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Introducing the Patient Pad

Posted on June 30, 2011 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

 

One of the biggest theoretical advantages of bringing IT into the patient care environment is using technology to replace human labor.  This is more difficult than it sounds.  Some argue that EMRs are actually a step backwards in this regard, reducing health care professionals to data entry clerks.  One of our biggest labor costs is paying office staff to enter patient demographic and clinical information into the EMR.  IT options are available to automate that process.  We have had very good success with our web portal, which allows patients to enter their own data directly into the EMR from home.

But that same technology has failed miserably in our waiting room.  We have tried desktops in private areas and tethered laptops but patients will not use them.  Tablets would probably work better but we have not tried them because of the expense and the risk of theft.  Several commercial solutions are available that use tablets.

An Atlanta-based company, Digital Assent, has a solution and a business model that may help with both of these issues.  The Patient Pad is a tablet device that works well in the waiting room but its operating system renders the device useless outside the wireless connection.  The device itself must be seen to be fully appreciated.  It’s great for its intended purpose but you would never want to take it home.

The Patient Pad is dedicated to patient check-in and data entry in the waiting room.  Like the web portal patients enter their own demographic and clinical data into the Patient Pad, which is then pushed directly to the EMR.  The data input screens are customizable to match the practice’s existing data structure.  When data entry is complete the patient may keep the Pad and review relevant educational and marketing materials based on the information they entered.

Equally innovative is DA’s business model.  The physician gets the tablets for next to nothing.  The revenue comes from sponsors who place ads and educational material on the device.  We are currently working with several pharmaceutical and hearing aid companies to get material relevant to our practice on to the Patient Pad.

To this point DA has only worked with private pay cosmetic practices.  We are the first practice in regular medicine to try the Patient Pad.  As always we are implementing gradually, doing the patient interface first and then building the EMR interface.   So far it has been well received and is doing far better than the desktop workstations or laptops ever did.

I will post an update after we are fully implemented.

I have no financial interest in Digital Assent.

Medical Care and Primary Care without Insurance Allows Technology to Flourish

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve previously posted that I believe the real EMR innovation will likely have to come together with healthcare innovation. The basic premise being that our current insurance reimbursement system is a weight on the backs of EMR software. The insurance requirements cause much of the unwieldy interfaces that are put out by EMR software and insurance requirements and limitations are a huge limiter on the technology innovation that could occur in healthcare.

Imagine how much more streamlined the EMR interface could be if EMR companies worried about patient care and not reimbursement. Imagine the new technologies that would be implemented if you weren’t so worried about the office visit reimbursement model we have today.

This premise is why I was so intrigued by this post on the popular Tech Startup blog, Techcrunch, called “The Most Important Organization in Silicon Valley That No One Has Heard About.” In the article, Dr. Samir Qamar has been putting together a different model for healthcare. “For only $49 per month and $10 per visit, MedLion is able to provide high quality medicine at a price point nearly any family can afford.”

How is he able to do this? Here’s a quote for part of how he’s able to accomplish it:

Part of MedLion’s value proposition has been availability to its patient base. Like many direct primary care practices, they find more than half of their patient interaction is via electronic means, as they aren’t forced by reimbursement rules to have a patient come to their office for something that could be done simply over phone or email. We want to be available for our patients whether they are in the Bay Area, Bali or Boise.”

I’m not sure if Dr. Qamar has found all the healthcare Innovation secret sauce, but I’m grateful for pioneering entrepreneurs like Dr. Qamar that are willing to try something different. Plus, there’s no better place for the application of technology than in these new models for healthcare. It’s exciting to consider what technology could really do when it’s not shackled by the 100 pound gorilla.

Two faces of Eve: CMS payment cuts and MU

Posted on I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Let’s get real for a moment, shall we?  I just read a post about the AHA blasting CMS for supporting payment cuts to help balance the budget.  At the same time, CMS is offering all of this “free” money in the form of incentive payments for incentivizing doctors to buy expensive electronic medical records systems to get an extra $2 per $100 billed.  So is CMS interested in giving doctors more or less?  I’m a bit curious here, as I’m sure many others are as well.

Let’s see.  In January 2012, the SGR formula for payment reductions to doctors will cut off 29%, or $29 per $100 billed.  If you add back $2 per $100 billed, you get a net loss of $27 per $100 billed by doctors.  Even if you get $44K back from CMS over 4-5 years, this would really only cover the cost of setting up the EMR equipment, if that.

Although most of my patients are pretty tuned-in and tell me how much they understand “completely” why I am opting out of Medicare as of tomorrow, July 1, I still periodically get a few questions from other patients, asking, “What’s so bad about Medicare?”  Maybe I’m nuts, but in my mind this really makes a statement about the different levels of enlightenment out there among the general public regarding why some doctors are opting out of Medicare these days.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

HIMSS EHR Association Offers HIE Strategy, World…Yawns?

Posted on June 29, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

In my naivete, I thought the following might be a serious milestone, or at least a thought-provoking read.  Consider the serious tone of this announcement:

The HIMSS Electronic Health Record Association (EHR Association), a collaboration of 46 EHR supplier companies, announced today the availability of a major new white paper “Supporting a Robust Health Information Exchange Strategy with a Pragmatic Transport Framework”.  The focused recommendations in the white paper, aimed at key health IT stakeholders, are based on proven standards and successful health information exchange (HIE) implementations around the world.

Then I took a few spoonfuls of my cereal, drank some coffee and my mind woke up. Oh yes, right, an announcement and a white paper will power the languishing HIE market into action. Right, and President Obama will show up next week and do my laundry.

Honestly, folks, I’m an analyst with health IT background, not a developer or CIO type — so I’m not qualified to say exactly what technologies will work. But I do know posturing when I see it, and that HIMSS press release is rife with quasi-visionary statements. More pointedly, the paper does little more than point to some successful projects and say “See, aren’t they great?”

In any event, I have little confidence in any announcement that proposes to offer the solution, or even the outline of the solution, to any of life’s big problems:  say, the national debt, the struggle for world peace or linking a bunch of fragmented, siloed regional clinical data-sharing projects into a workable whole.

Lest you think I’m a lone cynic, ponder this reaction from an EMR industry insider who preferred to remain anonymous:

“Just about all of this white paper beyond the Direct Project stage is pure B.S. Bits and pieces can be demonstrated at Connectathons, etc. but it will be impossible in the real world to have generalized usefulness with all this overly complicated garbage. It is almost as if the EHRA is conspiring to thwart real interoperability progress.

Look for the push methodologies/capabilities arising out of the initial Direct Project pilots to expand to provide the functionalities this report claims are not possible. This will happen and just supersede all this proposed nonsense because it will simply, incrementally work.”

Now *that* analysis makes tremendous sense to me. If The Direct Project — or other efforts to follow — can foster the growth of sensible data-sharing schemes, we might just get our national HIE. If not, well, don’t look to announcements like these for answers.

Learning from First Hand EMR Experience

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been really excited about a project I’ve been working on that does interview of various people within the EMR and EHR world. It’s a site appropriately called EHR, EMR and Healthcare IT Interviews.

It’s a new site and so we’re just getting started posting content, but we have a bunch more interviews on the way. We’re trying to make it a great mix of people with first hand experience selecting and implementing an EMR with other leaders in the EMR and EHR industry. For example, I’m putting together some interviews of EHR vendor CEO’s that should be really interesting.

I don’t know about the rest of you, but I find that one of the best ways for me to learn concepts is to hear other people’s experience. There’s something beautiful about learning from someone else’s work.

For example, there were a lot of great lessons shared in an EMR interview posted today. I found it really interesting that they were already doing 9 of the meaningful use criteria with basically no effort on their part. Plus, they found the ePrescribing to be one of the most challenging requirements. Both are great pieces of information for someone else trying to show meaningful use.

I’ll keep working hard at bringing more and more of these first hand experiences to you. Let me know if there are people you think I should interview. I’m all about finding new people with interesting EHR perspectives.

Lessons Learned from our EMR Upgrade – Part 3

Posted on I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

It is after 11 PM and I have just arrived home after a meeting with our practice leadership.   Why so late?  The meeting doesn’t start until 7 PM.  We docs can’t afford to take time out of our practices to meet during the day.  We moonlight as CEOs, CIOs, managers, etc. for our own practices.

This was the first meeting since March that was not dominated by unhappy discussions about the system upgrade.  It wasn’t even mentioned.  Tonight’s EMR discussions were forward looking, including e-prescribing, which just went live for us yesterday, and the pending results of our meaningful use gap analysis that will come out next week.  I think we have reached an appropriate point to take some perspective on our difficult upgrade.

To state the obvious first, we bit off too much at once.  Going 6 years without a software upgrade is bad enough.   But doing a major database conversion at the same time?  And buying all new servers?  And switching to VMware?  What the heck were we thinking?

As I mentioned yesterday we were afraid of using the database merge program (a.k.a. the migration tool) on our precious database until the vendor got more experience with it.  We also thought it was a reasonable strategy to feel all the pain all at once rather than spread it out over several smaller steps.  Regarding our 6 figure server purchase we were trying to cheat the old rule that any computer you buy will be obsolete by the time you get it home and plug it in.

In retrospect those were all good thoughts.  They just weren’t enough.  We failed to realize that while the migration tool was getting better through time, our database and applications were at the same time getting bigger and more complicated.  Every year we added an average of 50,000 new patients to our database.  We also added applications like our web portal and more automated document scanning / indexing.  Time also allows strange things to happen…such as when one office accidentally started scanning clinical documents into the practice management database.  Tens of thousands of documents were in the wrong place.  We picked up on it ahead of time and thought we had fixed it but the migration tool still had a problem with those image files.  Sometimes I wonder if we should have upgraded sooner and taken our chances with a less mature migration tool running on a smaller, less complicated, less entropy-riddled database.

The upgrade was harder and far more stressful than the original implementation in 2005.  I think this was because we no longer had paper charts as a lifeboat when the system wasn’t working well.  The gradual, no-hassle approach to EMR implementation that I wrote about months ago is not an option when you are switching databases.  I have a new found respect for practices that are forced to switch EMR programs.

VMware was a much bigger hassle than I expected.

When one considers that the upgrade occurred at the end of 6 years of relatively hassle-free system performance it really wasn’t that bad.   But it sure felt bad at the time, not knowing when or if we were going to get the bugs fixed.

 

Haven’t Been Paid your EHR Incentive Money Yet? One Possible Reason Why

Posted on June 28, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The CMS FAQ site has a great question up that I have a feeling a number of doctors will be interested in knowing the answer to:
I am an eligible professional (EP) who has successfully attested for the Medicare Electronic Health Record (EHR) Incentive Program, so why haven’t I received my incentive payment yet?

Here’s their answer:

For EPs, incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year.

The Medicare EHR incentive payments to EPs are based on 75% of the estimated allowed charges for covered professional services furnished by the EP during the entire payment year. Therefore, to receive the maximum incentive payment of $18,000 for the first year of participation in 2011 or 2012, the EP must accumulate $24,000 in allowed charges. If the EP has not met the $24,000 threshold in allowed charges at the time of attestation, CMS will hold the incentive payment until l the EP meets the $24,000 threshold in order to maximize the amount of the EHR incentive payment the EP receives. If the EP still has not met the $24,000 threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March 2012 (allowing 60 days after the end of the 2011 calendar year for all pending claims to be processed).

Payments to Medicare EPs will be made to the taxpayer identification number (TIN) selected at the time of registration, through the same channels their claims payments are made. The form of payment (electronic funds transfer or check) will be the same as claims payments.

Bonus payments for EPs who practice predominantly in a geographic Health Professional Shortage Area (HPSA) will be made as separate lump-sum payments no later than 120 days after the end of the calendar year for which the EP was eligible for the bonus payment.

For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.

This is actually something that I’ve written about before (probably on EMR and HIPAA), but I have a feeling many people weren’t looking at the details to realize why they aren’t getting their incentive money. You have to wait until you have enough Medicare Allowable Charges before they’ll pay you. I think this is a smart plan I do find it interesting that there were some clinics that had enough allowable charges in 3 months to receive the full EHR incentive money right away. I’d love to see some stats on medicare allowable charges per provider. Would be interesting to see how this aspect of the EHR incentive program affects Medicare providers.

Either way, hopefully this information will help someone who is wondering where they EHR incentive money is. Thanks to @jimtate for tweeting the FAQ and reminding me of this part of the program.

How much interoperability do doctors really want?

Posted on I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Dr. Alberto Borges recently wrote in MD Magazine,

“The ability to universally interconnect doctors and hospitals (the central, most important mandate of the HITECH Act) continues to elude us, and will be a daunting task with more than 400 non-interoperable ‘certified’ EHR systems in the marketplace (http://hcp.lv/kAwUHL).”

I have to wonder how many practicing doctors would actually prefer to have a lot more additional data and records to wade through about each patient.  If they could have access to years of data from every single healthcare facility that the patient has ever visited, then this presents us with the potential problem of a glut of  reading that is potentially a waste of time.  I wonder if anyone has thought about this issue.  On one hand, I tell myself, there is probably a snowball’s chance in hell of this ever becoming a reality, given the wealth and diversity of systems out there already or in the planning phases for coming online in the future.  On the other hand, what if it did happen?  I think it’s important to be careful what one wishes for.  It just might turn out to be less productive than one could hope.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

Lessons Learned from our EMR Upgrade – Part 2

Posted on I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

As I discussed in the last blog post we were very busy this past spring with our biggest EMR upgrade to date:

  1. Upgrade from the 2005 software to the 2010 version (2011 upgrade delayed on the advice of our VAR), making a big jump.
  2. Purchase new servers and new memory (SAN)
  3. Switch to virtual servers / VMware
  4. Convert our database from 2-database structure to single database to accommodate the 2010 software.

This was more of a system replacement than an upgrade.  The only parts that weren’t completely replaced were the network components and some peripheral applications (web portal and document scanning).

Despite realistic expectations the upgrade took longer than expected.  Some problems took many weeks to solve.

  1. Despite a successful test run, the dual-to-single database conversion was fraught with problems and took longer than expected.  The computer that was running the conversion software (called a “migration tool”) had a RAM failure during the operation, which slowed the conversion down but didn’t kill it.  When we saw the operation slow down we had a dilemma – do you stop to troubleshoot or let it keep running slowly?  We have over 250,000 patient records in our database so the conversion was expected to take well over 72 hours – longer than a weekend.  That meant we were already looking at EMR down time during office hours.  We stopped the migration to diagnose and replace the RAM.  Then the migration tool itself failed, forcing another interruption and requiring our vendor to troubleshoot and patch the migration tool.  The migration tool is an unusual piece of software.  You only need it once so about the time you have learned to use it you don’t need it anymore.  On the vendor side, every customer’s database / hardware situation is different, so the migration tool is never totally debugged.  That is why we delayed our upgrade so long – we wanted the vendor to gain some experience with the migration tool before we used it.  We were still by far the largest database conversion they had ever done.  In spite of the difficulties the result was an intact single database that gave us no further trouble once the migration was completed.
  2. Another contribution to our delay in upgrading was waiting for our vendor to support VMware and give us hardware specs.  Even with that accomplished VMware was a nightmare to set up.  Performance was very slow initially and took days to correct.  The biggest problem was the printers.  Printer preferences were lost several times a day and it was not unusual for my documents to get printed at a member practice across town despite having reset my printer preferences several times that day.  That wreaked havoc on clinic operations and took over a month to fix.
  3. We were blindsided by a bizarre “failure” of a T1 line to one of our offices.  The line was somehow put in some sort of diagnostic mode, rendering it unable to function but showing it as normal to our monitoring.  For days we assumed that office’s performance problems were related to the upgrade.
  4. Some issues were purely our fault.  We did not adequately staff our upgrade operations.  We had only our chief operating officer and our IT specialist to handle problems and questions; they couldn’t get off the phone long enough to fix anything.  This also impaired communications significantly.  To make things worse each of them had immediate family members become suddenly ill, requiring that they take some time off during the upgrade.

The next post will be my analysis of this great adventure.

 

Singapore Launches National EHR, London Hospitals Go To The Cloud

Posted on June 27, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Today I bring you a couple of interesting clinical data stories from outside the U.S. One involves a cloud pilot and the other a national EHR; while U.S. providers are toying with the former, I doubt the latter will ever happen. Anyway, without further ado:

* Singapore Launches National EHR

Working with Accenture, the country of Singapore recently launched one of the world’s first national EHR systems. The system itself seems straightforward — it will capture medical data and patient demographics across clinic, acute care and community hospital settings — but its scale makes the project unique.

Obviously, the U.S. is nowhere near to creating such a network, and given our industry’s chaotic structure, I don’t see it happening anytime soon. Even centralized, nationally-controlled health systems are struggling to pull something like this off.

It certainly helps that Singapore has a population of just five million; the country plans to spend $144 million just to reach this relatively small group. It’s hard to imagine what it would cost to roll out such a network across the U.K., much less a giant country like the U.S.

Not surprisingly, Accenture worked with many vendors to make the rollout work, including Oracle, Orion Health, IBM and HP.  The partners completed the first stage of the rollout in 10 months (pretty impressive, if you ask me!)

*  National Health Service Pilots Cloud-Based Health Data Services

Next month, London’s Chelsea and Westminster Hospitals plan to begin storing all patient data in in the cloud. The effort, known as E-Health Cloud, is a National Health Service pilot test. The system will offer fine-grained access controls, allowing patients to decide exactly which clinicians, friends and family members can access their records.  According to a report in Engadget, security is tight; users will have to verify their ID multiple times to access their medical data.

As you may know, a small number of U.S. hospitals are experimenting with storing data in private and public clouds. But I’d wager that this effort, backed by a national entity that can roll things out when it pleases, is likely to move far more quickly than U.S. healthcare cloud deployments.

So, progress in Singapore and the U.K.  Somehow, knowing what can be done, the state of regional HIEs and cloud projects in the U.S. seems a little bit depressing, doesn’t it?