IT for Healthcare

HIStalk interview with dbMotion GM

HIStalk posts an exclusive interview with Peter van der Grinten, dbMotion's General Manager of US/Canada operations.  dbMotion is an Israeli company with extensive experience in the RHIO/IDN interoperability arena.  They garnered a mention here back in May of this year when we discussed RHIO and growing the stand-alone EMR into the interoperable EHR.

van der Grinten:

If you look at healthcare today, with rising costs, IDNs and RHIOs need to make interoperability the focus. We’re on a mission to get this interoperability where it benefits patients the most. UPMC wants to give better care to their patients. If we can deliver interoperability solutions without spending billions to convert everyone, that's the way to go. It doesn’t require the massive investment of a single vendor solution, but provides patient benefit.

The dbMotion website is positively Spartan but it does have a brief video that touts their real-world experience putting together an information exchange for Clalit, a 14-hospital, five million patient hospital network in Israel.  Check it out to learn more about how the RHIO movement is taking shape.

The Healthcare Payer Debate

There's a pretty hot debate going on over at Brewed Fresh Daily right now about the merits and pitfalls of our current healthcare payer system versus universal/single-payer healthcare (versus some as-yet-undiscovered-but-undoubtedly-infinitely-better system).  It probably isn't going to solve any of the world's problems but it is fun to watch!

Link

CCHIT Certification Ranks Expanded to 33

The list of newly CCHIT-certified EHR vendors was released yesterday.  The list included a couple of Northeast Ohio companies - Noteworthy Medical Systems and ProPractica - among its 11 new members.

According to the press release, "The CCHIT Certified^SM mark—the only recognized “seal of approval” for ambulatory EHR products—provides the first consensus-based, consistent benchmark to help physicians reduce their risk when investing in this technology."  Most non-CCHIT vendors would probably take issue with that verbiage. . . .

Speaking of Stakeholder Involvement. . .

At the end of this post, and as an echo to Dr. Rob Lamberts' calls here, we called for greater patient participation in the transformation of healthcare, especially the adoption of HIT measures and incentive policies such as P4P.  As if on cue, we then ran across this post by Dr. Steve Beller, also at The Medical Blog Network, on this exact subject.

If the American public is to ever stand up and demand meaningful change, they would need a sensible rallying point, something they can understand and support, and something that is powerful enough to withstand the push-back from the mighty self-interests gaining from the status quo who will resist such change. . . .

If I’m correct, rallying the public first requires educating them about why feeling insecure about their health and finances is the most rational reaction to the current healthcare system. They then have to debate what changes are necessary to transform the system, which requires further education, along with good collaborative communication for discussing and evaluating ideas.

Interesting.  There's a longer thread at The Health Care Blog with some back and forth on this subject.

There's also an article at abcnews.com that touches on the Healthcare IT revolution and it's role in bringing about better, more efficient, more cost-effective care:

 

Better availability of information will improve quality and customer service, but it is by no means certain that the adoption of information technology will inevitably lead to big cost savings.

Some efficiency will be gained by eliminating transcription costs and reducing duplication of tests, but better information may actually lead to higher spending. After all, with more information about their conditions, patients may seek additional treatment.

Information can be used to hold down health care costs, but that requires political will. . . .

If we choose as a society to use information for hard decisions, costs will be contained. But the model will be different from the

United Kingdom

and

Germany

. We'll use incentives and cost sharing, not outright bans and price controls. Examples are emerging in the public and private sectors.

The political will required will come of greater understanding and participation on the part of all Americans when it comes to their healthcare, the options they face, and how new technologies impact those options.  The "rallying point" required is two-fold: 1) "Better availability of informaiton. . . . " and 2) better communication of that information.  As healthcare consumers (patients) learn to demand more of each, they will become better partners to their doctors in the ongoing process of their own health maintenance.  That's a goal both doctors and patients can get behind. 

Changing Culture Improves Care

Dr. Brent James, a Harvard-trained surgeon and statistician working with Utah's Intermountain Healthcare, is working hard to change the culture in which physicians practice.

When James began researching to compare treatment results, he found the discrepancies were staggering.

"It turns out that physicians mis-estimate the truth about 20 to 50 percent," James said.

He found doctors were far less accurate if they relied on their memories rather than on computer data. Armed with his statistics, James began to change the medical culture.

This article is brief but has some good information.  Also, check out Dr. Rob Lamberts' blog on The Medical Blog Network for analysis from a practitioner:

Many physicians oppose pay for performance, saying that it is so wrought with problems that it will cause more problems than it solves. I think, however, that one of the main reasons they oppose it is fear of finding out that their quality does not stack up.  In our practice, analysis of our data showed significant deficiencies in certain areas. Rather than get upset by these deficiencies, however, we were able to correct these problems and greatly improve the care for our patients.

That sort of blunt assessment may not win many friends in the healthcare community but it seems to us that it's exactly what is called for today.  There is clearly a disconnect between the community of healthcare providers (generally) and the best interest of patients.  According to Dr. Lamberts: The patient is often left out of the discussion regarding EMR and P4P. I believe that they stand to have the greatest benefit from the adoption of these changes.  We need to find ways to include every stakeholder in this discussion and work to better understand how the tools of technology can help create more efficient, higher quality care settings and improve communication between physicians and patients - all while ensuring that physicians are compensated for the increased quality of care they provide.

Another stolen laptop. . . even rats learn eventually!

Upon first seeing this, we could barely bring ourselves to read another "stolen laptop" story.  Then, after further deliberation, it seemed right just to point out that, once again, it isn't the technology that's the problem here.  It's the UNBELIEVABLE stupidity of the person that leaves sensitive patient data in a mobile computer in their car.

[Alllina Hospitals spokesperson David] Kanihan said that the nurse whose computer was stolen said she had left the laptop in her car when she went in to a Minneapolis lab to drop off a specimen. The nurse believes she locked the vehicle, he added. The theft was reported to Minneapolis police.

It's so simple.  Never, never leave a computer with patient data anywhere where it can be stolen.  Don't leave it on the front seat while you run into the gas station for cigarettes; don't leave it in the trunk while you stop off to get a sandwich.  Just don't.  Handcuff it to your wrist, if you must, but don't ever let it be compromised.  You would think that after reading fifteen of these stories in the past six months, people would learn!

Leavitt Calls for Coordination of IT and Genetics

Happy Friday, all!  Here's an interesting piece of news to carry you into the weekend.  The actual article is brief but sparks some thought - and we imagine, discussion - over the repercussions of tying such controversial information as patient genetics to their health record(s).  The goal, according to Leavitt, is "to standardize the use and storage of genetic data so it can become part of the national electronic health-record system under development at HHS."  Concerns about insurers denying coverage - or raising premiums - based on genetic predisposition to disease(s) will be the stumbling block for any such initiative, though, according to bioethics expert Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania:

The chance of replacing today’s largely paper-based records system with a system combining genetics and IT, given today’s legal environment and a payment system dominated by private-sector health insurance companies, “is somewhere between hopeless and none,” Caplan says. While the goal of standardizing the technology is laudable, patients will not stand for a system that allows insurers to charge rates based on a genetic forecast of future health, he says.

Again, the article itself doesn't delve too deeply into the various issues but goes far enough to get the conversation started.  It will be interesting to see how this plays out; we've heard other rumblings on this and are starting to see more and more.

Have a great weekend and see you Monday.

Small & Medium Practices to Demo P4P

CMS announces a new three-year pay-for-performance demo program for small and medium physician offices.

Under this demonstration, physician groups will continue to be paid on a fee-for-service basis. Participating physicians will submit data on up to 26 quality measures related to the care of patients with diabetes, congestive heart failure and coronary artery disease, as well as the provision of preventive health services such as immunizations and cancer screenings to high-risk patients. During the first year, the program will be a “pay-for-reporting” initiative to provide baseline information on quality and to help physicians become familiar with the quality measurement process. In subsequent years, practices will be eligible to earn incentives of up to $10,000 per physician and up to $50,000 per practice annually.

Link

Looming Shortage of Geriatric Specialists in US

This story is an interesting counterpoint to our usual high-tech focus.  According to leading medical experts, there is a "mismatch between supply and demand" for elderly care specialists that will cause serious problems down the road.  Much of the problem revolves around the fact that care for the elderly isn't sexy.  According to Dr. Marie Bernard, "[Medical students] want to do laser-guided this and endoscopic that."

[Caring for the elderly is about] common-sense remedies in a health care system that rewards the heroics of specialists, in both compensation and prestige.  The best-paid doctors are those who do the most procedures; radiologists and orthopedic surgeons top the list with average annual incomes of $400,000. Geriatricians, who do a residency in internal or family medicine and then a fellowship in geriatrics, are near the bottom, at $150,000 a year.

Technology's great but ultimately, as stories like this prove, it's just a tool that helps caring, talented folks find ways to heal people.  We think that's important to keep in mind when discussing technology's impact on healthcare.

 

Preparing for National Provider Identifier

Information on preparing your organization for compliance with the upcoming National Provider Identifier standard:

To move into the new National Provider Identifier environment, healthcare organizations must create several crosswalks to submit claims properly, post remittances accurately, and research past claims and remittances.

Link
NPI FAQ