The KHIT Blog: Time for procrastinating is over, folks

Wednesday, October 3, 2012

Time for procrastinating is over, folks

Failure to do Year One Stage One 90-day Meaningful Use attestation in 2012 will whack $5,000 off your aggregate incentive potential. Money on the table, my friends.

What does the Stage 1 Meaningful Use deadline really mean?
EHR Intelligence, Patrick Ouellette, October 3, 2012

BTW, See "Structured Procrastination"

www.StructuredProcrastination.com

I'm currently reading this book. It's hilarious. Heard the author interviewed on NPR, had to get it for my Kindle.

ON TONIGHT'S "PRESIDENTIAL DEBATE"

From the New England Journal of Medicine

Election 2012

Health Care Reform and the Presidential Candidates (free PDF)

The editors asked the Democratic and Republican presidential nominees, President Barack Obama and former Massachusetts Governor Mitt Romney, to describe their health care platforms and their visions for the future of American health care. Their statements follow.

Pretty interesting (if predictable). Side by side. Worth your time.

POST "DEBATE" THOUGHTS

I'd been predicting to some of my colleagues at the office that the MSM pundit corps would declare Romney the "winner" tonight. They're the media equivalent of Vegas Sports Books. You want the "line" to stay close. Otherwise you can't make money. They want this to be a putative "nail-biter" right down to western time zone poll-closing times.

Sure enough. Never thought the President would pretty much just hand it to Mr. Romney, though. But, he did.

Pretty weak and shallow, the whole thing, coming from both debaters. And, Jim Lehrer looked like he was sweatin' being late for Bingo.

I was going to blog some more tonight (no shortage of things to discuss), but, nah, I'm goin' to bed.

___

GOOD MORNING. BACK TO WORK

Nice ONC blog report on Meaningful Use barriers.

Using Information about Challenges to EHR Adoption and Meaningful Use to Find Global Solutions
October 2, 2012, 2:36 pm
Lisa-Nicole Danehy, Project Officer, Regional Extension Center Program , and
Dawn Heisey-Grove, Public Health Analyst, Office of Provider Adoption Support

In November 2011, the Office of the National Coordinator for Health Information Technology (ONC) began working with the nation’s 62 Regional Extension Centers (RECs) to create a comprehensive dataset of challenges that providers are experiencing in the journey toward electronic health record (EHR) adoption and meaningful use.

RECs represent 136,000 primary care providers, approximately 45% of all United States providers, and serves as an early-warning system to ONC and others about what providers across the country might be experiencing as they work to achieve meaningful use of certified EHR technology. The dataset is also an important tool that the RECs use to target interventions that will help their providers achieve meaningful use...

Good information. Read the entire post. A couple of summary take-away graphics from their very nice deck (pdf).

Notice the "resolutions" tabulated for September 2012. Reflective of 2012 attestation Crunch Time? Maybe that and the fact that we've all been getting repeatedly admonished to "update your Barriers in Salesforce," the CRM from which ONC draws REC project performance data.

How about "challenges" and resolutions thereof stratified by EHR vendor? That's what I'd like to see, in particular given that

RECs represent 136,000 primary care providers, approximately 45% of all United States providers, and serves [sic] as an early-warning system to ONC...

Yeah. You have these data in the Salesforce CRM, ONC.

I might need a day to peel this onion back.

We represent nearly half of primary care? Too bad RECs appear to be expendable by next year.
___

FROM OUR FRIENDS AT HEALTH CARE RENEWAL

Wednesday, October 03, 2012
Honesty and Good Sense on Electronic Medical Records From Down Under

Australians seem to not be as seduced by the Siren Song of cybernetic miracles as health IT leaders in the United States.

It took an Australian computer scientist at U. Sydney to dissect and perform a detailed analysis of the internals of an American EHR system, the results of which were disturbing to say the least. This was a task the American members of the American Medical Informatics Association (AMIA) should have taken on. It's not as if they're unaware of clinical IT problems...

I wrote about this Aussie thing in a prior post (Sept 22nd post). I will have more to say about this. I told this poster I was stealing this line:

"seduced by the Siren Song of cybernetic miracles"

Caption contest: "___________ lashed to the mast."

___

BOBBYG RANT

On the resistant MD's "I'm not a data entry clerk, dammit!"

OCT 4th UPDATE:

GOP lawmakers urge halt on meaningful-use payments

By Jessica Zigmond and Joseph ConnPosted: October 4, 2012 - 5:00 pm ET

HHS should suspend incentive payments to providers in the electronic health-records program and delay penalties to those that do not integrate health IT until the federal department can define clear, interoperable standards, House Republican leaders suggested Thursday in a letter to HHS Secretary Kathleen Sebelius...

...ONC chief Dr. Farzad Mostashari, speaking to a conference of chief medical information officers in Chicago, when asked during a question-and-answer session about the letter, said that his office was initially created by executive order of Republican President George W. Bush and has ever since “has enjoyed bipartisan support.” But “a few weeks before an election is still the silly season,” Mostashari said. “That's what they call it in Washington.”

Seventy percent of hospitals have registered for the EHR incentive payments, and 55% have received their first-year payments, Mostashari said. Healthcare organizations have made plans and are looking for that money to be paid. “This is a commitment that we cannot lightly pull back,” Mostashari said. “It's not just, 'you promised,' it's the importance of it.” But, he said, rescinding the program would require legislation that would have to pass both houses of Congress, be reconciled, and “the president would have to sign it.”

“Sometimes it's useful to remember how American government works,” he said.

Wow.

No comments:

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
___

"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
___

"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
___

"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
___

"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
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"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
___

"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.

The KHIT Blog

Search the KHIT Blog

Wednesday, October 3, 2012

Time for procrastinating is over, folks

No comments:

Post a Comment