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Wednesday, July 18, 2012

"The Health Care Handbook" considered

So, yesterday, I ran across this post on The Health Care Blog, wherein the (anonymous) "reviewer" waxed effusive.
The book is the work of two medical students, Elisabeth Askin and Nathan Moore. When Elisabeth and Nathan worked to educate themselves about the American health care system they couldn’t find a source that was comprehensive, understandable and non-biased – so they decided to write it themselves. After thousands of hours of research, writing, and consulting with dozens of national experts, the Health Care Handbook is now available. It’s rigorously researched and scrupulously unbiased yet written in a conversational and humorous tone that’s a pleasure to read and illuminates the convoluted health care system and its many components. The book is essential reading for health professionals, health professions students, and anyone who interacts with the U.S. health care system.
$7.99 Kindle edition? Safe bet. 1-click Whispernet, whoosh...

I downloaded and read it. Nicely done. If you've been immersed in the health care system for as long as I have, you won't find much new detailed information here, but, as the authors note, that's not the principal audience.
We’re students ourselves, so we have firsthand insight about what students don’t know, what they want to know, and what they need to know. As such, students are our primary focus for this book...
We think the book will hold the most value for the following:
  1. Students in undergraduate, graduate, and professional programs focused on medicine, nursing, dentistry, pharmacy, allied health, medical research, biotechnology, public health, public policy, economics, finance, health care administration, business, and law. Heck, throw in history and political science, too! 
  2. Health care professionals who want to expand their knowledge about what affects them in the workplace or who want a reference for continuing education. 
  3. Lay readers who are sufficiently interested in learning more about health care to have started reading a book about it. In short, if you ever find yourself confused by a news article about what an Accountable Care Organization is, or you don’t have quite enough information to argue with your Uncle Dan about pharmaceutical companies, or you’re annoyed that everything you read has an agenda— then this book is for you.
    (Kindle Locations 179-180)
I find it indeed balanced and comprehensive -- at a (probably appropriate) "survey course" level. It has been worth my money and my time. See also the NY Times' recent "Two Medical Students Navigate the Health Care Maze."

My only laments go the the short shrift given HIT (in addition to an equally cursory treatment of clinical "statistics"):
Health Information Technology 

While the technology used in medical devices continues to improve, health care communication and organization systems at most institutions are stuck in the pagers-and-faxes era. (Unfortunately, they've ditched the acid-washed jeans.) Health information technology (IT) is a simple concept: the application of electronic systems in organizing and using health data, from writing prescriptions to transmitting MRI results digitally. However, as with many aspects of health care, this simple concept quickly becomes extremely complicated when put into practice. For one, health IT goes by many different names, such as electronic health records (EHR), electronic medical records (EMR), and personal health records (PHR). Different software systems may all call themselves EHR, which would suggest they are comparable; however, they may not perform the same functions or have the ability to communicate with each other. The best definition and system may not be clear for those who are actually using it to provide care.
What is clear is that health IT has the potential to significantly improve the efficiency and error rate of health care systems. (Spell check is pretty great and all, but ending the tyranny of physicians’ messy handwriting is a true feat: now 25% of prescriptions are issued electronically.)   Of course, potential doesn’t necessarily equal results— the largest study to date failed to show any improvement in quality of care, cost, length of stay, or readmission rates for hospitals that have implemented EHRs. Health IT penetration is still relatively low in the U.S. — only 1.5% of hospitals have comprehensive EHR systems, while 7.6% operate a basic EHR. Nevertheless, the federal government has prioritized health IT and has unveiled a range of measures to encourage the adoption of EHRs across the country. Interestingly, the one area in which health IT has already been implemented quickly and universally is medical billing— 99% of hospitals have computerized patient billing systems. Money has an uncanny ability to speed anything along, doesn’t it? (Kindle Locations 2256-2271)
That's pretty much it. Also, search on "health information exchange," "HIE," "interoperability," "meaningful use".

Nada. Zilch. "0 matches found."

Well, another resource that fills in some of the blanks. Recall my March 28th, 2012 post, wherein I reviewed Fred Trotter's excellent "Meaningful Use and Beyond."

This book rocks!

As do Joe Flower's "Healthcare Beyond Reform," and Dr. Toussaint's "Potent Medicine" and "On The Mend" (scroll down in the latter two posts), to cite just a few of my top 10.

As does the compelling "Medicine in Denial," which I've cited multiple times.


Why the EHR market is on the brink of mass consolidation
July 18, 2012 | Robert Rowley, MD, Healthcare and health IT consultant, practicing family physician

The number of vendors of Electronic Health Records products seems unsustainable. Stimulated by federal Meaningful Use incentives, plus the irresistible tide of pressures and encouragement from all sides (specialty societies, peers, licensing boards, insurance payers), the uptake of EHRs has been steadily increasing...

This scenario seems ripe for consolidation. Market forces, however, are rather Darwinian – novel approaches abound (“mutation”), but many will not achieve market penetration (“selection”). Failure of products, even well-designed ones, are part of the startup experience – true in all market spaces, not just health care.

There will likely be some consolidation. As is seen in other sectors, when companies buy other companies it is more a purchase of their market footprint than it is a purchase of their technology. In fact, examples of mergers with ultimately incompatible technologies behind them abound...
So, nearly half of the "certified" EHRs have no attestors to date? I'm havin' a Clinic Monkey Moment.

Yes, there will indeed be a "shakeout."

More Dr. Rowley:

Market analysis of the EHR industry is compiled from 2011 Meaningful Use data. This 116-page comprehensive document is intended to be an indispensable resource for those who want a detailed understanding of the current state of the EHR industry – consultants, vendors, and investors will find this an important reference manual as they view the competitive landscape of Electronic Health Records (both ambulatory and hospital).
$6.90 a page. Can you say "nano-niche market"?


As of today 141 relational tables (these people are busy). I'm working on tallying up all of the vars and their cumulative data storage and bandwidth overhead. This (above) is a snip from the audit log dictionary.


Nice presentation deck here (PDF).


This is nicely done. You can click state by state (and by other criteria) for interactive statistical graphics.

Click to enlarge. Note that, as of "04/31/2012," (red oval annotations) our Utah brethren were kicking our Nevada butts. But, they have one major vertically integrated system (IHC) and one major metro area to service as a priority. We have to deal with Clark (S) and Washoe (N) counties (far flung, comprising ~90% of the state population), and have a number of competing delivery systems along with our (ever-declining) independents.

More to come...

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