HIMSS13 New Orleans: March 3 - 7!

I'm pretty stoked.

Dear Member of the Media:

Thank you for registering for HIMSS13, scheduled for March 3-7, 2013, in New Orleans.  We have received your registration, and you are confirmed to receive media credentials for HIMSS13.

You can pick up your media credentials on-site at HIMS13 in the HIMSS Press Room, Room 263, at the Ernest N. Morial Convention Center in New Orleans.  The media credentials will not be mailed, but must be picked up in the press room.

The press room will be open Sunday, March 3, through Wednesday, March 6, from 8 a.m. – 5 p.m., on Thursday, March 7, from 8-11 a.m.

The HIMSS Press Room is a working room for members of the media only. You will find computer hook-ups for your laptop and work stations for you to use during the conference. Breakfast and lunch is served every day beginning Sunday, March 3, through Wednesday, March 6. Breakfast only is served on Thursday, March 7.

You will be receiving other updates from us with specifics on media activities at the conference.  We would ask that you hold Monday, March 4, at 10 a.m. for our Annual HIMSS Leadership Survey Media Brunch/CIO panel.  Look for more information on that event in the months ahead.

We are glad you can join us in New Orleans…and we look forward to seeing you there.  If you have questions, you can check with Joyce Lofstrom or Peter McCormack, who are managing HIMSS13 Media registration.

See you in NOLA!

Thank you.
HIMSS13 Media Registration

Given the incredible HIMSS12 activity here in Vegas last year, this should be even better. The Big Dawg is one of the keynoters.

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THAT HARDY HOLY GRAIL PERENNIAL,
"THE HIGH PERFORMANCE HEALTH CARE SYSTEM"

It's a fine report (pdf). Nothing much we didn't already know, though.

It seems like every think tank and foundation in the nation issues one of these every year. I paraphrase in summary:

"Transparency, align incentives for collaboration, innovation, and efficiencies, pay for value rather than volume, leverage information and new technologies, reduce overall and per capita cost..."

"I Pledge Allegiance To The Triple Aim..."

I like to print out read every word of every health policy publication that comes my way (yellow highlighter an red pen at the ready), but there are only so many hours in the day, and I have my own outset triage scan strategy. In this case I begin with Command-F (Ctrl-F on Windoze platforms) and look for the Usual Suspects keywords and phrases, e.g., in this paper (word/phrase and # of hits):

• information (50)
• health information (5)
• technology (13)
• innovation (24)
• value (82)
• high-value (27)
• transparency (6)
• collaboration (2)
• efficiency (3)
• process (2)
• workflow & work flow (0)

Obviously there's a bit of overlap in the foregoing.

I look at the surrounding context for each search hit, usually +/- a sentence or paragraph. What I see here are the usual laudatory high-level Motherhood and Apple Pie exhortations.

Zero allusions to "workflow," two irrelevant hits on "process," and this on "efficiency."

Health information technology: Policies and funding to encourage physicians, hospitals, and other providers to use electronic health records and exchange information to improve the efficiency and quality of the care they provide. [pg 21]

Let's go back seven and a half years to reflect on how little things have changed:

Health care's 'Prisoner's Dilemma'

...If health care’s IT problems are a reflection of its broader economic problems, then the strategic conflicts within the health insurance and hospital industries themselves—the two most obvious beachheads for HIT development—are sufficient explanation for why we have no interoperable health care infrastructure. Notwithstanding the happy talk of their advertising, health insurers aim to attract and lock in healthy people and drive away sick ones. The less masqueraded goal of the hospital is to attract and lock in sick people and market to those who are not sick yet. Having an interoperable HIT system that allows patients to shop around, with their fully portable EMRs, for a higher-quality or lower-cost health insurer or hospital works directly against these goals.

For insurers in particular, this strategic conundrum over HIT is a redux of the broader managed care conundrum about prevention, which is essentially the prisoners’ dilemma at the heart of game theory. The prisoners’ dilemma always results in an unfortunate ending: All actors in the game would be rewarded if they cooperated and did the right thing by each other. But none will do the right thing without assurance that the other players will all follow, and so they each do exactly the wrong thing, limiting their own downside and thus creating a suboptimal outcome for all. The best way for a health insurer to use HIT to cope with the prisoners’ dilemma is to design a proprietary system that makes it easy for healthy members to sign up; difficult for sick members who need good information to find it and thus remain satisfied with their plan; and even more difficult for everyone outside the insurer’s own organization (that is, everyone looking to get paid) to navigate it. The worst way to cope with the prisoners’ dilemma is to provide an open, interoperable system that works equally well for all members and can exchange data with all other health insurers.

First-mover disadvantage.

A broader version of game theory bearing on the health care industry—when applied to something as formidable as the development of IT standards and interoperable data exchange systems—confronts all industries that are unable to achieve technical standardization. This impediment is steeped in problems of competitive strategy for all industries and can be summed up in what Michael Porter first identified as “first-mover disadvantage.”This concept explains why Joe’s insurer would not want to build an information system connecting its numerous data systems with the nation’s hospitals. Why would one insurer go to all of the financial and strategic cost of creating a ubiquitous information system that would benefit its competitors? For exactly the same reason that IBM created the Internet. Indeed, IBM did not create the Internet—the federal government did—but IBM and all of its competitors have made a fortune creating things that run on, over, off, and because of the Internet. But suppose for a moment that Joe’s insurer were foolish enough to violate this strategic principle and initiate at its own expense an HIT system that allowed it to exchange data with all of its contracting hospitals, physicians, labs, and pharmacies. First, would it be able to get those providers to go to the expense of connecting with the system? (Or would it have to subsidize them, the way WellPoint had to subsidize physicians to get them to use its e-prescribing system?) Second, would it be able to get those same providers to retool their workflows around the new system? Finally, would it build that system based on open standards that would allow its competitors to exchange the same kind of data with those same providers? The health insurer might be able to answer “yes” to the first two questions, but only if it were willing to answer “yes” to the third, thus burning its own capital and internal resources on behalf of its competitors...

[Sept 2005 Dot-Gov: Market Failure And The Creation Of A National Health Information Technology System, J.D. Kleinke]

Groundhog Day.
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ERRATUM: SPEAKING OF KEYWORD SEARCHING

I saw where David Bergman had linked this on his ARCH-IT site

ONC FY 2013 Budget Proposal. Search on "REC," "Extension," "Regional," whatever. "Not found."

But, they did take pains to note themselves in some detail.

ONC provides leadership, program resources and services needed to guide nationwide implementation and meaningful use of health IT. The programmatic activities of ONC are carried out by the following offices:

The Office of the Deputy National Coordinator for Programs & Policy is responsible for: implementing and overseeing grant programs that advance the nation toward universal meaningful use of interoperable health IT in support of health care and population health; coordinating among HHS agencies, offices as well as relevant executive branch agencies; the public health IT programs and policies; developing the mechanisms for establishing and implementing standards necessary for nationwide health information exchange; and, formulating plans, policies and regulations related to the mission of ONC. These activities are carried out by:

• The Office of Policy and Planning;
• The Office of Standards and Interoperability;
• The Office of State and Community Programs; and,
• The Office of Provider Adoption Support.

The Office of the Chief Scientist is responsible for identifying, tracking and supporting innovations in health IT; promoting applications of health IT that support basic and clinical research; collecting and communicating knowledge of health care informatics from and to international audiences; and, advising the National Coordinator on the educational needs of thefield of health IT.

The Office of the Chief Privacy Officer is responsible for advising the National Coordinator on privacy, security, and stewardship of electronic health information and coordinating ONC’sefforts with similar privacy officers in other Federal agencies, state and regional agencies, and foreign countries. The Office of the Chief Privacy Officer also supports privacy and security efforts in ONC’s programs.

The Office of Economic Analysis, Evaluation, and Modeling utilizes advanced quantitative modeling to simulate the microeconomic and macroeconomic effects of investing in health IT; provides advanced policy analysis of health IT strategies and policies to the National Coordinator; and, applies research methodologies to perform evaluation studies of health IT grant programs. 

The Office of the Deputy National Coordinator for Operations is responsible for activities that support ONC’s numerous programs. These include: budget formulation and execution; contracts and grants management; facilities and internal IT management; human capital planning; stakeholder communications; policy coordination; and, financial and programmatic oversight.

These activities are carried out through:

• The Office of Mission Support;
• The Office of Communications;
• The Office of Grants Management; and,
• The Office of Oversight.

Also noted:

Stage 1 of meaningful use was focused on data capture and sharing. This includes accelerated adoption of EHRs, capture of critical information in EHRs, and health information exchange. Stage 2 of meaningful use will be focused on demonstrating health system improvement, which includes more widespread adoption, data exchange, and process improvement. Stage 3 of meaningful use will be focused on transforming health care, and population health through health IT.

Well, OK. Best of luck to everyone. We're already finessing assistance requests for Stage 1 Year 2 (and 3 for early adopters). RECs are only chartered for assistance through Stage 1 "M3" -- Milestone 3, Stage 1, Year 1.
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LOL, THE BIG DAWG ON THE GOLDEN GLOBES

Our HIMSS13 co-Keynoter.

I'm sitting here blogging on Sunday night (6 pm PST), got the Globes on in EyeTV in  a window on my Mac.

Man, I want to get an interview with him in NOLA. (Yeah, right.)
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CONTENTIOUS DISCUSSION ON THCB

The simple truth is that EHR systems do not currently offer cost savings equal to purchase price. With some solutions, there’s an uncrossable chasm between sticker price and ROI...

Purchasing an EHR is not like a buying a car that you just get in and drive away. It’s like buying a car that you have to stop and recalibrate every mile with the assistance of the trained experts in the back seat who charge you a fee every time they have to listen to you speak or look under the hood.

Indeed. From A Tale of Two Studies: What Are the Actual Costs of an EHR?

...While it is generally acknowledged by most (certainly not all, which you know if you’ve spent any time on HIStalk) that the ready availability and automated cross-checking of electronic health records improves care, there is no definitive study showing dramatic clinical improvement, demonstrable return on investment, etc.
Indeed, we now have a number of studies suggesting exactly the opposite:

• The implementation of an EHR upends organizational structure and often slows down the provision of care.
• The introduction of an EHR into a dysfunctional organization tends to exacerbate, not alleviate, said dysfunction.
• Much of the promise of health IT is in interoperability, and the industry is a long way from reaching that goal.
• Physicians generally dislike most health IT solutions.
• Patients would rather the doctor look at them instead of the monitor.

This is not to say that healthcare should bring the EHR train to a screeching halt. We know how technology has transformed other industries. We know that paper records are archaic and put patients at risk while asking them to maintain endless patience when the same test has be performed a third time. And we know that electronically is the only way information can be shared in a timely manner...

These complaints have been around for a long time. I've been addressing such issues across the breadth of this blog's publication.
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No HIPAA Omnibus Final Rule yet (Jan 14th). In other HIPAA news:

Cloud-based EHRs create medical privacy risks
HIPAA details how data should be protected, but one organization says the law doesn’t offer physicians information specific to Internet-based systems.
By PAMELA LEWIS DOLAN, amednews staff. Posted Jan. 14, 2013.

A patient advocacy group is calling on the government to issue guidance to physicians on how cloud-based technology should be implemented and used so fewer patients are put at risk of data breaches.

Deborah C. Peel, MD, chair of Patient Privacy Rights, sent a letter to the Dept. of Health and Human Services’ Office for Civil Rights in December 2012 asking the agency to help physician practices better understand and prepare for vulnerabilities specific to cloud-based technologies. The patient privacy watchdog and advocacy group, based in Austin, Texas, was founded by Dr. Peel, a psychiatrist.

In 2011, 41% of office-based physicians were using a cloud-based electronic health record system, according to a July 2012 report by the Centers for Disease Control and Prevention. Such systems are attractive to many physicians because of their affordability.

Cloud-based practices typically pay a monthly subscription fee to a vendor who stores their data and allows practices to access records using an Internet connection. The approach reduces the need for expensive hardware and servers associated with stand-alone systems that can cost as much as $30,000 and require a full-time staff to maintain...

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WEEKEND SIDE PROJECT

Doing another DVD artwork piece for my friends in Adobe Illustrator, CS6.

This young man Ole is ridiculous!

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MARCH 15 UPDATE
THE HEALTHCARE BLOG ON LINKEDIN

I got an invite to join TCHB LinkedIn Network. Done. Check it out. (May be login firewalled)

WEDNESDAY, MARCH 16

No HIPAA Omnibus Final Rule yet. Now, I'm starting to wonder whether they're going to keep it bottled up until HIMSS13.

From The Health Care Blog: CodeRed, David Dranove on "Unleashing the Innovation Monster"

Ironically, the key to unlocking the power of market forces may be a bit more regulation. Of course we need more vigorous antitrust enforcement. But we also need to bring order to the world of electronic medical records. One advantage enjoyed by the integrated firm is the ability to get all of its providers to use the same EMR platform, thereby facilitating the exchange of information that is vital to improving efficiency and quality. Independent physicians are reluctant to adopt EMR, due to the cost, but they also are reluctant to choose a particular EMR system for fear of aligning themselves with a particular hospital that uses the same system. (This would weaken the physician’s bargaining position.) President Bush established a commission to develop EMR standards, but the result was unsatisfactory and incompatible systems continue to coexist. Without enforced compatibility (and either carrots or sticks to assure adoption), the virtual healthcare organization will remain a pipe dream. Even the most visionary healthcare executive will be reluctant to do business with an independent provider if the potential for information exchange is limited.

This is an excellent read. Click the title link. Would love to get J.D. Kleinke's reaction to it. Maybe he'll comment in the article's comments section.

"incompatible systems continue to coexist"

Ya think? As of today there are 1,486 and 277 ambulatory and inpatient "Meaningful Use 2011 CHPL Certified Complete Systems" littering the health IT landscape. A total of 1,763 complete EMR systems, all "standardized" to the narrow Meaningful Use criteria and virtually nothing else that matters to end-users.

But, hey, Differentiation+Opacity = Margin
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More to come...