Watching the East Coast prepare for Hurricane Irene last weekend had me flashing back to the aftermath of the tornadoes that hit Joplin, Missouri, earlier this year. Would hospitals suffer the same levels of destruction that St. John’s Regional Medical Center did? Would they be as successful in evacuating patients and treating them off-site with limited supplies and infrastructure?

Fortunately, lessons learned from providers in Joplin, and to a greater extent from the devastation of Hurricane Katrina in 2005, enabled providers along the East Coast to implement well thought-out disaster preparedness plans at their facilities. Mother Nature also lent a hand by withholding from Hurricane Irene the extreme conditions her predecessor unleashed on the South some six years ago.

The team at North Shore – Long Island Jewish Health System makes a compelling case study for the smoothness with which detailed planning can bring to hospital evacuation scenarios. The short video below gives a glimpse into the efforts the hospital’s staff put forth to evacuate 252 in-patients and 50 emergency department patients in less than 24 hours. The helpful Mr. HISTalk has compiled a brief list of updates on several additional hospitals affected by the storm (scroll down to the bottom of the post for updates).

It was by pure coincidence that news of e-MDs’ launch of its Rounds® mobile EMR app for the iPhone reached my desk just as Hurricane Irene was closing in on land. The new app enables physicians to remotely and securely key in patient information from their EHRs via their mobile device – surely a tool that physicians would find useful in treating patients during an evacuation process such as that undertaken by North Shore-LIJ.

Patrick Hall, Executive Vice President of Business Development at e-MDs, told me that the mobile health solution was launched “to help our physician clients stay connected to patient information. We have observed that [they] have been dealing with more and more work when they are away from the office. This provides them with a convenient tool to deal with some of this, using an easily carried device that gives them access to complete patient information so they can make informed decisions about patient care.”

I’ll be interested to learn if any hospitals or private practice physicians came away with “success” stories because of their mobile EMR solutions. I think we can all breathe a sigh of relief that successes this time around far outnumber the failures.

Folks, today I thought I’d take things in a different direction in share links to my favorite health IT bloggers.  Each brings insight, straight talk and deep experience in the healthcare business to the table.

By the way, just to avoid bragging too much, I haven’t included the other blogs in the Healthcare Scene network, but I recommend them highly!

Now, without any further ado, here’s the list:

* The Candid CIO:  This blog offers a rare view into the mind of the IT leader of a large health system.  It’s written by Will Weider, CIO of Ministry Health Care and Affinity Health System. As he notes, the system includes 14.5 hospitals and 400 employed physicians across northern and central Wisconsin. Weider delivers as promised: he’s candid, conversational and quite willing to share his frustrations when things don’t go well.  Definitely a worthwhile read.

*  The Healthcare IT Guy:  This blog, which is written by health IT consultant Shahid Shah, is always an interesting read. His goals are ambitious — he calls the blog a “healthcare IT, EMR, EHR, PHR, medical content, and document management advisory service” — but believe it or not, he manages to cover pretty much all of this territory. Shah is an entertaining writer with a very long health IT resume, and he knows his stuff.  I learn something new whenever I visit.

* HISTalk:  Something’s always bubbling away at HISTalk, an influential site where insider industry folks come to hang out. Mr. HISTalk, an anoymous health IT administrator, not only provides interesting content, but also draws out juicy gossip from readers. For example, check this item out:  ”Re: Cerner. Word on the street is that Cerner is getting ready to announce some big organizational changes and these are not good kind of changes for the employees (may be good for Wall Street, however). This is supposed to hit the CareAware division pretty hard.”  I don’t know if any blog is a “can’t miss” but it’s a good idea to visit now and then.

So, I hope you enjoy these sites — I have for years. Meanwhile, I’m open to hearing about other great health IT blogs as well. Please feel free to let me know if there’s others you admire.

Everyone in healthcare is currently talking about the recently released proposed rule on Accountable Care Organization (ACO). In fact, I posted on EMR and HIPAA a guest post about the ACO Legislation and its ties with healthcare IT, meaningful use and EMR. It’s definitely worth a read.

This move to ACO’s (and to some extent healthcare IT) were described nicely by Maria Todd on Twitter:

@ehrandhit Traditional HIT? The days for business as usual in healthcare ARE OVER!

April 4, 2011 10:22 am via webReplyRetweetFavorite

@AskMariaTodd

AskMariaTodd

As many have said, the ACO train has left the station. In an October article, HIStalk posted about the movement of hospital organizations acquiring physician practices and offered some lessons learned from similar movement back in the 1990′s.

An interesting analysis: hospitals are buying up primary care practices to prepare themselves to become Accountable Care Organizations, which could be the end of the line for small, independent practices. Hospitals are looking at increasing PCP salaries like a Wall Street analyst looks at price-to-earnings ratios, knowing that internists and family practitioners generate hospital revenues at nine times their average salaries, while expensive specialists generate a multiple of only five times their salary. For industry noobs, it’s time for hospitals to get taken to those 1990s cleaners all over again, because:

1. Docs sell out precisely because they don’t want to work  as hard for their new hospital employer as they did for themselves (duh).
2. Hospitals are notoriously bureaucratic and inefficient managers, making them particularly unsuited for running a low-overhead medical practice in every way from EMRs to personnel policies to regulatory compliance.
3. Private practice docs hate and distrust everything about hospitals except the money they have and don’t usually change their opinions or behaviors just because they sell them their practices.
4. Doctors resent taking orders and being told how to practice medicine, especially from suit-wearing hospital MBA-types who fancy themselves business experts despite always having worked for a paycheck instead of themselves, making it likely all these deals will fall apart in 4-5 years like they did last time around, with the docs scrambling to start up new practices without the benefit of a location, an EMR, or patients that they sold away to the local hospital in a frenzy of co-opetition.
5. Patients aren’t much more enthused about hospitals than doctors are, so they aren’t exactly thrilled to see the big sign go up over their friendly little doctor’s office knowing it’s the same folks with ED waits, bad cafeteria food, and terrible parking.

I’ll be really interested to see how these ACO organizations play out and if it is indeed the end of the small physician practice. Although, my gut feeling say that this is cyclical.

While hospitals buying physician practices is one method for creating an ACO, I’d love to hear other models that might be used to create an ACO. Feel free to sound off in the comments with your thoughts and ideas.

HISTalk posted an interesting comment from Allscripts about KLAS and why Allscripts stopped working with KLAS to rate their EHR software:

We agree that there is a conflict of interest in having vendors pay large fees to the same company that is producing the ratings. We reached the same conclusion a few years ago and discontinued the practice. After our recent merger with Eclipsys, we inherited an existing Eclipsys contract that was in place with KLAS, so the information reported by the writer was technically correct. However, we have now canceled that contract and we do not currently pay KLAS anything. We realize that is counter-intuitive as we currently are and have consistently been highly rated across many product categories by KLAS, but ultimately we didn’t feel it was right to pay a firm that was also rating our products.

I’ve never really understood why so many people have put so much value in KLAS. I’ve never found it to be that value (at least on the EHR rating side).

The problem is that SOOO many people are looking for a source of information on how to rate and rank the various EHR vendors. They’re looking for some way to differentiate the 300+ EMR companies out there. Unfortunately, there’s no ranking, certification, JD Power like or consumer report like service that does this for EHR software.

I think there’s a huge opportunity there, but it’s a nearly impossible task to do it effectively (ie. it provides value to the doctors) and without any sort of conflict of interest. Thus we end up with services like KLAS.

A number of people are starting to write about the meaningful use criteria. I’ll plan on highlighting a number of the comments happening around the web about meaningful use here on EMR and EHR. The first up is the always interesting HIStalk’s thoughts (see bullet points below) on the recently released meaningful use interim final rule and a link to HISTalk’s excel file listing the provider requirements for meaningful use (a good place to start for doctors).

• I’m trying to figure out who the big winners will be if these criteria are approved. Consultants for sure. Companies like RelayHealth that provide eligibility, claims, and information exchange services. Companies that can perform a security analysis. Vendors that offer a usable medication reconciliation function. Vendors with patient portals. Companies that can help put vital signs information directly into the EMR.
• Losers: EMR vendors already strapped to pay for CCHIT certification who now have to cough up another million or two to meet the additional requirements. That’s another blow to small and innovative vendors who aren’t raking in the cash, meaning the market tilts even more in favor of the older, bigger ones whose sales were so limited that the government decided to intervene in the free market in the first place. Market consolidation is probably good, but I expect the development agenda will now be even more driven by Uncle Sam, not users (especially since the HITECH sales window is small, so even sales-driven innovation may dry up once everybody has chosen their dance partner).
• Lots of folks, me included, expected the criteria to be a slam dunk for moderately tech-savvy hospitals and practices. Not so: considering the small percentages of them using CPOE and e-prescribing, the minority that can provide electronic copies of information to patients, and the small number of practices that can provide patients with fast access their online health information, the these are stretch goals. I bet those requirements will be dialed back in the final version for that reason.
• Good luck with providing the denominator number for the reimbursement measures. You will need to know the total number of prescriptions generated, the number of orders issued, and the number of episodes in which medication reconciliation should have been performed. The document indicates an estimated time to generate the denominator at one hour using the EMR’s capabilities, which is surely a mistake since the EMR doesn’t help you count paper orders.
• The CPOE requirement is generous to hospitals, which have been screwing around since the 1980s trying to get doctors to use CPOE with dismal results. They are required to hit only 10% CPOE usage since “CPOE is traditionally one of the last capabilities implemented at hospitals.” (like, decades after buying it?) Practices, most of them considering their first EMR in a quick ramp-up to earn HITECH money, need 80% usage right out of the gate. I expect changes here, too, with the hospital target raised and the practice one lowered.
• With the minimal CPOE usage required for hospitals, the five required (and undefined) clinical decision support rules won’t have much impact on patient outcomes.
• The report cites a pseudo-fact that, “Some vendors have estimated that EHRs could result in cost savings of between $100 and $200 per patient per year.” Vendors say a lot of things, but I believe only those that are enumerated in a contract, preferably with rewards or penalties to encourage backing up self-serving statements with risk. I’m not sure I would have included that stat.
• The report used the high estimate of EHR cost from a range of $25,000 to $54,000 per provider, stating that “we believe the cost of such technology will be increasing.” Why should software costs increase when user bases are increasing, which should allow vendors to spread their fixed software development costs over more users? The only one factor that would raise the price is the vendor cost of complying with certification requirements (government meddling in free markets never comes free).
• That higher upfront EMR cost makes the elusive $44K jackpot even less enticing. Doctors were already avoiding EMRs because of cost and negative workflow impact. Providers are questioning whether they can qualify for the incentives and whether they trust the government to pay them.
• Conclusion: if you like the idea of having the government use taxpayer money to encourage the use of specific products in the pursuit of lofty and possibly unrelated goals, this at least pushes some theoretical behavior change in the users who choose to participate. If you’re a provider trying to decide whether the government money has too many strings attached, this might convince you that it does. And if you asked me how the odds of high EMR utilization changed with the release of these proposed requirements, I’d say they got worse.

I can’t help but repost something that HISTalk posted about one of the companies that’s now CCHIT preliminary ARRA certified and the meaning of said certification:

From Lester Bangs: “Re: ARRA certification. Companies like this one (and they aren’t alone) get checked off on SOME of the ARRA criteria (which are changing) and get labeled as Pre-ARRA Certified by CCHIT. Amazing. And we wonder how folks are confused.” I found CCHIT’s disclaimer more interesting (click the above screen shot to enlarge) since it clarifies that the certification is preliminary, possibly irrelevant depending on the standards that are eventually approved, and possibly worthless since CCHIT may not even be a recognized certification body by them.

I’ve always loved HISTalk, but I’m even happier to see that him and I agree about CCHIT certification. I’m sure Mark Leavitt is really glad he’s cutting out of CCHIT when he did.