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Tuesday, January 8, 2013

Wiki Doc Resource: "The Living Textbook of Medicine"

This is pretty cool.

Register, log in, and contribute.

Some low hanging fruit Health IT topical areas:

Be sure to view all of the "See Also" links.

ALSO: hook up with WikiDoc on Twitter.


Even though billions of dollars are being invested in electronic health records, the promise of cost savings has not reached its potential due in part to “sluggish adoption of health IT systems” and a U.S. health system that needs to change the way it provides medical care service, researchers at RAND Corp. say in a new analysis...

“We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data,” write Rand researchers Arthur Kellermann and Spencer Jones. “Providers must do their part by reengineering care processes to take full advantage of efficiencies offered by health IT, in the context of redesigned payment models that favor value over volume.”...
Yeah. Transparency, interoperability, and workflow redesign. I've been blogging about these issues for going on three years now.

"The health IT systems that currently dominate the market are not designed to talk to each other," the two claim. Even with large, integrated healthcare delivery systems that are models of healthcare IT adoption and use—the Veterans Affairs Department and Kaiser Permanente—"information stored in those records is essentially useless if the patient seeks out-of-network care," they said. "The lack of interoperability is so stark that it has led some to speculate that major health IT vendors are opposed to interoperability."

Regarding EHRs' ease of use, the authors said user interfaces on different systems should be similar enough that a clinician could move from one system to another "without extensive retraining," just as a driver can hop between rental cars and "drive any vehicle off a rental lot without instruction."
Whopping $1.2 billion in EHR payments in December
There was a gold rush in December, and not just at the malls.
The CMS estimates it paid out a record $1.2 billion in December as hospitals, physicians and other professionals filed a flood of claims for Medicare and Medicaid electronic health-record system incentive payments.

"This is our single largest monthly payment by a factor of three," Robert Anthony, a health insurance specialist with the CMS' Office of eHealth Standards and Services, said Tuesday to members of the Health Information Technology Policy Committee.

For the month of December, Medicare paid out $175 million and Medicaid paid $80 million in EHR-use incentives to physicians and other professionals, while Medicare and Medicaid paid $1 billion to hospitals, according to CMS estimates. The December payments pushed the total estimated payouts since the start of the EHR incentive programs, created by the American Recovery and Reinvestment Act of 2009, to $10.3 billion, Anthony said.

The deluge of applications continued in early 2013, with 2,000 eligible professionals filing incentive payment claims on a single day, Jan. 2, the first business day of the new year, Anthony said...


From The National Academy for State Health Policy.

"...Leaders recognize HIT as a key building block for the infrastructure of delivery system transformation, to enable far-reaching reforms that are targeted to solve the biggest issues. However, because HIT and delivery system initiatives have not been well aligned historically, leaders face significant challenges in orienting siloed efforts toward a common goal..."
Ya think?

I reached out to the authors (pdf). One replied, graciously. I reciprocated.
apropos of “alignment,” there are as of today a total of 3,873 ONC “Certified” HIT systems (complete and modules) -- 1,473 and 276 outpatient and inpatient “complete” systems respectively. There is no required common schema / data dictionary standard; indeed, schema are still regarded as proprietary – core HIT product RDBMS value feature differentiators. Consequently, cross-system “data mapping” comprises a significant barrier to “ transparency” for “alignment.”

We at the RECs have to sign non-disclosure agreements just to be able to use EMR vendors’ “sandbox/training accounts,” prohibiting us from divulging any “under-the-hood” stuff we learn (and we only have a handful of vendors who even grant us such limited access).

Try to imagine 3,873 AC power wall socket architectures. 3,873 web browser source code schema…
If the point requires further elaboration, consider that a three prong "Meaningful Use Certified" NEMA 5-15 (15 A/125 V grounded Type B) wall outlet would need only faithfully delivery 125 VAC. The physical design specs ("usability?") of the socket receptacle would not be ONC-CHPL criteria. That you might need hundreds to thousands of shapes and sizes of plugs would be your problem. The "information" would be there (electrons under pressure), but its utility would be dependent on the (proprietary) technological capability to port/transport it from source A to destinations B-Z with 100% accuracy and precision.

BTW: Food and Drug Administration Safety and Innovation Act (S. 3187, July 9, 2012)

Will the FDA continue to beg off Health IT regulatory oversight?

How Healthcare Pros are Using Social Media (Infographic)
Ok so I recently folded under pressure from colleagues (or maybe I was really curious) and decided to check out all the fuss around Pinterest. Apparently, it’s the fastest growing social network or something and recently opened up to everyone to get an account. In any case, I came across this infographic that pointed out some trends from a survey that my buddy Ed Bennett conducted – check it out:


Yes, this is tangential, but, RECs are charged with helping achieve HHS's "Triple Aim" -- better patient experience, improved population health, and reduced cost. Does stuff like this imped such ends?

SBM: The Dr. Oz Red Palm Oil (non-) Miracle

If there is an antithesis to the principles of science-based medicine, it’s probably the Dr. Oz show. In this daytime television parallel universe, anecdotes are evidence. There are no incremental advances in knowledge – only medical miracles. And every episode neatly offers up three or four takeaway health nuggets that more often than not, seem to leave the audience more ill-informed about health and medicine than they were 30 minutes earlier...

If there is a common characteristic of complementary and alternative medicine (CAM) proponents who believe themselves to be scientific, (and I include Dr. Oz in this group), it is that they extrapolate weak clinical evidence into grandiose claims, while cherry picking the most supportive strands of evidence to give the impression of being evidence-based...

If there is one thing that really frustrates me about the Dr. Oz show is that he ignores the boring-but-factual and always hypes the gimmicks. Red palm oil is no exception. It’s foolish and short-sighted to declare red palm oil as healthy or beneficial based on the limited data that exists. The history of dietetics and nutrition is replete with cases of extrapolating preliminary data into supplement and dietary advice, only to see population-level data, and good clinical trials later refute it. ... The impact of red palm oil consumption on your health is likely to be insignificant, compared to the big drivers of health. But none of this matters on the Dr. Oz show. Because just as quickly as this post is published, Oz will have moved on to the next dietary fad, leaving consumers who watch his show more confused than ever about what constitutes good health and nutrition.
"CAM" in the WikiDoc
Sociological and psychological explanations for belief in CAM efficacy

There are both social/cultural and psychological reasons:

Social or cultural reasons:

  • the low level of scientific literacy among the public at large
  • an increase in anti-intellectualism and antiscientific attitudes riding on the coattails of new age mysticism
  • vigorous marketing of extravagant claims by the "alternative" medical community
  • inadequate media scrutiny and attacking critics
  • increasing social malaise (conspiracy theories) and mistrust of traditional authority figures - the antidoctor backlash
  • dislike of the delivery methods of scientific biomedicine.
Psychological reasons:
  • the placebo effect
  • the will to believe
  • self-serving biases that help maintain self-esteem and promote harmonious social functioning
  • demand characteristics - the obligation to respond in kind when someone does them a good turn
  • post hoc, ergo propter hoc fallacy ("after this, therefore because of this"; the basis of most superstitious beliefs)
  • psychological distortion, such as confirmation bias and Cognitive dissonance (inability to respond to criticism of alternative medicine in order to reduce one's cognitive dissonance)
Recognizing that not every meaningful use measure applies to every provider, this fact sheet gives specialty providers tips about how to successfully meet meaningful use measure requirements and navigate the Medicareand Medicaid Electronic Health Record (EHR) Incentive Programs.

Are you facing measures that require data you don’t normally collect as a specialist? While eligible professionals (EPs) can choose measures that apply to their practice, in some cases, data that has been collected by another provider—for example, a referring physician— can be used to fulfill required measures.
Pretty interesting and useful resource. Link here (pdf).

Summary: Medicare spending per beneficiary grew just 0.4% per capita in fiscal year 2012, continuing a pattern of very low growth in 2010 and 2011. Together with historically low projections of per capita growth from both the Congressional Budget Office and the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary, these statistics show that the Affordable Care Act has helped to set Medicare on a more sustainable path to keep its commitment to seniors and persons with disabilities today and well into the future. The success in reducing the rate of spending growth has been achieved without any reduction in benefits for beneficiaries. To the contrary, Medicare beneficiaries have gained access to additional benefits, such as increased coverage of preventive services and lower cost-sharing for prescription drugs.
OK, HHS eager, early PPACA self-congratulation aside, how much of this is "cost-shifting" rather than "cost increase attenuation"? And, while, per capita is nice, the Baby Boomers are going to dramatically increase the size of the Medicare bene pool, so overall cost is likely to continue upward.


From THCB, Quote of the day:

'...The ACA tries to increase access to health insurance through a bewildering combination of Medicaid expansions, private insurance subsidies, health insurance exchanges, and the infamous health insurance mandate.  It attempts to improve healthcare quality through things such as reimbursement reforms and promotion of electronic medical records.  And it encourages the formation of more efficient healthcare organizations, with inscrutable names like “accountable care organizations” and “medical homes”.'

More to come...

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