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Usability, Interoperability are Political Questions: We Need an EHR Users Group

Posted on October 6, 2017 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Over the years, writers on blogs such as this and EMRandHIPAA have vented their frustration with lousy EHR usability and interoperability problems. Usability has shown no real progress unless you count all the studies showing that its shortcomings cost both time and money, drives users nuts, and endangers patient lives.

The last administration’s usability approach confused motion with progress with a slew of roadmaps, meetings and committees. It’s policies kowtowed to vendors. The current regime has gone them one better with a sort of faith based approach. They believe they can improve usability as long it doesn’t involve screens or workflow. Interoperability has seen progress, mostly bottom up, but there is still no national solution. Patient matching requires equal parts data, technique and clairvoyance.

I think the solution to these chronic problems isn’t technical, but political. That is, vendors and ONC need to have their feet put to the fire. Otherwise, in another year or five or ten we’ll be going over the same ground again and again with the same results. That is, interop will move ever so slowly and usability will fade even more from sight – if that’s possible.

So, who could bring about this change? The one group that has no organized voice: users. Administrators, hospitals, practioners, nurses and vendors have their lobbyists and associations. Not to mention telemed, app and device makers. EHR users, however, cut across each of these groups without being particularly influential in any. Some groups raise these issues; however, it’s in their context, not for users in general. This means no one speaks for common, day in day out, EHR users. They’re never at the table. They have no voice. That’s not to say there aren’t any EHR user groups. There are scads, but vendors run almost all of them.

What’s needed is a national association that represents EHR users’ interests. Until they organize and earn a place along vendors, etc., these issues won’t move. Creating a group won’t be easy. Users are widely dispersed and play many different roles. Then there is money. Users can’t afford to pony up the way vendors can. An EHR user group or association could take many forms and I don’t pretend to know which will work best. All I can do is say this:

EHR Users Unite! You Have Nothing to Lose, But Your Frustrations!

There’s a New Medicare ID Coming in April – CMS Dumps SSN

Posted on September 26, 2017 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Following a 2015 Congressional directive, CMS is abandoning its Social Security based Medicare ID for a new randomly generated one. The new card will be hitting beneficiary’s mailboxes in April with everyone covered by a year later.

The old ID is a SSN plus one letter. The letter says if you are a beneficiary, child, widow, etc. The new will have both letters and numbers. It is wholly random and drops the coding for beneficiary, etc. Fortunately, it will exclude S, L, O, I, B and Z, which can look like numbers. You can see the new ID’s details here.

                           New Medicare ID Card

Claimants will have until 2020 to adopt the new IDs, but that’s not the half of it. For the HIT world, this means many difficult, expensive and time consuming changes. CMS sees this as a change in how it tracks claims. However, its impact may make HIT managers wish for the calm and quiet days of Y2K. That’s because adopting the new number for claims is just the start. Their systems use the Medicare ID as a key field for just about everything they do involving Medicare. This means they’ll not only have to cross walk to the new number, but also their systems will have to look back at what was done under the old.

Ideally, beneficiaries will only have to know their new number. Realistically, every practice they see over the next several years will want both IDs. This will add one more iteration to patient matching, which is daunting enough.

With MACRA Congress made a strong case for Medicare no longer relying on SSNs for both privacy and security reasons. Where it failed was seeing it only as a CMS problem and not as a HIT problem with many twists and turns.

Sorting Through HIT’s Cultural Revolutions

Posted on June 15, 2017 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

HIT is a small ship in the large IT sea. Whether we like it or not whatever stirs IT will rock HIT’s boat – to stretch an analogy. Sometimes it’s a tidal change in how we do business. Dial up modems, for example, gave way to high speed lines revolutionizing all that they touched.

Sometimes these revolutions – to switch analogies are much welcome and undeniable. No one is going back to MS-DOS or parallel interfaced printers. Sometimes, though, IT gets caught up in cultural revolutions (CRs) that eventually fade and disappear, but take a toll before their done and gone.

Chinese Cultural Revolution Poster

Chinese Cultural Revolution Poster. Source: chineseposters.net

By cultural revolutions I don’t mean the extremes of Chairman Mao’s creation, with Red Guards who destroyed everything and everyone in their path. We’re far more kinder and gentler than that. The CRs I’m talking about are organizational or technical fads noted for their promoters’ evangelical zeal. Heavily promoted they soak up organizational time and effort often with little to show.

To be sure IT’s not the only organizational sphere with fads. DOD’s Program, Performance Budgeting System (PPBS) is a famous 1960s example. It promised an almost mechanical solution to DOD’s major logistical, operational and performance review problems. It didn’t. Little changed. That doesn’t mean PPBS didn’t have some practical aspects, or that it didn’t leave behind some improvements. However, little justified its over blown hype and massive organizational disruption.

IT and HIT have had their share. Six Sigma, CMMI, and ISO 9000 quickly come to mind. I would add XML and Big Data. Advocates pushed these in the name of curing many woes or reaching new heights by adopting a new way of thinking or doing. However, CRs almost always just put old beer in new bottles.

Spotting a Cultural Revolution

Each day brings something new in IT/HIT. Here some ways to determine if what you’re facing is a fad or not:

  • Advocates. Who’s promoting it? Who certified them and what did that entail?
  • Analogues. Who’s implemented the CR and can you speak to them freely?
  • Client Demand. What do your clients think? Do they want you to adopt the new ways?
  • Effort. What effort will it take to adopt the CR? What are the opportunity costs?
  • Focus. Does the CR require your staff to stop what it’s doing and attend lengthy, expensive seminars?
  • Jargon. Do the advocates speak terms you know, or do they promote a whole new language you’ll have to master?
  • Organizational Fit. How well does the CR fit into your current way of doing things?
  • Payoff. What are the CR’s specific, definable advantages?
  • Segments. Does the CR give you a menu of choices or is it an all or nothing approach?
  • Sponsors. Who’s the CR author? Is it a standards organization, a movement by knowledgeable users or a self referencing group?

CRs aren’t a simple matter of useful or not. Sometimes even fads can bring a useful approach wrapped up in hyperbole.  For example, XML advocates claimed it would change everything. After that promotional tide receded, XML became another tool. The challenge, then, is being able to see if the current CR really offers anything new and what it really is.

Two Worth Reading

Posted on April 6, 2017 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

HIT is a relatively small world that generates no end of notices, promotions and commentaries. You can usually skim them, pick out what’s new or different and move on. Recently, I’ve run into two articles that deserve a slow, savored reading: Politico’s Arthur Allen’s History of VistA, the VA’s homegrown EHR and Julia Adler-Milstein’s take on interoperability’s hard times.

VistA: An Old Soldier That May Just Fade Away – Maybe

The VA’s EHR is not only older than just about any other EHR, it’s older than just about any app you’ve used in the last ten years. It started when Jimmy Carter was in his first presidential year. It was a world of mainframes running TSO and 3270 terminals. Punch cards still abounded and dialup modems were rare. Even then, there were doctors and programmers who wanted to move vet’s hard copy files into a more usable, shareable form.

Arthur Allen has recounted their efforts, often clandestine, in tracking VistA’s history. It’s not only a history of one EHR and how it has fallen in and out of favor, but it’s also a history of how personal computing has grown, evolved and changed. Still a user favorite, it looks like its accumulated problems, often political as much as technical, may mean it will finally meet its end – or maybe not. In any event, Allen has written an effective, well researched piece of technological history.

Adler-Milstein: Interoperability’s Not for the Faint of Heart

Adler-Milstein, a University of Michigan Associate Professor of Health Management and Policy has two things going for her. She knows her stuff and she writes in a clear, direct prose. It’s a powerful and sadly rare combination.

In this case, she probes the seemingly simple issue of HIE interoperability or the lack thereof. She first looks at the history of EHR adoption, noting that MU1 took a pass on I/O. This was a critical error, because it:

[A]llowed EHR systems to be designed and adopted in ways that did not take HIE into account, and there were no market forces to fill the void.

When stage two with HIE came along, it meant retrofitting thousands of systems. We’ve been playing catch up, if at all, ever since.

Her major point is simple. It’s in everyone’s interest to find ways of making I/O work and that means abandoning fault finding and figuring out what can work.

Health IT End of Year Loose Ends

Posted on December 13, 2016 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

In that random scrap heap I refer to as my memory, I’ve compiled several items not worthy of a full post, but that keep nagging me for a mention. Here are the ones that’ve surfaced:

Patient Matching. Ideally, your doc should be able to pull your records from another system like pulling cash from an ATM. The hang up is doing patient matching, which is record sharing’s last mile problem. Patients don’t have a unique identifier, which means to make sure your records are really yours your doctor’s practice has to use several cumbersome workarounds.

The 21st Century Cures Act calls for GAO to study ONC’s approach to patient matching and determine if there’s a need for a standard set of data elements, etc. With luck, GAO will cut to the chase and address the need for a national patient ID.

fEMR. In 2014, I noted Team fEMR, which developed an open source EHR for medical teams working on short term – often crises — projects. I’m pleased to report the project and its leaders Sarah Diane Draugelis and Kevin Zurek are going strong and recently got a grant from the Pollination Project. Bravo.

What’s What. I live in DC, read the Washington Post daily etc., but if I want to know what’s up with HIT in Congress, etc., my first source is Politico’s Morning EHealth. Recommended.

Practice Fusion. Five years ago, I wrote a post that was my note to PF about why I couldn’t be one of their consultants anymore. Since then the post has garnered almost 30,000 hits and just keeps going. As pleased as I am at its longevity, I think it’s only fair to say that it’s pretty long in the tooth, so read it with that in mind.

Ancestry Health. A year ago September, I wrote about Ancestry.com’s beta site Ancestry Health. It lets families document your parents, grandparents, etc., and your medical histories, which can be quite helpful. It also promised to use your family’s depersonalized data for medical research. As an example, I set up King Agamemnon family’s tree. The site is still in beta, which I assume means it’s not going anywhere. Too bad. It’s a thoughtful and useful idea. I also do enjoy getting their occasional “Dear Agamemnon” emails.

Jibo. I’d love to see an AI personal assistant for PCPs, etc., to bring up related information during exams, capture new data, make appointments and prepare scripts. One AI solution that looked promising was Jibo. The bad news is that it keeps missing its beta ship date. However, investors are closing in on $100 million. Stay tuned.

 

Hospitals and General Grant Have a Lot in Common

Posted on October 20, 2016 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

A few weeks ago, I was having a bad dream. Everything was turning black. It was hard to breath and moving was equally labored. It wasn’t a dream. I woke up and found myself working hard to inhale. Getting out of bed took determination.

I managed to get to our hallway and call my wife. She called 911 and DC’s paramedics soon had me on my way to Medstar’s Washington Hospital Center’s ER. They stabilized me and soon determined I wasn’t having a heart attack, but a heart block. That is, the nerve bundles that told my heart when to contract weren’t on the job.

A cardiology consult sent me to the Center’s Cardiac Electrophysiology Suite (EP Clinic), which specializes in arrhythmias. They ran an ECG, took a quick history and determined that the block wasn’t due to any meds, Lime disease, etc. Determining I needed a pacemaker, they made me next in line for the procedure.

Afterwards, my next stop was the cardiac surgery floor. Up till then, my care was by closely functioning teams. After that, while I certainly wasn’t neglected, it was clear I went from an acute problem to the mundane. And with that change in status, the hospital system’s attention to detail deteriorated.

This decline led me to a simple realization. Hospitals, at least in my experience, are much like Ulysses Grant: stalwart in crisis, but hard pressed with the mundane. That is, the more critical matters became in the Civil War, the calmer and more determined was Grant. As President, however, the mundane dogged him and defied his grasp.

Here’re the muffed, mundane things I encountered in my one overnight stay:

  • Meds. I take six meds, none exotic. Despite my wife’s and my efforts, the Center’s system could not get their names or dosages straight. Compounding that, I was told not to take my own because the hospital would supply them. It couldn’t either find all of them or get straight when I took them. I took my own.
  • Food. I’d not eaten when I came in, which was good for the procedure. After it, the EP Clinic fed me a sandwich and put in food orders. Those orders quickly turned into Nothing by Mouth, which stubbornly remained despite nurses’ efforts to alter it. Lunch finally showed up, late, as I was leaving.
  • Alarm Fatigue. At three AM, I needed help doing something trivial, but necessary. I pressed the signaling button and a nurse answered who could not hear me due to a bad mike. She turned off the alert. I clicked it on again. Apparently, the nurses have to deal with false signals and have learned to ignore them. After several rounds, I stumbled to the Nurses’ Station and got help.
  • Labs. While working up my history, the EP Clinic took blood and sent for several tests. Most came back quickly, but a few headed for parts unknown. No one could find out what happened to them.
  • Discharge. The EP Clinic gave me a set of instructions. A nurse practitioner came by and gave me a somewhat different version. When we got home, my wife called the EP Clinic about the conflict and got a third version.
  • EHR. The Hospital Center is Washington’s largest hospital. My PCP is at the George Washington University’s Medical Faculty Associates. Each is highly visible and well regarded. They have several relationships. The Center was supposed to send GW my discharge data, via FAX, to my PCP. It didn’t. I scanned them in and emailed my PCP.

In last five years, I’ve had similar experiences in two other hospitals. They do great jobs dealing with immediate and pressing problems, but their systems are often asleep doing the routine.

I’ve found two major issues at work:

  • Incomplete HIT. While these hospitals have implemented EHRs, they’ve left many functions big and small on paper or on isolated devices. This creates a hybrid system with undefined or poorly defined workflows. There simply isn’t a fully functional system, rather there are several of them. This means that when the hospital staff wants to find something, first they’ll look in a computer. Failing that, they’ll scour clipboards for the elusive fact. It’s like they have a car with a five speed transmission, but only first and second gear are automatic.
  • Isolated Actors. Outside critical functions, individuals carry out tasks not teams. That is, they often act in isolation from those before or after them. This means issues are looked at only from one perspective at a time. This sets the stage for mistakes, omissions and misunderstandings. A shared task list, a common EHR function, could end this isolation.

The Hospital Center is deservedly a well regarded. It’s heart practice is its special point of pride. However, its failure to fully implement HIE is ironic. That’s because Medstar’s National Center for Human Factors in Healthcare isn’t far from the Hospital.

The problems I encountered aren’t critical, but they are troublesome and can easily lead to serious even life endangering problems. Most egregious is failure to fully implement HIT. This creates a confusing, poorly coordinated system, which may be worse than no HIT at all.

I’m Now a Thing on the Internet of Things

Posted on October 11, 2016 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Thanks to a Biotronik Eluna 8 DR-T pacemaker that sits below my clavicle, I’m now a thing on the internet of things. What my new gizmo does, other than keeping me ticking, is collect data and send it to a cell device sitting on my nightstand.

biotronik-eluna
Once a day, the cell uploads my data to Biotronik’s Home Monitoring website, where my cardiologist can see what’s going on. If something needs prompt attention, the system sends alerts. Now, this is a one way system. My cardiologist can’t program my pacemaker via the net. To do that requires being near Biotronik’s Renamic inductive system. That means I can’t be hacked like Yahoo email.

The pacemaker collects and sends two kinds of data. The first set shows the unit’s functioning and tells a cardiologist how the unit is programmed and predicts its battery life, etc. The second set measures heart functioning. For example, the system generates a continuous EKG. Here’s the heart related set:

  • Atrial Burden per day 

  • Atrial Paced Rhythm (ApVs) 

  • Atrial Tachy Episodes (36 out of 48 criteria) 

  • AV-Sequences 

  • Complete Paced Rhythm (ApVp)
  • Conducted Rhythm (AsVp) 

  • Counter on AT/AF detections per day 

  • Duration of Mode Switches
  • High Ventricular Rate Counters
  • Intrinsic Rhythm (AsVs) 

  • Mode Switching
  • Number of Mode Switches 

  • Ongoing Atrial Episode Time
  • Ventricular Arrhythmia

Considering the pacemaker’s small size, the amount of information it produces is remarkable. What’s good about this system is that its data are available 24/7 on the web.

The bad news is Biotronik systems don’t directly talk to EHRs. Rather, Renamic uses EHR DataSynch, a batch system that complies with IEEE 11073-10103, a standard for implantable devices. EHR DataSynch creates an XML file and ships it along with PDFs to an EHR via a USB key or Bluetooth. However, Renamic doesn’t support LANs. When the EHR receives the file, it places the data in their requisite locations. The company also offers customized interfaces through third party vendors.

For a clinician using the website or Renamic, data access isn’t an issue. However, access can be problematic in an EHR. In that case, the Biotronik data may or may not be kept in the same place or in the same format as other cardiology data. Also, batch files may not be transferred in a timely fashion.

Biotronik’s pacemaker, by all accounts, is an excellent unit and I certainly am glad to have it. However, within the EHR universe, it’s one more non-interoperable device. It takes good advantage of the internet for its patients and their specialists, but stops short of making its critical data readily available. In Biotronik’s defense, their XML system is agnostic, that is, it’s one that almost any EHR vendor can use. Also, the lack of a widely accepted electronic protocol for interfacing EHRs is hardly Biotronik’s fault. However, it is surprising that Biotronik does not market specific, real time interfaces for the products major EHRs.

MGMA Blames Rise in HIT Costs on Fed’s Regs

Posted on September 15, 2016 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

MGMA’s released a study of 850 member’s practices showing HIT costs up by more than 45 percent in the last six years. MGMA puts much of the blame on federal regulations. It’s concerned that:

Too much of a practice’s IT investment is tied directly to complying with the ever-increasing number of federal requirements, rather than to providing better patient care. Unless we see significant changes in the final MIPS/APM rule, practice IT costs will continue to rise without a corresponding improvement in the care delivery process.

There may be a good case that the HITECH act is responsible for the lion’s share of HIT growth for these and other providers, but MGMA study doesn’t make the case – not by far.

What the study does do is track the rise in HIT costs since 2011 for physician owned, multispecialty practices. For example, MGMA’s press release notes that IT costs have gone up by almost 47 percent since 2009.

In fairness, MGMA also notes that costs may have also gone up do to other costs, such as patient portals, etc. However, the release emphasizes that regulations are at great fault.

Here’s why MGMA’s case falls flat:

  • Seeing Behind the Paywall. If you want to examine the study, it’ll cost you $655 to read it. Many similar studies that charge, provide a good synopsis and spell out their methodology. MGMA doesn’t do either.
  • Identifying the Issue. It’s one thing to complain about regulations. It’s quite another to identify which ones specifically harm productivity without compensating benefit. MGMA cites regulations without so much as an example.
  • Lacking Comparables. MGMA’s press release notes that total HIT costs were $32,000 per practitioner. However, this does not look at non HIT support costs, nor does it address comparable support costs from other professions.
  • Breaking Down Costs. The study offers comparable information to practitioners by specialty types, etc. However, all IT costs are lumped together and called HIT.
  • Ignoring Backgrounds. MGMA notes that HIT costs rose most dramatically between 2010 and 2011, which marked MU1’s advent. It doesn’t address these practices’ IT state in 2009. It would be good to know how many were ready to install an EHR and how many had to make basic IT improvements?
  • Finessing Productivity. Other than mentioning patient portals, MGMA ignores any productivity changes due to HIT. For example, how long did it take and what did it cost to do a refill request before HIT and now? This and similar productivity measures could give a good view of HIT’s impact.

It’s popular to beat up on HITs in general and EHRs in general. Lord knows, EHRs have their problems, but many of the ills laid at their doorstep are just so much piling on. Or, as is this case, are used to make a connection for the sake of political argument.

Studies that want to get at the effect HIE and EHRs have had on the practice of medicine need to be carefully done. They need to look at how things were done, what they could accomplish and what costs were before and after HIT changes. Otherwise, the study’s data are fitted to the conclusions not the other way around.

MGMA’s a major and important player with a record of service to its members. In this case, it’s using its access to important practice information in support of an antiregulatory policy goal rather than to help determine HIT’s real status.

Is Interoperability Worth Paying For?

Posted on August 18, 2016 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

A member of our extended family is a nurse practitioner. Recently, we talked about her practice providing care for several homebound, older patients. She tracks their health with her employer’s proprietary EHR, which she quickly compared to a half-dozen others she’s used. If you want a good, quick EHR eval, ask a nurse.

What concerned her most, beyond usability, etc., was piecing together their medical records. She didn’t have an interoperability problem, she had several of them. Most of her patients had moved from their old home to Florida leaving a mixed trail of practioners, hospitals, and clinics, etc. She has to plow through paper and electronic files to put together a working record. She worries about being blindsided by important omissions or doctors who hold onto records for fear of losing patients.

Interop Problems: Not Just Your Doc and Hospital

She is not alone. Our remarkably decentralized healthcare system generates these glitches, omissions, ironies and hang ups with amazing speed. However, when we talk about interoperability, we focus on mainly on hospital to hospital or PCP to PCP relations. Doing so, doesn’t fully cover the subject. For example, others who provide care include:

  • College Health Systems
  • Pharmacy and Lab Systems
  • Public Health Clinics
  • Travel and other Specialty Clinics
  • Urgent Care Clinics
  • Visiting Nurses
  • Walk in Clinics, etc., etc.

They may or may not pass their records back to a main provider, if there is one. When they do it’s usually by FAX making the recipient key in the data. None of this is particularly a new story. Indeed, the AHA did a study of interoperability that nails interoperability’s barriers:

Hospitals have tried to overcome interoperability barriers through the use of interfaces and HIEs but they are, at best, costly workarounds and, at worst, mechanisms that will never get the country to true interoperability. While standards are part of the solution, they are still not specified enough to make them truly work. Clearly, much work remains, including steps by the federal government to support advances in interoperability. Until that happens, patients across the country will be shortchanged from the benefits of truly connected care.

We’ve Tried Standards, We’ve Tried Matching, Now, Let’s Try Money

So, what do we do? Do we hope for some technical panacea that makes these problems seem like dial-up modems? Perhaps. We could also put our hopes in the industry suddenly adopting an interop standard. Again, Perhaps.

I think the answer lies not in technology or standards, but by paying for interop successes. For a long time, I’ve mulled over a conversation I had with Chandresh Shah at John’s first conference. I’d lamented to him that buying a Coke at a Las Vegas CVS, brought up my DC buying record. Why couldn’t we have EHR systems like that? Chandresh instantly answered that CVS had an economic incentive to follow me, but my medical records didn’t. He was right. There’s no money to follow, as it were.

That leads to this question, why not redirect some MU funds and pay for interoperability? Would providers make interop, that is data exchange, CCDs, etc., work if they were paid? For example, what if we paid them $50 for their first 500 transfers and $25 for their first 500 receptions? This, of course, would need rules. I’m well aware of the human ability to game just about anything from soda machines to state lotteries.

If pay incentives were tried, they’d have to start slowly and in several different settings, but start they should. Progress, such as it is, is far too slow and isn’t getting us much of anywhere. My nurse practitioner’s patients can’t wait forever.

ONC’s Budget Performance Measure Dashboards Makes Goal Tracking Easy

Posted on August 9, 2016 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

I recently wrote a post how it’s not easy to compare ONC’s spending plans with what it actually did. That’s not the case with ONC’s Budget Performance Measures. Its Performance Measure dashboard makes those comparisons easy and understandable. For example, you can look up EHR adoption among office based physicians.

Here’s how to use it. On the dashboard page, Figure I, select a general area using the radio buttons. Depending on your choice, the system will list specific issues. You select the one you want from the drop down menu on the right. You can also adjust the period covered. Right clicking a graph downloads it.

Figure I – ONC Dashboard Menu

ONC Dashboard Menu

It’s in the graph that the dashboard excels. It clearly shows targets and results. For example, Figure II shows that while office EHR adoption has grown over the years, it’s running below ONC’s goals. If you’d only saw the actual – which is the case with ONC’s budget — you’d only see adoption going up. You’d have no clue ONC’s goal wasn’t met.

Figure II – ONC Primary Care Adoption

Office Based Primary Care Doc Adoption

These dashboards give the public a way to understand what ONC wants to do and how well — or not so well — its done toward its goals. In doing so, ONC has given us a scoreboard that not only measures what it’s doing, but it also allows the public to focus on benchmarks. ONC’s fiscal reporting isn’t the clearest, but with these dashboards they’ve done themselves well.