Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Significant Articles in the Health IT Community in 2015

Posted on December 15, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Have you kept current with changes in device connectivity, Meaningful Use, analytics in healthcare, and other health IT topics during 2015? Here are some of the articles I find significant that came out over the past year.

The year kicked off with an ominous poll about Stage 2 Meaningful Use, with implications that came to a head later with the release of Stage 3 requirements. Out of 1800 physicians polled around the beginning of the year, more than half were throwing in the towel–they were not even going to try to qualify for Stage 2 payments. Negotiations over Stage 3 of Meaningful Use were intense and fierce. A January 2015 letter from medical associations to ONC asked for more certainty around testing and certification, and mentioned the need for better data exchange (which the health field likes to call interoperability) in the C-CDA, the most popular document exchange format.

A number of expert panels asked ONC to cut back on some requirements, including public health measures and patient view-download-transmit. One major industry group asked for a delay of Stage 3 till 2019, essentially tolerating a lack of communication among EHRs. The final rules, absurdly described as a simplification, backed down on nothing from patient data access to quality measure reporting. Beth Israel CIO John Halamka–who has shuttled back and forth between his Massachusetts home and Washington, DC to advise ONC on how to achieve health IT reform–took aim at Meaningful Use and several other federal initiatives.

Another harbinger of emerging issues in health IT came in January with a speech about privacy risks in connected devices by the head of the Federal Trade Commission (not an organization we hear from often in the health IT space). The FTC is concerned about the security of recent trends in what industry analysts like to call the Internet of Things, and medical devices rank high in these risks. The speech was a lead-up to a major report issued by the FTC on protecting devices in the Internet of Things. Articles in WIRED and Bloomberg described serious security flaws. In August, John Halamka wrote own warning about medical devices, which have not yet started taking security really seriously. Smart watches are just as vulnerable as other devices.

Because so much medical innovation is happening in fast-moving software, and low-budget developers are hankering for quick and cheap ways to release their applications, in February, the FDA started to chip away at its bureaucratic gamut by releasing guidelines releasing developers from FDA regulation medical apps without impacts on treatment and apps used just to transfer data or do similarly non-transformative operations. They also released a rule for unique IDs on medical devices, a long-overdue measure that helps hospitals and researchers integrate devices into monitoring systems. Without clear and unambiguous IDs, one cannot trace which safety problems are associated with which devices. Other forms of automation may also now become possible. In September, the FDA announced a public advisory committee on devices.

Another FDA decision with a potential long-range impact was allowing 23andMe to market its genetic testing to consumers.

The Department of Health and Human Services has taken on exceedingly ambitious goals during 2015. In addition to the daunting Stage 3 of Meaningful Use, they announced a substantial increase in the use of fee-for-value, although they would still leave half of providers on the old system of doling out individual payments for individual procedures. In December, National Coordinator Karen DeSalvo announced that Health Information Exchanges (which limit themselves only to a small geographic area, or sometimes one state) would be able to exchange data throughout the country within one year. Observers immediately pointed out that the state of interoperability is not ready for this transition (and they could well have added the need for better analytics as well). HHS’s five-year plan includes the use of patient-generated and non-clinical data.

The poor state of interoperability was highlighted in an article about fees charged by EHR vendors just for setting up a connection and for each data transfer.

In the perennial search for why doctors are not exchanging patient information, attention has turned to rumors of deliberate information blocking. It’s a difficult accusation to pin down. Is information blocked by health care providers or by vendors? Does charging a fee, refusing to support a particular form of information exchange, or using a unique data format constitute information blocking? On the positive side, unnecessary imaging procedures can be reduced through information exchange.

Accountable Care Organizations are also having trouble, both because they are information-poor and because the CMS version of fee-for-value is too timid, along with other financial blows and perhaps an inability to retain patients. An August article analyzed the positives and negatives in a CMS announcement. On a large scale, fee-for-value may work. But a key component of improvement in chronic conditions is behavioral health which EHRs are also unsuited for.

Pricing and consumer choice have become a major battleground in the current health insurance business. The steep rise in health insurance deductibles and copays has been justified (somewhat retroactively) by claiming that patients should have more responsibility to control health care costs. But the reality of health care shopping points in the other direction. A report card on state price transparency laws found the situation “bleak.” Another article shows that efforts to list prices are hampered by interoperability and other problems. One personal account of a billing disaster shows the state of price transparency today, and may be dangerous to read because it could trigger traumatic memories of your own interactions with health providers and insurers. Narrow and confusing insurance networks as well as fragmented delivery of services hamper doctor shopping. You may go to a doctor who your insurance plan assures you is in their network, only to be charged outrageous out-of-network costs. Tools are often out of date overly simplistic.

In regard to the quality ratings that are supposed to allow intelligent choices to patients, A study found that four hospital rating sites have very different ratings for the same hospitals. The criteria used to rate them is inconsistent. Quality measures provided by government databases are marred by incorrect data. The American Medical Association, always disturbed by public ratings of doctors for obvious reasons, recently complained of incorrect numbers from the Centers for Medicare & Medicaid Services. In July, the ProPublica site offered a search service called the Surgeon Scorecard. One article summarized the many positive and negative reactions. The New England Journal of Medicine has called ratings of surgeons unreliable.

2015 was the year of the intensely watched Department of Defense upgrade to its health care system. One long article offered an in-depth examination of DoD options and their implications for the evolution of health care. Another article promoted the advantages of open-source VistA, an argument that was not persuasive enough for the DoD. Still, openness was one of the criteria sought by the DoD.

The remote delivery of information, monitoring, and treatment (which goes by the quaint term “telemedicine”) has been the subject of much discussion. Those concerned with this development can follow the links in a summary article to see the various positions of major industry players. One advocate of patient empowerment interviewed doctors to find that, contrary to common fears, they can offer email access to patients without becoming overwhelmed. In fact, they think it leads to better outcomes. (However, it still isn’t reimbursed.)

Laws permitting reimbursement for telemedicine continued to spread among the states. But a major battle shaped up around a ruling in Texas that doctors have a pre-existing face-to-face meeting with any patient whom they want to treat remotely. The spread of telemedicine depends also on reform of state licensing laws to permit practices across state lines.

Much wailing and tears welled up over the required transition from ICD-9 to ICD-10. The AMA, with some good arguments, suggested just waiting for ICD-11. But the transition cost much less than anticipated, making ICD-10 much less of a hot button, although it may be harmful to diagnosis.

Formal studies of EHR strengths and weaknesses are rare, so I’ll mention this survey finding that EHRs aid with public health but are ungainly for the sophisticated uses required for long-term, accountable patient care. Meanwhile, half of hospitals surveyed are unhappy with their EHRs’ usability and functionality and doctors are increasingly frustrated with EHRs. Nurses complained about technologies’s time demands and the eternal lack of interoperability. A HIMSS survey turned up somewhat more postive feelings.

EHRs are also expensive enough to hurt hospital balance sheets and force them to forgo other important expenditures.

Electronic health records also took a hit from ONC’s Sentinel Events program. To err, it seems, is not only human but now computer-aided. A Sentinel Event Alert indicated that more errors in health IT products should be reported, claiming that many go unreported because patient harm was avoided. The FDA started checking self-reported problems on PatientsLikeMe for adverse drug events.

The ONC reported gains in patient ability to view, download, and transmit their health information online, but found patient portals still limited. Although one article praised patient portals by Epic, Allscripts, and NextGen, an overview of studies found that patient portals are disappointing, partly because elderly patients have trouble with them. A literature review highlighted where patient portals fall short. In contrast, giving patients full access to doctors’ notes increases compliance and reduces errors. HHS’s Office of Civil Rights released rules underlining patients’ rights to access their data.

While we’re wallowing in downers, review a study questioning the value of patient-centered medical homes.

Reuters published a warning about employee wellness programs, which are nowhere near as fair or accurate as they claim to be. They are turning into just another expression of unequal power between employer and employee, with tendencies to punish sick people.

An interesting article questioned the industry narrative about the medical device tax in the Affordable Care Act, saying that the industry is expanding robustly in the face of the tax. However, this tax is still a hot political issue.

Does anyone remember that Republican congressmen published an alternative health care reform plan to replace the ACA? An analysis finds both good and bad points in its approach to mandates, malpractice, and insurance coverage.

Early reports on use of Apple’s open ResearchKit suggested problems with selection bias and diversity.

An in-depth look at the use of devices to enhance mental activity examined where they might be useful or harmful.

A major genetic data mining effort by pharma companies and Britain’s National Health Service was announced. The FDA announced a site called precisionFDA for sharing resources related to genetic testing. A recent site invites people to upload health and fitness data to support research.

As data becomes more liquid and is collected by more entities, patient privacy suffers. An analysis of web sites turned up shocking practices in , even at supposedly reputable sites like WebMD. Lax security in health care networks was addressed in a Forbes article.

Of minor interest to health IT workers, but eagerly awaited by doctors, was Congress’s “doc fix” to Medicare’s sustainable growth rate formula. The bill did contain additional clauses that were called significant by a number of observers, including former National Coordinator Farzad Mostashari no less, for opening up new initiatives in interoperability, telehealth, patient monitoring, and especially fee-for-value.

Connected health took a step forward when CMS issued reimbursement guidelines for patient monitoring in the community.

A wonky but important dispute concerned whether self-insured employers should be required to report public health measures, because public health by definition needs to draw information from as wide a population as possible.

Data breaches always make lurid news, sometimes under surprising circumstances, and not always caused by health care providers. The 2015 security news was dominated by a massive breach at the Anthem health insurer.

Along with great fanfare in Scientific American for “precision medicine,” another Scientific American article covered its privacy risks.

A blog posting promoted early and intensive interactions with end users during app design.

A study found that HIT implementations hamper clinicians, but could not identify the reasons.

Natural language processing was praised for its potential for simplifying data entry, and to discover useful side effects and treatment issues.

CVS’s refusal to stock tobacco products was called “a major sea-change for public health” and part of a general trend of pharmacies toward whole care of the patient.

A long interview with FHIR leader Grahame Grieve described the progress of the project, and its the need for clinicians to take data exchange seriously. A quiet milestone was reached in October with a a production version from Cerner.

Given the frequent invocation of Uber (even more than the Cheesecake Factory) as a model for health IT innovation, it’s worth seeing the reasons that model is inapplicable.

A number of hot new sensors and devices were announced, including a tiny sensor from Intel, a device from Google to measure blood sugar and another for multiple vital signs, enhancements to Microsoft products, a temperature monitor for babies, a headset for detecting epilepsy, cheap cameras from New Zealand and MIT for doing retinal scans, a smart phone app for recognizing respiratory illnesses, a smart-phone connected device for detecting brain injuries and one for detecting cancer, a sleep-tracking ring, bed sensors, ultrasound-guided needle placement, a device for detecting pneumonia, and a pill that can track heartbeats.

The medical field isn’t making extensive use yet of data collection and analysis–or uses analytics for financial gain rather than patient care–the potential is demonstrated by many isolated success stories, including one from Johns Hopkins study using 25 patient measures to study sepsis and another from an Ontario hospital. In an intriguing peek at our possible future, IBM Watson has started to integrate patient data with its base of clinical research studies.

Frustrated enough with 2015? To end on an upbeat note, envision a future made bright by predictive analytics.

We’re Just Getting Started with an Internet of Healthy Things (Part 1 of 3)

Posted on November 24, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The release of Joseph Kvedar’s book The Internet of Healthy Thingscoincided with the 15th annual symposium on Connected Health, which he runs every year and which I reported on earlier. Now, more than ever, a health field in crisis needs his pointed insights into the vision widely shared by all observers: collaborative, data-rich, technology-enabled, transparent, and patient-centered.

The promise and the imminent threat

A big part of Dr. Kvedar’s observations concern cost savings and “scaling” clinicians’ efforts to allow a smaller team to treat a larger community of patients with more intensive attention. As I review this book, shock waves about costs are threatening the very foundations of the Affordable Care Act. Massive losses by insurers and providers alike have led to the abandonment of Accountable Care Organizations by many who tried them. The recent bail-out by UnitedHealth was an ominous warning, eagerly jumped on by Fox News. Although other insurers issued assurances that they stay with the basic ACA program, most are reacting to the increased burden of caring for newly signed up patients by imposing insufferably high deductibles as well as extremely narrow networks of available providers. This turns the very people who should benefit from the ACA against the system.

There is nothing surprising about this development, which I have labeled a typical scam against consumers. If you sign up very sick people for insurance and don’t actually make them better, your costs will go up. T.R. Reid averred in his book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care that this is the sequence all countries have to follow: first commit to universal healthcare, then institute the efficiencies that keep costs under control. So why hasn’t that happened here?

Essentially, the health care system has failed us. Hospitals have failed to adopt the basic efficiency mechanisms used in other industries and still have trouble exchanging records or offering patients access to their data. A recent study finds that only 40% of physicians shared data within their own networks, and a measly 5% share data with providers outside their networks.

This is partly because electronic health records still make data exchange difficult, particularly with the all-important behavioral health clinics that can creat lifestyle changes in patients. Robust standards were never set up, leading to poor implementations. On top of that, usability is poor.

The federal government is well aware of the problem and has been pushing the industry toward more interoperability and patient engagement for years. But as health IT leader John Halamka explains, organizations are not ready for the necessary organizational and technological changes.

Although video interviews and home monitoring are finding footholds, the health industry is still characterized by hours of reading People magazine in doctors’ waiting rooms. The good news is that patients are open to mobile health innovations–the bad news is that most doctors are not.

The next section of this article will continue with lessons learned–and applied–both by Dr. Kvedar’s organization, Partners Connected Health, and by other fresh actors in the health care space.

We’re Hosting the #KareoChat and Discussing Value Based Care and ACOs – Join Us!

Posted on June 23, 2015 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.

ACO and Value Based Reimbursement Twitter Chat
We’re excited to be hosting this week’s #KareoChat on Thursday, 6/25 at 9 AM PT (Noon ET) where we’ll be diving into the details around Value Based Care and ACOs. We’ll be hosting the chat from @ehrandhit and chiming in on occasion from @techguy and @healthcarescene as well.

The topic of value based care and ACOs is extremely important to small practice physicians since understanding and participating in it will be key to their survival. At least that’s my take. I look forward to hearing other people’s thoughts on these changes on Thursday’s Twitter chat. Here are the questions we’ll be discussing over the hour:

  1. What’s the latest trends in value based reimbursement that we should know or watch? #KareoChat
  2. Why or why aren’t you participating in an ACO? #KareoChat
  3. Describe the pros and cons you see with the change to value based reimbursement. #KareoChat
  4. What are you doing to prepare your practice for value based reimbursement and ACOs? #KareoChat
  5. Which technologies and applications will we need in a value based reimbursement and ACO world? #KareoChat
  6. What’s the role of small practices in a value based reimbursement world? Can they survive? #KareoChat

For those of you not familiar with a Twitter chat, you can follow the discussion on Twitter by watching the hashtag #KareoChat. You can also take part in the Twitter chat by including the #KareoChat hashtag in any tweets you send.

I look forward to “seeing” and learning from many of you on Twitter on Thursday. Feel free to start the conversation in the comments below as well.

Full Disclosure: Kareo is a sponsor of EMR and EHR.

Do We Want a Relationship With Our Doctor?

Posted on June 22, 2015 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.

As is often the case, this weekend I was browsing Twitter. Many of the people and hashtags I follow are healthcare and health IT related. Many of the tweets related to the need to change the healthcare system. You know the usual themes: We pay too much for healthcare. We deserve better quality healthcare. We need to change the current healthcare system to be focused on the patient. Etc etc etc.

This wave of tweets ended with one that said “It’s all about the relationships.” I actually think the tweet had more to do with how a company was run, but in the beautiful world of Twitter you get to mesh ideas from multiple disciplines in the same Twitter stream (assuming you follow a good mix of people). I took the tweet and asked the question, “Do We Want a Relationship With Our Doctor?

If you’d asked me a year ago, I would have said, no! Why would I want a relationship with my doctor? I don’t want any relationship with my doctor, because that means that I’m sick and need him to fix something that’s wrong with me. I hope to never see my doctor. Doctor = Bad. Don’t even get me started with hospitals. If Doctor = Bad then Hospital > Doctor.

I’m personally still battling through a change in mindset. It’s not an easy change. It’s really hard to change culture. We have a hard core culture in America of healthcare being sick care. We all want to be healthy, but none of us want to be sick. Going to the doctor admits that we are sick and we don’t want anything to do with that. If we have an actual relationship with our doctor, then we must be really sick.

From the other perspective, do doctors want relationships with their patients? I’ve met some really jaded doctors who probably don’t, but most of the doctors I’ve met would love an actual, deep relationship with their patients. However, they all are asking the question, “How?” They still have to pay the bills, pay off their debts, etc. I don’t know many doctors who have reconciled these practical needs with the desire to have a relationship with their patients.

The closest I’ve seen is the direct primary care and concierge models. It’s still not clear to me that these options will scale across healthcare. Plus, what’s the solution for specialists? Will ACOs and Value Based Reimbursement get us there. I hear a lot of talk in this regard which scares me. Lots of talk without a clear path to results really scares me in healthcare.

What do you think? Do you want a relationship with your doctor? Do doctors want a relationship with their patients? What’s the path to making this a practical reality? Are you already practicing medicine where you have a deep, meaningful relationship with your patient? We’d love to hear your experience.

Assessment Released of Health Information Exchanges (Part 1 of 2)

Posted on January 6, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Like my Boston-area neighbors who perennially agonize over the performance of the Red Sox, healthcare advocates spend inordinate amounts of time worrying about Health Information Exchanges (HIEs). Will the current round of exchanges work after most previous attempts failed? What results can be achieved from the 564 million dollars provided by the Office of the National Coordinator since 2009? Has the effort invested by the government and companies in the Direct project paid off, and why haven’t some providers signed up yet?

I too was consumed by such thoughts when reading a reported contracted by the ONC and released in December, “HIE Program Four Years Later: Key Findings on Grantees’ Experiences from a Six-State Review. Although I found their complicated rating system a bit arbitrary, I found several insights in the 42-page report and recommend it to readers. I won’t try to summarize it here, but will use some of the findings to illuminate–and perhaps harp on–issues that come up repeatedly in the HIE space.
Read more..

Looking Back at 2014: Thermidor for Health Care Reform?

Posted on December 29, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

As money drains out of health care reform, there are indications that the impetus for change is receding as well. Yet some bright spots in health IT remain, so it’s not yet time to announce a Thermidor–the moment when a revolution is reversed and its leaders put to the guillotine. Let’s look back a bit at what went right and wrong in 2014.
Read more..

Which Comes First in Accountable Care: Data or Patients?

Posted on September 30, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The headlines are stark and accusatory. “ACOs’ health IT capabilities remain rudimentary.” “ACOs held back by poor interoperability.” But a recent 19-page survey released by the eHealth Initiative tells two stories about Accountable Care Organizations–and I find the story about interoperability less compelling than another one that focuses on patient empowerment.
Read more..

Are Limited Networks Necessary to Reduce Health Care Costs?

Posted on September 10, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Among the dirty words most hated by health care consumers–such as “capitation” and “insufficient medical necessity”–a special anxiety infuses the term “out-of-network.” Everybody harbors the fear that the world-famous specialist who can provide a miracle cure for a rare disease he or she may unexpectedly suffer from will be unavailable due to insurance limitations. So it’s worth asking whether limited networks save money, and whether they improve or degrade health care.
Read more..

Why Accepting Patient Email is a Practical Requirement of the Affordable Care Act

Posted on July 31, 2013 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 following is a guest post by Zachary Landman, M.D., Chief Medical Officer for DoctorBase.
landman fb
With the infusion of 30 million patients into the U.S. healthcare system in the coming years, the physician shortage is only going to worsen. In Massachusetts, which has had a similar healthcare legislation enacted since 2006, improvements in healthcare coverage and access are highly associated with physician shortages. Prior to the implementation of the health law in Massachusetts, internal medicine and family practice physicians were in deemed to be in “adequate” supply. Almost immediately following the legislation and in nearly every year since, however, the specialties have listed as “critical.”  While the percent of covered patients in the system has reached upwards of 95%, the result has been that physicians are increasingly difficult to visit. Appointment wait times have soared into weeks and months for some specialties and there has been frustration from both patients and providers regarding access.
MMA workforce 2006 and on
An even direr scenario is expected to play out on a national scale when 55 million people currently without insurance enter the healthcare market through subsidized exchanges. Economists predict that the current shortage of physicians will balloon to 63,000 by 2015 and escalate to 130,600 by 2025, due to both increasing demand and dwindling supply. To add salt the wound, a 2012 Physicians Foundation survey demonstrated that nearly half of the 830,000 doctors in the U.S. are over 50 meaning that as the number of patients swell, the supply of physicians will conversely retract.

Clearly, the way healthcare is provided will need to fundamentally change in order to accommodate the three main tenants of the Patient Protection and Affordable Care Act: Access, Quality, and Cost. One potential way is to simply force physicians and healthcare providers to see more patients in the current set of time or work longer or more frequently to maintain their level of reimbursement. Physician time, however, especially for chronically ill and complex patients has become a relatively “inelastic product.”

Physicians already experience significant rates of burnout, are feeling overworked, and have increased the frequency of patient visits to between and 6 and 9 minutes per encounter. Some studies suggest that trying to reduce this amount of time further may actually cause an increase in costs due to inadequate care, counseling, and increased frequency of complications. I would therefore argue that we have reached a point at which physicians cannot increase the volume and frequency of patient care without a fundamental alteration to the paradigm of healthcare.

Secure email may just be the answer. Securely messaging patients can provide a way to fundamentally alter the type and scope of care provided remotely leading to a maintenance or even reduction in the amount of patient care conducted in the office. The fundamental “if” in this scenario, however, is that it must save physician time. For example, physicians have known the value of hand hygiene in patient care for nearly two centuries, but only recently has widespread adoption been shown in an inpatient setting. What led to the main change? Time.  It takes considerable time to cleanse hands thoroughly between each visit. Only when the practice became a time-neutral or time saving event were physicians keen to alter practice behavior. With the inclusion of quick, visible, and easy to use dispensers outside each patient room, these two principles finally coincided.

It’s the same with email. Many physicians worry that by accepting patient messages, their already inelastic time will continually be stretched, forcing them to work longer and harder for a non-reimbursed activity.  After studying more than 11,000 physicians over three years, I have found that the effective use of secure messaging saves physicians on average 45 minutes per day.

Three hours and forty-five minutes per week. That’s a lot of time. And here’s where it comes from.

#1 – Triage. Physician messages should be directed to a practice manager or physician extender who triages the messages and forwards to the appropriate individual. In our case, we found that nearly two-thirds of “physician” messages could actually be handled by office staff. These messages were typically related to hours, availability, insurance coverage, consultant phone numbers, or other back office functions. Our surgeons found that by including a nurse practitioner or physician assistant could also further reduce the number of “MD-level” messages.

For example, minor concerns regarding wound or incision appearance, follow-up timing, suture removal, or questions from visiting nurses were all routinely and commonly handled by the midlevel provider. The exact nature of each question was handled in accordance with physician comfort and expectations. Ultimately, the number and quality of the messages that were directed to physicians were important, timely, and appropriate which led to fewer ED visits, sameday appointments, and phone calls.

#2 – Mobile. Physicians who are able to read, review, and send messages from their mobile device were able to find a considerable amount of “lost” time in their day. Physicians are constantly on-the-move: between patients, rounding, to the hospital and back, to lunch and back, on the elevator, etc. We found that these “micro-minutes” in each day added considerable effectiveness to mobile messaging. As discussed in #1, physician messages were already screened to be important and relevant and so a timely response is indicated. Physicians were able to answer these questions on-the-fly, leading to further confidence in the system on behalf of the patients and fewer voicemails or messages to return at the end of each day.

#3 – Voicemail. Voice messages are the bane of nearly every provider’s life. They are difficult to understand, slow, and take considerable time to review, record, and answer. Through points #1 and #2, the volume and frequency of voicemails decline considerably. The top competitor to patient portals and secure messaging is the phone. It’s universally understood, easy to use, and an immediate response is obtained. Only when patients have an easy to use portal that they can easily access anywhere (and from any device), send a secure message with confidence that it will be reviewed by the provider in a timely manner, and rewarded with a response will patients choose a new system. That’s exactly what our experience has been and there’s absolutely no reason that this cannot be replicated on a national scale.

Whether secure patient email (and ultimately our healthcare legislation) is a failure or a success relates to the patient and provider experiences and our ability to create a harmonious interplay of accessibility, ease of use, and time.

Zachary Landman, M.D. is the Chief Medical Officer for DoctorBase, a San Francisco mobile health technology company considered to be the leader in mobile cloud-based health messaging services that serves more than ten thousand providers and nearly five million patients. Landman is a former resident surgeon at Harvard Orthopaedics and graduate of University California San Francisco School of Medicine. During his career at the intersection of healthcare, technology, and industry, he has developed interactive online musculoskeletal anatomy modules for medical students, created industry sponsored resident journal clubs, and published numerous peer reviewed articles on imaging and outcomes in spine and orthopaedic surgery. Currently, he is leading the development of DoctorBase’s pioneering patient engagement and automated messaging suite, BlueData.

Fee for Service is Dead

Posted on July 9, 2013 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.

In a recent call with the Collaborative Health Consortium, Mark Blatt, MD, Director of Intel Health made some pretty strong statements as a front end to the Healthcare Unbound conference happening this week. In his comments he essentially predicts the end of Fee-For-Service, calling it a dinosaur that will not survive and saying that “this is like a 30-day eviction notice…and it’s happening faster than anyone thinks.”

I find this really interesting because he’s the second high level leader in healthcare that I’ve heard say that the switch away from Fee for Service is happening faster than any of us realize. I wonder what the consequences will be of us not realizing this change is happening. Plus, the odd thing is that we can all see this change happening. Is is that we’re just not understanding the consequences the change will have on the healthcare business?

I also was really intrigued with Mark Blatt’s list of thing you need for a successful transition from Fee for Service:
1. Patient empowerment
2. Mobilize data
3. Share data
4. Gather and store data

When I first considered this list, I realized that EHR could help to enable all of these things. In many ways it already is working to make many of these things possible in an organization. Without the EHR’s involvement, many of these objectives will fall flat.

Although, I also realize that many of these objectives require something outside of the EHR. Will they eventually integrate with the EHR, that’s the vision of some EHR vendors. However, I believe it will take years for us to get there. Until we get there, I think it’s going to create a really tough integration challenge for organizations.

You can hear all of Mark Blatt’s comments in the video below.