The KHIT Blog: March 2015 Senate committee Interoperababble hearing

Wednesday, March 18, 2015

March 2015 Senate committee Interoperababble hearing

I'm not sure how long the video will be up on the committee website. They have pdf files of the prepared witness testimonies on the site. There's a short edited hearing excerpt on YouTube here:

I watched the entire hour and 45 minutes. I've emailed to inquire as to whether there will be a transcript. It was a good hearing, as these things go. Very collegially bipartisan. Lots of concerns aired about the progress and status of the Meaningful Use program, specifically aimed around the continuing lack of effective and widespread "interoperability"/data exchange. (What I have coined as "Interoperababble®.")

UPDATE

As reported by iHealthBeat:

Senate Committee Addresses Meaningful Use, Interoperability

During a Senate Health, Education, Labor and Pensions Committee hearing on Tuesday, senators and stakeholders discussed issues regarding the meaningful use program and barriers to achieving interoperability, Healthcare Informatics reports.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments (Perna, Healthcare Informatics, 3/17).

Hearing Details on Meaningful Use
In an opening statement, Senate committee Chair Lamar Alexander (R-Tenn.) said that "evidence suggests" that while the meaningful use program has spent $30 billion, it has so far failed to deliver on its promises to "improve care, improve coordination and reduce costs."

Specifically, Alexander noted that eligible professionals and hospitals have struggled with the program to the point where CMS has been forced to delay or update its requirements three times. He added, "Half of physicians have not met the requirements of the program and are now facing penalties"...

Yeah, OK, "so far failed to deliver..."

From my March 6th post:

For one thing, I have noted before what I call "Health IT Policy ADHD." Major legislation gets passed and funded, and when we don't get immediate, dazzling results, we go sour on it, lamenting its "failure," and calling for its demise. HITECH is not that old. There have really only been four years of full-bore boots-on-the-ground operation. REC contracts were let in 2010, and the RECs spent most of their first year getting their sea legs under them and scurrying about hustling skeptical clinical participants.

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BUT WAIT! THERE'S MORE...

Gotta love it. From Healthcare IT News.

Epic trades jabs with CommonWell Health Alliance
Epic's 'rhetoric is a slap in the face'

Comments by Epic's head of interoperability in a Senate HELP Committee Tuesday have triggered members of the CommonWell Health Alliance, the subject of some of the comments, to fire back at the Verona, Wisconsin-based EHR giant.

Peter DeVault, Epic's director of interoperability, spoke before the Senate committee on the topic of interoperability and Epic's role in moving it forward. In the questions portion of the hearing, Senator Tammy Baldwin, D-Wisconsin, shifted the conversation, asking DeVault candidly: Why isn't Epic a part of CommonWell?...

The two-year old CommonWell has 1,000 physicians live on it, he said, compared to 100,000 physicians on Epic's Care Everywhere. Healthcare IT News reached out to CommonWell officials for the most up-to-date number but did not receive a response by publication time.

DeVault's comments didn't sit well with one of CommonWell's founding members (and one of Epic's chief competitors), Cerner.

His "rhetoric is a slap in the face to many parties working to advance interoperability," according to a statement released by Cerner officials shortly after the committee hearing. "It was discouraging to hear more potshots and false statements when it's clear there is real work to be done. We're committed to CommonWell as a practical, market-led way to achieve meaningful interoperability."

There's been tension between Epic and CommonWell ever since the latter group's launch at the 2013 HIMSS Annual Conference & Exhibition.

At that HIMSS13 announcement, athenahealth CEO Jonathan Bush emphasized that anyone was invited to CommonWell – even a vendor of "epic proportions."...

Kumbaya...

More, from Modern Healthcare:

'Doc fix' bill would overhaul health IT policy, too
By Darius Tahir | March 19, 2015

The bill introduced Thursday to replace Medicare's sustainable growth-rate formula for physician pay would also significantly alter federal policy on health information technology...

Lawmakers have ... used the legislation to take aim at obstacles to realizing the benefits of IT in healthcare, particularly the lack of interoperability, or data-sharing, between electronic health records.

The SGR bill establishes a July 2016 deadline for HHS to develop metrics to quantify progress toward more data-sharing among hospitals and other providers. HHS would have to account for the progress by December 2018...

This bears watching. A long road yet to an actual law, though.
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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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Wednesday, March 18, 2015

March 2015 Senate committee Interoperababble hearing

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