The Top Gun of Health Train Express Blogs for 2016 (so far)

Our readership fluctuates quite a bit, averaging a paltry 200-300 users/day. Most of the readership is from the U.S. and the U.K.

This year we had several posts that went well above 1000 readers/day.  Like most internet publications readership depends heavily upon Google searchs.  Readership continues for days, weeks months and even years.  We network our contributions on facebook, twitter Newsana, Digg, Redditr and a list of email subscribers. We have an RSS  feed as well.

Top Gun Posts:

11 TOP PATIENT QUESTIONS ABOUT TELEHEALTH Affordable Care Act causing more mega=-mergers Sleep is not an Option Revised Food and Drug Labels New Hope for Stroke Patients The Senior Learning Network The Five Percent in Health Curing Cancer MentalHealth, Behavioral Health, and Neuroscience. Patients Cannot Always Access Complete Medical Records There were many others receiving between 750 and 950 readers/day.  Our readership continues to grow consistently...thanks for  your interest.

The Affordable Care Act, Accountable Care Organization and the Election

Better Together Health 2016 Event - Better Together     Are we really

The Affordable Care Act has stimulated many changes in health care. What is  considered good or bad depends upon the viewpoint of the provider and/or patient.

We have not yet seen the details of the Republican plan so Health Train Express will not offer our evaluation. Decisions based upon political rhetoric are at the least foolish, and at the worst dangerous.

It is doubtful if the ACA will be repealed entirely. Significant amendments ill be made. Other than some displeasure in the provider and health insurance industry patients who are able to access care are at less risk of not getting urgent care.  Even that presents problems in terms of provider accesss and the high deductible and premium expence for most receiving a partial subsidy. For those who are indigent, they have not expenses.

The progress of the organization being promoted by Medicare and some private insurers is the Accountable Care Organization (ACO).  The progress of developing this organization is fraught with many barriers. The ACO is an HMO on steroids.

Perhaps the closest organization to an ACO is the Kaiser Permanente model. The Counsel of Associated Physicians Group recently held a symposium, Better Together Health 2016 Event - Better Together.

The speakers represent a broad spectrum of the view on Accountable Care Organizations.

ROBERT PEARL, MD   CHAIR, COUNCIL OF ACCOUNTABLE PHYSICIAN PRACTICES
Robert Pearl, MD, is Executive Director and CEO of The Permanente Medical Group and President and CEO of the Mid-Atlantic Permanente Medical Group. Dr. Pearl serves on the faculties of the Stanford University School of Medicine and Graduate School of Business. Dr. Pearl is a frequent lecturer on the opportunities to use 21st century tools and technology to improve both the quality and cost of health care, while simultaneously making care more convenient and personalized.

SENATOR JOHNNY ISAKSON    (R-GA), CO-CHAIR, SENATE FINANCE COMMITTEE CHRONIC CARE WORKING GROUP

Senator John Hardy Isakson (R-GA) is serving his second term in the U.S. Senate, and was recently tapped to lead the Senate Finance Committee’s Chronic Care Solutions working group with Senator Mark Warner (D-VA). The work of the bipartisan committee is to begin exploring solutions that will improve outcomes for Medicare patients requiring chronic care. Isakson is the first Georgian since the 1800s to have served in the state House, state Senate, U.S. House of Representatives and U.S. Senate. He also serves on the Senate HELP Committee, Senate Finance Committee, the Senate Foreign Relations Committee, the Senate Ethics Committee, and the Senate Veterans’ Affairs Committee.

TIM GRONNIGEr    DEPUTY CHIEF OF STAFF, DIRECTOR OF DELIVERY SYSTEM REFORM AT CMS
Tim Gronniger is the deputy chief of staff and director of delivery system reform at CMS. He was formerly a senior adviser for healthcare policy at the White House Domestic Policy Council (DPC), where he was responsible for coordinating administration activities in healthcare delivery system reform. Before joining DPC he was a senior professional staff member for Ranking Member Henry Waxman at the House Committee on Energy and Commerce, responsible for drafting and collaborating to develop elements of the Affordable Care Act. Before joining the Committee staff, Tim spent over four years at the Congressional Budget Office.

CECI CONNOLLY    PRESIDENT AND CEO, ALLIANCE OF COMMUNITY HEALTH PLANS

Ceci Connolly became president and CEO of the Alliance of Community Health Plans in January 2016. In her role, she works with some of the most innovative executives in the health sector to provide high-quality, evidence-based, affordable care. Connolly has spent more than a decade in health care, first as a national correspondent for The Washington Post and then in thought leadership roles at two international consulting firms. She is a leading thinker in the disruptive forces shaping the health industry and has been a trusted adviser to C-suite executives who share her commitment to equitable, patient-centered care.

KAREN CABELL, DO    CHIEF OF QUALITY AND PATIENT SAFETY, BILLINGS CLINIC

Dr. Karen Cabell is the chief of quality and patient safety and a practicing internal medicine physician at Billings Clinic, an integrated medical foundation healthcare organization, located in Billings, Montana. Dr. Cabell has implemented diabetes, heart failure and HTN disease management registries along with point-of-care tools for patients and clinicians to better manage chronic disease. She was involved with Billings’ rollout and adoption of an electronic health record implementation since 2004 including all clinic sites and regional partners to include 15 other hospitals with clinics across a 500-mile radius. Dr. Cabell has been instrumental in gaining alignment between the EHR, quality and patient safety as well as strategic planning to support Billings Clinic’s organizational goals of clinical excellence, operational efficiency, market growth and development, and financial strength.

REGINA HOLLIDAY    PATIENT RIGHTS ACTIVIST, ARTIST, AUTHOR

Artist Regina Holliday is a patient advocate known for her series of murals depicting the need for clarity and transparency in medical records, and for founding the Walking Gallery movement. The Walking Gallery consists of more than 350 volunteer members who make statements about the lapses in health care at public meetings by wearing business suits or blazers painted with patient stories. Holliday’s experiences during her husband’s illness and subsequent death inspired her to use painting as a catalyst for change. Backed by her own patient and caregiving experiences, she travels the globe heralding her message of patient empowerment and inclusion in healthcare decision making. Holliday’s mission is to demand a thoughtful dialog with officials and practitioners on the role patients play in their own healthcare.

MARC KLAU, MD

ASSISTANT REGIONAL MEDICAL DIRECTOR, SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP

Dr. Marc Klau has been with the Southern California Permanente Medical Group for 31 years. He is currently the regional chief of Head and Neck Surgery, providing leadership for 100 surgeons.  He is also the Assistant Regional Medical Director for Education, Learning and Leadership. He now oversees the new KP School of Medicine and all of the Southern California Kaiser Permanente residencies, as well as continuing medical education and leadership.

JANET MARCHIBRODA

Artist Regina Holliday is a patient advocate known for her series of murals depicting the need for clarity and transparency in medical records, and for founding the Walking Gallery movement. The Walking Gallery consists of more than 350 volunteer members who make statements about the lapses in health care at public meetings by wearing business suits or blazers painted with patient stories. Holliday’s experiences during her husband’s illness and subsequent death inspired her to use painting as a catalyst for change. Backed by her own patient and caregiving experiences, she travels the globe heralding her message of patient empowerment and inclusion in healthcare decision making. Holliday’s mission is to demand a thoughtful dialog with officials and practitioners on the role patients play in their own healthcare.

DIRECTOR, HEALTH INNOVATION INITIATIVE, BIPARTISAN POLICY CENTER

Janet Marchibroda is the director of the Bipartisan Policy Center’s Health Innovation Initiative in Washington, DC. She has been recognized as one of the Top 25 Women in Healthcare by Modern Healthcare and is a nationally recognized expert on the use of health IT to improve healthcare quality.

LEANA WEN, MD  HEALTH COMMISSIONER, BALTIMORE CITY

Since taking the reins of America’s oldest health department in Baltimore, Dr. Leana Wen has been reimagining the role of public health including in violence prevention, addiction treatment, and urban revitalization. Under Dr. Wen’s leadership, the Baltimore City Health Department has launched an ambitious overdose prevention program that is training every resident to save lives, as well as a citywide youth health and wellness plan. She is the author of the book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, and is regularly featured on National Public Radio, CNN, New York Times, and Washington Post. Her talk on TED.com on transparency in medicine has been viewed nearly 1.5 million times.

Better Together Health 2016 Event - Better Together

Health IT Potpouri

There is an overwhelming amount of information about HIT on the web, blogs, email newsletters and a Google search will turn up literally hundreds of resources.

For this week, May 8 2014 I have compiled this list of hot topics and links:

Innovation event brings new ideas, ROI ROI -- whether the "I" stands for innovation or for investment -- will be among the many topics up for discussion at the National Healthcare Innovation Summit, which kicks off May 13 in Boston. The organizers promise "the kinds of innovations that people can take home and use tomorrow." When EHR design is a 'what not to do' Among the healthcare developers workshopping better approaches to technology design at HxRefactored in Brooklyn next week will be Stephen Buck, who'll offer some "lessons learned" from looking closely at leading EHRs -- specifically, how not to design a user interface. EHR incentive payouts climb to $23B More than 370,000 Medicare and Medicaid eligible providers have earned an EHR incentive payment so far, with 64,000 new participants attesting to meaningful use for the 2013 reporting year. Health agency inks $71M EHR contract The Defense Health Agency has put a foot forward with revamping its clinical information systems after it inked a bridged contract with a Reston, Va.-based technology and defense company.

The current landscape of data exchange networks is disjointed, with health care systems scrambling to uncover sustainable business models. The need for interoperability is greater than ever. What will the model look like in the future and what are organizations doing to move toward more valuable data exchange? Ashish Shah, Medicity’s CTO, and I recently discussed these industry drivers with Anthony Brino, editor of Government Health IT. Read the article HIE at a Crossroads.

Carolinas HealthCare System CareConnect got an early start on creating a robust network for data exchange. Take a look at this recent case study highlighting Medicity’s role in connecting the health care ecosystem to enable a 360-degree view of patients across the care continuum.

Still no consensus on digital/mobile/connected health Posted: 06 May 2014 10:06 PM PDT A while back — three months, to be exact — I asked readers if they had a preferred term to describe “the application of new, personalized technologies to healthcare.” I gave you the choice of digital health, connected health, wireless … Continue reading →

Interoperability beyond doom or gloom

HIE among U.S. non-federal acute care hospitals has been trending upward since 2008, in fact, and it took some major leaps forward in 2013.

An EHR 'buying spree'? Maybe not quite

M*Modal Drives Anywhere, Anytime Medical Dictation with Enhancements to iOS Mobility Solution

Posted: 05 May 2014 09:01 AM PDT

Understanding that physicians require more comprehensive, flexible clinical documentation solutions that reflect the fast-paced highly mobile health care environment, M*Modal today announced enhancements to its Fluency Flex™ Mobile dictation application for iOS 6.0+ devices. Moving beyond the capture of clinical notes during … Continue reading →

Patients want online access to records

More than half of people with chronic conditions say the ability to get their electronic medical records online outweighs the potential privacy risks, according to a new survey by Accenture.

Big chill for telemedicine?

New guidelines issued by the Federation of State Medical Boards could have a chilling effect on the growth of telemedicine -- especially in rural areas and among low-income patients, say some patient advocates, healthcare providers and healthcare companies.

An EHR 'buying spree'? Maybe not quite

Some analysts are predicting the next "great wave" in EHR purchasing among U.S. hospitals to be just around the corner. But do the numbers really bear that out?

EHR certification criteria under fire

The hits keep on coming for the new EHR certification criteria, as the American Medical Association and Telecommunications Industry Association send their complaints to ONC on the heels of similar criticism submitted earlier by the EHR Association.

The “unconfirmed rumor of a huge acquisition” that HIStalk (a.k.a. the National Inquirer of health IT) tweeted about on Wednesday apparently is that IBM was going to acquire Epic Systems. Mr. HIStalk on Thursday expressed some reservations.   @DaLAWon Much … Continue reading →

• » Why EHRs are Key to Better Clinical Data

EHR certification criteria under fire

The hits keep on coming for the new EHR certification criteria, as the American Medical Association and Telecommunications Industry Association send their complaints to ONC on the heels of similar criticism submitted earlier by the EHR Association.

$11 Billion DoD EHR Contract

Posted: 01 May 2014 10:51 AM PDT

Nextgov has a great article up which outlines many of the details of the soon to be bid out Healthcare Management Systems Modernization contract. I’d prefer to call it the DoD EHR Contract or AHLTA replacement contract. Certainly there’s more … Continue reading →

10 technologies on the rise

Explore Medical Practice Insider's guide to emerging apps and devices for the medical practic

If you want to learn more about ACO formation and Operational Issues: Attend

this event either in person, or as a webinar.

Press Release: Brookings/Dartmouth Fifth ACO Summit Announces New Keynote Speakers Sean Cavanaugh & Alice Rivlin

A Hybrid Conference and Internet Event The Leading Forum on Accountable Care Organizations (ACOs) and Related Delivery System and Payment Reform Sponsored by Engelberg Center for Health Reform at the Brookings Institution and Dartmouth Institute for Health Policy and Clinical Practice June 18 - 20, 2014 Hyatt Regency on Capitol Hill, Washington, DC Online In Your Own Office or Home live via the Internet with 24/7 Access for Six Months www.ACOSummit.com

For Summit registration information, visit www.ACOSummit.com/registration.php, email registration@hcconferences.com, or call 800-503-3597.

Brief EHR Notes, 40% EHR Replacement, and $23 Billion EHR Market http://ow.ly/2GkTlr

Brief EHR Notes, 40% EHR Replacement, and $23 Billion EHR Market | EMR and HIPAA

RT @kevinmd: Brevity is the soul of a good EMR note http://t.co/AuHO9FWPp2— athenahealth (@athenahealth) May 4, 2014 It's amazing how this has shifted.

Outsourcing IT for Small & Mid-size Hospitals

SAYING GOODBYE.....TO YOUR EHR

What remains the same in HIT since 2004 is a farily uniform opinion on the usability of EHR in daily clinical practice. (Doubt)

What  MD has not already spoken about the unusability factor buried deep in your key board and/or mouse. The requirements for HIPAA security, Meaningful use attestations, and interoperability are key requirements for MU.

30% of   EHR  users are dissatisfied with their current EHR and plan to replace them. (KLAS)   If your practice is one of them and you are faced with a large expense to upgrade your HIT system you will want to find a new EHR that meets all MU requirememts.

Vendors have received considerable feedback (criticism) about their present system’s inadequate framework for clinical patient flow and have time to redesign their software.

Prior to the finality of MU3 now may be the time for a new EHR.

The confluence of the Affordable Care Act, proposed Accountable Care Organizations, Increasing meaningul use mandates, improved Cloud services, vendor experience leading to some improvement in user friendliness, and user experiences and demand provide a fertile environment for change.

Calculating ROI with the old system vs a new one has to do with flow, efficiency, and the cost of replacement. If your EHR runs in the cloud the decision is simple...the changes are done at the host site. All software changes are performed off site in the vendor’s facility. eliminating any work disruption at the clinic.  Your original vendor contract should have had stipulations for the added expense of upgrading to meet eventualities of MU or other requirements. Since there is much competition among vendors, a competitive advantage may be the offering of enhanced maintenance and software upgrades.

If you are ‘retiring” your present system due to regulatory changes, consult with your accountant and legal counsel whether you can accelerate the depreciation and write off a portion of the expected life of your old system.  If possible this may ease some of the pain of a poor investment.

Most EHRs were built upon  features present in a practice management system, designed to maximize reimbursement, and maximize charge for each encounter. The new paradigm will be based not upon volume but upon improved outcomes, and decreased cost, for at least some of the encounters.

The field of ACO is new,  everyone knows what an ACO is supposed to do, but it is hard to find one. Several ACOs now are operating and some early statistics show savings and reduction in costs.

Interoperability is a requirment of MU1 and the ONC encouraged this with a framework for disparage EHRs to communicate with each other. Regional Health Information Exchanges experienced a challenge in developing sustainable business plans not dependent upon long term government grants, although the HITECH Act provided start up capital.  A new niche industry developed for HIE infrastructure.  

Some hospitals and providers have committed to these HIEs, but there is a significant difference between potential users and those in the HIE.  Many providers have interoperable systems, and have attested to it’s use. However many do not use the feature either because pre-existing methods are in use or there are no other providers to communicate.

An analysis of our regional health information exchange IHIE.org reveals this fact. The analysis is from the largest HIX in Southern California, and may differ significantly from other organizations.

Accountable Care Organizations will require data and the HIX may provide that avenue to collect and display operational numbers for the ACO.  HIX may become more affordable with expanding functionality to include ACOs requirments without building an entire new infrastructure.

Health 2.0 India

The term Health 2.0 is an outgrowth of Web 2.0 as second generation internet technology and web sites developed in the last decaded of the 21st Century. It now is synonymou with the annual gathering of HIT professionals, including EMR,  HIE,  Mobile apps, Web Portals, and WiFi enabled embedded sensors

Health 2.0 has developed a global presence, beginning in the United States and expanding first to Europe, and Asia. Begiinning as a relatively small meeting it has grown exponentially.  The geographic diversity allows 'techies' in a wide variety of locations and cultures to meet and translate ideas as well as market to potential users. It serves well as a '"thought tank" for mobile health, consumer directed Many software development occurs at these meetings.

Health 2.0 India is the most recent iteration of the exposition.  It begins on February 7, 2014 in Bangalore, India.

2014 Topics will include :

• Designing an improved patient experience for a Billion people

• Trending – Startups, Funding and Accelerating Health 2.0

• Health 2.0 in the village

• Quantified self, wearable sensors and trackers

• Mobile health in real life

• Rise of big data and better decisions

• Pharma and better outcomes

• C-Level executives unplugged

• Unmentionables amplified – Sex, Sport & Rock n’ Roll

India has unique demographics and geographic criteria. It is heavily rural, with scattered villages, weak infrastructure and other limitations for networks. Rural communities often have no electricity. Telemedicine and televideo is highly desireable to spread the healthcare workforce.

One advantage is as infrastructure is built, cell phone, cable internet will be built with modern technology including fiberoptic backbone.

EMR Incentives Derailed?

 

Friday, October 05, 2012

Lawmakers Urge HHS To Halt Payments for EHR Incentive Program

ln a letter to HHS Secretary Kathleen Sebelius, House Ways and Means Committee Chair Dave Camp (R-Mich.) and GOP chairs of several House health subcommittees asked HHS to suspend incentive payments for Stage 2 of the meaningful use program,Modern Healthcare reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.

Letter Details

The letter charges that nearly $10 billion might have been wasted because the rules under Stage 2 of the meaningful use program -- created by CMS and the Office of the National Coordinator for Health Information Technology -- are "weaker" than the rules for Stage 1.

The letter specifically states that certain standards in Stage 2 are either "insufficient" or "woefully inadequate," including requirements that:

• A summary transfer be provided in electronic format only 10% of the time;
• Radiology and laboratory orders be electronic 30% of the time; and
• Medication reconciliation and electronic prescribing take place 50% of the time.

According to CMS data, the EHR incentive program as of June 2012 has disbursed $7.1 billion. Meanwhile, ONC has received $2 billion through the federal stimulus package for health IT programs (Zigmond/Conn, Modern Healthcare, 10/4).

ONC Response

During a forum in Chicago on Thursday, National Coordinator for Health IT Farzad Mostashari defended the stage 2 rules and downplayed the lawmakers' request, noting that the period before a presidential election is known as "the silly season."

Mostashari noted that the requested changes would require congressional and presidential approval (Cadet, Cardiovascular

 

Technorati Tags: Farzad Mostashari,ONC,Hitech,meaningul use,Kathleen Sibelius,stimulus package

What's New??

Okay, I have submitted to my urge to upgrade the RHIO blog to something a bit more diverse and expand the scope of it to include other interesting health related information. With this transition to ver 2.0 of blogger.com, comes the ability to do some fancier things such as RSS feeds and other techno-marvels I can name but clearly go beyond the capability of my 1943 CPU. This is merely a test posting you have found after being referred from the old blog site.
All future posts will be made to "Health Train Express".