Ten plus years ago, I was giving talks suggesting that at some point relatively soon the EMR was going to become a reality. In 1999, at Harris Interactive I actually got the chance to launch a study which I hoped was going to soon show a relatively steep growth in EMR use in physicians’ practices. (The study was called Computing in the Physician’s Practice). Sadly because the study wasn’t a huge financial success and because I wandered off to do other things, it was only fielded in late 1999 and early 2001.
Above the Fold
Dispatches from IHI’s quality forum
By 
Don Berwick is one of the leading lights of the health care quality world; an
oft-quoted and published visionary who founded the Institute for Healthcare Improvement to spread the gospel of transformation and improvement around the world. Sometimes, however, he can come across as messianic, especially when preaching to the choir in a setting like the IHI Forum, which took place last week in Nashville.
Some criticize Berwick and IHI for a lack of measurable outcomes for the interventions they preach. The most recent complaint like this concerns IHI’s 5 Million Lives campaign, which recommended that hospitals adopt a series of interventions to improve patient safety, promising that if they did so, 5 million patients would be saved.
The campaign officially ended at this week’s conference, and no one at IHI can show data on the number of lives saved. It’s true that Berwick has a powerful voice and a broad platform, and he could use it to structure the work that needs to be done, rather than sticking to a combination of inspirational cheerleading and emotional appeal. But back when no one was thinking about quality, Berwick was championing it; and for some community hospital quality leaders who feel like they are the lone voice in the wilderness, his words keep them going all throughout the year.
Health Wonk Review. Vince K Drag-net’s it in
Health Wonk Review: The Just the Facts, Ma’am Edition.
Superbly done, even if I never saw the TV show.
Slicing the health reform pie
I doubt anyone would disagree with the statement that America’s health care costs are too high, continue to grow at an unsustainable rate, and reform is critical to control costs, get everyone covered, and improve quality.
In the wake of the election, I see one positive and magnanimous press release after another coming from the health care special interests. The press is full of daily stories touting the coming health care reform efforts as different this time. The stakeholders understand things are different, know we have to do something, and are ready to cooperate, goes the reasoning. Really?
Shifting costs from public to private payers
The other day, the American Hospital Association, the Blue Cross /
Blue Shield Association, Premera Blue Cross and America’s Health
Insurance Plans (FYI – HPHC is a member and I’m on the Board of
AHIP) released a joint study on public and private payment rates.
The
study was prepared by Milliman, Inc., one of the nation’s most well
known number-crunching health care consulting firms. Readers of
this blog will not be surprised to learn that the study shows that
Medicare and Medicaid pay a lot less for health care services than the
Blue Cross and private health plans pay. But I must say, even I was
a little surprised by the size of the differential.
Electronic Medical Records and Obama’s Economic Plan
On Dec. 6, President-elect Obama announced the
three major pillars of his economic recovery plan: rebuild our
roads/bridges, enhance our schools including broadband, and deploy
electronic health records for every clinician and hospital in the U.S.
I can summarize all my advice to the new administration in one sentence: Allocate
Federal funds of $50,000 per clinician to states, which will be held
accountable (use it or lose it) for rapid, successful implementation of
interoperable CCHIT certified electronic records with built in decision
support, clinical data exchange, and quality reporting.
Open source is a transparent Trojan horse
By Scott Shreeve
I have been blogging and twittering
from the World Health Innovation and Technology conference this week
while waiting to present today. The keynote speaker before me was Scott
McNealy, the Chairman and founder of Sun Microsystems. He has a long
and storied history with Sun, and a well earned reputation as the “human quote machine.”
He delivered.
His talk started with several examples of his health care experience
(long time user as a hockey player and father of four boys) and
business experience had so many corollaries. The fight for standards.
The fight for common interfaces. The fight for privacy and security.
The find for high quality, low cost, and transparency.
Healthcare and the Job Market
Looking for a bright spot in Friday’s dismal job report? Think how
bad it would have been had the health care sector not added 52,100 jobs
last month.
That’s right. While the rest of the economy was shedding nearly
600,000 jobs and the nation’s once-proud automobile industry went
begging for a bailout so it could continue to pay for, among other
things, its employees and retirees health care bills, hiring remained
robust at the nation’s hospitals, physician offices, diagnostic labs,
nursing homes, and home health care agencies.
This raises an interesting conundrum for health care reformers who
are primarily concerned about the unsustainable rise in health care
costs. Who in the midst of a deep recession will be willing to whack
away at medical waste when it is one of the only sectors generating
lots of new jobs for thousands of fearful Americans?
TECHNOLOGY
Why Clinical Groupware May Be the Next Big Thing in Health IT
Clinical Groupware is intended for use by groups of people and not just
independent practitioners or individuals. It is not the same thing as
an electronic health record, but may share a number of features in
common with EHRs, such as e-Prescribing, decision support, and charting
of individual visits or encounters, both face-to-face and
virtual. Neither is Clinical Groupware bloated with extra features and
functions that most providers and patients don’t need and, with good
reason, don’t want to pay for.
The Best $20 Billion You’ll Ever Spend
Dear Mr. President, please
accept my heartfelt congratulations for recognizing health information
technology (IT) as one of the most promising targets for public
investment at this crucial moment.
As a (formerly practicing)
doctor, I’d diagnose our economy on the verge of a Code Blue, and our
healthcare system with a more chronic but equally threatening
condition. You’ve recognized how these two illnesses interrelate, with
spiraling healthcare costs damaging business competitiveness and job
losses threatening healthcare coverage. If I may offer a second
opinion, I concur 100% with your decision to apply the chest paddles
now, charged with $20 billion of investment.
Five “Shovel-Ready” Health Care Reforms
Microsoft Health Vault’s leader Peter Neupert has a wonderful blog post
that makes two important points
really well. One message is that health
care reform is about the outcomes, not the technology. We should think
expansively about which technologies to invest in, based on the results
we want to get.
The other message is the economic stimulus package is different than
the reform effort. It is moving at hyper-speed through Congress, and it
may be difficult for staffers and other advisors to sort through and
incorporate what may seem like opposing Health IT views against a
backdrop of traditional ideology and extremely forceful special
interest lobbying.
Washington, Please don’t bail out the health care industry
A health care Marshall Plan — $50 Billion stimulus to get
electronic health records (EHRs) in every doctor’s hands or $50,000 to
each physician -– what an incredible marketing job. Detroit, are you listening? Stop whining to Congress that you need a
bailout. Tell them you want to be the new alternative energy Manhattan
Project, get the money, and then keep building SUVs and flying around
in corporate jets. To Congress, Daschle, and Obama, please don’t do this. Our industry,
health care, combines the worst of the Big Three automakers with the
worst of the hubris, dishonesty, and failure of the public trust of
Wall Street. Please do not bail us out.
An Open Letter to the Obama Health Team
By
It seems likely that the Obama administration and Congress will spend a
significant amount on health IT by attaching it as a first-order
priority to the fiscal stimulus package.The easy solution would be to spend most of the health IT funds on
EHRs. The EHR industry has made it easy by establishing a mechanism to
“certify” EHR products if they incorporate certain features and
functions.
Stimulus bill offers docs big incentives for technology, but demands effective use
The economic stimulus bills are a great step forward for health information
technology and medicine.
The two bills,
“HR1” and “S1,” continue to barrel down the legislative track and
continue being amended, but as currently written they create real
incentives for adopting certified electronic health records – upwards
of $40,000 per physician starting in 2011.
The legislation
emphasizes rewarding designs that improve care and create a path for
certification of records with added functions, such as decision
support, order entry, connections to other systems and reporting on
quality measures. The bill focuses on implementation by tying the
physician bonuses to proven, effective use. The stimulus package also
formalizes the Office of the National Coordinator for Health
information Technology (ONC).
A Shared Roadmap and Vision for Health IT
By John Halamka, Mark Leavitt & John
Tooker
Today’s economic crisis has highlighted our need for breakthrough
improvements in the quality, safety and efficiency of health care. The
nation’s business competitiveness is threatened by growing health care
costs, while at the same time our citizens risk losing access to care
because of unemployment and the decreasing affordability of coverage.
Meanwhile, the quality variations and safety shortfalls in our care
system have been well documented.
Next Steps for Interoperability
There are some folks in Washington who have made statements that we
should delay investments in EHRs because current vendor products lack
the functionality needed to support a coordinated healthcare system.
Others have said that we lack the standards or security framework to
implement interoperability. Here are my thoughts.
Take a look at
the successes in Massachusetts and New York with commercial EHR
products. We’ve implemented eClinicalWorks, which includes decision
support, e-prescribing, administrative transactions with payers,
clinical summary sharing across the community, and quality measurement
(all the National Quality Forum high priority measures). It’s
web-based, using a service oriented architecture in a cloud computing
environment. By implementing this product at BIDMC, we’re meeting all
the payer guidelines for delivering appropriate, coordinated, high
value care. Vendor products from Epic, Allscripts, NextGen, GE,
Meditech, eMDs, MedSphere, and other CCHIT certified vendors have
similar features.
Like the Institute of Medicine’s (IOM) 2001 counterpart report,
“Crossing the Quality Chasm,” a new report from the National Research
Council of the National Academies
is complex, full of new ideas assembled from multiple disciplines, and
is likely to have seminal importance in framing public policy from now
on. “Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions”
was released last month in draft, but there is so
much to comment on that I think it’s wise to begin with a quote from
the committee that sums up the central conclusion:
The greatest health care IT generation
By John Halamka
In Washington, Healthcare Information Technology policy planning is
accelerating at a pace that is faster than at any time in history (at
least my 30 years in healthcare IT). Over the past few days, the House Ways and Means Committee completed the Health Information Technology for Economic and Clinical Health Act (HITECH), as part of the American Economic Recovery and Reinvestment Plan. At the same time, the House Appropriations Committee has completed a bill
that is not meant to stand alone. It outlines $2 billion in funding for
the programs authorized by section 4301 of the Ways and Means Committee
bill.
By Scott Shreeve MD
I read with interest a recent article by my favorite health care reporter, Joe Conn, who has long time interest in the commercial success of the VistA Electronic Health Record system developed by the VA.
VistA has an incredible, well described impact on the clinical and
system peformance of the VA. Given its availability through the Freedom
of Information Act, it can and should seriously be considered as a
potential solution for government-based health care information
technology. I mean, why not? The several billion dollars already
invested, and the several billion dollars already wasted on
alternatives, would hopefully help the new administration come to their
senses to realize the development of a common platform for all
government related health IT would make good business sense.
Freenomics is a term coined in Silicon Valley to describe a free web
service paid for by other revenue sources (usually advertising) –
Google searches, Yahoo mail, Wiki lookups, YouTube videos are all
examples of free services paid for by other revenue sources. Applying
this business model to EMRs is groundbreaking. An ad-based EMR that
maintains a robust, professional, full-featured offering challenges how
we think of the EMR business.
Quality, Cost and Connected Health
By JOSEPH KVEDAR Connected health is the use of messaging and monitoring technologies to
bring care to where the patient is, when the patient needs it. This
approach has enormous opportunity to increase quality while lowering
the overall cost of care. Early returns on this approach are quite
encouraging. We are starting to weave connected health into the fabric
of our health care system, with good results.
The Technology Hype CycleWhy Bad Things Happen to Good Technologies
Fresh on the heels of my recent bar coding epiphany
comes another “unintended consequences” article. It turns out that the
whipsawing that accompanies the adoption of new technologies is
completely foreseeable, the “Why doesn’t this thing work right?” phase
is as predictable as the seasons. You can chart the course of virtually any
health information technology on the Hype Cycle curve. In the case of
computerized provider order entry (CPOE), the trigger was the
development of the technology in the 70s and 80s (the first CPOE system
was implemented at El Camino Hospital during Nixon’s presidency). The
Peak of Expectations was turbo-charged by the research in the 1990s by
Bates demonstrating its value in one highly unusual organization
(Brigham & Women’s Hospital), working with a homegrown system. The
apogee was the endorsement of CPOE by the Leapfrog Group in 2002.
A Transparent Health Record
By Adrian Gropper, MD
Transparency, in the form of a complete, patient-centered and
accessible health record is a policy principle that can drive the next
wave of health care innovation. Investing exclusively in institutional
EHRs will further stifle efficiency, innovation and improvement.
Web-based clinical summaries (CCR+DICOM+PDF) that are available for
patient control foster patient-centered care, clinical collaboration,
and research, and must be included in health care reform if we are to
effectively improve provision of health care for patients and
clinicians.
Fact or Fiction: Electronic health records save money
Of all the initiatives endorsed by outgoing Secretary of Health Mike
Leavitt, few are likely to be met with as much agreement as the need for wider adoption of electronic
health records (EHR). While there is general agreement on the need for
this technology investment—both presidential campaigns included EHR in
their health platforms—the cost ramifications are still up for debate.
Will electronic health records reduce costs? There are compelling
reasons to answer both “yes” and “no.”
Google Health and the PHR: Do Consumers care?
Google Health’s unveiling last week and Microsoft’s HealthVault
launch last October are important milestones in the evolution of Health
2.0. Both of these heavyweights have the resources and potential to
improve the health consumer’s customer experience. What’s missing from all of these conversations is the elephant in
the room: Do consumers really care about having online personal health
records?
Untangling the electronic health data exchange
By David Kibbe
This post is to help a non-technical audience
untangle some of the confusion regarding health data exchange
standards, and particularly come to a better understanding of the
similarities and differences between the Continuity of Care Record (CCR) standard and the CDA Continuity of Care Document
(CCD). But what I’m most interested in is getting beyond the
technical, political, or economic positions and interests of the
proponents of any particular standard to arrive at some principles that
demonstrate in plain language what we are trying to achieve by using
such standards in the first place.
The Wisdom of Patients – Social Media In Health Care
People
— citizens, patients, caregivers, “consumers” — are early adopters of
social media i
n health,
compared to other industry stakeholders
including providers, plans, payers, and suppliers such as pharmas and
medical equipment companies. This is but one of many findings in my report, The Wisdom of Patients, which was published yesterday by the California Healthcare foundation.
Management guru Tom Peters likes Health 2.0, Wennberg, PLM, Millenson, but not the medical establishement
I didn’t know that Tom Peters (the In Search of Excellence guy) knew or cared about health care, but he certainly does.
In just one blog posting he reveals his impatience (putting it mildly) with the general level of doctors skills, his approval of Michael Millenson’s and the Dartmouth group’s work on medical quality variation, and he shows that he likes Health 2.0 and PatientsLikeMe — not least because he thinks that the medical establishment is reacting negatively to them!
