a lapse in judgment that deserves censure – he should not lose his job.

Let’s start with some background. Paul took the helm of BIDMC 8 years ago. At the time, the hospital – which operates in the shadow of its more storied Harvard cousins, Brigham and Mass General – was in crisis: its staff was dispirited, it was losing a million dollar a week, and it was still reeling from the challenges of blending the cultures of its two recently merged progenitor hospitals, Beth Israel and Deaconess. (Hint: the religious mismatch was only the start of the tsuris.)

Paul was an unusual choice for the position of CEO. BIDMC CEOs have historically been physician-leaders, whereas Paul’s major prior roles had been to teach Environmental Policy at MIT and to lead the Massachusetts Water Resources Board, where he spearheaded the cleanup of Boston Harbor. Some folks wondered whether he was up to the task of being CEO.

Is HITECH Working? #7: Where’s Plan B? Congress and ONC need to address major flaws in HITECH

May 26, 2010• 4

By VINCE KURAITIS JD, MBA and DAVID C. KIBBE MD, MBA

Pop quiz: Among early-stage companies that are successful, what percentage are successful with the initial business model with which they started (Plan A) vs. a secondary business model (Plan B)?

Harvard Business School Professor Clay Christensen studied this issue. He found that among successful companies, only 7% succeeded with their initial business model, while 93% evolved into a different business model.

So let’s take this finding and reexamine our human nature. In light of these statistics, what makes more sense:

Defending Plan A to your dying breath?
Assuming Plan A is probably flawed, and anticipating the need for Plan B without getting defensive?

We question many of the assumptions underlying HITECH Plan A. We also want to talk about the need and content for Plan B in a constructive way.

In this essay we’ll discuss:

1) The Need for HITECH Plan B

2) Questioning Assumptions — Issues to Reconsider in Plan B

a) Rewarding Incremental Progress
b) Addressing Root Causes for Non-adoption of EHR Technology
c) Questioning Health Information Exchanges (HIEs) as Building Blocks for the Nationwide Health Information Network (NHIN)
d) Catalyzing Movement Toward Modular EHR Technology
e) Focusing Incentives on High Leverage Physicians
f) Recalibrating Expectations for EHR Technology Adoption
g) Getting Bang-for-the-Buck in Achieving Meaningful Use Objectives
h) Comprehensively Revamping Privacy/Security Laws vs. Tweaking HIPAA
i) Maximizing Sync Between HITECH and PPACA
j) Leveraging Potential for Patient-Driven Disruptive Innovation
k) Promoting EHR Adoption Beyond Hospitals and Physicians, e.g., long-term care, home health, behavioral health, etc.
l) Dumping CertificationContinue reading…

Alexandra Drane, fabulous, poacher, with PODCAST

May 25, 2010• 4

By Matthew Holt

One of my favorite people has the (first of) her (several) 15 minutes of fame in the NY Times today. Alex Drane tells all about growing a small business into a pretty big one (although it’s in the NY Times art of running a small business section as I guess Eliza isn’t General Motors). Most interesting thing they print is that she recruited her team by stealing them from her competitors. Her technique was to call them up and ask the person they wanted if anyone they knew needed a new job! And apparently she wants all her employees to leave and run their company (or maybe she was misquoted!)

But don’t forget that besides her day job Alex is the force behind Engage with Grace which she’s taking to TedMed this Fall (yes we know the TedMedsters are two years behind Health 2.0, but we’ll forgive them in this case).

But most importantly, look at that smile….

ATT00002

And you’ll see Alex at Health 2.0 Goes to Washington if we can just wrestle her to get her demo in order later this week!

CODA–And as an added bonus I got to record a podcast with Alex this very afternoon! (Click on the dark bar below and it turns into a player)

Alex Drane interview

Commentology: Is This the Future of Insurance Negotiations?

May 25, 2010• 1

Names withheld to protect the innocent.

Dear Patient:

You may have read
recent media
coverage concerning contract negotiations between XXXX Insurance
Company and XXXX Healthcare Group. First, on behalf
of XXXX
Healthcare Group, our hospitals and our physicians, I would like
to
apologize that you heard this information via the media and not from us.
We
were very surprised XXXX Insurance
Company contacted the press about the negotiations because when XXXX
released its media communications,
we hadn’t even had a face to face discussion about the contract
proposals. Most
contract negotiations include actual “negotiating” to arrive at
reasonable
terms, but it appears XXXX Insurance
Company preferred to start things off by pressuring patients to end
their
existing relationships with family physicians and local hospitals.

We believe XXXX Insurance
Company’s approach of distorting the facts and
misleading the public instead of negotiating a reasonable contract is an
attempt to deflect attention from XXXX Insurance
Company’s overall plan to increase their profits. It’s a negotiating
tactic we
feel is designed more to frighten patients than resolve differences.

We want to give our
patients as
much information as we can to help them navigate this situation. First,
you
should be aware that XXXX Insurance
Company is required by law to notify you by June 1, 2010 that the
contract may
terminate on July 1, 2010 and XXXX Insurance
Company may even advise you to select a new in-network physician. Your
letter
should arrive any day but your coverage with XXXX Insurance
Company remains unchanged today.

However, that
letter does
not mean you must change your physician. We understand how important it is for you to maintain a relationship
with a
physician you trust and knows about your health. That is why our
existing contract
allows patients and employers to request XXXX
Insurance Company to keep the doctors and facilities in-network for one
year or
until the employee’s subscriber contract anniversary date, whichever
date is
earlier should we not have a new contract in place by July 1.

We encourage patients
and their
employers to write to XXXX Insurance
Company today and request they keep XXXX Healthcare
Group doctors and facilities
in-network and to continue to negotiate a fair contract.

XXXX Insurance Company has
alleged XXXX Healthcare Group’s costs are higher
than
state and national averages. We disagree with this statement and
challenge
their data. We monitor the cost of care very closely through independent
actuaries used by many of the largest payors in the country and know
that our
commercial reimbursement is comparable to other healthcare providers
across the
state. We asked XXXX Insurance
Company to substantiate its data, which is based on its own company
information, but they have ignored our request.

In the last two years XXXX
Insurance Company earned $2.6
billion in profits. In contrast, XXXX Healthcare
Group has made $10 million in net
income in the last two years while also providing $222 million in
charity care
for patients who were uninsured. While XXXX
Insurance Company wants to argue they are fighting for their members,
it’s
clear they are looking for ways to prepare for healthcare insurance
reform
while still maintaining their profits for shareholders. One of those
ways is to
squeeze hospitals and physician clinics that are already operating on
very slim
margins.

Even though the
negotiations
have started rather unpleasantly, we will work in good faith to come to
terms
with XXXX Insurance Company so you
can continue to have XXXX Healthcare Group
physicians and hospitals as
an option for your care.

If you have any
questions
concerning this situation you can call us at xxx-xxx-xxxx.

Sincerely,