The KHIT Blog: KatrinaCare.gov update

Monday, February 3, 2014

KatrinaCare.gov update

From WaPo:

HealthCare.gov can’t handle appeals of enrollment errors
By Amy Goldstein, Published: February 2

Tens of thousands of people who discovered that HealthCare.gov made mistakes as they were signing up for a health plan are confronting a new roadblock: The government cannot yet fix the errors.

Roughly 22,000 Americans have filed appeals with the government to try to get mistakes corrected, according to internal government data obtained by The Washington Post. They contend that the computer system for the new federal online marketplace charged them too much for health insurance, steered them into the wrong insurance program or denied them coverage entirely.

For now, the appeals are sitting, untouched, inside a government computer. And an unknown number of consumers who are trying to get help through less formal means — by calling the health-care marketplace directly — are told that HealthCare.gov’s computer system is not yet allowing federal workers to go into enrollment records and change them, according to individuals inside and outside the government who are familiar with the situation...

Recall my October 28th post.
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ONC HealthIT Update

DeSalvo stays the course to better care
WASHINGTON | February 3, 2014

Karen DeSalvo, MD, took the helm at the Office of the National Coordinator for Health Information Technology on Jan. 13. Though she says she is still in "the listening phase," it would be incorrect to say she is still getting her bearings. Whether today as ONC chief, or as a medical resident in the 90s, or as a practicing physician at Charity Hospital in New Orleans, or as vice dean for community affairs and health policy at Tulane University School of Medicine, or as New Orleans’ health commissioner, DeSalvo has kept a steady course on doing everything she could to help improve care.

The story has already been told several times. She grew up poor in Austin, Texas. She and her two sisters were raised by a single mother.

"I experienced healthcare through the public system, in public clinics that were not as a consumer-friendly as we would like," DeSalvo told the Health IT Policy Committee during her second day on the job.

It’s one of the experiences that guides her today as she takes on the ONC mantle to continue her pursuit for better care.

DeSalvo talked with Healthcare IT News Editor Bernie Monegain about the challenges ahead...

I wish her well. She certainly has a huge, contentious task on her hands. Click the article title link above, read the entire interview.
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SAVE THE DATE

Agenda here (pdf). It will be webcast for those who can't attend live.

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ERRATUM

New book order just arrived via Amazon.

It was expensive. Not available in Kindle edition at this point. Hope it will prove worth it. I will let you know.
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HRSA UPDATE

EXECUTIVE SUMMARY: PROGRESS IN ELECTRONIC HEALTH RECORD IMPLEMENTATION THROUGH HRSA GRANTS TO HEALTH CENTER CONTROLLED NETWORKS, OEI-09-11-00380

WHY WE DID THIS STUDY
One goal of the Health Resources and Services Administration (HRSA) is to ensure that all of its health centers implement health information technology (HIT), including electronic health record (EHR) systems. Since 2007, HRSA has awarded $176.9 million in grants to networks of health centers known as health center controlled networks (HCCNs) to support this goal through the acquisition, implementation, and “meaningful use” of EHR systems. To assess the grants’ contributions toward HRSA’s HIT goal, we assessed health centers’ progress in using HRSA grants—funded by the American Recovery and Reinvestment Act (ARRA)—to implement EHR systems that support meaningful use. HRSA did not require demonstration of meaningful use as a condition of the grants, but has stated that Stage 1 meaningful use objectives, as set forth by the Centers for Medicare & Medicaid Services, are a reasonable baseline to assess health center progress in implementing EHR systems. We also did this study to determine whether health centers face challenges related to the financial sustainability of their EHR systems.

HOW WE DID THIS STUDY
We surveyed health centers that participated in HRSA’s ARRA-funded HCCN grant projects that supported EHR implementations and enhancements. Using survey responses, we determined the extent to which health centers established the capability for the Stage 1 meaningful use objectives. We also determined whether health centers reported facing challenges related to the financial sustainability of their EHR systems. To supplement the survey responses, we reviewed grantee progress reports and conducted visits at 11 health centers.

WHAT WE FOUND
Most health centers established the capability for meaningful objectives related to capturing data. However, fewer health centers established the capability for meaningful use objectives related to sharing data. Establishing the capability for objectives relating to sharing data often requires health centers to incur additional EHR-related costs. Although 76 percent of health centers reported facing financial sustainability challenges, grantee progress reports contained limited information related to the financial sustainability of EHR systems at health centers.

WHAT WE RECOMMEND
We recommend that HRSA (1) use data to understand progress towards meaningful use objectives and to provide guidance and technical assistance to health centers, (2) ensure that HCCN grantees provide information on the financial sustainability of EHR systems at health centers, and (3) examine the feasibility of collecting information directly from health centers regarding the financial sustainability of their EHR systems. HRSA concurred with all of our recommendations.

Full report here (pdf).
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FROM THCB:
THIS IS PRETTY INTERESTING

I've wondered for some time why Apple hasn't taken a major run at the health care space. Even put up a quick blog touting it two years ago.

"They have more cash on hand than the U.S. Treasury. They exemplify innovation, how to delight customers, how to put them effortlessly in control. They know hardware. They know software. They know Mobile. They know the internet. They know strategic partnerships. They know how to succeed in the market while adding significant value to our lives. They could do PHR (Personal Health Records), they could do HIE (Health Information Exchange), they could do HIX (Heath Insurance Exchange). No other American company is positioned to do these things, either outright or via industry leadership coordination..."

This latest bears watching.
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More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
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"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
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"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
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"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
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"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
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"'Solutions' exist only in mathematics."

- Karen Martin
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"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
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"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Monday, February 3, 2014

KatrinaCare.gov update

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