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Tuesday, February 19, 2013


Is an EHR backlash brewing?
February 19, 2013, Tom Sullivan, Editor

There’s a new hashtag in the Twitterverse: #EHRbacklash.

Reasonably easily traced to Feb. 3, when it was typed by Bob Brown, vice president of professional services for HIE consultancy Mosaica Partners, the hashtag was inspired by a Twitter conversation Brown had with Harold Smith III.

“He coined the term,” Brown said. “I coined the hashtag.”

#EHRbacklash was born as EHRs, vendors, and the meaningful use incentive program are under perhaps as much fire as they’ve faced yet.

On Tuesday, in fact, Black Book Rankings managing partner Doug Brown essentially struck at all three by saying that “meaningful use incentives created an artificial market for dozens of immature EHR products,” a scenario that may trigger “the year of the great EHR switch,” in 2013. Black Book reported data to back up that assertion: 31 percent of the 17,000 active EHR users the firm surveyed indicated they were "dissatisfied enough" with their EHR to consider making a switch.

A day earlier, the American Medical Association (AMA) wrote in an editorial that CMS “would do well to take a breather,” given that even though Stage 1 is not completed, CMS is already leading the industry to Stages 2 and 3.

“Outside help should be enlisted to review how the meaningful use program has gone so far,” AMA’s editorial noted. “Then, substantive change can be made to requirements so meaningful use of EHRs really does mean better and more efficient care, and not just lots of meaningless data entry and technological frustration.”

Last week, Edmund Billings, MD, chief medical officer for Medsphere Systems, wrote that HIT vendors are engaged in “prolonged foot-dragging on interoperability and even basic data interfacing,” despite the availability of technical interfaces and open standards. “Yes healthcare IT is their business, but interoperability is not in their nature.”...
Yeah. My quickie Photoshop contribution to the dustup.

Let's be clear. It's not an "EHR backlash" per se, it's "Meaningful Use Stage 3" pushback.


And, what do I find...?

Not online just yet. Stay tuned...

2/21 UPDATE: The article has been posted online. Well worth your time.
When we think of breakthroughs in medicine, we conjure up images of new drugs or new surgeries. When we think of changes to the health-care system, byzantine legislation comes to mind. But according to a growing number of observers, the next big thing to hit medical care will be new ways of accumulating, processing, and applying data—revolutionizing medical care the same way Billy Beane and his minions turned baseball into “moneyball.” Many of the people who think this way—entrepreneurs from Silicon Valley, young researchers from prestigious health systems and universities, and salespeople of every possible variety—spoke at the conference in Las Vegas, proselytizing to the tens of thousands of physicians and administrators in attendance. They say a range of innovations, from new software to new devices, will transform the way all of us interact with the health-care system—making it easier for us to stay healthy and, when we do get sick, making it easier for medical professionals to treat us. They also imagine the transformation reverberating through the rest of the economy, in ways that may be even more revolutionary.

Health care already represents one-sixth of America’s gross domestic product. And that share is growing, placing an ever-larger strain on paychecks, corporate profits, and government resources. Figuring out how to manage this cost growth—how to meet the aging population’s medical needs without bankrupting the country—has become the central economic-policy challenge of our time. These technology enthusiasts think they can succeed where generations of politicians, business leaders, and medical professionals have failed.

Specifically, they imagine the application of data as a “disruptive” force, upending health care in the same way it has upended almost every other part of the economy—changing not just how medicine is practiced but who is practicing it. In Silicon Valley and other centers of innovation, investors and engineers talk casually about machines’ taking the place of doctors, serving as diagnosticians and even surgeons—doing the same work, with better results, for a lot less money. The idea, they say, is no more fanciful than the notion of self-driving cars, experimental versions of which are already cruising California streets. “A world mostly without doctors (at least average ones) is not only reasonable, but also more likely than not,” wrote Vinod Khosla, a venture capitalist and co-founder of Sun Microsystems, in a 2012 TechCrunch article titled “Do We Need Doctors or Algorithms?” He even put a number on his prediction: someday, he said, computers and robots would replace four out of five physicians in the United States.

Statements like that provoke skepticism, derision, and anger—and not only from hidebound doctors who curse every time they have to turn on a computer. Bijan Salehizadeh, a trained physician and a venture capitalist, responded to reports of Khosla’s premonition and similar predictions with a tweet: “Getting nauseated reading the anti-doctor rantings of the silicon valley tech crowd.” Physicians, after all, do more than process data. They attend at patients’ bedsides and counsel families. They grasp nuance and learn to master uncertainty. For their part, the innovators at IBM make a point of presenting Watson as a tool that can help health-care professionals, rather than replace them. Think Dr. McCoy using his tricorder to diagnose a phaser injury on Star Trek, not the droid fitting Luke Skywalker with a robotic hand in Star Wars. To most experts, that’s a more realistic picture of what medicine will look like, at least for the foreseeable future...

Professional groups see lack of evidence in meaningful use criteria
Ed Burns, News Writer - Published: 20 Feb 2013

As the Health IT Policy Committee continues to develop the stage 3 meaningful use criteria, providers are questioning the evidence policymakers are using to justify the new regulations.

The November 2012 request for comment on draft stage 3 recommendations, issued by the Health IT Policy Committee (HITPC) and convened by the Office of the National Coordinator for Health IT (ONC) to devise meaningful use policy suggestions, "doesn't have a discussion that would review the literature on these items and provide evidence from pilot studies or discuss the cost versus the benefit," said Chantal Worzala, director of policy at the American Hospital Association (AHA). "It simply says, 'We think we should do this next,' and we think that's a problem."

Worzala said this kind of approach to rulemaking is an issue because it could represent a missed opportunity for the health care system, and could even create risks to patient safety. She said the majority of health care professionals recognize that IT tools, such as electronic health records, have the potential to greatly improve care quality. However, providers need to know for sure that the systems they implement have been proven to produce these benefits.

Furthermore, implementing unproven technology could lead to unintended consequences, Worzala said. For example, certain meaningful use criteria require physicians to use their electronic health record (EHR) systems to maintain up-to-date medication lists and use decision support systems to determine medication doses. However, some providers have already seen these systems provide dangerous recommendations, jeopardizing patient safety...
And, from the NY Times:
A Digital Shift on Health Data Swells Profits in an Industry
Julie Creswell

It was a tantalizing pitch: come get a piece of a $19 billion government “giveaway.”

The approach came in 2009, in a presentation to doctors by Allscripts Healthcare Solutions of Chicago, a well-connected player in the lucrative business of digital medical records. That February, after years of behind-the-scenes lobbying by Allscripts and others, legislation to promote the use of electronic records was signed into law as part of President Obama’s economic stimulus bill. The rewards, Allscripts suggested, were at hand.

But today, as doctors and hospitals struggle to make new records systems work, the clear winners are big companies like Allscripts that lobbied for that legislation and pushed aside smaller competitors.

While proponents say new record-keeping technologies will one day reduce costs and improve care, profits and sales are soaring now across the records industry. At Allscripts, annual sales have more than doubled from $548 million in 2009 to an estimated $1.44 billion last year, partly reflecting daring acquisitions made on the bet that the legislation would be a boon for the industry. At the Cerner Corporation of Kansas City, Mo., sales rose 60 percent during that period. With money pouring in, top executives are enjoying Wall Street-style paydays.

None of that would have happened without the health records legislation that was included in the 2009 economic stimulus bill — and the lobbying that helped produce it. Along the way, the records industry made hundreds of thousands of dollars of political contributions to both Democrats and Republicans. In some cases, the ties went deeper. Glen E. Tullman, until recently the chief executive of Allscripts, was health technology adviser to the 2008 Obama campaign. As C.E.O. of Allscripts, he visited the White House no fewer than seven times after President Obama took office in 2009, according to White House records.

Mr. Tullman, who left Allscripts late last year after a boardroom power struggle, characterized his activities in Washington as an attempt to educate lawmakers and the administration.

“We really haven’t done any lobbying,” Mr. Tullman said in an interview. “I think it’s very common with every administration that when they want to talk about the automotive industry, they convene automotive executives, and when they want to talk about the Internet, they convene Internet executives.”...

Executives at smaller records companies say the legislation cemented the established companies’ leading positions in the field, making it difficult for others to break into the business and innovate. Until the 2009 legislation, growth at the leading records firms was steady; since then, it has been explosive. Annual sales growth at Cerner, for instance, has doubled to 20 percent from 10 percent.

“We called it the Sunny von Bülow bill. These companies that should have been dead were being put on machines and kept alive for another few years,” said Jonathan Bush, co-founder of the cloud-based firm Athenahealth and a first cousin to former President George W. Bush. “The biggest players drew this incredible huddle around the rule-makers and the rules are ridiculously favorable to these companies and ridiculously unfavorable to society.”...

The records systems sold by the biggest vendors have their fans, who argue that, among other things, the systems ease prescribing medications electronically. But these systems also have many critics, who contend that they can be difficult to use, cannot share patient information with other systems and are sometimes adding hours to the time physicians spend documenting patient care.
“On a really good day, you might be able to call the system mediocre, but most of the time, it’s lousy,” said Michael Callaham, the chairman of the department of emergency medicine at the University of California, San Francisco Medical Center, which eight months ago turned on its $160 million digital records system from Epic. Michael Blum, the hospital’s chief medical information officer, said a majority of doctors there like the Epic system.

Whatever the case, the legislation has been a windfall to top executives at the leading health records companies. Neal L. Patterson, who grew up on a farm near Manchester, Okla., population 100, co-founded Cerner in 1979. As Cerner’s sales have soared in recent years, so have Mr. Patterson’s fortunes. From 2007 to 2011, he received more than $21 million in total compensation, according to the executive compensation research firm Equilar, and his stake in the company is worth $1 billion.
In recent years, Mr. Patterson and his wife, Jeanne Lillig-Patterson, who ran as a Republican for Congress in 2004, have emerged as social and business leaders in the Kansas City, Mo., area. Mr. Patterson is also co-owner of a real estate development firm whose ventures include a 1,200-acre community near Kansas City called the Village of Loch Lloyd, featuring a Tom Watson-designed golf course.
Think about that, doc, when you're coding for a measly 99123 encounter.

12% of Docs Meet Meaningful Use Rules
By David Pittman, Washington Correspondent,
MedPage Today
Published: February 20, 2013
Just over 12% of about 509,000 eligible physicians said they met requirements for meaningful use incentives for electronic health records (EHRs), early study results show.

Less than 10% of specialists and 17.8% of primary care providers attested to enough meaningful use to receive incentive payments through Medicare and Medicaid as of May 2012, according to a letter published in the Feb. 21 issue of the New England Journal of Medicine.

"Although these data suggest rapid growth in the number of providers achieving meaningful use, this pace must accelerate for most eligible professionals to avoid penalties in 2015," Adam Wright, PhD, of Brigham and Women's Hospital in Boston, and colleagues wrote...

"Successive stages of meaningful use increase in difficulty, and it is not yet clear how many eligible professionals will successfully attest in these later stages," the authors said. "The downstream effects of meaningful use on quality, safety, and efficiency are not yet known, and further increases in EHR adoption, functionality for clinical decision support systems, and research are needed to ensure the effectiveness of the meaningful use program."...
Wright's work also found attestation rates vary greatly from state to state. While the median was 7.7%, use varied from 1.9% in Alaska to 24.2% in North Dakota. Primary care providers comprised 44% of all attestations.

Physicians used EHRs from a total of 310 different vendors, with the top five vendors accounting for 58.5% of physicians who met Stage 1 requirements. The top 15 vendors accounted for 80.1% of attestations.

Physicians have complained that using EHRs slows their work flow and reduces productivity.
"Successive stages of meaningful use increase in difficulty, and it is not yet clear how many eligible professionals will successfully attest in these later stages"

Nonetheless, ONC is prepared to allow the RECs to quietly exit the stage, notwithstanding that data indicate that EPs working with RECs are more than twice as likely to make it to Attestation relative to EPs who go it alone.


Re: @FarzadsBowTie

Farzad, I was wearing a bow tie 39 years ago.

CODA: piling on.



Dallas / Fort Worth Healthcare Daily.
I have watched this news get repeatedly and uncritically reposted this week. The total number and percentages of Meaningful Use Attestations “to date” will look DRAMATICALLY different once all of CY 2012 is accounted for (there was a huge Q4 eligibility spike, which is still being attested through next Thursday). Everyone involved with the program knows that things really picked up steam in the second half of 2012 — outside the scope of this analysis.

This story does not add much value. It’s clearly implying that the program is failing.
But, wait, there's more...
Electronic medical records probed for over-billing
Critics question credibility of federal panel charged with investigating

The Obama administration is forging ahead with a multi-billion dollar plan to shift from paper to electronic medical records, despite continuing concerns the program may be prompting some doctors and hospitals to improperly bill higher fees to Medicare. An investigation into those billing questions — which convened a hearing Wednesday — has yet to produce much in the way of results, and critics are questioning the seriousness of the efforts. 

Some digital records software marketed to medical professionals may be encouraging use of elevated billing codes that pay fatter fees, according to the nation’s top health information technology official. That could undermine cost savings the government expects to achieve by adopting the digital systems.

“There is a lot we don’t know about that,” Farzad Mostashari, the National Coordinator for Health Information Technology, said Wednesday at a hearing of policy experts studying the billing issue. “We don’t know if the shift (in higher billing) reflects appropriate coding or inappropriate coding.” He added: “We don’t know if this leads to an increase in costs … or has other impacts.”...

Donald W. Simborg, a California physician who participated in two government groups that studied the billing fraud issue, said on Wednesday that Mostashari’s review relies too heavily on panel members with close ties to the burgeoning health information technology industry. He questioned its effectiveness in determining if the digital equipment contributes to Medicare billing fraud.

Simborg likened the situation to “asking the NRA to investigate gun violence.” Simborg noted that the policy committee consists of strong supporters of electronic health records “who could hardly provide an unbiased and objective view on this.”...


More to come...

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