The KHIT Blog: Congratulations, President Obama

Wednesday, November 7, 2012

Congratulations, President Obama

Now, can we please get on with it? No shortage of things to be done. Huge challenges remain across the breadth of policy fronts.

Today's REC blog word cloud

RELEASE THE HIPAA HOUNDS!!!

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NICE BLOG HERE

The Future of Health Care in Obama’s Second Term
Posted on November 7, 2012
By Joanne Conroy, MD

Although members of the Obama team are now celebrating their election victory, the next four years will not be smooth sailing. Ignoring the campaign rhetoric, there is still much more work to be done in order to reshape our health care system; the effect on academic medical centers and teaching hospitals will be significant.

The political conscience is still being driven by the fear of the fiscal cliff, which dominates most Washington conversations. Both political parties agree that health care is a significant contributor to our present and future deficit and that we have to figure out how to deliver more care at a lower cost. But, they argue about what to call it, who gets credit, and whether the solution is bigger government involvement or a dominant private market?The potential cuts to NIH funding and graduate medical education support do not go away with another four Obama years. We anticipate that the president will reform the tax code and transform how we deliver health care. The latter will be his lasting legacy.

However, in all this chaos, there are opportunities. While we no longer hope for a bipartisan middle ground on health care — and rancor will certainly escalate if President Obama is reelected — to many people, the Affordable Care Act is starting to look like a tangible business opportunity. Every insurer is looking at the 30 million uninsured people who will receive coverage through a mix of subsidized private insurance for middle-class households and expanded Medicaid for low-income people. These new markets could be worth $50 billion to $60 billion in premiums in 2014, and as much as $230 billion annually within seven years. The structure and implementation of these programs present specific challenges for AMCs...

A lot of fine content on this blog. Highly recommended. Added them to my blogroll.
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Recent HIE news...

UC DAVIS HEALTH SYSTEM'S INSTITUTE FOR POPULATION HEALTH IMPROVEMENT RELEASES FIRST-OF-ITS-KIND BUYERS' GUIDE FOR HEALTH INFORMATION EXCHANGE

(SACRAMENTO, Calif.) — The UC Davis Health System's Institute for Population Health Improvement (IPHI) today released the first edition of its "HIE Ready Buyers' Guide" to facilitate health information exchange (HIE), especially in California.

Produced by IPHI's California Health eQuality (CHeQ) program in collaboration with California Health Information Partnership and Services Organization (CalHIPSO) and state HIE leaders, the guide identifies the base features and standards that should be in place to facilitate health-care data exchange today...

Some very good information in the full pdf report, e.g.,

Click to enlarge

From the top:

INTRODUCTION
Dramatic advances in telecommunications and information management technologies have substantially transformed American culture and many industries, but healthcare has materially lagged other sectors in adopting these new technologies. U.S. healthcare still relies on antiquated methods of recording, storing and sharing information, leading to many of the now well-documented problems in care coordination, quality and patient safety. Improving healthcare quality and care coordination requires that care-related information flow rapidly and securely between and among physician and other healthcare provider offices, hospitals, and other settings of care. To achieve this will require widespread adoption of electronic Health Information Exchange (HIE).

Notwithstanding the improved information flow that electronic health records (EHRs) make possible within a hospital or medical practice, even certified EHRs often have limited capacity to share important care-related data with other EHRs. Upgrading EHRs so that information can be exchanged with other EHRs typically requires additional customization to create interfaces that allow the EHRs to communicate with each other. This requires additional expense and time.

To facilitate the adoption of HIE and help address the need for EHRs to “talk with each other”, the California Health eQuality (CHeQ) program in UCD’s Institute for Population Health Improvement (IPHI), has produced this HIE Ready Buyers’ Guide to identify interoperability and interface features that should be in place to support healthcare data exchange today...

Kudos. Nicely done.
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Headline:

CMS made $645 million in meaningful use payments in October alone, according to draft estimates released Nov. 7.

That's approximately the 4-year price tag for all 62 RECs. A new infusion of REC funding would be in order, I would think.

Interesting YouTube: "Modern Compliance Solutions"

UPDATE

How Obama's Re-election Will Change Medical Practice Staff
Blog | November 07, 2012 | Staff, Healthcare Reform
By Aubrey Westgate

It’s official. President Obama has secured another four years in the Oval Office, and with it, healthcare reform. For many practices, that means big staffing changes are on the horizon.

An estimated 30 million people will gain insurance as a result of the Affordable Care Act. At the same time, the Association of American Medical Colleges anticipates a shortfall of 45,000 primary-care physicians and 46,000 specialists in the coming decade.

To deal, practices will need to find new ways to improve and enhance access to patient care — some practices already are.

“We’ve seen [demand for nurse practitioners (NPs) and physician assistants (PAs)] steadily climbing throughout the year and we don’t anticipate it changing or flattening off any time soon,” Tricia Pattee, director of product management at HealtheCareers Network, told Physicians Practice.

“This is due to the physician shortage, and we’re seeing a lot of the NPs and PAs backfilling where physicians haven’t been able to be filled and taking on a lot of those responsibilities. With the [outcome of] the election last night, we do anticipate the increased number of patients needing care to also affect this and to continue the increase in demand” for NPs and PAs.

Of course, as demand heats up, supply cools down. If your practice is considering hiring an NP or PA in the near future, prepare for some stiff competition...

Note: registration firewalled content. This is a highly contentious area in the health care press.

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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, November 7, 2012

Congratulations, President Obama

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