More on Scott Shreve and HIE from CALRHIO

For those of you who have already read Scott's blog you will realize here is an experienced professional who has laid "the railroad tracks" for Enterprise Health Records. I recommend the article highly to others.

CALRHIO has elaborated a comprehensive plan for the state of California to plan and implement a Health Information Exchange Backbone. This structure will be built out by Medicity and Perot Systems. It will integrate both state, county and private health care providers.

For details I have extracted the information from their posting.
It follows:



HIE Utility Service at-a-Glance

PURPOSE
To build a statewide health information exchange (HIE) utility service that will offer California health care providers and patients secure electronic access to patient medical records, where and when needed.

CalRHIO’s primary goal is to deliver critical health information services securely, reliably, and affordably to clinicians, patients, state, county, and federal health agencies, and communities throughout California.

PROFILE
The CalRHIO HIE Utility Service will provide a suite of services from which individual organizations and regional efforts can select to use some, all, or none. The financing model is designed so that participants are not paying for initial development and implementation of the utility service. Those who benefit pay only for the services they need and use.

The CalRHIO HIE Utility Service will provide health information exchange services that are:
available at a price that no one entity can achieve alone
flexible and adaptable to support a wide variety of legacy systems and technical environments – services adapt to existing technology
designed to permit local users to consume and pay only for those services they find valuable and are not duplicative of services provided locally
ARCHITECTURE
Service Oriented Architecture (SOA): SOA framework and Web services platform facilitates scalable, incremental growth and is capable of quickly deploying new services through the re-use of existing services. Because of the variability in IT system environments, as well as the diversity of business and clinical landscapes within health care communities, no one architectural model will suffice. Given the existing challenges, an architectural style of design for constructing HIE models must be flexible and adaptable to resolve variability and diversity issues. A Web services implementation of SOA can meet these complex, diverse business and technical requirements characteristic of HIE initiatives.

UTILITY SERVICES
Phase I: Establish a state layer or “backbone” of data and services
Phase II: Create regional overlays that leverage and expand on the state layer by adding local data sources and additional services
STATE LAYER - State Network Backbone consists of data and services
· Data: state and multi-regional clinical feeds (claims history from payers, lab/pathology reports from national labs, Meds from RxHub and SureScripts)
· Applications: Master Patient Index (MPI), Record Locator Service (RLS), e-Prescribing
· Options (for regions that are ready):
o Integration Hub: translates patient-centric health information between various Electronic Medical Record (EMR) vendor applications
o EMR Gateway: clinical feeds from lab/path reports from national labs, Meds from RxHub and SureScripts to the physician’s EMR application
REGIONAL LAYER – regional overlay of state network with local data and services
· Data: Local clinical data from hospitals, local labs and imaging facilities (data to include labs, radiology reads, transcription, etc.)
· Application Services: include a MPI; RLS; Electronic Health Record (HER) & Personal Health Record (PHR); medication management (e-Prescribing & medication reconciliation); clinical messaging (referral, lab & imaging orders and results; and data warehouse for reporting and analysis
· Integration Hub Service : translates patient-centric health information between various EMR vendor applications.
· EMR Gateway Service: clinical feeds from lab/path reports from national labs, Meds from RxHub and SureScripts to the physician’s EMR application

State Layer
State of California Clinical Data Services
MPI
RLS
EMR Gateway
Patient
Payor
Provider
Claims
History
RxHub
SureScripts
National
Labs
National Data Feeds
Statewide, Real-time
Clinical Data Access




Region A
State of California Clinical Data Services
MPI
RLS
EMR Gateway
Patient
Payor
Provider
Claims
History
RxHub
SureScripts
National
Labs
National Data Feeds
Region
B
Region
C
Regional Layer
Local Data
(From Labs, Hospitals, EMR)
EMR Gateway
Regional Reporting
BENEFITS FOR ALL USERS
· An information infrastructure that supports optimum care delivery methodologies, transparency, patient empowerment, and integrated health care records
· A utility-like infrastructure that moves health care information efficiently and at a cost that is a small fraction of the money saved for payers, patients, and providers alike
· Affordable utility services that facilitate regional health information exchanges and interconnections among them

PHASE I USERS
· EMERGENCY DEPARTMENTS
· CLINICS
· PHYSICIAN OFFICES

PRIVACY and SECURITY
Users must be authorized and authenticated and have either obtained a patient’s consent or documented an emergency. All data sharing will be carried out pursuant to state and federal laws involving patient consent, privacy, and security. Will require all appropriate parties agree on data sharing scope and methodology.

PARTICIPATION
Participation by individual organizations and communities is completely voluntary. Participation is NOT mandated by any private or public entity.

FAQ
Q: Why is CalRHIO creating a technology platform of its own instead of relying entirely on local organizations to provide a technology platform that satisfies local needs?

A: Time is of the essence. On average, every business day in California more than 50,000 patients are receiving suboptimal clinical care solely because we do not have a comprehensive method for moving patient records where and when they are needed. To rely solely on local organizations to individually engage in the expensive and time consuming effort to select vendors, develop detailed requirements, and supervise a complex HIT project will materially delay the widespread sharing of important patient medical information. CalRHIO is offering an option that organizations and communities can use to meet their individual needs and help advance HIE throughout the state.

CalRHIO and ITS STRATEGIC PARTNERS
Medicity and Perot Systems Corporation were selected to build the CalRHIO utility service through a competitive bidding process. Medicity and Perot Systems were selected because their solution offers a strong, proven, and scalable technology platform that will eliminate limitations on how individual health care organizations and local communities design and implement the health information exchange services they need.

In addition to a suite of solutions that are already integrated and interoperable, Medicity and Perot Systems brought an innovative financial model to the table that will enable CalRHIO to sustain the project long term. Creating a sustainable business model is one of the biggest challenges for health information exchange efforts nationally.

COST AND FINANCING
· The financing model eliminates the front-loaded expenses that penalize the early adopters.
· Cost to the Point of Sustainability: Capital required to finance an implementation that is thereafter sustainable without further capital infusion will require up to $300M with financing coming in two stages: 1) initial private equity funding covering the phase one build of the state HIE backbone and 2) after backbone delivery of basic information and proof of concept, final funding with more traditional debt financing replacing private equity capital. A connected California could save $9B annually.

Stakeholder
HIE Benefits
Physicians
· More “real time” information from outside clinical setting
· Rapid access to test results and ability to track medication history
· Changes the point of clinical aggregation from physician’s desk to having aggregated clinical data accessible electronically – reportable and available anywhere, anytime
· Improves referred patient flow, eligibility determination
· Improve patient experience
· Improves administrative efficiencies and offers administrative savings
· Improves the consistency and completeness of documentation
Health Plans
· Potential to drive down administrative costs
· No capital required; only an expense-related payment, and then only after patient HIE services actually rendered
· Potential to significantly reduce expenditures for unnecessary, redundant, or ineffective services
· Pathway to improved care, quality
· Support for value driven health care and pay-for-performance by helping health care organizations track and document the efficiency and appropriateness of care patients received
· Potential to perform widespread data capture for analysis of utilization rates and quality and performance measurements, which has the potential to reduce costs and improve quality of care
Hospitals
· Reductions in administrative times: (Experience of Indiana HIE is 12 min. reduction in nurse and pharmacist time for each admission as a result of “delivering synthesized useful medication histories to hospitals”)
· Improves care delivery and efficiency through immediate access to information that assists clinicians in diagnosis and treatment
· Support for medication reconciliation in accordance with JCAHO requirements
· Source for patient coverage eligibility for both private and public health plans/insurance
Patients
· Improve care at the point of delivery (including reduced medical errors)
· Improve overall coordination of care
· Improve application of evidence-based medicine
· Facilitate greater patient engagement in their health care through networked personal health records
Employer
· Improve transparency on cost and quality
· Help educate consumers about value and ultimately reduce cost through increased preventive care and lower hospital admissions
· Improve quality of care and reduce preventable admissions
Public Health
· Move toward ability to aggregate surveillance data of disease and critical patient information during disasters or bioterrorist threats

Scott Shreeve, MD: A New Dimension: Introducing the XHR

Scott Shreeve, MD: A New Dimension: Introducing the XHR

NATIONAL HEALTH INFORMATION NEWS-WATCH

Timely and current information regarding RHIOs in the United States is available at NHIN Watch, http://nhinwatch.com/performSearch.cms?channelId=1

The Office of the National Coordinator for Health Information Technology (ONCHIT) offers a listserv mail list which announces what ONCHIT is doing to advance RHIO development.
It can be found at: https://list.nih.gov/archives/health-it.html

Google announces collaboration with Practice Fusion

Practice Fusion and Google, the internet search engine have announced a collaboration whereby the EMR and RHIO solution will be offered to providers free of charge. Income will be derived from advertising banners supplied and linked by Google, which will be accessible from the EMR pages used by the provider online. Privacy issues are one of the main concerns for this business model, which however can be addressed since the advertising would not be linked to particular patient's records.

Featured in RHIO Monitor CALRHIO selects Vendors

Featured in: RHIO MonitorCalRHIO Selects Medicity and Perot Systems Corporation to Build Statewide Health Information Exchange for California
CalRHIO Selects Medicity and Perot Systems Corporation to BuildStatewide Health Information Exchange for California
SAN FRANCISCO, Calif., March13, 2007 – CalRHIO announced today that it has selected Medicity, Inc.,teamed with Perot Systems Corporation (NYSE:PER), to build a statewidehealth information exchange utility service that will offer Californiahealth care providers secure electronic access to patient medicalrecords, where and when they are needed.
“CalRHIO’s primary goal is to deliver critical health informationservices reliably and affordably to clinicians, patients, state,county, and federal health agencies, and local exchange effortsthroughout California,” said CalRHIO CEO and President DonaldHolmquest, MD, JD. “Medicity and Perot Systems were selected becausetheir solution offers a strong, proven, and scalable technologyplatform that will eliminate limitations on how individual health careorganizations and local communities design and implement the healthinformation exchange services they need.”
“In addition to a suite of solutions that are already integrated andinteroperable, Medicity and Perot Systems brought an innovativefinancial model to the table that will enable us to sustain the projectlong term,” said Molly Coye, MD, MPH, one of the founding directors ofCalRHIO’s board and CEO and president of the Health Technology Center.“Creating a sustainable business model is one of the biggest challengesfor health information exchange efforts nationally,” Coye noted, citingfindings of a federal study she chaired last year that assessed ninestatewide HIE initiatives.
Medicity and Perot Systems’ first step will be to assist in theprocurement of private seed money to fund start-up costs for theCalRHIO HIE utility service, including building the statewide backboneinfrastructure and integration, marketing and communication, andCalRHIO’s operating budget. Financing requirements for this phase areestimated at $300 million.
The health information exchange platform will make it possible forphysician offices, hospitals, and health plans that have invested inhealth information technology to use their current technology to accessdata outside their walls. While details of charges are yet to bedetermined, the savings expected as a result of having betterinformation will be many times greater than the cost, according toHolmquest.
Through its partnership with Medicity and Perot Systems, CalRHIOwill offer a suite of secure, privacy-protected services from whichorganizations can select to use all, some, or none. For example, forcommunities that want to enable all their health care providers toexchange information, CalRHIO’s HIE utility service will offer anoptional alternative to building and financing their owninfrastructure. For communities that have already initiated localhealth information exchange efforts, the services offered will becompatible and complementary.
“It is imperative that we get a technology solution up and runningas soon as possible to accommodate the needs of California doctors,hospitals, and patients,” Holmquest said. “Every day in California,50,000 or more patients are experiencing suboptimal care solely becauseimportant medical information is missing from their records. Payers andpatients are paying huge additional costs because of the fragmentedcare that result from lack of timely information.”
-

Cerner Statement

I missed last week’s deadline for RHIO MONITOR and Health Train Express due to some interviews and other related projects on EMR. I myself am in the midst of examining and implementing an EMR for my practice. In the process I have had the advantage of my research and study of RHIO as coordinator of a RHIO. In my evaluation it has become apparent that having an EMR which is certified by CCHIT is the ticket of admission, for any serious vendor. All that hard work of the past two years is paying off and demonstrates the process will take time and much patience. Of course I am speaking to the choir, but it emphasizes that we need to do a lot more educating of our fellow physicians. The scope and depth of understanding varies tremendously amongst physicians about EMRs, and RHIOs. There continues to be a divide between vendors and providers. According to my sources they have a difficult time and spend much of it explaining IT to providers. Providers’ eyes glaze over when given a new set of vocabulary and how these systems operate. The differences are also generational. Younger MDs have a set of material from their education which now exposes almost all school children to the basics and more of computers. Microsoft Windows is now the W of the three Rs.
One publication I have access to is a resource is “Functional Matrix” of a number of EMR solutions as prepared by the American Academy of Ophthalmology. While focused on ophthalmology it organizes in a readable manner the items all provider should look at when examining EMRs.
This resource can be found at: http://www.aao.org/aaoesite/promo/business/EMR3.cfm
A profound statement by the CEO of Cerner was quoted in iHealthbeat, published by the California Health Foundation.
“
Cerner CEO: Revamp Health Care Reimbursement SystemMarch 01, 2007
The U.S. health care reimbursement system is "grossly inefficient" and "needs to be changed," Cerner Chair and CEO Neal Patterson said Tuesday at the Healthcare Information and Management Systems Society conference in New Orleans, the Kansas City Star reports.Patterson cited the Healthe Mid-America program, run by Cerner, as an example of how the system could be improved. The independent, not-for-profit program manages the employee health records of Cerner and about 20 other Kansas City-area businesses. Program participants can use an electronic debit and information card to pay for a physician visit and to access computerized personal health records with a PIN, the Star reports. Patterson cited a study that found that 31% of U.S. health care spending is on administrative costs and said that one of Cerner's "goals is to eliminate insurance companies as they exist today." The Healthe Mid-America program is being tested in the Kansas City area, and Cerner hopes eventually to expand the program nationwide, the Star reports (Karash, Kansas City Star, 2/28).

End quote: The Kansas City Star link expands on this brief .

Information from HIMMS Summit Meeting

HIMSS Chair Kicks Off Conference by Touting Necessity of Health ITFebruary 26, 2007
The health IT industry should stop debating the value of electronic health records and accept the technology's importance in the future of health care, Buddy Hickman, chair of the Healthcare Information Management Systems Society board, said on Monday in his opening remarks at the annual HIMSS conference in New Orleans, Healthcare IT News reports."Placing the focus on quality, patient safety and necessary clinical process improvements is consistent with HIMSS' mission and with the reasons why adoption of [health IT] was strongly recommended by the Institute of Medicine's Crossing the Quality Chasm report," Hickman said.Hickman also encouraged the industry to have a unified voice on goals, policies and messages, including a broader view on health IT from the federal and state levels. "In this way, [health IT] becomes part of a necessary solution to critical challenges rather than being viewed as a lesser priority competing for funds," he said."Through smart public policy, alliances and the right incentives, we can create the right kind of national health information network -- one that contributes to quality, safety and better outcomes for all," Hickman said, adding, "If we don't do this now, we only create a greater challenge to fix later" (Enrado, Healthcare IT News, 2/26).


Microsoft last year acquired medical database developer Azyxxi and currently has more than 600 employees focused on health care projects, according to Microsoft Vice President Peter Neupert. Health care "is a huge sector of our economy," yet it still is relatively low tech, he said. As the country's aging baby boomers require more medical attention, the need for health care technology will become clearer, Neupert said. Microsoft CEO Steve Ballmer on Monday will speak at the Healthcare Information Management Systems Society's annual conference in New Orleans. IBM General Manager Dan Pelino said that better computer systems could improve the accuracy of data, prevent duplication and reduce errors. More than 4,000 IBM employees are working on health care products, USA Today reports. IBM also is developing a nationwide patient database with HHS that would store patient information regardless of which hospital or physician a patient visited. Intel and Motion Computing this month unveiled a laptop for physicians and nurses that includes a digital camera to take pictures of patients.

Further Cutbacks Proposed by Bush

Featured in: RHIO MonitorPresident Bush's new proposals for cutbacks to Medicare and Public Health Funding will impact RHIO development
Further Barriers to Implementing RHIOs Submitted by gmlevinmd123 on Mon, 02/19/2007 - 9:41am.
The catch 22 of Pay for Performance. The health insurance industry as represented by IHA is big on P4P and medicare is following suit without waiting for health IT to catch up so that it can be implemented properly.. At the same time it is espousing paying MDs for improving quality the administration defocuses and presents these new proposals. Write your Congressman!!
Physicians not only pay a fair share of taxes, but are now being asked in some states (California-Schwarzzenegger proposal) to pay a 2% surtax at the state level to fund expansion of insurance to the uninsured...??undocumented aliens, as well??
Even large medical groups will not remain immune to these cutbacks, especially hard hit will be MD providers who have a disproportionate amount of seniors, ie, ophthalmologists, urologists, geriatricians, cardiologists, urologists, and more.
EARLY WARNING SIGNS: Reported in AMA news
Washington -- President Bush presented an austere fiscal year 2008 budget to Congress earlier this month, pledging no new money for Medicare physician reimbursements and proposing to slash the rate of public health program growth in other areas.
If no changes are made, doctors could see an across-the-board cut of 10% or more next calendar year.
"Without adequate funding, physicians cannot make needed investments in health information technology and quality improvement, and seniors' access to health care is placed at risk."
Several times in the past, the White House budget has not set aside money to boost doctor pay, but lawmakers have approved such appropriations anyway.
Bush has called on Congress to increase defense spending while eliminating the federal budget deficit by 2012. The plan assumes not only that physicians will undergo yearly Medicare rate reductions for each of the next five years but that lawmakers will approve more than $75 billion in additional Medicare reductions over that time. The proposal would slow the program's projected growth rate from 6.5% to 5.6% over five years.
For those of you who like to watch government budget projections, here is a summary:
Target: Medicare
President Bush has proposed cutting Medicare's projected spending by more than $75 billion over the next five years. Here are some of the biggest ways the White House hopes to save the government money:
Action
5-year savings
Inpatient hospital updates of inflation minus 0.65% each year
$13.8 billion
Home health agency updates of 0% each year
$9.7 billion
Skilled nursing facility updates of 0% in 2008 and inflation minus 0.65% each following year
$9.2 billion
Part B premiums increased for patients with higher incomes
$7.1 billion
Outpatient hospital updates of inflation minus 0.65% each year
$3.4 billion
Part D premiums increased for patients with higher incomes
$3.2 billion
Source: White House budget proposal
BLOGGING is now an important source of information for many people, and as we have seen the internet has played an important an unexpected role in political outcomes. I encourage all those interested, physicians, non physicians, health care pundits, to contribute to trusted.md and other blogs regarding health care.


This post has also been posted on www.trusted.md
Gary Levin MD
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Help

Congress has officially approved of CMS’ decision to implement P4P. I recently read somewhere that CMS would increase physician reimbursements (and hospitals, too I suppose) by 300 million dollars with this incentive (if providers are able to conform to their requirements) I also read that physicians such as myself will not face the 5% annual SGR reduction in CMS payments. This has been massaged into the politically correct phrase as a “raise in reimbursements” (the lord giveth and the lord taketh away). So we are given back that which was taken from us and then told it is a “raise”.
Let’s face it, decision makers in Washington and some state capitols as well as legislators are out of touch with reality. Placing more administrative burdens on an already very dysfunctional barely functioning healthcare system is “insane”, and so are those that make these proposals, and then vote them into effect to placate a worried electorate about whether they will be able to afford another doctor visit or hospitalization.
Many physicians I know have retired in their mid 50s to sell soap or enter MLM businesses, sell real estate or go into other businesses, which tells you a great deal about the stressors on physicians.
I can find hundreds of consulting groups, and health care foundations that study everything to death, make more recommendations which increase further the cost of health care, couching their recommendations in terms such as quality initiatives, pay for performance, etc etc. There is a whole new lingo out there that most physicians do not comprehend, but must learn.
I am not optimistic about our health system in the United States. IT and RHIOs are a small part of what we need. If you are very rich or dead poor in poverty your health care is assured. The large mass of diminishing middle class are at great risk, if they lose employment, and/or their group health policies, have pre-existing illnesses, the quickly join the uninsured. Even those fully employed and insured are soon priced out of full insurance coverage.
HSAs are a joke, I tried one last year and found that it takes quite a while to meet the deductible, and the policies are worded in such a way for a family that the deductible for a family is what counts, not the individual users. You also cannot use it unless you fund the HSA upfront. If you have chronic illness and have high expenses from day one….you may not be able to save . I suspect the IRS will expect accounting through the HSA and not direct payments out of pocket. HSAs are a great deal for the banks and the insurers. It will not save healthcare dollars, nor reduce utilization. When people get sick, they seek medical care.
This year I became unemployed for a time and went onto COBRA, about a month later at the end of the year I finally reached my 4800 dollar HAS deductible. One week later it was January and the deductible started over again. True the premium was lower with the HAS but we had medical drug expenses of about 650 dollars that month….we cancelled our COBRA, went bare and are now forming our own group to obtain group health insurance. Individual coverage is out of the question. Now why is that? Seems to me all the individuals who are not in a group could be put into a group of “the individuals who are not in a group”
And now GWB is proposing tax law changes to “make healthcare more affordable”.
And another thing, when you sign up for insurance you are given an effective date which may be any part of the year, yet your deductible rolls over at each calendar year, whether it’s been six months, four months or eight months since you signed up. The contract is for one year…..so why are you cancelled if you miss one payment? Seems to me it is all weighted toward the insurer, not the patient.
As I write this article I am seeing this from the patient (now known as a consumer) aspect; let alone the physician provider side. The billing and coding aspects of reimbursement have turned into a high stakes poker game with a new industry spun off…..the reimbursement consultant who charges anywhere from 500 dollars to 3000 per year to update the practices on insurance billing practices and codes which change from year to year. It’s a bit like poker. And if you make a mistake you are accused of fraud and a buse, fined, or worse kicked out of a program.
I have been practicing over 30 years since I finished medical school. My the world has changed.
Insurance companies control everything. Recently I moved practice locations back to a community where I first started off as a young ophthalmologist. I discovered that my home hospital had disbanded the ophthalmology department and there were several outpatient centers that did all the eye surgery.
Now, insurance companies usually require the physician to have hospital staff priveleges to be on their provider list…..how does one go about that one? Some doctors already on the hospital staff are now paid to take ER standby call…..they are grandfathered in as staff members, but there is no way for new ASC doctors to be proctored in a hospital setting unless the ASC is part of the hospital. Worse than that some ASCs are privately owned and owners will not allow open access thereby eliminating competition in their geographic area. In my next article I will further details the requirements and administrative bureaucracy that has been generated to “protect” patients (from whom?)

Report from the IERHIO Annual Summit Meeting

Inland Empire Regional Health Information Organization held it’s annual summit meeting this week in Riverside California under the auspices of the RCMA and SBCMS. A live meeting web conference had presenters from Canada, Pennsylvania and Northern California. The group was quite eclectic with different approaches to the challenge of health information data input, storage and exchange. The Department of Public Health of Riverside County was also represented by Janis Neuman M.D. and and Geoffrey Leung M.D They discussed their ongoing projects and needs. Dr Leung recently returned from Taiwan and stated that he wished the U.S. was on a par with Taiwan in regard to health IT. Laura Landry represented the Long Beach Initiative. Their non profit has been funded and they have selected a vendor. They have excellent support from grants as a result of the expertise of P.H.F.E.
The attendance and support of area and regional hospitals was non-existent, although we have heard each hospital and IPA are investigation EMR solutions. Also present were Dr. Ron Bangasser from Beaver Medical Clinic and Dr. Edward Hess, formerly from Kaiser Permanente. Commentary was heard regarding the Kaiser experiences and their usage of “Epic”.
A presentation was made by Sabatini Montatesti, who is the CEO of ES Enterprises Inc. ES Enterprises is building out a non profit health data exchange for northeast Pennsylvania including Geisinger Medical Center and surrounding hospitals, clinics and physicians. This rural area has unique challenges in that there are a great number of uninsured patients. Funding for the non profit was through charitable donations and hospital contributions. The depth of his knowledge and architecture for the health data exchanges is impressive.
We also heard from other vendor solutions. Clinical Integration was represented by Mark Crespin, Steve Leider and Paul Bessingminder who presented from Vancouver, B.C.
Practice Fusion presented their proposed solution as well. The vendors had an opportunity to answer some challenging questions from our steering and advisory committee.
Ellen Badley represented the California Department of Health representing Cindy Ehnes. She spoke briefly about the Governor’s proposal for health IT and his “Universal Health Care for California” The “takeaway message” for her was the importance of reducing the chasm between state health care and private health care, and that health IT for each is not mutually exclusive.
Our group is obviously biased toward developing some form of integrated health information system.
There was much philosophical and hypothetical discussion about several models both financially and technically.
There was a great concern that our dysfunctional health care system would consider starting another venture in IT regardless of our motives. The group also discussed the inadvisability of a political state ment of universal health care without a major overhaul of the IT infrastructure to support increased numbers of insured in the system. We certainly cannot provide more care for less money and not without a revolution in our health data system.
While some believe a non-profit organization offers some advantages it is the opinion of this writer that is a more expensive and time consuming entity to form and attract users.
My belief is that a sound private entrepreneurial model with a private placement and subscription service would offer greater efficiency and less cost to develop. Because of the intense capital investment to plan, build and maintain an enterprise level solution and/or small practice solutions initial start up cost is critical.
Mission critical items include time to implement, reliability, vendor experience and availability. Jeff Rose of Health Alliant discussed time to implement and train a system in Riverside County at one week per installation which added up to 900 weeks for the provider and hospital base in our region. (which is over ten years)
As a result of two years of independent study, meetings, and information gathering I have developed some opinion on what our region can accomplish in a cost effective and expedient manner.
A proposal will be forthcoming in the next several weeks.
Thank you to all who have attended these meetings, donating valuable time, effort and much expertise for the benefit our our health care system and our patients.

Gary Levin M.D.

SUMMIT MEETING IERHIO RIVERSIDE CALIFORNIA

DATE: TUESDAY JANUARY 23 2007
TIME: 6:00 PM
PLACE: RIVERSIDE SAN BERNARDINO MEDICAL SOCIETY HEADQUARTERS


LIVE WEB CONFERENCE: MICROSOST OFFICE LIVE MEETING

Attendees have received email invitation. If you have not received an email invitation and wish to attend send email request to:
gmlevinmd@gmail.com

House Keeping Notes

Some of you may have noticed that Health Train Express now has an RSS Feed. The Icon which is orange and located on the right sidebar allows you to "subscribe" to the feed. If you click on the icon (orange) it will pop up the option to subscribe directly to your browser favorite folder, or whatever feed you use. Any time you use your browser you can find and click "Health Train Express" and see the short summary of the latest posting, without remembering urls.

If you wish please make comments on the blog. If you have problems doing so, please email me directly at gmlevinmd@gmail.com I have not been getting any commentary since I converted to the new blogger and new title. Perhaps it is a glitch.

I look forward to the meeting on January 23 2006. Contact me with suggestions at my email as well, or leave a comment here.

The meeting will be interesting with new participants from around the country via web feeds and audio conferencing.

Which Locomotive are you in Front of?

This article in Southern California Physician in early January seemed to juxtapose with the title of my blog. Lytton Smith M.D. categorizes five different locomotives in the "health train express" which threaten to either derail or provide synergy in converting our present health care non-system into an efficient one focused on optimal patient care and outcomes.

With his permission I have copied a few key remarks:

After 30 years in healthcare, I think of these payment conflicts as locomotives of varying size and power. Each train carries a different constituency.Locomotive No. 1 represents the health plans. Thinking they drive the healthcare train, they charge ahead. Focusing on profits to maintain their stock value causes them to ignore the economics of actually paying for the care they expect from physicians and hospitals.Locomotive No. 2 includes hospitals. They carry the EMTALA burden as best they can. Despite complaining about being underpaid, many thrive by billing high charges for basic services. Health plans ignore the hospital charges because they are contracted. The hospitals with poor payer mixes and poor contracts close their doors or sell to alleviate their burden.Shoveling coal in Locomotive No. 3, the physicians rattle down their track. Due to antitrust rules and their own sense of independence, physicians have trouble coordinating the function of their train. With so many internal conflicts--group practice vs. solo practice, primary care vs. specialties--who has time to watch where the train is headed?In flashy Locomotive No. 4, a scenic rail car, are the legislators. With their top-rated medical insurance and VIP status, they protect themselves from the vicissitudes of medical financial struggles by passing laws to assure themselves that all will be well. Locomotive No. 4, fueled often by the engineers of Locomotive No. 1, looks sleek and rumbles along, trying to avoid seeing Locomotive No. 5.Locomotive No. 5 is the longest train of all, containing patients. With many classes of service, it consumes enormous energy as it moves down the track. Like No. 3, No. 5 has no focused leadership. But because of its enormous size, this train has the most potential momentum. No. 5 occupies the most important track as all the other trains exist to serve it.If Locomotives No. 1, 2 and 3 cannot resolve "fair and reasonable" vs. "usual and customary" issues, I fear that Locomotive No. 5 will push Locomotive No. 4 into crushing the others. The resulting collision will create a force for a single-payer system. The drive for all parties to "get their fair share" may result in an oligarchy in which no one is well served. In this environment, mavericks like Dr. Reddy will surely need to look elsewhere for financial satisfaction.Lytton W. Smith, MD, editor for the OCMA, is a physician practicing family medicine with the St. Jude Heritage Medical Group in Yorba Linda. Dr. Smith welcomes feedback on his articles and can be reached at editor@socalphys.com.


Perhaps the advent of social health care blogs and the entry of consumer driven plans and opinons will become the "caboose"

www.socalphys.com