IT for Healthcare

Cincinnati Hospitals in Feud Over Health Alliance

Two Cincinnati-area hospitals, St. Luke and Christ, are engaged in a dispute with regional healthcare group, Health Alliance.  The two member hospitals are arguing that the group's leadership have made decisions that endanger their charitable mission to uninsured and indigent in the neighborhoods they serve.  In a bit of inspired hyperbole, an Alliance attorney likened the decision to withdraw to "dropping the nuclear bomb."  Presumably without the mushroom cloud, firestorms, and massive amounts of radioactive fallout.

Federal Investigators Warn of Privacy Issues with US NHIN

This NYT article is getting a lot of looks recently.  The GAO is chiding the Bush Administration for pushing for EHR and interoperability without a firm and realistic security plan in place:

The Bush administration has no clear strategy to protect the privacy of patients as it promotes the use of electronic medical records throughout the nation’s health care system, federal investigators say in a new report.

This topic is in the news more and more these days and is clearly on the minds of many.  One interesting point I'd like to see clarified:

Several members of Congress have drafted legislation to clarify consumers’ control over such data. One proposal, by Senator Sam Brownback of Kansas and Representative Paul D. Ryan of Wisconsin, both Republicans, would establish health data banks in which people could store electronic copies of their medical records. Under the bill, a consumer would “maintain ownership over the entire health record” and could control access to it.

By contrast, under existing federal rules, hospitals and other health care providers generally do not have to obtain a patient’s consent to use or disclose information for “treatment, payment or health care operations.”

There's no mention of the logistics of the Brownback-Ryan proposal.  One wonders if they have any idea how that would work, what strictures it would impose on the healthcare industry, whether it's at all feasible, etc. . . .  For instance, if the "consumer" had control of what was in the "bank" there would still be data at the doctor's office.  Would the bill address the individual locations and how they protect patient data?  Would it be realistic to expect that the patient-controlled record could be used as an accurate, reliable record for doctors to work with?  We've already seen protestations against PHR that allow patients to "edit" their records.

Is this even something that Congress can be trusted to deal with?  Should the market be allowed to work out these issues?  Is it too early to answer any of these questions???  Any ideas?

Doctors Buck Against UnitedHealth Dictates

On the heels of today's earlier post re: P4P and how many doctors feel it's a push by insurance companies to drive down costs with little regard to quality, I ran across this article on UnitedHealth's mandates for lab tests and procedures.

One concern voiced is over a "facility fee" that UH dropped which paid gastroenterologists to do certain procedures in hospital or ambulatory surgery centers:

Edward Cattau, chairman of the national affairs committee for American College of Gastroenterology, says that while some procedures can be safely performed in offices, there is far less state oversight compared with hospitals or surgery centers. Doctors should decide, he says, where to do procedures.

Connecticut doctors say the move amounts to a 30% pay cut because most doctors prefer to do the procedures in surgery centers or hospitals.

"We do see it clearly as an attempt to drive things into the office purely based on finances and not safety," says Cattau.

"[A]t what level should a health plan be able to dictate where medical services are provided?" asks Jeanine Freeman, senior vice president of legal affairs for the Iowa Medical Society.

For its part, United calls this particular rule "an acknowledgment that it costs a doctor more to do them in-office."

CA Health Plans: P4P over $55 Million

Seven CA plans (Aetna, BC of CA, BS of CA, CIGNA, Health Net of CA, PacifiCare, and Western Health Advantage) paid out a combined $55 million to an estimated 35,000 physicians who met Integrated Health Association's Pay for Performance standards in 2006.  Wait. . . misread that figure.  35K doctors are eligible.  It doesn't say how many were paid.  Interesting because my initial thought was that $55M over 35K is an average of about $1571 per doctor.  Not much considering the investment of time and money it takes to get there.  A figure we'd like to see is the average payout and what it took to get to the highest levels of payout - something that would give some real perspective.

Many physicians are suspicious of (or downright hostile toward) P4P, viewing it as an insurance company move to ultimately lower reimbursement.

(Third, will P4P be an excuse for some payers to reduce reimbursement? Medicare is the most influential payer to announce a P4P initiative because Medicare's reimbursement rates are the benchmark used by other insurance providers. For example, an insurer may reimburse at 110 percent of the Medicare rate and another, at 85 percent. If private payers parallel Medicare in lowering reimbursement but do not also adopt a performance bonus, physician reimbursement would decrease.)

An article sent our way by FOB (Friend of Blog) Darrell Pruitt decries P4P as a tool of insurers to get physicians to spend less money:

"We're concerned that as insurers try to maximize profits they are saying that the doctor that charges the least amount of money is the highest quality," said Dr. Jim Rohack, a cardiologist and AMA board member.

Insurers deny such motives.  And according to IHA's numbers, physicians "reported screening about 60,000 more women for cervical cancer, testing nearly 12,000 more diabetics, and administering approximately 30,000 more childhood immunizations than during the previous year for their patients enrolled in participating health plans."  Probably not something that saved the plans money in the short term - but that they expect will save money over time as less cervical cancers go unchecked and more patients with diabetes learn to control their condition.

It's a complex question that doesn't benefit from the simplifications of either the pro or con camps.  The principle is sound but the execution may not have yet caught up.  Or perhaps it has?  We don't really know as long as we don't understand how much the doctors in CA are getting individually for meeting P4P standards.

Take a look here at the Transparency Report on 2006 Payouts.  See what you make of that and whether it's helpful information.

More information on IHA's P4P program
Letter: Questioning CMS's P4P Results
IHA Press Releases

Should States Get in to EHR "Banking"?

Dr. William Yasnoff, founder of eHealthTrust, wants states to get into the business of EHR "banking".  That is to say, creating a repository for EHR data that would receive "deposits" from physicians but be controlled by patients.  Since this is the business eHT engages in, one assumes that he is either advocating for states to take his business away or, more likely, for states to contract his company to do the "banking". 

I need to review the details but my initial reaction is that it sounds like a sort of "hosted RHIO" that makes getting such an organization easier to get off the ground.  Could be a good answer to the myriad questions facing the future of EHR and interoperability.  What do you think?

Links
Article
Dr. Yasnoff Interview
eHT FAQ - What is it and how does it work?

Retail Clinics Enhance Primary Care Physicians Business

My initial reaction while reading this piece was that retail clinics would syphon patients away from already hurting private practices.  Then this:

Michael O’Neil, senior vice president and chief operating officer of Memorial Health System in South Bend, Ind., says the one-hospital system’s three MEDPOINT Express clinics have helped bring new patients into the network. “About 30 percent of the people coming in are not connected to a provider, and many require subsequent follow-up care,” he says. “We’re seeing a lot of our affiliated primary-care physicians get a number of referrals from these operations.”

Clearly the folks visiting these retail clinics are gaining much needed care at affordable rates; meanwhile, physicians are benefitting from bringing more of these folks - until now on the fringes of healthcare in America - into the system.  One hopes that the American healthcare system in general will also benefit from that early and preventive care many of these people would not have gotten otherwise.  I'm feeling optimistic today, so if you think my glasses are too rosy or see some reason(s) why Wal-Mart providing your healthcare is inherently wrong, let me know.

Menu of Services & Prices (MEDPOINT)

Buckeye RHIO Taking Shape

Central Ohio hospitals, in conjunction with Compete Columbus, the Ohio Hospital Association, and physicians, are coming together to build a community information exchange.  OhioHealth, which includes major

Columbus

hospitals (

Riverside

, Grant, and Doctor's) as well as many smaller facilities in the region, will spearhead the effort.  The article mentions a couple different RHIO models but gives no word on the logistics of this particular incarnation.  It mentions the so-called NEO RHIO here in the Greater Cleveland area, which we recently reported was resurfacing after three (or so) generally torpid years of lolling about on the regional backburner:

 

Hospitals in

Cleveland

,

Akron

and

Canton

plan to begin sharing patient information this year.

 

"If you come to me and had open heart surgery in such and such place and I can’t get the data, I’d repeat the test," said Dr. Brian Keaton, an emergency medicine physician at

Akron

’s   Summa Health System.

 

Keaton, who is leading the Northeast Ohio information exchange, said the program was created to improve care, not save money. It will cost as much as $4 million annually and initially be funded by fees from grants, loans and participating hospitals. Hospitals would pay on a sliding scale based on size.

The article also points out that

Cincinnati

has a functional (though not yet fully-fledged) RHIO known as HealthBridge:

 

In

Cincinnati

, a nonprofit agency called HealthBridge was created so hospitals, laboratories and radiology centers can share lab results and tests. It has a $2.5 million annual operating budget.

 

The agency has plans for doctors to share information with hospitals as well, said Keith Hepp, HealthBridge’s vice president of development.

Exciting times here in "The Heart of it All."

Columbus Dispatch Article

 

HIT Security Trianing

Privacy and security are a process.  They require the proper mindset from employees of healthcare organizations.  This brief article serves as a valuable reminder that security is a weakest link proposition.  No matter how well conceived your organization's protocols are, they are only as strong as the actual practice.

[Tacoma (Washington) Community Colleg health information management  distance learning instructor Kelley] Meeusen advises trainers to ask employees at the beginning of training whether they’ve ever sought treatment at the facility.

“Now they have a personal stake. Then I start elucidating what information we hold--addresses, telephone numbers, Social Security numbers, birth dates--everything necessary to steal your identity,” he says. “We also know what diseases they have [and] what procedures they’ve had. We know whether they’ve had psychiatric care, whether they’ve abused their children, [and] whether they’ve cheated on a spouse--we know all of these things about our patients—and our patients include you, your loved ones, and your coworkers.”

IT staff and security professionals will do their part to ensure information security, but typical employees can practice safe password behavior, adhere to organizational policies, and report inconsistencies or problems to the information security officer. Even employees who probably don’t have computer access (e.g., housekeeping staff, security guards, etc.) can contribute to facility access control by noticing people or things that are out of place.

The piece goes on to discuss the role of ongoing training and oversight:

Constant reminders are most effective, Meeusen says. As a trainer, he employs a gamut of techniques--including newsletters and a station at the organization’s patient safety fair--to bring HIPAA to the forefront of employees’ minds and actions.

Security requires constant vigiliance.  But the price is worth paying.  As Meeusen points out:

“For us to accurately diagnose and treat our patients, we need them to tell us everything--even things that they’re not going to tell their spouse or their best friend. If they don’t trust that we’ll secure what they tell us, then they’re not going to tell us."

HP Overtakes IBM

Not really on topic - though HP is considered the infrastructure leader in Healthcare IT - but we would be remiss (as an HP Business Partner) if we didn't point out that HP overtook IBM for annual revenue in 2006 (by an admittedly narrow margin) - $91.4 billion to $91.7 billion - to become the largest IT company (by revenue), in the world.  HP passed Dell for worldwide PC supremacy Q3 2006, too.  Overall a good year for HP in spite of some not-so-hot press.

Link

NHIN Demonstrations Deemed 'Success"

January 25-26, 2007 saw the Third Nationwide Health Information Network Forum descend on Washington, D.C. to further the cause of a unified national health information exchange (HIE).  You may recall that four independent consortia - lead by Accenture, Computer Sciences Corporation, IBM, and Northrop Grumman, respectively - were awarded the opportunity (read: grant money) to create prototype networks that demonstrate the road ahead for a single system.

IBM teamed with hospital systems in New York, North Carolina, and Virginia to develop a secure, public standards-based HIE that allows data sharing across distant communities.  The prototype includes the integration of seven proprietary EHR systems as well as a PHR system "intended to address patient privacy concerns."  In fact, according to FirstHealth (one of IBM's partners in NC) CIO David Dillehunt, "We took great pains to address privacy and security, to look at the patient perspective."

This brief piece asks the question, "Who will pay?" in response to Dillehunt's assertion that he is working with IBM to engage in a real-world deployment of the developed system.  That's the question many regional operations (RHIO) are asking today.  The answer, according to Dillehunt: IBM will pay for some of it but there are obvious values to the system that he believes will motivate stakeholders to pony up.  That's likely to be the strategy moving forward across the nation and certainly here in Northeast Ohio.

There isn't too much information on the other three prototypes, at least not that I've seen.  If anyone out there has anything interesting, let us know.

IBM Press Release