Rob and Kevin on the Health Train Express

Kevin MD will be hosting Rob Lambert on a live Q&A at 10 PM EDT  Wednesday, April 29, 2009.  Join us.

Roxana Saberi on the Health Train Express

From THCB,

Bloggers across the web are holding a blog rally in support of Roxana Saberi, who is spending her birthday on a hunger strike in Tehran's Evin Prison, where she has been incarcerated for espionage. According to NPR, "The Iranian Political Prisoners Association lists hundreds of people whose names you would be even less likely to recognize: students, bloggers, dissidents, and others who, in a society that lacks a free press, dare to practice free expression."

 

We here at Health Train Express have decided to join the Blue Ribbon campaign (Blue is for blogging) to honor and show support for those journalists, bloggers, students and writers imprisoned in Evin Prison, nicknamed "Evin University," and other prisons around the world, for speaking and writing their minds. 

Please consider placing a blue ribbon on your blog or website this week to show your support.  Also, please ask others to join this blog rally.

Cystic Fibrosis on the Health Train Express

CURE CYSTIC FIBROSIS.....HONOR YOUR MOM BY SENDING A CF CARD TO HER ON MOTHER'S DAY....MAKE A DONATION, SAVE THOUSANDS OF CHILDREN'S LIVES

Pitfalls of PHR

from: THCB

Should You Keep Your Own Medical Records?

By RAHUL PARIKH, MD as written on "The Health Care Blog"

Personal Electronic health records raise doubt

Google service's inaccuracies may hold wide lesson

Dave deBronkart's records had wrong data.

When Dave deBronkart, a tech-savvy kidney cancer survivor, tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, a new free service that lets patients keep all their health records in one place and easily share them with new doctors, he was stunned at what he found.

Personal health records, such as those offered by Google Health, are a promising tool for patients' empowerment - but inaccuracies could be "a huge problem," said Dr. Paul Tang, the chief medical information officer for the Palo Alto Medical Foundation, who chairs a health technology panel for the National Quality Forum.

For example, he said, an inaccurate diagnosis of gastrointestinal bleeding on a heart attack patient's personal health record could stop an emergency room doctor from administering a life-saving drug.

Google said his cancer had spread to either his brain or spine - a frightening diagnosis deBronkart had never gotten from his doctors - and listed an array of other conditions that he never had, as far as he knew, like chronic lung disease and aortic aneurysm. A warning announced his blood pressure medication required "immediate attention."

DeBronkart eventually discovered the problem: Some of the information in his Google Health record was drawn from billing records, which sometimes reflect imprecise information plugged into codes required by insurers. Google Health and others in the fast-growing personal health record business say they are offering a revolutionary tool to help patients navigate a fragmented healthcare system, but some doctors fear that inaccurate information from billing data could lead to improper treatment.

 

DeBronkart - who blogged about his Google Health experience on the website e-patients.net - has some simple advice for patients who use personal health records.

"Check it," he said. "See if it's accurate."

"Claims data is notoriously inaccurate and notoriously incomplete with respect to an expression of the problems a person has," said David Kibbe MD,  a senior technology adviser to the American Academy of Family Physicians

This fact negates the proposed effectivenss of a CMS' program of Pay for Performance, based upon claims data from physicians. For years Medicare has based cost containment on raw data regarding utilization from coding information on claims made without regard to the clinical data behind the claims.   Few of us are privy to their exact 'thought process'.

11 Classic blog posts on EMR adoption

Our greatest glory is not in never failing, but in rising every time we fail."
~ Confucius

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KevinMD posts a summary 11 classic posts since 2004 on electronic medical records.  Some of these are still valid. However, there seems to be a gradual but definite shift towards HIT adoption.

1. The low adoption rate of electronic records
2. Will physicians sacrifice for the future of health IT?
3. How to fund electronic medical records wisely
4. Medical students who are used to electronic records
5. Funding electronic medical records and bailing out the Big Three automakers
6. Do electronic medical records really reduce malpractice risk?
7. Do electronic medical records lead to fraudulent documentation?
8. Are hospitals the primary beneficiaries of the health IT stimulus?
9. How the widespread adoption of electronic medical records can raise health care costs
10. Are poor products to blame for the slow adoption of EMRs?
11. Op-ed: Why doctors still balk at electronic medical records

Now HIT funding and adoption seems inextricably woven into the fabric of the "stimulus package".  Healthcare now has additional responsibilities that go way beyond patient care.  Healthcare now accounts for a significant portion of the GDP, and is now the recipient of "stimulus" money at the taxpayer's largesse. Thus adds to the chaos and dysfunction of taking care of 'a patient'.

It now becomes more difficult for the doctor to make correct treatments for the patient, since he now has to worry about how his decisions and orders effect overall health budgets.  

 

del.icio.us Tags: healthtrain express,emr,hitech,emr adoption

Health Train's New Track

Make everything as simple as possible, but not simpler. Albert Einstein

 

Are they Listening? Apparently so. Providers now have an eager, and respected voice at one of the ‘decision making’ levels in the bureaucracy of those inside the “beltway”. David Blumenthal the new head of ONCHIT has made some public statements in regard to ‘haste makes waste’. In his recent statements in the April 9, 2009 edition of the NEJM Dr Blumenthal reiterates what most all providers already know. “Keep it simple”.

Dr. Blumenthal, most recently director of the Institute for Health Policy at Massachusetts General Hospital/Partners HealthCare System in Boston, states in the NEJM article that one challenge for HITECH is a tight schedule. "The infrastructure to support HIT [health information technology] should be in place well before 2011 if physicians and hospitals are to be prepared to benefit from the most generous Medicare and Medicaid bonuses," he writes. Appointed last month as the national coordinator for health information technology in the Department of Health and Human Services, internist David Blumenthal, MD, will play a key role in implementing a portion of the American Recovery and Reinvestment Act dubbed the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Don't Force Physicians to Buy User-Unfriendly Systems

What those standards and policies will look like is Dr. Blumenthal's other big worry. According to HITECH, only a certified EHR system qualifies for a bonus, yet the law doesn't specify who will perform the certification. There's a contender in the wings — the Certification Commission for Healthcare Information Technology (CCHIT) — but Dr. Blumenthal writes that many CCHIT-certified programs "are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system."

Other “power players” in the advisory role for HIT, David Kibbe, Sam Karp, and Ben Park all summed it up by stating the following:

All the EHR authorities interviewed by Medscape Medical News agreed with Dr. Blumenthal's assertion that physicians will feel more motivated to use EHRs if third-party payers reimburse them for improving the quality and efficiency of healthcare. Family physician Ben Park, MD, an EHR user for 30 years and CEO of a 200-physician network in Indiana and Ohio, said more pay-for-performance programs and their reliance on data collection would hasten EHR adoption, assuming payers put more money on the table. "Right now, it's peanuts for performance," he said.

For many physicians and HIT advocates, the "meaningful use" requirements of HITECH represent another unsettling question mark because they have' not been fully spelled out. For example, physicians must use their EHRs to report how they perform on clinical quality measures that HHS has yet to select, but which will lean toward the management of high-cost, chronic diseases. Dr. Blumenthal warns in his NEJM article that the bar for meaningful use could be set too high, frustrating physicians and hospitals. Sam Karp recommends starting low, with quality measures as elemental as receiving lab results electronically, or reducing adverse drug interactions (made possible by automatic alerts that pop up during electronic prescribing).

Don't Force Physicians to Buy User-Unfriendly Systems

What those standards and policies will look like is Dr. Blumenthal's other big worry. According to HITECH, only a certified EHR system qualifies for a bonus, yet the law doesn't specify who will perform the certification. There's a contender in the wings — the Certification Commission for Healthcare Information Technology (CCHIT) — but Dr. Blumenthal writes that many CCHIT-certified programs "are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system."

Dr. Park's desire for higher pay also applies to the HITECH incentives, which he considers too low. Sharing his view is Micky Tripathi, president and CEO of the nonprofit Massachusetts eHealth Collaborative, which has helped some 600 physicians implement EHR systems. Based on his group's experience, Mr. Tripathi estimates that $44,000 in incentives under Medicare would cover only about two thirds of a physician's EHR costs over 5 years.

"The way this program is currently structured, the odds are quite low that EHRs will get high adoption," Mr. Tripathi said.

del.icio.us Tags: onchit,blumenthal,healthtrain express,karp,nejm,ehealth collaborative,ehr,hie,cchit,hhs,hitech

HIMMS REPORT from iHealthbeat

Federal Stimulus Package Hot Topic of This Month's Annual HIMSS Conference

This Audiocast  Special Report from iHealthbeat discusses the overall view of new funding of health IT.

New Stimulus package incentive payment estimates

Newly Named Health IT Chief Addresses Federal Stimulus Funding

And it just keeps getting better and better. "I'm from the government and I am here to help you."