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Thursday, July 18, 2013

"RECs are well positioned to continue to assist providers with the full implementation of the EHR Incentive Programs..."

Well positioned

From Dr. Mostashari's Senate Finance Committee hearing testimony yesterday (pdf).

Seriously? It will be interesting to see what remains of the RECs at the end of February, 2014 when the last little dribs of Stage 1 REC funding finally run out (all we were funded for). Farzad loves to allude to the venerable Agricultural Extension Centers by way of warm and fuzzy REC analogy. They are still around today, authorized by Congress via the Smith-Lever Act.

Of 1914.


Consider, above, just the Medicare EP (ambulatory) side of things. If you attested in 2011, again on 2012, and will attest for 2013 (all Stage 1), you will have gotten 86.4% of the incentive funds (assuming you had sufficient Part-B for the max each year). If you began attestation in 2012 and attest for 2013, you'll have gotten 68% of the money.

You will have to update to a Stage 2 certified EHR release ($$$) for 2014. There will only be $6,000 of remaining incentive money potential for the remaining two years (and you'll be coping with ICD-10 and more stringent HIPAA compliance -- not to mention the sequester cuts, which have already adversely impacted the program). See my July 8th post on other aspects of the "Withering of Meaningful Use."

And, you'll be paying fee-for-service for Stage 2 help, whether it comes from the Surviving Sons of REC or from commercial consultants.

What's not to love?

BTW, Dr. Mostashari's live testimony doesn't match up verbatim with his submitted statement. Not even close. There's video of the hearing. Worth watching.

They will have another next week in which vendors will testify. I wonder whether the ever-entertaining Jonathan Bush will be on hand for the festivities.

John Thune bandied the "REBOOT" report about, and Senator Hatch called for "hitting the Pause Button."

I don't see much coming of any of this, beyond the usual handwringing. While the House would certainly vote to defund the remainder of HITECH (if they could sandwich it in between the 40th and 41st poignant votes to Repeal ObamaCare), I rather doubt the Senate can and will muster the requisite 60 votes via which to cut off funding. Meaningful Use incentive funds are not subject to annual appropriations bills, IIRC.

We'll see.


This is interesting.

Master of Science in Healthcare Quality, Safety & Information Technology
Health care quality, safety and information technology program graduates will be prepared to assume leadership roles in the development, design, implementation, evaluation and sustainability of improvements in performance outcomes. In addition, these individuals may assume key roles in education, research, and public policy. Some of these roles may include directors of quality departments or other leadership roles in quality organizations, research and development scientists, health information management or privacy and security specialists.

Loyola University Chicago graduates receiving a transformative education as engaged scholars will be prepared to transform health care. Health care industry sectors demanding QSIT professionals:

  • Provider organizations, including hospitals, outpatient facilities, home health organizations, and integrated delivery systems
  • Quality, safety and information technology vendors, including product development and management firms (e.g., electronic medical record suppliers) as well as education and support firms
  • Governmental health care agencies, such as Centers for Medicare & Medicaid Services (CMS), Health & Human Services (HHS), or Office of the National Coordinator for Health Information Technology (ONC)
  • Public/private organizations focused on quality improvement in health care, such as the Joint Commission (JC), National Quality Forum (NQF) or National Committee for Quality Assurance (NCQA)
  • Professional provider organizations, such as the American Medical Association (AMA) or American Nurses Association (ANA)
  • Universities, including research and education roles
  • Consulting firms
  • Health insurance organizations
  • Health policy research firms and think tanks
  • Community-based advocacy and service organizations
 Upon completion of the QSIT degree, the student will be prepared to:
  • Synthesize key concepts in quality, patient safety and healthcare information technology and management in health care organizations
  • Apply principles and tools from quality, safety, informatics and information technology and measurement science to problem solving and performance measurement in health care organizations
  • Formulate ethical and socially just solutions to the quality and safety problems confronting health care organizations
  • Assume leadership roles within health care systems to promote quality, safety and the use of health information technology
I'm gonna submit an "information request," even though I know it means I will likely be henceforth endlessly badgered via email and phone by some "Admissions Counselor" -- a.k.a. outsourced call center employee reading a script and fishing for a credit card. Unless I've missed something, I don't see any info on their site regarding cost.

I had a transient lapse in judgment a couple of years ago and clicked on a Facebook ad for the "Master of Science in Law" program at Champlain College in Vermont. At the time I was eyeball deep in jousting with our HIE lawyers regarding HIPAA and Nevada SB43 privacy and consent policy stipulations. as a staff member of our "cross-functional privacy and security task force. I'm too old to go to law school, and I don't have a spare hundred grand strewn about. Would a 2nd Masters, a Master's in Law get me any traction with attorneys who always just roll their eyes and pat you on the head with their patronizing 'you just don't understand Legislative Construction' thought bubble blow-off?

I decided not. And, the relatively low MSL admissions requirements comprised a yellow flag.

Two years later, they're still on my case. "Admissions Counselors." Right.

More from Loyola QSIT...
The MS degree in QSIT is planned as a two-year, 36 credit hour, cohort, on-line program with two-day immersion to take place during each of the Spring and Fall semesters. Cohorts will be admitted in the Fall semester. With its holistic and inter-professional approach, the QSIT degree program will integrate a variety of core competencies, including: measurement science, outcomes management, ethics, information systems, research methods and leadership.

Interprofessional concepts will be infused into both immersion and course activities. Five principal members of the QSIT faculty are registered to attend the May 2013 IPEC Interprofessional Faculty Development Institute for Quality & Patient Safety. The IPEC Institute is an opportunity for our faculty team to create an implementable plan for interprofessional curricular design in support of the new QSIT program.

Immersion experiences will be carefully planned to fully complement coursework. During the immersions, Loyola faculty from nursing, medicine, public health and the Graduate School, as well as Loyola and Trinity clinical and administrative leaders will be invited to present short seminars on current relevant topics in quality, patient safety and health information management.

An integral component of the immersion weekends will be experience in the Clinical Simulation Learning Laboratory (CSLL). Through the use of case scenarios, QSIT students will have the opportunity to enhance their technical, communication, critical thinking and decision-making skills as they face simulated quality, safety and information technology challenges. The use of roles, clinical scenarios, faculty feedback and debriefing contribute to a rich and life-like interprofessional learning environment in the CSLL.

Immersion experiences will combine socialization and learning activities designed to develop a community of scholars and leaders as well as provide opportunity for rooting of social justice values to the pursuit of health care quality and safety.

Structure of Each Proposed Focus

The QSIT degree will offer only one focus. Students will individualize their programs through the inclusion of selected Specialty course options based on previous experience, coursework, and career goals, and in consultation with the Graduate Program Director.

The 36-credit Master of Science Degree in Healthcare Quality, Safety, and Information Technology (QSIT) is organized around five Core courses (15 credits), three Advanced Core courses (9 credits), three Specialty courses (9 credits), and one Capstone course (3 credits). Insituations where students have had equivalent courses, a maximum of six credit hours may be transferred in and applied toward the MS degreeIn all cases, students must complete a total of 36 credit hours to fulfill the coursework degree requirements, with a minimum of 30 credits taken through Loyola University Chicago.
I note the absence of any overt Statistics courses in the curriculum (though they do allude to "measurement science"). This is probably a good thing, given the miserable way Stats is typically taught at the undergrad level (I will always be grateful that I came to stats via the UTK Philosophy Department's "Inductive Logic" and "Philosophy of Science" courses). You can take the gamut of conventional univariate stats, bivariates/multivariates, correlation and regression, analysis of variance, and sampling methods and emerge with your cluelessness intact.

From my bank credit risk modeling days, in my blog post "Tranche Warfare":
...I once interviewed a pleasant young hire prospect (playing house "liberal-arts-guy" dumb), a woman with a Master's degree in Statistics (University of Denver). Offhandedly, I asked her to explain to me, in plain plebian English, the concept of "Standard Deviation."

She couldn't do it. She haltingly gave me all the Stats textbook jargon: "Root Mean Squared (RMS) Deviation," the "Square Root of The Mean Squared Deviation, corrected for degrees of freedom" blah, blah, blah...

I dropped the line of questioning.

OK. The Standard Deviation is simply the "average" or "expected" variation around an "average." You calculate an arithmetic average. Unless each value is identical, there is variability. The Standard Deviation -- beneath the hood of all the Scary Greek Shit -- is simply the amount of variation to "expect," "on average."

We hired her anyway. It wasn't my call. She lasted about 3 months, did a few banal yet aesthetically pleasing Excel sheet graphs and Powerpoint assemblages, and then moved on to inflict her thoroughly academically pedigree'd ignorance elsewhere.

Perhaps stuff like this will suffice for QSIT students:
Outcomes Performance Management Methods CMAN 440 (3 credits). This course focuses on methods, techniques and tools employed in outcomes performance management and patient safety. Emphasis is on: application of quality improvement, evidence-based practice and safety approaches; strengths, limitations, purposes and appropriate uses for accepted performance measurement and decision support methods, effective use of statistical process control, variance analysis, guidelines, protocols, root cause analysis, failure mode and effects analysis and other measurement tools and methods; design, implementation and evaluation of performance management programs...
Maybe. Looks promising. I encourage people to look into it.

I think my time, though, may be better spent reviewing and renewing my CQE and studying up for and taking and passing the IAPP CIPP/US exam (I'm an IAPP member in addition to my HIMSS and ASQ memberships).


The Feds' curriculum consortium put a lot of work into this. Now available for public download distribution, free (warning: huge zip files).
Component 1
Introduction to Healthcare and Public Health in the US
This component is a survey of how healthcare and public health are organized and services delivered in the US. It covers public policy, relevant organizations and their interrelationships, professional roles, legal and regulatory issues, and payment systems. It also addresses health reform initiatives in the US.

Component 2
The Culture of Healthcare
For individuals not familiar with healthcare, this course addresses job expectations in healthcare settings. It will discuss how care is organized inside a practice setting, privacy laws, and professional and ethical issues encountered in the workplace.

Component 3
Terminology in Health Care and Public Health Settings
Explanation of specific terminology used by workers in health care and public health. Note that this is NOT a course in data representation or standards.

Component 4
Introduction to Information and Computer Science
For students without an IT background, this Component provides a basic overview of computer architecture; data organization, representation and structure; structure of programming languages; networking and data communication. It also includes basic terminology of computing.

Component 5
History of Health Information Technology in the U.S.
This component traces the development of IT systems in health care and public health, beginning with the experiments of the 1950s and 1960s and culminating in the HITECH act, including the introduction of the concept of “meaningful use” of electronic health records.

Component 6
Health Management Information Systems
A “theory” component, specific to health care and public health applications. Introduction to health IT standards, health-related data structures, software applications; enterprise architecture in health care and public health organizations.

Component 7
Working with Health IT Systems
This is a laboratory component. Students will work with simulated systems or real systems with simulated data. As they play the role of practitioners using these systems, they will learn what is happening “under the hood.” They will experience threats to security and appreciate the need for standards, high levels of usability, and how errors can occur. Materials must support hands-on experience in computer labs and on-site in health organizations.

Component 8
Installation and Maintenance of Health IT Systems
This component covers fundamentals of selection, installation and maintenance of typical Electronic Health Records (EHR) systems. Students will be introduced to the principles underlying system configuration including basic hardware and software components, principles of system selection, planning, testing, troubleshooting, and final deployment. System security and procedures will also be introduced in this component.

Component 9
Networking and Health Information Exchange
This unit will address the OSI, including the purpose and content of each of its seven layers: physical, data link, network, transport, session, presentation, and application. Products, processes, protocols and tools at each level will be explained. This unit will also focus on the flow of data through the models as data is transmitted and receive by end devices.

Component 10
Fundamentals of Health Workflow Process Analysis & Redesign
This component covers fundamentals of health workflow process analysis and redesign as a necessary component of complete practice automation. Process validation and change management are also covered.

Component 11
Configuring Electronic Health Records
This component provides a practical experience with a laboratory component (utilizing the VistA for Education program) that will address approaches to assessing, selecting, and configuring EHRs to meet the specific needs of customers and end-users.

Component 12
Quality Improvement
Quality Improvement introduces the concepts of health IT and practice workflow redesign as instruments of quality improvement. It addresses establishing a culture that supports increased quality and safety. It also discusses approaches to assessing patient safety issues and implementing quality management and reporting through electronic systems.

Component 13
Public Health IT
For individuals specifically contemplating careers in public health agencies, an overview of specialized public health applications such as registries, epidemiological databases, biosurveillance, and situational awareness and emergency response. Includes information exchange issues specific to public health.

Component 14
Special Topics Course on Vendor-Specific Systems
Provides an overview of the most popular vendor systems highlighting the features of each as they would relate to practical deployments, and noting differences between the systems.

Component 15
Usability and Human Factors
Discussion of rapid prototyping, user-centered design and evaluation, usability; understanding effects of new technology and workflow on downstream processes; facilitation of a unit-wide focus group or simulation.

Component 16
Professionalism/Customer Service in the Health Environment
This component develops the skills necessary to communicate effectively across the full range of roles that will be encountered in healthcare and public health settings.

Component 17
Working in Teams
An experiential course that helps trainees become “team players” by understanding their roles, the importance of communication, and group cohesion.

Component 18
Planning, Management and Leadership for Health IT
This component targets those preparing for leadership roles, principles of leadership and effective management of teams. Emphasis on the leadership modes and styles best suited to IT deployment.

Component 19
Introduction to Project Management
An understanding of project management tools and techniques that results in the ability to create and follow a project management plan.

Component 20
Training and Instructional Design
Overview of learning management systems, instructional design software tools, teaching techniques and strategies, evaluation of learner competencies, maintenance of training records, and measurement of training program effectiveness.

Component 0
Version 3.0 Change Documents
These documents provide information about general changes that occurred across all 20 Components as well as information about changes by Component and Unit.

More to come...

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