And in case you’d forgotten what the health care reform battle is really about, here’s video from Reuters about an open air clinic for the uninsured in Virginia…
Above the Fold
The Master and I agree on the goals
Writing in his blog in the NY Times, Uwe Reinhardt sets out three overarching goals of health reform
1. Financial barriers should not stand between Americans and preventive or acute health care that they sincerely believe will address concerns over a troubling medical condition, in a timely manner, before that condition grows into a critically serious illness.
2. Having received needed health care, no American family should be so financially devastated by medical bills that it cannot meet routine daily living expenses — for example, make utility or mortgage payments on time or finance the education of the family’s children.
3. The future growth in national health spending should be constrained to fall significantly below currently projected spending growth, which has the United States devoting about 40 percent of its G.D.P. to health care by mid-century.
All other goals are subordinate to these three overarching goals, as are the means to reach them.
Last week I posted a very similar “Two rules by which to judge a health reform bill”.
Rule 1 A health care reform bill needs to guarantee that no one should find themselves unable to get care simply because they cannot afford it. Neither should anyone find themselves financially compromised (or worse) because they have received care.
Rule 2 A health care reform bill needs to limit the amount of GDP that is going to health care to its current level, with an overall aim of reducing the share of health care going to GDP.
Uwe is a touch more eloquent in his goals 1 and 2 which split apart my Rule 1, and he’s a touch less aggressive in his goal 3, which is my Rule 2. But other than that these are the same.
Unfortunately in his column of the previous week Uwe created a list of 8 (but it could have been 20) completely contradictory statements about the completely “confused state” of what Americans seem to demand from health reform.
And right now the confusion seems to be winning.
A Practicing Doctor’s Prescription for Health Care Reform
By JORDAN SHLAIN
Our national healthcare system needs a ‘step-change’, not incremental change. We are facing a vast and complex problem. Let’s use it as an opportunity; rather than blaming our nation’s health problems solely on corporations, providers, insurers, or the government, let’s also think constructively about individual behavior and incentives.
Why do we stop at a red light? Why do we pay our grocery bill when we check out? Why are we compelled to ‘service’ our car when the red indicator light starts to flash? The simple answer is that if we don’t we know we will incur a penalty. Either we have to pay to get things fixed later, or we pay extra financial fees, or we get nasty looks from our neighbors.
A behavioral sociologist would offer a more complex answer: such contracts form the heart of a civic society. We behave in accordance with laws and a sense of civic duty (we abide traffic signals) because we understand that preserving the community is ultimately self-preserving. We act in ways consistent with financial incentives, or disincentives (we service our cars) because it is immediately self-preserving.Continue reading…
Dumb and Dumber
I can’t say that I’ve been fantastically impressed by the Democrats’ choice of this year to go after health reform, or their explanation of what it is. And I understand that the only interest of the Republicans is to destroy any political win in the hope that they get a repeat of 1994…although it is just possible that despite their confidence the voters also remember the 2000–2008 period which will also precede the 2010 election.
However, the amount of crap emanating from the right about what’s in the health bills and the evidence of that by what’s showing up in the “tea parties” now invading Democrat congressional members’ town halls is quite extraordinary and does require at least some notice.
Report Identifies Five Key Challenges to Health Information Exchange
The government’s $19 billion investment
in health information technology is a pivotal catalyst in our pursuit
of a smart, fully interconnected health information system. However,
as we wait for this investment to take root, there are several immediate
issues the Department of Health and Human Services and the Office of
the National Coordinator of HIT must address.
In a recent paper for the Federation
of American Hospitals, my Avalere colleagues and I distilled the following
five concrete issues that officials must tackle to ensure we create
an HIT infrastructure that fulfills its promise of improved access,
quality, and value.
Kamen: Healthcare Debate “Backward Looking”
Segway inventor Dean Kamen thinks the wonkish debate over healthcare reform in Washington is largely missing the point. In an interview with Popular Mechanics editor-in-chief James Meigs and deputy editor Jerry Beilinson, Kamen tells the magazine:
“We now live in a world where technology has triumphed, in many ways, over death. The problem with that is that it’s enormously expensive. And big pharmaceutical giants and big medical products companies have stopped working on stuff that could be extraordinary because they know they won’t be reimbursed, according to the common standards. We’re not only rationing today; we’re rationing our future. ““If you project forward these horrific costs of treating everybody and you want to assume we are not going to respond to that by making the therapies better, simpler and cheaper and in some cases completely wiping out the [diseases], well you know what? We might actually get to that situation—if we stop investing in technology, if we stop believing that the future ought to be better than the past. ““If somebody in this country wants to explain to me that we ought to be spending about twice as much supporting sports as on all of our pharmaceuticals, then stop spending.” “I think this debate shows a fundamental lack of vision, a lack of confidence, a lack of understanding of what’s possible.”
Commentology
Reader Murry Ferris writes in:
I am a 65 year old retired ad exec and also an insulin-dependent
diabetic. I have other medical complications, but taking care of the
diabetes is the big one.Every day I test my blood glucose
levels as many as ten times. A box of test strips retails for between
$40-$60 and lasts less than a week…. you do the math. In case you
were not aware, your glucose levels are in a state of constant flux
depending on your intake of food and exercise. Bottom line, keep your
levels, "level" and you'll lead a more normal life.Now with all the
talk about raising taxes to pay for the rising cost of health care I
hear absolutely no discussion about reining in the unjustified
increases of medical supplies and equipment. Just ten years ago I
could buy test strips for $10. Now they come in slick PVC canisters,
wrapped in four-color labels and packed in plush slick cardboard boxes
stuffed with layers of "instructions" and phony code strips. Remember
all you need do is stick your finger an put a drop of blood on the end
of the strip. How hard is that?So, for $2,600 a year I get to
stick my finger ten times daily, throw a pile of unread and expensive
packaging in the trash, and pay increasingly higher health care
costs.
Practice Fusion gets investment from Salesforce.com
By MATTHEW HOLT
We’ve been keeping tabs on Practice Fusion since the early days and THCB regulars will have noticed several comments and an article from CMO Robert Rowley. CEO Ryan Howard’s been hinting for a while that they were going to be getting into bed with a major software player, that shared their SaaS approach, and today they announced an investment from Salesforce.com, who we also know has been sniffing around health care too. This will include Practice Fusion becoming part of the Force.com (kind of an app store for the Salesforce.com ecosystem, although my guess is that few physicians are going there right now to look for records (not sure they’re going to Wal-mart either, though)
Practice Fusion is claiming that 19,000 users are already on its system which includes basic practice management, as well as a pretty complex EMR workflow. Coming soon will be a greater ability to share information with patients and other physicians over the platform—which allows it to spread via viral marketing. i.e. I’m referring you this patient, click here to get their data and sign up for this free EMR too. It’s not yet CCHIT certified, but Howard is aiming to be eligible for “meaningful use” money when the criteria are finally established.Continue reading…
Here’s how Navigenics Health Compass works, part 1
Here's part of the fun of working on health 2.0 projects–you get to try interesting stuff. Want to know how doing the spit for a Navigenics DNA test works? Here’s Health 2.0 star intern Lauren Verrilli (who we happen to share with Navigenics showing you how.
Click here to see it
Finally, A Reasonable Plan for Certification of EHR Technologies
A caution to readers: This post is about methods for certifying Electronic Health Record (EHR) technologies used by physicians, medical practices, and hospitals who hope to qualify for federal incentive payments under the so-called HITECH portion of the American Recovery and Reinvestment Act (ARRA). It may not be as critical as the larger health care reform effort or as entertaining as Sarah Palin, but it WILL matter to hundreds of thousands of physicians, influencing how difficult or easily those in small and medium size practices acquire health IT. And indirectly for the foreseeable future, it could affect millions of American patients, their ability to securely access their medical records, and the safety, quality, and the cost of medical care.
Three weeks ago, on July 14-15, 2009, the ONC’s Health IT Policy Committee held hearings in DC to review and consider changes to CCHIT’s current certification process. The Policy Committee is one of two panels formed to advise the new National Coordinator for Health IT, David Blumenthal. In a session that was a model of open-mindedness and balance, the Committee heard from all perspectives: vendors, standards organizations, physician groups, and many others.
And then, on July 16, they released their final recommendations on what is now referred to as “HHS Certification.” The effects of their recommendations – these are available online and should be read in their entirety to grasp their extent – are potentially monumental, and could very positively change health IT for the foreseeable future.
At the heart of these hearings was the issue of who will define the certification criteria and who will evaluate vendors’ products. Among many others, we have voiced concerns that the Certification Commission for Health Information Technology (CCHIT), the body currently contracted by HHS to perform EHR certification, has been partial to traditional health IT vendors in defining the certification criteria, and in the ways certification is carried out, and thereby able to inhibit innovation in this industry sector. Despite its leaders’ claims that the certification process has been developed using an open framework, CCHT’s obvious ties to the old guard IT vendors have created an overwhelming appearance of conflict of interest. That appearance has not been refuted by CCHIT’s resistance to and delays in implementing interoperability standards, or by its focus on features and functions over safety, security, and standards compliance.
In the hearings that led to the recommendations, longtime IT watchers were treated to some extraordinary commentary, much of which dramatically undermined CCHIT’s position.
“HHS Certification means that a system is able to achieve government requirements for security, privacy, and interoperability, and that the system would enable the Meaningful Use results that the government expects…HHS Certification is not intended to be viewed as a ‘seal of approval’ or an indication of the benefits of one system over another.”
In other words, as the definition of Meaningful Use is now tied to specific quality and safety improvements and cost savings that result from health IT — among them e-Prescribing, quality and cost reporting, data exchange for care coordination, and patient access to summary health data — HHS Certification will closely follow. Rather than pertain to an EHR’s long list of features and functions, some of which have nothing to do with Meaningful Use, certification will be focused on each IT system’s ability to enable practices and hospitals to collect, store, and exchange health data securely.
Who Determines the Certification Criteria
The Office of the National Coordinator – not CCHIT – would determine certification criteria, which “should be limited to the minimum set of criteria that are necessary to: (a) meet the functional requirements of the statute, and (b) achieve the Meaningful Use Objectives.” As regulator, funder for this project, and a major purchaser of health services, the government, not users or vendors, will now determine HHS’ Certification criteria.
A New Emphasis on Interoperability
“Criteria on functions/features should be high level; however, criteria on interoperability should be more explicit.” That is, functions/features criteria will be broadly defined, but there will be a greater focus in the future on the specifics associated with bringing about straightforward data exchange.
Multiple Certifying Organizations
ONC would develop an accreditation process and select an organization to accredit certifying organizations, then allow multiple organizations to perform certification testing. In other words, the Committee recommended that CCHIT’s monopoly end.
Third Party Validation
The “Validation” process would be redefined to prove that an EHR technology properly implemented and used by physician or hospital can perform the requirements of Meaningful Use. Self-attestation, along with reporting and audits performed by a Third Party, could be used to monitor the validation program.
Broader Interpretation of HHS Certification
HHS Certification would be broadly interpreted to include open source, modular, and non-vendor EHR and PHR technologies and their components.
These bold, forward-thinking proposals from the HIT Policy Committee have not been accepted yet. But in our opinion they should be. These measures would encourage new technologies to enter the market for physician medical practices seeking EHR technology, and wrest control away from the legacy health IT vendors that have maintained barriers and delayed adoption, so you can be sure that the old guard players are doing everything possible to have them rejected.
But these are hugely progressive steps in the right direction, toward allowing HIT to enable improvements in care and cost efficiencies that would be in the best interests of users and the public at large. If implemented, the changes recommended by the HIT Policy Committee would create greater choice, more standardization, lower price, less interruption of the practices — as well as a check from CMS or Medicaid each year to help smooth the implementation, starting in 2011.
David C. Kibbe MD MBA is a Family Physician and Senior Advisor to the American Academy of Family Physicians who consults on health care professional and consumer technologies. Brian Klepper PhD is a health care market analyst. Their collected collaborative columns may be found here.
