The KHIT Blog: Stage 2 and CEHRT 2014 announcements

Wednesday, February 22, 2012

Stage 2 and CEHRT 2014 announcements

Breaking. Farzad is the HIT Rock Star!

The Stage 2 NPRM won't be posted in the Federal Register until tomorrow, they told us. The conference hall was packed, SRO overflowing to a 2nd location. What I saw and heard on Stage 2 looks pretty good. The 2014 EHR Certification stds are another matter. That should be interesting.

A significant question remains. Dr. Mostashari went to great lengths in multiple sessions to exuberantly extoll the virtues of "our 62 Regional Extension Centers." But, I have yet to hear or read one peep about any more REC funding. Our federal REC grant money essentially runs out mid- 2013 -- before Stage 2 even ensues. I rather doubt that financially stressed PPCPs are likely to line up to pay us "commercial" consulting rates (begging that whole REC "sustainability" issue), particularly given that the incentive reimbursement payments decline year after year.

While it's certainly swell that "ONC [is] in line for [a] budget boost" of 8.2% in the President's FY2013 budget proposal, I find this article excerpt, well, curious.

Among ONC’s efforts, the 62 health IT regional extension centers have registered 130,000 physicians – about one-third of all primary care providers and more than two-thirds of all rural providers in the nation – to help them adopt and demonstrate meaningful use.

“As of January 2012, nearly 60,000 REC-assisted providers had implemented EHRs with e-prescribing and quality reporting capabilities, and more than 5,000 of these providers have achieved meaningful use,” HHS said in its proposed budget.

OK, yeah, but these were the low-hanging fruit fairly attestation-ready providers, more or less early HIT adopters (ignoring for the sake of simplicity the myriad "free money" 2011 Medicaid A/I/U attestors). So, let's see, the REC work will get more difficult per new EP signup, the subsequent years' reimbursements will go down (and with it perhaps the incentive to participate), vendors are sure to charge for Stage 2 compliant upgrades, but RECs will magically become "sustainable" pronto and be able to continue to serve?

OK, yeah. I suspect an increase in Monster.com Moments.

Relatedly, according to Federal Computer Week,

At the same time, the national coordinator office’s influx of Recovery and Reinvestment Act of 2009 funding is trickling to a halt, from $157 million in fiscal 2011, to $5 million in the current year, to zero next year, the budget document shows.

One last observation, per iHealthBeat.org:

The [2013] budget also includes funding to increase ONC's staff by 11% to 191 employees.

Expect an uptick in the DC wonky "you-actually-have-to-tie-'em" bowtie market. In fairness, ONC is a very small shop as Beltway federal entities go, and I have yet to meet one ONC employee that wasn't at the top of her/his game.

ALSO JUST IN

Modern medicine is designed for groups. The interactions of drugs, patients, and diseases are unpredictable—clinical trials are population based and do not account for personal idiosyncrasies, much less medical histories. In The Creative Destruction of Medicine, pioneering geneticist and cardiologist Eric Topol introduces a radical new approach—by bringing the era of big data to the clinic, laboratory, and hospital. With personal technology, doctors can see a full, continuously updated picture of each patient and treat each individually. Powerful new tools can sequence one’s genome to predict the effects of any drugs, and improved imaging and printing technology are beginning to enable us to print organs on demand. Topol offers a glimpse of the medicine of the future—one he is deeply involved in shaping.

Yeah. Weeds' 101, really. See my posts "Down in the Weeds'."

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More to come. Run out of time today. Got invited to an AthenaHealth dinner at Trump tonight. Below, my UT colleague the awesome Christie North at this afternoon's Beacon Communities presentation.

Great job, Christie and the other panelists from MN, OK, and CA.

Off to The Trump.

Thanks, Sam, great evening with you and a number of REC folks!

Run home. Sleep hard, sleep fast. Got an early meeting in the morning at the office.

THURSDAY CRACK OF DAWN QUICK UPDATE

Sen. Warner calls for tougher standards for electronic medical records
By Julian Pecquet - 02/22/12

Congress’s gambit to create a national system of electronic health records is “at risk of failure or mediocrity” if federal regulators continue to water down the standards that doctors and hospitals must meet, Sen. Mark Warner (D-Va.) wrote in a letter to federal health officials...

...Warner said the process so far has been “too limited.” For example, regulators don’t publish performance data for certified vendors, and failing to deliver medical data to a public health agency is still acceptable...

Indeed. Critics joke that "you could get a spreadsheet 'certified'."

Erratum: Below, check this out. Click the logo banner.

Funny stuff. Click her blog link.
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More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
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"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[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.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
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"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
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"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
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"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
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"'Solutions' exist only in mathematics."

- Karen Martin
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"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
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"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Wednesday, February 22, 2012

Stage 2 and CEHRT 2014 announcements

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