This week Health 2.0 is ongoing in Washington, D.C. Another kudo to Matt Holt and Indu who had this visionary idea to promote many web based consumer directed systems for health education.
HEALTH TRAIN EXPRESS Mission: To promulgate health education across the internet: Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
Wednesday, June 2, 2010
Tuesday, June 1, 2010
EMR and HIT Usability
The Feds well meaning attempt to stimulate HIT development addresses only one aspect of the reticence of physicians reluctance to move toward using EMR.
The other large stumbling block is 'usability'. How user friendly is the system? Can the user enter data with the least number of key strokes and/or mouse movements and clicks? Who analyzes and gathers this data? I call for each vendor to produce this data.
I know this to be a fact since I have used several EMR systems, AHLTA and VISTA/CPRS. These perhaps are not the best indicators of usability. Neither can usability be generalized for primary care, vs specialty care. Each requires different indicators for successful implementation.
Successful implementation in the ambulatory physician setting is not the same as in a hospital setting. The range of users in hospital is far greater than in the physician office.
How can collaboration improve the user rate of compliance.
Some of the aspects of compliance regarding post hospitalization protocols may be adapted for EMR usage as well.
Sensitivity to operations,
Deference to expertise,
Reluctance to simplify,
Resilience,
Preoccupation with failure:
Jonathon Bush of Athena Health has this to say about HITECH, Meaningful Use, and other topical interests: (Caution you are entering the 'no spin zone' and some material may not be suitable for some watchers.)
Monday, May 31, 2010
Sunday, May 30, 2010
Saturday, May 29, 2010
Some Hospitals, Clinics at Risk of Not Qualifying for Federal EHR Funds
Just How far along are we on the tracks of the Health Train ??
Most clinics and some hospitals are behind in their efforts to switch to electronic health record systems to qualify for payments under the 2009 federal economic stimulus package, according to a new report from HIMSS Analytics, the Healthcare Information and Management Systems Society's research unit,
Report Findings
According to the HIMSS Analytics report, 30% to 40% of U.S. hospitals could be at risk financially and operationally for not meeting the meaningful use criteria.
Meanwhile, more than 50% of independent clinics in the U.S. are at risk for not meeting meaningful use criteria.
The survey also offered insight into where hospitals are on HIMMS' seven-stage EHR adoption model. Stage 0 is the lowest level of IT adoption and Stage 7 is the highest.
The report found that in 2009:
- 7% of hospitals were at Stage 1 -- which means that they have lab, radiology and pharmacy systems set up -- down from 12% in 2008;
- 17% of hospitals were at Stage 2 -- which means they have a controlled medical vocabulary, limited clinical-decision support and the ability for health data through a continuity-of-care document format, plus all Stage 1 systems and functions -- down from 31% in 2008;
- 51% of hospitals were at Stage 3 -- which means that they have computerized systems for nursing documentation, picture archiving and communication outside of the radiology department, and advanced error-checking and clinical decision-support functions, plus all Stage 2 systems and functions -- up from 36% in 2008; and
- 14% of hospitals were at Stage 4 or higher, more than twice the rate -- 6% -- in 2008.
John Hoyt, vice president of health care organizational services at HIMSS, said the survey shows that a digital divide remains between larger and urban hospitals and smaller and rural facilities, adding that the national financial crisis played a factor in the problem.
Hoyt said that hospitals are expected to spend more on health IT applications through 2015, in part because of federal stimulus funding.
According to HIMSS Analytics, hospital capital spending for health IT is projected to increase by 2% between 2009 and 2010, and hospital capital spending for software applications is expected to account for 46.5% to 48.3% of the total IT capital budgets in 2010
The federal time table for adoption of EMR is unrealistic, and many users will chose the incorrect and/or inadequate HIT solution to qualilfy for the federal incentive payment.
The time period for announcement, closure and choice of grantees is too short, and many potential recipients do not become aware of them until too late.
Wednesday, May 26, 2010
I can save....what ??!!!
I serve as a non-paid consultant for a collaborative group attempting to initiate a regional health data exchange.
I've been on the scene beginning in 2005 when ONCHIT was initiated by then President George Bush. Despite my enthusiasm and positive attitude I have seen relatively little progress, with few isolated successes on a limited basis. Lots of talk but little data exchange taking place.
There are many reasons for this, however I digress. Today's post is about the illusion of savings and the disparity between gains among specialists vs. primary care practices.
Technology can be a wonderful thing, if it truly serves you. How about a 70" flat screen in a small bedroom....get the idea, a bit of an overkill. Specialists seem to enjoy high tech...after all that is why they became specialists with scopes, micro surgery, electronics, imaging, and even telemedicine. It even seems closer to basic science, which is where most of us started.
How many of us have bought some special item for our practice, with much enthusiasm and soon it was gathering dust because we were too busy to use it. Two or three years down the line you may still be making payments and your read about version xxx which obsoletes your 'anchor' sitting in the corner. (or under a desk.)
In the process of consulting I have observed the theme of
consultants coming, going and moving on to the next project.
Having been away from my 'group' the past years I saw that there had been some movement toward the 'goal'. There were 25 intersted potential stakeholders. Their next goal was to raise 100,000 dollars to pay a chosen consultant to plan and implement a health data exchange for our region.
I thought to myself, some progress. Then I had a sinking feeling, here we go again! They were going to pay 100,000 dollars for their 'skin in the game'. Not one piece of hardware, software or data exchange. We can postulate how much that will cost.
Two of the three consultants had conflicts of interest, and one was an unbiased well known national authority on these matters.
There are serious doubts about improving efficiency and a negative return on investment.
Paul Roemer has an interesting analysis of incentives, ROI in a careful breakdown of your individual practices.
The EMR Equation: Break-even Point for Meaningful Use
Especially useful is the "Productivity Calculator". Perhaps biased and/or self serving by it's sponsor SRS. it gives one the ability to run your own analysis of what EMR will do to your bottom line.
If you are beginning to feel like we are on a merry- go- round,
then watch this video:
Writing this blog is so much fun....even if no one reads it.
Tuesday, May 25, 2010
What can one little car do on The Health Train Express?
It seems a bit overwhelming, doesn't it? All the pontificating, posturing, analysis and input from people who really know little about caring for people. Many are producing chaos, and dysfunctional behavior, much like the rest of our government. In an attempt to overcontrol our governments now compete with one another rather than caring for basic needs in the population.
Imagine how ludicrous, the state of Arizona has to protect it's southern border by itself, when the federal government can't or won't....Imagine the state of Virginia telling the federal government that what they propose with health care is unconstitutional. The federal government suing a state government. Impossible, you say....no it is REAL.
It sounds like an impending civil war. We worry more about what arab countries think about us, and how our European allies rate us in the world. We allow slave labor in China to produce electronics cheaply for large computer companies.
Here is the story of ONE extra-ordinary American, as reported in the Star Tribune:
Twila Brase, founder of the St. Paul-based Citizens' Council on Health Care, blocks more public policy than she builds, but she has become a force to be reckoned with.
Twila Brase has no idea why a magazine named her one of America's 100 most powerful people in health care, and, frankly, neither do her critics.
"I find that hard to believe," said Peter Wyckoff, a longtime lobbyist for senior citizens who worked for a decade around Brase at the State Capitol. "She may be one of the 100 people most setting back health care reform."
The 51-year-old nurse turned activist is hardly a household name. Yet in Minnesota political circles, Brase, founder of the St. Paul-based Citizens' Council on Health Care, enjoys the reputation of a self-made libertarian lightning rod, an increasingly powerful free-market contrarian who blocks more public policy than she creates.
Among insiders, she is an acknowledged master of political theater, turning out raucous crowds for hearings and staging publicity stunts such as a recent "Obamacare" shredding party in the Capitol rotunda. She said she solicited no votes for Modern Healthcare magazine's 2009 list of "100 Most Powerful People in Healthcare."
"I don't know how I got in," she said. "And I may never get in again."
Tax records show that Brase works in a small office for $48,000 a year. Still, her name appears at No. 75 among the nation's health care movers and shakers. She shares billing with President Obama (No. 1), Secretary of Health and Human Services Kathleen Sebelius (2) and pharmaceutical industry chief Billy Tauzin (39), and her rank of 75th places her ahead of the president of the American Medical Association, the president of the American Academy of Family Physicians and the president of the Blue Cross and Blue Shield Association.
Brase opposes anything she thinks constricts individual freedom or invades privacy. That puts her at odds with many of the most popular concepts in modern health care: evidence-based medicine, electronic medical records, DNA databanks, doctor quality ratings.
"If government gets to control when and if you get health care," Brase said in an interview, "you no longer have liberty, and your right to life is controlled."
Brase knows this philosophy makes it difficult to build public policy. But anyone who thinks she doesn't affect the construction process is in for an attitude adjustment. A decade ago, she threw roadblocks in the way of a state medical database and a public health immunization policy. She opposed President Bill Clinton on health care in 1993 and opposes President Obama today.
She followed up the recent shredding party with a call for Gov. Tim Pawlenty to veto the Legislature's health care plan because it included too much government control.
Critics might say that Brase merely piggybacked on predictable politics. But as the DFL-controlled Legislature slogged through its session, trying to resolve the health care impasse with the governor, Brase counted a win.
"We don't get everything," she said. "But we stop something."
"She's managed to stop or water down some pretty important stuff," former state Health Commissioner Jan Malcolm acknowledged. "She put real brakes on data collection and immunization policy." Malcolm does not think that it is a good thing. As the chief architect of Minnesota's health policy, she found Brase frustrating. In her current job advocating for health care for the disabled through the Courage Center, Malcolm says Brase's contention that the government has no role in health care defies reality.
Her concept
Brase's alternative to government-run health plans would be "medical sharing organizations," groups of individuals who band together by choice and pay collectively for the medical care of those who need it when they get sick.
Nor is she a big fan of private health insurance companies. Although she pays for an individual catastrophic care policy with a high deductible, she considers traditional health insurance wasteful. "I always pay cash," she said. "I negotiate prices."
On a recent visit to the dermatologist, Brase said, she got the doctor to do a $150 mole removal for 90 bucks.
Constructive alternative?
Her ability to negotiate with politicians and health care advocates has not been as successful.
"It's more what she's opposed to than what she's for," Malcolm said. "I never found Twila to be abrasive or disrespectful. But you could talk to her for hours and not make a dent."
Added Wyckoff: "She does not work very collaboratively with most advocates. The price of criticism is a constructive alternative. I don't think she has a constructive alternative."
Brase obviously disagrees.
"We're protecting the rights of citizens," she said. "We're protecting choices. People who describe me as a wing nut don't believe in the heritage of this country."
"She's tenacious," said Rep. Tom Emmer, the Republican gubernatorial candidate. "When people mock her for her views, she backs them up with facts. She's not going to take the spin. She's an asset to both sides."
"She represents what I believe," said shredding party-goer Karen Minar. "She speaks for regular people who go to work every day and pay their bills."
In November, she appeared at a business health care forum in Kentucky, sharing the dais with former U.S. Surgeon General Joycelyn Elders and health care experts from Canada and the Harvard Business School.
This is heady stuff for a farm girl from southern Minnesota with a nursing degree from Gustavus Adolphus College in St. Peter, Minn. Brase left nursing in 1994 after stints at St. Paul's Children's Hospital and in schools in St. Paul and Robbinsdale. She left to crusade against what she considered President Clinton's attempt to let government take over health care. She wasn't a political person, she said, just "true blue for freedom."
Brase's first volley came in an op-ed piece in the Star Tribune in 1994. She signed it as the head of a group that existed only in her head. After the op-ed ran, a sympathizer contacted her and said he wanted to join. "Good," Brase told him, "here's when we'll have the first meeting."
The first meeting blossomed into a six-member board chaired by businessman Martin Kellogg, president of a plastics company in Stillwater, who felt health care reform was too "institutionalized."
"She's very quick," Kellogg said. "She doesn't talk about what she doesn't know. She's a tool for no one."
Brase doesn't sell or rent the Citizens' Council's 12,000-member e-mail list. Meanwhile, her influence has grown a lot faster than her income.
"She became a larger force over the years," Wyckoff said.
Sunday, May 23, 2010
Cystic Fibrosis Car on the Health Train
Edwin Leap's post today focused on the March of Dimes. It brought to mind my interest in Cystic Fibrosis. the CF Foundation sponsors an annual walk/run each year, GREAT STRIDES. Although less well known it is a significant event in the lives of those families who have a CF relative in their lives. The event(s) took place this year on May 13 2010. Although it is too late to participate this year.....plan on it for 2011.
At any one time there are about 20,000 CF patients alive. CF is a recessive gene requiring a gene from each parent....one in 2,000 people (caucasians) carry the gene.
Survival rates have improved to the mid 30s, largely due to the research support given by the CF Foundation in their sponsored trials. Were it not for the CF Foundation CF would be an Orphan Disease.
The CF gene was one of the first genes identified in the human genome. It is responsible for encoding a protein in the cell wall that controls chloride transport across the cell membrane. You can learn more about it.....here.
My son was born in 1988 and I was told the average survival was to age 17 yrs, and that he would probably not get past age 10. When he was 2 years old the CF gene was identified, when he was three Pulmozyme (DNAse) was released after clinical trials were completed. (the first genetically produced drug by Genentech) He is now twenty-one years old
Along with these breakthroughs significant advances have been made in antibiotics, airway clearing medications, enzyme replacement medications and early aggressive interventions.
Further genetic studies have identified several subtypes of CF and the multiple alleles causing CF. Treatment courses can now be modified by the genetic mapping of individal CF patients.
When you think about the March of Dimes, think also about "GREAT STRIDES" for CF.
Here are some other ways we can make a difference.
May is Cystic Fibrosis Awareness Month. Cystic fibrosis is a life-threatening disease that affects 30,000 people in the U.S., and approximately 10 million people are symptomless carriers of the CF gene. There is no cure. Learn more about CF at www.cff.org.
Please consider joining me, Frank Deford, Rosie O'Donnell and friends, Boomer Esiason, Lewis Black, and Francis Collins in our effort to change CF (Cystic Fibrosis) to CF (Cure Found)
Friday, May 21, 2010
The 'Breast' Health Care
Here is the problem when government begins mandating health care.
The USPSTF said women in their 40s should balance the benefit of a mammogram with the potential harms. Those harms: false positives, radiation exposure and subsequent follow-up tests, but also the possibility of diagnosing and treating a cancer in a woman that never would have threatened her life. A special communication published last year in JAMA noted that increased screening for both breast and prostate cancer “may be increasing the burden of low-risk cancers without significantly reducing the burden of more aggressively growing cancers and therefore not resulting in the anticipated reduction in cancer mortality.
Opposing opinions:
These USPSTF recommendations run counter to the expert guidance of the American Cancer Society, American College of Radiology (ACR) and Society of Breast Imaging
The American College of Radiology (ACR) applauds Sen. David Vitter (R-LA) for his recent letter to U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius demanding that, in compliance with recently passed health care reform legislation, HHS immediately remove from all HHS sponsored web sites and materials any references to the discredited and potentially deadly November 2009 U.S. Preventative Services Task Force mammography recommendations.
These USPSTF recommendations run counter to the expert guidance of the American Cancer Society, American College of Radiology (ACR) and Society of Breast Imaging and have undoubtedly confused many women to the point that they have refused needed care.
The federally funded and staffed USPSTF includes representatives from major health insurers, but not a single radiologist, oncologist, breast surgeon, or any other clinician with demonstrated expertise in breast cancer diagnosis or treat
Since the onset of regular mammography screening in 1990, the mortality rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent. Ignoring direct scientific evidence from large clinical trials, the USPSTF based recommendations to greatly reduce breast cancer screening on conflicting computer models and the unsupported and discredited idea that the parameters of mammography screening change abruptly at age 50. There are no scientific data to support this premise.
Everyone's Got It
It seems to be all over the place, front pages, blogs, new media, old media, radio talk shows, TV talking heads, and politicians as well.
Everyone and their brother has an opinion and is an expert on health care, policy and reform.
Health is something everyone has, excellent, good, bad or indifferent. Despite our excellent technology good health is not guarranteed. It takes careful planning, exercise, good nutrition and an attempt at leading a non-toxic life physically, and emotionally and for most people, spiritually. Perhaps I should place spiritually first.
Planning financially is now almost impossible for many people. The employer based funding is still a major issue one that the government only partially dealt with in health reform. A lot of people do not have employer based plans or lose them with career changes. The current recession has made it more difficult.
The way the reform is structured if I was still an employer I would tell my employees to join a government sponsored health exchange. It would be cheaper for me to pay the fine than to fund my own health benefit plan. Not only would I have to pay part of my employees premium I would have to support a human resources department to administer it. Obama has no idea of how companies work.
Unlike the government I do not have to do multimillion dollar surveys or fund a think tank and/or foundation to make that decision. It is pretty much common sense.
Committees Unveil Bill To Raise Medicare Payments Until 2013
On Thursday, Democratic leaders on the House Ways and Means and Senate Finance Committees released a summary and finalized legislative text of the so-called "extenders" bill (HR 4213), which would raise doctors' Medicare reimbursements by 1% to 2% annually through 2013, Politico reports (Haberkorn, Politico, 5/20).
Tuesday, May 18, 2010
The Schizophrenia of the Feds
There is a lot of hype about healthcare stimulus funding, ARRA, HITECH and ONC.
Surveys amongst the nations top hospital CIOs are not 'bullish' about any of these programs.
HealthSystemCIO reports:
In what makes for a disturbing combination, CIOs are both doubtful that the federal government (HHS/CMS/ONC) will have the HITECH program fully operational by the time incentives are to be paid out, and pessimistic about their chances of qualifying for those payments, according to the healthsystemCIO.com April SnapSurvey.
The takeaways are:
1. Disconnect between deadlines for payments, and finalization of Meaningful use criteria
2.Hospitals will judge and plan their HIT plans in line with improving qualityof care, efficiency and individual needs rather than the promise of dubious federal funding.
3. The program envisioned and planned by ONC and HITECH is not adequate and will run out of cash (much like the 'cash for clunkers" program).
Individual Providers also face the same conundrum. Caution is the better part of action at this point. A fear of being 'left out' is driving most acquisitions at this point. Careful ROI is still prudent.
In actuality the ROI may be a negative number for many providers. Will the losses be greater with or without an EMR. The rule of negative incentives still prevails.
Politico a well known web site published in Arlington Virginia gives a nicely worded summation of too much to soon.
But as a particularly stringent and new regulation nears, numerous medical groups say that the aggressive government push to digitize is too much, too soon. Health information technology in the United States remains highly fragmented, so any large overhauls, experts warn, must work on a timeline that stretches years into the future.
Saturday, May 15, 2010
Vending Machine Medicine
I was reading Distractible MD this morning and came across this photo that Rob Lambert posted.
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