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Wednesday, August 24, 2011

Talk Dirty to Me

Recently, on The Health Care Blog:
Just because my electronic systems didn’t end up costing me anything, it turns out that even though I bill Medicare less than $25,000, I’m still eligible to apply for some of the stimulus money. So just for shits and giggles, I hooked up with a government funded entity whose stated purpose in life is to help me get that money. Cool.

I’ve had a couple of visits with them so far. It turns out that my freebie EMR has features which I hadn’t bothered using yet, mainly because they didn’t seem particularly useful in the provision of medical care — that’s what I do, remember? — to patients. One of them was a so-called “Demographics” section, right below such vital information as patient name, address, phone numbers, and birth date. This section contains three pieces of information I have to enter, one from a set of radio buttons, and two from pick lists, mechanisms that allow for the collection of what is known as “structured data” instead of just information I type into the EMR “free form”.

The first item is “Ethnicity”. There are three radio button options: Hispanic, Non-hispanic, and Unspecified (the default).

The second item is “Preferred Language”, to be selected from a pick list. I can only enter one option.

The third item is “Race”, again to be selected from a pick list. They include “African or African American”, “Asian or Asian American”, “European or Caucasion American”, plus several other basically meaningless classifications. (For example, what entry do I use for an individual from the Indian subcontinent?) Unlike “Language”, I can enter as many of these options as I wish.

What? The? F?

Wow. Click the link. Read the entire post.

...features which I hadn’t bothered using yet, mainly because they didn’t seem particularly useful in the provision of medical care..."

Really? I know everyone is focused these days on the Boogeyman "government wanting these data for use in 'disparities CER' for cost and Lifestyle Control," but, I have to ask, "aren't you at all interested in analytically mining your own patient data for some stratified intel on where you might be hitting and missing?" Any statistician would kill for 4-5,000 structured data records per year (per provider) via which to gain some useful insights.

Don't Ask, Don't Know.

More to come...

Thursday, August 11, 2011

2011 ONC Regional Conference in Hollywood

Just got back home (Thursday evening). Lots to blog about. I learned a lot, from a lot of very smart, dedicated people. Below, Farzad Mostashari, MD, ScM, ONC head. Great guy. Inspiring speaker.

Well, what I'd thought might be The 800 lb. Gorilla in the Ballroom was dispensed with by about the 3rd question from the floor during Farzard's post-speech Q&A: that concerning the looming deficit "triggers" mandating deep cuts in federal discretionary spending should the "Junta" -- ahem, Bipartisan Congressional Super Committee -- be unable to agree on what to reduce or eliminate by Thanksgiving week 2011.

"I'm not losing a lot of sleep over it."

OK. "Broad Bipartisan Support" yadayada, and all that. What else could he say, though, that wouldn't precipitate a rush for the fire door exits and a spike in new members at et al?

I guess we'll know soon. The entire 4-yr REC program cost is a spit in the budgetary ocean. We're invisible; we're, like, what? -- a week in Afghanistan? But, the Meaningful Use provider reimbursement money is a whole 'nuther deal. Pull those funds and it's Game, Set, And Match for the RECs.

But, then, there's stuff like this recently:
In July, House Majority Leader Eric Cantor, R-Va., released his own list of health care spending cuts totaling approximately $350 billion in federal savings over 10 years. Rep. Cantor has provided limited details about his proposals, but the broad concepts include:
  • Increasing penalties for health care providers failing to adopt electronic health records under Medicare “meaningful use” requirements would save $1 billion..
Cantor, no less. Maybe we will be spared. Maybe. But, consider the fevered, anxious gnashing of teeth already underway with the looming prospects of DoD cuts: "Defense cuts loom large for 'super committee'."
Not surprisingly, Defense Secretary Leon Panetta has described the automatic cuts as the "doomsday mechanism." He's warned that the prospect of nearly $1 trillion in reductions over a decade would seriously undermine the military's ability to protect the United States.
August 16th headline update

Need I say more?

Gonna be a perversely interesting 3 months. I hope we will get to continue our work, as indeed "The Time is NOW."

Above, recent Vermont Governor Jim Douglas, who addressed "The Emerging HIT Landscape on our Evolving Roles" during the opening keynote session. He was great.

Below, they set up a photo booth, and asked us all to have our pictures taken for the ONC "Putting the 'I' in Health IT" public awareness campaign.

On the subject of "public awareness," involvement, and resources, check out these sites:

Click the images for the links.

I attended a number of the breakout sessions: Public Awareness Campaign, Privacy, Security, Behavioral Health, and Workflow Redesign (I was on the panel on that one). The public awareness session was great, because none of this stuff will work effectively long-term absent public awareness and buy-in. They presented a fine campaign plan.

The back-to-back Privacy and Security sessions were held in a conference room so cold you have hung a side of beef in there. Tons of detail, most of which I'd already been studying at length (see prior posts). I still don't have a good answer to my question "does 'express consent' uniformly dictate a 'wet signature'?" (My feeling is "no, it does not.")

"Behavioral Health" was really just about the SAMSHA/HIPAA myriad strict disclosure constraints pertaining to drug and alcohol treatment programs, not at all about other aspects of mental/behavioral health more broadly. Useful information in any event.

The Workflow session was OK. I was a bit disappointed in my contribution to it, quite frankly. And, it was the first session right after the big buffet lunch. You could detect a lot of Food Coma setting in.

Live and learn.

All in all, a very worthy conference.

Note of appreciation: one of my REC counterparts from another state whom I'd met last year at the 2010 Regional in Salt Lake City came up and greeted me and said "Keep blogging. We all read your blog all the time. You say the things we all think about but won't say out loud."

That's pretty humbling and gratifying. I really have had no idea. I don't track my traffic stats on this blog (like I did on my now-suspended Santa Fe blog). It's not why I do this. I had one fellow HIT blogger criticize me recently over the length of my posts, i.e., that were I to chop stuff up into short bites posted more frequently, I'd get better hits.

Yeah. Understood. Well, there's enough of that already. And, again, it's not why I write this blog.


Dr. Fortuna (ASQ Health Care Division Chairman) copied me on a PDF of this new IOM report
, Engineering a Learning Healthcare System: A Look at the Future - Workshop Summary:
The fundamental notion of the learning healthcare system—continuous improvement in effectiveness, efficiency, safety, and quality—is rooted in principles that medicine shares with engineering. In particular, the fields of systems engineering, industrial engineering, and operations research have long experience in the systematic design, analysis, and improvement of complex systems, notably in such large sectors as the airline and automobile industries. Working cooperatively with the National Academy of Engineering (NAE), the Institute of Medicine (IOM) organized Engineering a Learning Healthcare System: A Look at the Future to bring together leaders from the fields of health care and engineering to identify particularly promising areas for application of engineering principles to the design of more effective and efficient health care—a learning healthcare system. This report presents the summary of the meeting’s discussions.

Currently, the organization, management, and delivery of health care in the United States falls short of delivering quality health care reliably, consistently, and affordably. As health care continues to increase in scope and complexity, so will the challenges to efficiency. In part, the capacity to address these challenges will depend on the ability to develop information about the relative effectiveness of interventions in a fashion that is more timely and practical than is typically the case for individually designed prospective studies, such as randomized clinical trials. It will also depend on the ability to design delivery systems in which the dynamics at the component interfaces are much more efficient. In both cases, the adaptation of engineering principles to facilitate continuous learning will be key.

Workshop Premises
  • Health care is substantially underperforming on most dimensions: effectiveness, appropriateness, safety, cost, efficiency, and value.
  • Increasing complexity in health care is likely to accentuate current problems unless reform efforts go beyond financing to foster significant changes in the culture, practice, and delivery of health care.
  • Extensive administrative and clinical data collected in healthcare settings are largely unused for new insights on the effectiveness of healthcare interventions and systems of care.
  • If the effectiveness of health care is to keep pace with the opportunity of diagnostic and treatment innovation, system design and information technology must be structured to ensure application of the best evidence, continuous learning, and research insights generated as a natural by-product of the care process.
  • Engineering principles are at the core of a learning healthcare system—one structured to keep the patient constantly in focus, while continuously improving quality, safety, knowledge, and value in health care.
  • Impressive transformations have occurred through systems and process engineering in service and manufacturing sectors—e.g., banking, airline safety, automobile manufacturing.
  • Despite the obvious differences that exist in the dynamics of mechanical vs. biological and social systems, the current challenges in health care necessitate an entirely fresh view of the organization, structure, and function of the delivery and monitoring processes in health care.
  • Taking on the challenges in health care offers the engineering sciences an opportunity to test, learn, and refine approaches to understanding and improving innovation in complex adaptive systems.

A 341 page "summary"? LOL. I'm going through it.
"[P]romising areas for application of engineering principles to the design of more effective and efficient health care"?

Yeah, that'll be universally loved. Notwithstanding the truth of it.

More to come...