2011 Nevada Health Care Forum, Oct 11th

It'll be a full and an interesting day, no doubt. I attended last year, and wrote about it in my October 13th, 2010 blog update (scroll down).

My CEO Marc Bennett (pdf) will be on the HIE panel. I've known Marc since 1993. He just exudes comprehensive knowledge.

This year I'll take my good camera. Stay tuned, more to come...
___

JUST IN

ONC, Health 2.0 launch popHealth app challenge
October 10, 2011 | Mary Mosquera

The Office of the National Coordinator for Health IT and the Health 2.0 entrepreneurial organization have opened a contest for developers to innovate with the popHealth tool beyond its reporting functions so healthcare providers can learn more about their patient populations and improve their care.

popHealth is an open source reference implementation software service that can automate the calculation and reporting of the ambulatory care clinical quality measures in stage one of meaningful use. Its data gathering and calculation capabilities make it easier for providers to discern trends in patient populations...
___

ICD-10 And Meaningful Use Dominate AHIMA 2011
October 11, 2011, Ken Congdon, editor in chief, Healthcare Technology Online

Last week marked the 83rd annual American Health Information Management Association (AHIMA) convention. This year's event was held in Salt Lake City, and attendance seemed a bit lighter this year than in years' past — perhaps the result of fiscal cautiousness given our struggling economy. However, one contingent of the AHIMA membership community was at the conference in full force — coders. This attendance, no doubt, was heavily influenced by the upcoming transition from ICD-9 to ICD-10 code sets scheduled to take place in October 2013. ICD-10 will increase the sheer number of codes by nearly five times — from 14,000 to almost 70,000 — and changes the format of codes overall. For example, an ICD-9 code could only be up to five characters in length, where an ICD-10 code can be up to 7 characters long. These changes require upgrades to coding software and supporting backend systems, as well as significant change management on the part of the coding community. As expected, a number of ICD-10 solutions and services were on display in the AHIMA 2011 Exhibit Hall geared toward helping healthcare facilities meet these new coding requirements...

___

THIS IS A GROANER

Law firm loses hard drive with patient records
Attorneys represent St. Joseph cardiologist sued for malpractice
By Tricia Bishop, The Baltimore Sun
8:31 p.m. EDT, October 10, 2011

A Baltimore law firm lost a portable hard drive containing information about its cases, including medical records for 161 stent patients suing cardiologist Dr. Mark G. Midei, a firm client, for alleged malpractice at St. Joseph Medical Center in Towson.

The drive was lost Aug. 4 by an employee of Baxter, Baker, Sidle, Conn & Jones who was traveling on the Baltimore light rail, according to a letter obtained by The Baltimore Sun that was sent to one of the stent patients last week — two months after the drive went missing.

The storage device held a complete back-up copy of the firm's data, including medical records related to the stent malpractice claims, along with patient names, addresses, dates of birth, social security numbers and insurance information...

...But it's unclear if the law firm would be covered by the medical record privacy law, the Health Insurance Portability and Accountability Act, commonly known as HIPAA. The incident may have exposed a loophole, said Marc Rotenberg, executive director of the Electronic Privacy Information Center in Washington and an adjunct professor at Georgetown University Law Center.

HIPAA regulates the protection of patient information by "covered entities" — providers of health care or health plans and data management companies. But malpractice attorneys aren't expressly mentioned.

"Under HIPAA, covered entities have an affirmative obligation to encrypt" data, Rotenberg said, adding that it "may be the case that a law firm is not a covered entity." He called the lost drive a "serious issue, particularly considering the sensitivity of medical information" and said that situation could pose a "problem for the firm, because people might say they were being negligent."...
___

More to come later. I'm off to the Nevada Health Care Forum.

POST-FORUM NOTES


Above: The calm before the storm. I got there early. Below, the crowd filled in. Nice turnout.

Above, my CEO, Marc Bennett, on the HIT/HIE panel.

Below, presentation of the day. The Mayo Clinic. Dr. Swensen: "Half of what we spend every year nationally on health care is recoverable waste."


Throw it down, Sir! You are not alone.

Indeed.

ThedaCare by any other name. Regarding which I've been harping for quite some time.

Above, also from the Mayo Clinic presentation. Something to do with IQ. I'm not kidding (more to follow on that slide, lol). I hope we can get copies of his presentation deck.

Below, a lunch break presentation from the Green Valley High School Choir. Very, very nice.


Met a lot of cool people today.

More to come. Tired tonight. Both me and my new shelter rescue puppy.

Carlos. Woof.
___

ACOs?

There was much discussion at the Forum regarding the potential viability of "Accountable Care Organizations" (and a lot of hedging; justifiably so). Apropos of the subject, from AmedNews:

ACOs face steep funding shortfall, learning curve
A survey says there's "still a lot of confusion" about accountable care organizations and a lack of resources dedicated to them.
By VICTORIA STAGG ELLIOTT, amednews staff. Posted Oct. 11, 2011.

A majority of hospitals, medical centers and physician groups are developing accountable care organizations, but few have dedicated the resources necessary to build one successfully.

An understanding of how this part of health system reform works is sometimes lacking, according to the Accountable Care Organization Readiness Study released Sept. 21 by the management consulting firm Beacon Partners in Weymouth, Mass.

The Patient Protection and Affordable Care Act states that accountable care organizations for Medicare beneficiaries will launch on Jan. 1, 2012. On March 31, the Centers for Medicare & Medicaid Services issued a proposed rule on ACOs. A final rule is under development.

Beacon queried about 200 executives at hospitals, academic medical centers, ambulatory clinics and physician practices during the summer. About 92% were in the planning stages of an ACO, and 30% said they had an operational ACO.

Although significant work is required to create an ACO, the survey found that few health systems were devoting sufficient resources to establish one. CMS has estimated that an ACO will take $1.8 million to launch and run. The American Hospital Assn., however, has data indicating that $11.6 million to $26.1 million is needed to operate an ACO...
__

There was also a lot of Forum discussion on the likely outcomes and impacts of the current SCOTUS challenges to the PPACA ("Obamacare"). No one, however, noted that ACOs are legislatively established by the PPACA -- Section 3022, to be precise.


I also find it noteworthy that ACO activity is to commence this coming January 1st, yet we still have no operationally governing CFR Final Rule.

Moreover, should the law be struck down in toto, the ACO piece goes down with the ship, I would think.

BobbyG's 15 second Photoshop musing.

OK, BELOW, WHAT WILL BE THE UPSHOT OF THIS NEWS?

Health information technology: Incentives may not always serve intended purpose

Survey suggests some awards are going to doctors who have been using electronic health records for years
By Josh Israel and Kimberly Leonard

About half of the first batch of federal dollars meant to encourage doctors and hospitals to switch to electronic records went to providers who were converts to the technology long before the stimulus program was announced, an iWatch News analysis suggests.

The analysis could raise questions about whether the government will be able to meet its goal of widespread adoption of health information technology. While these early numbers are hardly conclusive, they suggest that a large swath of payments intended to be an incentive for new adoption of electronic health records are merely rewarding health providers for minor adjustments to systems they have had in place for years...
__

Well, yeah, the "low hanging fruits," 'eh?

THIS IS PAINFULLY FUNNY

I recently receive a letter from another specialist I had occasion to consult. It was an excellent evaluation, clearly dictated, and in a style not yet of the computer-generated boilerplate type that is becoming commonplace now that the electronic medical record is taking hold...

Click the image for the link.
___

NICE HIE BLOG FIND


Very smartly presented, clean, well-organized, and easy to navigate. Great resource. I put them in my blogroll. Click the banner to check it out.

GREAT NEW HIE ARTICLE


Excerpt from the full AHIMA Journal article (original link here):

Legal Considerations in Joining an HIE
By Chris Dimick
…
State Law versus HIPAA
Another legal HIE issue comes when state law is more strict than HIPAA when it comes to exchanging and releasing medical records. This especially comes into play with state laws centered on protecting specially protected records like substance abuse and HIV/AIDS data.

Typically the trained HIM professional is responsible for dissecting a record request by a neighboring state and reconciling the two state laws. But when requests come from unfamiliar states, HIM professionals need to carefully consider the two states’ laws and decide what is legal to send through the HIE. EHR systems complicate matters as currently most cannot truly segregate all parts of a person’s record that fall into a certain protective category. An HIM professional can pull complete protected records, but usually hints to things like mental health and disease are viewable in other sections of the record, like medication history. HIV treatment records could be blocked, but an HIV drug cocktail on the medication list might get sent unnoticed.

“When I transmit the medication history for a patient, I probably have not weeded out those medications that are only related to the individual’s treatment for their mental health illness,” Egan says. “That is the sort of crossover that folks really have to sit down and figure out how they are going to do that.” There are two current solutions to this legal risk. An organization can over-block records, excluding everything with a diagnosis code related to the specially protected information. Or an organization can stretch their patient consent document to cover multiple years and include consent for exchanging specially protected information in an HIE. “That is harder on the lawyer side because you are really stretching the knowing consent into ‘I agree that you can release this for anything that might come up in the next couple of years,’” Egan says. “That is a little bit of a harder case.”

Intellectual Property Rights
Sometimes more than just a patient’s record gets exchanged during health information exchange, like intellectual property. Business processes, database details, facility-developed patient data, and software details can all be revealed when an organization exchanges data through an HIE…

Malpractice
The use of an HIE, or lack thereof, could lead to lawsuits in the future. While no cases have been filed yet, Egan and Orth see the potential for malpractice lawsuits being filed if a provider had access to vital information through an HIE but failed to review the information.

In the past record transfers have not been immediate enough to constitute a lawsuit stemming from a provider not accessing an exchanged record. But as HIEs improve their processes and speed up their delivery, malpractice suits could appear. Facili- ties would need to modify their practice procedures to ensure staff has checked whether there is further relevant information about each patient by way of an HIE... [pp 62-64]

I am sort of the Office Crank on the topic of "obtaining consent" (see prior posts). Nice to see this.
___

A SHOUT-OUT TO ONE OF MY COLLEAGUES

Fern Percheski, our resident Sensei of All Things Grant Related, is one of the authors (Chapter 9) comprising this book just released and now available on Amazon.


Click the book cover image. Fern and I go back to my first stint with HealthInsight in the early 1990's. She is the best.

Oxford University Press, 'eh?

IF AIR TRAVEL WORKED LIKE HEALTH CARE

___

TIME-SENSITIVE:
MY NOTE REGARDING YEAR-ONE STAGE-ONE ATTESTATION

Click to enlarge. No time left to putz around with this.
___

My heart goes out to Steve Jobs' family and friends

From Apple:

If you would like to share your thoughts, memories, and condolences, please email rememberingsteve@apple.com

BILL GATES

“I’m truly saddened to learn of Steve Jobs’ death. Melinda and I extend our sincere condolences to his family and friends, and to everyone Steve has touched through his work.

Steve and I first met nearly 30 years ago, and have been colleagues, competitors and friends over the course of more than half our lives.

The world rarely sees someone who has had the profound impact Steve has had, the effects of which will be felt for many generations to come.

For those of us lucky enough to get to work with him, it’s been an insanely great honor. I will miss Steve immensely.”

__

I hope others can step up to fill this void and keep the momentum going. This is a huge loss for humanity in addition to the heartbreak his family and friends are undeniably enduring.

__________

Apropos of this blog's purpose, e.g.,

FaceTime is HIPAA compliant and encrypted, could change the way physicians and patients communicate

Healthcare communications is rapidly changing – patients now routinely email their physicians, physicians connect with each-other via mobile-based professional networks, and more. The introduction of Apple’s FaceTime video chat sparked excitement and discussion in the healthcare community about its possible use in telemedicine. However, many were wary about associated patient privacy issues and HIPAA compliance.

It seems that this question has now been answered. According to Apple, calls made via FaceTime can be HIPAA-compliant with the appropriate security configuration. The news that this ubiquitous, free communications platform meets these rigorous standards has potentially wide implications for how patients, physicians, and others in healthcare communicate...

...FaceTime has the potential to broaden the exchange of information among physicians, provide greater convenience to patients, and improve the quality of patient care...

There could be no better way to honor his memory than to forge ahead with such innovations.
___

National Health IT Hype Week, Sept 27th

I would have loved to have been there, actually (personal reasons aside), given that we're in a period of "Let A Thousand VC-funded Flowers Bloom."

John Moore of Chilimark Research has a great cross-post up on The Health Care Blog ("Trickle Down Health") summarizing his reactions:

While Health 2.0 can get overwhelming with the number of rapid fire, albeit shallow demos from the multitudes of vendors who are all trying to make their mark in a market that has experienced a significant amount of churn, the event is invigorating for the passion that is shown. Sure, everyone is hoping to make a living on their next greatest innovation, but unlike virtually any other health IT related conference, those at Health 2.0 have passion. They are on a mission. They want to truly change healthcare. They want to make a difference. That passion is contagious. Unfortunately, that passion appears to be confined to the digerati.

Looking around at the Health 2.0 audience one sees a sea of almost exclusively upper, middle class professionals that are tapping away on their iPad, smartphone or laptop. When one sits back and thinks about the many demos seen, virtually all of them seem to be designed for this audience...

LOL. When I first read "a market that has experienced a significant amount of churn," my bleary pre-coffee Sunday morning eyes saw "chum." Apropos, I guess.

Unsurprisingly, HIT seems to be a new dot.com bubble arena to a great degree. I can't get those after-images of the old circa 2000 Superbowl TV ads out of my head.


See "8 Dot-Coms That Spent Millions On Super Bowl Ads And No Longer Exist."

My fav from those days is one I cannot find online anywhere. It was called "Mrs. Barky," wherein this too-young startup guy is trying to explain his vaporware concept to this wealthy bejeweled tea-sipping dowager mark, hoping to extract some big seed money. When she inquires as to the name of his company, he, seeing her yapping little spoiled lapdog, grins slyly and says without missing a beat, "Mrs. Barky."

John Moore continues:

...Maybe the most disturbing part of the event was the on-stage interview with a mother of eight kids (she was white, middle age and clearly upper middle class) showing how her family is tapped into the quantified self movement with the various Apps they use to track their health and fitness. This is not representative of the broad swath of the American populace who are the ones that will drive our healthcare system off the proverbial cliff. It is that grandmother in Indiana who is caring for her diabetic, overweight husband, two grandchildren, a daughter suffering from an addiction and a son-in-law who is unemployed and has no health insurance that we need to talk to, have up on stage to tell us what they need to better manage their health and interaction with the healthcare system. And we need not go to that extreme, how about just having someone from a safety-net clinic talk about their needs? Sadly, no such representatives were to be found at Health 2.0...

As I noted in the comments 'I am reminded of Gawande’s “The Hot Spotters”.'

...Every country in the world is battling the rising cost of health care. No community anywhere has demonstrably lowered its health-care costs (not just slowed their rate of increase) by improving medical services. They’ve lowered costs only by cutting or rationing them. To many people, the problem of health-care costs is best encapsulated in a basic third-grade lesson: you can’t have it all. You want higher wages, lower taxes, less debt? Then cut health-care services.

People like Jeff Brenner are saying that we can have it all—teachers and health care. To be sure, uncertainties remain. Their small, localized successes have not yet been replicated in large populations. Up to a fourth of their patients face problems of a kind they have avoided tackling so far: catastrophic conditions. These are the patients who are in the top one per cent of costs because they were in a car crash that resulted in a hundred thousand dollars in surgery and intensive-care expenses, or had a cancer requiring seven thousand dollars a week for chemo and radiation. There’s nothing much to be done for those patients, you’d think. Yet they are also victims of poor and disjointed service. Improving the value of the services—rewarding better results per dollar spent—could lead to dramatic innovations in catastrophic care, too...

More to come shortly. The second cup of coffee beckons...
___

ASA RASKIN'S "MASSIVE HEALTH"


No denying the chops of this kid. We'll see what comes of this initiative. There's finally some content on the website.

With healthcare costs rising faster than inflation, a crisis looms on the horizon. Health happens between doctor visits. We need tools to address our health that we love to use. More than 750 people have applied to work with us, over half of them doctors and health professionals. Why? Because everyone knows change is necessary...

...we also help your docs by giving them better insight into trends and issues, by doing the statistical and visualization work for them. That lets them focus on helping you, rather than wasting time staring at numbers.

"Statistical and visualization work"? Like, uh, Stratasan, whom I've mentioned before?


Or, Gapminder?

___

Apropos of the foregoing:

The HIT of ACOs, part 2: Beyond HIE
September 29, 2011 | John W. Loonsk, MD, CMO CGI Federal

Will accountable care organizations follow the lead of HIEs in analyzing data across participating providers, or surpass them?

In this series, we are examining ways health IT can best support the goals of accountable care organizations (ACOs) for health reform.


In our first article we focused on how clinical care and administrative data, as well as software tools, can be arrayed to support quality and efficiency analytics and reporting for an ACO. Data analytic technology usually operates retrospectively on non-transactional data that can be accumulated from diverse systems. As such, while not easy it is perhaps the easiest part of architecting an ACO technical infrastructure. There are analytic challenges in accumulating, normalizing, linking and processing the “iceberg” of both data visible in measures and the greater quantities of less-visible, supportive data needed for analytics and reporting...

Indeed.

Of equal -- no, even more timely interest:

UnitedHealthcare sees lower ER use with data exchange
September 29, 2011 | Mary Mosquera, Government Health IT

MINNETONKA, MN – UnitedHealthcare is beginning to experience reduced hospital and emergency room use as a result of payers and providers sharing patient data through health information exchange in its eight patient-centered medical home pilots around the country.

What is emerging is that the exchange of clinical information for medical management is getting comprehensive enough at the point of care to be able to evaluate the cost effectiveness of the service, according to Sam Ho, MD, executive vice president and chief medical officer, UnitedHealthcare.

With that data, “medical necessity determinations can be made closer to real time and obviate the need for unnecessary diagnostic settings and unnecessary treatment referrals,” he said in a recent online presentation sponsored by the eHealth Initiative, a non-profit organization that promotes health IT...

Well, yes, but "reduced hospital and emergency room use" comes out of some entities' hides, 'eh?

Very interesting. New, sustainable business models must emerge.
___

FIRST MONDAY IN OCTOBER

Obama's healthcare law tops new Supreme Court term

WASHINGTON (Reuters) - President Barack Obama's sweeping healthcare overhaul will top the agenda in the new Supreme Court term that opens on Monday and could be the most momentous in decades...

...Returning from its three-month recess, the nation's highest court will confront legal challenges seeking to strike down Obama's signature domestic policy achievement and a host of other charged issues in its 2011-12 term.

The healthcare law, Obama's signature and most controversial domestic achievement that figures to be a prominent issue in the U.S. elections in November 2012, already has overshadowed the term's other cases.

The law, which aims to provide more than 30 million uninsured Americans with medical coverage and to slow soaring costs, has wide ramifications for the health sector, affecting health insurers, drugmakers, device companies and hospitals.

"That of course would be the big enchilada," said former U.S. Attorney General Dick Thornburgh in discussing the healthcare cases and the new Supreme Court term at a briefing sponsored by the conservative Washington Legal Foundation.

RULING COULD GO EITHER WAY

Legal experts said it was impossible to predict how the Supreme Court might rule on the healthcare law and said a decision could hinge on whether Congress exceeded its powers by requiring that Americans buy insurance or face a penalty.

"It will be a close case," Jonathan Cohn, a former deputy assistant attorney general at the U.S. Justice Department in the George W. Bush administration, said at the briefing...

Well, like Yogi, "I never make predictions, especially about the future," but I've seen some intriguing ones by a number of pundits with SCOTUS-watching cred. Like, say, "5 to 3 to uphold, Kagan recusing."

Yeah, I know, that cuts against the assumed Roberts Court grain, but...
___

UPDATE FROM THE "I'M IN THE WRONG BUSINESS" NEWSWIRE

ONC awards E-Consent Trial project to APP Design
October 03, 2011 | Molly Merrill, Associate Editor, HealthcareIT News

WASHINGTON – The Office of the National Coordinator for Health IT recently awarded a contract to APP Design, Inc., to be part of its electronic consent pilot project...

...[which] will seek to find an efficient, effective and innovative way to help patients better understand their choices regarding whether and when their healthcare provider can share their health information electronically, including sharing it with a health information exchange organization...

Contract No. HHSP23320110023WC, $1,239,908.99

Interesting.
___

More to come...

The only person who enjoys change is a baby with a wet diaper

 YEAH. to wit

The Challenge of ICD10 Adoption
by John Halamka

On October 1, 2013, the entire US healthcare system will shift from ICD9 to ICD10. It will be one of the largest, most expensive and riskiest transitions that healthcare CIOs will experience in their careers, affecting every clinical and financial system...

...Most small to medium healthcare organizations are desperate. They are consumed with meaningful use, 5010, e-prescribing, healthcare reform, and compliance. They have no bandwidth or resources to execute a massive ICD10 project over the next 2 years...

And don't forget PQRS, HIE, and various QIO 10th Scope HIT related initiatives. At times it all seems pretty crazy. One astute commenter in the foregoing Halamka post:

ICD-10 is one piece of a much larger picture. What is the common denominator of: meaningful use, value based purchasing, the March ACO regs, Medicare’s hospital and physician quality reporting initiatives? They all impose “nice to have” documentation requirements which subtract clinician time from direct patient care in the name of “transparency” and “accountability”.

Health care providers added one million jobs since 2007, despite declining utilization in virtually every category of service (hospital admissions, physician visits, etc.). A lot of those jobs were to cope with the escalating complexity of reporting requirements in the payment transaction.

Halamka is exactly right: we need to be simplifying and consolidating payment transactions, and reducing the documentation burden on caregivers. And it isn’t for provider convenience (or enabling them to hide quality defects) , but for the impact on cost and the patient’s experience of care. The micromanagement of medical practice has reached crisis stage.

FROM ACROSS THE POND

September 27, 2011, 7:40 AM
Lessons From Britain’s Health Information Technology Fiasco
By STEVE LOHR, NY Times
Government press releases tend to be bland, earnest blather. But not one posted on the British Department of Health’s Web site last Thursday. Its headline: “Dismantling the NHS National Programme for IT.”

To translate the acronyms a bit, the NHS is Britain’s state-run National Health Service and the program in question was the ambitious drive to computerize England’s health records and let doctors, clinics and hospitals share patient information electronically. The project, begun in 2002, was budgeted at £12 billion (about $19 billion) and the government hailed it as “the world’s biggest civil information technology program.”

The British digital health project has been a slow-motion train wreck for some time with last week’s announcement mainly confirmation — and a pledge to change course. (The announcement was also a political gesture, as the Conservative government of David Cameron tries to get as much distance as it can from an unpopular initiative, begun by Tony Blair’s Labor government.)

Yet the United States is about to begin its own government-funded drive to accelerate the adoption of electronic health records, with Washington set to hand out more than $20 billion in incentive payments over the next five years. So what are the lessons to be learned from the English experience? ...

OK, first lesson? Guess.
___
A SHOUT-OUT TO MY WIREC PEEPS

I was on a HITRC Practice Workflow and Re-design CoP call and web presentation yesterday (9/27) during which we had a presentation by WIREC, the Washington-Idaho REC, a QualisHealth QIO REC contract initiative (like our own).

They are all over it (and, they are not the only ones). I cannot say enough good about these people. One slide that I screen-captured:

Bring it. Lean.

I started this blog on May 10th 2010 touting Lean for health care.
___

QUICK UPDATE FROM THE DEPARTMENT OF
"IS OUR CHILDREN LEARNING?"

Yeah, I know...
___

OCTOBER 1ST UPDATES

First, from The Health Care Blog:

Adverse Events is an interesting place.
As is Stratasan.com.



More shortly...

National Health IT Week, Sept 12 - 16

Comprehensive health care reform is not possible without system-wide adoption of health information technology, which improves the quality of healthcare delivery, increases patient safety, decreases medical errors, and strengthens the interaction between patients and healthcare providers.

With Meaningful Use now providing the way forward, eligible providers across the country increasingly understand the benefits for themselves and their patients, and are adopting Meaningful Use compliant electronic health records...

www.healthitweek.org

___

A CAUTIONARY OBSERVATION

'[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...

…Most clinical decision-making is gray, not black and white. What I would like to see is a comprehensive study is how computers affect issues in the gray world - how computers impact or improve the totality of decision-making on sociological and psychological problems, which may be more subjective rather than objective.'

- Richard Reece, MD

Interesting. I've written about these clinical decisionmaking issues before. Difficult stuff.

UPDATE; Apropos of the foregoing comes this (PDF) from Health Affairs:

Today’s ‘Meaningful Use’ Standard For Medication Orders By Hospitals May Save Few Lives; Later Stages May Do More

ABSTRACT The federal government is currently offering bonus payments through Medicare and Medicaid to hospitals, physicians, and other eligible health professionals who meet new standards for “meaningful use” of health information technology. Whether these incentives will improve care, reduce errors, and improve patient safety as intended remains uncertain. We sought to partially fill this knowledge gap by evaluating the relationship between the use of electronic medication order entry and hospital mortality. Our results suggest that the initial meaningful-use threshold for hospitals—which requires using electronic orders for at least 30 percent of eligible patients—is probably too low to have a significant impact on deaths from heart failure and heart attack among hospitalized Medicare beneficiaries. However, the proposed threshold for the next stage of the program—using the orders for at least 60 percent of patients, a rate some stakeholders have said is too high—is more consistently associated with lower mortality. Our results suggest that the higher standard that will probably follow in the second stage of meaningful-use regulations would be more likely than the first-stage standard to produce the improved patient outcomes at the heart of the federal health information technology initiative.

___

ONC STRATEGIC PLAN 2011 - 2015 (PDF)

"The technologies collectively known as health information technology (health IT) share a common attribute: they enable the secure collection and exchange of vast amounts of health data about individuals. The collection and movement of this data will power the health care of the future. Health IT has the potential to empower individuals and increase transparency; enhance the ability to study care delivery and payment systems; and ultimately achieve improvements in care, efficiency, and population health.

However, these technologies – including electronic health records (EHRs), personal health records (PHRs), telehealth devices, remote monitoring technologies, and mobile health applications – are remarkably underutilized today. In 2010, only 25 percent of physician offices and 15 percent of acute care hospitals took advantage of EHRs. Even fewer used remote monitoring and telehealth technologies. While many consumers access their banking information online daily, only 7 percent have used the web to access their personal health information..."

We shall see shortly the extent to which Congress will permit these initiatives to continue.

___

THIS IS NICE (the ACO M.O.?)

Oh The Jobs (Debt?) You'll Create! from Marketplace on Vimeo.

___

THE JUNTA -- UH, DEFICIT REDUCTION COMMITTEE -- COMETH

1. Presidential Support: President Barack Obama proclaims September 11-17 National Health IT Week. Techies everywhere rejoiced that an entire week will be devoted to health IT. An excerpt from the proclamation reads, “Health information technology connects doctors and patients to more complete and accurate health records. Tools like electronic health records and electronic prescriptions help patients and providers make safer, smarter decisions about health care.” Support from the White House is paramount to the continued success of health IT initiatives in the future. It’s refreshing to have Presidential-level support for that work.

2. The Super Committee: Technically speaking, it’s the Joint Select Committee of Deficit Reduction, and there was a lot of talk about the Committee and its work. The bi-partisan assembly composed of six members of the House and six from the Senate is charged with finding more than $1 trillion in savings over the next 10 years. That means the couch cushions will be over turned and every drop of savings matters. Even something as detailed and technical as health IT will be considered for cost savings and efficiencies. So, it’s crucial that the health IT community maintain an active dialogue with the Super Committee members about the integrity and importance of HITECH funding.

3. Minority Health: Numerous workgroups held Congressional briefings on the state of their affairs. One of those groups launched earlier this year is the HIMSS Latino community. Together with the HHS Office of Minority Health, they are addressing significant issues facing minority populations and how health IT can ease some challenges they face. In their Congressional briefing, the group shared a community-wide concern for healthcare provider shortages and ways to close the disparity gap in minority populations. They also discussed the increasing importance of patient involvement in the healthcare process and how health IT initiatives like patient messaging can improve the delivery of care.

UPDATE: APROPOS OF #2 ABOVE

...While there has been no overt effort to repeal the HITECH Act, which authorized up to $27 billion in incentives for Meaningful Use of EHRs, anything is considered possible as Congress moves to reduce the size of the federal budget deficit. So HIMSS' appeal is more than just pro forma.

"National efforts to transform healthcare delivery systems and to bend the cost curve, including implementation of improved quality measures and reporting systems, are entirely dependent on the widest possible adoption of EHRs and [health information exchange]," HIMSS says in its recommendation to Congress. "Meaningful Use of EHRs supports quality reporting that helps providers analyze and continually improve the quality of care they provide."

Moreover, HIMSS adds, many small practices and smaller community hospitals would not have the resources to implement EHRs without government financial support...

From the Sept 16th FierceHealthIT.com article HIMSS urges Congress: Create a national patient identifier

Yeah, the HIT field ought to be a bit anxious.
___

BUDGET CUT CASE IN POINT


From the blog of the CEO of the American Society for Quality:

The Fight for Baldrige–What’s Next?
Posted on September 16, 2011 by borawski

Well, it’s come to this.

On Wednesday, the Senate Appropriations Subcommittee on Commerce, Justice and Science voted to zero out for the Baldrige Program for fiscal year 2012. Yes, I’m disappointed. It’s likely though that Congress will not pass a budget and resort to a continuing resolution. It’s already on the floor and could extent funding for Baldrige.

But this really shouldn’t be such uphill work As I said in ASQ’s public statement, Congress should be shining a light on Baldrige recipients and point with pride to their accomplishments as an example of what the best can do. Baldrige recipients are creating jobs, saving lives and enriching students. It’s discouraging that the Subcommittee apparently doesn’t understand how valuable the government’s role has been. In these challenging times, model programs — like Baldrige — should be showcased, not eliminated...

Dicey times ahead. Let's hope initiatives like this (below) don't fall victim to the meat axe.

About the Health Data Initiative

The Health Data Initiative is a major new public-private effort that aims to help Americans understand health and health care performance in their communities -- and to help spark and facilitate action to improve performance.

The fundamental approach being taken by the initiative is to catalyze the advent of a network of community health data suppliers (starting with HHS) and “data appliers” who utilize that data to create applications that (1) raise awareness of community health performance, (2) increase pressure on decision makers to improve performance, and (3) help facilitate and inform action to improve performance.

A lot of good work being done, with great promise. I hope it continues. Let's hope we don't end up with this by the end of the year.


Yeah, I know, I have a vested interest. And, I certainly have my detractors (just about all of them using anonymous or otherwise untraceable screen names). This one is one of the more civil ones.


"Academic dilettante." Gotta love it.
___

September 11, 2001

I simply and humbly reflect on our heroic First Responders of that ghastly day a decade ago, and on the subsequent life-and-limb sacrifices of so many thousands of my countrymen and women is its wake.

If blood will flow when flesh and steel are one
Drying in the colour of the evening sun
Tomorrow's rain will wash the stains away
But something in our minds will always stay
Perhaps this final act was meant
To clinch a lifetime's argument
That nothing comes from violence and nothing ever could
For all those born beneath an angry star
Lest we forget how fragile we are

On and on the rain will fall
Like tears from a star like tears from a star
On and on the rain will say
How fragile we are how fragile we are
How fragile we are how fragile we are...

- Sting

Another "Use Case"

NORTH KINGSTOWN, RI, Sep 07, 2011 (MARKETWIRE via COMTEX) -- Improved outcomes for patients is believed to be an important benefit of using electronic health records, yet few physicians can cite specific instances where such software has made a life-saving difference. Dr. Shankar Santhanam of Lawrenceville, NJ, is a notable exception. He recently used the Amazing Charts electronic health record (EHR) system to save a patient's life by following the evidence-based, decision-support recommendations offered by the software...

Story link here.

Anecdotal, to be sure. Nonetheless...
___

And, how about this, from The Health Care Blog?

The Cleveland Experiment

By JOHN MOORE

There have been a number of research studies published that question the value of Electronic Health Records (EHRs), particularly as it pertains to improving quality of care and ultimately outcomes. Chilmark has always viewed these reports with a certain amount of skepticism. Simple logic leads us to conclude that a properly installed (including attention to workflow and thorough training) of an enterprise software system such as an EHR will lead to a certain level of standardization in overall process flow, contribute to efficiencies and quality in care delivery and ultimately lead to better outcomes. But to date, there has been a dearth of evidence to support this logic, that is until this week...

Electronic Health Records and Quality of Diabetes Care
NEJM | August 31, 2011 | Topics: Health IT, Quality of Care
Randall D. Cebul, M.D., Thomas E. Love, Ph.D., Anil K. Jain, M.D., and Christopher J. Hebert, M.D.

One commenter was unimpressed:

The study is flawed by selection bias and investigator bias. This report simply reaffirms that wealthy and educated people are more compliant and achieve better outcomes. The pro HIT bias of the NEJM and the ONC is more than evident.

___

VOICE RECOGNITION UPDATE

Apropos of that, see

Natural Language Processing Coming to HIM Depts.

Natural Language Processing technology can take transcribed text, structure it into computable data, and apply SNOMED CT and other terminologies or codes for richer data abstraction and analysis.

During an educational session at the American Health Information Management Association annual convention, Oct. 1-6 in Salt Lake City, two NLP experts will walk through the technology and its potential. They'll cover tagging and preparing data for electronic health records meaningful use reporting, identifying caps in ICD-10 coding, and tools needed for data mining, among other issues. "We want the audience to walk away understanding how NLP works," says Dee Lang, vice president of product management and strategy at Precyse Solutions, Wayne, Pa...

...Educational session 7142, "Driving Your Organization to Meaningful Use with Data Analytics," is scheduled on Oct. 3 at 4:45 p.m. More information is available at ahima.org.

See also the Praxis article "Why Templates Don't Work."
___

More to come...