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· RAND analysts say misaligned incentives hinder interoperability Hyperlink · It’s “currently difficult, if not impossible, for providers to get comparative data on the usability of competing health IT systems,” Kellerman and Jones write. “Instead of demanding product transparency or insisting that health IT vendors create more user-friendly technology, many large healthcare systems have rushed to adopt existing systems to qualify for time-limited incentives.” · Mentioning speculation “that major health IT vendors are opposed to interoperability,” Kellerman and Jones point to several EHR horror stories — provider and vendor lawsuits, medication errors and “alert fatigue” — as detailed in a 2009 Bloomberg Businessweek article, “The dubious promise of digital medicine.” · While Kellerman and Jones paint a somewhat bleak picture, they noted the health IT success of organizations like Intermountain Healthcare and the Department of Veterans Affairs. And in the past few years, the issue of interoperability has risen to the fore, with health IT leaders realizing the need for common standards for exchange, since returning to paper-based records really isn’t a viable option. · I am not sure “Interoperability” sufficiently addresses the scope of the issue. I feel this is viewed by many as a “ATM Syndrome” problem as we had 20 year ago where ATM’s were specific to branded cards. What I fear is missed is the complexity of the data model and the scope of standards required for health care data and how far we are from having either. Remember the Don Simborg / Ralph Korpman debate regarding distributed vs. centralized processing. The argument went “since we do not know the relationships between all data elements in medicine, we must have the ability to link any element to any other on an adhoc basis”. Essentially an all to all interface requirement impossible (then and now) for interfaced systems (N2-N). It didn’t work so well with Ralph’s centralized systems either (Remember HDS) but that’s another discussion. What do you think? · PwC's Health Research Institute identifies the top ten health industry issues to watch in 2013 Hyperlink 1. States on the frontlines of Affordable Care Act implementation 2. Consumer revolution in health coverage 3. Medtech industry braces for excise tax impact 4. Caring for the nation’s most vulnerable: dual eligibles 5. Bring your own mobile device: convenience at a cost. Doctors and nurses are bringing their own mobile devices to work, but many hospitals do not yet have a secure enough environment to protect sensitive patient information. 6. Goodbye cost reduction, hello transformation 7. Customer ratings hit the pocketbooks of healthcare companies 8. Meeting the new expectations of pharma value 9. Bigger than benefits: employers rethink their role in healthcare 10. The building blocks of population health management · Likelihood of Choosing Doctor by Their Use of Health Information Technology, by Type of Health Plan, 2012 Hyperlink · · 35% of U.S. adults have gone online to figure out a medical condition; of these, half followed up with a visit to a medical professional. According to a report by Pew Research Center’s Internet & American Life Project; Health Online 2013 Hyperlink · Women are more likely than men to go online to figure out a possible diagnosis. Other groups that have a high likelihood of doing so include younger people, white adults, those who live in households earning $75,000 or more, and those with a college degree or advanced degrees. · When we asked respondents about the accuracy of their initial diagnosis, they reported: 1. 41% of online diagnosers say a medical professional confirmed their diagnosis. An additional 2% say a medical professional partially confirmed it. 2. 35% say they did not visit a clinician to get a professional opinion. 3. 18% say they consulted a medical professional and the clinician either did not agree or offered a different opinion about the condition. 4. 1% say their conversation with a clinician was inconclusive. · Does this mean we are tracking to greater telemedicine? I think a Skype (or similar) connection with a health professional enhanced with a device that would provide basic health information (TPR, EMR) would greatly reduce clinic and office visits or at least serve as a triage to direct the patient to the appropriate services. What do you think? · The Federation of State Medical Boards has produced an overview of telemedicine licensure across the US Hyperlink Highlights include: · Ten (10) state boards issue a special purpose license, telemedicine license or certificate, or license to practice medicine across state lines to allow for the practice of telemedicine. · Fifty-seven (57) state boards plus the DC Board of Medicine require that physicians engaging in telemedicine are licensed in the state in which the patient is located. · Fifteen (15) states currently require private insurance companies to cover telemedicine services to the same extent as face-to-face Consultations. · New bill aims to remove coverage restrictions of telemedicine Hyperlink · The Telehealth Promotion Act of 2012 (H.R. 6719), sponsored by Rep. Mike Thompson (D-CA), would increase federal support and payments for telehealth services nationwide. · Is there a new (or at least significantly modified) model for hospitals/health care providers? I was impressed by this article identified that relates a discussion with Cleveland Clinic CEO Dr. Delos "Toby" Cosgrove on consolidation, cutting costs, and how health care will be disrupted. It is well worth the read. Hyperlink A couple of the interesting points discussed include: · “Health Care is 24 percent of the federal budget, this is a huge industry. After restaurants and hospitality, this is the biggest industry in the United States”. · “25 percent of the hospitals right now are in the red, so very low margin. If you look at what happened in airlines, what happened in supermarkets, what happened in bookstores etc., they all consolidated, they brought scale so they could drive efficiency, I think that's what's happening in health care right now.” · “First of all, (Cleveland Clinic) we're a medical group, we're physician- led, we make our decisions about how we're going to rule ourselves, what sort of facilities we're going to do, etc. The second thing is that all the physicians are salaried. We have no financial incentives to do more or to do less. We just try to look after what the needs are for a patient because it doesn't make a difference to us personally. The third thing is that we all have one year contracts, there's no tenure, and we have annual professional reviews. I don't know of another institution that has annual professional reviews and one year contracts. In the annual professional review we go over all individuals' contributions to the organization and that contributes to our decisions about what we do about salary and whether we reappoint or don't. I've had 37, by the way, 37 one-year contracts.” · “Most hospitals are organized around the department of surgery, the department of medicine, the department of pediatrics — there was essentially a guild system for whatever your profession was. And what we said is, wouldn't it be nice to organize a hospital around what a patient needs? Novel idea, have a hospital organized around patients. If you've got a headache you don't know whether you need to see a psychologist, a neurologist, or a neurosurgeon. So let's put everybody who deals with a neurology system in a neurological institute, and we'll have one head. So if you go in for your headache, you can see whomever, right in that one location. Everybody whom you could potentially need to see is right there in one location and they talk to each other, they're physically proximate to each other. “ · However, another facet of consolidation can be seen in this article which describes a competition for dominance between hospitals in Boise, Idaho. “In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint.” Hyperlink · Red Cross: More U.S. Adults Turning to Mobile Apps in Emergencies Hyperlink About 20% of surveyed U.S. adults have used smartphone applications in emergency or disaster situations, according to a survey by the American Red Cross, MobiHealthNews reports. The survey also found that: · 76% of surveyed social media users said they would expect to receive assistance within three hours after posting a request for help through a social media website like Facebook or Twitter; and · 40% of surveyed U.S. residents said they have used social media websites to inform others about their safety during an emergency (Eng, Consumer Reports, 9/4). · New board trims Allscripts CEO Tullman's pay after rough patch Hyperlink Mr. Tullman this year is in line to receive stock worth just $1.9 million and a cash bonus of just 20 percent of his salary, according to a U.S. Securities and Exchange Commission filing last week by the electronic medical records firm. That's much less than last year, when his compensation was driven up by a generous stock award worth $5.9 million and a bonus of nearly $469,000, or 60 percent of his $787,500 salary. In 2011, his total pay soared 76 percent, to nearly $7.2 million, even as the health care software company struggled in the wake of the $1.3 billion acquisition of hospital IT firm Eclipsys Corp. in 2010. · HL7 to Offer Free License for Standards, Other Properties Hyperlink The free property includes all standards, domain analysis models, profiles, implementation guides and some tools. The intellectual property will not be licensed on the open source market, under which other developers may make enhancements. The freely available property means the content must be licensed for use but the license is free. HL7 will continue to control the content, which will continue to be developed and balloted following the organization’s internal rules and standard development requirements under the American National Standards Institute. · Tables Show Differences in Measures for Stages 1 and 2 Hyperlink The tables compare core and menu objectives, showing which measures are new, changed or removed. · Link to the table for eligible professionals · Link to the table for hospital measures · What Percentage of Health Care Providers Use Smartphones During Patient Consultations? Hyperlink Seventy-four percent of surveyed physician assistants say they use smartphones during patient consultations, according to a recent report by Manhattan Research.
· IOM: Technology Could Help Fix U.S. Health System's Problems Hyperlink an 18-member panel of experts identified challenges facing the health care system and provided recommendations for improvement. · If anyone wants to be certified for Stage 1 you better hurry and apply no later than October 3, 2012. The current Temporary Certification Program is scheduled to end the next day when the Permanent Certification Program becomes effective. · Permanent Certification Program · Link to the Phase Two final rule · Political Heavyweights to Keynote HIMSS13 Hyperlink President Bill Clinton and combative political consultants James Carville and Karl Rove are among the confirmed keynote speakers for the 2013 HIMSS Conference & Exhibition in New Orleans next March. · It’s Go-Time for ICD-10 Hyperlink "It's a change of such momentous proportion," says Jacobs, director of IMA Consulting. "It is unlike anything that has happened to the industry." Even the introduction of diagnosis-related groups, the foundation of prospective payment, pales in comparison, she adds. "DRGs did not affect every single department like I-10. This is a change that will affect every single functional area in the hospital, every person and system that touches a claim. We don't really know what will happen in 2014. I do envision a lot of claim rejections." The wild card is the actual ICD-10 compliance date. CMS has postponed its implementation several times, even after asserting that the most recent ostensible go-live date of October 2013 was etched in stone.
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Quotes
“Confidence is what you have before you understand the problem” Woody Allen, quoted in the Monterey County, California, Herald
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