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Monday, January 13, 2014

Next up...

Register here. An important two days via which to get a sense of just where the federal Health IT effort is headed and what progress might be expected. Incoming ONC head Dr. Karen DeSalvo certainly has her work cut out for her.

Then, in February,

Register here.

Former President Bill Clinton keynoted last year at HIMSS13 in NOLA. It was fabulous.


I spend a lot of time online defending health IT from the large contingent of irascible Perfectionism Fallacy naysayers. I get called a "troll," a "EHR Vendor shill," and told I have no right to even opine because I'm not a physician.

Well, this man is a physician:
...Modify my note with today’s findings and conclusions.  Write, in the computer, any new orders.  The orders are instantly checked for allergies, compatibility, dose, availability, redundancy and communicated to the proper department.  Complete.  Legible. Efficient. Accessible and transmittable (via encrypted form).  Even fun.

The quality of medical care because of clarity, accuracy, speed and the quality of communication is multiplied, probably exponentially. Problems are not forgotten. Errors are quickly identified. The valuable efforts of patient and professional are not wasted.  The time needed to create extraordinary medical records is cut at least in half.  The medical record is not just another device, like a pencil, tape measure or paper chart. It is a tool to guarantee, amplify and create quality.

Is the future here?  Are present day EMRs the Holy Grail?  Not yet. They still have major problems in data input, across system compatibility and universal access. However, they a stunning technology that saves cost not only by saving time, but by improving the quality of the record and therefore the quality of care.  In the future, not to far away, EMRs will interface with medical information and research databases and work with each doctor with each patient on each day to assure the most accurate diagnoses, the best treatment and the best chance of cure.  Even now, they are revolutionary...
From The Health Care Blog.


Had my initial visit with my new Primary, in the brand-new John Muir Medical Group facility in Walnut Creek. They provide a pretty nice patient portal. I was able to go in ahead of time and start populating some data.

I got there at 7:30 a.m. Everyone was all spiffed out, cherubic, effusively solicitous. This was opening day for the new complex at 1450 Treat Blvd. The place is beautiful. Registration was a breeze, both in the expansive downstairs foyer and up at outpatient internal med in suite 250.

Free patient Wi-Fi. I'd brought my Mac Air, just in case I had any extended wait time. Nice.

Muir uses EPIC. There were bugs. The M.A. doing my vitals and CC, etc. Had trouble logging into the large wall-mounted terminal in the exam room. Had to make a tech support call. I don't like the wall terminal thing. That is so yesterday.

My new doc came in, sporting a laptop. Along with him came an IT dude.

EPIC support. It was needed. I bit weird, being worked up and examined by my new doctor with this IT guy in the room.

Nonetheless, we hit it off. Young doc, a D.O. (I'd weighed the relative merits of going with someone closed to my age). I told them I did Health IT journalism and gave them each my card. The doc kept anxiously apologizing for any glitches in this initial encounter. It'll be big-time shakeout cruise this week for them, I'm sure.

No problem. I'd used the portal internal email a head of time to send him a PDF of my last complete progress note dump from Dr. Gong's Encounter Pro EHR in Vegas (my prior Primary).

He'd not yet seen it.

He told me they'd immediately eRx my two maintenance meds renewals to Walgreens close to the house where I've been getting my scrips, and he wrote me a lab order for fasting bloodwork.

Later in the day I got a call from Dr. Gong's office, telling my they'd gotten a renewal request they couldn't fill because I was overdue for my latest f/up visit.

"Look, I called you in December advising that I'd moved to the Bay Area and was looking for a new Primary, and would like Robert to give me any referrals he could."

Never heard back.

So, now I gotta get in someone's face at Walgreens here to straighten out the eRx mistake.

An "EPIC" day. I really like this new doc. We'll see how my experience with Muir goes.


+200k blog hits, +1,000 Twitter followers. Just keep plugging away.

Meaningful Use Incentive Payments Reach Nearly $18 Billion, CMS Says
January 15, 2014, Alex Ruoff 

Jan. 14 --The Centers for Medicare & Medicaid Services has issued nearly $18 billion in Medicare and Medicaid incentive payments through its meaningful use program, a CMS official said Jan. 14.

As of November 2013, the CMS had paid 334,081 hospitals and health-care providers more than $17.77 billion in incentive payments to adopt electronic health record systems, Robert Anthony, an eHealth specialist for the CMS, said at a meeting of the Health IT Policy Committee.

Although registration with the meaningful use program slowed slightly in November and December, Anthony said, it remains a widely popular program.

More than 93 percent of all hospitals eligible to receive an incentive payment through the meaningful use program had registered for a payment by November. More than 80 percent of all health-care providers eligible to receive an incentive payment through the meaningful use program had registered for payment by November, he said.

Registration Slowing

Provider registration for the Medicare meaningful use program hit a four-month low in November, according to CMS data. Just 3,081 health-care providers and 30 hospitals registered in November to participate in the Medicare program, the lowest since July.

Registration for the Medicaid meaningful use program by health-care providers hit a four-month low in November, according to the CMS. Just 2,175 health-care providers registered in November to participate in the Medicaid meaningful use program, the lowest since August...

Data source. The relatively easy money has been paid. Going forward it will be significantly more difficult, in pursuit of significantly fewer incentive payment dollars.

apropos, "medical bridges to nowhere"?
Is Meaningful Use based on a 'flawed mindset' of healthcare?
January 15, 2014 | By Ashley Gold

According to Patrick Soon-Shiong, M.D., billionaire and chief executive officer of healthcare IT company NantHealth, the Meaningful Use incentive program was born out of a flawed view of the healthcare industry.

Speaking at the Clinton Foundation's 2014 Health Matters conference in La Quinta, Calif. on Tuesday, Soon-Shiong said the creation of Meaningful Use has built "medical bridges to nowhere," Healthcare IT News reported.

"We've funded systems that don't talk to each other," he said. "Nobody has looked at healthcare as a systems approach."
At the J.P. Morgan 32nd Annual Healthcare Conference in San Francisco a day earlier, Soon-Shiong officially launched NantHealth, a "transformational healthcare IT company converging science and technology through a single integrated clinical platform, to provide actionable health information at the point of care, in the time of need," according to an announcement. The company, it would appear, is Soon-Shiong's answer the HITECH Act.

For instance, according to the announcement, its interoperable Clinical Operating System (iCOS), which can talk to any software, is currently installed in 150 practices, integrating 50 individual systems, managing 3.3 million patient records across 22 electronic medical records.

"Nobody has looked at healthcare as a systems approach," Soon-Shiong said.

Members of Congress are using the continued debate over the Medicare sustainable growth rate as an opportunity to require more interoperability among electronic health records in the Meaningful Use program.

Sens. John Thune (R-S.D.) and Mike Enzi (R-Wyo.) recommended an amendment to the SGR fix that would require interoperability by 2017 in order for a provider to be a meaningful user of EHRs. Sen. John Cornyn (R-Texas) suggested a slightly different amendment that would require the U.S. Department of Health & Human Services to adopt standards to ensure that EHRs were interoperable by 2017. The House SGR bill also called for interoperability by 2017.

Stage 3 of the Meaningful Use program is slated to begin in 2017.


Per CMS:
"Medicare EPs Must Attest by February 28 at 11:59 pm ET to Receive 2013 Incentive.

If you are an eligible professional (EP), the last day you can register and attest to demonstrating meaningful use for the 2013 Medicare EHR Incentive Program is February 28, 2014. You must successfully attest by 11:59 p.m. Eastern Standard Time on February 28 to receive an incentive payment for your 2013 participation.

You must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.

More to come...

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