April 30, 2011
Most physicians will tell you that for them, the two most important relationships are patient-to-physician and physician-to-physician. How does this translate into designing an effective, easy-to-use EHR?
The current issue of Healthcare Informatics has a thoughtful article by Mark Hagland on this topic.
Hagland notes in the introduction:
“After all, what is physician documentation really for? …Physician documentation serves many different purposes and requirements, from the most basic, including for individual physicians to be able to recall details about their patients and for them to be able to pass on that information to other physicians and clinicians, to a host of other purposes, including billing, medical-legal compliance, and clinical data analysis.”
A decade ago, before the move to EHRs, physicians used only paper records and they would write their SOAP (subjective, objective, SOAP [subjective, objective, assessment, plan] note, and as part of that plan, they would also write down what they were ordering for the patient. However, when the first EHRs were designed, the physician ordering got separated from the SOAP note. In many cases physicians then ordered without doing any documentation.
According to Dr. Jeffrey Rose, head of informatics at Acension Health in St. Louis, EHR vendors should create a “unified” solution, in which documentation and ordering are simultaneous processes. He added that documentation should be a “mix of granular and structured documentation…it has to contain the ability to dictate or free-text nuanced communications, so you retain the patient’s story.”
That can be a lot to ask, especially when you are trying to keep the EHR low-cost, easy-to-use and interoperable with other systems.
For the full article see www.healthcare-informatics.com
April 26, 2011
What does ACO stand for? Awesome consulting opportunity.
LOL. That’s the latest joke making the HIT rounds. It is funny but it is also true.
An article in today’s KevinMD reports “ A whole industry has grown up around the dream of ACOs: conferences, newsletters, webinars, journal publications, and, of course, consultancies.”
The article, (by an MD heading a consulting company) explains that ACOs came about because a number of health care leaders in government and the private sector “started talking about how we need to focus our improvement efforts directly on the delivery system – the doctors and hospitals – as opposed to trying pressure health plans to do the work. And, they said, we ought to realign the payment system so that providers are paid for producing good outcomes – not just providing a bunch of services. Put these two concepts together and…voila! a new idea is born (or as some think, an old idea is repackaged and, I guess we would more accurately say, reborn).”
The “old idea” is, of course, HMOs or managed care. An ACO is very, very similar to a capitated medical group. Some 15 million Californians currently receive their care through these groups, and they have shown a proven ability to hold down costs.
What has been missing, at many of these medical groups, is an effective EHR system linking all the physicians. Kaiser, which is one of the few medical groups with an EHR that connects all its physicians, has shown that additional savings are possible when this connectivity is achieved.
The original article on KevinMD is available here
April 23, 2011
The federally chartered Health Information Technology Policy Committee held a hearing last week on the question of whether it’s possible to test the usability of EHRs. According to a report by Modern Healthcare’s Joe Conn, “Opinions on the viability of such testing ranged from outright skepticism to absolute confidence.”
The MHC story noted “Dr. Ross Koppel, a sociology professor at the University of Pennsylvania School of Medicine, said the cost of developing a system to measure usability would be trivial relative to that tool’s potential to spur health IT innovation and contribute to patient safety. ‘We’ve had innovations in bells and whistles while core functional usability was largely ignored.’”
In a February 2010 posting on his blog “Life as a Healthcare CIO,” John Halamka noted that usability (or lack thereof) is one of the top 10 barriers to EHR adoption.
In a comment to Dr. Halamka’s post, Robert M. Schumacher, Ph.D. noted that “Usability is confusing. It is often described as an attribute, ‘that application is really usable.’ However, it can also be viewed as a process.”
“We can say that one system has higher or lower usability than another. This usability attribute describes the ease with which people can use the system to achieve a goal, and consists of three measurable components: efficiency, effectiveness, and satisfaction. For instance, we can measure how many transactions happen in a given period of time or the number of errors that are made.”
Usability is certainly an important point of differentiation for many smaller EHR vendors. There is a large (and growing market) among specialist physician practices that have been given (or forced to purchase) an EHR system by a hospital only to find it doesn’t meet their needs. For example, many surgeons are used to dictating their notes and do not want to spend a large amount of time at a keyboard at the end of the day typing.
For them, voice recognition, not just plain dictation but also in template selection and form filing and recall, is a key attribute that is lacking from many “legacy” EHR systems.
To see the Halamka blog http://geekdoctor.blogspot.com/2010/02/ehr-usability.html
April 20, 2011
Does your web site or latest news release contain a typo?
PR Newswire reports that in March the editorial teams at their three main bureaus, Cleveland, Albuquerque, and Washington, D.C., caught 12,215 errors in press releases. That’s just in one month.
When I take on a client, I strongly recommend they use either PRNewswire or BusinessWire. Yes, these firms are more expensive than some of the “do it yourself” services, but they check every news release for spelling and grammatical errors. They also provide excellent reach and many distribution options.
When I get copy from clients some of the most frequent errors I find are improper use of quotation marks, improper use of “its” (it’s is the contraction for it is, its is the possessive form), failure to capitalize the word Internet and improper capitalization of executive titles (you don’t capitalize titles that are placed after the person’s name).
The PR Newswire story noted that a recent release highlighted a company’s efforts to begin a search for a new director. One of the proposed directors? Governor Charles “Christ.” Spellcheck failed to find it because the name, while incorrect, is a commonly spelled word.
In this case, the editor saw the incorrect word, confirmed that the governor’s name is Charles Crist and fixed it.
PR Newswire added that addresses are frequent pitfalls, virtual and otherwise. For example, one release contained references to the “9 Floor,” as opposed to “9th Floor,” and “87 Avenue” instead of “87th Avenue.”
Some people may say “big deal, it’s just a typo.” But incorrect spelling and grammar reflects badly on the company and the marketing department.
The full story is available at http://blog.prnewswire.com/2011/04/18/reading-for-detail-proofing-tips-from-our-editors/
April 15, 2011
The first in-home medical tests with an Internet connection were introduced in the early 1990s. I can remember seeing a demonstration of a blood pressure monitor hooked up to a dial-up modem. My employer, CIGNA, provided about 50 to a group of Medicare beneficiaries in a demonstration project. Some of the seniors had never used a computer before. The project didn’t go far. Many of the health plan members did not use them and when they did, the devices weren’t always accurate.
The at-home medical device industry has come a long way since then. The Technology Review reports on a start-up company, QuickCheck Health, based in Excelsior, MN, eager to bringing more diagnostic testing to the home. The company is developing tests for urinary tract infections, strep throat, and other ailments that will be sold at drugstores for consumers to use at home
The article reports that many consumer diagnostic tests are already in use for pregnancy, ovulation, fertility, HIV, and other conditions, however, treatment or follow-up care requires a visit to the doctor. At-home tests for other conditions, such as urinary tract infections, are available, but most doctors are reluctant to prescribe antibiotics or other medication without validating the results.
QuickCheck Health plans to change that by requiring patients to log on to a website or call to learn the results of the test. If the test is positive, the user will be directed to an online health-care provider, who can prescribe treatment.
“The consumer doesn’t know what they have until they check in online or via phone, and the remote provider has confidence that this was a positive test,” says QuickCheck CEO Tom Henke. “That confirmation makes us different, and valuable to consumers and physicians.”
QuickCheck hopes customers will be attracted to the allure of greater convenience and less cost. An emergency room visit for strep can cost $650, and a doctor’s visit costs about $200, even though the cost of a strep test is about $2 and the cost of the antibiotics to treat it is about $4. QuickCheck aims for a retail cost of $10 to $15 for the test, and $35 for the physician’s assessment.
Will the new company find success? I’m not sure, but I see several hurdles. The first is licensing. Currently it is illegal in many states for physicians to prescribe medications over the phone or via internet without seeing the patient in-person. And when a consumer shows up at a physician’s office with one of these test results, the doctor will almost certainly order his own test.
Of course, if you are a concerned parent and you give your kid a strep test and comes back negative, you will be greatly appreciative.
For the full article see http://www.technologyreview.com/biomedicine/37372/?nlid=4352&a=f
April 12, 2011
The $38 billion allocated under the HITECH Act to spur hospitals and physicians to adopt health IT has apparently been spared from the budget cutters’ axe.
Although reporters and legislative analysts are still dissecting the details of the complex deal, it appears health tech emerged relatively intact.
According to a story in today’s Washington Post, the biggest cuts in the HHS budget will come in children’s health and community health.
“The Children’s Health Insurance program will be cut by $3.5 billion. The cuts would only affect rewards for states that make an extra effort to enroll children. However, as the Post’s Philip Rucker reports, officials with knowledge of the budget deal said that most states were unlikely to qualify for the bonuses and that sufficient money would be available for those that did.
“Roughly $2.2 billion would be cut from the COOPS program — a third of the program’s budget. The program is a provision of the new health-care law that subsidizes loans to civil and community groups that come together to create health insurance cooperatives.”
In addition, Business Insurance reports that ”Congressional negotiators…have agreed to strip a provision in the health care reform law requiring employers to give low-paid employees company-paid vouchers to purchase coverage in state health insurance exchanges.”
This is not too surprising. Many Republicans have voiced support for healthcare IT. After all, it has been touted as a way to eventually lower healthcare spending.
April 8, 2011
Want to win prestigious award for your medical group or hospital?
The HIMSS “Stories of Success” program is now open for submissions. The award recognizes organizatioins that have used some aspect of health information technology to improve the quality of care, specifically the National Patient Safety Goals of The Joint Commission (TJC) and national recommendations of the National Priorities Partnership (NPP).
The project is sponsored by HIMSS and co-sponsors American Society for Quality (ASQ), the National Committee for Quality Assurance (NCQA), and the National Patient Safety Foundation (NPSF), with a representative from each along with the HIMSS Patient Safety & Quality Outcomes Committee serving on the case study review group.
The recognition program is open to any size medical group or hospital and there are two “tiers,” one for smaller organizations (community hospitals) and another for large organizations like Kaiser.
Vendors cannot directly apply, but, can support a star client with their submission.
To learn more see http://www.himss.org/storiesofsuccess/caseStudies.asp
Bwlow is an example of a winner from last year, the Queens Long Island Medical Center.
“EHR Backbone and Patient Centered Medical Home Initiative.” Results: 4% improvement in quality of diabetic care, 21% decline diabetes-related mortality, reduction $18,000/patient healthcare costs.”
As you see, the program can focus on something specific and measurable results. Last year, a lot of smaller community hospitals and local medical groups received awards, so you don’t have to be the Mayo Clinic to win.
April 5, 2011
Several editorial commentaries have lauded the HHS for writing the new ACO rules so they “align” with the EHR meaningful use rules. For example, a Healthcare IT News column notes that one of the proposed ACO rules “says that 50 percent of participating providers must be meaningful users. The industry is heading toward meaningful use, so once meaningful use is achieved, applying that expertise to the ACO model is a logical and strategic next step.”
That’s good news, however, while the meaningful use rules align with the just-issued ACO rules, they potentially clash with an older set of federal incentives, the upcoming regulations on e-prescribing.
The President of the AMA, Dr. Cecil B. Wilson, writes in a commentary in this week’s American Medical News that current federal policies will penalize physicians who do not use e-prescribing software in the first six-months of 2011.
According to Dr. Wilson, “The AMA believes the penalty policy is unreasonable in that it will force physicians to purchase stand-alone e-prescribing software just to avoid penalties — software most of them will end up discarding when they transition to a complete EMR system.”
“Under law, physicians cannot receive incentives from both programs simultaneously, yet they will face a penalty if they decide to participate in one over the other,” the AMA president notes.
Dr. Wilson, who notes he has been in practice in a small medical group in Florida for 30 years, assumes that it is difficult or impossible for small medical groups to purchase and successfully adopt an EHR and qualify for meaningful use by the end of the year.
I am here to report that there are several affordable EHR systems on the market, including one from ChartLogic (a Westside client) that are easy to use. I have personally talked to several ChartLogic customers, all small practices, that have gotten their EHR up and running (including e-prescribing) within a matter of weeks.
To read the entire AMA editorial see http://www.ama-assn.org/amednews/
April 1, 2011
CMS has issued its proposed rules for ACOs and hospital organizations, the biggest potential beneficiaries, are already weighing in with (mostly) positive endorsements.
The rules have been covered extensively in the trade press and the Wall Street Journal. I think the most comprehensive coverage is at the Kaiser Health News site:
One key point is missing from the proposed ACO proposal: rules on the use partial and full capitation in medical groups.
As Don Crane, CEO of the California Association of Physician Groups noted in one news report, “We know all about ACOs because we have ACOs already. We’ve got capitation, and that is the accountability for cost, and we have a longstanding pay-for-performance program, and that’s the accountability for quality. So we have the twin pillars for accountability right now.”
However, other news reports said the 400+ pages of proposed rules do not mention capitation.
As Don Crane points out, capitation has worked fairly well in California for three decades. Capitation has a big PR problem however. First of all, it sounds like “decapitation,” which is associated with the Guillotine and death. Maybe they can come up with a new name for it. After all, HMOs have transformed into “health plans.” How about “group payment model?”
Second, capitation clearly leads to a form of economic health care rationing, whether by physicians or medical group executives (or both). When it comes to discussing health care economics in Congress, rationing is very, very unpopular. The CMS planners assembling the ACO rules saw what happened to their boss Don Berwick; they will probably try and wait until a new CMS director is confirmed before putting forward any rules regarding capitation.
Initial reports about the healthcare IT requirements were cautious. The headline in Health Data Management read “CMS Sets the IT Bar Very High for Medicare.”
The HDM story noted, ”The ACO would have an infrastructure, such as information technology, that enables the ACO to collect and evaluate data and provide feedback to the ACO providers/suppliers across the entire organization, including providing information to influence care at the point of care via, for example, shared clinical decision support, feedback from patient experience of care surveys, or other internal or external quality and utilization assessments.”