Friday, October 19, 2012

About $7.7B in Meaningful Use Payments Doled Out, CMS Says

 

On Wednesday, CMS officials provided an update on the meaningful use program, saying that about $7.7 billion in incentive payments had been distributed as of last month, Government Health IT reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.

The officials offered the update during the Healthcare Information and Management Systems Society's Government Health IT Virtual Briefing.

For the Rest of the Story, Visit Digital Health Space

 

Monday, October 8, 2012

The End of The Beginning

 

You are in the right place, but the party has ended here.  According to the webmaster you should not be seeing this page.

Then please click here to go to Digital Health Space…..all will be fine.

Several Announcements

 

1. This week Health Train Express will be re-branded as Digital Health Space. It’s time for a change. Frankly I am burned out on trains, and relating health care issues to cars on a train. It is a bit dated, since most people have never been on a train, and most trains haul freight.  Today’s world operates much faster.  It also coincides with a deeper dyve into social media as a consultant and enabler for medical practices and hospital to also dyve into social media and m a  Digital Health Space now has a Facebook page and a Google Plus Page.

2. Once a week  “60 Minutes of Health” will be on Google Hangouts, time and day of the week TBA. Each week we will feature a different aspect of health care, information technology, and integrating social media into medical practice. We will have guests and discuss how social media is impacting business as well as medicine, politics and more.

3. Redirect to the blog ‘Digital Health Space'”

Photo

Happy Columbus Day !

 

Sunday, October 7, 2012

Health Radio Now

 

 

We have added a new feature on our blog, which updates daily.  Health Radio Now, and audio news dialogue, sponsored by Live365.  You will find the link on the right banner about 2/3rd of the way down.

Now for the news:

As reported on EMR Thoughts:

About:  Allscripts

The rumblings are starting to get more and more solid about Allscripts plans to discontinue MyWay. It seems they’ve started by informing their VARs and that’s where the word has gotten out most. Allscripts hasn’t quite said that they’ll be sunsetting MyWay, but the writing is on the wall.

That’s because MyWay is the descendant of Mysis which was bought by Allscripts as a ‘leader” for their Professional Allscripts.  The code is not Allscripts, the ;product bears no relationship to the professional version. Caveat Emptor.  They maxed out their purchase price.   Caveat Emptor

One person I talked to about this said that the fact that Allscripts discontinuing MyWay wasn’t much of a surprise considering what a terrible product it’s been. The term he used most often to describe the product was “buggy.” This wasn’t surprising to me since one of my most discussed posts was one on Evaluating Allscripts EMR which I wrote on my EMR & EHR website.

It seems that Allscripts plan is to discontinue MyWay and try and move those users to Allscripts Professional. The migration of the data seems like it will be free, but it doesn’t seem that Allscripts has yet indicated whether they’ll tack on an extra fee for the more expensive Allscripts Pro product.

I was told that Allscripts did say that they’d be incorporating the best features of MyWay into Allscripts Professional. The person I talked to about this laughed a bit since there were very few features in MyWay that users loved. He assumed that it HAD to be referencing the Full Note composer in MyWay which he said providers seemed to like for documenting the clinical side of things.

I’ve also heard a rumor that Allscripts might be looking for a way to do the Allscripts professional training through some sort of online means. Considering the complexity of Allscripts pro and the configuration and training required to make it functional and workable, this seems like a failed strategy to me. We’ll see how this plays out since I’m sure Allscripts is still defining this strategy.

Of course, the VARs that are supporting all the MyWay implementations will be scrambling with their own plan. I expect many of them won’t be happy with the idea of switching from MyWay to Allscripts professional and will consider other EHR. The obvious option is Aprima since they created the original MyWay and then forked the project to create their current Aprima EHR offering.

I’m told that Aprima has totally redone the PM side of their Aprima EHR which is a good thing since many weren’t satisfied with the PM in MyWay. It certainly makes a lot of sense for Allscripts MyWay VARs to consider Aprima since it will provide a similar user experience for their users and I have little doubt that Aprima will be able to port the data out of MyWay and into Aprima. My only question is if that’s the right move. Should you move to Aprima because it’s an easy transition or should a Var instead search to find the best EHR out there (which could be Aprima in the end anyway, I’ll leave that judgment to others)?

No doubt many of the other EHR vendors out there are going to look at this as a great opportunity for them as well. I’d be interested to learn more about Allscripts MyWay technology structure and how well the data can be ported to another EHR.

And may I also add:

It must be an interesting time at Allscripts with this happening along with talks of Allscripts considering a sell out to a Private Equity Buyer.

Is CEO Tullman preparing his “exit strategy/”

 

Friday, October 5, 2012

Social Media Camp sponsored by Mayo Clinic

 

Slideshare by Lee Aase

The Debate----Who won?

Last night’s presidential debate turned out to be a big surprise to the Democrats who have been behind Barak Obama since 2008’s Presidential campaign and the past almost four years.

It has been the first opportunity to see Barak Obama mano a mano with a Republican opponent. since he took office The first debate was largely about the economy, a subject that Mitt Romney knows well, and has a market place recovery plan based on solid economic theory.

Obama seemed to be on the defensive, basing his facts on the present recovery plan initiated by him during his term in office. He seemed to be on the defensive, as well as unskilled in debate tactics and appearance at the podium.  His advisors either did not prepare him well for a debate, or he decided to ignore their advice.

This is typical of Barak Obama and reflects his actions and lack of bipartisan communications. He seems to march on and inevitably will self-destruct.

Anticipation will run high about the debate on health reform. Given his performance last night, health reform is in danger as Obama and the Democrats passed the law without one Republican vote. In fact Romney took the occasion to announce that his first action the day after he is inaugurated would be to repeal PPACA and put a hold on further implementation while revisions are studied.

Governor Romney’s  bold statement even before the debate on health reform announces the aggressive campaign the Republicans will run against PPACA. Mitt Romney is certainly the expert on working out bipartisan support for health reform he accomplished in Massachusetts.

His performance gives great hope to the health care community for significant revision and/or repeal of PPACA as it stands.

What the debate crystallized is the opportunity to significantly alter the present course of health reform.  It may polarize the debates further, although it may created an opening for more discussions.  Romney in his comments on PPACA emphasized the negative effect on Medicare Beneficiaries from PPACA.

What physicians need  to do now is to advance the causes of patients, advocacy for them and providers to strengthen that patient-centric model being espoused by supporters of PPACA, without real meaning for the term.  PPACA is not about patients and providers. It is much more about insurers, more bureaucracy, poorly devised cost control methods, fines, penalties and negative incentives.

Causes for concern include the lack of primary care providers to support 25 million or more patients entering the system, the uncertainty of how the federal government and states will partner ( and even in some cases, states have already balked at cooperation with the federal government),  the rapid rollout of HIT in the form of EHRs that may be unproven and even inaccurate,  HIEs that are still in their infancy, Looming changes for the ICD 10 diagnostic codes, planning and implementation of Accountable Care Organizations (ACO).  In the real world whatever projected savings in health care will be eaten up by the sheer volume of technology and simultaneous projects, all inter-related.

Physicians are aware of the complexity of change and the laws of unintended consequences, health planners are optimistic that they can forecast unforseen changes, which has been disproven time after time. 

The debate will continue………..

 

Health Train Express Back on the Track ?

 

Here is a quick response from HIMSS (less than 24 hours after Congress asks for hold on HIT.

(from EMR and  Health IT News)

About HIMSS

Washington, DC)  HIMSS opposes the October 4th call from four House Republican leaders for the Department of Health and Human Services (HHS) to “immediately suspend the distribution of incentive payments until [the Department] promulgates universal interoperable standards.”  HIMSS emphasizes the significant progress that has been made towards the adoption of Electronic Health Records (EHRs) and exchange of health information since the Medicare and Medicaid EHR Incentive program began in 2011.

The House Republican leaders’ letter asks HHS to take additional steps to “advance  interoperability and meaningful use” of health information technology (IT).  HIMSS notes that the Stage 2 Final Rule, published by the Department on September 4, moves the Nation definitively towards interoperability.

These conflicting opinions are undoubtedly due to the ‘rush to EMR and HIE’ in a frenzy of spending frenzy to benefit the HIT industry.

Congress and HHS rolled out incentives for unproven and largely non-vetted systems.

There are 3 stages in the meaningful use criteria for eligibility for federal incentives. The requirements are supposed to be staged in regard to difficulty to attain with new HIT and EMR systems. Now there is some disagreement to the credibility of the Stage II criteria as Stage I has been completed.  The government incentive is dependent upon an  unrealistic schedule which imposes penalties for delayed installation of EHRs , which motivates providers to buy immature and inadequate EMR systems.

 

EMR Incentives Derailed?

 

Friday, October 05, 2012

Lawmakers Urge HHS To Halt Payments for EHR Incentive Program

ln a letter to HHS Secretary Kathleen Sebelius, House Ways and Means Committee Chair Dave Camp (R-Mich.) and GOP chairs of several House health subcommittees asked HHS to suspend incentive payments for Stage 2 of the meaningful use program,Modern Healthcare reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.

Letter Details

The letter charges that nearly $10 billion might have been wasted because the rules under Stage 2 of the meaningful use program -- created by CMS and the Office of the National Coordinator for Health Information Technology -- are "weaker" than the rules for Stage 1.

The letter specifically states that certain standards in Stage 2 are either "insufficient" or "woefully inadequate," including requirements that:

  • A summary transfer be provided in electronic format only 10% of the time;
  • Radiology and laboratory orders be electronic 30% of the time; and
  • Medication reconciliation and electronic prescribing take place 50% of the time.

According to CMS data, the EHR incentive program as of June 2012 has disbursed $7.1 billion. Meanwhile, ONC has received $2 billion through the federal stimulus package for health IT programs (Zigmond/Conn, Modern Healthcare, 10/4).

ONC Response

During a forum in Chicago on Thursday, National Coordinator for Health IT Farzad Mostashari defended the stage 2 rules and downplayed the lawmakers' request, noting that the period before a presidential election is known as "the silly season."

Mostashari noted that the requested changes would require congressional and presidential approval (Cadet, Cardiovascular

 

Monday, October 1, 2012

HealthCare Oktoberfest and Social Media Planning

 

Yes, it’s true the beginning of October in healthcare signals a highpoint for innovation conferences in San Francisco.

Either  by design or fortuitous coincidence there as several major health reform meetings in the next two weeks in the city by the bay, San Francisco.

About Health Innovation Week

Following the success of Health Innovation Week in 2010 and 2011, Health 2.0, LLC and Health Care Conference Administrators, LLC (HCCA) are delighted to announce our return. For 2012 Health Innovation Week in San Francisco. will be October 3-12. (Yes, we’ve turned it into a 10 day week!)

Core events of Health Innovation Week include the National Medical Home Summit and the 6th Annual HIPAA Summit West, followed by the HealthCampSFBay unconference (CANCELLED) and the 6th Annual Health 2.0 Conference. You can click on the graphics above to get more information about any one of the conferences. Finally the DC to VC event will harvest the best startups.

 

The HIT Startup Showcase Challenge include these functions

  • Care Transitions/Care Coordination
  • Big Data/Healthcare Analytics/Predictive Risk Modeling
  • Health Information Exchange/Interoperability & Integration
  • TeleHeath/Remote Diagnosis/MD Virtual Consult
  • Healthcare Transparency Solutions (Pricing, EBOs “made easy,” Risk Calculators)
  • Marketplaces for Healthcare Services (Insurance, Directories, Pre-paid Cards, Discounts)
  • New Models of Primary Care (Concierge Medicine, Patient Centered Home)
  • Social Networking for Providers (Shared Best Practices & Evidence, Professional Networking & Referral Management)
  • EHRs/Clinical Documentation
  • Consumer Wellness & Gaming or Social Networking for Patients
  • mHealth and mobile apps (with a large vision)

 

Sunday, September 30, 2012

Health Information Technology Video Film Festival

     

 

Health Train Express is designed to bring health care providers out of their own silos.

The health care industry is already involved in data exchange and interoperability. The next step in order to move forward is  to dissolve distance and barriers between information, science, medical science and social media.  Social media allows all to dip their toes into areas physicians have previously ignored either intentionally, time constraints, or accidental negligence.

It is equivalent to the ‘cocktail party’ of social circles….many of which have led to great discoveries and collaborations.

2012 and the Developer Challenge has thus far brought major innovative mobile health applications to the world stage. Winners will harvest not only a moderate of cash prizes, but attract the world stage of kick starter funds and venture capital. The cast of new possible star will create enthusiasm to industry critical analysis. This is occurring as electronic health records are adopted by hospitals and physicians alike.

 

Health2con is occurring in San Francisco next week and is anticipated to bring more new players to mHealth. Physicians and hospital managers as well as health information technology producers are observing the potential connect with other industries and adoption of not only information technology  robotic, analytic and even gaming applications in design of  healthcare and scientific problem solving.

Medicine X at Stanford University took place September 28th - 30th

image

Rhiju Das, PhD in his video found below  outlines the use of online gaming in analyzing and producing proteins and uses RNA as a model.  Players log in online to participate in analyzing structure of RNA, not only it’s nucleotide base,

ARCHIVED EVENTS FROM FRIDAY’S PRESENTATIONS

SATURDAY’S PROGRAM

Stanford Medicine X  Rock Health

23andMe

Sonny Vu on Wearables: A Coming Revolution?

Dr. Larry Chu gives opening remarks at Stanford Medicine X

David Van Sickle on Asthmapolis

Rhiju Das, PhD on RNA Design Rules from a Massively Multiplayer Cloud Laboratory

 

SUNDAY’S PROGRAMS

Design Prototypes Emergency Situation on a Large Display. Adding Order to Chaos

Esther Dyson  A view from Space.

A well known creative and visionary Innovator, and Venture Capitalist (over 20 investments in HIT.  Artificial Intelligence is often invisible, embedded in things like ‘Siri’. Several markets for IT, Consumers, Employers especially HR People (human resources who want people to be healthy), and market for good health. Health Providers individually and in concert with Employers to optimize health, wellness, and good data from applications like Healthtap, Fitbit, Social Media is a large catalyst for adoption of mobile health applications.

Design Conundrums

Michael Graves, Architect & Patient distinguished for many architectural awards and a diversity of design fields. You can follow him on social media.

Our Present reimbursement system is a problem and hinders data collection.

Safecast, a data collection web site

How much data, where is it coming from, and is it accurate ?

 

All videos were taken from Livestream in real time.  Our thanks to them.

 

Friday, September 28, 2012

The IRS wants your Health Insurance Premium

 

The Numbers just do not add up………..so let’s print more money. Would you ever believe that your health care would involve the IRS as an enforcement arm of the government.

Yes, the collection and enforcement arm of the IRS with all it’s powers that be, including wage levies, seizure of assets, and bank levies will monitor your health finances. 

And rumor has it that there will be blood collection centers set up at each IRS office.

By RICARDO ALONSO-ZALDIVAR

WASHINGTON (AP) - Nearly 6 million Americans - most of them in the middle class - will face a tax penalty for not carrying medical coverage once President Barack Obama's health care overhaul law is fully in place, congressional budget analysts said Wednesday.

The new estimate amounts to an inconvenient fact for the administration, a reminder of what critics see as broken promises.

The numbers from the nonpartisan Congressional Budget Office are significantly higher than a previous projection by the same office in 2010, shortly after the law passed.

The earlier estimate found 4 million people would be affected. The difference - 2 million people- represents a 50 percent increase.

That's still only a sliver of the population, given that more than 150 million people currently are covered by employer plans. Nonetheless, in his first campaign for the White House, Obama pledged not to raise taxes on individuals making less than $200,000 a year and couples making less than $250,000.

And the budget office analysis found that nearly 80 percent of those who'll face the penalty would be making up to or less than five times the federal poverty level. Currently that would work out to $55,850 or less for an individual and $115,250 or less for a family of four.

Average penalty: about $1,200 in 2016.

 

"The bad news and broken promises from Obama care just keep piling up," said Rep. Dave Camp, R-Mich., chairman of the House Ways and Means Committee, who wants to repeal the law.

There was no immediate response from the administration.

The Congressional Budget Office said most of the increase in its estimate is due to changes in underlying projections about the economy, incorporating the effects of new federal legislation, as well as higher unemployment and lower wages.

Starting in 2014, the new health care law requires virtually every legal resident of the U.S. to carry health insurance or face a tax penalty. The Supreme Court upheld Obama's law as constitutional in a 5-4 decision this summer, finding that the insurance mandate and the tax penalty enforcing it fall within the power of Congress to impose taxes. The penalty will be collected by the IRS, just like taxes.

The budget office said the penalty will raise $6.9 billion when fully in effect in 2016.

The new law will also provide government aid to help middle-class and low-income households afford coverage, the financial carrot that balances out the penalty.

Nonetheless, some people might still decide to remain uninsured because they object to government mandates or because they feel they would come out ahead financially even if they have to pay the penalty. Health insurance is expensive, with employer-provided family coverage averaging nearly $15,800 a year for a family and $4,300 for a single plan.

The Supreme Court allowed individual states to opt out of a major Medicaid expansion under the law. The Obama administration says it will exempt low-income people affected by state decisions from having to comply with the insurance mandate.

Most Americans will not have to worry about the insurance requirement since they already have coverage through employers, government programs like Medicare or by buying their own policies.

Many Republicans still regard the insurance mandate as unconstitutional and rue the day the Supreme Court upheld it.

However, the idea for an individual insurance requirement comes from Republican health care plans in the 1990s.

It's also a central element of the 2006 Massachusetts health care law signed by then-GOP Gov. Mitt Romney, now running against Obama and promising to repeal the federal law. The approach seems to have worked well in Massachusetts, with virtually all residents covered and dwindling numbers opting to pay the penalty instead.

 

Thursday, September 27, 2012

Expect The Unexpected

 

Caregivers are a hearty lot.  Social media can play a distinct supportive role in their activities. Most of us at some point in our lives will care for an aging parent or relative.  If not, there is certainty you will be in a relationship with someone who is a care giver.

When outfitting an expedition, one has to plan for everything: from the rare but potentially catastrophic dangers (raging lions, swollen rivers, thunderous storms) to the mundane, commonplace annoyances (fleas, thorns, thirst, hunger) that can be just as deadly.

When people look back in the future at the circuitous route of technological progress in the caregiving space, Rajiv Mehta will probably garner a decent mention. A tireless advocate on the topic, he’s devoted his considerable energy, and brain, to bringing about easier and simpler ways to manage the challenging, often misunderstood and frequently overwhelming issues around family caregiving.

 Wen Dombroski M.D. is also on this team of visionary leaders

 

Now he’s getting ready to launch the next version of his caregiving tools (called Unfrazzle). He gave a talk recently in Australia about the ‘journey’ that caregivers (even though they don’t know that’s what they are) set off on, and his sensible advice was to think of this as an adventure, and spend the time and effort necessary to outfit yourself for the journey. What I like about that analogy is that it effectively focuses the mind on the need to prepare, without triggering shutdown in the listener from calamitous tales of woe and horror that are never an easy sell. Looking forward to seeing the next rev when it’s live and hearing Rajiv present at a future Aging2.0 event.

 
 
Rajiv Mehta , “At Australia’s Health Informatics Conference 2012 in Sydney recently, I gave a keynote address on “Outfitting Families for Caregiving Journeys” highlighting the importance and challenges of dealing with the mundane aspects of caregiving — the overwhelming, and seemingly never-ending, torrent of widely varying, trivial tasks shared amongst a loose network of family and friends. Through stories of actual caregiving situations I make these issues “real”. In the talk I also describe my own efforts over the past few years to address this issue, and the opportunity for healthcare professionals to better prepare families for caregiving crises via addressing the mundane.
 
Rajiv Mehta is a NASA scientist with heady degrees from Princeton, Stanford and Columbia and four years as a product manager at Apple , who has devoted himself to sharpening the cutting edge of technology and caregiving, working with the Quantified Self movement, developing Tonic, a mobile-based self care assistant and joining the board of the Family Caregiving Alliance. Now he’s getting ready to launch the next version of his caregiving tools (called Unfrazzle). He gave a talk recently in Australia about the ‘journey’ that caregivers (even though they don’t know that’s what they are) set off on, and his sensible advice was to think of this as an adventure, and spend the time and effort necessary to outfit yourself for the journey. What I like about that analogy is that it effectively focuses the mind on the need to prepare, without triggering shutdown in the listener from calamitous tales of woe and horror that are never an easy sell. Looking forward to seeing the next rev when it’s live and hearing Rajiv present at a future Aging 2.0 event.

Next:  Social Media and Telehealth:

 

Tuesday, September 25, 2012

Health Information Technology Moves at The Speed of Light

 

The title of this post is both literal and figurative. Yes data does travel at the speed of light, however progress in developing a nationwide interoperable network has been much slower.

The idea of a NHIN has been around since the early 21st Century and there have been many regional attempts, a few which have been successful, thus far.

Regional health information exchanges have made some progress, however ‘buy in’ is still difficult to promote in competing hospital systems.

Fueling this progress has been the following, promoted by the “Open Government” policies which encourage and entrepenurial spirit in both government and the private venture capital market.  No longer will government be the main engine for building a national network, it will function as a “convener” as stated by Aneesh Chopra

The White House and ONC announced that providers and public health agencies in Minnesota and Rhode Island began exchanging health information using specifications developed by the Direct Project, an 'open government' initiative that calls on cooperative efforts by organizations in the health care and information technology sectors. (February 2, 2011)
The press conference was moderated by Farzad Mostashari, MD, ScM, Deputy National Coordinator for Programs and Policy, ONC, and includes remarks from Dr. David Blumenthal and Aneesh Chopra.

There is has been progress in the NHIN is outlined here:

It was obvious from the enclosed video from this meeting that the principals (lots of fist pumps, back slapping, and handshakes)

Speakers included industry and government professionals who helped make the Direct Project launch a success: Mark Briggs, MSc, Chief Executive Officer, VisionShare; Glen Tullman, Chief Executive Officer, Allscripts; Sean Nolan, Chief Architect, Microsoft Health Solutions; and, Albert Puerini, Jr, MD, President and CEO, Polaris Medical Management, President and CEO, Rhode Island Primary Care Physicians; and, Todd Park, Chief Technology Officer, U.S. Department of Health and Human Services.

Some consternation was expressed about the barrier of HIPAA as it is now structured. Many secure transactions already do occur via the internet and some of those secure features should be used to transmit health data.

It becomes obvious technology is outstripping regulatory and legal concerns. It became obvious as well that ‘data” can be transmitted packaged in secure email as a pdf or text file from provider to provider. That is an elegant and simple means to do so.  It does not allow for data fields for analysis, however that is another matter. And it is truly separate.

The basic patient centric model involves only provider-patient-provider interaction, and this must take precedence. The rest is frosting on the cake. (author’s opinion)

Insurers and government agencies who want that data should develop a system that can extract what they need as a separate and isolated goal.