What didn't Occur in 2007!

As 2008 begins I started out to clean house. This included defragmenting my hard drive, checking on my windows updates, deleting about 1 GB of uneeded files, running my AV program, anti-spam program, tuning my router, checking my download speeds, and other mundane tasks.

I also updated my list of goals for 2008 and beyond. Looking back on 2007 and further beyond I realized a great number of things had not occurred.

1.Universal Health Care. Except for Massachussetts, had not occured.

2. The number of uninsured  had not decreased.

3. There still was no worldwide epidemic of SARS virus. The pandemic event that was predicted to "thin" the human population still lurks.

4. RHIOs had a very dismal year.

5. Adoption of EMR has failed to "take off" as predicted.

5. CMS and Social Security had failed to go bankrupt, However the bean counters, statisticians and others continued to "see the future" as bleak.

6. The annual SGR adjustment did not go into effect on January 1, 2008 as scheduled.

7. Physicians have not stood together regarding opposition to pay for performance, (or reporting).

8. The number of medical school applicants stopped it's five year decline.

9. I did not quit practicing medicine. (I still like patients)

10 I did not get recertified

11. I did not lose my medical license.

12. I did forget to renew my DEA.

13. HMOs and insurance carriers did not raise my reimburment but did warn us that they will reduce our reimbursement if we don't adopt P4P and HIT.

Merry Go Round or Roller Coaster??

Happy New Year to all.

2007 was a year of up and downs for RHIOs and EMRs in the United States. A small number of RHIOs have made some progress and some group practices and hospitals have adopted or are moving toward  EMRs.  Many RHIO efforts have stalled due to lack of stakeholder enthusiasm.

Analysts like to point out how far behind the U.S. lags in EMR implementation.  Their statistics are flawed and reveals how statistics can be manipulated to prove almost anything.

First of all European nations have healthcare systems which are much more socialized and run by central governments.. If one analyzes their EMRs, they are focused on complications, adverse reactions and limited to primary care.

This article from Health affairs expands on my statements:

 

""UK practices best for IT to track medical errors

20 Nov 2006, e-Health Insider Primary Care

GPs in the UK are well ahead of colleagues around the world in having information systems which track medical errors, according to a survey of primary care doctors in seven countries.

The survey of primary care doctors’ office systems in seven countries, the 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, reveals striking differences in primary care practice internationally.

Family doctors in Holland are the most likely to have systems that enable sharing of records electronically with other clinicians and New Zealand doctors were the most likely to say that they can access records when outside the office although even in New Zealand only one-third reported such access.

A total of 79% of UK GPs questioned for the survey reported that they have systems to document all adverse events compared with 7% to 41% in all other countries. More than 6,000 physicians took part in the survey from Australia, Canada Germany, Holland, New Zealand and the US as well as the UK.

The study found that Canadian and US primary care physicians lagged well behind doctors from other countries in terms of access to electronic medical record (EMR) systems. Top performers were again Holland where 98 % of family physicians said they use EMRs followed by New Zealand (92%), the U.K. (89%), and Australia (79%). A total of 42% of primary care physicians in Germany said they used EMR compared with only 28% of US doctors and 23% of Canadian doctors.

Canadian and US doctors were also the least likely to have systems that provided decision support. Only 10% of Canadian doctors and 23 % of US doctors receive computerised alerts compared with 93% in the Netherlands and 91% in the UK. At least two of five US and Canadian doctors also find it "very difficult" or "impossible" to identify patients overdue for a test or preventive care, versus one out of five or fewer in the other countries.

The researchers commented that while Germany and Canada lag behind the leading countries on EMRs, each has national plans to move forward. Germany is planning an “e-health smartcard” capable of including information about medications, allergy and blood type and Canada working on a project to link clinicians and provinces across sectors.

The researchers state that to date the US has built IT capacity by relying mainly on market-driven individual care systems such as Kaiser Permanente or that developed by the US Department of Veterans Affairs, together with physician investment. They add: “The United States appears to be the only country without a national plan to support expanded primary care IT capacity. “

This last statement is flawed and untrue. By order of the executive branch of the United States,  ONCHIT (The office of the National Coordinator for Health Information Technology) was established in 2003.  Congress has mandated Health IT, but has failed to fund it for several years.

The "Golden Rule" applies here.  "He who has the Gold rules!!"

Predictions for 2008 (And beyond)

It's that time of year for resolutions and futurist's predictions. I am a frequent reader of Medinnovations blog by Richard Reese, M.D. Dr Reese is a far more eloquent and articulate writer than I could ever hope to be. As a retired pathologist he sees the big picture from afar.
Amongst his predictions at his website, www.medinnovationblog.blogspot.com/ are commentary about RHIOs and EMRs. Despite the fact that I have been a proponent for RHIOs, HIEs and the like I have seen little progress for connectivity. There has been slow adoption of EMR. Physicians do need portals to access lab and imaging results from other sources. No doubt the physician wannabees and other "controllers" of our medical destiny (as well as the health IT sector) want to see all of this put into place. Physicians, while attempting to remain proactive find themselves sadly far behind the power curve, and and most are certainly not in the position to invest in this technology for many reasons. While most if not all providers who have adopted EMR state "they would not go back", this is a very biased answer since they have invested thousands of dollars into their "systems". (would you negate your investment with a negative evaluation?) .

In an election year the politicians in either party will be jockeying regarding their positions in regard to health care funding. Implementing Health IT is a solution that on the surface is politically correct.

My evaluation is "the jury is still out" . It is far too early to sign the death certificate for RHIOs.

Happy New Year to all.

THE STATE OF RHIO

In a recent article from "DATA WATCH"  Adler, et al have surveyed the activity, success and failure rate of RHIOs across the United States.  The article can be found at "Health Watch".

Electronic clinical data exchange promises substantial financial and societal
benefits, but it is unclear whether and when it will become widespread. In early 2007 we
surveyed 145 regional health information organizations (RHIOs), the U.S. entities working to
establish data exchange. Nearly one in four was likely defunct. Only twenty efforts were of
at least modest size and exchanging clinical data. Most early successes involved the exchange
of test results. To support themselves, thirteen RHIOs received regular fees from
participating organizations, and eight were heavily dependent on grants. Our findings raise
concerns about the ability of the current approach to achieve widespread electronic clinical
data exchange. [Health Affairs 27, no. 1 (2008): w60–w69 (published online 11 December
2007; 10.1377/hlthaff.27.1.w60)]

The appeal of electronic health information exchange (HIE) in general, and
RHIOs in particular, is evident. An electronic, interconnected regional infrastructure
represents the rational approach to handling the volume and specificity of
health-related information required to efficiently deliver optimal care, particularly
in information-intensive specialties

THE CHIEF MEDICAL INFORMATION OFFICER

CLINICAL INFORMATION EXCHANGE

A  White Paper on the rise and role of the CHIEF MEDICAL INFORMATION OFFICER

Clinical Information Exchange is pleased to present this timely review of the role of physicians in deploying EHR, EMR and clinical information systems such as CPOE, Lab reporting, and connectivity.

Physician leadership is a critical success factor for health information technology initiatives, but best practices for structuring the role and skills required for such leadership remain undefined. The authors conducted structured interviews with five physician information technology leaders, or Chief Medical Information Officers (CMIOs), at health systems which broadly used health information technology. The study aimed to identify the individual skills and organizational structure necessary to for a CMIO to be effective. The interviews found that the CMIOs had significant management experience prior to serving as CMIO and were positioned and supported within each health system similar to other executive leaders; only one of the five CMIOs had formal informatics training. A review of the findings advocates for the CMIO to have a strong background and role as a physician executive supported by knowledge in informatics, as opposed to being a highly trained informaticist with secondary management expertise or support.

Are you a highly computer-savvy physician? Well, now may be your golden hour, according to one blogger. The position of chief medical information officer (CMIO) is getting hotter by the minute, as hospitals seek doctors to manage their investments in clinical IT categories like EMRs, e-prescribing and clinical support systems. CMIOs often make $200K or more per year, with some enjoying much larger salaries than that. And this isn't a boring job--they get the shape the future of medicine, as defined by the new systems coming on board to manage data. Isn't this worth examining?

The presence now of the chief medical information officer title indicates its growing importance in healthcare. Organizations are likely focusing on the necessary integration of technology and medical applications, which requires significant physician input and leadership,

FROM: ADVANCE FOR HEALTH INFORMATION EXECUTIVES

Vol. 10 •Issue 2 • Page 64

A Place for the CMIO

By Betsy Hersher

The CMIO position got its start in marketing the value of clinical systems, but the role has grown in stature and is moving many health care organizations forward.

I t seems that we have been writing and talking about the emerging role of the chief medical information officer (CMIO) for many years now. We have monitored this growing trend since 1992.

The increase in the number of information technology (IT) physicians has been significant. If we view IT physician roles as an evolution, we can analyze this trend as a historically separate iteration. In the 1980s, as clinical systems started to appear, the first group of "in-house docs" built their own clinical systems. However, in the late 1980s, the CIO began working with clinicians to gain process understanding, credibility and buy-in during the selection and implementation of new clinical systems. The utilization of internal physicians who continued practicing 50 to 75 percent of their time served the purpose in the earliest iteration of a role with no title, little authority and no clear job description. Few educational programs supported those clinicians. Also, most of the clinicians had little experience in project management of clinical information systems.

The CMIO concept

The concept of the CMIO grew slowly, probably dating from 1992, until the present. The second iteration of this new role visibly changed. There was significant buy-in from peer clinicians and the executive team. The title of CMIO took shape with a large component of the job marketing the value of clinical systems in the delivery of care.

Job descriptions and accountabilities remained vague and time spent practicing decreased. The position reported to the CIO in most organizations. Vendors and consulting firms started hiring clinicians to support product development, customer service and marketing. In this vendor group of physicians, clinical practice for the most part stopped. Typically, the clinicians in those roles were passionate, although deliverables were vague, and success difficult to measure. Vendors and consulting firms used titles such as physician executive, vice president of transformation, and not CMIO, which seemed to be adopted by the health care delivery systems.

The reporting structure had little uniformity. Vendor jobs were vigorous with significant travel and little or no career path. Clinical systems evolved rapidly with a simultaneous need for physician involvement in quality, compliance, the electronic medical record (EMR) and computerized physician order entry (CPOE).

As the new century started, government, business and hospital boards of directors began demanding significant and costly clinical systems to meet their quality and cost expectations. The mandates came from so many arenas the demand for IT-experienced clinicians grew exponentially, following a similar growth pattern as the evolution of the CIO's role in the late 1980s. However that's where the similarity stopped.

The reporting structure

At the start of the decade, a few job descriptions, accountabilities and career paths applied to clinicians.

The title of CMIO on the provider side became a common denominator.

Still reporting to the CIO, the CMIO role became essential and recruitment from outside organizations became necessary. Until only recently, physicians continued to practice 20 to 30 percent, to maintain their credibility.

However, many events occurring simultaneously affected the CMIO role significantly. The Institute of Medicine's "To Err is Human" report got government and industry more involved, which also triggered board concern and action. Quality, safety and compliance began to move the CMIO reporting structure away from the CIO to the chief medical officer and chief operating officer. Some CMIOs also began reporting to the CEO, particularly if quality was part of their portfolio.

Physicians became project executives with little or no management experience. During this rapid change, the first and second group of physicians moved from vendors and consulting firms for a variety of reasons. They began leaving and going back "home" to the delivery systems. Thus was born the current and third iteration of IT physicians.

What was lost is found

The industry has realized that the practice of medicine one day a week does not define a respected CMIO. So, what defines the role? The CMIO role is growing so rapidly that support structures can hardly keep pace. Physicians have very full plates. Meanwhile, boards and executive teams are under great pressure to quickly deploy EMRs and CPOE.

During the last few years C-level suites have been entirely wiped out at some health care organizations. New executive teams decided that changing the CMIO reporting structure was a potential option. Today, government, business, boards and consumer pressure influence the physician roles. Boards and executive teams are panicking over the need to have CPOE, EMRs and complex clinical databases, with a corresponding demand for physician CIOs. Overly engineered organizational charts are the result, but will any over-hiring support the CMIO position and physician CIO?

Some executive teams have kept the current CIO and have hired a senior CIO. The concept of an "Office of the CIO" is gaining momentum. The Office of the CIO can include all of the senior IT leadership (the CIO, CMIO, chief technology officer and office of project management).

In many instances, the Office of the CIO is used extensively as an outsourced environment. Facilities are seriously considering hiring CIOs who are physicians. Those physician CIOs will need a strong operational support team outsourcing and/or creating a viable team by utilizing the Office of the CIO.

Hersher Associates, Ltd., conducted a survey of 246 facilities in November 2005. Of 100 respondents, 48 percent had hired a CMIO and 52 percent had not. In a similar Hersher Associates survey in 2001, 36 percent indicated having a CMIO and 59 percent had not hired a CMIO.

Those figures coincide with our national search assignment statistics. In 2001, Hersher Associates placed two CMIOs; in 2002 six CMIOs; in 2003 five CMIOs; and in 2004 six CMIOs. In 2005 Hersher Associates had completed or was engaged in ongoing searches for eight CMIO candidates.

Today, the demand is great for an experienced CMIO. What is driving the demand and what role should the third-iteration CMIO play?

Good for business

According to Tom Tintsman, MD, executive director for clinical information services at UCDavis Medical Center in Sacramento, Calif., "It is believed that the business boom of the 1990s was the result of automation increasing productivity in the United States. If one believes this, one believes that 'lubricating a process' using IT is good for business."

Tintsman said that health care speakers and writers casually accepted that the industry had not adopted process automation like other businesses. Imagine a businessperson sitting on a health care facility's board listening to that line of thinking. The board member would apply his/her personal business experience with information systems (IS) and ask IS to automate its processes. Health care management would agree that their processes should be automated but quickly add that automation is expensive and slow, and the risk of clinician resistance is high. The businessperson would persist and ask for a proposal to automate clinical care.

Tintsman continued, "To prepare such a proposal, large, high-level questions must be answered. What are we really attempting to do? Does it require new executive skills and knowledge? Should the organizational structure be changed? Automating the clinical care process is more expensive and challenging than building a new facility. The project changes everything and everyone in the organization. Changes of that magnitude must be supported by the board, sponsored by the CEO, and lead by the COO. The COO knows from experience the large risk of physician and/or nurse rejection. To mitigate that risk, the COO begins a search for a CMIO, not certain about reporting relationships, responsibilities or the EMR program process. Supporting this view in the last two years, we have seen reporting changes for both the CMIO and the CIO."

In order to accelerate new senior roles for physicians, we are beginning to see overly engineered organizational charts usually hiring skilled implementers. Some of the third-generation IT physicians have become disillusioned. If they work in complex health care delivery systems, their funding suddenly may disappear. If they work with a vendor or consulting firm, their roles are sometimes changed or eliminated.

It appears that the safest and most productive health care enterprise is on the delivery side for the physicians. One of the motivators for becoming a CMIO was to define and develop or install systems for delivery of patient care.

The majority of IT doctors have earned the right of passage so they can give 100 percent of their time and effort to their still relatively undefined job as they become key members of the executive teams.

Where from here?

The 2005 Hersher Associates, Ltd., survey shows a slight change in reporting structure.

Of the 48 respondents, 61 percent of the CMIOs report to the CIO, 20 percent report to the CEO and 8 percent report to the CMO. This is a clear shift reflecting some changes in responsibility mentioned earlier.

The following skills, attributes and areas of experience will support success for a clinician in an IT role:

�previous hands-on work in management, consulting, installation/project oversight;

�passion;

�ability to collaborate;

�leadership;

�ability to teach; and

�patience.

What are some of the common circumstances that can get in the way of an IT physician's success? Factors include:

�wrong job, wrong reason;

�no real authority;

�lack of managerial experience;

�lack of support;

�unrealistic or wrong expectations;

�few meaningful job descriptions.

How can a physician make himself or herself attractive to an organization, peers and the board? Consider the following:

�insist on management responsibility;

�budget responsibly;

�learn how politics work;

�attain or work toward an MBA;

�most import, cultivate the ability to explain technology-based business decisions to other stakeholders.

The continuing CMIO role

An increasing number of today's organizations see the need for CMIOs and vice presidents of quality and safety. Those roles are being filled by physicians. The hiring of physician CIOs is a trend receiving national attention in response to CPOE, EMRs and other significant issues and costly implementations. Significant new skills are needed for the CIO role, too. Physicians need to be careful to review the support systems available to manage their role. With IT clinical ambulatory and in-house implementation a scarce commodity, we perceive a potentially broader role for the CIO. This opens the door for other clinical leaders.

It appears that vendors are also seeing a renewed need for physicians to be available for a myriad of key responsibilities.

Arlene Anschel, senior vice president of Hersher Associates, who works with many CMIOs, said, "The marriage of the vendor and physician is one that provides a mutually beneficial working relationship. Vendors utilize systems physicians' expertise in sales, consulting, research and development, and education. Physicians who have minimal applied or operational experience can gain skills in implementations, consulting, project management and knowledge of software. Working in the vendor's client hospitals enables them to learn about clinical systems. They serve as consultants to the hospital physicians and provide education on the use of the vendor product. They become trained in a practical and hands-on way in the clinical systems arena."

Anschel continued, "Even if a physician has formal academic training, the vendor provides 'graduate school,' and prepares the physician for the next step into senior positions in health care delivery organizations. These can include CMIO, executive positions in information systems, senior roles in research and development, and even, perhaps, CIO.

The physician provides the vendor with a means to interact with clinicians and executives in their respective client organizations. Accordingly, the vendor can benefit from physicians who have good business and entrepreneurial skills. The physician and vendor serve as a resource for each other and create a win-win situation."

Nonetheless, physicians should exercise caution when reviewing the support and dollars available for any new position. An employment contract is essential to this relationship. Beware of taking a role that could become expendable in two years.

A technological management role

Most organizations have started or are actively planning to implement an EMR with CPOE. The CMIO is finally being recognized as an important role in many health care organizations. Some organizations are looking beyond the vendor implementation and asking how information systems can be used to improve the quality of care and the productivity of their clinicians. If organizations are struggling with the best structure, executive skill and knowledge for the implementation, adding those objectives will be even more challenging.

Once again, this raises the question of the CMIO's reporting structure and responsibilities.

Some new organizational charts show a potential partnership with the organization's current CIO. Based on our observations, the CIO's operational team reporting separately could cause havoc and project problems. Now that we have a large number of qualified CMIOs and more on the way, it is incumbent on the health care community to -understand that this is no longer an emerging role but one that is established and recognized as a key position.

Ms. Hersher is president and founder of Hersher Associates, Ltd., a Northbrook, Ill. executive search and consulting firm.

Editor's note: The author acknowledges the significant contributions to this article by Arlene Anschel, senior vice president of Hersher Associates, Ltd. and Tom Tintsman, MD, executive director for clinical information services at University of California Davis Medical Center in Sacramento.

Interested parties may contact :

Gary M. Levin MD, President, CIE, Clinical Information Exchange Tel: 951-530-1351; cell or SMS 951-746-9145

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Happy Holidays to All

It's been some time since I last posted here. Busy season with other priorities have engulfed me.

I have been working on a white paper regarding the rise and role of the CMIO, Chief Medical Information Officer.  I have a deadline to post this before Christmas descends upon us.

Recent Developments

Quote of the Day:
We are always getting ready to live, but never living.
--Ralph Waldo Emerson

 

Health Train Express has recently become acquainted with a Canadian solution to RHIOs search for the "ultimate" application for their interconnectivity needs.  It bypasses the problems of "governance issues" and the thorny issues of "who owns what".

Many of these issues ignore the primacy of information transfer, efficiency, accuracy, and quality of healthcare delivery in this country.  In addition to that concern, it is not necessary to re-invent a "wheel" that already exists.

What we need has been well established by many consortiums, RHIOs and health information exchanges.  Do we all need all of it? The answer is profoundly "NO".

What about those providers who do not have broadband internet connectivity?

There are many pieces in the mix for a RHIO or Health Information Exchange.  Some of these are already provided by proprietary systems, such as clinical laboratories, hospital portals, secure messaging systems, Hospital PAC systems,etc.

The California Regional Health Information Organization provides a well structured outline and roadmap for developing governance; and also a library,   HIE toolkit  of documents for RFIs, RFPs, and other essentials for vendors, hospitals, providers and IT departments.

SELF CERTIFICATION ???

Groups To Launch No-Cost EHR Interoperability Testing Software

A no-cost, open-source software tool for testing the interoperability of electronic health record systems will be available to vendors March 21, 2008, Government Health IT reports.
The tool, which is being jointly developed by the Certification Commission for Healthcare IT and Mitre, will allow vendors to ensure that their EHR systems can exchange information on patients treated by more than one provider.
The tool, called LAIKA, also will initially support testing of the Health Level 7/ASTM Continuity of Care Document, a core set of patient information including:

• Name;
• Address;
• Health problems; and
• Medications (Ferris, Government Health IT, 11/9).

Mark Leavitt, chair of CCHIT, said, "This project is an important first step in our journey toward testing and certifying the interoperability of health IT systems" (Merrill, Healthcare IT News, 11/9).
CCHIT and Mitre have undertaken this open-source project without government support, Government Health IT reports.
Developers will demonstrate the tool at the Feb. 12, 2008, CCHIT meeting (Government Health IT, 11/9).

Next Article

Readers are invited to send feedback to: ihb@chcf.org

RPM or Remote Patient Monitoring

Microsoft has launched it's Health Vault application.

With this announcement comes a large list of positive and negative reactions in the marketplace.  The most positive aspects are the "commodization" and accessibility of these devices to consumers at affordable prices.

 

RPM data can and should enter the consumer electronics mainstream.  In addition, RPM data should be viewed as just one more type of medical data, similar to lab data, pharmacy data, physician notes, etc., that is equally plug and play.

But...There are Tradeoffs

Depending on whether you are a user or a seller of RPM, you probably reacted differently when reading Bill Crounse's casual reference to devices and services becoming "commoditized".  Regardless of your reaction, he's right.  HV will hasten the already occurring commoditization of RPM devices.

When the RPM market started, many of the devices were priced in the $6-8 K range.  Today prices have dropped to $1-2 K, and will go lower. 

We have all heard stories where RPM devices eventually would become consumer purchases made at Best Buy and Circuit City, and that prices would be in the range of other consumer technology purchases.  That day will arrive in 2008 when Continua Alliance compliant offerings begin hitting the street.

The RPM market is moving from

• High unit prices rooted in the industry's early focus on medical device markets and business models
• Proprietary devices, proprietary IT,  non-interoperable data
• Low unit volume, moderate margins per unit
• Competition based on the vendor lock-in through high changing costs

To:

• Low unit prices as the technology evolves toward consumer markets and consumer business models
• Intereroperable devices, common IT platforms, and interoperable data
• High unit volume, low margins per unit
• Competition based on value and service

Where exactly commoditization and HV come together is not clear. The efforts of Continua will bring to market multi vendor interoperability, true plug and play connectivity. Microsoft can deliver plug and play interoperability with your personal computer, but little else.

 

What do you think?

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).

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 www.healthvault.com  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....

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?

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.

DailyStrength.org 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.

ZocDoc.com lets patients book physician and dentist appointments online, similar to the way OpenTable.com allows diners to make online reservations for restaurants

RateMDs.com takes a page from consumer rating sites like Yelp and RateMyTeachers.com - 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, ICYou.com 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.

OrganizedWisdom.com: 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:

NursesRateDoctors.com: 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.