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Thursday, January 25, 2007

Report from the IERHIO Annual Summit Meeting

Inland Empire Regional Health Information Organization held it’s annual summit meeting this week in Riverside California under the auspices of the RCMA and SBCMS. A live meeting web conference had presenters from Canada, Pennsylvania and Northern California. The group was quite eclectic with different approaches to the challenge of health information data input, storage and exchange. The Department of Public Health of Riverside County was also represented by Janis Neuman M.D. and and Geoffrey Leung M.D They discussed their ongoing projects and needs. Dr Leung recently returned from Taiwan and stated that he wished the U.S. was on a par with Taiwan in regard to health IT. Laura Landry represented the Long Beach Initiative. Their non profit has been funded and they have selected a vendor. They have excellent support from grants as a result of the expertise of P.H.F.E.
The attendance and support of area and regional hospitals was non-existent, although we have heard each hospital and IPA are investigation EMR solutions. Also present were Dr. Ron Bangasser from Beaver Medical Clinic and Dr. Edward Hess, formerly from Kaiser Permanente. Commentary was heard regarding the Kaiser experiences and their usage of “Epic”.
A presentation was made by Sabatini Montatesti, who is the CEO of ES Enterprises Inc. ES Enterprises is building out a non profit health data exchange for northeast Pennsylvania including Geisinger Medical Center and surrounding hospitals, clinics and physicians. This rural area has unique challenges in that there are a great number of uninsured patients. Funding for the non profit was through charitable donations and hospital contributions. The depth of his knowledge and architecture for the health data exchanges is impressive.
We also heard from other vendor solutions. Clinical Integration was represented by Mark Crespin, Steve Leider and Paul Bessingminder who presented from Vancouver, B.C.
Practice Fusion presented their proposed solution as well. The vendors had an opportunity to answer some challenging questions from our steering and advisory committee.
Ellen Badley represented the California Department of Health representing Cindy Ehnes. She spoke briefly about the Governor’s proposal for health IT and his “Universal Health Care for California” The “takeaway message” for her was the importance of reducing the chasm between state health care and private health care, and that health IT for each is not mutually exclusive.
Our group is obviously biased toward developing some form of integrated health information system.
There was much philosophical and hypothetical discussion about several models both financially and technically.
There was a great concern that our dysfunctional health care system would consider starting another venture in IT regardless of our motives. The group also discussed the inadvisability of a political state ment of universal health care without a major overhaul of the IT infrastructure to support increased numbers of insured in the system. We certainly cannot provide more care for less money and not without a revolution in our health data system.
While some believe a non-profit organization offers some advantages it is the opinion of this writer that is a more expensive and time consuming entity to form and attract users.
My belief is that a sound private entrepreneurial model with a private placement and subscription service would offer greater efficiency and less cost to develop. Because of the intense capital investment to plan, build and maintain an enterprise level solution and/or small practice solutions initial start up cost is critical.
Mission critical items include time to implement, reliability, vendor experience and availability. Jeff Rose of Health Alliant discussed time to implement and train a system in Riverside County at one week per installation which added up to 900 weeks for the provider and hospital base in our region. (which is over ten years)
As a result of two years of independent study, meetings, and information gathering I have developed some opinion on what our region can accomplish in a cost effective and expedient manner.
A proposal will be forthcoming in the next several weeks.
Thank you to all who have attended these meetings, donating valuable time, effort and much expertise for the benefit our our health care system and our patients.

Gary Levin M.D.

Saturday, January 20, 2007


TIME: 6:00 PM


Attendees have received email invitation. If you have not received an email invitation and wish to attend send email request to:

Sunday, January 14, 2007

House Keeping Notes

Some of you may have noticed that Health Train Express now has an RSS Feed. The Icon which is orange and located on the right sidebar allows you to "subscribe" to the feed. If you click on the icon (orange) it will pop up the option to subscribe directly to your browser favorite folder, or whatever feed you use. Any time you use your browser you can find and click "Health Train Express" and see the short summary of the latest posting, without remembering urls.

If you wish please make comments on the blog. If you have problems doing so, please email me directly at I have not been getting any commentary since I converted to the new blogger and new title. Perhaps it is a glitch.

I look forward to the meeting on January 23 2006. Contact me with suggestions at my email as well, or leave a comment here.

The meeting will be interesting with new participants from around the country via web feeds and audio conferencing.

Friday, January 12, 2007

Which Locomotive are you in Front of?

This article in Southern California Physician in early January seemed to juxtapose with the title of my blog. Lytton Smith M.D. categorizes five different locomotives in the "health train express" which threaten to either derail or provide synergy in converting our present health care non-system into an efficient one focused on optimal patient care and outcomes.

With his permission I have copied a few key remarks:

After 30 years in healthcare, I think of these payment conflicts as locomotives of varying size and power. Each train carries a different constituency.Locomotive No. 1 represents the health plans. Thinking they drive the healthcare train, they charge ahead. Focusing on profits to maintain their stock value causes them to ignore the economics of actually paying for the care they expect from physicians and hospitals.Locomotive No. 2 includes hospitals. They carry the EMTALA burden as best they can. Despite complaining about being underpaid, many thrive by billing high charges for basic services. Health plans ignore the hospital charges because they are contracted. The hospitals with poor payer mixes and poor contracts close their doors or sell to alleviate their burden.Shoveling coal in Locomotive No. 3, the physicians rattle down their track. Due to antitrust rules and their own sense of independence, physicians have trouble coordinating the function of their train. With so many internal conflicts--group practice vs. solo practice, primary care vs. specialties--who has time to watch where the train is headed?In flashy Locomotive No. 4, a scenic rail car, are the legislators. With their top-rated medical insurance and VIP status, they protect themselves from the vicissitudes of medical financial struggles by passing laws to assure themselves that all will be well. Locomotive No. 4, fueled often by the engineers of Locomotive No. 1, looks sleek and rumbles along, trying to avoid seeing Locomotive No. 5.Locomotive No. 5 is the longest train of all, containing patients. With many classes of service, it consumes enormous energy as it moves down the track. Like No. 3, No. 5 has no focused leadership. But because of its enormous size, this train has the most potential momentum. No. 5 occupies the most important track as all the other trains exist to serve it.If Locomotives No. 1, 2 and 3 cannot resolve "fair and reasonable" vs. "usual and customary" issues, I fear that Locomotive No. 5 will push Locomotive No. 4 into crushing the others. The resulting collision will create a force for a single-payer system. The drive for all parties to "get their fair share" may result in an oligarchy in which no one is well served. In this environment, mavericks like Dr. Reddy will surely need to look elsewhere for financial satisfaction.Lytton W. Smith, MD, editor for the OCMA, is a physician practicing family medicine with the St. Jude Heritage Medical Group in Yorba Linda. Dr. Smith welcomes feedback on his articles and can be reached at

Perhaps the advent of social health care blogs and the entry of consumer driven plans and opinons will become the "caboose"