The Meaningful Use May Mean

This morning I had a chance to sit in on a conference hosted by Centricity, to discuss meaningful use as a criteria for selecting your next EMR or upgrading your present EMR.

Both physician providers represent fairly large user groups who already have implemented GE Centricity, an enterprise sized EMR solution.

The complete slide deck of the presentation will be available in the next several days.

Several of the presenters are physicians  MDs.  Med Star Health is a present  user of their EMR solution.  Peter Basch M.D., an internist and member of this large group  reviewed the tenets of HITECH and its financial incentives for adopters, and penalties for non adopters.  Groups in underserved areas will receive an additional 10% incentives.  Additional funding will also come from Medi-caid, up to $60,000 per provider.

Dr Basch presents an excellent review of the M.U. development process. It seemed quite credible.

Meaningful use should be easily obtainable by present users.  New users will find these criteria are reachable..

Stage 1: final rule metrics have been announced:

Latest edition provides:

Fewer, Lower Thresholds, and  reduced reported burden.

Changes have been made to allow slower adoption and still obtain incentives.

Peter Basch M.D. presented their Med Star  MU Roadmap

His pronouncements are clear and loud.

click on the image, and then use ctrl + or ctrl – to zoom in and out.

Meaningful use is a done deal, the law of the land. First step in how hospitals and providers will function and be reimbursed in the future. 

Non-Medicare providers will find that other insurers are already adopting MU as criteria. and cannot be ignored.

A vital take-away is that you MUST be analytic and pre-qualify your intended EMR to be MU compatible and CERTIFIED. This is so important that empty promises from vendors  are meaningless.  (show me the beef!!)

Simeon Schwartz MD of Med West pointed out the one button coding click in their EMR from doctor to carrier, with no other human hand intervening. This generates efficiency and immediate ROI.

eRx adds major efficiency to ordering prescriptions and also in future ACO verification of patient receiving and using the medications prescribed.

My takeaway is:

BE IN A LARGE GROUP, JOIN A GROUP, INTEGRATE YOUR PRACTICE WITH ANOTHER PRACTICE.

IF YOU ARE SOLO……GOOD LUCK !!! START NOW, HIRE A CONSULTANT TO DO THE HEAVY LIFTING, DO NOT BUY CHEAP, THIS IS ONLY GOING TO BECOME MORE BURDENSOME UNLESS THE SYSTEM YOU ACQUIRE IS ROBUST AND CAN DO THE MU THING….

This is the beginning of meaningful use, not the end. Do not implement minimalistic solutions.

LiveJournal Tags: meaningful use,medstar,centricity,health train

Social Networking Update

 

It’s time for Health Train Express  to do some CME in social networking and all the new words, and eponyms that develop with a new subspecialty in medicine.

How does social networking impact on medicine and your practice?  Well, it is a huge new aspect which all providers need to watch closely.

It is no longer a ‘geek thing”  or just  a place where Betty Boop posts some nudie pictures that predatory “perps” lurk and wait. 

There is or should be no ‘prejudice’ or strange looks from our colleagues at those of us who know about and use ‘social media’ in the course of our day.

It has become a new highway of information, rivaling Google and perhaps surpassing it’s formidable market presence.  In fact I would bet your bottom dollar that Google, Apple, Yahoo and others are watching closely, and perhaps even leasing out their excess capacity on their network servers to facebook, linkedin and others.  I even predict a buyout in the near future of one of these networking services by another network site. 

There are several books and web sites dedicated to learning the basic lingo of social networking.  Read one or some of these ‘esteemed’ reference sources….

Board Certification in one or all of these areas will soon be available.(tongue in cheek)

That's why, with help from the smart folks at technology publisher O'Reilly Media, they’ve assembled a glossary of social-networking terms every physician should know. And for all the techno-jargon that gets tossed around, rest assured you don't have to be a member of the Geek Squad to fathom the implications these issues have for strategy and budgeting

I recommend the following publications:

Facebook, The Missing Manual

YouTube: An Insider's Guide to Climbing the Charts

 

 

With 3.2 million unique visitors each month, LinkedIn is by no means the largest social network around. However, thanks to its unique niche, LinkedIn might be the most valuable network you can join as a business professional.

A list of Social Networking Sites

And finally last, but not least (as 0f June 2009) the list of medical and health related social networking sites.

Meaningful Use or Meaningless Data

 

The climb (path) to Meaningful Use

 

Today  MARGALIT GUR-AIRE waxed mightily in his writing on the Health Care Blog.  I like MARGALIT GUR-AIRE , a brilliant medical writer, who far exceeds my minimalistic attempts to display my inadequacies in the written word.

 

Meaningful or meaningless data?  It remains to be seen about the benefits of all this data. First of all the 'system' is currently 'non existent" except for relatively small silo's of information limited to established larger health institutions and/or medical clinics  that have integrated EHRs
Much of the stimulus funding for EMR by HITECH has been driven by empty promises for the potential of a unified data sharing system. The system as envisioned and yet to be implemented mandate of APPA will not even begin to grow until after 2014.  Larger portions of the country are not served by the broadband connections required to become a part of NHIN or even local HIEs.

And there will be a significant segment of providers who simply will not participate even with the incentives which are inadequate.
The larger question is who will even look at this data as it accumulates in storage media hidden away in systems deep underground in government systems that are already obsolete?? So not to discount all the experts in this era, while it all has great potential, there remains many visible pitfalls, and unknown barriers to the utopia of EMR. There is not much in it for the individual provider in terms of face to face patient contact other than medications, Rx Writing, and history and physical findings. And these metrics are difficult to obtain during a patient encounter, creating diminished efficiency whose cost will be transferred to fewer patient encounters, less time to talk to patients, and more, not less frustration for the provider.  We all would like to drive that BMW, but few can afford it, and many sell it when the warrantee ends.
But what do I know....I usually am correct and see ten or more years into the future, having experienced 40 years of medical practice.  My younger brethren have yet to experience the upheavals caused by well intended tsunamis that travelled through medical reimbursement changes in the past. But that will not matter in a health system that will largely become a civil service department of the government(s).

The Computer is  a  Moron (Peter Drucker, 1909-2005 elaborates further.

Technorati Tags: health train,meaningful use,nhin,broadband,the health care blog,aire,drucker

Another Cool Thing

I love time savers. As a physician, like all of you I am pressed for time. Anything that shortens my tasks without sacrificing quality is a ‘meaningful use” nominee.

Having said that I have just discovered the utility of ‘tiny url’. This little doo-hickey is a downloadable add in for either Firefox (my preferred browser) and Internet Explorer. With one tiny click on your toolbar, a copy and a paste you are off and running. I see great potential for it’s use in EMR applications.

Another tiny tidbit for today.  Their domain name is in the Cocos Islands. (is this another offshore financial opportunity?) (Australian territory)

Technorati Tags: tiny url,health train,meaningful use,cocos

Another CMS Eponym

What is a “ ZPIC”  ?  (see below)

 

 

WASHINGTON (AP) - They don't seem that interested in hot pursuit. It took private sleuths hired by Medicare an average of six months last year to refer fraud cases to law enforcement.

Have you looked in your post office lately? Perhaps your photo will be up there, soon.

 

According to congressional investigators, the exact average was 178 days. By that time, many cases go cold, making it difficult to catch perpetrators, much less recover money for taxpayers.

A recent inspector general report also raised questions about the contractors, who play an important role in Medicare's overall effort to combat fraud.

click on the image

Groucho, Harpo and Zeppo.  Question of the day, Who were the other two Marx brothers????

 

 

Out of $835 million in questionable Medicare payments identified by private contractors in 2007, the government was only able to recover some $55 million, or about 7 percent, the report found.

Medicare overpayments - they can be anything from a billing error to a flagrant scam - totaled more than $36 billion in 2009, according to the Obama administration.

 

As ranking Republican on the Senate panel that oversees Medicare, Grassley is trying to find out why it takes the contractors so long, and how much the government is currently paying the companies. In 2005, taxpayers paid them $102 million.

At least seven private companies Medicare calls "Program Safeguard Contractors" are working to detect fraud, part of a program that dates to the late 1990s. They oversee specific areas of jurisdiction, and some have more than one contract with Medicare.

 

In practice, their performance has been uneven. The contractors have widely different track records. One identified $266 million in overpayments in 2007, while another found just $2.5 million, the Health and Human Services inspector general said in May.

 

The private sleuths will now be called "Zone Program Integrity Contractors" - or ZPICs for short.

Technorati Tags: cms,medicare,marx brothers,fraud,contractors,zip

We’re Back !!!

 

As I promised the technical glitches have been fixed.

I reposted several previous posts to be sure it is working.

Have a nice weekend….

 

thank you Microsoft

The Clothesline

I don't know about you, but I and most physicians are fed up with being hung out to 'dry'.

Same old, same old.

Doctors with Medicare patients will start seeing a 21 percent pay cut this week after Congress failed to defer the cuts by two more years.

This Story appears today in the Washington Post.

• The Senate had until June 1 to avert the cuts. It is not expected to vote by Tuesday, when the Center for Medicare and Medicaid Services' temporary hold on Medicare claims expires.

Some members of the American Medical Association signed white lab coats instead of a petition to voice their displeasure on Sunday at the group's annual meetings in Chicago. The coats will be delivered to lawmakers in Washington on Friday, a spokeswoman said.

"The Senate's failure to act before June 1 made the 21 percent cut the law of the land," AMA President J. James Rohack said in a statement. "Physicians will start seeing a 21 percent cut in Medicare payments this week that will hurt seniors' health care as physicians are forced to make practice changes to keep their practice doors open."

Legislation to restore doctor's pay -- known as the "doc fix" -- is part of a broader aid package that includes jobless benefits and more financial aid for the states. In his Saturday radio address, President Obama called on lawmakers to avert the pay cuts, faulting Republicans for the delay. "After years of voting to defer these cuts, the other party is now willing to walk away from the needs of our doctors and our seniors," Obama said.

Republicans call the package fiscally irresponsible and said it would add $80 billion to a bloated federal deficit. Some moderate Republicans say they will vote for the package if the cost is offset by cuts elsewhere in the federal budget.

President Obama this weekend told us all how much he 'cares' about doctor reimbursement. 

 

What a sham.  

 

If that were the case there should have been room in the monstrous 1200 page heath reform bill to (link takes a while to load))include a permanent fix to the SGR (sustainable growth rate)

Better pony up and get some more clothespins....before they are all gone!!

Vending Machine Medicine

I was reading Distractible MD this morning and came across this photo that Rob Lambert posted.

I could not resist passing this along to my readers.  It says a lot about what has and is happening to our domain as physicians.  I wonder if it talks too.

The Yo-Yo Effect

The past several months reveal how disconnected the plan for health care reform has evolved. There was little transparency regarding the evolution of the bill, except for political posturing. The present administration has no experience in business leadership, nor basic economic theory.

The fact that the flawed SGR formula, hastily conceived in the early 1990s, was not addressed in the health reform bill attests to the simple fact that cost is a major factor in the legislation. Universal care was never a top priority except to assuage the proletariat.  SGR was and is held out as a bargaining chip and as a diversion for most  physicians.

The effects of the SGR impact very severely on ophthalmologists, urologists, geriatricians, some internists  and somewhat on cardiologists and pulmonologists.  These practices serve a large medicare population, and the SGR impact as presently structured or not eliminated will be devastating.

Primary care physicians can select to minimize medicare or eliminate it all together from their business model, with much less impact on their practices.

Thus, some specialists will have little choice but to either quit entirely, or fire half their staff, and reduce the quality and accessiblity of their practices to senior citizens.  These practices will ill afford to acquire new technology.  The physical structures of medicine will decline, poor maintenance, bare floors, and peeling paint.

The past several months have been  a Yo yo  for physicians  with hope for resolution of the SGR fiasco, and then dashed as we are used as a political football.

del.icio.us Tags: yo yo effect,sgr,political footbal,bargaining chip,healthtrain express

Non Publishing Notice

I have just discovered my daily blog has not published for the past week.  I am working on finding the cause and solution.. I will be back!!!

Social Media ROI

Information Technology gurus often talk about Return On Investment or ROI. The term is used to assess the worth of IT investment, it's increase in productivity, or efficiency and it's long term ability to save on costs. 

It often is focused on the fixed capital investment and ongoing maintenance cost of purchasing and maintaining such systems.

Web-based Health 2.0 offers an immediate ROI.  ROI should be analyzed on the basis of what it does for you, the physician and your patient, not just a number based on dollars spent/dollars returned.  The numerator in that equation is close to if not zero.

If you substitute time as the numerator and results as the denominator it becomes even more apparent what health 2.0 offers you in your office or clinic.

Without notice the physician is able to lookup detailed specifications of medications, cross reactions,  in a fraction of the time compared to textbooks, and paper journals.  Google search or Pubmed search is an actual  world wide search.

Health 2.0 is driving advances in medicine and healthcare.

It is not a fad, and those who ignore it for much longer will be left in the dust.

The Mayo Clinic, an institution known for it's acumen in adopting new technology that has proven it's worth, has established a social media  presence.  May already has a significant presence on You Tube as a patient teaching media, and even on Twitter followed by 60,000 followers.

Admittedly this is a paltry following compared to more prurient interest sites such as Lindsay Lohan, Paris Hilton or Mel Gibson.

Twitter and Facebook have become more than social networks for communicating with friends.  It now presents a powerful platform for marketing and branding of products and services. It is more powerful than Google in that it provides an elective means of synchronous communications if chosen by participants.

And according to the Mayo Clinic, Social Media Networking presents substantial dangers due to it's inherent exponential Viral spread, much like a pandemic. 

What percentage of patients discover you via the yellow pages?

It is much more likely that they have found you on an online service via superpages, or an online listing in their health insurance website.  The classic paper yellow pages have become an indecipherable listing. The internet search engines allow a focused search for the individual patients. 

 

del.icio.us Tags: social media,mayo clinic,health 2.0

Coalitions of Collective Intelligence

Thanks to the marvels of the internet and webinars I was able to attend the ACE  2010 event in Chicago from my well worn desk chair in my  den here in California.  Glen Tulman, CEO and extrovert of Allscripts was very good at analogizing much of health care with other industries, for example, Education.

Mr. Tulmann led off with the well worn exclamation that "Health is not a Commodity", but rather a "Community", which he compares to a coalescence of a collective intelligence.

During the webinar I was interrupted by a telephone call from "Dr Chronos", a new iPad EMR vendor.

I will return to that a bit later.

Mr. Tullman compared the manufacturing of a pencil with that of a computer.  It seems the pencil requires a significant amount of 'collective intelligence to bring it forth from a tree, deliver it to a manufacturing plant, grind it into a pencil along with the graphite core, apply the eraser with a band of metal and label it correctly as a No. 2  pencil, or whatever. Also don't forget the distribution process, packaging, marketing, etc.

He readily admitted the increased complexity of the computer and it's coalition of community involving Microsoft, Google, Wikipedia, You Tube, and Facebook.

While most computers have a common operating system, he correctly observes that Health Care does not have a common operating system.  He implies that what health care needs is an Operating System.

Mr. Tulmann also pointed out the disparity between professionals such as doctors and administrators, or business people, and compared to our teacher educators and their administrators.

Mr. Tulmann presented several projects where large dysfunctional or non functioning communities were revitalized block by block, one at a time. As an example he discussed Mr.Geoffrey Canada, a black American who was an instrumental leader in re-vitalizing Harlem in this same manner.  I can see this analogy as it applies  to  healthcare.

The presentation was broad, general and not very specific, although it seemed to be pointing toward the latest well-spring of governmental largess, health information exchanges.

He outlined several health systems goals in San Diego to integrate health data information retrieval. These are Scripps and Sharp Health System......

ACE 2010 was mostly a media event for Allscripts personnel, the marketing and sale force.  There were no really innovative ideas. It does however give one the sense of how the HITECH act has 'enabled' vendors' to sell their products.  Users are still skeptical...

del.icio.us Tags: Allscripts,health operating systems,google,you tube,facebook,wikipedia,glenn tullman

US Healthcare vs UK N.H.S.

 

Recent reports from the UK indicate changes that will decentralize control from it's present organization and distribute accountability and decision making authority to physicians.

This story represents when individuals have little or no control over their working environment.

 

Oxford hospital child heart ops 'should stay suspended'

The report cleared consultant Caner Salih of any wrongdoing

Child heart surgery should remain suspended at Oxford's John Radcliffe Hospital where four babies died until improvements are made, a report says.

Surgery was suspended when four children died between last December and February, after being operated on by consultant surgeon Caner Salih.

The report found the deaths were not due to errors of judgement but Mr Salih was not given appropriate supervision.

Mr Salih was cleared of any wrongdoing by the report.

The independent report, commissioned by the South Central Strategic Health Authority (SHA), found there were problems in Mr Salih's induction and mentoring when he began work at the hospital.

All four deaths occurred shortly after his appointment.

He subsequently decided to stop operating and told the trust of his concerns, including a lack of support.

The SHA's chairman Dr Geoffrey Harris has apologised to the families of the babies who died.

"We offer our sincere condolences and we apologise that, in the cases, the standards of care were not what was expected," he said.

Analysis

Continue reading the main story

Fergus Walsh, BBC Medical Correspondent

At first glance this report has worrying echoes of the Bristol inquiry a decade ago.

Both dealt with the deaths of babies following heart surgery.

Both listed failings in the management of surgery and the poor culture of reporting concerns.

But the Bristol inquiry was on an altogether bigger scale and dealt with failures stretching over a decade during which time 29 babies died.

Doctors were struck off and a radical overhaul of paediatric heart surgery ordered.

In this case it was the surgeon who performed the operations who raised concerns and there is no suggestion that he performed poorly.

Action was taken within three months of the first death whereas at Bristol the high death rate continued for years.

Aida Lo, whose daughter Nathalie was one of the four babies who died, told BBC News: "It makes me angry because if they were not ready to do the operation they should have waited to do it.

"It's about human life.

"I can't believe it. It makes me sad. I have been crying, it has been very painful."

Mr Salih complained about the age of equipment and poor working practices at the paediatric care unit, asking for operations to cease, the report panel found.

The report does not criticise his care, saying "all the cases were complex and surgery was high risk".

It found that arrangements for clinical management were "less than adequate".

"In Mr Salih's four cases, we found no evidence of poor surgical practice, but that he would have benefited from help or mentoring by a more experienced surgeon; and that it was an error of judgment for him to undertake the fourth case," the report found.

It recommended an overhaul of the way the hospital deals with serious incidents, better clinical and managerial leadership and to develop ways to identify adverse trends in surgical outcomes earlier.

The hospital's children's heart unit is the smallest in England, carrying out just 120 or so operations a year.

The report also recommended that there needed to be an adequate caseload so surgeons "can maintain their expertise", by a mix of expanding the trust's service and forging links with another centre.

Sir Jonathan Michael, chief executive of the Oxford Radcliffe Hospitals NHS Trust, which runs the hospital, said the hospital had improved its procedures since the deaths.

Continue reading the main story

Aida Lo, whose daughter Nathalie was one of the babies who died, said the report was "very painful"

• Mother's grief over heart death

But he added he did not believe child heart surgery should remain suspended, saying the unit had "a lot to offer the NHS".

In a statement, the trust said it understood the past few months had been "difficult for the families of the children whose deaths resulted in this investigation".

"Children's heart surgery has been carried out at Oxford since 1986, with good outcomes," it said.

It said a review of clinical governance and risk management had begun in April to "streamline our internal systems and reporting lines".

"We recognise that in such a large organisation, processes can become over-complex and we are working to address this issue and ensure that we adopt a more uniform approach across the whole trust in the future.

"We want to be clear that where there are things to learn from the report published today, we will develop plans to tackle those issues as a matter of urgency."

It has until 17 September to report back to the SHA with an action plan.

The Care Quality Commission, which independently regulates health and social care in England, said the hospital was being monitored and its quality and safety standards were to be reviewed.

Meanwhile a helpline has been set up by the hospital trust for patient inquiries: 01865 572900.

More on This Story

Related stories

• Mother's grief over heart death 29 JULY 2010, OXFORD
• Heart surgery unit under review 26 APRIL 2010, OXFORDSHIRE
• Children's heart surgeon leaves 05 MARCH 2010, OXFORDSHIRE
• Surgery halted after child deaths 04 MARCH 2010, OXFORDSHIRE
• Hospital suspends child heart surgery 03