The recent history of electronic medical records in ambulatory care, or what we now call EHR (electronic health record) technology, can be divided roughly into three phases. Phase I, which lasted approximately 20 years, from about 1980 to the early 2000’s, was an era of exploration and early adaptation of computers to outpatient medicine. It coincided with the availability of PCs that were cheap enough to be owned by many doctors, and with the increased capacity of off-the-shelf software programs, mainly spreadsheet and database management systems such as Lotus, Excel, Access, and Microsoft’s SQL, to lend themselves to computerized capture of health data and information. Phase II coincided roughly with the American Academy of Family Physician’s (AAFP’s) commitment to health IT as a core competency of the organization, and with its support/promotion of the early commercial vendors in the Partners for Patients program, a national educational campaign inaugurated in 2002 which involved joint venturing with vendors that included Practice Partners, MedicaLogic, eClinicalWorks, and eMDs, among others. Several other physician membership organizations joined this effort to popularize EMRs, or crafted their own education programs for their members based on the AAFP’s model. The most popular Phase II products were, and still are for the most part, client-server software applications that run on local networks and PCs within the four walls of a practice, and tend to use very similar programming development tools, back-end databases, and support for peripherals such as printers. The industry grew, albeit sluggishly, from roughly 2002-present in an unregulated environment, with increasing support from quasi-official industry groups like HIMSS and CCHIT, and with the blessing of many professional organizations, including the AAFP, ACP, AOA, and the AAP. Best estimates are that the numbers of physicians using EHR technology from a commercial vendor roughly tripled during this period, from about 5% of physicians to about 15%. The Bush administration gave moral support to the industry, but did not provide funding or payment incentives, and mostly left the industry to itself to sort out the rules, including certification. The industry is now entering a new phase, one we predict will significantly depart from the previous two eras.Continue reading…
Above the Fold
What’s Next? Follow the Money
By ROBERT LASZEWSKI
With the passage of the Senate Finance bill the health care effort now moves to a critical stage with the Senate Majority Leader and the House Speaker now clearly in charge. The more important effort will be Reid’s. Pelosi’s final product will be more predictable (very liberal) but Reid’s will have to be more practical. Every inch Reid moves away from the more moderate Baucus bill will cause problems.
The big issue is going to be money—just whose taxes are going to get raised to the tune of $500 billion to pay for it.
The Senate Finance bill has the $211 billion “Cadillac” benefits tax. Dead on arrival. No way the party that put the unions ahead of the Chrysler bondholders is going to cross their traditional allies on this one. The $40 billion tax on medical device makers is also under pressure and likely to at least shrink.Continue reading…
Why is this the one thing?
By JOE FLOWER
When the terrorist attacks of 9/11 hit the United States, and then suddenly we were plunged into war, first in Afghanistan and then in Iraq, I don’t remember anyone demanding that the wars be “deficit neutral.” No one talked about whether we could afford them. They were things we just had to do.
When George W. Bush proposed giving vast sums to rich people in the form of tax cuts, no one argued that it would be “deficit neutral.” Rather, it was argued that cutting taxes wouldn’t bring in less tax revenue at all, it would bring us more tax revenue, because the economy would grow so much faster. And besides, it was somehow terribly urgent, something we just had to do.
When the banks tottered and needed to be shored up with taxpayer money to the tune of nearly $1 trillion, there was no way to argue this would be “deficit neutral.” We might get the money back, we might not. Whether we could afford it was not the question, we just had to do it to save the banking system. Similarly, the “Stimulus Bill” was terribly urgent, and something we just had to do, whether we could afford it or not.Continue reading…
Will We Get a Health Care Bill in 2009?
It’s decision time. The Congress will or won’t pass a major health care bill during the next few weeks.Will we get health care reform in 2009?Almost certainly not. As I have been saying for months, if we get a bill it will be more a trillion dollar entitlement expansion funded by relatively minor provider cuts and about $500 billion in tax increases.
That is not health care reform.Will we get that trillion-dollar entitlement expansion health care bill?That outcome lies in the coming convergence on Capitol Hill of three extraordinarily powerful, and contradictory, forces.
Physician Accountability for Violation of Safety Rules: The Time For Excuses Has Passed
In a recent New England Journal, Peter Pronovost and I make the case for striking a new balance between “no blame” and accountability. Come on folks, it’s time.
At most hospitals, hand hygiene rates hover between 30-70%, and it’s a near-miracle when they top 80%. When I ask people how they’re working to improve their rates, the invariable answer is “we’re trying to fix the system.”
Now, don’t get me wrong. I believe that our focus on dysfunctional systems is responsible for much of our progress in safety and quality over the past decade. We now understand that most errors are committed by good, well-intentioned caregivers, and that shaming, suing, or shooting them can’t fix the fallibility of the human condition.Continue reading…
Ur Doin It Wrong
By CINDY THROOP
Susannah Fox aptly illustrated what is happening in health care during the ‘The Patient Is In’ panel of the Health 2.0 conference with some amusing LOLCat pictures captioned “ur doin it wrong.” Put simply, when it comes to involving patients in health care and health information technology, chances are, ur doin it wrong.
When I was at the Fall 2008 Health 2.0 conference a year ago, someone asked me, “where are the patients?” Well, I didn’t see any there, but without a doubt, patients made their debut at the Spring 2009 Health 2.0 conference in Boston. When ePatient Dave spoke to the audience from the balcony, it represented a symbolic shift in health care. So, is the Health 2.0 conference doin it wrong? I don’t think so. Is there room for improvement? Sure.
As Trisha Torrey noted during the patient panel, while it’s nice that patients had their own panel, patients should be on every panel. Good point and well said! I do, however, think it is important to acknowledge that the Health 2.0 conference did a great job and has set a new standard for patient participation.
Months of preparation and work went into a video project documenting patients’ use of and experimentation with Health 2.0 services to manage their health. Thank you to Indu Subaiya and Lizzie Dunklee for truly putting patients at the center of Health 2.0 with that project. It will be interesting to see how upcoming conferences, especially those that claim to be about patients, measure up.
If you are curious about the patient revolution (you’ve only seen the tip of the iceberg), read Sarah Greene’s e-patients.net post: Participatory Medicine as Revolution! Think Critically! Communicate! Revolution is not about marketing hype and conferences with the word “patient” or “ePatient” in the conference name.
The days of 1.0 medicine and health care are over. Things will never be the same. You can join the revolution or get left behind. Kudos to the Health 2.0 team for supporting the patient revolution in health information technology.
Cindy Throop is a University of Michigan-trained social science researcher specializing in social policy and evaluation. She is one of the few social workers who can program in SAS, SPSS, SQL, VBA, and Perl. She provides research, data, and project management expertise to projects on various topics, including social welfare, education, and health. www.cindythroop.com
Obama Administration CTO Aneesh Chopra at Health 2.0
Shutting Down Social Media? Not Here.
By
Paul Levy is the President and CEO of Beth Israel Deconess Medical Center in Boston. He blogs about his experiences at Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive and where this post first appeared.
The following email message was broadcast last week in a Boston hospital. Of course, you can guess my view of this: Any form of communication (even conversations in the elevator!) can violate important privacy rules, but limiting people’s access to social media in the workplace will mainly inhibit the growth of community and discourage useful information sharing. It also creates a generational gap, in that Facebook, in particular, is often the medium of choice for people of a certain age. I often get many useful suggestions from staff in their 20’s and 30’s who tend not to use email. Finally, consider the cost of building and using tools that attempt to “track utilization and monitor content.” Not worth the effort, I say.Continue reading…
Op-Ed: Our Misplaced Faith in High-Tech Medicine
By MERRILL GOOZNER
The following essay appeared on the website of the Hastings Center, which is running a colloquium on the values behind health care reform.
“One could make a good case that improvements in education and job creation could be a better use of limited funds than better medical care.” – Daniel Callahan, “Medical Progress: Unintended Consequences”
The president emeritus of the Hastings Center opens his insightful essay with the observation that the American people’s faith in medical progress is boundless. In this short comment, I want to expand on his thoughts by reexamining the cardinal tenets of that faith, since they embody a set of values that distract us from building a society that promotes good health, an infinitely more difficult task than building a better sick care system.Continue reading…
Around the Web in 60 Seconds: Health 2.0 San Francisco
All Things Digital "Keas' Adam Bosworth speaks about new health care startup" by Kara Swisher
Fast Company "The Future of Healthcare is Social" Forbes "Must Read Health Blogs"
Official Google Blog "Fall update on Google Health"
NY Times.com "A White House Message to Healthcare Start Ups"
NY Times.com "Startups Aim to Transform Visits to the Doctor"
TechCrunch "Google Health signs 2 insurers. Only has 267 to go"
VentureBeat "Two Dozen of the Most Innovative Healthcare Apps"
VentureBeat "Will Health 2.0 startups usher in consumer-driven healthcare?"
iHealthbeat "FDA's growing role regulating Health 2.0, Health IT" by George Lauer
iHealthbeat "Federal CTO: Health 2.0 'Key Pillar' of Health Care Innovation"
American Public Media / Marketplace "Health care Meets and Greets Health 2.0"
Reuters "Kaiser Permanente joins Health 2.0 accelerator"
Eliza "Eliza Has Quite a Happening at Health 2.0"
