Wednesday, October 17, 2007

Economic Advantage????

This news from iHealthbeat:

Do we have a choice about EHR?


October 17, 2007

Boston Health Network Requires All Physicians To Adopt EHRs by 2009

Partners HealthCare System in Boston is requiring all of the physicians in its network to adopt or agree to adopt electronic health records by Jan. 1, 2008, or else they will be removed from the network, Tom Lee, CEO of Partners Community HealthCare, said, Modern Healthcare reports.
Partners expects to lose between 15 and 20 primary care physicians this year because of the mandate, and it could lose some patients if those physicians stop referring patients to Partners hospitals, Lee said.
To retain their network status, about 5,000 physicians in the network will be required to adopt either Partners' or GE Healthcare's EHR or sign an agreement that they will adopt EHRs during 2008. However, by Jan. 1, 2009, any physician without a connection to the network EHR system will be removed from the network.
Mario Motta, a cardiologist in the network, said the mandate is a "two-edged sword" because the benefit of EHRs is higher reimbursement rates from insurers, although Partners is not providing any funds to help physicians adopt the systems.
Lee added that funds are available to improve Partners' EHR system and to train physicians on it (DerGurahian, Modern Healthcare, 10/15).

Thursday, October 4, 2007

Microsoft Health Vault

from iHealthbeat,

"Microsoft has launched its HealthVault program, which offers consumers online personal health records. The company hopes that individuals will let health care providers directly transmit prescriptions, test results and other medical information to their HealthVault accounts. PHRs will be stored in a secure, encrypted database, and patients will be able to set the privacy controls"

Seeing this post I raced to find the "Vault"... First of all, it is complicated to set up, requiring a download of the basic program, and then and number of "connect" interfaces.  It is not designed for patients to enter their medical history, so it is not a true PHR, or personal health record. In addition, the patient must download a number of drivers for "devices".. These devices, so far include

"Healthy Circles", icePHR (In Case of Emergency),  these also interface with a blood pressure transduce, glucometer, spirometer,

There are several other websites one must go to to setup, enter, and read the data. Microsoft has developed a number of  "partners", which I will not mention here, just advise the reader to go to  Microsoft also has an interconnect program called "connect IQ", a portal that almost looks like a HIE, or RHIO.

For the patient, especially an elderly patient this will be difficult to setup, and use.  It will require a nurse or technical assistant to set it up and make it operational.  There will also be considerable expenses for the remote monitors.  The site also states that providers will be able to transfer medical records to the PHR as well. If all of this can be managed it does develop some slick looking tables and graphs of blood pressures, glucose levels,pulmonary function tests, and probably eventually a probe that will report CBCs and blood chemistries.....all from home.

The big question is will payors reimburse for all of this...Will this become part of P4P ?

This is not a patient oriented design.  Even for me it was a long pathway to download and figure it all out.  Setting up the actual vault took some time to complete, and then it was still an empty shell.  But then again I am only a doctor......more later....

Tuesday, October 2, 2007

The "Monkey on your Back"

I think one of the issues most providers are grappling with in regard to HIT and EMRs in their office is not only the initial investment of capital, but the ongoing "relationship" between the practice and the vendor(s).  Will you have a "tiger by the tail?"

The daily operation of the practice will be entirely dependent upon your PMS and/or EMR system. Witness the recent "crash" of the entire West Coast VA CPRS system. A recent iHealthbeat article quoted that it was the worst incident effecting quality and safety of care in the VA system.

The vendors have their "business model" for profitability, and they are not about to let providers interfere with that fact.

Keep in mind we are in the early phase of EMR and  HIT "buildout"

There will initially be a "bubble" as providers invest in EHRs, RHIOS, etc  Eventually the acquisition rate will flatten out. With diminishing returns will the vendors jack up maintenance contracts and costs for updates.

About 18 months ago Allscripts began offering a  "free eRx system which operates as a portal application. It is necessary to enter patient information in the system the first time it is used for a new patient.  Allscripts now offers "a bridge" to connect it to your PMS. They don't say much about interfaces for  EMRs.  Most of the interfaces cost about 300 dollars initially and 240 dollars each year afterward.  One interface was quoted at 695 dollars. There  are  many with "custom" as the interface quote.  Now I can see an upfront charge for an interface, but an annual charge is something else, unless there are some other changes in software after the initial installation. (sounds like Microsoft)...Windows "Live". I wonder what the rest of you thinks about this?

Monday, October 1, 2007

Whose Network is it, Anyway??

The San Francisco Chronicle featured an article highlighting Health 2.0 and the wave of consumer (patient) oriented web sites. people can choose among 500 support groups - from celiac disease to pulmonary fibrosis - create an online journal to chronicle their disease and send electronic hugs to other members. lets patients book physician and dentist appointments online, similar to the way allows diners to make online reservations for restaurants takes a page from consumer rating sites like Yelp and - a popular site that allows students to "grade" teachers and administrators - by allowing patients to anonymously praise or pan their doctors.

Dubbed the YouTube of health care, allows patients to share their stories through online video clips.

Other Web sites, such as PatientsLikeMe, offer people battling devastating diseases the ability to discuss and track in great detail the treatment options other patients in their disease group are trying. Aligns doctor-reviewed and user-generated health content to help people make decisions.

ReliefInSite.comRelief in Site. com: Helps patients record and track their pain and medications and share it with their doctors, nurses, pain specialists, therapists, friends and family members

And I like this one the best: Recruits nurses to give their candid assessment of doctors........for the surgeons who throw instruments.....

It seems Health Information Networks are developing in ways which we could not imagine.


Today  I came across a focused PHR solution for Lasik surgeons. Safeguard your Sight

Many times patients undergo refractive surgery on their eyes, and require enhancements or cataract surgery at a later date. Often times it is with a different ophthalmologist and the prior records are unavailable.  Ophthalmologists are able to upload their "data" before surgery, and after surgery. The data resides on a server. Patients can access this information for a fee and give the results to the new surgeon.