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Comprehensive health care reform is not possible without system-wide adoption of health information technology, which improves the quality of healthcare delivery, increases patient safety, decreases medical errors, and strengthens the interaction between patients and healthcare providers.
With Meaningful Use now providing the way forward, eligible providers across the country increasingly understand the benefits for themselves and their patients, and are adopting Meaningful Use compliant electronic health records...
A CAUTIONARY OBSERVATION
'[I]t is one small step from using the computer for “helping “ doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the “good,” facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter...Interesting. I've written about these clinical decisionmaking issues before. Difficult stuff.
…Most clinical decision-making is gray, not black and white. What I would like to see is a comprehensive study is how computers affect issues in the gray world - how computers impact or improve the totality of decision-making on sociological and psychological problems, which may be more subjective rather than objective.'
- Richard Reece, MD
UPDATE; Apropos of the foregoing comes this (PDF) from Health Affairs:
Today’s ‘Meaningful Use’ Standard For Medication Orders By Hospitals May Save Few Lives; Later Stages May Do More___
ABSTRACT The federal government is currently offering bonus payments through Medicare and Medicaid to hospitals, physicians, and other eligible health professionals who meet new standards for “meaningful use” of health information technology. Whether these incentives will improve care, reduce errors, and improve patient safety as intended remains uncertain. We sought to partially fill this knowledge gap by evaluating the relationship between the use of electronic medication order entry and hospital mortality. Our results suggest that the initial meaningful-use threshold for hospitals—which requires using electronic orders for at least 30 percent of eligible patients—is probably too low to have a significant impact on deaths from heart failure and heart attack among hospitalized Medicare beneficiaries. However, the proposed threshold for the next stage of the program—using the orders for at least 60 percent of patients, a rate some stakeholders have said is too high—is more consistently associated with lower mortality. Our results suggest that the higher standard that will probably follow in the second stage of meaningful-use regulations would be more likely than the first-stage standard to produce the improved patient outcomes at the heart of the federal health information technology initiative.
ONC STRATEGIC PLAN 2011 - 2015 (PDF)
"The technologies collectively known as health information technology (health IT) share a common attribute: they enable the secure collection and exchange of vast amounts of health data about individuals. The collection and movement of this data will power the health care of the future. Health IT has the potential to empower individuals and increase transparency; enhance the ability to study care delivery and payment systems; and ultimately achieve improvements in care, efficiency, and population health.
However, these technologies – including electronic health records (EHRs), personal health records (PHRs), telehealth devices, remote monitoring technologies, and mobile health applications – are remarkably underutilized today. In 2010, only 25 percent of physician offices and 15 percent of acute care hospitals took advantage of EHRs. Even fewer used remote monitoring and telehealth technologies. While many consumers access their banking information online daily, only 7 percent have used the web to access their personal health information..."
We shall see shortly the extent to which Congress will permit these initiatives to continue.
___THIS IS NICE (the ACO M.O.?)
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THE JUNTA -- UH, DEFICIT REDUCTION COMMITTEE -- COMETH
1. Presidential Support: President Barack Obama proclaims September 11-17 National Health IT Week. Techies everywhere rejoiced that an entire week will be devoted to health IT. An excerpt from the proclamation reads, “Health information technology connects doctors and patients to more complete and accurate health records. Tools like electronic health records and electronic prescriptions help patients and providers make safer, smarter decisions about health care.” Support from the White House is paramount to the continued success of health IT initiatives in the future. It’s refreshing to have Presidential-level support for that work.
2. The Super Committee: Technically speaking, it’s the Joint Select Committee of Deficit Reduction, and there was a lot of talk about the Committee and its work. The bi-partisan assembly composed of six members of the House and six from the Senate is charged with finding more than $1 trillion in savings over the next 10 years. That means the couch cushions will be over turned and every drop of savings matters. Even something as detailed and technical as health IT will be considered for cost savings and efficiencies. So, it’s crucial that the health IT community maintain an active dialogue with the Super Committee members about the integrity and importance of HITECH funding.
3. Minority Health: Numerous workgroups held Congressional briefings on the state of their affairs. One of those groups launched earlier this year is the HIMSS Latino community. Together with the HHS Office of Minority Health, they are addressing significant issues facing minority populations and how health IT can ease some challenges they face. In their Congressional briefing, the group shared a community-wide concern for healthcare provider shortages and ways to close the disparity gap in minority populations. They also discussed the increasing importance of patient involvement in the healthcare process and how health IT initiatives like patient messaging can improve the delivery of care.
UPDATE: APROPOS OF #2 ABOVE
From the Sept 16th FierceHealthIT.com article HIMSS urges Congress: Create a national patient identifier
...While there has been no overt effort to repeal the HITECH Act, which authorized up to $27 billion in incentives for Meaningful Use of EHRs, anything is considered possible as Congress moves to reduce the size of the federal budget deficit. So HIMSS' appeal is more than just pro forma.
"National efforts to transform healthcare delivery systems and to bend the cost curve, including implementation of improved quality measures and reporting systems, are entirely dependent on the widest possible adoption of EHRs and [health information exchange]," HIMSS says in its recommendation to Congress. "Meaningful Use of EHRs supports quality reporting that helps providers analyze and continually improve the quality of care they provide."
Moreover, HIMSS adds, many small practices and smaller community hospitals would not have the resources to implement EHRs without government financial support...
Yeah, the HIT field ought to be a bit anxious.
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BUDGET CUT CASE IN POINT
From the blog of the CEO of the American Society for Quality:
The Fight for Baldrige–What’s Next?Dicey times ahead. Let's hope initiatives like this (below) don't fall victim to the meat axe.
Posted on September 16, 2011 by borawski
Well, it’s come to this.
On Wednesday, the Senate Appropriations Subcommittee on Commerce, Justice and Science voted to zero out for the Baldrige Program for fiscal year 2012. Yes, I’m disappointed. It’s likely though that Congress will not pass a budget and resort to a continuing resolution. It’s already on the floor and could extent funding for Baldrige.
But this really shouldn’t be such uphill work As I said in ASQ’s public statement, Congress should be shining a light on Baldrige recipients and point with pride to their accomplishments as an example of what the best can do. Baldrige recipients are creating jobs, saving lives and enriching students. It’s discouraging that the Subcommittee apparently doesn’t understand how valuable the government’s role has been. In these challenging times, model programs — like Baldrige — should be showcased, not eliminated...
About the Health Data Initiative
The Health Data Initiative is a major new public-private effort that aims to help Americans understand health and health care performance in their communities -- and to help spark and facilitate action to improve performance.
The fundamental approach being taken by the initiative is to catalyze the advent of a network of community health data suppliers (starting with HHS) and “data appliers” who utilize that data to create applications that (1) raise awareness of community health performance, (2) increase pressure on decision makers to improve performance, and (3) help facilitate and inform action to improve performance.
A lot of good work being done, with great promise. I hope it continues. Let's hope we don't end up with this by the end of the year.
Yeah, I know, I have a vested interest. And, I certainly have my detractors (just about all of them using anonymous or otherwise untraceable screen names). This one is one of the more civil ones.
"Academic dilettante." Gotta love it.
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