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Sunday, October 28, 2012

Fred Trotter at Strata Rx 2012

I met Fred at Health 2.0 (I've previously reviewed his excellent book. now re-titled "Hacking Healthcare" in my July 18th post). This conference took place the week after Health 2.0 2012 SF.

Data MAKE a difference. You guys are publishers?

Cool, Fred. I had hair once too, son.

BobbyG 1976, Tuscaloosa AL,
the Zappa Years.
36 years ago.


Epatients: The hackers of the healthcare world
A quick reference for becoming an empowered patient.

I help build open source software tools that patients can use to have greater control and influence over their own healthcare (like the Direct Project and Your Doctors Advice). As as result, I’ve become quite familiar with other tools that do the same sorts of things. There is a community of patients who are deeply interested in the ways in which they can become more engaged and how they can specifically use technology to achieve this. This community calls themselves epatients. The epatient community asked me to write a short collection of resources for “becoming an epatient.”

The “e” in epatient is intentionally obscure. The initial assumption is that the “e” stands for “electronic,” as it does in “email.” But in fact, the “e” stands for “engaged” or “empowered.” Nonetheless, reference to email is intentional: The epatient community recognizes that leveraging data is a critical part of empowering a person who happens to be sick. Patients must be “electronic” to become fully “engaged.” I think of epatients as the healthcare equivalent of makers and hackers. More importantly, they are the people I have in mind when I write software...

Apropos of the foregoing:

Report of the Lucian Leape Institute Roundtable On Care Integration

A host of barriers make care integration difficult to achieve in the U.S. health care system. Alone, any one of them poses a formidable challenge; together they form a seemingly impenetrable obstacle to achieving the integration goal. While we acknowledge the difficulties they create, there are specific actions that can overcome them. In this section we discuss the most significant barriers that stand in the way of care integration. In the next, we discuss actions that could accelerate progress on the integration agenda in the face of these barriers.

Physician Autonomy

Deeply ingrained in the profession of medicine is the teaching that a physician has an individual and personal responsibility for his or her patient; this includes providing the best possible treatment and ensuring that he “does no harm” to his patient. This personal responsibility is core to a physician’s training and for most defines what it means to be a physician professional. It is also a foundational principle in the code of professional ethics for the medical profession, drives legal accountability in licensure and tort actions, and is reflected in the fee-for-service payment model for doctors (and other health professionals).
This model of the autonomous physician deciding for the passive patient informs the image of the physician that appears in popular culture (e.g., television series such as “ER” and “House”). Patients’ dependence on their physicians has been reinforced by the information asymmetry that has existed (and been protected) between the two parties. This construct was appropriate 50 years ago when most care involved a single physician supported by a handful of modestly trained professionals. Then it was important for the safety of the patient that the doctor be the “captain of the ship”; he or she was the best-trained person to do this.

But medical science and technology have advanced far beyond those days. The disease burden in our society has changed as well. Rarely now is a patient cared for by a single physician acting from his office with a small office staff.  The majority of care provided in the United States today is for chronic illness (Vogeli et al. 2007), and the proportion is likely to grow as the population ages and as acute care continues to improve. The average patient with a single chronic illness will be cared for by six to nine physicians, at multiple sites, over a prolonged period of time (Vogeli et al. 2007). Moreover, patients and their families are increasingly better informed and able to take a central role in decision making, effectively becoming “coproducers” of their own care. Especially in chronic illness care, they are their own primary caregivers, managing their medications, lifestyle changes, diets, exercise and physical therapy, as they live with their illnesses 24 hours a day, seven days a week, year round...

Lack of Expertise

The contrast between health care and other industrial sectors is striking in the paucity of production design experts involved with the people actually doing the work on a day-to-day basis. Unlike companies such as General Electric, Agilent, or Hewlett- Packard, for example, most health care systems employ few, if any, industrial design engineers. Nor do they provide extensive training or preparation in the use of the tools of production and operational design and management. One exception is the Virginia Mason Medical Center, which has committed significant resources to developing the expertise required to transform its entire management system: over the last eight years, large numbers of the Virginia Mason staff—including doctors, nurses, other clinicians and support staff, and management—have traveled to Japan to participate in a training program at the Toyota Institute and visit plants using lean meth- odologies. ThedaCare, Denver Health, and Intermountain Healthcare have prepared experts in their own domestic programs and have achieved similar improvements.

Without this expertise it is difficult to see how an industry as complex as health care delivery can hope to achieve greater care integration. A huge deficit exists both in the expertise required to undertake the initial design and transformation, and in the expertise required to measure, analyze, and learn as systems are changed. Both are required to continually improve the processes based on actual experience.

Excellent paper (pdf). I've covered these issues (and progressive leadership individuals and organizations) before multiple times. IHC, ThedaCare and Lean, the Weeds' "Medicine in Denial," etc.


The Kiss of Death for Meaningful Use Efforts

The kiss of death to an electronic health records meaningful use effort is boiling down the criteria to a checklist of to-do items for physicians. That’s the word from Jeff Loughlin, project manager at the Massachusetts eHealth Collaborative and executive director of the Regional Extension Center of New Hampshire.

“Physicians hate lists and once you think of meaningful use as a list, you are doomed to failure,” Loughlin said at the MGMA Conference in San Antonio. The program does provide qualification criteria in list format, he acknowledged, but the way to streamline adoption of meaningful use is to describe the criteria not as discrete tasks, but rather as steps that are part of any practice’s given workflow...


Would Romney kill meaningful use?
October 29, 2012 | Erin McCann, Contributing Editor

Presidential candidate Mitt Romney is no stranger to health information technology advocacy. As governor of Massachusetts, he helped spur initiatives such as the $50 million nonprofit Massachusetts eHealth Collaborative, for instance, and he signed a 2003 bill meant to enable Bay State providers to more widely adopt e-prescribing.

But some experts say Romney’s Republican platform, promoting limited federal government and increased fiscal autonomy to the states could very well put federally funded health IT initiatives at risk.

Ed Daniels, consultant for health IT firm Point-of-Care Partners, wrote that, when it comes to health IT, “Romney is likely to be more of a cheerleader than a funder.”

He surmised that if Romney were elected, eventually, “Government incentive payments for EHR adoption likely will be dropped from future budgets.”...
...Deven McGraw, director of the Health Privacy Project at the bipartisan Center for Democracy and Technology, however, argues that it could go either way if Romney were elected.

“Some folks were worried that, with the economic downturn and the need to address the deficit, that the dollars authorized by Congress for electronic health records might have a target on their back because they have an extended payout,” McGraw told Healthcare IT News. “There is money that’s promised but not yet spent, which makes it a very attractive target for a cut because nobody has those dollars yet."

As of September, $7.7 billion of that meaningful use money has been paid out to providers. As National Coordinator for Health IT Farzad Mostashari, MD, told the audience at a September HIMSS event: “Whoever qualifies, gets paid; there's no hard cap."

Government officials have pegged high estimates of EHR incentive payments at possibly exceeding $27 billion, leaving a potential $19.3 billion sitting and waiting for the providers’ race to attest.

McGraw remains hopeful the money won’t be taken back if Romney is elected – for two reasons. The first is that the benefits of EHRs are generally widely accepted by Republicans and Democrats alike. The second is that providers have already paid big money to update and implement their EHR systems.

“A whole lot of healthcare providers across the country have already made investments in anticipation that they will be reimbursed by the federal government,” she said. “It would be hard to take it back.”...
Assuming the election is not delayed owing to Hurricane Sandy, our expectations will clarify just a bit in a week.

More to come...

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