Monday, July 13, 2009
IT staffing issues
The newly published July issue of Hospitals & Health Networks includes a story I wrote about the worsening staffing crunch in health IT.
Between the rush to install EMRs by January 2011, tighter HIPAA privacy and security requirements and the transition to ICD-10 coding and ANSI X12 5010 transactions, it could be a tough next few years for IT departments. But you probably already knew that.
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Between the rush to install EMRs by January 2011, tighter HIPAA privacy and security requirements and the transition to ICD-10 coding and ANSI X12 5010 transactions, it could be a tough next few years for IT departments. But you probably already knew that.
Labels: ARRA, HIPAA, ICD-10, IT staffing
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Friday, July 10, 2009
It's crunch time at Health Wonk Review
The latest Health Wonk Review went up earlier this week at the BNET Healthcare Blog, a site I've contributed to. Host Ken Terry, late of Medical Economics, focuses on the myriad opinions surrounding the comprehensive healthcare reform proposals that have gripped Washington.
My post about the American Medical Association's curious reaction to the national health IT push made the list of interesting reads not directly related to the reform debate.
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My post about the American Medical Association's curious reaction to the national health IT push made the list of interesting reads not directly related to the reform debate.
Labels: health reform, Health Wonk Review
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Tuesday, July 07, 2009
Google vs. Bin Laden?
How's this for a headline? "Entrust my medical records to Google? I'd rather give them to Bin Laden."
That was the headline accompanying a column in Tuesday's London Daily Mail. Columnist Stephen Glover (no, not Steve-O of "Jackass" and "Dancing With The Stars" fame/infamy--and I only know his real name because his sister is an old friend of mine) is scared to death by the prospect of a company like Google storing medical records.
"People who deposited their medical records with Google would no doubt be given assurances that they would not be passed on to third parties. But Google would not go to the trouble and expense of storing such information unless it hoped to benefit from it in some way," Glover writes.
"Here is a company which, through a variety of means, is building up a profile of each of us - or at any rate those of us who use computers. I understand, of course, that it has no over-arching intention of ordering or controlling our lives, and that the information it holds about us is used for its own commercial gain. But it would be absolutely the last company in the world to which I would entrust my medical records. I would far rather stick them in an envelope and send them to Osama Bin Laden or Vladimir Putin," he continues.
Wow, I know I've been harsh on Google in the past, but never like that.
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That was the headline accompanying a column in Tuesday's London Daily Mail. Columnist Stephen Glover (no, not Steve-O of "Jackass" and "Dancing With The Stars" fame/infamy--and I only know his real name because his sister is an old friend of mine) is scared to death by the prospect of a company like Google storing medical records.
"People who deposited their medical records with Google would no doubt be given assurances that they would not be passed on to third parties. But Google would not go to the trouble and expense of storing such information unless it hoped to benefit from it in some way," Glover writes.
"Here is a company which, through a variety of means, is building up a profile of each of us - or at any rate those of us who use computers. I understand, of course, that it has no over-arching intention of ordering or controlling our lives, and that the information it holds about us is used for its own commercial gain. But it would be absolutely the last company in the world to which I would entrust my medical records. I would far rather stick them in an envelope and send them to Osama Bin Laden or Vladimir Putin," he continues.
Wow, I know I've been harsh on Google in the past, but never like that.
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Monday, July 06, 2009
AMA and EMRs, continued
Last month, I wrote a rather scathing piece on the BNET Healthcare blog about the American Medical Association's annual House of Delegates meeting. I wrote another one for FierceEMR. Admittedly, I focused on a handful of fringe ideas, though one of the more audacious ones actually wound up in a resolution that the House of Delegates adopted as AMA policy. For BNET, I wrote:
In FierceEMR, I wrote:
Not surprisingly, the posts drew several comments and e-mails.
AMA Board Chairman Joseph Heyman, M.D., someone who actually does understand—and use in his own practice—EMRs and information technology, left a detailed response on the BNET post, attempting to clarify the organization's position on health IT. He's right in saying that the AMA did come out in strong support of the stimulus. My criticism was about a few delegates who spoke out rather loudly about the stimulus.
Heyman also discusses the AMA's online tools for physicians to learn about health IT, something I admittedly didn't mention in my post, though it wasn't completely relevant to my argument. I did interview Heyman at the meeting, and included some of his comments in a story I did in the July Physician Office Technology Report of Part B News. I'd like to extend an invitation to Heyman to do a podcast with me at some point in the future so we can discuss all of these issues, as well as his own practice's successful experience with an EMR.
Another, anonymous, commenter suggested that other organizations, like the American Academy of Family Physicians has an agenda that "more closely aligns with the big winners of the last election cycle, and helped buy them a seat at the table." Yeah, that would explain why some of the more conservative members of the AMA House of Delegates feel shunned. This person also says that "HIT providers"—vendors and consultants—are the real winners from the stimulus. That's certainly a risk of the massive program.
The comments on the FierceEMR piece were more supportive of my argument. "Smart Doc" said: "To call this organization an anachronistic dinosaur would not give proper credence to how out of touch it is, not only with the public, but with physicians themselves. Like others of their ilk, they're against government intervention except when it directly subsidizes them."
I'm not sure if I'd go that far, but I'm certainly on record as saying the AMA really does not represent the interests of all physicians, as the organization claims to.
My favorite exchange, though, came from Jack Smyth, the very pragmatic president and CEO of ambulatory EMR vendor Spring Medical Systems. After the FierceEMR commentary appeared, he e-mailed me to clarify the rules for the Medicare e-prescribing bonus program that took effect this year:
I'm very proud of my subsequent response:
I also asked Smyth for permission to post our exchange. He then responded: "I love your "Wilson's prescription pad" comment! Yes you can use my email in your blog. I don't have time to post responses on websites and I don't like all of the banter (most of it useless) that a comment like this would create. I'll let you do that."
Consider it done.
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[A]nother resolution directs the AMA to tell the federal government that the EMR incentive program "should be made compliant with AMA principles by removing penalties for non-compliance and by providing inflation-adjusted funds to cover all costs of implementation and maintenance of EMR systems."
It's one thing to ask for more money to cover ongoing expenses. It’s another thing altogether to conclude that the government is not in compliance with the principles of a private organization. Talk about the tail wagging the dog.
In FierceEMR, I wrote:
Delegates also took issue with the Medicare e-prescribing bonus program that passed during the Bush administration and began this year. They said the requirement that physicians write 50 percent of their Medicare Part D prescriptions electronically was too onerous, and recommended that the threshold be lowered to 25 percent.
Not surprisingly, the posts drew several comments and e-mails.
AMA Board Chairman Joseph Heyman, M.D., someone who actually does understand—and use in his own practice—EMRs and information technology, left a detailed response on the BNET post, attempting to clarify the organization's position on health IT. He's right in saying that the AMA did come out in strong support of the stimulus. My criticism was about a few delegates who spoke out rather loudly about the stimulus.
Heyman also discusses the AMA's online tools for physicians to learn about health IT, something I admittedly didn't mention in my post, though it wasn't completely relevant to my argument. I did interview Heyman at the meeting, and included some of his comments in a story I did in the July Physician Office Technology Report of Part B News. I'd like to extend an invitation to Heyman to do a podcast with me at some point in the future so we can discuss all of these issues, as well as his own practice's successful experience with an EMR.
Another, anonymous, commenter suggested that other organizations, like the American Academy of Family Physicians has an agenda that "more closely aligns with the big winners of the last election cycle, and helped buy them a seat at the table." Yeah, that would explain why some of the more conservative members of the AMA House of Delegates feel shunned. This person also says that "HIT providers"—vendors and consultants—are the real winners from the stimulus. That's certainly a risk of the massive program.
The comments on the FierceEMR piece were more supportive of my argument. "Smart Doc" said: "To call this organization an anachronistic dinosaur would not give proper credence to how out of touch it is, not only with the public, but with physicians themselves. Like others of their ilk, they're against government intervention except when it directly subsidizes them."
I'm not sure if I'd go that far, but I'm certainly on record as saying the AMA really does not represent the interests of all physicians, as the organization claims to.
My favorite exchange, though, came from Jack Smyth, the very pragmatic president and CEO of ambulatory EMR vendor Spring Medical Systems. After the FierceEMR commentary appeared, he e-mailed me to clarify the rules for the Medicare e-prescribing bonus program that took effect this year:
You commented about the 50% rule for getting the eRx bonuses this year and next. In your statement you mentioned that unless a physician prescribes controlled substances, they should be able to qualify.
The way I understand it, if a doctor enters the prescription in the eRx system, it counts. Even if they have to print it out and sign it, because it's a controlled substance, or even if the pharmacy doesn't accept eRx and it has to be faxed to the pharmacy. There are several "G" codes that can be added to an office visit or prescription refill that allow the various scenarios to qualify for addition to the numerator of the equation.
I'm very proud of my subsequent response:
Thanks again for writing. I think you're right about getting credit for entering it into an eRx system, regardless of whether it's controlled or if the patient simply wants a printout. In that case, I have no idea why the AMA thinks 50% is too high. You're either entering scripts electronically or you're not, unless perhaps you're Dr. House and you've stolen Wilson's prescription pad.
I also asked Smyth for permission to post our exchange. He then responded: "I love your "Wilson's prescription pad" comment! Yes you can use my email in your blog. I don't have time to post responses on websites and I don't like all of the banter (most of it useless) that a comment like this would create. I'll let you do that."
Consider it done.
Labels: "House", AMA, ARRA, blogging, e-prescribing, EMR. Spring Medical Systems, politics
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Wednesday, July 01, 2009
EMR failures and uninstalls
Before I forget, I had the cover story in the May issue of MD Net Guide, on the subject of EMR failures and uninstalls in physician practices.
In a similar vein, Healthcare IT News last week had a story about a high number of EMR uninstalls in the Phoenix area.
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In a similar vein, Healthcare IT News last week had a story about a high number of EMR uninstalls in the Phoenix area.
Labels: EMR, EMR failure
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Monday, June 22, 2009
ONC to meet with potential CCHIT alternatives
SEATTLE—Here's a juicy rumor from the first day of the sixth annual Healthcare Unbound conference: the Office of the National Coordinator for Health Information Technology is planning a July meeting with several people considering starting up certification bodies to compete with the Certification Commission for Healthcare Information Technology.
I say it's a rumor because I haven't been able to confirm this information yet. It does make plenty of sense, though. ONC head Dr. David Blumenthal wrote in the New England Journal of Medicine back in March that "many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system."
This does not mean that CCHIT will get frozen out of the certification process, just that it shouldn't come as a surprise if the federal government recognizes more than one certifying entity.
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I say it's a rumor because I haven't been able to confirm this information yet. It does make plenty of sense, though. ONC head Dr. David Blumenthal wrote in the New England Journal of Medicine back in March that "many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system."
This does not mean that CCHIT will get frozen out of the certification process, just that it shouldn't come as a surprise if the federal government recognizes more than one certifying entity.
Labels: CCHIT, David Blumenthal, ONC
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Thursday, June 18, 2009
Answering the mail
I have to admit I'm shamefully behind on blogging this week. Between the AMA House of Delegates meeting, deadlines for FierceMobileHealthcare Tuesday and FierceEMR Thursday, plus a dentist's appointment thrown in for good measure, I've been too busy or too tired to post here. I also submitted an entry for the BNET Healthcare blog, but it hasn't been posted yet.
Meantime, I've left some people hanging.
While I was on the air with news anchor Andrea Darlas of WGN-AM 720 in Chicago to discuss President Obama's speech to the AMA, I promised this link to a story about a high-schooler in Washington state who correctly diagnosed herself in science class with Crohn's disease after doctors were stumped for years. Folks, this is why we need clinical decision support.
Fellow blogger Lodewijk Bos of the Im-Patient blog commented that he would like to see examples of the paranoia I observed at the AMA meeting. OK, but I have to link you to commentaries I wrote elsewhere, for FierceMobileHealthcare and FierceEMR. I humbly offer my "The audacity of 'nope'" headline from the latter commentary for the Headline Hall of Fame.
Tonight, "Anonymous," my biggest fan, left a comment asking where the proposed definition of meaningful use is. It's right here, my friend. Actually, that page contains instructions on how to comment on the proposal. Scroll down for links to the preamble, a matrix of the proposed requirements and the CMS backgrounder on Medicare and Medicaid health IT provisions in the American Recovery and Reinvestment Act.
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Meantime, I've left some people hanging.
While I was on the air with news anchor Andrea Darlas of WGN-AM 720 in Chicago to discuss President Obama's speech to the AMA, I promised this link to a story about a high-schooler in Washington state who correctly diagnosed herself in science class with Crohn's disease after doctors were stumped for years. Folks, this is why we need clinical decision support.
Fellow blogger Lodewijk Bos of the Im-Patient blog commented that he would like to see examples of the paranoia I observed at the AMA meeting. OK, but I have to link you to commentaries I wrote elsewhere, for FierceMobileHealthcare and FierceEMR. I humbly offer my "The audacity of 'nope'" headline from the latter commentary for the Headline Hall of Fame.
Tonight, "Anonymous," my biggest fan, left a comment asking where the proposed definition of meaningful use is. It's right here, my friend. Actually, that page contains instructions on how to comment on the proposal. Scroll down for links to the preamble, a matrix of the proposed requirements and the CMS backgrounder on Medicare and Medicaid health IT provisions in the American Recovery and Reinvestment Act.
Labels: AMA, ARRA, clinical decision support, CMS, meaningful use
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Monday, June 15, 2009
If you're in Chicago ...
I will be a guest on WGN Radio AM 720 in Chicago at approximately 12:10 p.m. CDT. today, shortly after President Obama's speech to the American Medical Association concludes.
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Labels: AMA, Barack Obama, media
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ONC confirms Tuesday release of 'meaningful use' proposal
CHICAGO—David R. Hunt, M.D., acting chief medical officer of the Office of the National Coordinator for Health Information Technology just confirmed that HHS will indeed release tomorrow a proposed definition of "meaningful use." That's the standard by which healthcare organizations will qualify for health IT stimulus funding starting in 2011.
By the way, the official HHS Web site for health IT programs has moved to http://healthit.hhs.gov.
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By the way, the official HHS Web site for health IT programs has moved to http://healthit.hhs.gov.
Labels: meaningful use, ONC
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Sunday, June 14, 2009
N.J. bill would ban non-CCHIT EMRs
This is something I reported for the new FierceEMR last week: There's a bill in the New Jersey legislature that would effectively ban the sale and use of health IT products that don't carry CCHIT certification.
My story got picked up Friday by iHealthBeat, where it quickly became one of the top five most-viewed stories and No. 1 on the list of most e-mailed.
The story even drew a comment from CCHIT Chairman Mark Leavitt, who linked to a post on the commission's blog. There, I learned from a commenter that the bill made it out of committee on a unanimous vote. That's an ominous sign. If states start setting their own EMR rules, we'll be left with 50 different systems of interoperability, few of which would actually interoperate with other. We will have wasted billions of taxpayer money on more silos.
If some of the paranoia about EMRs that I heard Sunday at the American Medical Association annual meeting really is representative of practicing physicians—and not just the protectionist Medical Establishment—this country is in trouble.
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My story got picked up Friday by iHealthBeat, where it quickly became one of the top five most-viewed stories and No. 1 on the list of most e-mailed.
The story even drew a comment from CCHIT Chairman Mark Leavitt, who linked to a post on the commission's blog. There, I learned from a commenter that the bill made it out of committee on a unanimous vote. That's an ominous sign. If states start setting their own EMR rules, we'll be left with 50 different systems of interoperability, few of which would actually interoperate with other. We will have wasted billions of taxpayer money on more silos.
If some of the paranoia about EMRs that I heard Sunday at the American Medical Association annual meeting really is representative of practicing physicians—and not just the protectionist Medical Establishment—this country is in trouble.
Labels: AMA, CCHIT, EMR, interoperability, Legislation
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