EMR update from MGMA

The Medical Group Management Association just released it’s annual survey about electronic medical records. This 2011 report is based upon 2010 data.

The data represent the aggregate experience of more than 120,000 physicians in medical practice., MGMA conducted a study funded by PNC Bank, to explore the barriers and benefits of EHR adoption from 4,588 healthcare organizations.

The Study reveals:

• Expected productivity loss during transition is the main barrier to EHR implementation, according to study participants who still use paper records.
• Study participants are pleased with their EHRs overall, despite some not seeing an increase in productivity - Nearly 72 percent of EHR owners said they were satisfied with their overall system, but only 26.5 percent reported increased productivity since implementation.
• Time allocation is key to a successful EHR implementation - 53.2 percent of respondents felt that they either ‘mildly’ or ‘severely’ under-allocated the training time needed during the implementation of their EHR system.

Many consultants feel some justification from this study which confirms what is the most significant barrier to adopting an EMR.  The end-game is that many more resources, both in time, specialized personell must be allocated to the training process, and that many questions do not arise until the user is in a particular setting or event that has not be addressed. Users will then adopt a ‘workaround’ for that moment to continue their activity without interruption to call a ‘help line’, or disturb a colleague who may be more knowledgable.

A more complete report is available here:

MGMA detailed  specific recommendations and alternative methods for training physicians to use EMR.

Younger physicians now recently trained wil have some experience with EMR, however it may not translate directly to another practice. In fact users who are familiar and trained in one system often have more difficulty learning a second or even third system. Many physicians attend patients at more than one facility.

USC-LAC Medical Center         UCLA Medical Center

The ball point pen works equally well in all hospitals and clinics.

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Google's Larry Page May Pull Back on Health Portal: WSJ

 

eWEEK.com reports: 

 

As part of a corporate streamlining, Google co-founder and incoming CEO Larry Page may reduce resources for Google's personal health portal, according to The Wall Street Journal."One project expected to get less support is Google Health, which lets people store medical records and other health data on Google's servers, said people familiar with the matter," the WSJ article states.

"Google Health will just become a basic service without much support. Over time without strategic interest from a senior leader, it will basically become a tool for developers," Shah predicted.

That gives me such a warm feeling ! This is an apt announcement as to why MDs do not trust PHRs, and EMRs

"I think it would be a political and PR nightmare for them to kill Google Health. That's why I don't think they  would say we're pulling the plug completely on it," Moore said.

Google Health or PHRs may not affect the market for EHRs (electronic health records), according to Shah. (Wrong !)  This move will set off many warning bells to both doctors and patients alike. If a huge profitable enterprise like Google which has many books of business cannot or will not support digital information in the healthcare space, what makes anyone believe that smaller niche EMR companies can or will survive over the long run.  What happens when the exponential growth rate and profitability decreases or disappears when incentives end?

EMRs demand long term plans and commitments from vendors. Anyone looking at a company which provides a critical infrastructure for a practice should do a thorough financial biopsy of the company and get advice from financial experts.

Weak standards and lack of consumer interest have hurt adoption of PHRs, according to Chilmark.

Schmidt introduced Google Health at the HIMSS (Healthcare Information and Management Systems Society) conference on Feb. 28, 2008. Since that time, Google has treated the site as a "sandbox" and invested more in its Android mobile platform, Moore said.Microsoft's health care effort may be more organized overall than Google's, despite struggles by both companies in PHRs, experts say. Microsoft, unlike Google, has a chief health care strategist, Shah noted.

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OBAMACARE.MEDICAID FOR ALL

Chuck Wilder interviews Dr Richard Amerling President of the American Association of Physicians and Surgeons (AAPS), and Director of the Outpatient Dialysis at Beth Israel Medical Center. Dr. Amerling is the author of Physician’s Declaration of Independence.”ObamaCare Endgame: Medicaid for All”

Here are the interviews: LINK

Wilder also interviews other opinion makers, Seton Motley President of Less Government, Editor in Chief StopNetRegulation.org A publication of the Center for Individual Freedom. "House Votes this Week to Reverse FCC Net Neutrality Power Grab" (www. lessgovernment.org) ................................. Jim Gilchrist Founder and President of the Minuteman Project, Jim is a veteran of the U.S. Marine Corps and recipient of the Purple Heart award for wounds sustained while serving with an infantry unit in Vietnam, "A look at the report:Federal Agents Told to Reduce Border Arrests, Arizona Sheriff Says" (http://www.minutemanproject.com/) ............................... Richard Amerling, MD is a nephrologists practicing in New York City. He is an Associate Professor of clinical medicine at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center. He is Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence."ObamaCare Endgame: Medicaid for All" (http://www.aapsonline.org/medicare/doi.htm). ............................Katharine DeBrecht Author and staff writer for the Tea Party Review

Too many physicians endorse the “single payer” concept. Some are legitimately frustrated by the increasing difficulty in getting paid by private insurance companies and so called “health maintenance organizations.” My response is, “What if the single payer is Medicaid?” Unless ObamaCare is defeated in the Supreme Court, or defunded/repealed by Congress, we may soon be in a position to answer that question.
It has become clear that a major goal of ObamaCare is massive expansion of Medicaid. It mandates that states increase Medicaid eligibility, and provides temporary funding to this end. Medicaid rolls in many states have already swelled due to the prolonged recession and high unemployment. According to CNNMoney: “Strapped states are scrambling to address Medicaid's ballooning costs before the federal government cuts back a critical source of funding this week. Medicaid is one of state's costliest burdens. And the weak economy swelled the rolls to record numbers. Nearly 49 million people -- or almost one in six Americans -- were covered by the safety net at the end of 2009, the latest figures available

Furthermore, federal control of private health insurance and the bureaucratization of private medicine under ObamaCare will lead all private insurance down towards Medicare and Medicaid levels.

Medicaid is an excellent example of a failed government program. Even a cursory look at Medicaid should convince any rational person that government has no business being involved with health care. It was created in 1965-66 as an “add-on” to Medicare, the major entitlement passed as part of the Great Society under LBJ. While Medicare bribed physicians with “usual, customary, and reasonable” reimbursement (and a long-forgotten pledge not to interfere with care), Medicaid payments to physicians were, from the outset, pathetic. Thus, Medicaid was set up as a third tier system; one that would relegate its beneficiaries to hospital emergency rooms and clinics, rather than to private medical offices. Medicaid payments to physicians to this date in most states are well below the cost of care. The minimal participation of private physicians in the Medicaid program, which was by design, doomed the program to provide very expensive, fragmented, low quality care. How can a program that virtually excludes private physicians now be expanded and hope to succeed? Obviously, it cannot.

ObamaCare mandates an increase in Medicaid physician payments to Medicare levels in the hope of inducing more doctors to participate. This might have worked ten or fifteen years ago when Medicare payments were decent. Now, through price controls and cuts, they too, barely cover the cost of treatment. Also, the boost is temporary; payments revert to current levels after two years. Why would doctors take on Medicaid patients under this scenario? Many will not participate.

Medicaid is a fiscal and humanitarian disaster, providing fragmented, lousy, and expensive care. It is a welfare system and enslaves participants in permanent poverty. Rather than expanding, it should be cut. The federal government should rescind all rules regarding Medicaid and return to the states their share of funds as block grants. States should be free to develop their own approaches to health care for the needy. One such approach, proposed by my colleague, Dr. Alieta Eck in New Jersey, offers free medical malpractice insurance to physicians who donate four hours per week to charity care. Let fifty solutions blossom in the fifty sovereign states!

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T.E.D. General Stanley McChrystal

You should wonder what is General McChrystal doing on the Health Train? Hopefully by the time you have disembarked I will have conveyed to you the analogy of his leadership in the military and health care. He spoke at T.E.D. In Long Beach CA in 2011.

General McChrystal, of course is the former commander of U.S. And International forces in Afghanistan. A four-star general, he is credited for creating a revolution in warfare that fuses intelligence and operations. The analogies of changes in warfare and healthcare are immediately apparent.

The environment has changed. Health care is dispersed...using chat, video phone calls, complex communications, and may not be face-face.

1. Leadership

2. Technologies

3. Inversion of expertise, many changes at lower levels (digital)...Leadership experience.

4. Increasing reliance on electronic media places barriers for leadership, hands on.

5. Generational differences, shared purposes with different expertise, experience, vocabulary.

6. Ranger commitments to each other....Physician commitments to patients.

7. Addressing the possibility of failure, in a goal but not as a professional.

Does this sound familiar?

1. Challenges to leadership altered and magnified by generational changes.

2. Explosive and disruptive technology changes in diagnosis, delivery of care, and in technology, media and data storage, as well as process.

3. Challenges of senior health care givers and professionals obtaining expertise in #4. Inversion of electronic and media knowledge in juxtaposition to clinical expertise by senior physicians.

5. Generational differences in education and training processes, with a requirement of shared purpose in patient care and wellness.

6. Physician-patient commitments and physician-physician-hospital institution commitment and or patient care. (will this be the ACO?)

7. The possibility of failure? ACCA, ACOs. A non-system failure has already ocurred, it was not a goal, but the lack of a clearly defined endpoint.

8. Are we prepared for another failure? Was medicare a failure? Success or failure can only  be  determined in the context of time and setting. Medicare was designed in the early 1960s when there were fewer seniors eligible, and there were fewer diagnostic and therapeutic interventions as choices. continued…………..

   del.icio.us Tags: aco,mcchrystal,leadership,health reform

ACO, DOJ, ACA,IRS and WAIVERS

 

Details of the ACO, Accountable Care Organization are beginning to emerge.  This link to CMS is the actual proposed rule from Don Berwick MD, currently the Head of CMS.

42 CFR Part 425
[CMS-1345-P]
RIN 0938-AQ22      

This proposed rule would supplement section 3022 of the Affordable Care
Act which contains provisions relating to Medicare payments to providers of services and suppliers participating in Accountable Care Organizations (ACOs).

The Notice is both comprehensive and fairly specific about ACOs, and includes a glossary of acronyms that is arcane to most readers.

The Notice of Rule Making stipulates commentary be made by :

Instructions on pages 1 & 2 detail delivery methodology.  Send in your comments.

On another ACO front, the Inspector General has issued a number of Waivers allowing ACOs to bypass restrictive anti-trust law and also prior thrulings in regard to medicare restrictions including:

The application of the Physician Self-Referral Law, the Federal anti-kickback statute, and certain civil monetary penalties (CMP) law provisions to specified financial arrangements involving accountable care organizations
(ACOs) under the Medicare Shared Savings Program.

In addition, section 1115A(d)(1) of the Act, as added by section 3021 the ACA, authorizes the Secretary to waive the same fraud and abuse laws, among others, as necessary solely for the purposes of carrying out
the provisions of section 1115A of the Act with respect to the testing of certain innovative payment and service delivery models by the Center for

Medicare and Medicaid Innovation.

Commentary may also be made in accordance with the instructions on page 2 of the notice

IRS implications: NOTICE 2011-20   Another elephant in the room, the IRS, elaborates on ACOs, tax-exempt organizations qualifying for 501C status, and pretty much repeats the party-lines from HHS in regard to ACOs, all designed to grease the rails in regard to health reform as legislated by the ill-informed congress

Department of Justice, also weighs in on the liklihood of real violation of current  federal anti-trust law, and guidelines for avoiding same.

It becomes obvious to the reader that health reform is well orchestrated, designed to overcome most of the free-market rules that remain.

The law will all but paralyze the ability to  deliver  healthcare via small medical practices.

del.icio.us Tags: aco,justice,hhs,irs,anti-trust,cms,medicaid,inspector general,waivers,rule making,aca,affordable care act

Dr A is no longer Anonymous Mike

The doctor who was known as Dr A went public several months ago. The tension was palpable when he announced that he was admitting to who he was….Dr. Mike Sevilla, from the heartland of our great country. He and Governor John Kasich (of FoxNews fame) both hale from Ohio, where all good things Americana bloom even in the dead of winter’s snow and ice storms.  Dr. A, excuse me, Dr Sevilla, is a hearty soul, working all week, on call many nights  and then off to weekend meetings with the Ohio OSMA, summer Podcast Camp, (at least that is what he will admit to.)  He is often seen in his car (can’t quite figure out what kind it is) doing a video pod cast). Mike I hope you don’t text and drive…Here’s a sample of Dr.Mike at Ohio Student Medical Association (OSMA).

Mike is an avid first adopter !!

Dr Mike Sevilla

Hat’s off to you Dr. Mike Sevilla, a real family doctor !

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The Death of Transparency and User Friendly Health Information from CMS, HHS, Public Health

 

 

It was two short, short years ago that the Obama administration thrilled data and transparency wonks by launching Data.gov, USASpending.govand a number of other ambitious sites. But as Marshall Kirkpatrick reported in our top story this week, Congress is now planning to eliminate the sites' funding. There's a push to save them (check the story for the updates), but I have a sinking feeling that it was just too good to last.

Two years ago the incoming Obama administration launched a number of ambitious websites, most notably Data.gov, that were dedicated to offering public and government data to the outside world. The stated intention was to foster transparency and offer a platform for the development of new software and services. It appears those experiments may be over for now.

Today the Sunlight Foundation and Federal News Radio reported that the public projects Data.gov, USASpending.gov, Apps.gov/now, IT Dashboard and paymentaccuracy.gov as well as a number of internal government sites including Performance.gov, FedSpace and many of the efforts related the FEDRamp cloud computing cybersecurity effort would be taken offline in coming weeks due to budget cuts by Congress. Perhaps things like electronic government, software platforms and public accountability were just fads, anyway.

The Victims: 

2011 County Health Rankings

What’s New

 

US Government Web Services and XML Data Sources

 

Update:. We're hearing from several places that there's a potentially viable effort to save these sites and organizations. Here is one perspective on that and you can also see the Sunlight Foundation'sSave the Data petition. See also Alex Howard's in-depth reporting on this news published on Friday

 

del.icio.us Tags: health 2.0 challenge,transparency in government,sunlight foundation,data.gov,federal news radio,performance.gov,fedramp

Socializing on The Health Train Express

Gary M Levin M.D.

Health Train Express is now being followed and featured on Social Media Today.

While not  particularly a health care related topic, the fact that Health Train Express was aggregated by a highly visible social media site bodes well for the rapidly increasing interest in Social Media in the Health Care space. Social Media Today is an independent online community for professionals in PR,  or any other discipline where a thorough understanding of social media is mission critical. Every day, we provide insight and host lively debate about the tools, platforms, companies and personalities that are revolutionizing the way we consume information. This  mission also applies to health care. As medicine progresses through the use of EMR and the  implementation of Health Information Exchanges, health professionals will also adapt social media in their patient relationships, hospital to practitioner communications, and B2B .

These two presentations give example and vision as to what Social Media can be.

Social Media Today and MVP at Womma 09

Medicine is unique in that important privacy and confidentiality issues must be addressed as well, and there will be certain limits for healthcare professionals.  

Commentary is welcome:

.

del.icio.us Tags: social media,facebook,twitter,health train express,b2b,privacy,hipaa

HHS Change of Command

 

Kathleen Sebelius is stepping away from her present position of Secretary of  Health and Human Services, and Obama’s crusade for Health Reform.  Why? In the next week we will hear many reasons.

Why is this Lady smiling??

Let’s go through the littany of reasonable explanations, that are all politically correct. I assign no  specificity to this news, however here is the usual boilerplate form  stored in each personel file of indiviuals hired by the government.(on the day they are hired)

1 I regret  having to inform you that due to personal and family (or  health related) issues I must step aside from my position. I have enjoyed working with you, and wish you every success with your ongoing endeavor.

2. In lieu  of being terminated, I resign.

3. The specifications and duties of my position are not as what was described in your position offering.

Mrs. Sibelius stepped into an almost impossible situation, given the change of administration, the ensuing debate over health-reform, and the consequent mandates placed upon the Secretary of Health and Human Services.  The scope of the project exceeded that of putting a man on the moon.  Congress did not read the legislation, let alone the fine print.  There are no less than 1000 ‘the secretary shall…….”in the law.  The ensuing reaction of the electorate was deafening.

Mrs. Sebelius’ background, education and work record is exemplary. As a former Governor of Kansas (2002-2010). she dealt with serious budget challenges, 

In 2001 Sebelius was named as one of Governing Magazine's Public Officials of the Year while she was serving as Kansas Insurance Commissioner.

In November 2005, Time named Sebelius as one of the five best governors in America, praising her for eliminating a $1.1 billion debt she inherited, ferreting out waste in state government, and strongly supporting public education – all without raising taxes, although she proposed raising sales, property, and income taxes. The article also praised her bipartisan approach to governing, a useful trait in a state where Republicans have usually controlled the Legislature.

In February 2006, the White House Project named Sebelius one of its "8 in '08," a group of eight female politicians who could possibly run and/or be elected president in 2008.

In 2009, Forbes named Sebelius the 57th most powerful woman in the world.  In 2010, Forbes named Sebelius the 23rd most powerful woman in the world.

In reviewing her qualifications for Head of HHS, the only relevant health  item is her stand regarding abortion.(pro-abortion)u

Sebelius was doomed from the start, but exhibits fortitude in facing down considerable and credible opposition to the Obama plan for health reform. The

del.icio.us Tags: HHS,Sebelius,Health Reform

However the majority of the implementation falls squarely on the Head of HHS. 

Thus far President Barak Obama’s selection to lead the most powerful institutions in American Medicine have been spectacular failures. Don Berwick will most likely be leaving rather than facing a heated congressional hearing.

The Opinions expressed here are solely the property of the author.