Predictions for 2011
December 29, 2010
Along with egg nog and after-Christmas clearance sales, late December always brings predictions for the coming year.
In the healthcare IT space, several consulting firms (e.g. IDC, PWC) have recently issued predictions for 2011.
Brian Horowitz, HIT reporter for eWeek magazine does a good job in summing the various prognosticastions into a “top five” list.
See the full article here: http://www.eweek.com/c/a/Health-Care-IT/Virtualization-EHRLinked-Devices-mHealth-to-Lead-Health-Care-IT-in-2011-Analysts-640839/
Included in the top five ideas selected by eWeek are:
1. Health care IT departments will increasingly adopt virtualization. The article reports that limited space in hospital basements will “force the hand of most CIOs who have stuck to physical servers to start really moving to virtual servers.”
2: Stand-alone medical devices will become more integrated in IT strategy and priorities. We’ve heard this before, of course, but does seem to be coming true. At a recent conference, the CIO of Sharp Healthcare said his HIS was currently collecting data from more than 50 different types of medical devices.
3: Identity and access management will be essential tools in fighting data breaches. The article notes the increasing number of data breaches in health care and posits that “a single log-in for multiple databases will be vital to centralize IAM (identity access management.”
“Provisioning and deprovisioning log-in credentials will be easier with a single-sign-on procedure,” the article adds.
I had not seen the term deprovisioning before, but I like it as a wonderful new piece of jargon. I can see (my own prediction for 2011) that it will quickly replace simple, boring old words like deny, restrict and cancel.
Defining Value in Healthcare
December 27, 2010
We all want value in healthcare, but what is it exactly? How should it be measured?
Michael Porter, the famous Harvard Business School professor and author of 12 books on management, has written an excellent article in the current New England Journal of Medicine on value.
The full article is available here http://healthpolicyandreform.nejm.org/?p=13328
Porter defines value as “the health outcomes achieved per dollar spent.”
He adds that value is “neither an abstract ideal nor a code word for cost reduction.” He adds that it remains “largely unmeasured and misunderstood.”
What about HEDIS? He points out that of the 78 HEDIS measures for 2010, “all but 5 are process measurs and none are true outcomes.”
There are many reasons why we aren’t currently measuring value. “Providers tend to measure only what they directly control in a particular intervention,” he notes
“Costs are measured for departments or billing units rather than for the full care cycle over which value is determined.”
Many of Porter’s points have been made before, but this article (and the accompanying charts) state the problem in very understandable way.
One question I have is “Does any country currently measure value effectively?”
The UK and its NHS certainly measure the various cost elements (drugs, hospitalization) very carefully, but do they measure value “over the full cycle of care?”
Allscripts is Black and Orange
December 22, 2010
Ever wondered what the screens of the various EHR vendors look like?
Information Week has published a slide show that includes screen shots of 17 “leading” EHR vendors (they don’t explain how the 17 were selected out of the 300+ vendors available).
The presentation is available on the Information Week Web site, here: http://www.informationweek.com/news/galleries/healthcare/EMR/showArticle.jhtml?articleID=228800771&pgno=3&isPrev=
For example, you can see that Allscripts uses orange and black on its main screen, while Athena Health uses green. The majority of EHRs use various sedate hues of grey and blue.
Prices for some products are also given. For example, eClinicalWorks is avaiable for “a one-time license fee of $10,000 for the first provider and $5,000 for each additional provider, plus monthly fees that range from $200 to $650…”
NextGen’s ambulatory system is “available through a software-as-a-service (SaaS) subscription model for smaller practices that want to avoid the upfront costs. A monthly subscription costs $599 per provider. ”
I’ve represented a number of EHR vendors over the years and I’ve seen different philosophies about showing the product to noncustomers. Some companies allow visitors to demo their systems via their home page, while other companies insist on taking your contact info and making an appointment before letting you “into the tent” to see their product.
Feds Want Anti-Fraud Software
December 19, 2010
Predictive modeling software can project healthcare costs for various population groups, can it also be used to detect Medicare fraud?
Officials at the CMS hope so. Healthleaders.com reports that CMS is soliciting private companies to provide “state-of-the-art fraud fighting analytic tools to help the agency predict and prevent potentially wasteful, abusive or fraudulent payments before they occur.”
The tools would be used by the National Fraud Prevention Program as well as the Department of Justice Health Care Fraud Prevention and Enforcement Action Team (HEAT).
A recent pilot program linked public data with fraud alerts from private payers and court records and uncovered a scheme in which several suspect providers were found to have opened up multiple companies at the same location, on the same day. They used provider numbers of physicians in other states.
Currently, private health plans use data analytics to examine suspicious or “outlier” claims, such as a 22-year-old man needing heart bypass surgery or a 60-year-old woman obtaining a C-section. Theoretically, by tapping into large data bases of claims, fraudulent Medicare claims could be detected prior to payment.
Help! Docs can’t meet eRx in 2011.
December 14, 2010
When I sat at a table of hospital CIOs at a local conference earlier this month, they all agreed that the ICD-10 requirements scheduled to take effect in 2013 would have to be postponed.
Now it looks like all the physician groups in the country are asking that a new CMS timeline for implementing e-prescribing in 2011 be postponed.
A letter, signed by the American Medical Association, 53 medical specialty societies and 49 state medical societies, was sent to HHS Secretary Kathleen Sebelius. It asked her to revise a federal timeline that calls for penalizing physicians in 2012 and 2013 for not using electronic prescribing in 2011.
The letter noted that many physicians are “working in good faith” to implement EHRs and meet the MU requirments. The physician organizations add that this “last minute decision” by CMS will force physicians to buy eRx software systems that they will later discard when they transition to a complete EHR system.
The complete letter is available here: https://www.aamc.org/download/165276/data/sign-on_letter_on_e-prescribing_penalties.pdf
Bedside Manner vs. CPOE
December 12, 2010
What is more important in hospital patient care: communicating effectively with patients or having a CPOE system?
According to a commentary by Joe Bormel, M.D., MPH
CMO & VP, QuadraMed, posted on the Healthcare Informatics website, the former is more important than the latter.
Dr. Bormel, citing the care his mother had at anonymous hospital in the Northeast, noted the facility laced CPOE, but had implemented several “patient friendly” practices that impressed him.
He noted the hospital had an established a practice of bringing patients’ families in on rounds. The hospital, which still used paper records, also assigned a “care team” to his mother and did a very good job of sharing patient information and care instructions through paper documents.
Note that Quadramed primarily sells revenue cycle management and schedule software for hospitals and does not have an EHR product. So his “objectivity” may be compromised. Still, he has a point, since many hospitals are in crash programs to implement CPOE to meet the meaningful use requirements.
The full blog is available here http://www.healthcare-informatics.com/
A Race for MU Certification
December 8, 2010
In a webinar held yesterday, Mark Anderson, head of AC Consulting Group, and a respected authority on EHR vendors for medical groups and hospitals, reviewed why the new CCHIT certification is important.
To see a full list of vendors who have received either “partial” or “full” certification, see the ONC’s website: http://onc-chpl.force.com/ehrcert
So far, 130 EHR systems have received certification: 85 full or complete status and 45 partial or modular status.
Anderson said a partial or modular certification is like “graduating from kindergarten,” while getting full certification is “getting a college degree.”
Anderson said it is important for medical groups to choose a fully certified vendor because products that receive “modular certification” will not qualify for ARRA Incentive Payments unless they are augmented by one or more secondary products.
Large hospitals that have many vendors may want to deal with several “modular” systems (e.g. emergency department) but medical groups with limited IT staff would be better off with one vendor that is fully certified, Anderson said.
He expects the numbe of fully certified systems to grow from 85 today to about 140 by 2012.
CIOs Focused on MU, Not ICD-10
December 6, 2010
At the HIMSS So. Calif. CIO Panel held December 2 in Los Angeles, panelists agreed that meaningful use is their top priority.
The panel included Marc Probst, CIO, Intermountain Healthcare; Bill Spooner, CIO, Sharp Healthcare; Jon Manis, CIO, Sutter Health and Gene Fernandez, CIO, LA Care Health Plan.
The panelists all said they expect to meet the MU requirements. Two panelists the cost of meeting the requirements will exceed the government reimbursement, but that it was important to meet the standards anyway.
All four panelists said they had not yet focused on meeting ICD-10 requirements. One hospital CIO said he believed ICD-10 was a “coding issue” that benefited payers and not hospitals. Another CIO said he expected the ICD-10 rules to be pushed back because so many hospitals would not be able to meet them.
About 300 people attended the event, held at the California Endowment’s conference center, adjacent to Union Station in downtown LA.
Privacy-The Horse is Out
December 1, 2010
While various high-level committees are arguing over possible protections for individual medical records, life insurers are perfecting new data mining records that predict behaviour with uncanny accuracy.
It appears that in terms of protecting (or hiding) your personal health history from insurers, the “horse is out of the barn.”
Even if you could protect the confidentiality of your medical records, the life (and health) insurers can “rate” your risk factors by sifting through masses of online data.
A recent story in the Wall Street Journal reports that
life insurers are using data mining techniques to predict people’s longevity.
The computer technology is being worked on by (among others) Deloitte Consulting. Life insurers including Aviva USA, American International Group Inc. and Prudential Financial Inc. are considering the technology.
Potentially, life insurers would no longer require blood and urine tests to assess people’s health. By data mining online data such as online shopping details, catalog purchases, magazine subscriptions, leisure activities and information from social-networking sites, the insurance executives believe they can predict future health with a s much accuracy as a lab analysis of their bodily fluids.