Who Reads Instructions?

Okay, I have always been an early adopter. And that extends to the recent introduction of Windows 8 (Metro)  Metro seems to be designed to be a GUI that is an enlarged smartphone screen. It is meant to be used on a touchscreen tablet.

Perhaps  Redmond intended Windows 8 to be sympatico with Windows phone users even though that market is still very immature and follows on a merger (purchase) of Nokia by MSFT.  Nokia as you will remember almost tanked with it’s now defunct Symbian OS. 

Loading the OS as a self installing .exe file from a USB stick was straightforward, even though it took several reboots and several long pauses with no indication whether it had crashed.  Patience paid off and the opening screen appeared. Warning the opening screen is a mono-color with a strange looking fish in the center. For aquarium lovers, you already realize it is a ‘siamese fighting fish’.  There must be some hidden meaning in that logo. Perhaps the code spells out Steve Jobs.

I bring this up on Health Train Express because there are probably many of you who are tempted to try Windows 8. I don’t think I would rush to use it for your office systems as yet. Reserve it for playtime.

Have no fear, despite the warnings of non support, I have not needed it thus far and have used it for almost three weeks.

I took out my backup insurance by copying all my important documents, photos, and personalized settings to an external hard drive and also to the cloud. In the past I have had some very bad experiences whereby a backup program in one OS was incompatible with a recovery in another new OS.  With that in mind, all went well, and because I use the cloud now for 90% of my computing both online and offline.

Beginning with blogger I have steadily migrated to more and more of Google’s offerings because of it’s synchronicity and it’s overlap of social media, document sharing, email and it’s android relationship.  In the near if Google’s chrome becomes more prevalent the need for Windows is less.

Because I blog and work in social media a great deal of the time, Chrome presents the most usable means of switching from Google + to twitter and Facebook.  The addition of Google Hangouts is the pudding in the pie.  Don’t forget YouTube as well.

Other than not working with my AIO HP all seems fine. It has a generic HP printer driver that shines. Printer drivers are the acid test for compatibilty, since printers are very finicky and exacting.

The only thing Google needs to do is develop a HIPAA compliant secure video conference and you have a low cost ready made teleconferencing solution that could alter the cost equation for healthcare.   What used to cost about 50,000 for a telemedicine set up now costs not much more than a laptop or tablet pc. P.S. it also works on a smartphone reasonably well.

Two projects in which I am directing are the use of it for a “Virtual Photo Walk” and “ Blind Veterans Help Desk”.  The later seems like an oxymoron, however I have a dedicated Veteran’s Advocate who convinced me it was worth a trial.  It seems useful for partially blinded patients to socialize.

Finally, I am glad I did not read the instructions, especially since there are no really official instructions, or accompanying help file.

It took about a week of experimenting with all the icons, buttons and learning to swipe using the mouse on a laptop. Microsoft promises a new $ 75.00 dollar swipable mouse pad in the near.

Technorati Tags: Windows 8,Windows Metro,blind veterans,virtual photo walks

Where do Health and Social Media Intersect ?

Online Health Care Discussions 98% Patient Driven

 

A bold statistic reveals how little medical providers are participating in the use of Social Media regarding health issues.

Recent statistics show that close to 90% of providers are familiar with or use social media such as twitter, facebook or google in their daily activities.

Dike Drummond MD writes on “HealthWorksCollective” and reveals that providers provide less than 2% of information except in the case of lung cancer where it jumps to a “whopping 9%” in online chat.  In a number of cases the majority of the discussion is driven by the patient’s caregiver. Alzheimer’s disease tops that statistic as you might expect.

The authors of this infographic focused on disease specific discussions and found the most discussed topics to be

• Depression
• Fibromyalgia
• Breast Cancer
• ADD
• Asthma
• Cardiovascular Disease

Infographic and article source:  NMCITE

[INFOGRAPHIC] 

Despite predictions about the adoption of social media for physicians in reality social media is more often used by caregivers.

There are opportunities for education and training of care-givers in health to enhance their efforts to support either their clients or their family using social media such as facebook, twitter, and Google +

Google + further enables social media with Google Hangouts affording a direct video conferencing ability amongst ten participants.

Further information is available at Digital Health Space on Google Plus.

Physicians should lead their staff in developing this modality.

Technorati Tags: digital health space,google+,social media,caregiver,physicians,dike drummond md,healthworks collective

ACOs Gaining Ground in Illinois

 

ACO is the hottest three-letter word in health care

Accountable care organizations take up only seven pages of the massive new health law yet have become one of the most talked about provisions. This latest model for delivering services offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping down costs. A cottage industry of consultants has sprung up to help even ordinary hospitals become the first ACOs on the block.

New Insurer-Hospital ACO Touts Early Success.

With only six months of data, the largest hospital system in Illinois, Advocate Health Care, and major health insurer Blue Cross Blue Shield of Illinois (BCBSIL) are declaring some early successes with its provider-payer accountable care organization, which is the largest commercial ACO, Scott Sarran, BCBSIL's chief medical officer, said in a Kaiser Health News article.

Advocate Health Care based in Chicago and BLBSIL's ACO called AdvocateCare has 250,000 PPO members and 125,000 HMO members, according to Sarran. In its first six months of 2011, the ACO resulted in hospital admissions per member dropping 10.6 percent, compared to 2010, and emergency department visits decreasing 5.4 percent, Kaiser Health News reported.

Even though the federal government offers under the 2010 health reform law a platform for Medicare ACOs, providers and payers have joined forces to create their own ACOs outside of the Medicare Shared Savings Program. For example, Hoag Memorial Hospital Presbyterian, Blue Shield of California and Greater Newport Physicians IPA just weeks ago announced its intent to create an accountable care initiative, and Pioneer ACO Atrius Health recently hinted in a FierceHealthcare interview that it is considering partnerships with commercial insurers, having already begun talks in reducing costs.
 

"If we're doing this in the Medicare arena, why can't we do this in the commercial environment, as well, and then be rewarded for the benefit we bring to the reduction in total expenses in Medicare PPO patients?" Atrius Health President and CEO Gene Lindsey said.

 

"Before, we were limited to the fee-for-service revenue that would be associated with caring for those patients. So this opens up a whole new vista in healthcare finance when we are looking for new ways to fully fund the programs of care that we want to offer," he said.

The administration forming ACOs will take considerable effort and startup costs amounting to several millions of dollars according to:

What are ACO start up costs ?

That's the"$64,000 question"

We have three separate estimates, with disparate figures.

The projected start-up costs of an accountable care organization (ACO) can vary widely, depending on who you talk to. The Centers for Medicare & Medicaid Services (CMS) estimates that it will take $1.7 million per ACO, based on a 2008 study of the Physician Group Practice Demonstration project, according to an Institute for Health Technology Transformation white paper released last week. The American Hospital Association (AHA), however, estimates ACO start-up costs are between $5.3 to $12 million, depending on hospital size. The Institute for Health Technology Transformation reports that it could take $7.5 to $11.3 million for a 200-bed hospital or $1 to $11.7 million for a 200-physician practice.

 

FierceHealth IT offers further details

 

Technorati Tags: accountable care,american hospital assoication,institute for health technology,medicare,ppo,kaiser health,advocate health care

We Won’t Know What’s In There Until We Pass It

 

When the Affordable Patient Protection Bill (APPA) bill was in congress many congressman could not or did not read the entire bill.  The bill was 1200 pages of the “Secretary of HHS” shall implement the following”…………..The bill was global, including many issues with health IT, public health, ACOs, and  set deadlines for implemenation without regard to the impact of each phase.

Some said that we would not now what was in it until it was passed.  That statement is probably the most true statement of the entire furor over health reform.

The initial phase included forbidding exclusions for previous illness and doing away with uninsurabilty as well as allowing dependent minors to remain on parent’s policies until the age of  25.  Those two items surely drove up the cost of health insurance.  Someone had to pay for insuring uninsurable people. Surely it sounds wonderful and it immediately reduced political pressure about health reform.

It may have been a bit backward to set up the financing after increasing the expense. I don’t understand the math but then again I don’t print money.

Jeff Young, at the Huffington Post describes it this way.

“The good news is that health care reform could lead your employer to put a little more money in your paycheck. The bad news is that if they do, it's probably because they aren't providing you with health insurance anymore.

The Congressional Budget Office estimates that 4 million fewer people will get health benefits from their employers in 2016 compared to what the agency projected a year ago. More people will end up on Medicaid, the government health program for the poor, and more companies will decide to stop offering health benefits and let their workers buy their own coverage through insurance "exchanges" the government will establish in 2014. The Congressional Budget Office doesn't estimate how much wages might increase for those who lose company health benefits.

How could this translate into bigger paychecks for workers? Economists consider health insurance to be part of how much companies "pay" workers because fringe benefits cost them money, said Paul Fronstin, director of the Health Research & Education Program at the Employee Benefit Research Institute. If a company decides to stop providing health insurance, they are likely to pay a little more. Companies may choose to offer workers extra money that could be used to help pay for health insurance instead of providing benefits themselves.

The Congressional Budget Office also says this will allow the government to raise more money to pay for health reform because wages get taxed but money spent on workplace health benefits doesn't. Employers that drop workers from their insurance rolls also will pay penalties to the government.

Jobs would remain the most common way for Americans to get health insurance. The new projections about health care reform don't say fewer people overall will get insurance at work, just a smaller number than the budget agency previously thought. This year, 154 million people are covered by their employers and 161 million will be in 2016, the Congressional Budget Office says.

There's no guarantee things will play out that way. Economic and budget projections are constantly changing and the parts of the health care law that are supposed to expand coverage don't exist yet. Moreover, Fronstin said, economists' assumptions about companies treating benefits like pay aren't always accurate in the real world.

Reading further it becomes obvious there are many  ‘what if's’ an unspoken hope that the present economic doldrum will come to an end, and the planners have given themselves more than ‘wiggle room’ to call it a success.

Whatever it is we should not blame “Obama Care”  Much of the ideas were formulated long before he came into office.

The Patient Affordability and Protection Act is the correct term. That term seemed the most innocuous and benevolent term for major disruption and uncertainty in the health system.

Part II (later this week)

Health Insurance Exchanges, to be….or not to be. Who will do it?

 

Technorati Tags: Hhs,public health,affordable care act,aco,uninsurable,jeff young,huffington post,congressional budget office,employers

At Long Last ! Inland Empire HIE to go Live April 1 2012

 

Gary M. Levin M.D.

I feel like the great grandfather who set something in motion that might have occurred anyway.  I do have the satisfaction of knowing I was right all along back in 2002 when I am sure I was hailed as the “Don Quixote’ of the Inland Empire. There were few then that could appreciate the vision of what we see unfolding.

All I can add is a profound  “Thank you   to those who took up the  baton when I laid it down, as I weathered several serious illnesses. There are now many community physicians, paid consultants, and champions of the movement. My dream and ambition would not have occurred except for them.

Ten years passed. And today I read some good news.

“  One of those exchanges is Inland Empire Health Information Exchange (IEHIE), which is made up of 48 providers in Riverside and San Bernardino counties, and is scheduled to become operational April 1.

At a time when the value and sustainability of public health information exchanges (HIEs) are being questioned, Inland Empire Health Information Exchange (IEHIE), which plans to go live on April 1, is making a case for both.

IEHIE, comprising 48 healthcare organizations in Riverside and San Bernardino counties including hospitals, physicians and payers, boasts an operational self-funded business model and a collaborative spirit. These two critical components make IEHIE unique, according to Executive Director Richard Swafford.

There is no public funding or state grants for IHIE. Any public funding comes from county stakeholders, a large managed care medi-cal organization (IEHP) which serves 600,000 participants and multiple hospital and physician group stakeholders.    From day one IHIE was drawn up and implemented by the stakeholders without public involvement and it will be sustainable. 

The collaborative spirit carried over to the business model. All stakeholders agreed to pay for value-added services via a fee structure determined by participant type – payers by number of lives, medical groups per physician and hospitals by bed size. IEHIE was formed as a 501(c)3 organization, with the goal of breaking even, not making a profit, Swafford explained. Although the HIE infrastructure contract with Orion Health, whose Orion Health HIE platform is powering the exchange, was completed some six months ago, it wasn’t signed until the current 14 pilot participants paid their fees in advance. “We aren’t relying on grants as a mechanism for sustainability,” he emphasized.

Sustainability has always been the glass barrier for RHIOs and now HIEs. Some of the most successful HIEs failed shortly after the startup grant money was gone. (Santa Barbara Exchange, started by David Brailer MD, the first head of ONCHIT.)

IEHIE’s strategy is also to be the utility for entities that want to leverage other programs and capabilities. The accountable care organization (ACO) model, for example, requires the ability to share patient information in order to effectively participate in an ACO environment. “We rely on our participants to tell us what their requirements are so we can integrate them into our overall strategy,” Swafford said.

When the community-based HIE goes live April 1st, Gagnon predicted, “We’re going to knock everybody’s socks off.”

Online Web Rating Sites: FAIL WHALE

 

 

 

Columnist Ron Lieber writes that consumers are not posting online reviews of their health care experiences as often as they are posting online reviews of restaurants and other services.

Lieber writes that websites such as HealthGrades, RateMDs, Yelp and Angie's List have offered a platform for health care reviews, but "listings are often sparse, with few contributors and little substance." He adds that there is a "demand and supply problem: many people want this information and more consumers would trust it if the sites had more robust offerings."

According to Lieber, some physicians have "silenced patients away" by asking patients not to review them online or by suing patients who do so.

In addition, some patients might choose not to review their doctors "for a far more ordinary reason: if they live in a small town or are only one or two degrees of social separation from physicians or their family members, they may not want to create any awkwardness," Lieber writes.

He also notes that some patients might "idolize their doctors," adding that it is "exactly this sort of unquestioning mind-set that may cause such low participation (or disproportionately positive reviews) at many review sites."

Lieber writes, "The only solution, then, is to keep populating these sites en masse if you dare and your doctor doesn't seem to be the suing sort, taking care all the while to tell the truth and be fair" (Lieber, New York Times, 3/9).

 

Technorati Tags: healthgrades,ratemd,ratings,physician ratings

Black Holes in Health Care…What Comes out The Other Side

 

Eric Topol MD calls for the “Creative Destruction of Medicine”

My readers will verify that I am always ‘guessing’ that technology increases the cost of medical care.  But not always. Eric Topol readily gives an alternative, and probably viable explanation in most cases.

Certainly many diagnostic advances and procedural advances in surgery which shorten hospital stays, shorten surgical procedures,  convert in patient events to outpatient events, and more accurate billing.  Hopes for using computers to assess outcomes and new treatments may decrease costs of re-hospitalization, prevent ‘never happen” incidents and reduce errors in prescribing.

He speaks to not only IT advances and emphasizes advances in cancer therapy

“The title simply captures the extraordinary opportunity we have to vastly improve the way we think about and practice medicine. The term “creative destruction” denotes a transformation that accompanies radical innovation. But this transformation is not likely to emanate from the medical community, the traditional way innovation jumps forward. In the current era of social networking, the transformation will likely come from a convergence of technology and consumerism, especially in the cancer space, which offers the most near-term opportunity for positive change.”

This is an extraordinary statement by Eric Topol MD . We all sense the tsunami of changes occuring in health care…reform, financial, information technology, genomics, proteomics,

I have already seen this occuring in social media, with group advocacy circles on Google plus and interpersonal interaction for patients in Google Hangouts, a video conferencing application whereby 10 participants can interact in real time visually, and share documents, videos and background window’s screens.

You will say what about HIPAA and privacy? The folks using this space seem to say,

“Frankly Scarlet, I don’t Give a Damn” People want change and will use the means to accomplish it, and meet their needs. Government, move out of the way or get run over or kicked out.  They don’t want more bureaucracy.

By self-organization—there are groups out there already taking the lead with online patient empowerment communities. The people in these communities trust their peers more than their doctors, for one reason, because their peers have like conditions that are discussed freely. <We have already seen the profound impact of social networking in the health space, and it’s just the tip of the iceberg. When people have their personal physiologic metrics and genomics on handheld devices, they’ll band together, and you’ll see a movement that will change medicine.>

With creative destruction, you destroy very expensive methods with marginal benefit. In the United States, we spend $350 billion per year for prescription dugs, and we know at least one-third of that is total waste, offering no benefit or, even worse, inducing serious side effects.

Pharmacogenomics is a perfect way to destroy the old wasteful model of prescribing drugs. It’s very inexpensive to run genotypes, once we have basically cracked the code—knowing the specific variant allele(s)—for each drug.

We have inexpensive ways to drill down to the things that produce good outcomes. For instance, I’m a cardiologist and I don’t have to send a significant proportion of patients to a facility to have a formal echocardiogram, because I have a handheld high-resolution device that’s just as good as the hospital laboratory. Why do we send people to facilities for sleep studies that reimburse at $3,000 per night when the same study could be done in the person’s home for less than $100 and get the same data? (Yes, there are home devices to do it yourself sleep studies.) And insurance will pay for it.

Most physicians are busy already keeping up with journals and advances in medicine, surgery, CME, hospital responsibilities, night and weekend call and the like I call for a new resource….”Digital Health Space”.  Digital Health Space will attempt to take over your searches for solutions in software, hardware and technology to solve your problems in managing your office, patients and hospitals.

 

Technorati Tags: consultancy,hie,emr,phr,cme,digital health space,creative destruction,technology,eric topol,social networking,social media,genomics,proteomics

THE ROCK & THE HEALTH TRAIN

 

Several days ago THE ROCK began it’s journey from a dusty rural quarry near Riverside California on it’s way to the LACMA.  The trip has been in planning for many years.

  

 

It’s journey unexpectedly created a ‘pop culture’ movement as it travelled along surface streets because it is too big to ride on the freeways.  Top speed was 8 MPH on the straight-always.  Thousands gathered at several points creating spontaneous block parties and cheers.

MAKES YOU WONDER, HOW DID THEY BUILD THE PYRAMIDS ? THIS WAS ONLY ONE ROCK !

 

Riverside CA can be proud that a  piece of  ‘The Rock’ will be levitated at the LACMA.

THE ROCK ARRIVES AFTER A WEEK LONG JOURNEY:

Details on how the rock came to be can be found

Levitated Mass by artist Michael Heizer is composed of a 456-foot-long slot constructed on LACMA's campus, over which is placed a 340-ton granite megalith. As with other works by the artist, such as Double Negative (1969), the monumental negative form is key to the experience of the artwork. Heizer conceived of the artwork in 1968, but discovered an appropriate boulder only decades later, in Riverside County, California. At 340 tons, the boulder is one of the largest megaliths moved since ancient times. Taken whole, Levitated Mass speaks to the expanse of art history, from ancient traditions of creating artworks from megalithic stone, to modern forms of abstract geometries and cutting-edge feats of engineering. Frequently asked questions.(PDF | 234kb)

I Will be out on the Links this weekend..tweet me.

 

Interesting news from the NHS.

NHS Hospital doctors told to rethink weekend working

A shortage of senior doctors is said to be at the heart of the problem.  There is mounting evidence of an association between higher death rates and weekend care. We can't prove that it is a causal link, but we cannot ignore it either.

Dr Mark Porter, the British Medical Association's consultants chairman, said the mounting evidence about the problem meant it was time for doctors to put themselves forward if needed.   At the end of last year, the research company Dr Foster found mortality rates rose by 10% at weekends. Other studies have shown similar correlations, in particular the presence or absence of senior doctors - has been highlighted as a key factor.

NHS medical director Sir Bruce Keogh added: "Having more senior staff and consultants around at weekends is fundamental to the NHS shifting from a five-day-week to a seven-day-week.

The NHS has a radically different management system for it’s hospitals. Each ‘trust’ is responsible for the management of their system. This gives the illusion of ‘freedom of choice’ and more independent thinking rather than a top down mentality.

Those in command of our system (is there anyone?) should assess these finding carefully.

In the American system it is a matter of a department and medical staff assessing availability at the local level and bringing resources in alignment with need. Deaths on weekends should be addressed on specific cases not administratively. Peer to peer pressure would be the most efficient manner to bring a better result.

Can and will social media help?

Technorati Tags: on call,weekends,nhs,deaths,twitter

You Tell me Your Story and I will tell you Mine

 

The Web Is Awash in Reviews, but Not for Doctors. Here’s Why.

The New York Times in its 'Money' section attempts to analyze the failure of Web based physician review sites. They attempt to equate sites such as Zagat, Yelp, Angieslist, and others to physician review sites.

 

Companies have tried to collect reviews of doctors since the early days of the Web, and RateMDs.com has gathered more than most. The founder, John Swapceinski, was inspired to create it after his success with a site called,Other doctors have taken matters into their own hands. Writing in the online magazine Slate n 2008, Dr. Kent Sepkowitz, of the prestigious Memorial Sloan-Kettering Cancer Center in New York, gleefully recounted his creation of fake reviews on a couple of sites.

These physicians are probably outliers, though. The American Medical Association speaks for most doctors. Robert Mills, a spokesman, sent me a statement that he said was from the A.M.A.’s president, Dr. Peter W. Carmel, that read, in part, “Anonymous online opinions of physicians should be taken with grain of salt and should not be a patient’s sole source of information when looking for a new physician.”

Companies have tried to collect reviews of doctors since the early days of the Web, and RateMDs.com has gathered more than most. The founder, John Swapceinski, was inspired to create it after his success with a site called RateMyProfessors.com, which is well known for the “hotness” rating that college students assign (or not) to their teachers.

But getting in the faces of the previously untouchable professional class has inevitably led to legal threats. He says he gets about one each week over negative reviews and receives subpoenas every month or two for information that can help identify reviewers, who believe they are posting anonymously.

None of the litigants at Angie’s List have been doctors so far, but that doesn’t mean they are thrilled with her health reviews. “They told me that ‘patients aren’t smart enough to figure out whether I’m a good doctor,’ ” she said. “But I told them that these conversations have been happening all along.” The only difference with the site, she pointed out, is that the doctors get to listen in.

Other doctors have taken matters into their own hands. Writing in the online magazine Slate in 2008, Dr. Kent Sepkowitz, of the prestigious Memorial Sloan-Kettering Cancer Center in New York, gleefully recounted his creation of fake reviews on a couple of sites.

These physicians are probably outliers, though. The American Medical Association speaks for most doctors. (authors note: The AMA represents only about 160,000 doctors out of 850,000 doctors in the United States ) Robert Mills, a spokesman, sent me a statement that he said was from the A.M.A.’s president, Dr. Peter W. Carmel, that read, in part, “Anonymous online opinions of physicians should be taken with grain of salt and should not be a patient’s sole source of information when looking for a new physician.”

The question of privacy and confidentiality are uppermost in healthcare providers minds and the patient's rights are codified in the HIPAA law protecting their information. Turning the other shoe, what would patients reactions be if physicians rated their patients individually and posted it on the web? Of course physicians are prohibited from doing so. What's good for the goose may also be good for the gander.

Word of mouth is another matter where an individual patient does not recommend a particular doctor or may remark to another person that they did not like the physician in question. Publishing opinions in a public forum without concrete evidence is merely opinion. disclaimers opens one to libel and slander actions. Ranking 1-5 in different categories is vague and is not “standardized” as to what is a 1, 2,3,4, or 5.

Technorati Tags: zagat,yelp,angieslist,webmd,healthgrades,ratemd,privacy,libel,slander

CMS Morale Low?

 

The Washington Post recognized that there is trouble in Paradise. CMS (the center for Medicare and Medicaid Services) or what used to be known as Medicare has a big problem (other than funding).

  Outgoing Secretary Kathleen Sibelius

President Obama is fighting to save his signature health-care reform law in the Supreme Court and on the campaign trail, where Republican candidates are promising to kill the Affordable Care Act. Yet even if the president prevails, he’s got a big problem: The agency that must implement the law has a revolving door at the top.

Never heard of the CMS? It’s the agency charged with making the Affordable Care Act, known as “Obamacare” to critics, work by drafting regulations and providing oversight. With a budget of $820 billion, the CMS is one of the largest purchasers of health care in the world, paying for services for one in three Americans and interacting daily with thousands of hospitals, doctors and other providers.

But for years, Congress has undermined the agency’s authority and, on the eve of historic change, has left it without a permanent leader. (Office of the Secretary)

The administration’s two-year-old law brings the agency significant new responsibilities: helping oversee insurance exchanges in 50 states, finding ways to deliver care more efficiently, and guiding changes to and expansions of the agency’s core programs.

While everyone complains about the size of ‘big government’ CMS is probably the most efficient administration in the federal system. 

In an interview, Berwick, a physician and expert on health-care quality, said he was “impressed and gratified” by the way his staff rallied around his call to implement Obama’s sprawling initiative. The administration’s two-year-old law brings the agency significant new responsibilities: helping oversee insurance exchanges in 50 states, finding ways to deliver care more efficiently, and guiding changes to and expansions of the agency’s core programs.

In fact, Congress has been putting more on the agency’s plate for years. The CMS has had to oversee a 2003 prescription drug benefit for seniors, ensure patient privacy, help weed out waste and fraud, and develop a system for grading hospitals and nursing homes. Meanwhile, it has been criticized for focusing more on getting checks to hospitals and doctors than on ensuring quality or finding ways to trim health spending.

In 1999, a group of former administrators and health policy experts wrote an open letter to Congress decrying the “mismatch” between the CMS’s resources and its “mammoth assignment.” The number of Medicare and Medicaid beneficiaries has soared since the programs started in 1966, with tens of millions of baby boomers expected to swell the rolls in coming years. Yet the agency has the same number of employees it had during the Carter administration — about 4,900. By comparison, the Social Security Administration, with a smaller budget, has 62,000 workers.

Gail Wilensky, who ran the agency for two years under President George H.W. Bush, said the CMS has become a much more sophisticated operation. “It’s not just a check-writing agency anymore,” she said. But the turnover at the top sends the wrong message to employees, who she said respond by being “more inward and protective.”

“What happens, I think, when you have a lot of turnover is senior staff loses its confidence and is less willing to take risks,” Berwick said, adding that the churn in administrators “demoralizes and confuses” staff members. As for the GOP: “It’s a game to them,” he said.

Technorati Tags: health train,cms,medicare,sebelius,berwick,wilensky,obamacare,affordable care act,morale

What Hath EMR Wrought?

New technology is wonderful and you can be certain that along with new advantages also comes new challenges and unintended consequences.

Attorneys love written information.  The written word carries with it some degree of ambiguity, illegibility, missing information, however the digitized medical record is a far different beast.

Once entered into a data field it is there….forever. There is little doubt if it was or was not recorded. The EMR most of the time requires a certain amount of information to be entered in critical fields or one cannot continue to the next  step. This can present challenges during depositions and/or trial.

In many cases this has radically changed the process of preparing for and going to trial for medical malpractice.

AMED NEWS today emphasizes and outlines these changes. Hopefully some of the comments here and in their article can guide readers.

New Jersey doctor being sued for medical negligence has been accused by a plaintiff’s attorney of modifying a patient’s electronic history. A printing glitch caused the problem, Flynn said, but the accusation has meant extra time and defense costs. Computer screen shots were reviewed, more evidence was gathered and additional arguments were made.

“This has taken a life of its own, and we’ve done virtually no discovery on the medical aspects of the case,” she said. “The cost of the e-discovery alone is in excess of $50,000.”

• How to reduce EMR liability
• See related content

System breaches. Modification allegations. E-discovery demands. These issues are becoming common courtroom themes as physicians transition from paper to EMRs, legal experts say. Not only are EMRs becoming part of medical negligence lawsuits, they are creating additional liability.

Medical data breaches are among the most common reasons that electronically stored information lands doctors in court.

Many of the risks have nothing to do with patient care or medical competence. The term medico-legal liability has taken on a new face.

E-discovery is a growing area of concern, said Joshua R. Cohen, a medical liability attorney and president of the New York State Medical Defense Bar Assn. While legal requests once entailed only paper records, attorneys are now seeking every accessible electronic record, including films, lab reports, emails and phone records.

“Plaintiffs are trying to use e-discovery as a weapon of mass discovery,” Cohen said.

The article in AMED NEWS goes on to cover many points, here are the bullets:

How to reduce EMR liability

As the number of electronic medical records increases, so do certain legal risks, medical liability experts say. Common mistakes doctors make with EMRs and how attorneys recommend that physicians reduce their liability risks:

• Mistake: EMRs allow users to move quickly through patient records, but cutting and pasting information makes it easy to paste incorrect information.
  Recommendation: Refrain from copying and pasting EMR data, and be cautious when moving from one patient’s record to the next.
• Mistake: Computer programs can help doctors make a differential diagnosis, but the templates don’t often include every possible symptom and corresponding medical condition.
  Recommendation: Doctors should not become overly dependent on electronic diagnosis aids. Electronic systems are no substitute for hands-on diagnosis.
• Mistake: Because EMRs allow physicians to move through patient charts much more quickly than paper charts, attorneys are noticing that some doctors are not being thorough when writing notes electronically.
  Recommendation: Physicians should keep meticulous electronic notes on each patient and take time to document each chart.
• Mistake: Some practices can fail to safeguard electronic patient data.
  Recommendation: Practices should encrypt all information on computer devices and have policy that discourages employees from taking portable devices out of the office.
• Mistake: A system may not clearly indicate changes to records.
  Recommendation: Physicians should install systems that show transparency when modifications are made and/or have a program lockout period where no more modifications can be made to a record.
• Mistake: Doctors may fail to follow notification requirements in the event of a data breach.
  Recommendation: Be clear on what your state law requires when a data breach occurs, and make sure employees follow the rules immediately.
• Mistake: Doctors may destroy or delete electronic records when a lawsuit is possible.
  Recommendation: If doctors suspect they are being sued, they must preserve all electronic data related to the patient in question, including emails, phone messages and computer records.

Source: Attorneys Catherine J. Flynn and Michael Moroney of Weber Gallagher Simpson Stapleton Fires & Newby LLP in New Jersey

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