Reviewing the Past

Yesterday I was privileged to witness the growth of our Inland Empire Health Information Organization. After one false start five years ago it now will happen.   Bottom line,  you just follow the money and the open pocketbook of the U.S. Congress (your taxpayer dollars)

I had been away for almost five years after planting a seed for the development of this important initiative.

Five years ago when David Brailer MD was head of ONCHIT few knew what was being planned nor what would come to fruition.

For those who want to look at some of those days click here…..

I don’t really remember writing some of these blogs , but this one was particularly funny (at least to me)

After a long hard search I found my original blog post announcing the formation of the Riverside Regional Health Information Technology Group  WHAT WAS I THINKING??? circa February 2005 (over five years ago)!!!

Health Information Exchanges and Electronic Medical Records Part II

 

Part I in my previous blog   ………………

 

I describe HITECH and APPA and the negative reward system to create incentives for physicians and hospitals to acquire and use electronic medical records.

 

Today I am going to describe several critical and key issues which will greatly impact on providers in their daily work.

Here is the scenario.

Dr Gofaster is an internal medicine physician who attends patients at two different hospitals, BeHospitalized Medical Center and Don’tbeAdmiited Center for Cardiac Arrest.  He is on call for both E.Ds

His iPhone do it all sounds an alarm and he receives an SMS from BHMC E.D. Dr Gofaster sees the patient and records his EMR for patient  I.Dont Wantadiehere.  Following admission the next day he sees his patient but is unable to see the ED notes because the outpatient system is entirely different and not connected to the inpatient EMR. (my experience in the federal US Army AHLTA system.)  He experiences some difficulty using the two differing systems in one hospital.

 

Dr Gofaster’s iPhone do it all goes off again summoning him to the ED at DBAMC.  He arrives in five minutes, sees the patient and has a problem using the entirely different EMR in the second ED.  After admission he goes to the floor and sees another inpatient. He is again stymied using the inpatient EMR since it is different from BHMC.  He either forgot his password or left it in his wallet in the car.

Summary,  two different hospitals,  Four different EMRs

Four different passwords that require changes every 90 days.

Dr Nowslowingdownmore attempts to enter his password incorrectly three times in a row…the system now tells him he is locked out and he must answer 4 challenge questions, which  he cannot remember nor answer.

  His alternate choice is to dial 1-800-IDONT-SEE-PATIENTS, he is placed on hold after answering four voice mail prompts,  #,@,!,&,&  unless it is on the weekend when he must enter at least 1 number,  one  upper case letter, one lower case letter, and be no less than ten digits long.

Upon contacting a support specialist (who is in Singapore) he is asked what version is his hospital software.

Thirty minutes later he is  ready to record his EMR.  As he logs in the log in page announces that the system is down for the next 4 hours for maintenance, with the message. “We are sorry to inconvenience you, doctor.

Dr Nowslowingdownmore heads to his office and starts his workday in the office.  He enters the first patient room. Patient

I.Wantagohome is pacing because he needs to leave (he is an attorney)  Dr N. Slowingdownmore attempts to log in his office system, but receives a message

he must change his password and he cannot use any of his old passwords.  He is locked out while attempting to answer two of his six alternate secret questions and answers.

 

Dr N.Slowingdownmore gives it up and pulls out his trusty No.2 yellow pencil and waits ten minutes while Betsy tries to find a progress notes sheet (they are buried under some old floor mops in the storage room).  Dr. Slowingdownmore notes that his pencil has never been sharpened and their are no pencil sharpeners, so he pulls out a scalpel  blade to sharpen it.  In the process he slices the tip of his index finger on his writing hand off.

Dr. S swears loudly, throws his iPhone against the wall, shattering it as it falls to the floor. 

His medical assistant  Suzie Icantakeitanymore brings in a certified letter from the medical staff office placing him on probation due to his incomplete hospital  charts.

Get the picture, all you do-goody HIT folks and Politicos???

Names have been changed to protect the guilty.

Health Information Exchanges and Electronic Medical Record Negative Reward Incentives

 

 

Health Information Exchanges and Electronic Medical Record Negative Reward Incentives are still controversial. The American Recovery and Reinvestment Act includes a wide variety of mandates, including HITECH to stimulate acquisition of EMR and building a national health information exchange network.

As a student and consultant of health information exchange development and the federal and state government incentives for ‘rapid’ development’ of medical digital records, I am struck at the lack of organized medicine’s and individual practitioners opinions regarding EMRs.

Congress has been sold a ‘bill of goods’ much like buying the Brooklyn Bridge for $1.00. (And the price will go up next year if you don’t buy it now). This is very much snake oil medicine, at its worst.

Let me be clear about one thing.  I am not anti-EMR or anti-HIE development.  The present developmental plans benefits mostly health information technology vendors

I am not a Luddite, by any means, however from all the information I have been able to gather, there are few if any  studies that document meaningful return on investment.

This “catalytic innovation”, a term which I coined five years, ago is a disruptive technology.

Physicians and patients should contact our senators and representatives in Congress and at the state level to change the formula for incentives. The EMR products offered to physician practices and consumer electronic health records,  are not mature enough to invest billions of dollars at the taxpayer’s expense. The timeline is defective in several ways.

1. Evaluation, study and implementation also require training time.

2. The HIT industry does not have the manpower and/or resources to accomplish this within the specified time period.

3. There has been very limited success for practitioners and hospitals to adopt EMR.

4. The impact of the health reform legislation has yet to be determined on the overall cost of health care. Numerous early studies indicate the cost to the consumer will rise substantially with health reform. Certainly the stated goals are admirable for our society. Early indicators are that the insurance industry will do it’s best to maximize profit during the early years of health reform as a hedge against future legislation requiring expanded coverage of benefits and the mandates from the states to eliminate the ‘uninsured’. States are not in the health care business and previous experience with major risk policies reveals that States depend upon private insurers to manage and indemnify the policies and operate Medicaid and Medicaid HMOs. The same market forces will continue to impact the model and many insurers will refuse to offer these policies or drop contracts with the state.

5. It will require several more years prior to penalizing those who do not adopt EMR, when the current  products of choice are inadequate, and based upon old models of billing and collections.

6. Certainly if the stated goal of medical homes as well as non-procedural reimbursement methodology the present plan is not in line with the goals of increasing efficiency, nor collecting meaningful information. Our currently available EMR  systems address neither the purported goal of meaningful data for individual practices, nor promoting best outcomes. The current Gantt chart time line will  stimulate the acquisition of poorly designed clinical information systems.

7. The term meaningful use (for whom?) is inadequate and is not defined in terms of the differing type of practices, or hospitals.

more……in my next blog post.

 

LiveJournal Tags: emr,meaningful use,health information exchange,health reform,emr incentive,health train express

Rising Stars in Health Reform

Sermo has arisen in the past three years as a powerful media voice for the grass roots of physicians.

FOR IMMEDIATE RELEASE

Sermo Named to Fast Company Magazine’s List of World’s Most Innovative Companies

Largest Physician Community Recognized as ‘Political Force’ Behind Healthcare Reform Efforts

Cambridge, MA, February 24, 2010 — Sermo (http://www.sermo.com), the world’s largest online community for physicians, today announced it has been named to Fast Company Magazine’s list of the world's most innovative companies. Sermo earned its ranking for providing a free web service – referenced by Fast Company as a ‘facebook for doctors’ - where physicians can collaborate and improve patient care. The company was also cited as a ‘political force’ after 11,500 physician members composed, signed and delivered a petition opposing the American Medical Association's acceptance of the House healthcare reform bill in the summer of 2009.

To create this year’s list, Fast Company’s editorial team analyzed information on thousands of businesses across the globe to identify creative models and progressive cultures. Sermo was recognized alongside the most respected healthcare innovators in the world, including athenahealth, GE, Cisco, Patientslikeme, and Kaiser Permanente.

“Since launching in 2006, more than 20% of all US physicians have joined the Sermo community,” said Dr. Daniel Palestrant, CEO & Founder of Sermo. “As the physician community has grown, so too has our client list, which now includes 10 of the top 12 pharmaceutical companies. These companies are engaging physicians through our social media offerings built specifically to increase brand awareness and provide valuable market intelligence not possible through other channels.”

Unlike other models, Sermo is free of advertising and free to physicians. Revenue is generated as clients purchase products to interact with specialists. To learn more about Sermo’s social media offerings, visit www.sermo.com/clients.

The complete Fast Company Most Innovative Companies list and related stories appear in the March 2010 issue of Fast Company magazine, on newsstands currently and online at www.fastcompany.com/MIC.

About Sermo
Sermo is the largest online physician community, where over 112,000 physicians collaborate to improve patient care. Sermo provides access to its community for clients that need fast, actionable insights into treatments, drugs and devices. Learn more at www.sermo.com.

Of some interest is the fact that Sermo and the AMA originally were in a partnership which dissolved within the first  year of their agreement.  Sermo’s contention is that the AMA does not truly represent any majority of American Physicians and  has a conflict of interest in holding the copyright for the CPT codes.

 

Another embryonic politically active forum is Docs4Patientcare.org   This organization abruptly sprouted last year during the health reform debates. For more information go to their website. 

Health 2.0 International

Please click to expand to fill screen

 

 

Medical Social Networking has gone global, from the U.S. to the U.K. and beyond into specialty societies.

A quick google search will bring up many social networking sites, some with authentication required, membership requirements,and also open networks.

The Elephant in the Boa Constrictor

Richard Reece M.D. who writes Medinnovation Blog aptly analogized HIT  and the Government. 

The Elephant in the Room

Before resigning in frustration as the first “HIT Czar,” David Brailer observed in a 2005 in a New Times Times interview , “The elephant in the living room is what we’re trying to do is the small physician practice. That’s the hardest part, and it will bring this effort to its knees if we fail.”

The Blind Men and The Elephant

The second metaphor is the Blind Men and the Elephant. Our health care system is an elephant. Everyone feels the elephant’s parts differently. Doctors hanging on to the tail feel the system is an encircling rope, purchasers touching the leg feel it is an immovable tree, plans holding the trunk feel it is a squirming snake, and government officials riding on the head feel it as a global positioning satellite devices, capable of controlling the direction of the elephant.

 

As Dr Reece so eloquently espouses:

“What concerns me is what will come out the distal end of the boa constrictor once the digestive process ends.”

Certification Central

The ONC has announced the approval of both CCHIT and the Drummond Group as agents for certifying interoperability and other standards for EMR.  Both groups fulfilled the requirement of the ONC and the NIST.

 

This ruling should bring much relief to CCHIT and those vendors who have participated willingly and volunteered to develop and test the standards. CCHIT has been in operation since 2006.

 

Some were critical and concerned that CCHIT represented mainly vendors, while the Drummond Group would be more unbiased. Competition is always a good thing, and should enhance affordability for those vendors seeking certification for EMRs.

This is another ‘elephant for the boa constrictor to swallow.