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Friday, September 28, 2012

Time to play nice

I saw your latest blog post, including the piece about ARCH-IT.  It's nice to know that others are paying attention to what we've been doing, even if it isn't evident on our website. Much as I would like to report more website progress--as well as a launch date--that would be premature.  Suffice it to say that we are working on it, but our other work has been somewhat more urgent.  And yes, due to your prodding, we are making our website development a much higher priority.

In other news, I am pleased to report that our membership continues to grow.  We now have more than 20% of RECs as members, and we are actively in discussions with a number of others.  But perhaps more importantly, we have had a host of fruitful meetings with members of congress to educate them about the good work that REC programs are doing.  For example, over the summer I met with staffers from two senate offices, and just this week I met with committee and legislative staff serving the Energy and Commerce's Subcommittee on Health. It was a great meeting, and they are pleased to hear both about ARCH-IT and what RECs are doing in districts around the country.

At ARCH-IT, we have mostly been focused on member recruitment and on government relations, with a growing focus on program development.  We are exploring a number of initiatives to bring RECs with similar revenue generation models together, as well as to leverage the REC purchasing power on behalf of RECs.  Given the heterogeneous nature of REC programs, we're focusing the business opportunities, not on a total business model.  Sustainability is THE hot button issue right now.  We hope to make a program announcement in the coming weeks which I hope you'll attend.

Of course, you should know that, unlike the RECs, ARCH-IT didn't even start with seed funding, so we're not only doing this with limited staff, but with limited funds, too.  I realize this is all chicken and egg kind of stuff, but given that we have only existed since April, I'm pleased with our progress, even if I'm not yet satisfied with the results.  Your involvement and your clear web savvy would be a huge help, if you're willing to lend us a hand. 

Again, I want to thank you for keeping us honest with regard to our website development, but I assure you that a lack of reported activity via the website is not the same as no activity.

Should you have any questions, please don't hesitate to reach out to me.  I can be contacted as noted below, and would welcome an opportunity to talk to Healthinsight about joining ARCH-IT.

I look forward to speaking to you soon.



David M. Bergman
Executive Director
Association of Regional Centers for Health Information Technology

Hi, David

I pay attention to everything HIT, every day.

I will post this on my blog -- with your permission, -- and I will quit cracking on you. Thanks for not taking personal offense. I bet I've irritated some of your startup participants. But, we're all after the same goals, and I always have taken pains to not call anyone out by name.

And, yes, you can count on me to help. I offered that at the outset, I believe, and never heard a word in response. I believe my reaction at the time was "I guess I'm just too radioactive."  :)

BTW- Health 2.0 granted me a press pass for the San Francisco conference Oct 7th to 10th, so I'll be there soaking it all in.

Amid distractions...

BTW, my Congressman is Joe Heck. I've talked with one of his staffers (nice young man) about the reported pending House Energy & Commerce Committee hearings on the Meaningful Use program. From the looks of the website, it seems like of their content was written by Sean Hannity's writers. Garishly hostile. So, I would expect that any Meaningful Use hearing would largely be an accusatory star chamber exercise via which to bash HHS/CMS/ONC.

I offered to come on my own dime and testify re my in-the-trenches POV. I rather doubt they'll take me up on it. Nothing's scheduled yet, anyway. They may have bigger fish to fry right now.

Good to hear from you.




Well, my apologies for not taking you up on your offer a little sooner--I'd love your help.

Can we set up some time to talk next week?  Thank you!

Yes, you should feel free to post this--I wrote it with that in mind.

I'm aware of the MU hearing, but was told that it wasn't scheduled yet.  I was also told that we (Arch-it) would be a great addition. I'll keep you posted on any developments on that front.

Thanks again for your prodding!


How about 9 Pacific next Tuesday, Oct 2nd? (noon your time) I can call you.

My Mondays are always hell, meetings all day.


Sorry, Bobby.  I can't do Tuesday.  How about Thursday?  Say 10:00 AM PDT? 



OK. Want me to call you?


Sure. Thanks,


It's all good.


I'm not the only wiseass out there in Snarkland:

Blog: An empty-chair conversation with Eric Holder on EHRs
Here’s a conversation somebody should have had with an empty chair.

Let’s pretend the chair is U.S. Attorney General Eric Holder.

“You know, Mr. Holder, we pay doctors as if they're sewing shirtwaists in some sweatshop loft in New York's garment district in the 19th century. If they whip in some more-elaborate stitching, so to speak, we try to keep track of that and pay them a little more, but basically, we just pay them like pieceworkers.

“So, Mr. Holder, work with me on this analogy.

“Let's suppose, instead of making them sew (i.e., treat patients) the old-fashioned way, whipping in stitches (I mean documenting their work) with needle (pen) in hand, let's make them all get pedal-powered sewing machines (by that, of course, I mean electronic health-record systems).

“Old ways die hard, Mr. Holder, and the best of these machines are, admittedly, kinda clunky, but still, I think we can sell the docs on switching over to them by explaining that once they buy and install the machines and once they figure out how to use them, they should be able to crank out in a given day a lot more shirtwaists (by that, I mean patient visits).

“But this is the real selling point, Mr. Holder. With the machines, the docs' production of the more-difficult, intricately stitched shirtwaists (the more thoroughly evaluated patients) will jump. That'll be good for the patients and docs, particularly if we don't change the piece rate.

"So, the sales staffs of the machine vendors will sell the docs on the machines by saying they're gonna make a lot more money. It's brilliant.

“We can try this first as a pilot, Mr. Holder. Then, we'll toss in a few billion bucks for down payments on new machines. We'll get all that money back and more through the docs' increased productivity.

“But wait, just thinking out loud here: Won't we have to pay the docs more? Because once they get handy with these machines, they'll produce more, especially the higher-cost stuff.

“What's that, Mr. Holder? You've got an idea? Cut the docs' piece rate, right?



“Accuse the docs of fraud?


“You're kidding, right?

“You'll come off like Claude Raines in Casablanca.

“Didn't we just tell the docs to use the machines?

“And what if this all comes down in an election year?

“OK, so you figure, it's a big country, someone will have to be using the machines up against the chalk lines. Right, and then you say, 'I'm shocked, shocked!' Just like Claude Raines. We'll have a couple of show trials and the docs will dial it down on their own.


“Do you really think it will work?

“Nah, me neither.”


Can't have enough visual analogies. Let's say you start in the lower left, at "8 o'clock a.m.," and then go around in circles every day (often shutting of the lights and going home by 7 pm if you're lucky).


Uplift Medical, P.C. (Uplift) failed to provide forty-one individuals with timely access to their medical records and failed to cooperate with an HHS investigation of complaints regarding the company's noncompliance with HIPAA. Uplift argued that the medical records were not available because they were being used in a criminal hearing. As a result, HHS proposed a $4,351,600 penalty. Seems reasonable? Uplift did not request a hearing to challenge the penalty which was subsequently imposed by HHS.

Surprisingly, Uplift was no more cooperative in paying the fine than in cooperating with the investigation. As a result, HHS filed a complaint against Uplift and its owners to collect the penalty, alleging that Uplift continued operating after its corporate charter had been forfeited. HHS contended, and the court agreed, that Uplift had become a de facto partnership and its owners were therefore liable for the HIPAA civil money penalties as de facto partners. The court also held that the owners were barred from challenging the penalty for failure to exhaust their administrative remedies, by requesting a hearing and by the doctrine of res judicata.
Interesting (PDF).

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