Health IT Conversation…A New Blog
There are lots of great ideas about how to use health IT and exchange electronic health information to improve outcomes and reduce costs in our health care system. The recent, unprecedented commitment of our nation to support the meaningful use of electronic health records (EHRs) has accelerated the pace of conversation. ONC and others have been listening.
Listening is critical because there is no predicting when the most intriguing thoughts and advice will pop to the surface. It could be in a hallway conversation, in testimony before an advisory committee, or in an email. It could also be on a blog. This is why we are launching the Health IT Buzz blog today.
With this new venture, we hope to create a forum for engagement. We plan to report on progress, and create an open dialogue among members of the health IT community. We intend to address a wide and diverse range of timely topics relevant to the “why’s and how’s” of efforts to support the secure and seamless exchange of electronic health information. We will discuss our ongoing work to protect patient privacy, secure information, and implement standards. We’ll also be using the blog to provide additional information regarding our new grant programs. And the conversation wouldn’t be complete without discussing the meaningful use rulemaking and incentive programs, clarifying our vision and addressing key challenges.
We want to hear from citizens, patients, health professionals, managers, policymakers, technology enthusiasts and technology skeptics. We can’t succeed unless we understand the wishes and concerns of the many constituencies we serve. So join us. Let us know what’s on your mind. Read and learn with us. We look forward to hearing what you have to say.
– David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology
I certainly appreciate this new forum for communication in this critically important area. Will the new ONC blog be integrated into the current Federal Advisory Committee blog in the future so we do not have to recreate profiles?
http://healthit.hhs.gov/blog/faca/index.php/2009/11/19/aneesh-chopra-reflects-on-progress-to-date-what-is-to-come
I think it would be good at some point to explore how we can create a single profile for all the ONC/FACA/HHS blogs, perhaps using Open ID…
It’s necessary to push for IT advances. It will speed up the process. It will engage caregiving and reduce human suffering.
EHR/EMR certification is an important means to create and maintain standards and to help buyers differentiate between the good, the bad and the ugly. There are complaints about the current system (CCHIT) being biased in favor of the big and rich software developers. Any thoughts? True, false? What to do differently? How to make it just and affordable? Reasonable time frame? Re-certification ok, but how frequently?
Regarding your inquiry: “There are complaints about the current system (CCHIT) being biased in favor of the big and rich software developers.” I have worked since 2006 with over 30 EHR vendors pursuing CCHIT Ambulatory and Inpatient Certification. In the 2008 cycle I was directly involved in 10 certification projects. Quite a few of the vendors who I helped achieve CCHIT certification were neither big nor rich. A number of them simply saw certification as the cost of doing business. Quite a few had less than 200 users, some had fewer that 50.
Jim, you bring a great perspective to the point that many small vendors have accomplished the current certification process.
One new area that I am excited to see will be certification of open source solutions. This slideshare is a great introduction to the discussion:
http://www.slideshare.net/cchit/cchit-open-source-forum-at-himss-09
We will also see other certification groups entering the process (such as the Drummond Group) and I feel confident that the process will be fair. Because of the pressure to meet the meaningful use of certified electronic health records criteria to qualify for incentive payments under ARRA, any EHR vendor that does not get certified will have a hard time.
There will be two types of vendors in the future. Those that are certified and those that are no longer in business.
Jim- This “cost of doing business” will eventually be passed down to physicians like me. If you look at the EMR Matrix at emrupdate, the average cost of CCHIT certified EMRs came out to about twice that of non-certified EMRs (see http://www.malebits.com/article-friend-4278.html ).
CCHIT is an advertising ploy for “enterprise” vendors and does kill competition within the HIT industry and does nothing to assure that a certified EHR is usable, and numerous articles have recently shown that the installation failure rates + deinstallation rate total above 50%.
Fortunately, CCHIT is “dying on the vine” since the HHS pulled the plug and terminated its relationship on 7/16/2009 and since then has tried unsuccessfully to reinvent itself. The CEO, Mark Leavitt MD last week stated that he will soon retire/resign/leave the sinking ship. CCHIT- may it RIP forever! It was a bad idea whose time has come and gone…
Al
Appreciate this forum!
IT is the future of medicine. I am a DoD Primary Care Manager for about 1200 patients, but I am also human and sitting home sick today. Through our secure portal I am able to communicate with patients, renew prescriptions, reschedule appointments, order and reassure patients about lab tests, etc. I can review radiographic studies in my kitchen. One potential stumbler is system intercommunicability; I can talk to the Army but not to Kaiser or Cigna. But we have really good people working on that and I am confident that hurdle will be cleared. The other really huge threat is infosec, but it’s no different in telemed than it is in banking or proprietary research or other fields requiring secure internet connections.
Thank you for adding the forum for comments. First of all, I want to perhaps explain where I come from as I am out there front line working with regular family practice MDs for the most part and I hear and see everything. What we see and talk about on the web with the brilliant individuals here is not what’s going on in real life. We need education so badly and MDs need people to hold their hands to move them up the next level with Health IT. We have MDs at every level, some that are lucky that they have a fax machine, that they turn off at 5 pm every day!
One of my primary areas of focus are the devices that report data and this is being over looked as it is new and new devices are coming around every day it seems. MDs are going to eventually all be accountable for treatment plans as a result of this data. I wrote an EMR several years ago when everything was still on the desktop so that gives me a birds eye view if you will on content and who will be integrating their information with who next and how the payment processes work. 2 years ago based on my observations then, I predicted we would have riots over healthcare in the US, again just by having some code background and watching business trends, it’s not that hard to figure out. What we do have today is technology throwing us a new left curve every week, so the processes and decisions made last week need to be updated, just like software.
I see our Congress struggling with this and I basically view from what I see in the news and other places, a group of non-participants and to understand value, you need to participate. To clarify this, I mean participants in their own healthcare and working towards the same goal, I just hear nothing about any of this from any members and we all have health as it’s not like a car we can choose to have or not have one.
I have been kidded about my comments and probably deservingly so, but gee is there anyway we can bring Congress up to date with the fact that they really need to take a cold hard look at where technology is going in healthcare with more devices that are and will be reporting data? The FDA is somewhat into this now as cell phones become a relative device too as they collect data. Perhaps we could outfit members with a Fitbit to experience how this is going to work as we also need a healthy participatory sensing program so devices are not merely thrown at patients to use without proper implementation. Companies who make them are marketing like crazy, which I understand to a degree as they need the sales to stay in business, but still we need balance as marketing and the quest for immediate sales can disrupt a good implementation and short change education and training here.
Devices as such will be disruptive and we need to prepare for this and find implementations that will work and likewise Congress needs to acknowledge that this piece of the puzzle exists! The devices are coming faster than what people realize and I see it every day with posting about many of them on the blog. I recently spoke with the Innovation leaders at Kaiser and they have work in progress for a lot of this which is great, but they are only one faction and this is massive. Also, privacy needs to be addressed and consumers need to know exactly where their information is going, as some information, as in the case of pharmacy benefit managers does not fall under HIPAA, something I know many are trying to work on.
I would believe that if you ask any hospital CEO too on budgets about how difficult it is, they would agree as they are having to budget for items for the next year that do not exist today, same thing with devices that consumers/patients will and do use. In summary here, I think a greater awareness and participation with Congress would really help and we may get some better laws out of all of this if they were in the technology loop. I have asked many times for role models, but see none. I like the ones in particular that talk about PHRs and how good they are, and then later I ask when one they are using and I get no answer as they are repeating what they hear and in turn are non participants talking. Participation and talking about problems and success at all levels will truly help. If the folks at the top don’t buy in and acknowledge Health IT, well how do you work with the attitude of “its for those guys over there” and this seems to be all over the place. There are no big white hopes out there anymore, it is all collaboration and input from many sources, just like data is today:) It would be great to have everyone who speaks about what is good and perhaps a fruitful idea to be participants.
Again, I see the devices reporting data being totally ignored on their part of meaningful use and it does need to be addressed as things today are not in compartments like we are accustomed to seeing, you have more than one government agency in charge of regulations and processes over one product, company or the likes thereof. HHS, FDA, CMS, etc. could all be government entities that have to come together on many projects and regulations. I personally thing that some algorithmic centric laws would help, but I’ll leave that one for another discussion as many many not get that end, but I think we are headed in that direction as we need some specifics other than pages of text in order to have laws and regulations that are enforceable.
Sorry for the long first comment here and hope I provided some food for thought and am testing out the new blog:)
Device level interoperability / meaningful use is way below the radar level of ONC, but it is not being ignored in the larger interoperability world. (Just remember, there is a lot in this arena that is not directed by the U.S. government!)
I would direct your attention to the Integrating the Healthcare Enterprise effort (www.ihe.net), and in particular its Patient Care Devices domain, and to the Continua Alliance. They are establishing consensus standards-based approaches to reliable, interoperable device connection to EMRs, whether in the healthcare provider office/hospital, or from health devices in the home – even from implanted cardiac rhythm control devices (pacemakers/defibrillators).
This is terrific and glad we have the opportunity for this open forum. I currently support the health IT investments and progress made over the past 5-6 years. Every year we seem to advance EHR standards, EHR certification and EHR interoperabilty which leads, in my opinion, to more “meaningful use” of those EHRs and health IT in general. This will be incremental progress though with investments coming from many private and public stakeholders.
Hopefully, at the end of the day, we all want the same thing… a “sustainable” healthcare system that has increased care quality, increased patient safety, reduces waste and leads the world in technological advances, research and innovation?
I look forward to seeing this site and forum mature. Let’s just keep it civil and respective of all perspectives and experiences.
Thanks, Justin
Thank you very much, David. I think this Health IT Buzz will fill a much needed void.
Patient health record should be a high priority. Health records belong to patients and they should not have to beg for it.
Knowledge is power to make a change and to help in the eradication of disparities.
As a physician, I dream of the day when EHRs will be able to communicate with each other. One of my patients had 9 pelvic sonograms in a year at different medical sites to include the same E.R. x 2!
I also dream of the day when a patient will be able to track who is having access to his/her health info. The same way we can check our credit.
iHealthGlobal, PLLC
Eradicating Health Disparities in Women & Families
A woman-Centered Medical Home
Fairfax, Virginia
While providing a means for EHR vendors to receive certification is an important step in creating standards of development. The certification (CCHIT) is just a first step along a path that has just begun to scratch the surface of what it means to “provide meaningful use”. The certification does not ensure the purchaser of the software that the product does NOT pose any patient safety risks or that it does NOT have significant gaps in functionality that will cost the customer lots of money/time to figure out work arounds to dificencies in the application. The cost to the consumer in purchasing an EMR goes way beyond the cost of the software and it’s licenses, the true cost of ownership is often not realized until it’s too late turn back. More comprehensive/detailed certification criteria could help this current problem that so many people are faced with after purchasing their EMR.
The opportunity to share ideas and thoughts is much appreciated!
How do some of the commercial EHR providers compete with VISTA at the VA? Can they collaborate? Surely there are lessons to be learned on both sides.
Federal funding may be encouraging a move toward EHR, but there’s more to it than just installing systems. How can healthcare data pooling lead to a better system? More at http://www.healthcaretownhall.com/?p=1499
I would love to see education as a key component of this blog. I work with quite a few hospital systems assisting them with implementing EHR solutions for their hospital owned and community networks. In addition, we support State and hospital HIE implementations right down to implementing a solo practitioner. Four of my hospital systems when engaged, did not have a project plan, workflow, change management processes, NOTHING prior to our involvement. The problem is they were months into their implementation process, and causing havoc within their own organization.
Large scale implementation of EHR, HIE, PHR and ultimately achieving meaningful use is what we are all striving for. However, without education on how to do it successfully makes the entire objective unrealistic. Many of my clients are lost, frustrated and stuck in an aggressive roll-out plan without a project plan when we arrive for the first time . My passion as well as my team is to help physicians and healthcare organizations succeed in every way with adoption. Taking a client from start to finish is so rewarding, especially when they look at you after the pain is over, and tell you they could never imagine going back to paper. Walking into a client for the first time that is in flux due to treating an implementation as if they were rolling out a new platform of Windows is not what we like to see. We wind up assisting them identify teams, develop a project plan, perform major workflow re-design, and manage all of the moving pieces for a successful implementation.
It doesn’t stop there. For those implemented, how are you using your system now? Workflow is not about current state. It is understanding now and how to determine what needs to change to obtain the goals of efficiency, patient safety, medical malpractice risk reduction, ROI, legal chart implementation, and preparing for meaningful use criteria. We all know there is more that that!
I hope there is a lot of participation, and this blog supports education to help hospital systems, physician practices and other healthcare organizations understand the complexity of what needs to be done from selection all the way through implementation, care management, IT and meaningful use. I read so many press releases of IPAs, state and hospital system implementations. Just because everyone is announcing their participation, doesn’t mean they are doing it well. We are in the trenches. We see what is behind the press releases and it isn’t pretty.
Without the foundation of knowledge, success of implementation and meeting ONC criteria and other initiatives, will be more difficult than it needs to be. Thanks for listening and I am very excited to see and learn from those who participate.
While I agree with EHR Consultant related to the education of the staff along with identification of processes utilizing an electronic record, I also feel that there needs to be something identified as well around quality of care of the patient tied to the EMR.
Outcomes are easlily built into documentation, and can be utilized by the organization to help improve their local care of the patient. If the organization can prove they have identified best practice at some point post go live for their high volume patient diagnosis.
The other thing that I have seen over the years working with EMR, is the complaint of users including physicians on how difficult it is to utilize the application. Useability is highly important to get staff to fully utilize a system.
Dear ihealthGlobal, I agree that partnering of the EMR and the PHR would provide a more cohesive method for utilizing Health IT to improve our mildly effective health care system. I do not believe HHS is sincerely seeking cutting edge concepts or willing to look beyond the four corners of a box to identify all possible manners in utilizing Health IT. I sent the Secretary a concept that utilize the EMR but also incorporate other modalities that would empower patients and assist with reducing duplication and over utilization, which is necessary to tame the current healthcare beast. I basically got a straight dear john reply from Dr. Blumenthal. Where is the change that I can believe it?
The education approach of the Regional Extension Centers is a wonderful model to assist and education individual health care providers. Years ago, this Extension Center approach helped educate American farmers on best practices and new technologies resulting in an effective, productive agricultural system that lowered food costs for all Americans.
Hopefully, when we look back fifties years from now we can say this was the point where we finally used best practices and available technology to create an effective, productive health care system that lowered health care cost for all Americans.
The educational approach of the Regional Extension Centers is a wonderful model to assist and educate individual health care providers. Years ago, this Extension Center approach helped educate American farmers on best practices and new technologies resulting in an effective, productive agricultural system that lowered food costs for all Americans.
Hopefully, when we look back fifty years from now we can say this was the point where we finally used best practices and available technology to create an effective, productive health care system that lowered health care cost for all Americans.
Is there a way HRSA or ONC can create a virtual project workspace at no cost, that has secure ‘rooms’, so that organizations like MedExpedite can work securely with geographicaly dispersed providers?
We are EHR consultants who help providers (Hospitals, FQHC, Physician offices) prepare their processes and staff for EHR adoption, and help them select and implement the best fit EHR.
What will it take to start a Regional Extension Center in Texas ??? How can we help HRSA or ONC to do this?
The first round of applications for regional extension centers have already been submitted and the second round is due Dec 22. According to yesterday’s announcement there has been so much interest that they cancelled the third round. It is by region so I am quite sure that Texas will have at least 1 REC. Are you connected to your state planning process? Most local HIMSS chapters are also really good resources since they track what is happening on the local level.
ONC has a link on the web site right next to this blog http://healthit.hhs.gov/portal/server.pt?open=512&objID=1335&mode=2&cached=true
Thank you, Dr. Blumenthal, and HHS for hosting this forum for all to leverage! Providers race to beat the Janaury 2011 clock to maximize the subsidized Medicare and Medicaid reimbursements via major EMR implementations. But as we look at the 5 domains of “Meaningful Use”, opportunity spreads across the Provider’s enterprise, to reach the goals of providing effective. Potential examples :
1) Improving the U.S. health system (EMR systems with interoperability – going further to transform traditional paper processes)
2) Safety and quality (improved processes and communications that directly impact patient management, treatment)
3) Engaging patients (communicating effectively, proactively and with follow-up – personalized to individual needs)
4) Populations (from community outreach with Wellcare approach, developing inter/intra Provider initiatives, etc)
5) Privacy (moving from unsecure paper/digital processes that enable incidental or unqualified access to patient data)
And these examples just scratch the surface! We have 5 years to progressively transform the way we deliver Healthcare, with requirements growing increasing stringent, and reimbursements lessening. Throw in ICD-10 (the Y2K of Healthcare in October of 2013) to consider. Tall orders for this industry over relatively little time!
Looking forward to more discussions!
Nancy Richardson
(more info and associated .gov links at: http://healthcareindustry.blogs.xerox.com/ and LinkedIn “Healthcare Pulse on Health IT Group)
As an instructor of introductory Medical Informatics, I am grateful that ONC is seeking feedback from all levels. I do however, have several concerns:
1. We need to minimize the hype that has been associated with EHRs, in regards to substantial improvements in patient safety and quality. For every positive article written on the subject, there is a rebuttal or flaw in the literature. Digitizing and automating medicine is a logical step forward, like progressing from a typewriter to a word processor. It is too early to state for certain long term benefits, as supported by several articles published this month.
2. I agree with MGMA that some degree of testing of “meaningful use” is indicated to better understand the actual impact of decisions on productivity, workflow, ROI, etc, etc.
3. For those of us who instruct others about EHRs, it is a struggle to find a hands-on web based EHR so students can actually navigate through the different functions. I have used Practice Fusion and OpenEMR for this purpose but would welcome a generic (probably open source) model EHR that would meet meaningful use and could be used for education and research. As get closer to Workforce money being released, HIT extension centers being created and a final definition of “meaningful use” we will need every possible tool available to help clinicians and others understand EHR implementation before the 2011 date.
Thanks for your efforts…..
Have you tried the CPRS demo at the VA site? It is not as visually appealing as current, Windows-like applications, but at least you can play with it.
I too have struggled to find specific information about the EMRs available as I have tried to compare them. Nearly impossible without speaking with a salesperson…
Should be easier.
While this may not provide “specific” information about EHR’s, it does help select and filter the 287 different EHR applications. Yes, 287. No wonder it’s so hard to find just one.
http://www.ehrscope.com/emr-comparison
Charles
Besides the discussions around EHR’s ,i would like to see as one of the goals of this group is the implementation of all hipaa business transactions so hospitals and payers can move to a “no touch” revenue cycle. It is 13 years later and we do not have one provider or payer who is communicating all their business transactions through the hipaa transactions that were approved in 1996. The savings that hospitals and payers will experience will be much greater then EHR. We must mandate these transactions and IT needs to show the industry that it can de done..
Congratulations Dr. Blumenthal and the rest of your team at ONC and more broadly, HHS.
Some comments to add to those above:
1) Do not post sporadically, strive for continuity as this will keep folks coming back for more. There is just so much going on today in the HIT space and likewise so many who are trying to understand the actions taking place at HHS/ONC, that this forum/blog will create a unique opportunity to both get the word out as well as solicit feedback.
2) Do use this space to reflect on what HHS/ONC is seeing in the market with regards to best practices, be it extension centers, HIEs or EHR roll-outs. Regarding the latter, it will be particularly of value to discuss what are the key challenges that practices face when implementing an EHR and strategies to mitigate.
3) Lastly, while you do have a lot on your plate, would encourage you to expand upon what is discussed here to highlight new modalities of care delivery (particularly those that are consumer-led/driven) with a particular focus on how IT has facilitated such to occur and the benefits derived.
With my comment now being number 24 or so, clearly you have an audience. Use it wisely.
John Moore
Managing Partner
Chilmark Research
It is interesting that in you post never once is the word “patient” mentioned. Although many of us who are empowered don’t use that term it is still important to remember that the goal is not simply a higher quality more cost effective health care system but one that is patient centered. In order to end up with health care that meets their needs it is critically important to include this critically important stakeholder and to design our process around their needs and to include not simply meaningful use but “outcomes that matter” to them as well. This is “user centered” design is not simply including them as a receipent of their data via a PHR but designing the system itself around their needs and the critically important conversations that happen between patients and their providers.
It is excticing to see ONC reaching out to the broader community using some of the tools of Government 2.0. One simple suggestion to help organize the infomration (vs an endless thread of comments) would be to consider using a forum like “user voice” to allow people to now only share their thoughts and vote but structure them a little better.
A good example of one tool can be found at http://www.ideasforseattle.org/pages/27772-general where the new mayor of Seattle is soliciting ideas from the broader community. It allows you to not only group ideas but gives new ideas a chance to be seen as well. This also mitigates the tendency of some people to dominate the conversation.
I am fairly new to the healthcare field and work for a home health agency while attending school full time. I’m 25 and expect everything to be handled electronically now-a-days, it’s just the way my generation sees things. I worked in a pharmacy for 3 years (WALG) and was amazed by how seamlessly our entire workflow with patients and doctors was handled on a daily basis by computers through e-prescribing and electronical patient input via online or tele.
Once I transitioned to home health it was a whole different world. It seems that this area in healthcare is so behind in terms of HIT. I can say the same for other providers such as hospice, nursing services, therapy centers and small doctors offices. At first glance you can see it falls into a financial issue with hardware and software being the main causes but there are other ways of improving IT in a healthcare practice without having to worry about the financial burden. I am working on a few ideas that I hope will help benefit the provider and the patient. I look forward to learning more on HIT and the input of others on this blog.
Please be aware that ONC will waste billions without a reliable healthcare data integration engine. I sent a list of them to Dr. Blumenthal. Take action!
Hi Jan,
I fully agree with the necessity of semantically interoperable data exchange; however, the internet and web-based technologies are rapidly replacing the need for “national infrastructures” or “data integration engines.”
Those with iPhones and other web-enabled handhelds already know what I write to be true. For example, no massive nationwide infrastructure was needed to create the ability for me to know exactly where I am along my route home (or the nearest gas station much less my ability to pay for the gas with my Paypal account…) using my iPhone. Apple, Google and Paypal’s platforms present the information I need seemlessly in real-time and from data sources stored around the country without the US government doing anything other than making the “internet” available to all of us.
Care teams need to treat; business managers need to keep their practices profitable; technologists need to make tools necessary to accomplish both tasks simply, effectively and affordably; and the government needs to make it easy/efficient for all three to do what must be done to ensure our national security, competiveness and personal privacy.
Alex
Great posts. Going to try for a short bulleted comment – like / dislike votes will define quantitative success.
1) CCHIT certification is doable by both large and small companies – there may be a bigger point though (and HHS is addressing it)
– What evidence is there that CCHIT certified systems make care better, more accessible and/or more affordable?
– as stated above, many participants went through it as a “cost of doing business” ($50K for full cert + programming cost)
There are examples, we (docsite) have some and lots of others do as well – that it is possible to improve care by 25-50% in a 3-6 months through the delivery of the right information to the right spot in workflow (by the way, using paper or computerized documentation at the point of care). The evidence says it is about key questions and results at the point of care, along with population lists…
eg – A1c > 9 or missing from 26% to 12% in large practices; doubling of perfect care for diabetes in an IPA,
– moving diabetics in good control (<= 7) from 42% to 57% in 6 months;
– 50% increase in controller med use in asthma in primary care;
– 2/3 of patients with hypertension under control
HHS certification looks to be aiming for certifying WHAT has PROVEN to work to IMPROVE CARE or CARE DELIVERY in the literature – namely – structured data, decision support, performance monitoring and interoperable team communication – in short FEEDBACK at the PATIENT and POPULATION levels.
Congratulations – Please, Please keep the focus on what has proven to work for improvement, rather than what any group of "experts" thinks will work. Also, make the bar high enough to limit provider purchase of systems that meet initial criteria but really are not designed to improve population and patient care through enhanced workflow.
John Haughton MD, MS
Chair / CMO – DocSite
http://www.docsite.com
I love the continued public discussion of such an important national topic. In that vein, I’d like to keep the public discussion public. I don’t mind seeing ratings on comments, but I don’t appreciate that I have to use extra clicks to see unpopular views. Those are often the most important ones for me and others to understand as we try to move the field forward. It strikes me as unnecessary censorship that shouldn’t occur in this forum.
Keith, what do you mean about “have to use extra clicks to see unpopular views?” To me, it looks like all the posts are shown, so I don’t know what extra clicks you’re talking about.
This initiative is great and will help others collaborate on defining better HIT solutions. I believe we need a technology mandate – especially in Independent Pharmacy technology services.
Pharmacy Technology Resource and StongCord have committed to LTCP owners and business leaders to support and drive the industry’s first “Mandate to Technology Vendors”.
Generally there are several key anxiety points around any technology selection. There might be multiple choices of one particular technology or software which purport to be the “Right Choice”. There are many technology vendors who claim to have the “silver bullet” or the one – technology solution that could change everything!
Questions posed: What about cost of selection? What effects are there in a particular selection? The purchase of the technology is one aspect of over cost – but what about implementation, proactive customer-centric support, and ongoing management of your choices? What about your own organizational adoption (or not) of the new system(s)? [How about the anticipation of failed expectations and the inevitable self-posed question, “Now what?”]
Business Goals Supported by Technology: Don’t start with the technology or software suggested. Does the vendor in consideration have a understanding, foggy view, or maybe no view at all of your business strategy and their technology alignment for 1, 3, and 5 years out?
What is your business goal?
What are you attempting to achieve for your business? Remember you need a strategy first.
Strategy focuses. People that depend on Process. Enabled by Technology. (In that order.)
What business challenges/problems is the contemplated technology intended to resolve?
Can you measure it?
What are the Have-to-Haves vs. the Nice-to-Haves when it comes to technology in your business?
Will the vendor guarantee the results or credit you when the technology doesn’t perform to the standards purported in the sales process?
Pharmacy Technology Vendor Mandate Proposal: Every Vendor promoting products and services to the LTC Pharmacy should share the risk of technology cost and performance with the Pharmacy Owner/Operator in the form of performance-based credits to the Pharmacy. This could be broken into three categories.
Customer Support: Effective or not effective every time you call on a specific issue tracked by a “ticket” or “problem/ issue log”
Software / Technology – performance: Does it do all it was presented to do while in the presentation or demo? Does it work properly? Is the software and or technology keeping your pharmacy from being productive and or profitable? Are bug fixes / identified problems not being corrected month after month?
Customer Software & Interfaces: Between vendors – are there integrated pieces of software? If these integrations don’t work – is there a “blame game” and is the issues unresolved?
This mandate is a concept that is not new in other industries. Will the vendor’s in the LTCP space commit to “FUNCTIONAL INTEGRITY?”
Feedback Requested: We need to hear from Technology / Software Vendors & LTC Pharmacy Owners and Operators. We can change the playing field for Independent LTC Pharmacy operations and help improve productivity and profitability – however – we need your support.
Read full article here:
http://pharmacytechnology.blogspot.com/2009/11/ascp-2009-annual-meeting-in-anaheim.html
Please send us your thoughts and feedback to help create the foundation of this mandate. Please send us an email to: partners@pharmacytechnology.net
If the system is ever to be consumer driven, consumers must be empowered by having access to their PHI.
A significant issue is security and privacy, but this needs to be addressed simply and with current technology. I have had the same ATM four-digit PIN number for years and have never lost a cent.
Providers need secure log-in that times-out but does not require 30 minutes a day of time logging back in; why not recommend LincPass possibly with proximity capability to build on the federal investment to date?
http://hspd12.usda.gov/
http://www.nist.gov/public_affairs/factsheet/biometrics.htm
Security of data should be logical: I have my servers in a locked room with limited access protected with multiple layers of software and monitoring, so this is addressed.
The true critical points are data on-the-move through unencrypted portable devices, thumb-drives, and email; gaps in off-site back-up; and, unauthorized employee use. All of these are already addressed by existing technology & HIPAA.
The most significant barrier to “meaningful use” of improving outcomes and reducing cost is the biggest gorilla: the reimbursement structure of paying for sickness episodes. But, DRGs aren’t definitely determined until post discharge. Why not extend this period per and post (to cover preadmission testing and readmissions) and bundle it?
Align incentives for hospitals and physicians to reduce costs by improving care rather than just restricting/reducing it. Since physicians already drive 60-80% of inpatient costs and are extremely intelligent, when they have had a financial stake in the CMS Demo Projects costs have been reduced without any compromise of care.
http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/ACEFactSheet.pdf
http://www.ehcca.com/presentations/pfpaudio20070110/waters_wynn.pdf
My bio: http://www.linkedin.com/in/marshallmaglothin
Healthcare Reform Offers Once in a life time, National Investment Opportunity for us to Build a Smart/Intelligent Infrastructure Services for: Healthcare IT, Smart Grids, Transportation Systems, and Broadband. This Smart/Intelligent Infrastructure Investment will be an Enabler of New Jobs Creation and Economic Recovery.
For decades, Microsoft’s Desktop Applications have Increased Productivity, Efficiency, and Costs Savings in the Work Place.
Proper Deployment of Health Information Technology (HIT) Solutions and Training will Increased Pproductivity (i, e, medical data mining/warehousing, risks treatment, service delivery), Efficiency (i, e, medical errors, redundant and inappropriate care), and have a Costs Savings of around 20-30% oof our Annual National Healthcare Expenditures ($2.4 Trillions).
The Engiine of Economic Growth for this 21st Century is “Broadband.” We can start by, Deploying a pure Packet-based, All Optical/IP, Multi-Service National Transport Network Infrastructure, using Optical Ethernet throughout this National “Network of Networks.” This “Network of Networks” can then Connect all Optical Islands, Nationwide.
The Investment in this National “Network of Networks”, in addition to New Jobs Creation and Economic Recovery, can also Serve as a Business Driver for: e-Healthcare, e-Commerce, e-Education, Energy Systems, TransportationSystems, Social Networking, Entertainment, etc.
This type of Investment is like, the Investments that were made in the past, in Electrification of Rural Areas, and in the National Transportation Interr-State Highways, which Increased Productivity and the Nation’s GDP
Please See: http://www.gkquoquoi.blogspot.com Summary NHIN Deployment Plan.
Gadema Korboi Quoquoi
President & CEO
COMPULINE INTERNATIONAL, INC.
My wish has already been expressed but I need to emphasize some points. The national directive must address the need to move clinical AND administrative data and we must learn what does not work by studying where the shortcomings are for moving administrative transactions. HIPAA Administrative transactions were supposed to save millions of dollars but we are not even close to achieving savings or administrative simplification for three reasons:
1. The standards are not really standard. Data content still varies greatly (for example when checking eligibility each health plan reports different data) and there are no definitions of terms (e.g. what does effective date mean compared to start date)?
2. There is no national network / EDI yellow pages. MN mandated 100% electronic eligibility, claims and remittances. We are only at 50% because we can not determine from a health care ID card, how to connect to a health plan.
3. We are automating processes that should not be automated. This industry needs to step back and design what we really should be doing. For example, why implement a claim status transaction (where the provider says to the health plan – “hey, what happened to my claim?”) when instead we should make sure claims processing is timely and informative so the provider does not have to ask the question. Another example involves analyzing the cost-benefit of some of our processes. Recently MN started discussing how to standardize prior-authorizations for prescription drugs. We heard that prior-authorization now exists for 100s drugs and the requirements vary widely by PBM/health plan. We need to step back and discuss if we need prior-authorizations? What is the cost compared to the savings? Why have this process when we heard that one major health plan auto-approves 80% of them?
I am hopeful and happy you have created this forum.
Through the Social Services Depatment at the Salisbury medical center in NC, I submitted an advance notication of how to dispose of my remains, and to request Do Not Resusitate.
I was told this would be made a part of my electronic record, and automatically copied to all VA centers.
The problem I see is that although the name is spread throughout the VA, it is not spread to other hospitals outside the VA.
The soluition would be to form an IT that contains all advance notices from whatever source, so that in the event of my terminal illness, all hospital facilities would have a copy, and could request that the remains be available to all hospitals. For your record, my SS# is ***-**-****A.
I would appreciate receiving an acknowledgement of this message.
Edward Ferrill McKee, .
I have been looking into different kind of EMRs. With all different kinds of them available and various fee schedules, I found it really hard to compare one from the other. Any one has experience with EMRs that might fit 4 physician practice and has reasonable fee schedule ?
Dr. Lu,
eClinicalWorks is one EMR that is fairly affordable and is even available at Sam’s Club. One fee includes hardware/software and some services to get your EMR up and running.
Please bear in mind that this is not an endorsement of eClinical works. Just something to consider.
Dr. Lu,
not knowing what specialty you practice I might still be able to assist you in finding the provider that’s right for you and your peers:
* Ask your service provider for an extended trial period of the system without any obligation
* Get a money-back guarantee if the system does not work for you or if you encounter a slow in patient flow
* Visit a practice that is using the system that you are considering
* Make sure to get access to the source code to the software
Best of luck for your transition into the digital age of healthcare.
Respectfully,
Michael Sasse
Director of Sales & Marketing
QuickView Medical Records, Inc.
Choosing an EMR is a personal decision that a pratice has to decide on. At a recent BONES (ortho) conference here in Florida, a group was asked how many have implemented an EMR, several raised their hands. When the same people people were asked if they were “HAPPY” with their EMR, there were no hands in site, and you could hear crickets.
We support Allscripts, Misys, centricity, Greenway, Nextgen, Eclinicalworks, and several others. Is one better than the other? That depends on what the doctor is expecting, and how willing that docotor is adapt to the new workflow. What does make the difference is the support (IT) staff that is there during and after implementation, that is, the person that will be there AFTER the EMR vendor has gotten there $$$, and no longer visits. (in particular, look for a IT vendor with experience in the HIT industry).
If you are a specialist, find out what other specialists are currently using. In particular, look at practices that are now “Chartless”. If they are still implementing, or still accessing paper charts, you will never get a good feel for how the end workflow will be, as they may never fully implement it.
Charles
My advice : Try to remember the “hidden equation” when you pick an EMR : What is best for the DOC is not always best for the PATIENT.
Think about where most of your patients come FROM, and where they go TO. Then talk to the IT people at those places to see if you can pick the same EMR.
The problem is often that picking this “other EMR” may not be the best for YOU, because of cost, training, etc – But it may be in your patient’s best interest that you’re using the same EMR that they’re using where your patients are commonly seen.
Unfortunately, many docs pick the system that is best for them, and in the end, that doesn’t help the patient.
Even more unfortunately, there is no perfect solution for this problem. But at least consider it before you invest in an EMR.
Would love to hear some conversation about how HIT can impact racial/ethnic health disparities. What suggestions do you have on how to engage communities of color to ensure inclusion.
Dr. Blumenthal:
What is really upsetting is that we are throwing away taxpayer money into the establishment of an HIT infrastructure that has yet to be proven. Numerous reports have demonstrated that it may well end up increasing costs, advancing new errors, and will not significantly increase quality and in some cases be detrimental to patient health. The few studies that have been done directly comparing paper/basic EMR to the “certified” EHR have either come out with mixed or insignificant results to in some cases, even increased mortality in the EHR group.
The costs of “significantly using” EHR is staggering to the physician like myself, and I conservatively calculated in my MDNG column for it to be about $60000.00 (or more) per year. See http://www.hcplive.com/primary-care/mdng-primarycare/PC_Medicare_HIT_mandate
All of this forced use of the “certified” EHR within the Medicare framework will only force physicians out of Medicare just when we need them the most. In fact, I’ve called for the first physician tea party to protest forced HIT use- the “HIT 1115 Project” where physicians are asked to downgrade their participation in protest to the HITECH Act. See- http://www.hcplive.com/technology/blogs/the_hit_realist/0909/HIT_1115_project
It’s a shame that the major “enterprise” EHR vendors have so much influence over President Obama. I’ve vigorously followed this pattern:
– YOU (received in past grants from GE)
– Glen Tullman (Allscripts)
– Nancy-Ann DeParle (Cerner)
– John Glaser (Partners HealthCare System)
– Thomas Frieden, MD (eCW)
– Jeffrey R. Immelt (CEO, GE)
At least you are beginning to ask some questions, and steps like this blog are positive. Please begin talking to those of us in the clinical trenches, working 100 hour weeks just to see our Medicare and other insurance reimbursement dwindle year after year. We are the ones most affected by these HIT mandates & penalties which amount to nothing more than another cut in our reimbursements- you’ll hear a very different story than what you are getting from vendors, nurses, and academic elitist physicians like yourself who will not be impacted by the HITECH Act.
Sincerely,
Al Borges, MD
My biggest fear is to see a large investment being squandered on the legacy EMR vendors whose products appear aged, expensive to maintain. There are good reasons providers are not picking up EMRs quickly and it revolves around efficiency and usability. We are working with a number of physicians to create an open source product aim for primary care physicians which is available to all at a lower price (free with options to pay for customization or hardware hosting) but higher quality than the current leading options.
We need to nationalize drug databases with manufacturers providing better barcodes, make snomed, loinc, rxnorm, icd 9/10, cpt, and other standard content consistent for all to easily access.
We need certification that is focused on physicians being able to provide the best care in the shortest time – not the best billing data at the expense of turning physicians into data entry clerks.
The market will change quickly as the next generation of physicians who understand and are used to open source and SAAS models. Lets not slow things down with large handouts of the old systems.
thanks
Greg
Gregory Caulton
Principal at PatientOS Inc.
http://www.patientos.com
http://www.patientos.org
The two areas which seem to not get much attention in EMR discussions is Long-Term Care and Speciality Doctors who may require something a little different when it comes to EMR/EHR solutions. Being at a Rural Hospital these are critical services we provide to the community and it concerns me a little as there isn’t much discussion around EMR implementation; requirements; measurements; reporting in these areas today.
Lets hope in the rural and community environments we are able to leverage future EMR investment which will support these other services instead of implementing individual systems and driving up IT cost with multiple systems.
HEALTHCARE NEEDS A DICTATOR
=======================
Our healthcare system is in mess. There are too many policies, standards, and politicians, private, public, research, and business entities are involved, and they all are looking for their own interest, rather than the wellbeing of general populations. Same is true for the health information technology (HIT). Time is now, for us to clean up the mess we created and we can start with HIT. To do that we need a dictator, who can order people to execute without asking why. We are asking why, for too long, it is time for “just do it”, and hopefully Dr. David Blumenthal is the right dictator.
Extend Rxnorm to have: 1) Drug Classes (could use VA drug classes 2) Drug Interactions (Drug-Drug, Drug-Disease) 3) Formularies
This will decrease the cost of e-prescribing by as much as $10-$20 / physician / month (3rd party costs to get at this info) – while at the same time, increasing the simplicity of interoperable systems.
We spend lots of time moving from RxNorm to other systems and back due to above limitations of RxNorm.
It should be possible to create a moderated forum for community management of the drug interactions (participants get voted into position by participation and prowess).
As previously communicated by me to Dr. Blumenthal, wide-scale introduction of EHRs provides a one-time opportunity to introduce some standardization into the collection of clinical data. If done, this should permit deidentified data to be used for population clinical studies comparing, for example contemporaneous outcomes in patients with similar diseases and prognostic variables but with different interventions. From this, comparative effectiveness research could easily be conducted. The current heterogeneity among EHR systems and the degree of customization some of them permit needs to be balanced against benefits to be gained by promoting population studies. I hope that some standardization is incorporated into planning and would be available to help in its implementation.
Dr Blumenthal, starting a blog seems like there might be a degree of pacifying the villagers because they may be thinking of burning the castle. Its been two days and no second post? Serious blogs have posts several times a day – the authors are engaged and often answer posts to their main blog. Are you actually writing it yourself?
The whole problem, and why “meaningful use” is likely to totally fail is doctors are in the top one percent of IQ and the top techies needed for a really good EMR are in the top 5% in IQ. And then you have their industries as massive in scale and deep in detail. The problem is alluded to best in a quote from above:
“…standards are not really standard. Data content still varies greatly (for example when checking eligibility each health plan reports different data) and there are no definitions of terms (e.g. what does effective date mean compared to start date…”
To build an EMR to harmonize all this variable data is after the fact, oh by the data standards are not just variable but dynamic as well!!!
Almost all the comments here have to do with features not structure. There are two ways to build this structure. First is the way every other industrialized nation has gone, centralizing of healthcare into government hands. The 70 health entities are nothing more than this – admission of failure. While outcomes have proven this method to be superior to the US in most outcomes, like all socialist style, demand side economic systems, innovation and research suffer.
We have a chance to really lead by devising a new system – government regulation of the structure not the features. Like government control of the roads – we don’t tell people what cars to drive or where they can stop or not but we only set the standard “rules of the road” so there is uniform use but in individual ways. The pallet with the paint but people can paint what they want.
Right now we have everyone chirping in on what they think a picture should look like not the formula for the paint. If we want any kind of meaningful use EMR developers need paint formulas that will be accepted not elements of what a picture looks like. To get the latter means “impossibility.”
Companies, particularly large companies, are out to protect their interests, in fact it is their ethical responsibility. It is the ethical responsibility of government to protect the freedom and happiness of the people. It is in healthcare companies interest to confuse and prevent uniform standards. The company that controls the road controls the trucking on that road.
We need a government mandated and controlled structure. DICOM formats, HL7 interchange, the afore mentioned Formulary structure, forced IT network communication structure etc etc.
Doctors are not idiots, they will not accept the “to be meaningful use” it must have. If we have the structures mentioned above rationalized EMR companies will flood the market with software doctors WANT not need.
In Boston, didn’t you rationalize the system there? You did it with one vendor! That is impractical unless we want socialized medicine, which we don’t, but the principle is the same, a rationalized infra-structure – only through regulation not meddling in personal enjoyment or should I say physician’s practices.
Please comment unless, this blog is just public relations written by a ghost writer.
CEOmike
One of the most fundamental requirements for the exchange of clinical information is accurately identifying the associated patient. Industry literature reports that the use of state-of-the-art enterprise master person index systems to perform this function yields an error rate in the range of 4% to 10% which is unacceptable if the information is going to be used to guide clinical therapy. The use of a unique patient identifier can eliminate this error but Congress has proscribed any use of federal resources to even study this possibility since 1998. We formed Global Patient Identifiers Inc. (GPII) as a healthcare non-profit a year ago in order to attempt to provide a private industry solution to this problem. GPII implements two ASTM International standards that represent 20 years of work on this issue. Important elements included in our solution include: ability to issue globally unique identifiers, no national database of identification data, ability to track all locations where data resides for an identifier, full support for anonymous as well as identifiable sets of data, ability to balance patient needs for privacy and the need to exchange information, ability to concurrently support many different privacy and operational paradigms, and a system implementation that is orders of magnitude less expensive than previous proposals. More information at http://gpii.info.
In light of the current congressional prohibition about studying this issue how does ONC propose to address this ‘show stopper’ requirement in order to enable operation of Health Information Exchanges and the NHIN?
There is a December 16 meeting of HIT Policy Committee’s Nationwide Health Information Network (NHIN) Workgroup, but I can not find anything on the web site about the upcoming meeting. I imagine that this meeting will work to to provide recommendations to the National Coordinator on a policy framework for the development and adoption of a nationwide health information technology infrastructure that permits the electronic exchange and use of health information as is consistent with the Federal Health IT Strategic Plan and that includes recommendations on the areas in which standards, implementation specifications, and certification criteria are needed.
Since the NHIN Workgroup has been charged with creating a policy and technical framework that allows the internet to be used for the secure and standards-based exchange of health information, in a way that is open to all and fosters innovation. Will background material on testimony from stakeholder groups be made available, and will the meeting by webcast?
I have to say that I am very disappointed that these important meetings are closed door meetings. This goes completely against this administrations position on transparency. I hope that we will have a clear explanation of why this meeting is not open to the public.
Hi;
Would appreciate clarification on a couple of Qs related to Meaningful Use Requirements and HITECH incentive payments.
The August 2009 Health IT Policy Council Recommendations to National Coordinator for Defining Meaningful Use includes a footnote:
“The HIT Policy Committee recommends that incentives be paid according to an “adoption year” timeframe rather than a calendar year timeframe. Under this scenario, qualifying for the first-year incentive payment would be assessed using the “2011 Measures.” The payment rate and phaseout of payments would follow the calendar dates in the statute, but qualifying for incentives would use the “adoption-year” approach.”
Does this imply that hospitals first qualifying for HITECH incentive payments starting in FY 2013 would do so using the 2011 meaningful use measures for the first two years of incentives (FY 2013 and FY 2014) and then qualify for incentive payments for FY 2015 and FY 2016 using 2013 measures?
Also can a hospital qualify for incentive monies in 2011 and 2012, not qualify in 2013 then qualify in 2014 and 2015? Or are “breaks” not allowed, meaning in this situation the hospital would lose eligibility for incentive monies in 2013 and qualify for 2014?
Thanks,
Rajiv
I agree with the essence of what many are stating here…EMRs cannot remain propietary in any manner and continue to promise the expectation of a low cost and expeditious implementation or success. As an industry, we have the history of several such lessons to learn as reminders us the difficultly and cost of implementation. If fact, anyone that has used legacy call center technologies, cell systems, and proprietary software is undoubtedly familiar with the pain and expense associated with deployment, version compliance, and interoperativity.
I have personally dealt with all of these technology transitions across a number of clinical and administrative healthcare environments. In order to be truly accessible to all, including both the metro hospital and the rural clinic, web access is now paramount. It is far more versatile, accessible and much lower in cost. In addition, public acceptance of web based solutions as an accepted business and personal utility is quite high. Proprietary EMR systems will not go to the web quickly simply by their inherent design to generate and protect profits. By going the way of the web, they compromise the true protection that platform dependency affords. By the same measure, Google, RevolutionHealth and other notable web masters have proposed web PHR systems that could easily integrate with provider recordkeeping efforts. They continue to work preparing for what they see as the inevitable migration of medical recordkeeping to the web.
Just as proprietary mainframe and legacy systems could not be sustained due to the demands of customer access and growth, neither will proprietary EMR systems. Current EMR vendors that are not open source or do not offer natural GUIs to other platforms are already obsolete.
Our company moved directly to the web purposefully with no platform dependency in order to become highly competitive and serve a variety of health care markets. We purposefully develop in open technologies in order to remain flexible and inexpensive. In fact some of our most time-intensive side development work involves customizing our technology for EMR products riding on proprietary platforms. Usually, the counter to this debate is security. The web is now as secure as any proprietary health program available, in fact more so in many cases. Mechanical theft (stealing hard drives) is much more difficult when data is uploaded to a single high security center over the web instead of 800,000 localized EMRs (the number of private practices in the nation) each with at least one storage media on site. Regularly moving this media offsite by courier exposes it to at least 4 times the possibility of becoming compromised versus over-the-web storage. However, it requires a shift in our paradigm of recordkeeping thought, a negligible challenge when compared to the push back that is soon to ensue from a nationwide mandate to convert to EMR technology.
The fed directive could be best served to investigate internet-based internet MRs as opposed to localized, physician-owned EMRs.
Conceptually, providers would pay a smaller outlay for a service to use the “IMR” versus attempting to reinvent and fund their key administrative function, medical recordkeeping. With the current EMR model, feds and providers will likely stay opposed to each other, adoption will remain slow, and costs will be passed back and forth to the patient, provider and fed. As well regulatory oversight, upgrades, and provider training would likely be far less complex and cost intensive.
BTW, building accessible, low cost apps that anyone on any platform can use IS possible and CAN support Meaningful Use, NCQA, Medical Home. We are doing it today to demonstrate patient self management of chronic disease and injury.
From a patient’s perspective, I certainly hope “meaningful use” standards (not merely “structure” as in roadways) are defined and implemented. I want EHRs fully integrated from my primary care Dr. to one or more specialists to the ER, and even to my dentist (they are now checking BP & pulse because they don’t know when their patients last saw a HC professional).
The application of best-practice decision-support systems would also be appreciated. The technology exists; it is just crying for standards to make it useful and affordable (witness the evolution of the PC – both in cost and performance – once standards were established).
While I am a passionate doctor/CMIO, a concerned American, and a big supporter of “Fixing the Healthcare IT problem” – and was initially *THRILLED* to learn about ARRA/HITECH – I am now growing increasingly worried about the HITECH incentives and how they will impact every single physician and hospital in our country. Generally, I agree that drastic measures are needed to help solve this problem, but it seems we haven’t tackled the informatics portion of this equation : How to develop the informatics support needed to solve the technical migration and implementation issues? How to solve the political problems that thwart interoperability standards? And how to develop the support infrastructure needed for all this? I applaud the government for at least recognizing the size and severity of the issue. However, I am deeply concerned that forcing all docs into “Meaningful Use”, when so many obstacles remain, and profit margins are frighteningly slim, could potentially have far-reaching unintended effects. Has there been any analysis of about how many doctors will retire early, and how many hospitals could close? Ultimately, I’m left asking myself, “Is this really what we wanted?”. Still, I hope to continue to engage other docs, and be a part of the eventual solution, in whatever form it comes in. I thank Dr. Blumenthal and the ONC as they try to tackle some of these complex and far-reaching issues.
While we are all discussing “meaningful use” and what that means to the healthcare community as a whole, let’s not forget about Behavioral Health (Substance Abuse and Mental Health). Seems the entire country is talking about “interoperability” but everyone seems to forget about this small piece of the pie. In order to treat the “entire” patient, their behavioral health is an important piece. However, federal law (42 CFR Part 2) prevents us from sharing data with just anyone. Specific releases must be signed by the patient for each person that will have access to any PHI. This quickly becomes a managment and risk nightmare when we are talking about “sharing” data with RHIO’s or HIE’s in order to meet the “meaningful use” definitions.
A niche business that has been in existence for almost 30 years is the Release of Information (ROI) Industry. Within this industry companies have had the job of exchanging information per patient authorization, between patients, providers, insurance companies, attorneys and state and federal agencies. This industry has spawned many innovations within this industy. Today many ROI companies are able to send information electronically to requesters of patient medical inforamtion. This industry provides qualified employees and supporting technology to move medical information. Benefactors of these innovations have been the hospitals and provider offices looking for ways to reduce their costs, streamline a labor intensive operation and improve the quality of care for their patients. You can visit http://www.ahios.org for more information about these companies and the quality services they provide.
Bonnie Coffey President, Association of Health Information Outsourcing Services (AHIOS)
I’ve been reading through the web ONC website trying to get answers for our 105 bed hospital. I’ve got some questions… if anybody has answers they’d be appreciated…
- I’d like to talk to a REC – but appears that applications are still being accepted, so does this mean I wouldn’t be able to find a list of REC’s somewhere on the internet to contact?
- Is it fair to say that CCHIT is the one our vendor should be getting certified with? I don’t see any mention of any others and the certification appears to be something that will be rather complicated and needs to be started rather soon
- I see mention of “100′s of public comments” on ONC’s past diliberations… are these available to the public? I don’t see them posted anywhere
- I don’t know where to start in finding state (or federal?) agencies that we should be sending electronic immunization and biosurvelliance data to… who are they and how do we get their requirements for electronic transmissions?
Thanks so much.
I will help answer a question or 3 for you.
No grants have been provided to any REC’s yet, therefore, they don’t actually exist yet. Depending on your state, the REC may be state-wide or Region wide. In Florida, I believe there are 2 REC’s proceeding to round 2, and 1 REC entering in round 2. None of these cover the entire state, in fact, if all 3 got funded, they still wouldn’t cover the entire state. Each state is different in their approach.
CCHIT is “Currently” the only certification vendor. Drummond Group has announced that they will be certifing as well. Expect one or 2 more to pop up as standards are published.
As for the “100′s of comments”, I have no clue on this one, so I will pass.
On your final question, sending data to an agency, that once again is a state by state based function. In Florida, we have RHIO’s (Regional Health Information Organization, several of which are operational, and I sit on the Board of Directors for ours), and eventually Florida will also offer a stae-wide HIE, which will connect to RHIO’s and rural communities that don’t have RHIO’s. I can tell you that for our RHIO, we just require an HL7 interface from your EHR.
If you are in Florida, you can find your local RHIO here: http://www.floridarhios.com/
If you live elsewhere, let me know which state (or city), and I will see if we can locate your RHIO.
hope this helps,
Charles
Charles, this is great information – thanks. My state is New Hampshire. On the registries – I’m interpretting your comments that your state has public health agencies that house databases and your RHIO routes HL7 transactions from a hospital’s EHR to each state agency? Do you know which agency(s) they are? & which HL7 transactions are used? Also, if you don’t mind, can I ask a couple more? What advice could you give our IT dept about meeting the electronic insurance eligibility objective? If we have the software that advertises doing realtime eligibility, is it usually just a matter of contacting each payer and arranging connectivity with them? And finally, are there any grants we can apply for? I went to grants.gov and it’s confusing to me – it implies there are grants to help, but they seem to be things for an HIE, and our hospital wouldn’t be initiating an HIE…. but maybe I’m missing something?
Thanks again, Charles…
Welcome to the blogosphere! I’ve been a blogger for a few years (writing on HIE and hospital stuff) and have a book on social media in healthcare in production. I’ve addressed policies and guidelines and am please to see you promoting them up front.
This blog is a great idea and I look forward to visiting and sending you some traffic from my blogroll.
I believe IT and EMR’s is going to become a reality, finally… I’m working on putting a company together that will offer Critical Access hospitals a turn-key solution for obtaining EMR’s. I have medical equipment planners, architects, contractors and grant writers and others working jointly to provide this service at a fraction of a cost to the hospitals. Because this service would only be available to Critical Access Hospitals, which have a maximum 25 bed size, i.e., a finite number, I’m able to provide numerous Critical Access Hospitals the needed service (at a fraction of the cost) for acquiring grant money for the design and implimentation of installing an EMR system. I believe Critical Access Hospitals, which are small community based hosptals, are feeling the effects of this economy disproportionately, to a point many will have to close. The must be an economical means of providing this service to them, and I believe my concept will work.
I welcome anyone’s thoughts on this matter.
Some form of certification is unavoidable, weather the current form is the right one, at least seems debatable. What providers must understand is that such certification is no guarantee of quality. In fact, it has nothing to do with it. It’s more like food labeling; it tells you what is in (or not) the product you are considering buying but says nothing about how yummee it is (or not).
So we are still missing an element to help non-technical people decide what is good, what is better.
What if the American Medical Association came up with a set of criteria that independent agencies could test against? Such criteria could include measurements about ease and reliability of use, or rate how well the program corresponds to the needs of various medical practices based, say, on size and specialty, among other things. Talk about a system designed by doctors for doctors.
This is a very welcome sight (no pun intended) to the HIT Community. I look forward to reading about news, updates and general information right from the source.
On another note, there should be some mechanism to flag posts as advertisements or unnecessary banter for the site admin to review. Thoughts?
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V
Dr. Blumenthal, thank you for the white board to hear our voice. In Colorado we are initiating one of the larger USA proposed statewide Telehealth Networks under the FCC Rural Health Care Pilot Program. The Colorado Telehealth Network (CTN) – (www.cotelehealth.com) will connect broadband to over 350 Health Care Providers (HCPs) including all major hospital systems in Colorado, 95%+ of all hospitals in Colorado, Mental Health Clinics, Rural Health Clinics, FQHCs and Community Health Clinics. This is a virtual private network, HIPPA compliant and secure, connecting to the Internet 2 which will allow for a national tele-presence. CTN has applied for ARRA Stimulus funds through the BTOP subcategory Sustainable Broadband Adoption. There was a very short deadline for application (first round) with Notification to be given November 6th, 2009. We understand there were issues related to definition of rural, but is there a reason for delaying feedback on Sustainable Broadband Adoption (SBA)? It would seem the controversial issues that relate to the overall BTOP are not applicable to SBA.
Health and IT need to go hand in hand especially now in the digital age. We need to eliminate useless paper forms that only hurt the environment and go paperless. This should help merge the two fields together, while increasing information consistency
We need to integrate health care and IT. When this happens we can go to any doctor in the world and they can have access to all our records. this does raise privacy issues that need to be sorted out.
Integration of IT and business entities for which they work is always a desireable goal. However, even a perfect partnership of IT and the business would not solve the problems with global healthcare. We have HIPAA and other initiatives, but there is no
global foundation on which to build, access and/or distribute healthcare data. We still live in an environment driven by IT vendor
proprietary standards. As the industry rushes to implement an EMR/EHR/PHR applications, we have dozens of vendors selling products all of which use a different database schema. So we have an IT group in a hospital perfectly in sync with the hospital from a business perspective, yet every provider supporting the hospital has their own unique EMR system back at their office which does not integrate with the hospital system. An in turn, the nation-wide network of hospitals all have disparate EMR systems which also don’t integrate. The best we can hope for in t his environment is a myriad of “interfaced” databases. If, on the other hand, DHHS tries to work with the industry to define a stardard “EMR database schema”, the healthcare special interest groups will cry foul or the large software vendors will push for unique extensions that render any standard to be of marginal benefit.
The bottom line is that it is nice to hold IT accountable for partnership with the business, but let’s no forget the bigger picture
of special interests, lack of standards and competing agendas.
I would like to recommend that more effort and focus be put on the implementation of a UNIVERSAL PATIENT ID. If we want to be able to travel nationwide and have our health record “follow us”, we need to take this effort on. Relying on matching algorithms for our health records is not recommended, nor is it supportive of a robust national health record network. ~ Marisa Barbieri, Managing Partner and Lead Health Care IT Strategist. http://www.competsolutions.com
Innovations in the health IT sector as far as technology is concerned is essential to improving the way we look after people and diagnosis illness.
As an outsider looking in from the UK, i am fascinated by the insights that are being provided here. We have recently learnt that a billion pound NHS Health IT project could be abandoned (http://business.timesonline.co.uk/tol/business/economics/pbr/article6946336.ece) – it seems to be something that we just cannot seem to get right. I will be reading your blog with interest.
Implementation of a true medical information exchange will and must become a reality. But as in every major every technological shift, the solutions will be invented in components – these components will become more and more integrated over time. The integration of these component solutions will not only require time but the establishment detailed standards. These standards will be required to not only allow the information be transportable but also useable in the receiver’s medical system. So how does one respond to today’s immediate needs and yet ensure that you have a strategy that takes you to that end vision? We at Emanumit believe that one of those components is a solution that easily plugs into ones own medical system and then allows you to electronically extract and package patient medical information (all forms of patient information – including images, video and voice) onto a fully encrypted CD with viewing security is a solution to some of today’s immediate needs. This solution makes electronic patient information transportation a reality and responding to legal requests for medical information not only secure but provides the opportunity to reduce costs. If you want to know more drop us an email at Iwanttoknowmore@emanumit.com.
It is a great idea to provide ability for disparate systems to communicate via NHIN-CONNECT. Government has done the right thing to divert ARRA funds for this initiative. As a 28 year old company providing IT services to healthcare industry, we are very excited about this and have several adapter offerings to integrate an organization’s internal systems to the NHIN backbone. We look forward to working with government agencies, providers and software vendors.
Where do Indian Tribes fit into ARRA’s HIT funding?
Our healthcare systems monetary situation is paramount in continuing this country in a manner which is beneficial to everyone involved. I hope we can cut down on an already escalating situation!
I am all for the healthcare reform but I just dont see how this is going to help us Economically. We have seemed to steady the ship but if/when a healthcare bill passes we could see some reprocusiions.
Does there need to be change to our (USA) current Health Care System, and should that include integrated IT support? Absolutely. Is patient privacy going to be a concern, yes, but should it deter our common decision to move forward, no. Lets identify these common problems with common solutions to achieve a better Health Care System.
The problem with health records is that they are highly sensitive, and privacy and security become a major issue when moving to an electronic system, when security vulnerabilities can compromise data privacy. This the main concern I have about move towards EHRs.
It seems that at least once a week we get news about someone getting access to our supposedly private credit card information and/or financial information. That’s scary enough – but what will it mean when these same criminals get access to our medical records? I worry about all that private information out there just waiting to be hacked.
:O So mush Info :O … THis Is he MOst AMAzing SIte DUDe…
With a proper health care and IT we will be able go to any doctor in the world and they can have access to all our records. This does raise privacy issues that need to be sorted out.
Health care and IT.. Worrying security issues – privacy is after all an important factor!
Nice one..
I was also guessing that this is a virtual private network, HIPPA compliant and secure, connecting to the Internet 2 which will allow for a national tele-presence.
It truly is a system designed by Doctors for Doctors.
Thank you for that informative post. I really love to read articles that have good information and ideas to share to each reader.
Get technical (medically qualified staff) and non medical staff to communicate in a structured way with dialogue to help plan for future technologies and communication challenges will go a long way towards overcoming lots of barriers that presently stand in the ways of both
It’ll be interesting to see what ramifications the recently passed health care bill will have on this.
Health care reform is needed! Looking forward to seeing what will happen. Things will need refinement for sure, but at least the ball is rolling…
Great points. Regarding information sharing for health IT I read an article recently that viewed government as an operating system, and the branches of government as APIs. In this perspective then, health IT would be shared over the government operating system via a health sector API. This would ensure that congress and our elected representatives would have regulatory power over who and what information is being pulled. JMO
I agree with the other posts that discuss the need for a universal EHR that would follow the patient wherever they go, I imagine this somewhat like Taiwan’s “smartcard” technology, which I’m very interested in learning more about. Of course, security would be an issue with the “smartcard”, if it were lost or stolen, but is it possible to use biometrics along with the “smartcard”? I’m just a 2nd semester HIM grad student who has absolutely no experience in this field (I’ve been a dental hygienist for the past 13 years), so I’m not sure if what I propose can be done as of yet, but I can’t imagine we’re too far off the mark. The biggest issue would be trying to create protocols and integrate the differing programs into a central database. I’m in an “IT Applications in Healthcare” class this summer and learning a lot, and I’m intrigued by this website and other’s ideas. I will be checking in often.
This is great article! It’s time people get engaged in discussions like this. Health reforms is a must and everyone should get involved in creating it.
I am all for the reduction in healthcare cost and the need to improve our efficiencies in the healthcare system. With electronic health records, you do away with miss fillings of these medical records and have greater turn time will access to these documents.
Being of a generation that has grown up with technology constantly propelling forward, I recognize the need for, and inevitability of moving forward in the way we record, update, and exchange electronic health information. Common logic forces us to agree that problems, health and otherwise, which can be addressed with more readily available and accurate information are more likely to have the benefit of an improved outcome over those problems which are not able to be addressed in a fully informed manner. This being said, the idea of abundantly thorough, accurate health information potentially being accessible to the wrong people poses a great threat to privacy protection. I am definitely in favor of pursuing growth in the field of health IT and the exchange of electronic health information, however, I hope that those responsible for this growth will find new, better, and ultimately successful ways of ensuring that privacy of this health information is truly protected.
For an integrated IT solution to work there needs to be some uniformity of systems and records storage that allows both fast efficiency as well as protection patient confidentiality.
This can also be tied in with both General Practice, Specialist and Dental records databases.
So if a person was admitted to hospital in an emergency, the doctors there could access the patients’ GP records.
A system like this does exist in other countries that have a central organization for health.
Unfortunately, with each State acting as a separate entity, it makes this task somewhat difficult.
As a technology enthusiast it would seem that the health system could benefit greatly from being more accessible through technology. It seems absolutely incredible that every visit to a health care provider starts with having to fill out by ‘pen’ the same information that’s already in the DR’s system on a peice of photocopied paper. Why can’t they hand me an ipad with my records on it with two buttons, “correct” or “update”. In fact, instead of calling to confirm appointments, send an email which also shows me my insurance and medical records to check-in before arrival. This would cut waiting times, and cut office admin for the DRs. If we can figure out online banking security, we can figure this out surely?
Can all this information be kept safe? That’s the question I would like to see answered. I was at my doctors two months ago and all the records are electronic. When I arrived at the office it was wall to wall people. Their network was down. And they had to work the old fashion way. Result my appt was 2 hours late.
As one who promotes the greater use of technology in all walks of life I am an advocate of the use of the most modern IT technology in administration. If used properly not only does it create a better customer experience but it also can make for much more efficient.
In health administration perhaps moreso than in other fields, security of data is a huge concern but there are now systems available which, although they cannot absolutely guarantee 100% security, are certainly more secure than any other form of data storage and transmission
It seems that the use of paperless records is inevitable. From a efficiency and portability point of view it only makes sense. I do fear as others have pointed out the security issue of keeping these records confidential. Another fear that I have is the ability to integrate the information, there should be one format that all systems can read and one one software with the same templates so that there isn’t any confusion as to how to read and add information.
I agree that it is efficient and portable.. Coming from an IT background and having working in a hospital IT department I can speak that hospitals do have VERY secure servers, that are very hard to hack. Lets be honest I think someone would rather hack in and find financial information, which has been electronic for years, instead of find out medical information about you
Certainly the issues of confidentiality of patient information and software compatibility are huge. There has been a big push to use only electronic records in the past couple of years, and I know that my records at my local primary care physician’s office have been converted and the large manila folder which contained all my records doesn’t exist any more. If I were to move I wonder if the new doctor would have the same software and be able to use the data? If they didn’t have the same software and tried to convert the old files to some other format it would seem the risk of losing important information would be high. I would hope these types of issues are being addressed.
I think it only makes sense to input digital means of sharing health information into the system. Think about the costs that are currently associated with the current system that is in place. I’m just going to list a few that would be heavily impacted in a positive way if a system like this was put into place. Paper costs, physical location costs, travel costs, general supplies. You could have someone in a random location be serving people around the world. They could still make their current wage, and still perform the service required, but so many costs could be saved. This is an older post, and I’m really wondering why this has not come about in the real world yet. Especially considering the current “health care crisis” that we in the states are experiencing.
I think that one of the most effective uses of IT is in the field of mental health. Individuals now have access to a wide range of materials including computer based CBT courses, peer support forums and online counselling in various forms including email, ‘chat’, voice over IP, video, etc. Online counselling enables a greater degree of access to counsellng support. Clients in remote locations, clients with disabilities or clients who simply find it hard to sit in the same room as a therapist can engage in therapeutic work from the safety of their own home.
I have lived in an underdeveloped country for more than 10 years where health insurance is almost unheard of, let alone the the utilization of technology with it. It was a country where their drivers license and passports were manually made and there was only one computer present in a government department, sometimes there wasn’t even any.
Yes, health insurance is a major problem in America today, but after living in a country where people are expected to die simply because they cannot afford a 10 cent antibiotic, I find myself counting my blessings. I am totally for Health Care IT – the promise of convenience, practicality, and increased information will be very valuable to our nation. Maybe someday, when we have finally fixed our health care problems with technology playing a major role, we can extend a helping hand – maybe even just in the form of information and education – to third world countries who are not as fortunate as we are.
Electronic records will be the way of the future. The questions will be: Is the information secure? Is the information backed up to prevent loss in case of a server meltdown or some other technical problem? Will the information be put into a standardized software program that can be accessed by the medical community?
One of the major problems with our health care system is its runaway cost. Health IT and exchange electronic health information will go a long way in addressing this soaring problem.
Care must be taken, though, to protect patients privacy from pirate organizations and persons while allowing access to the pertinent sources.
I have been in the group benefits industry for over 16 years. It never ceases to amaze me the endless hours we spend reprocessing claims because of small clerical mistakes. This is the main reason health insurance is so costly, a small charge can escalate to hundreds if not thousands of dollars simply because of human error and clerical mistakes.
I truly believe the Health IT and exchange electronic health information to improve outcomes and reduce costs in our health care system is one of the best initiatives in this new economy. With the advent of technology, business processes and sophisticated systems, it makes no sense why the health industry should still operate in the old economy. If you talked in today’s terms, it would be like using telex machines and telegraphs to conduct day-to-day operations.
My concern is privacy: how can medical and financial records privacy be maintained as the records become more and more digitized? It is hard enough to maintain privacy among professional individuals, but when the material is digitized, a single lapse can be catastrophic.
How great it is to find out that government is concern to everyone’s health but the problem is the people. I think it’s time for us citizens to get involve with this health issues chat and time for us to be heard. Now, let’s give it a try.
Electronic records will be the way of the future. And I am pretty sure that there is a way to make them secure.
Student guy, regarding your comment that security can be maintained.
I doubt it, really. Identity theft is an issue I have tracked (and litigated), and it’s scale is truly shocking. There are two big issues at least. First, the human problem. Even with federal law protecting privacy, health care givers frequently publish (tell unrelated people) protected information. Secondly, there’s simply the technological battle constantly being waged by hackers and data sites. Remember a couple of years ago that California revealed that half a million credit information sites had been hacked by one entity? And last year consider the furor over the possibility of international government-sponsored hacking? I agree with you that computerization is the wave of the future, but I think it’s naive to believe the records will be kept private. They’ll be up for grabs.
Electronic records certainly are the wave of the future, but I for one am reluctant to see us move this way until we have the security question figured out. How many times has the government started down a path, expecting to iron out the details later, and citizens end up getting burned when those little details become enormous problems years later?
Canada is already moving in this direction with electronic records as part of their health-care system – but they also have been studying and debating privacy and security issues intensely at the same time. The Canadian Medical Association actually has a department that exists solely to keep their doctor members educated about the issues and advise them. I’d like to see that level of commitment in the U.S. before we start entrusting our private info to systems that may or may not be secure.
EHRs are a good thing and should be implemented but I do have a concern. Years ago I worked in the Medical Records Department at one of the biggest HMOs in the country. We had to place loose pieces of patient records created by physicians into the correct charts. Then when the patient charts would be later ordered again when a patient had another appointment, the loose notes, prescriptions, etc. would be then filed in the appropriate section of the chart according to date.
More often than you would think, the wrong patient notes would be filed in the wrong patient’s chart and if the health care professional didn’t spot the mistake the patient could possibly receive care that isn’t as good as it could be.
Luckily I’m a very healthy person but when I get older and start receiving more care, I will review my own chart on a regular basis for errors.
My point is that I hope that there will be an even better system of checks and balances in digital records…
Thanks for post. Very thought provoking. Health care costs are astronnomical. Something must be done and technology is our best bet. As a technology enthusiast it would seem that the health system could benefit greatly from being more accessible through technology. It seems absolutely incredible that every visit to a health care provider starts with having to fill out by ‘pen’ the same information that’s already in the DR’s system on a peice of photocopied paper. Why can’t they hand me an ipad with my records on it with two buttons, “correct” or “update”. In fact, instead of calling to confirm appointments, send an email which also shows me my insurance and medical records to check-in before arrival. This would cut waiting times, and cut office admin for the DRs. If we can figure out online banking security, we can figure this out surely? We must devote more and more resources to this area. Thanks again, Ann
I am appaled at the heatlh system. THere is always stuff on the news about the shortage of beds and staff. I hear some countries are proposing doing doctors consult by internet, how is that going to work. THere really needs to be some serious reform done, otherwise we are toast
I share Mr. Hogan’s skepticism about privacy being protected, but I will be interested to hear of the new developments in IT designed to protect privacy without bogging down the system in endless roadblocks to keep out hackers. I hear a lot from the president about how much money all this efficiency is going to save everybody–is there any data supporting any of those claims?
As the briefly mentioned phrase in your article “electronic health information” – recently is the rapid adoption of biometrics in health care – with multi-modal portable applications such as fingerprint + iris recognition (or any mix and match) to identify patients such that there would be greatly reduced mis-steps with regards to care.
Using “IT to improve outcomes and reduce costs in our health care system” is certainly a worthy objective.
But this goal is made more difficult by recent legislation that virtually puts our health care system under government control and management.
We are moving in the wrong direction. Sure, break the collusive ties between the insurance industry and the provider lobby.
But not at the expense of private sector involvement. Innovation and progress has its roots in the private sector.
Totally agree James. Though I think the use of online/communications resources is an excellent assistant to a system that is struggling, I still think major improvements are needed. I think enabling patients to be diagnosed and treated via video link would be a welcome addition.
Medical information can be made available electronically, but physicians need to look at and not necessarily rely upon another physician’s report. Sometimes the interpretation of a radiological exam is incorrect and results in further medical complications, loss of income, and additional medical expenses.
I am a dentist is Florida. We’re in the process of moving as many records as possible to a digital format. While it has been a bit of a pain it will be totally worth it over the long haul. Thanks, Dr. G
Möbel…
I genuinely treasure this work , Great post….
Thank you very much for this great information. More interesting, I have learned a lot of this topic. Thanks for sharing.
Thanks for the post, David. Healthcare IT is a big deal and technology will lend especially well to speeding up service levels for patients across hospitals everywhere.
IT is the future of medicine. I am a DoD Primary Care Manager for about 1200 patients, but I am also human and sitting home sick today. Through our secure portal I am able to communicate with patients, renew prescriptions, reschedule appointments, order and reassure patients about lab tests, etc. I can review radiographic studies in my kitchen.
Please know that ONC will spend enormous amounts without a efficient medical care information incorporation website. I sent a record of them to Dr. Blumenthal. Take action!
Good thoughts. The IT is everywhere and all are enjoying their benefits then why should health will remain behind. Health IT basically help to both doctors as well as patient in a way that it reduce time and cost to and even help in emergency that a patient can’t approach doctor directly.