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Tie Meaningful Use Definition to Desired Behavior

May 8, 2009• 7

By ANONYMOUS

Last week’s NCVHS hearings on meaningful use highlighted the growing disconnect between the change that many hope to see health IT support in our healthcare system and the emerging definition of “meaningful use.”

Improving our healthcare system will require much more than paying clinicians to implement health IT systems (certified or otherwise) or report clinical outcome measures. It will require incorporation of health IT into the daily processes of care delivery…as well as changes in clinician behavior.

I propose a definition of meaningful use, especially for the small physician practices that deliver that deliver most care, that is tightly linked with the changes in behavior that will be necessary for actual improving the quality, safety, and coordination of care.

First, the initial requirements for meaningful use should require both the implementation of a “certified” EHR and the “certification” by the appropriate regional extension service that the practice has considered process redesign issues in implementing and using its system. While this will require extensive interaction of practices with the forthcoming extension services (funded as part of ARRA), it will drive clinicians to available resources and encourage the kinds of process redesign changes necessary for improving care processes.

An Open Letter to the New National Coordinator for Health IT: Part 3 — Certification As The Elephant in Health IT’s Living Room

May 8, 2009• 22

By DAVID C. KIBBE and BRIAN KLEPPER

6a00d8341c909d53ef01157012476e970b-pi In the first and second parts of this series we talked about how and why there is no universal definition for the term “EHR.” Instead there is a legitimate, growing debate about the features and functions that “EHR technologies” should offer physicians seeking to qualify for HITECH incentive payments. We explored the layers of network technology, suggesting that federal regulators should “separate the data from the applications.”

We also argued that there is much to learn from development platforms, recently and in the distant past, that have used standards to open the aperture of innovation. The best of these standards have reflected the experience of what works rather than specifying how to make it work. Defining the standards for data, devices, and network technologies too restrictively could choke off innovation, rendering HITECH’s offerings whose expense and complexity are a barrier to, rather than an incentive for, adoption by physicians. Incoming National Coordinator for HIT David Blumenthal, MD seems to have been considering just this concern when he recently wrote:“… [M]any certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT.”

Project HealthDesign and Health 2.0 Accelerator

May 8, 2009• 4

By AARON APODACA and JULIE MURCHINSON

Round 2 of Project HealthDesign, funded by the Robert Wood Johnson Foundation, builds on a key learning from round 1: people live with and manage their health every day, not in discrete and separate episodes. This may seem like an obvious realization to some; but the “traditional” health care system most of us use is not really designed with this in mind. Our system is getting better at enabling patients to do things such as view a version of their electronic medical record or lab results online and automate appointment scheduling or payments. And yet, most of this progress is still limited to clinical and administrative data that is generated based on episodes of care and limited to the institutional medical record. This is where “observations in daily living” (ODLs) come in. Project HealthDesign defines ODLs as “personal clues to health that might include sleep patterns, diet, exercise, mood and medication adherence, all of which are critically important to health but not collected in a clinical setting.” By understanding ODLs, patients can be empowered to create a more meaningful portrait of their health, to shape daily health decisions and facilitate better health.

RFID EMR Pioneer Says “RIP”

May 8, 2009• 21

By MICHAEL MILLENSON Verichip_tiny

When Harvard Medical School and CareGroup CIO Dr. John Halamka agreed to place his medical information on an RFID chip and have it implanted it in his arm, he triggered an instant global spotlight on this unusual form of portable electronic medical record. The decision, made in December 2004 and disclosed in early 2005, captured worldwide attention from places a diverse as Fox News, the BBC and the New England Journal of Medicine (where Halamka contributed a commentary ).

As recently as 2007, a debate over chip privacy and safety versus having critical medical data instantly at hand (as it were) was featured in a PLoS Medicine exchange. In it, Halamka asserted, “Implantation of RFID devices is one tool, appropriate for some patients based on their personal analysis of risks and benefits, that can empower patients by serving as a source of identity and a link to a personal health record when the patient cannot otherwise communicate.”

Two years later, Halamka’s chip remains under his skin but he’s ready to turn over the idea that he’s a trendsetter to the undertaker. The technology “has been adopted by no one,” Halamka told me at a meeting on Patient-Centered Computing sponsored by Partners HealthCare’s Center on Information Technology Leadership. “As a technology it’s dead. Use the network, use the cloud to store your personal health records. Or in a pinch, use a USB drive. But the implanted RFID chip is not as a society where we’re going.”

Defining “Meaningful Use” of Health IT

May 8, 2009• 7

By STEVE BELLER

The federal government’s $20 billion stimulus programs for health IT (HIT) is on its way. Called Hitech—for Health Information Technology for Economic and Clinical Health Act—it will fund the development of innovative HIT and use a “carrot & stick” financial approach to encourage clinicians to use HIT in meaningful ways. A debate now raging is how to define “meaningful use.”¹

A Definition

Meaningful use, to me, means using HIT in ways that are of great value to the patient and other healthcare consumers. It doesn’t matter what types of software tools are used, what communication infrastructure is used, what standards are used, or what certifications are used. It just means that the using HIT should result in ever more effective and efficient (i.e., ever greater value) care delivery.

Increasing care value is unlikely unless clinicians obtain information and guidance assisting them in answering difficult questions, making tough diagnostic and treatment decisions, collaborating effectively, and taking competent action. In addition, healthcare consumers (patients, clients, customers, etc.) would benefit from assistance in selecting the most cost-effective treatment options for existing conditions, and in managing their own health in ways that prevent illness, control chronic conditions, and increase their wellbeing.

MedicExchange

May 7, 2009

MedicExchange does product reviews for radiology and HIT products. We have a thriving community of 50,000 decision makers who use the site to network, read customer reviews and research products for RFP’s. We are bringing transparency to the industry and trying to minimize ‘buyer confusion’ with a goal to help buyers make the right decisions. Our product showcase platform offers vendors and manufacturers a unique way to show off their products by using video, instant messaging and other tools to communicate with buyers and existing customers. We really think we are onto something but we want to hear what you think, register for free on www.medicexchange.com and network and research products with other decision makers.

The Health IT Stimulus and FQHCs — Don’t Forget About Us!

May 7, 2009• 5

By JAMES KAHN

James Kahn There is a critical element in the American Recovery and Reinvestment Act (ARRA) that targets funds for Federally-Qualified Community Health Centers (FQHCs). An FQHC is an organization defined by the Medicare and Medicaid statutes that receives funding under Section 330 of the Public Health Service Act. FQHCs provide primary care services for all age groups and provide preventive health services on site to some of the country's most vulnerable populations, and they are an important part of this country's primary care delivery system. Among services that FQHCs must provide directly (or by arrangement with another provider) include: dental services, mental health and substance abuse services, transportation services necessary for adequate patient care, hospital and specialty care. There are more than 16 million Americans who are served by FQHCs.

Op-Ed: Cost-Reduction Strategies Help Hospitals Weather Economic Uncertainty

May 6, 2009• 3

By DAVID MARKOSKI

David Markoski In today’s current economic climate, many hospitals are reducing staff to cut costs and balance their budgets. An even greater number are trying to reduce administrative costs to save money for the difficult days ahead and retain their employees.While reducing staff may help the bottom line, it may threaten a hospital’s long-term success by jeopardizing quality patient care and its reputation. Cutting non-salary costs, meanwhile, may save as much—or more—while kick-starting organizational recovery when the economy improves. Since these cost reductions do not compromise patient care or the level of support hospitals provide to their physicians, they create long-term efficiencies that will serve the hospitals into the future.Employee compensation accounts for the single largest item on a hospital’s budget, but the aggregated costs of goods and services are greater. These costs represent dozens of money-saving opportunities—from supply chain management and physician-preference items to service contracts and pharmacy—that can impact the bottom line without affecting patient care.

Jonathan Teich, CMIO, Elsevier

May 5, 2009• 1

By MATTHEW HOLT

Jonathan Teich, CMIO of Elsevier discusses the role of decision support in health care. Jim Lederer from Novant Health, a hospital system in North Carolina sits in on the interview and adds his perspective.

Andy Hurd, CEO, CareFx

May 4, 2009

By MATTHEW HOLT

Matthew is away in Peru sampling the delights
of the Andes this week. He had a very busy month with conferences
in Hawaii, HIMSS in Chicago, WHCC in Washington DC, and of course
Health 2.0 Meets Ix in Boston. Lots and lots of video was taken during
all those trips, and we gnomes back at THCB are taking the opportunity
to show you some of it. This week we're presenting all the interviews Matthew had at HIMSS in Chicago that haven't already been shown.

Andy Hurd, CEO, CareFx, talks about his company, which provides a way
of viewing disparate systems, by sharing views into different hospital
departmental systems quickly and relatively cheaply. It's a fix for the
messy "different systems don't talk to each other" problem, and it's
catching on in the big hospital market, with explosive growth last year.