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Monday, November 5, 2012

The Future of Health IT

One more day of ad nauseum negative campaign ads. The Presidency looks like a toss-up at this point. So, what if Governor Romney wins?

Consider Dr. Halamka's post on THCB:

The Election and Healthcare IT
Tomorrow the Presidential election process comes to an end and the advertising will finally stop. We’ll all be relieved. I especially look forward to a quiet dinner at home without robotic election-related calls.
What about healthcare IT? Will differences in the Obama and Romney platforms impact the momentum of Meaningful Use?
...The Romney Healthcare IT platform notes that Healthcare IT is an issue which has broad bipartisan support. No one argues that a foundation of healthcare IT implemented properly is essential for accountable care organizations. Quality, safety, and efficiency  all benefit from the process enhancement afforded by healthcare IT. Michael Leavitt, former Secretary of HHS and chair of the American Health Information Community (AHIC) will lead the Romney transition team and Leavitt has years of experience with healthcare IT issues from the early days of ONC. As Governor of Massachusetts, Romney supported the early EHR rollout efforts of the Massachusetts eHealth Collaborative.
However, there have been aspects of the Romney Healthcare IT platform which are concerning.
In my conversations with reporters, there has been a consensus that the Romney campaign will terminate stimulus related programs such as Meaningful Use. I’m concerned that eliminating Stage 2 and 3 stimulus dollars would slow the pace of adoption we’ve achieved over the past few years...
The political ability to suspend/cancel MU incentive funds, though, will also depend in large measure on a substantive shift of power via the congressional races, the ostentatious wielding of Sternly Worded House and Senate Concern Troll Letters to HHS Secretary Sebelius notwithstanding. But, suspension of MU payments means Game, Set, and Match loss for RECs.

It will be an interesting week.


Biggest obstacles to stage 2 EHR bonuses revealed

CMS data show that physicians who received meaningful use incentives in stage 1 left the toughest work for the next stage of the federal program.
By PAMELA LEWIS DOLAN, amednews staff. Posted Nov. 5, 2012.
About 251,000 physicians and other eligible professionals already have received more than $2.6 billion in payments for the first stage of the Centers for Medicare & Medicaid Services’ electronic health records incentive program. Collecting for stage 2 will rely on two things that, by and large, physicians have so far skipped: getting patients to look at their paperless records and exchanging data with others.
Data made available by CMS at an October virtual briefing hosted by the Healthcare Information and Management Systems Society show that objectives related to those two tasks were the most commonly deferred in stage 1. In that stage, physicians had to prove, or attest, that they could meet at least five of 10 designated menu objectives. They could defer the rest to stage 2, when the tasks would become mandatory and, in some cases, carry higher thresholds for compliance.
“It is a little concerning to us that the least popular menu objectives demonstrate one of the biggest hurdles with all of the electronic initiatives, and that is interoperability,” Elizabeth Shinberg Holland, director of the Health IT Initiatives Group in the Office of E-Health Standards and Services at CMS, said during the briefing.
Technology analysts said the numbers reflect physicians gravitating toward meaningful use items “that are an easier work flow change for them,” said Dawn Bonder, director of O-HITEC, the regional extension center serving Oregon.
Deferring items related to connecting with others makes meeting stage 2 more difficult. Doctors will have to meet most of the 10 menu objectives from stage 1, and those objectives will get stricter. “Those are the ones that are most aggressive in stage 2,” said Jason Fortin, senior adviser with Impact Advisors, a health IT consulting firm in Naperville, Ill.
To meet stage 2 requirements by 2014, practices over the next year will need to focus on getting vendors to perform necessary upgrades, improving patient engagement, and getting other organizations to adopt systems capable of receiving and sending data to and from their EHR systems, consultants said...
They'll be doing these things without RECs around to help, I would think.


 The bottled-up rules to set up President Barack Obama’s health care reform law are going to start flowing quickly right after Election Day.

But how long will that last? That depends on who wins the presidency.

The once-steady stream of regulations and rules from the Obama administration — instructions for insurance companies, hospitals and states on how to put the law in place — has slowed to a trickle in recent months in an attempt to avoid controversies before the election. Many states, too, have done little public work to avoid making the law an election issue for state officials on the ballot.

But work has been going on behind the scenes — both in the Department of Health and Human Services and at the state level. As soon as Wednesday, the gears and levers of government bureaucracy are likely to start moving at full speed again...
Given that CMS quietly flushed more than 3,000 pages of Final Rules late last week (see my prior post), this regulatory deluge ought to be something to behold. Give us the HIPAA Omnibus Rule, that's what I want to see in particular.


What is Dr. Sweeney up to these days?

We live in a data-rich network savvy world. With so much personal data readily available, you might expect to see a litany of personal harms, but pronouncements seem rare. Dr. Sweeney cites many reasons for this, perhaps the most important being the lack of transparency in data sharing arrangements. These hidden activities make personal harms difficult to detect. How then can policy makers and individuals make educated decisions about privacy and data utility in the absence of such knowledge? If a data beach occurs, how would you know your data was stolen if you never knew the breach company had it? There are many worthy uses for personal data beyond the person, so the goal is not to stop data sharing, but to understand the risks so society can address the risks responsibly and reap benefits.
Working on her own, Dr. Sweeney constructed a data map of flows of personal health data based on her own professional knowledge of data sharing arrangements. What was a little surprising was the comparison of her data map in 2010 to that of an earlier data map in 1997. Together these show the dramatic increase in the number and nature of data sharing during the tenure of the HIPAA Privacy Rule, the regulation that provides privacy to medical information in the US.
These maps shows representative, not comprehensive, descriptions of flows of health information between organizations based on ad hoc knowledge of committee members and researchers. What is needed is a comprehensive data map that records virtually all reports of personal data sharing arrangements found on the web.
Few requirements force non-government organizations to disclose with whom they share personal information, but information about the practices of these organizations may appear in privacy notices, IPO filings, documents in legal cases, and so on. Banks, brokerage houses, and insurance companies must have statements about information sharing. Online companies tend to have privacy notices. Government organizations file "system of records notices", which describes the type of information collected and leads to information about how the data are shared. There are many publicly available sources that document data sharing...

Great fun. Zoom in and out on the interactive maps on the site, pull on the nodes and move them around. Click on a node for a tabulation of any of the myriad data connections, e.g.,
Patient Alice Connections:
  1. Alice's Physician
  2. Alice's Hospital
  3. Managed Care Organization
  4. Employer's Wellness Program
  5. Life Insurance Company
  6. Retail Pharmacy
  7. Health Insurance Company
Alice's Physician Connections:
  1. Patient Alice
  2. Alice's Hospital
  3. Researcher
  4. Consulting Physician
  5. Accrediting Organization
  6. Lawyer in Malpractice Case
  7. Managed Care Organization
  8. Health Insurance Company
  9. Clearing House
  10. Transcription Service
  11. Ambulatory Discharge Database
  12. Bill Coding Service
  13. Public Health
  14. Patient Portal Service
Alice's Hospital Connections:
  1. Patient Alice
  2. Alice's Physician
  3. Researcher
  4. Consulting Physician
  5. State Vital Statistics
  6. Accrediting Organization
  7. Lawyer in Malpractice Case
  8. Managed Care Organization
  9. Health Insurance Company
  10. Clearing House
  11. ICU Management
  12. Transcription Service
  13. Equipment Monitoring
  14. Ambulatory Discharge Database
  15. Hospital Discharge Database
  16. Bill Coding Service
  17. Outcomes Analytics
  18. Public Health
  19. Patient Portal Service
Health Insurance Company Connections:
  1. Patient Alice
  2. Alice's Physician
  3. Alice's Hospital
  4. Alice's Employer
  5. Spouse's Self-Insured Employer
  6. Outcomes Analytics
  7. Disease Management
  8. De-identification Review
Prescriptions Database Connections:
  1. Retail Pharmacy
  2. Pharmaceutical Company
  3. Marketing Company
Retail Pharmacy Connections:
  1. Patient Alice
  2. Pharmacy Benefits Manager
  3. Prescriptions Database
  4. Clearing House
Ambulatory Discharge Database Connections:
  1. Alice's Physician
  2. Alice's Hospital
  3. Researcher
  4. Public Health
Hospital Discharge Database Connections:
  1. Alice's Hospital
  2. Researcher
  3. Outcomes Analytics
  4. Public Health
Public Health Connections:
  1. Alice's Physician
  2. Alice's Hospital
  3. Ambulatory Discharge Database
  4. Clinical Laboratory
  5. Hospital Discharge Database
  6. Researcher
  7. Centers for Disease Control

You probably don't need me to enumerate the potential problems here. Most of them at the doorstep of "patient Alice." Breach potential escalation? Error propagation? Data Mission Creep?...


Monday, 5 Nov 2012 | 3:52 PM ET Text Size
By: Jane Wells, CNBC Correspondent

Republican Mitt Romney has promised that if he wins the White House, he will derail the Affordable Care Act, aka Obamacare. As he and the President debate the costs and benefits of providing healthcare to all, behind the scenes, one part of the new law is being fought ferociously by many doctors — the mandatory move to electronic medical records.

Moving health-care records into the cloud would streamline the communication of information between doctors and hospitals about a patient's health history, potentially saving time, money, and lives.

So why are so many healthcare providers fighting it? They say the current solutions don't save anything...
"Into the cloud." I love that. Cliche of the decade thus far.


That was fun. Thanks, Lenny!

More to come...

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