The Nov/Dec 2011 issue of Healthcare Executive includes an article I wrote for the Satisfying Your Customers column, titled Engaging Staff with Social Media. In the article I describe how successful leaders will prepare for the shifts occurring in the healthcare workplace; including the push for efficiency and new generations. I also include a few examples of where social media is contributing to a more effective workplace in hospitals.
Social media technologies are tools that can help increase customer, physician and employee satisfaction. I hope you will take the time to read the article and share your thoughts.
Another blog post that includes a few great workplace examples is list of 20 hospitals with inspiring social media strategies.
I was interviewed for a recent article in Becker's Hospital Review that explores the common belief that older adults have more difficulty accepting and using technology. It includes some great comments about "digital natives" and "digital immigrants" by the other interviewees.
Speaking for myself, as a late Boomer, I can say that I certainly am a digital immigrant who has embraced technologies as I have found value to my work and life. And, I believe that this applies to older adults in general. There are differences in the generations and the oldest may need the most convincing and support, but it isn't that they can't incorporate technology into their daily life.
I remember older adults thinking it was a bit silly for people to carry around a cell phone. But, once they began to realize value - they feel safer because they can call for help -- then older adults start using the technology just as anyone else. If I'm correct, I also I believe this is how telephone adoption went. It took a long time for it to catch on and for people to find value in the technology.
Health IT is just one more advancement that needs to progress through the adoption cycle.
I've posted on the subject of volunteers, young people working in hospitals and those considering a career in healthcare administration, previously. However, this last week, I've been specifically researching Candy Stripers, who are sometimes referred to as Junior Volunteers.
Candy Stripers at Doctors Memorial Hospital, FL
I'd love to here your thoughts or stories about the youngest of our hospital workforce! If you prefer something more personal, send me an email: Christina {at} cthielst {dot} com
I'm thinking I should also start researching the Pink Ladies, too!
The American College of Physicians has released an update to its Ethics Manual and new or expanded sections include, among others, confidentiality and electronic health records, health system catastrophes, boundaries and privacy, social media and online professionalism. I really appreciate the manual and have pulled out a few key points based upon the topics I cover often on this blog.
All Changes to the Manual since the 2005 (fifth) edition
Healthcare-associated infection data on all hospitals in Califorinia has been released by the California Department of Public Health (CDPH). This means anyone can see the nosocomial infection rates of their local hospital by unit. But, I urge some caution among consumers with comparing rates of different hospitals and units. Instead, this data should be used to prepare questions and for a discussion with your physician or the hospital. Hospitals may be interested in using this data to benchmark themselves against other hospitals.
Healthcare-associated infections (HAIs) are infections that patients develop during the course of receiving healthcare treatment for other conditions. They can happen following treatment in healthcare facilities including hospitals as well as outpatient surgery centers, dialysis centers, long-term care facilities such as nursing homes, rehabilitation centers, and community clinics. They can also occur during the course of treatment at home. They can be caused by a wide variety of common and unusual bacteria, fungi, and viruses.
HAIs are the most common complication of hospital care, occurring in approximately one in every 20 patients. The following HAIs occurring in hospitalized patients are required to be reported to the CDPH by all California general acute care hospitals:
Data is also available on a couple of hospital practices that that contribute to a reduction in HAI rates and length-of-stay.
I participated in this morning's Gartner Worldwide IT Spending Forecast. Gartner, the technology research giant, brought together some wonderful speakers who shared information that I feel is important to healthcare -- especially at this moment in time. The issues will have major revenue implications for vendors (perhaps leading to service changes) and could delay current and planned IT initiatives (EHR adoption, HIE, etc) of healthcare organizations.
The floods in Thailand in October of 2011 severely impacted fabrication facilities and this has lead to a shortage of hard drives. It is predicted that it will take at least until the 3rd or 4th quarter of 2012 for the industry to get back to meeting demand. There is some uncertainty about this timeline.
This means:
One lesson that comes from this situation is to have multiple geographic locations for the manufacturing of components to help prevent business disasters like this one. In this case all of our (the world's) eggs (hard drives) are manufactured in one basket (Thailand).
PC and software spending is down due to the downturn in the economy. But, there was one bit of good news that I pulled from the discussion on software. Spending on software (tools) for collaboration is increasing. Companies are investing in technologies that will help them stay competitive and this means tools that will help their employees collaborate will reduce the need to bring on additional people.
Now, I've been seeing this in other industries and have started to see it trickle into healthcare. With health reform upon us, I hope my friends in the hospital start thinking a little more out of the box and how they too can leverage collaborative tools (aka social media) to improve efficiency and effectiveness in the workplace.
By Sheldon Needle
The real problem of an established medical practice moving into the realm of EHR is not the cost of the medical software package; it is not the training necessary for staff; and it is not security and backups.
The real problem of moving into EMR/EHR is the problem of unstructured medical data.
If you are involved in a new or relatively new practice, this is a no-brainer. Begin with a serious search to compare medical software vendors who are available to answer your questions honestly. It is not truly so difficult to get on a friendly medical screen to enter your patient’s blood pressure or lab test values. You can get used to that.
Neither is it difficult to take notes on a notebook that upload to the EHR system.
The real problem is taking your notes and dictation on a patient that go back 15 years and finding a way to get his possible symptoms, his worry about IBS, his headache history, and his worries over his children into a metrically available rendition that that does not take you or a member of your practices days to decipher. These notes are usually on dictation, hand written notes, and referral letters.
The concerns are many: this can take what feels to be forever, and the anxiety issues and unclear symptoms may not translate easily into metrics but may be critically important in future diagnoses.
There are two critical questions here:
In the long run, it doesn’t even matter if it is worth it. It will happen. Medicine as well as the rest of our cultural world, is becoming electronically-based whether we like it or not. But in the long run, it is worth it. Think of a patient going in to the hospital after a car accident, all by himself, and having all his data available to the admitting doctor in an instant: blood type, history, etc.
Think of a patient being referred to you, the specialist, and having all his patient history available in less than a minute. What a time saver! What insight!
Medical informatics has a number of methodologies it is using to translate unstructured data into useful and structured data.
Three basic methodologies exist to accomplish this:
These methods will be refined, utilized, and integrated in some way into most decent medical vendor software packages over the next few years. For you the physician or practice manager, this may start to pay off in a while, but you still have to get from hand written records into the database.
The obvious way to proceed makes use of our culture idea of, “going forward”:
The real message to practitioners moving to electronic health records is, don’t look at the top of the mountain when you start climbing, just put one foot in front of the other. Delaying the climb will not get you anywhere, but starting the march will move faster than you think!
Source:
Having recently spent time as an observer in a hospital setting, I was struck by the lack of intelligent planning and forethought made for doctors trying to move into an EMR / EHR environment.
Though I saw a well-known EHR panel on the computer screens within an ICU, and the EHR being used to record certain patient data, doctors were taking their notes in long-hand. Later on the same day I saw the same doctors transcribing their notes onto their computers. The doctors, doing double duty on note taking were not available to their patients because they were acting as secretaries.
When a large clinical environment is incorporating an EHR it has to be done in a modular way that does not impact productivity any more than it has to. The task is hard enough. If you are using an EHR to record point of care patient information, give your doctors a Notebook so they can take their notes electronically. In fact, insist on electronic note-taking. Incorporate change with some forethought to peoples’ time and effort.
This real-life observation just underscores the need to plan for transition to an EMR rather than throwing an institution into the chaos of change for its own sake, or for the sake of Meaningful Use incentive payments. As in all things, the old US Coast Guard motto holds true: Semper Paratus! Always be ready and prepared.
Most good EMR / EHR systems can offer medical clients some guidance as to best practices in incorporating EMR / EHR systems within their practices.
By Sheldon Needle
The prospects for EHR in the coming year are exciting but more than a little daunting. The issue is really how to find an EMR/EHR system that will organize and centralize the functions of your practice, without bankrupting you and throwing your staff and yourself into turmoil.
If you look at the websites for EMR vendors today, you can see that the functions they describe within their system –the integration of clinical records with practice management data, e-prescription, patient portals — could conceptually do wonderful things for you and for your patients in the way you handle their individual cases, but many of the details are still not working smoothly.
Here are some of the things to be aware of:
Remember, always read the fine print and ask every question you need to. Know that EMR software decisions is a very competitive business. The vendors need you just as much as you need them!
By Sheldon Needle
5010 is not only a date 3,000 years in the future: ANSI 5010 is the newest version of the HIPAA transaction standards regulating electronic transmission of medical and healthcare transactions. The existing standard is called 4010, and 4010 does not support ICD-10 coding.
The current coding standard for diagnosis and procedure coding is the ICD-9, and it has outlived its possibilities –it limits the number of new procedure and diagnostic codes that can be created.
This is how the CMS.gov (center for Medicare and Medicaid services, at: http://www.cms.gov) defines the ICD-10:
About ICD-10
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:
ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.
The transition to 5010 is supposed to happen by January 1, 2012. This means that electronic transmissions including claims, eligibility inquiries and remittance advices must be made in a 5010-compliant format. Healthcare providers, health plans and clearinghouses for transactions are all expected to upgrade their transmissions. Non-compliance may result in claims denied or slower payment.
Systems that are certified as ONC-ATCB for 2011/2012 are already 5010 compliant. If you are contemplating buying a system that is so certified, you do not have to worry about the software compliance, but you do need to educate your staff, including yourself, if you are the physician or the P.A., on what the differences between 4010 and 5010 mean to their everyday work.
If you are using old medical software that has not been updated, or are contemplating installing software that is not certified as ONC-ATCB for 2011/2012, you need to update to a newer version, or face delays and uncertainties in your billing and claims submission. In other words, do some serious upgrading, or else!
By Sheldon Needle
November 30, 2011: Today HHS Secretary Kathleen Sebelius announced incentives to speed the adoption and use of health IT in the form of meaningful-use qualified EHR in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.
The new administrative actions announced today, which will be made possible by provisions of the HITECH Act, will loosen requirements for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.
“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius. “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”
The press release continues to state: “HHS also announced its intent to make it easier to adopt health IT. Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.”“ (The italics are ours.)
We need to understand what acting quickly means: buying in 2011? Incorporating EHR within the next month, so that meaningful use occurs in 2011? This is not yet clear.
HHS is redoubling its effort to reach out with information, education, and the possibility of incentive payments to doctors and hospitals and vendors about stepping up the pace of transitioning practices and HER software to meet standards of Meaningful Use. What Meaningful use means to the individual practice depends on size, degree of implementation of the EHR, and the nature of the client base (how many Medicare or Medicaid patients, for instance, figures into the formula of Meaningful Use.
The Obama Administration is working to create a nationwide network of 62 Regional Extension Centers, comprised of local nonprofits, to help eligible health care providers learn how to participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.
See the HHS press release, at: http://www.hhs.gov/news/press/2011pres/11/20111130a.html to learn more.
Keep your eyes on the newspapers, government announcements and on this blog to learn about EMR and EHR news and updates.
By Sheldon Needle
You know that your medical practice will have to bite the EMR bullet sooner or later (actually, sooner). The digital handwriting is on the tablet, isn’t it? So what is it stopping you from moving ahead at a planned pace rather than being forced into converting your medical practice to an EMR at the 11th hour?
Here are some of the most common obstacles people face in converting their practices to the use of electronic medical record software, and here are some strategies to deal with them or get the process going:
1. How will we migrate from paper to digital images? Conversion of paper medical records to digital format: If you have your eye on an EMR, learn how tolerant it is of varying formats: does it accept PDF files? JPG format? Ascii text files? Extracts from excel files?
Don’t bit off more than you can chew to begin. If you are practice with reams of folders full of paper files to convert, decide how many years back you need to go in getting your EMR up and running. Perhaps you can start with one year of files via EMR? Or perhaps you need to go much further back?
Look into the possibility of having a consultant specializing in data conversion take charge of your files. There are companies that specialize in just such medical data conversions. If you are really desperate, hire your responsible college students, make the specs clear, and pay her decently!!
2. How will we train everyone in such a new system? Training your self and your staff: Once you have chosen your EMR system, engage the company’s own training staff; that way, you are sure you are being oriented in the current system, using the right documentation. Before you chose your EMR, see what kind of training options the company offers. You might go for a short orientation up front, with a good help desk that is available 24/7. Check reliable Electronic medical records ratings to see which companies provide good in person and on the phone / online support
3. Do we have to set up all the hardware and maintain the software? I don’t think we can manage that. Consider a cloud-based EMR solution: If you are reluctant to invest in a server and commit to the upkeep of hardware and software, consider a Web-based EMR solution, in which you log onto an EMR that worries about security, and updates to hardware and software.
4. How can I compare products so that my practice knows what it is getting into? How much can I trust referrals from other practices? Don’t put all of your EMR decision eggs into one basket: While personal referral are extremely helpful and reassuring, not all are meaningful for your unique EMR practice situation. There are many good EMR products to choose from, and each has its strengths, and its weaknesses.
The right choice will depend as much on the nature of your medical practice and the answers to many questions: What is your medical specialty? How many employees do you have? How expensive is the EMR, per year? How much money can you dedicate to investing in your EMR annually? Can you integrate your medical billing software with your proposed new EMR? Can you afford to hire a dedicated IT employee? How comfortable you and the others in your practice are with using an electronic device as the main source of medical input to your system. These are just a few of the many questions you need to ask yourself.
Talk to people in other practices, yes; but learn to ask the right questions and compare apples to apples and oranges to oranges. Great EMR comparison tools are available to you at no charge, and they can educate you to ask the right questions and maintain a solid baseline for comparison when choosing an EMR.
Researchers from the University of Tennessee Space Institute are developing a device which should make eye exams in children a whole lot simpler. The device is called the Dynamic Ocular Evaluation System (DOES) and it can screen the eyes for abnormalities, while the children watch a cartoon or play a computer game. Here’s how it works:
“DOES is low-cost, high-quality, and operator- and child-friendly. It takes about a minute to train someone to use it. The test is done as the child watches a three-minute cartoon or plays a computer game. Infrared light is used to analyze the binocular condition and the assessment is reported on-site within a minute. Neither eye dilation nor verbal response is required.
Hidalgo out of Cambridge, England has released its new wireless Equivital EQ02 LifeMonitor that can continuously record ECG, respiratory rate, skin temperature, and activity levels in patients. Data is analyzed using special software for PCs, web and mobile devices and can provide real-time results that can be immediately acted upon by clinicians.
Hidalgo’s technology has already been in use by UK’s Cambridgeshire Fire and Rescue, Addenbrooke’s hospital, and the US Marine Corps in Iraq where wireless, mobile, and easy to use devices save the day.
Agfa received FDA clearance for its DX-M digitizer with needle-based detectors for use in mammography and general radiography. It features the firm’s MUSICA2 advanced image processing software, three image resolution modes (50 μm pixel pitch (20 pixels/mm), 100 μm pixel pitch (10 pixels/mm) and 150 μm pixel pitch (6.7 pixels/mm)), a “drop-and-go buffer” for cassettes so you don’t have to wait for the digitization, and a number of other features that improve workflow.
The system can support both needle-based detector cassettes and standard phosphor plate cassettes, and the two types are colored differently to eliminate confusion.
While joint arthroplasty has become impressively advanced over the past few decades, the essence of the procedure still ultimately boils down to trial and error. Using pre-operative X-rays and intra-operative sizing guides, joint surgeons pick from a pre-set list of joint replacement “sizes.” Then, once the bone cuts have been made, temporary implants called “trials” are used to see how the fit is, and the best fit is selected. Rarely are these pre-determined sizes a perfect fit, but they are usually more than sufficient and function quite well.
However, in the quest for perfection, patient-matched custom implants are beginning to increase in popularity. Stanmore Implants just announced the launch of their custom matched unicondylar knee replacement system dubbed “Savile Row,” after the famous Tailoring destination. Unicondylar knee replacements are used in patients with isolated arthritis in one part of their knee and only replace the damaged portion.
Laser eye surgeries like LASIK and especially photorefractive keratectomy (PRK) can be painful on the eyes for a few days following the procedure. To alleviate the pain anesthetic eye drops are used, which have to be regularly administered by the patient. Not only is that inconvenient, but one can actually overdose a bit on them drops.
Now researchers at University of Florida are reporting that they developed a way to load topical anesthetics into contact lenses to provide extended delivery of pain relief in a uniform fashion. And since many of the patients that undergo eye procedures have been wearing contacts prior, they’re already used to putting them on.
Medtronic announced receiving European approval for its Endurant II AAA Stent Graft System and will be making it available globally.
The device provides a minimally invasive (endovascular) option for addressing abdominal aortic aneurysms and includes a few improvements on the previous model:
“The National Consortium of Breast Center's Board of Trustees has given their consent to the following position statement reflecting their stand on the issue of mammographic screening, in response to the recommendations made by the US Preventive Services Task Force.
National Consortium of Breast Centers, Inc.
Position Statement regarding the Mammography Screening Recommendations of the United States Preventive Services Task Force (USPSTF)
The National Consortium of Breast Centers (NCBC), the largest national organization devoted to the inter-disciplinary care of breast disease, requests the USPSTF rescind their new position on mammography screening.
The U.S. Preventive Services Task Force (USPSTF) published a paper detailing model estimates of potential benefits and harms to women screened for breast cancer with mammography.1 They provided an updated USPSTF recommendation statement on screening for breast cancer for the general population that alters currently accepted guidelines for women over 40 years old.2
The NCBC opposes the new guidelines as written. We cite specific evidence that screening mammography leads to early detection which leads to improved survival.3 In every country starting population screening, mortality declines coincide with onset of screening, not systemic therapy. These USPSTF models are not based on sound data, namely different denominators in the “harms” vs. “benefits” groups leading to invalid comparisons. Recent data from randomized controlled trials reveal significant mortality reductions evident approximately five years after screening programs were initiated. The reductions in age-adjusted, disease specific mortality (30-40%) since 1990 define screening program benefits not seen in the prior six decades. In the United States, these mortality declines continue at a rate of approximately 2% per year. 4 This mortality improvement counts as a remarkable public health achievement.
In addition, the USPSTF panel (comprised almost exclusively of primary care physicians) did not include breast imaging specialists nor was it represented by any of the multiple other specialists who collaborate to optimize patient outcomes. These specialists include pathologists, surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, technologists, geneticists, nurse navigators, educators and others.
The NCBC does not understand the assumptions used by the USPSTF to value human life. We note the cited literature was selective and failed to acknowledge equally powerful and credible peer-reviewed literature, which supports currently accepted breast cancer screening guidelines.
We would also like to note that quality of life has a significant value, not just survival. It is well established that if we discontinue mammography for women in their 40’s, the cancers eventually detected will be larger, more likely need more aggressive surgery, more likely need chemotherapy and more likely lead to other significant socio-economic concerns.
The NCBC requests input into future guideline development and vows to work with government, scientists and industry to keep the process transparent and keep the focus on the patient. We recommend further efforts target screening, risk assessment, education and awareness regarding the implications of positive and negative screening findings. Funding for further research is imperative and supported by the controversy these articles have generated.
Finally, we note the USPSTF article states, “whether it will be practical or acceptable to change the existing U.S. practice of annual screening cannot be addressed by our models.”1 The NCBC agrees with this comment and finds their screening guideline suggestions unacceptable. The NCBC believes many women’s lives will be placed at risk if current screening guidelines are altered. We respectfully request the Task Force rescind their position on this specific women’s healthcare screening policy.
# # # #
About NCBC: The National Consortium of Breast Centers (NCBC) is the largest national organization devoted to the inter-disciplinary care of breast disease. In keeping with our mission, to promote excellence in breast care through a network of diverse professionals dedicated to the active exchange of ideas and resources including: 1) To serve as an informational resource and to provide support services to those rendering care to people with breast disease through educational programs, newsletters, a national directory, and patient forums; 2) To encourage professionals to concentrate and specialize in activities related to breast disease; 3) To encourage the development of programs and centers that address breast disease and promote breast health; 4) To facilitate collaborative research opportunities on issues of breast health; and 5) To develop a set of core measures to define, improve and sustain quality standards in comprehensive breast programs and centers.
References:
1. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 738-747.
2. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 716-726.
3. Tabar L, Vitak B, Chen HT et al. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast cancer mortality. Cancer 2001; 91: 1724-1731.
4. American Cancer Society, Breast Cancer Facts and Figures, 2009-2010.
All content and design © 2009 by the National Consortium of Breast Centers, Inc.”
Have you taken the challenge yet? “What challenge?”, you ask. The Health 2.0 Developer Challenge or those on Challenge Post. These sites take advantage of the recent US initiative to make health databases available to the public.
Since 2010, both sites have hosted challenges sponsored by organizations, corporations, and the government. Some have monetary prizes, some just offer recognition. The goal is to bring software programmers, designers, and health care experts together for rapid application development. There are two types of developer projects: 1) challenges, which overseas team collaboration to build specific requested tech solutions, and 2) code-a-thons. Code-a-thons are typically one day or weekend events that spur teams to rapidly create new applications and tools to improve health care.
Health 2.0 and Challenge Post make it easy to form teams with their community boards and resources. Check out the wide array of challenges posted on their sites. Compare goals, deadlines and prizes. Make new contacts, enjoy the thrill of creativity, and the pride of helping find real solutions to health care issues. Several have December 31, 2011 deadlines, so check out the fun and competition, and register today!
containers that ring, play music and send emails to remind people to take sixteen different medications when loaded only once in two or three months. Another medication lid glows when it is time to take a pill and then records the time the bottle is opened and the pill was taken.
Multiple pedometers and sensors track steps, galvanic skin response, brain waves, and pulse and are easily synched with smartphone apps that forward reports to your doctor. Sensors can be placed in carpets, slippers, kitchen drawers and refrigerators to track movement of elders living alone. Reports can be sent to specified caregivers. One sensor tracks sleep patterns when placed in an arm band and then placed under your smartphone in the morning to sync and download and email the report. Airstrip Tech links doctors with EMTs in ambulances to follow monitors as the patient travels to the hospital. Two 5 minute Rapid Fire product demo sessions reviewed over 25 new products.
Several websites help patients track their medical information. Patients determine what they want to share and with whom. Some are open source; some are created by private companies. Patient groups like ePatient Dave and Patients Like Me encourage sharing collective medical information to foster a faster learning curve to how to best treat patients and diseases in the US and abroad.
I had the distinct honor of speaking on a panel about game play.
My expertise comes from creating and consulting on multiple smartphone apps related to food and nutrition. Gamification was a hot topic in multiple sessions, mentioned frequently as a terrific means to engage and educate patients. Interesting to me was the fact that some telemedicine products and apps already include game play. This is mostly in the form of Q&A or true/false questions. To celebrate Breast Cancer Month in October, a colleague, Nadine Fisher, MS RD LD, and I created the Apple app Breast Cancer Care. We included five true/false games and one food photo match game.
Many of the products I saw at Connected Health are first generation this year. One company rep said there were only a handful of tech vendors exhibiting last year. This year there were five exhibitor rows lining a hotel ballroom. This business is exploding. I have seen the future of medicine, and it is exciting and often fun. Games are a great hope to advance the health of the world for patients, caregivers, and professionals.
Here’s a link to a blog post about the panel on which I spoke. I was the only RD on the program.
http://mobihealthnews.com/13977/add-health-to-games-or-games-to-health
Games for Health Project originated in the United States in 2004.
Ben Sawyer was instrumental in its foundation and development into the force that it is today. It’s annual meeting draws hundreds of global participants each year in Boston.
So it was exciting news this year when Games for Health announced a European partner. It’s first meeting will be held in Amsterdam on October 24 and 25. The central theme is: How games and simulations can improve health(care) and make it affordable. The program is dynamic includes topics on five core tracks:
Cognitive and emotional health
Participatory health
Exergaming, active gaming and fitness
Rehabilitation games
Medical/Education and training
So if you are looking for an excuse to visit Amsterdam, the Games for Health Europe conference is a must do. It will be exciting to watch this innovative group develop and deliver fresh ideas and research on health games for the European health community.
Register today!
www.GamesforHealthEurope.org
Nick Yee, PhD, a research scientist at the PARC (the Palo Alto Research Center) has published studies that show how people’s behaviors change when they use avatars. One study notes how players engage when offered tall, attractive avatars, versus shorter, less attractive ones. He suggests that people will exercise longer and better when offered fit looking avatars.
James Watt, PhD is a serious games researcher at the University of Connecticut. He explains that social interaction is relative to masked identity. Group communication is best when there is also social interaction. So how about creating an avatar-likeness with body movements that still provides anonymity? Microsoft Xbox recently released Avatar Kinect that scans participants and then creates a general look-alike avatar of themselves – including body movements.
Players might not mind sharing personal attributes with friends, but would players feel comfortable revealing their size, hair color, and mannerisms to strangers, too? This remains to be seen, as medical professionals brainstorm about health applications. Consider in-home avatar group therapy sessions, patient education classes, addiction support groups, or parent clubs. Now layer on a health gaming twist. How about a virtually engaging game of Nutrition Jeopardy? The possibilities are tremendous! What kind of avatar health games do you envision? This field is wide-open for development. Game on!
Strong research is the foundation of the health professions, and health game development is no different. When a person’s health is being manipulated, then people expect the method or product to be well researched before being recommended. After all, the physician’s oath is, “First, do no harm …”
From the start, early thought-leaders recognized that progress in this emerging industry needed to rely on health professional collaboration based on sound, scientific research to prove efficacy. This is what researchers call, “the scientific method.” Developers, designers, funders, and players want to see supportive data. Multiple colleges and universities have stepped up to take the task, and many privately funded developers eagerly share their methods and results to further the cause. Unfortunately, researchers publishing their results has been a problem. Traditional scholarly journals do not target video games for health — until now.
Mary Ann Liebert, Inc, publishers of scores of well-respected peer-reviewed scientific journals have announced plans to publish Games for Health: Research, Development, and Clinical Applications this fall. Games for Health will be a peer-reviewed journal and has a stellar editorial board line-up. The Liebert press release stated the journal would be published bi-monthly and would be “dedicated to the development, use, and applications of game technology for improving physical and mental health and well-being. The Journal breaks new ground as the first to address this emerging, widely-recognized, and increasingly adopted area of healthcare.”
The Games for Health journal and it’s accompanying online presence is a welcome home for the health video games community. For more information check out www.liebertpub.com
Organized by the the IU School of Informatics at Indiana University–Purdue University Indianapolis (IUPUI), the 2nd annual Midwestern Conference on Health Games conference will be held in Indianapolis on October 28, 2011. Abstracts are being accepted now. The submission deadline is June 1. 2011. For more information please contact Vicki Daugherty at vdaugher@iupui.edu or 317-278-4123.
President Obama speaks to the nation about healthcare reform (AP photo)
Tonight, President Obama spoke to the nation about his plans for healthcare reform. He outlined how he plans to reform the current system and how he plans to pay for it including cutting over $100 billion worth of subsidies to insurance companies as part of Medicare.
Few key points:
He also touched upon the need to increase health IT and move way a fee for service system to a team-based approach to deliver healthcare.
Full Video:
Full Text: Obama’s Remarks on Health Care
(without question/answer session)
Following is a text of the prepared remarks by President Obama before his White House news conference on Wednesday, as released by the White House.
Good evening. Before I take your questions, I want to talk for a few minutes about the progress we’re making on health insurance reform and where it fits into our broader economic strategy.
Six months ago, I took office amid the worst recession in half a century. We were losing an average of 700,000 jobs per month and our financial system was on the verge of collapse.
As a result of the action we took in those first weeks, we have been able to pull our economy back from the brink. We took steps to stabilize our financial institutions and our housing market. And we passed a Recovery Act that has already saved jobs and created new ones; delivered billions in tax relief to families and small businesses; and extended unemployment insurance and health insurance to those who have been laid off.
Of course, we still have a long way to go. And the Recovery Act will continue to save and create more jobs over the next two years – just like it was designed to do. I realize this is little comfort to those Americans who are currently out of work, and I’ll be honest with you – new hiring is always one of the last things to bounce back after a recession.
And the fact is, even before this crisis hit, we had an economy that was creating a good deal of wealth for folks at the very top, but not a lot of good-paying jobs for the rest of America. It’s an economy that simply wasn’t ready to compete in the 21st century – one where we’ve been slow to invest in the clean energy technologies that have created new jobs and industries in other countries; where we’ve watched our graduation rates lag behind too much of the world; and where we spend much more on health care than any other nation but aren’t any healthier for it.
That is why I’ve said that even as we rescue this economy from a full-blown crisis, we must rebuild it stronger than before. And health insurance reform is central to that effort.
This is not just about the 47 million Americans who have no health insurance. Reform is about every American who has ever feared that they may lose their coverage if they become too sick, or lose their job, or change their job. It’s about every small business that has been forced to lay off employees or cut back on their coverage because it became too expensive. And it’s about the fact that the biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid.
So let me be clear: if we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket. If we do not act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction. These are the stakes of the debate we’re having right now.
I realize that with all the charges and criticisms being thrown around in Washington, many Americans may be wondering, “What’s in this for me? How does my family stand to benefit from health insurance reform?”
Tonight I want to answer those questions. Because even though Congress is still working through a few key issues, we already have agreement on the following areas:
If you already have health insurance, the reform we’re proposing will provide you with more security and more stability. It will keep government out of health care decisions, giving you the option to keep your insurance if you’re happy with it. It will prevent insurance companies from dropping your coverage if you get too sick. It will give you the security of knowing that if you lose your job, move, or change your job, you will still be able to have coverage. It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. And it will cover preventive care like check-ups and mammograms that save lives and money.
If you don’t have health insurance, or are a small business looking to cover your employees, you’ll be able to choose a quality, affordable health plan through a health insurance exchange – a marketplace that promotes choice and competition Finally, no insurance company will be allowed to deny you coverage because of a pre-existing medical condition.
I have also pledged that health insurance reform will not add to our deficit over the next decade – and I mean it. In the past eight years, we saw the enactment of two tax cuts, primarily for the wealthiest Americans, and a Medicare prescription program, none of which were paid for. This is partly why I inherited a $1.3 trillion deficit.
That will not happen with health insurance reform. It will be paid for. Already, we have estimated that two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health care programs. This includes over one hundred billion dollars in unwarranted subsidies that go to insurance companies as part of Medicare – subsidies that do nothing to improve care for our seniors. And I’m pleased that Congress has already embraced these proposals. While they are currently working through proposals to finance the remaining costs, I continue to insist that health reform not be paid for on the backs of middle-class families.
In addition to making sure that this plan doesn’t add to the deficit in the short-term, the bill I sign must also slow the growth of health care costs in the long run. Our proposals would change incentives so that doctors and nurses are free to give patients the best care, not just the most expensive care. That’s why the nation’s largest organizations representing doctors and nurses have embraced our plan.
We also want to create an independent group of doctors and medical experts who are empowered to eliminate waste and inefficiency in Medicare on an annual basis – a proposal that could save even more money and ensure the long-term financial health of Medicare. Overall, our proposals will improve the quality of care for our seniors and save them thousands of dollars on prescription drugs, which is why the AARP has endorsed our reform efforts.
Not all of the cost savings measures I just mentioned were contained in Congress’s draft legislation, but we are now seeing broad agreement thanks to the work that was done over the last few days. So even though we still have a few issues to work out, what’s remarkable at this point is not how far we have left to go – it’s how far we have already come.
I understand how easy it is for this town to become consumed in the game of politics – to turn every issue into running tally of who’s up and who’s down. I’ve heard that one Republican strategist told his party that even though they may want to compromise, it’s better politics to “go for the kill.” Another Republican Senator said that defeating health reform is about “breaking” me.
So let me be clear: This isn’t about me. I have great health insurance, and so does every Member of Congress. This debate is about the letters I read when I sit in the Oval Office every day, and the stories I hear at town hall meetings. This is about the woman in Colorado who paid $700 a month to her insurance company only to find out that they wouldn’t pay a dime for her cancer treatment – who had to use up her retirement funds to save her own life. This is about the middle-class college graduate from Maryland whose health insurance expired when he changed jobs, and woke up from emergency surgery with $10,000 in debt. This is about every family, every business, and every taxpayer who continues to shoulder the burden of a problem that Washington has failed to solve for decades.
This debate is not a game for these Americans, and they cannot afford to wait for reform any longer. They are counting on us to get this done. They are looking to us for leadership. And we must not let them down. We will pass reform that lowers cost, promotes choice, and provides coverage that every American can count on. And we will do it this year. And with that, I’ll take your questions.
The ONC policy committee on meaningful use has published an updated matrix on the subject. It can be found here.
Someone in the GOP needs to learn how to use Microsoft Visio, or the Democrats need to come up with a better plan for improving our healthcare system.
Republicans imagination of the Democratic Healthcare plan
If you believe this nightmare chart created by Congressman Kevin Brady’s office (R-Texas 8th District), then you’ll need a PHD in obfuscation to figure out what the Democrats are planning. More likely, however, is that Brady is painting an overly bleak picture of what a government plan might look like.
Jokes aside, as this battle continues to play out, both sides are sticking to their guns; however, the Obama administration believes it has the trump card: 60 votes. Bloomberg News is reporting that “Obama Open to Partisan Vote on Health-Care Overhaul.”
We’ll follow how this plays out, and keep you apprised of any interesting happenings.
UPDATE July 22, 2009:
Corrected Visualization of the Democratic Healthcare plan (PDF)
A graphic designer, Robert Palmer, took it upon himself to “correct” the republican nightmare chart and made it significantly easier to understand. The updated chart, along with a PDF can be found on Mr. Palmer’s Flickr page. He also penned a note to Representative Boehner:
Dear Rep. Boehner,
Recently, you released a chart purportedly describing the organization of the House Democrats’ health plan. I think Democrats, Republicans, and independents agree that the problem is very complicated, no matter how you visualize it.
By releasing your chart, instead of meaningfully educating the public, you willfully obfuscated an already complicated proposal. There is no simple proposal to solve this problem. You instead chose to shout “12! 16! 37! 9! 24!” while we were trying to count something.
So, to try and do my duty both to the country and to information design (a profession and skill you have loudly shat upon), I have taken it upon myself to untangle your delightful chart. A few notes:
- I have removed the label referring to “federal website guidelines” as those are not a specific requirement of the Health and Human Services department. They are part of the U.S. Code. I should know: I have to follow them.
- I have relabeled the “Veterans Administration” to the “Department of Veterans’ Affairs.” The name change took effect in 1989.
- In the one change I made specifically for clarity, I omitted the line connecting the IRS and Health and Human Services department labeled “Individual Tax Return Information.”
In the future, please remember that you have a duty to inform the public, and not willfully confuse your constituents.
Sincerely,
Robert Palmer
Resident,
California 53rd District
The Certification Commission for Healthcare Information Technology (CCHIT) has responded to the Office of the National Coordinator’s recently released Meaningful Use matrix [pdf]–and responded with a vengeance.
The bottom line: “CCHIT recommends that meaningful use measures be either simplified for 2011, or postponed until 2013.” CCHIT Annotations to the ONC's Meaningful Use Matrix (PDF)![CCHIT Annotations to the ONC's Meaningful Use Matrix [PDF]](http://healthcareitblog.mtbc.com/wp-content/uploads/2009/07/cchit-annotations.png "cchit-annotations")
Its recommendation was formed by comparing the CCHIT 2008 criteria against the meaningful use matrix prepared by the National Coordinator’s Workgroup on Meaningful Use and finding that while many of the 22 proposed objectives are fully supported by the current certification, at least 8 have minor to major gaps with the CCHIT 08 criteria.
Why Postpone?
The commission argues that “the lag between a decision to invest in EHR technology and its full, meaningful use in a provider organization is 1 to 2 years at best, and more typically, 3 to 5 years,” and for this reason it recommends postponing the 2011 measures until 2013. It isn’t that some EHRs do not currently meet the standards drafted for 2011 (MTBC’s EMR does), it’s that CCHIT criteria does not currently cover or test for all of the proposed 2011 measures. Additionally, CCHIT does not believe that the marketplace is fully ready to support some of the reporting standards outlined in the draft.
CCHIT has prepared an annotated response to the ONC’s matrix which highlights the actual points in contention for 2011. CCHIT’s letter to the ONC further clarifies CCHIT position on the topic.
As always, we will continue to cover this story as new developments arise and as key shareholders continue to weigh in with comments and responses.
Why don’t you let us know what you think? Should the 2011 measures be postponed until 2013?
When you buy a car, the manufacturer usually offers some kind of warranty on your purchase e.g. bumper-to-bumper coverage for 50,000 miles or 5 years, whichever comes first. Or coverage for 100,000 miles for the power train and 50,000 miles bumper-to-bumper. Some are now offering oil changes for life, free car washes, dry cleaning, or the salesman will pick up your kids from soccer practice if you make a purchase now. Ok, maybe they won’t pick up your kids, but you will please! buy now?
Francois de Brantes
Francois de Brantes, a nationally known advocate of health care quality, is hoping to bring warranties to healthcare. He and a few associates penned an article in Health Affairs describing the benefits of a new payment model for physicians which may inspire physicians to improve patient outcomes by putting their skin (and money) in the game.
The warranties which de Brantes proposes–Prometheus Payment as he’s called it–flip the current medical billing payment model on its ear. Prometheus Payment offers set fees to providers for recommended services, treatments and procedures. However, unlike the current system where all fees are covered by third-party payers, the provider now becomes a party in the payment process by assuming fiduciary responsibility for outcomes–should patients develop an avoidable outcome, providers become responsible for half the costs. The warranty is based on the costs of these avoidable outcomes and is risk adjusted for elderly or frail patients.
de Brantes and his co-authors explain that “the warranty concept has filtered into the self-pay portion of health care, such as corrective eye surgery, general cosmetic surgery, and dental care, which are often based on a global fee that includes any necessary rework by the provider. But it has taken much longer for warranties to appear in the third-party payer system.” They argue that with this global-fee model, overall costs in the healthcare can be reduced while improving outcomes for patients by making (and paying) the provider for any expenses before, during, and after the procedure.
The abstract to the Health Affairs article reads:
How health care providers get paid has implications for the delivery of care and cost control; the topic is especially important during an economic downturn with persistent growth in health spending. Adding “warranties” to care is an innovation that transfers risk to providers, because payment includes allowances for defects. How do such warranties affect patient care and bottom lines? We examine a proposed payment model to illustrate the role of warranties in health care and their potential impact on providers’ behavior and profitability. We conclude that warranties could motivate providers to improve quality and could increase their profit margins.
I find two points interesting.
This whole idea adds a new wrinkle to medical billing. As your billing service, we’d not only be incentivized to help you collect more money but also provide you tools to provide better patient care. Great news for you, we have a CCHIT-certified EMR which provides just the tools you need. Find out more here.
We will keep you posted if this model crops up at any payers near you.
Read more about Prometheus Payment:
On June 16 the Workgroup on Meaningful Use presented its recommendations on the definition of Meaningful Use. They prepared a preamble describing their overall path to this definition and a matrix to organize their recommendations for each year. For those who have been under a rock for the past 6 months, “meaningful use” is the defining measure by which the incentive payments included in the American Recovery and Reinvestment Act (ARRA) will be determined.
With this working definition, vendors, physicians, and hospitals can better plan for implementation and delivery of technology and services to achieve the measurable goals outlined by the Workgroup.
HITECH Act Incentives as outlined by the American Recovery and Reinvestment Act (ARRA)
Meaningful Use for Whom?
First it is important to note that “meaningful use” will have different meanings for hospitals and for groups in private practice. The preamble states “some features and capabilities will be recommended as required in an ambulatory setting before similar functions are expected to be widely used in the hospital.” This means that proving “meaningful use” will be a more rigorous exercise for private practices than it is for hospitals. However, private practices have a broader range of options and lower barriers of entry (cost, availability of technology, shorter implementation time frames, etc) when it comes to implementing technologies which can deliver “meaningful use.”
The Details
Let’s go over some of the measures which are planned for 2011 and look at some examples of each item. More details for each of the items below can be found in the matrix. John Halamka, MD of the CareGroup Health System of Harvard Medical School and the chairman of the US Healthcare Information Technology Standards Panel (HITSP) said in Healthcare IT News that this matrix still needs to be populated with the most up to date standards and an implementation guide. These details will help vendors and physicians alike ensure that their software meets these measures. Expect this in July.
Each of the items below has associated metrics which will need to be reported to verify meaningful use; for example, one of the objectives calls for reminders to patients for preventive/follow-up care. In order to prove meaningful use, the EMR application must be able to provide a reporting of the percentage of patients over 50 with annual colorectal screening. Keep in mind that each of the items below has an associated measure (found in the matrix) which will require reporting to an authorized agency.
Items marked with a Yes! indicate that the MTBC EMR helps your practice meet or exceeds these measures.
What Now?
Now that you know the definition of Meaningful Use what should you do now? The answer is simple: get an EMR. Ok it is not that simple, but you will be happy to know that you have plenty of options in the marketplace. Dr. Halamka writes, “Hospitals and Clinician offices now know what is expected for 2011, so the time is now to begin your software implementations.” Never before have there been so many EMRs which provide such a high level of functionality and interoperability. Today’s major differentiators are not function, but price and service.
MTBC Can Help
MTBC’s CCHIT certified EMR (free to MTBC medical billing clients) can help your practice meet the goals of 2011. Click here to find out more about MTBC’s unified medical billing and practice managagement services.
However, if “free” is not your bag, you have plenty of other options beginning at the $1,000 range and your imagination as the only limit. Vendors have become very creative in their pricing with new options emerging such as monthly subscriptions, charges for each fax sent from the EMR, hosting fees for web-based applications, fees for technical support by email, server replacement plans (a la replacement plans sold by big box stores), 50¢ per 100MB of storage, and many others.
MTBC’s EMR rivals those of its competitors because it is implemented, supported, and updated completely free of charge of its premium medical billing clients. To find out more about how MTBC’s EMR can help you meet the goals of Meaningful Use, request a demo today and, if you are not currently an MTBC billing client, find out how you can download a free trial.
Watch this space for more information regarding meaningful use and its impact on the healthcare IT.
Ahem….what do we say about privacy and data selling…bingo it appears as if you read through the entire article why else would this type of data be shared with Wall Street Investors to make a market for selling some new analytic algorithms. Now get this the investors got to see this “private” information that a patient can’t even get access to see. This reminds me of ePatientDave, “give me my damn data” and this is a total abuse here as the data is not being used for better care but for “better money”. 
Now this also says something about access to revenue cycling too, payers and integrators might want to visit this scenario and make sure that it stays on a server for one and what levels of access will be granted. Now this gets worse as the types of information and patients were related to mental health, HIV, Parkinson's and more. How many investors glazed over these records? Accretive gets paid on the revenue boost is provides. There are a lot of these types of 3rd parties around in healthcare and here’s another one used by Blue Cross who had some bad algorithms.
Actually when it comes down to payer disputes you wonder did the hospital bill erroneously on purpose or did they get some bad algorithms and a bunch of promises? If I were one of these patients, court might be on my mind and I would want to know what investors on Wall Street potentially or did see my data! On their website they talk about bringing increased discipline to the revenue cycle so is that 
the revenue cycle on Wall Street?
Well Fargo just dumped one of these types of companies recently and remember the big data breach at Stanford, also the fault of a 3rd party, so with history being built here who wants to trust a 3rd party today if you don’t have to as patient records end up on the web and in the hands of investors on the street. The 3rd party folks are the algorithm makers though that promise better profits and use of money. This whole scenario though is kind of sad as they were supposed to be helping a couple non profits boost their revenue but the hospitals probably had no clue on the methodologies like showing patients records was in the plan.
“The screen shot also includes numeric scores to predict the “complexity” of the patient and the probability of an inpatient hospitalization, and a box to describe
the “frailty” of the patient.”
Tine to start licensing and taxing those data sellers and have a federal disclosure site so we all know what’s going on, beginning to make more sense every day! The link below will describe a bit of this brainstorm. BD
http://www.myfoxtwincities.com/dpp/news/stolen-laptop-debt-collector-lawsuit-jan-19-2012ST. PAUL, Minn. - Minnesota Attorney General Lori Swanson has filed a lawsuit against a debt collector accused of failing to protect the confidential information of 23,500 hospital patients after a company laptop was stolen from a rental car parked in the Seven Corners are of Minneapolis.
The lawsuit filed Thursday alleges Accretive Health, Inc., a debt collection agency that is part of a New York private equity fund conglomerate, failed to protect the confidentiality of patient health care records and failing to disclose its involvement in their health care.
Last July, Accretive lost a laptop computer containing unencrypted health data of about 23,500 patients of two Minnesota hospital systems -- Fairview Health Services and North Memorial Health Care.
Under both contracts, Accretive controls and directs the work of hospital employees and “infuses” its own employees into the staffs of the hospitals. Accretive gets base compensation and incentive pay for helping the hospitals boost revenue or cut costs.
“The debt collector found a way to essentially monetize portions of the revenue and health care delivery systems of some nonprofit hospitals for Wall Street investors, without the knowledge or consent of patients who have the right to know how their information is being used and to have it kept confidential,” Swanson said.
The state seeks an order requiring Accretive to fully disclose to patients:
- What information it has about Minnesota patients
- What information it has lost about Minnesota patients
- Where and to whom it has sent information about Minnesota patients
- The purposes for which it amasses and uses information about Minnesota patients.
One more the mergers and acquisitions speak out again on how health insurance companies have diversified their portfolios and are no longer “just an insurance company” with numerous subsidiaries both in the Health IT area and even others in what you might consider “unrelated” businesses. Here’s one example below with a 
diversified interest with a new division created to distribute hearing aids and offer incentives for those in certain areas of the us to sign up for insurance plans. I sometimes wonder how other insurers view this?
Here’s another example of what one might consider a business outside of what we might normally consider a related business with low incoming housing investments in New Mexico. One thing to keep in mind today is all the aggregated data that flows and the algorithms and SQL statements that bring some of this together. Data is big business.
Just a couple weeks ago we read about the investment with mobile health and again we venture down into the data business here again as the Optum division which has many subsidiaries has a huge focus on data, and part of the renamed group was the old “Ingenix” company that has consulted and provided data services for years and last year settled their case with the AMA with short paying providers for out of network services.
This kind of brings me around again to what I call the “Alternative Millionaire’s Tax” with companies that buy and sell data and this seems to be a good place for a mention here as the Optum Division has been making money for years with aggregating and selling prescription and other data. With big profits as such we certainly could entertain a license and tax situation for those making billions on the data selling business. As a short comparison from another Healthcare company, Walgreens has estimated their data selling business to be valued at just under $800 million, so again something to give some thought to as hospitals, providers, and patients struggle to afford medical care today.
Another good article to read about the over sell and naïve and gullible nature of the US with both government and consumers, read what Nanex has to say as they are the folks that monitor and study rogue algorithms in the stock market and look for indicators of the “next flash crash”. A couple paragraphs are below and will the SEC be suckered in to this huge expense of programmers who want to make big dollars writing code convince a naïve and gullible SEC? It’s all over the place with digital illiteracy, steroid marketing and algorithms for huge profits only and they have teeth. At a certain point in time we might need to REALLY think about the value of some of the data we analyze today and the cost and this is worth a mention as this is the big growth area for United, algorithms and software analytics via consulting services. It is also worth a note that United last year hired the former Assistant Attorney General for the State of Minnesota for their general counsel.
Below is one example of the algorithm/software business as the company created a clearinghouse business and collaborated with an medical records company to integrate the services with Epic and of course this means more data revenue for the company and puts a bit of stress on other smaller existing clearinghouse businesses in the US as well.
One more thing too is let’s not forget that they also own a bank with over $1 billion on deposit with health savings accounts and I would guess this also leaves them open to lend money on monies held here and somewhat compete with other banks. As you can read in the quote below the funds are largely generated by employers, in other words large US corporations so they seem to go hand in hand, right?
“OptumHealth offers three types of HSAs, as well as tax-advantaged health care 
savings and spending accounts, debit-card services, benefits administration services, and payment products. About three-quarters of the bank’s 1.6 million accounts are employer-generated, while the other quarter are individual accounts.”
There’s also the Chinese investment the company bought early in 2010.
If you were to stop and look you might also notice one more subsidiary that can consult with biotech and device companies to introduce new products to the FDA and you know when you think about it they might just have a subsidiary to handle the entire process from FDA approval all the way down to provider reimbursement too. 
One other related item too is the purchase of physicians groups which is growing and the acquisition of Monarch in Orange County is one big example of buying a huge managed care group.
Again, in summary with such large profits and a lot coming from the data end of the business, this looks like one company where licensing and taxing the data sold for huge profits could fit and there are many more as Hedge Funds, Facebook and tons of other companies are cashing in royally and this all leads to bottom line profits for running algorithms on servers 24/7 that you can’t see, touch or talk to as far as the consumer is concerned, but automated algorithms for data mining and selling are yielding huge profits for corporate USA while as consumers we are becoming “data chasers” to fix a lot of the flawed data that is out there today. It’s a good idea today to read up and see how the corporate USA scene has changed tremendously due to the huge array of mergers and acquisitions as companies are not the same ones they were 2 to 3 years ago by any means. BD
UnitedHealth Group (NYSE:UNH) today reported fourth quarter and full year 2011 results, highlighted by strong enrollment and revenue growth in each of UnitedHealthcare’s benefits businesses and strong revenue growth at all Optum business units. Full year and fourth quarter 2011 net earnings were $4.73 per share and $1.17 per share, respectively. Cash flows from operations were $7 billion in 2011.
The Company continues to estimate 2012 revenues in the range of $107 billion to $108 billion and net earnings in the range of $4.55 to $4.75 per share.
Is there money in those algos? This story might answer that. Why would this employee who was a contracted programmer take this code? It’s worth money and if you read often enough you know I discuss those algos and software is nothing more than a group of algorithms, words of Bill Gates. 
A co-worker said the employee said the accused confused he lost the drive containing the code and get this, it’s the software (aka algorithms) that cost $10 million to develop to track the billions of dollars that the US government dispenses “daily” to government agencies..these are some pretty commanding algorithms…so the programmer apparently took the code and who knows where it would go next? A lot of government code is open source but don’t think that is the case here…what’s the next security breach to occur? BD
Bo Zhang, 32, of Queens, New York, worked as a contract programmer at the bank. He was accused of illegally copying software to an external hard drive, according to a criminal complaint filed in U.S. district court in Manhattan.
Authorities said the software, owned by the U.S. Treasury Department, cost about $9.5 million to develop.
A New York Fed spokesman said in a statement that the bank immediately investigated the suspected breach when it was uncovered and promptly referred the matter to authorities.
Zhang told investigators he took the code "for private use and in order to ensure that it was available to him in the event that he lost his job," the complaint said.
The code, called the Government-wide Accounting and Reporting Program (GWA), was developed to help track the billions of dollars the United States government transfers daily. The GWA provides federal agencies with a statement of their account balance, the complaint said.
This is kind of an alarming incident but when you read further it does not stop the treatment process and the secondary outbursts are surgically removed. This affects about half of those treated to be on alert, but not all of those develop the secondary skin cancer, only about a quarter of the 50% risk group.
This sounds like a big step in recognizing undesired side effect with oncology treatments. BD
Press Release:
Drug Used to Treat Melanoma with One Mutation Sets off a Cascade that Results in a Different Type of Skin Cancer in Cells with Another Mutation
Patients with metastatic melanoma taking the recently approved drug vemurafenib (Zelboraf®) responded well to the twice daily pill, but some of them developed a different, secondary skin cancer.
Now, researchers at UCLA’s Jonsson Comprehensive Cancer Center, working with investigators from the Institute of Cancer Research in London, Roche and Plexxikon, have elucidated the mechanism by which vemurafenib excels at fighting melanoma but also allows for the development of skin squamous cell carcinomas.
The very action by which the pill works, blocking the mutated BRAF protein in melanoma cells, sets off a cellular cascade in other skin cells if they have another pre-disposing cancer mutation and ultimately accelerates the secondary skin cancers, said Dr. Antoni Ribas, co-senior author of the paper and a professor of hematology/oncology.
About 50 percent of patients who get melanoma have the BRAF mutation and can be treated with vemurafenib, Ribas said. Of those, a fourth of the patients develop skin squamous cell carcinomas. The squamous cell carcinomas were removed surgically, and vemurafenib was not discontinued for this side effect.
“We wondered why it was that we were treating and getting the melanoma to shrink, but another skin cancer was developing,” said Ribas, who studies melanoma at the Jonsson Cancer Center. “We looked at what was likely making them grow and we discovered that the drug was making pre-existing cells with a RAS mutation grow into skin squamous cell cancers.”
The 18-month study appears in the Jan. 19, 2012 edition of the New England Journal of Medicine.
The combined research team performed a molecular analysis to identify the oncogenic mutations in the squamous cell lesions of patients treated with the BRAF inhibitor. Among 21 tumor samples studied, 13 had RAS mutations. In a different set of 14 samples, eight had RAS mutations, Ribas said.
“Our data indicate that RAS mutations are present in about 60 percent of cases in patients who develop skin squamous cell cancers while treated with vemurafenib,” Ribas said. “This RAS mutation is likely caused by prior skin damage from sun exposure, and what vemurafenib does is accelerate the appearance of these skin squamous cell cancers, as opposed to being the cause of the mutation that starts these cancers.”
Ribas’ group found that blocking the non-mutated BRAF in cells with mutated RAS caused them to send signals around BRAF that induced the growth of the squamous cell cancers.
The discovery of the squamous cell cancer mechanism has led to strategies to inhibit both the BRAF mutation with vemurafenib and block the cellular cascade with a different drug, a MEK inhibitor, before it initiates the secondary skin cancers, said co-senior author Professor Richard Marais from the Institute of Cancer Research in London, who developed the animal model for the study.
“By understanding the mechanism by which these squamous cell cancers develop, we have been able to devise a strategy to prevent the second tumors without blocking the beneficial effects of the BRAF drugs,” Marais said. “This may allow many more patients to benefit from these important drugs.”
Ribas said that this is one of the very few times that oncologists understand molecularly why a side effect to cancer treatment is happening.
“The side effect in this case is caused by how the drug works in a different cellular setting,” he said. “In one case it inhibits cancer growth, and in another it makes the malignant cells grow faster.”
Studies currently are under way testing BRAF and MEK inhibitors in combination in patients with metastatic melanoma, Ribas said.
“Our data provide a molecular mechanism for the clinical toxicity of a targeted oncogene inhibitor that apparently contradicts the intended effects,” the study states.
The study was supported by Roche, Plexxikon, the Seaver Institute, the Louise Belley and Richard Schnarr Fund, the Fred L. Hartley Family Foundation, the Wesley Coyle Memorial Fund, the Ruby Family Foundation, the Albert Stroberg and Betsy Patterson Fund, the Jonsson Cancer Center Foundation and the Caltech-UCLA Joint Center for Translational Medicine.
UCLA's Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2011, the Jonsson Cancer Center was named among the top 10 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 11 of the last 12 years. For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu.
Jon goes back to Foxconn-revisited…in his usual style and he says we need to make our factories look more like those in China. Workers live in dormitories and don’t know each other, cuts down on commuting and friendship. 
Workers are finding ways of improving their conditions, hotlines with trying to stop suicide and put nets around buildings to catch jumpers…I think we remember this from a year ago and he says in the US we call this “treating the symptoms”.
“It’s me, Siri, in your pants pocket working on giving you testicular cancer”…If it works for those factories, electronics would cost more..modern work fare…a game to the rescue…this is great humor but there are somethings I does make one ponder…there’s just one level and this is it…(the middle class) as algorithms are marketed and designed and sold to consumers.
He shows the work of the algorithms in place for sure in a humorous way. Why are health insurance companies getting into the low income housing business though? I hope this is not a Foxconn plan to create communities with jobs that pay little and have medical care on campus? What is up with this?
The same company owns a subsidiary that will basically give you a free hearing aid made in China if you sign up for their health insurance…more below…and the subsidiary they built to distribute and coming to Walmart soon as I understand…
He moves on to the next part, a game that has one level…hmmm…we another insurance company banking on this too…data to sell? Will this make you healthy? I prefer real knowledge.
I just ask is there where we are headed with mining and selling data today and big corporations taking over our day to day decisions? The more information they have to judge and discriminate, the ability to control and humiliate the middle class grows. 
At any rate with the use of algorithms today that have teeth and the amount of flawed data out there, are we going in this direction? I put this out for an awareness and perhaps to generate some though processes. I like technology and the good things it brings but am not oblivious to how it can also be abused as well and a NYU professor says it even better than me, read and listen up.
I sure hope Richard Cordray understands math and the power of the algorithms when used both in an intuitive and good manner and the reality of those who design for pure profit that hurts consumers. You can see, smell or touch them, but they are running on server 24/7 every day making like impacting decisions, crafted by some of the smartest programmers and developers that the money on Wall Street can buy.
Another good article to read about the over sell and naïve and gullible nature of the US with both government and consumers, read what Nanex has to say as they are the folks that monitor and study rogue algorithms in the stock market and look for indicators of the “next flash crash”. A couple paragraphs are below and will the SEC be suckered in to this huge expense of programmers who want to make big dollars writing code convince a naïve and gullible SEC? It’s all over the place with digital illiteracy, steroid marketing and algorithms for huge profits only and they have teeth. BD
“Wall street hires the best software developers money can buy. They write clever algorithms. These algorithms will only get more clever as time goes on. Which means they will always be changing. Now, writing software to detect what other 
software is doing is 100 times more difficult. Which in the software world means 100 times more expensive. Which means hiring people that do not exist, since Wall Street already snapped up the best, and you need the best times 100 (you can't make it up in quantity and just get 100 times more wizards, because many will have poor social skills, and you need these people to communicate).”
“You see the folly of trying to regulate the markets in real-time? Real-time raises the cost exponentially times a million. To a level that all the kings in the world couldn't afford. It would be one thing to track in real-time, things that had known behavior. Like your checking account being overdrawn. Maybe credit card fraud in the making (which, by-the-way, hasn't been perfected yet, despite lots of money and time thrown at the problem). “
http://www.thedailyshow.com/watch/mon-january-16-2012/fear-factory
To go back a little bit in time the chip was also set up to communicate with personal health records like Healthvault. The latest development on the chip was the ability to 
communicate real time glucose readings. The FDA has approved the product and the HealthLink software.
In addition, Medcomp who makes vascular access catheters will use the chip in vascular ports for identifying the port in a patient for proper medication dispensing. As it read here though the use with Medcomp still needs to secure FDA approval. This chip keeps coming back around with many lives. BD
DELRAY BEACH, Fla., Jan 17, 2012 (BUSINESS WIRE) -- VeriTeQ Acquisition Corporation ("VeriTeQ" or "Company"), a marketer of implantable, radio frequency identification ("RFID") technologies for patient identification and sensor applications, announced today it has acquired the VeriChip implantable microchip and related technologies, and Health Link personal health record from PositiveID Corporation. VeriTeQ is majority owned and led by Scott R. Silverman, former Chairman and CEO of PositiveID and VeriChip Corporation. PositiveID has retained an ownership interest in VeriTeQ.
VeriTeQ will focus on three main areas: patient identification and personal health record (PHR) access through the VeriChip implantable microchip and Health Link web-based PHR; implantable sensor applications; and identification of medical devices within the body. VeriTeQ will also focus on identification and sensor applications for animals.
VeriTeQ's acquisition also includes the rights to a Development and Supply Agreement with Medical Components, Inc. ("Medcomp"), a leading manufacturer of vascular access catheters. Under the terms of the agreement, Medcomp will embed the VeriChip microchip in its vascular ports to facilitate identification of the port in a patient and proper medication dispensing.
Doctors’ adoption of health information technology doubled in two years, according to a new report, Department of Health and Human Services Secretary Kathleen Sebelius released Wednesday. Sebelius also announced extension of the meaningful use qualification date to 2014. See link for more info – http://www.healthcareitnews.com/news/hhs-extends-mu-stage-2-deadline-spur-faster-emr-adoption?topic=01,08
The survey I posted earlier has now been completed – here are the results.
http://blog.softwareadvice.com/articles/medical/benefits-of-emr-software-survey-1081611/
High physician fees, rather than factors such as practice costs, volume of services or tuition expenses, were the main drivers of higher U.S. healthcare spending and physician income, according to research presented in the September issue of Health Affairs.
The study, conducted by Miriam J. Laugesen, PhD, and Sherry A. Glied, PhD, both of the Mailman School of Public Health at Columbia University in New York City, found that in some cases, physicians in the U.S. are paid as much as double their counterparts in other countries. There is also a larger gap between fees paid for primary care and fees paid for specialty care, particularly orthopedic surgeons, in the U.S. compared to other countries evaluated by the study.
Fees paid by public and private payors for primary care office visits and hip replacements were compared in six countries: Australia, Canada, France, Germany, the U.K. and the U.S.
Laugesen and Glied found that primary care physicians in the U.S. were paid, on average, 27 percent more by public payors for an office visit, and 70 percent more by private payors for an office visit, compared to the other countries. The largest difference in fees paid between countries was for hip replacements. Physicians in the U.S. were paid 70 percent more by public payors and 120 percent more by private payors for these procedures as compared with physicians in the other countries.
Across the fees analyzed by the study, the biggest disparities in pay to U.S. physicians existed on the private side. Fees paid by private insurers in six markets in the U.S. averaged about 33 percent above Medicare rates for primary care and 50 percent above Medicare rates for hip replacements.
“Our analysis suggests that policymakers in all countries need to consider how differential prices paid by both public- and private-sector payors to specialists influence specialty choices,” wrote the authors. “Furthermore, this analysis suggests a need for greater standardization of cross-national data on the nature of physician services provided, fees, education and incomes to allow ongoing comparative research on the relationship between prices and healthcare spending growth.”
Incomes were also higher for U.S. primary care and orthopedic physicians compared to their foreign counterparts.
The authors said other factors thought to contribute to physicians’ fees, such as high medical education tuition costs for American physicians or increased work volume, could not fully explain the disparity in fees when compared across the countries.
“Although the tuition cost of medical education in the U.S. borne by individuals is substantial, it cannot fully account for the observed differences between the earnings of U.S. physicians and physicians in all other countries,” wrote Laugesen and Glied.
For the services examined by the study, higher physician incomes did not appear to be due to a higher volume of services, though the authors acknowledged the rates of other procedures not studied may be higher and contribute to the elevated fees and incomes.
One possible explanation offered by the authors for the high U.S. physician fees was the notion that higher fees may reflect the cost of attracting highly skilled candidates. When physician fees in each country were compared to the mean incomes of the top 1 percent of households within that country, the results were broadly consistent, suggesting higher U.S. fees were the result of a “society with a relatively more skewed income distribution,” according to Laugesen and Glied.
The New York Times (9/6, B1, Freudenheim, Subscription Publication) reports, “Under heavy pressure from government regulators and insurance companies, more and more physicians across the country are learning to think like entrepreneurs.” One result is the rapid growth in joint M.D./M.B.A programs to 65 at present with an estimated 500 students. Some intersperse business courses with medical courses while others have students complete their medical training and add a year or more of business education. “Dr. Barry R. Silbaugh, chief executive of the American College of Physician Executives, a professional society that provides medical education courses and career counseling, said more start-ups were being run by doctors.” He explained that some “are focused on adapting technology to health care, not just electronic medical records,” adding, “The use of social media is of great interest to many younger physicians, and so is health care analytics.”
Like the dot-com bubble, the EHR bubble—nurtured by the government incentives—will not last. As I look at what’s happening in the market, it becomes apparent that at some point in the not-too-distant future, the EHR bubble will pop and many vendors will face financial challenges that will lead to their demise.
Several market factors will come into play, including:
To understand how these factors will affect EHR vendors, it is important to understand how such companies typically raise money and what kind of “hockey-stick” growth projections they made to attract investors.
Missed growth projections; continued expenses for implementation, support, and ongoing upgrades; and diminishing government incentives will leave many companies unable to find investors willing to fund their future growth.
There will be market consolidation, and financially strong companies will acquire distressed companies for pennies on the dollar.
…To read the full story, see HIStalk Readers Write.
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HHS has made it official—Stage 2 of meaningful use will be pushed back to 2014. The announcement by HHS Secretary Sebelius came as no surprise, following as it did the recommendation made by the HIT Policy Committee and the endorsement by ONC head Farzad Mostashari. The change only affects providers whose first incentive payment year is 2011, since they are the only providers who would be subject to Stage 2 regulations in 2013 had the delay not been implemented—everyone was already entitled to 2 years of meaningful use at Stage 1.
What I find interesting about all the hoopla that has accompanied the announcement is the spin the government put on the decision. According to the press release from HHS, “To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.”
Isn’t it a bit late for a provider to decide to adopt health IT this year? In reality, this announcement is too last-minute to change any adoption-related behavior or to accelerate EHR adoption. The announcement continued, “Perhaps most importantly, we want to provide an added incentive for providers attesting to meaningful use in 2011.” Apparently, the goal is to accelerate attestation rather than adoption—to encourage physicians who were already using certified EHR technology in a “meaningful way” to attest and to collect an incentive payment this year, instead of holding off attesting until 2012. This would create a potential PR benefit for the incentive program, which currently boasts nearly 115,000 registered providers, but reports that only 10,155 (9%), have successfully attested.
The benefit of the schedule delay accrues only to the early adopters, who now can earn 3 years of incentives under the less stringent requirements of Stage 1 (only, however, if they are willing to forego their 2011 Medicare ePrescribing bonuses—not a worthwhile trade-off for high-revenue physicians with large Medicare volumes). In its statement, HHS acknowledged the pushback from providers regarding how challenging even the Stage 1 requirements are. Perhaps, it would truly spur program participation and EHR adoption if all providers—not just the early adopters—were entitled to 3 years of meaningful use under Stage 1 rules. Also, if CMS has so little confidence that physicians will succeed at Stage 2, shouldn’t it reconsider how much it plans to raise the bar?
Related posts:
Last week’s EMR Straight Talk post, “Are EHRs Being Oversold,” hit a nerve, judging by the number of readers and the volume and intensity of comments submitted by physicians. Sadly, for every one of the physicians who took the time to write, there are scores of others enduring similar experiences. The following excerpts from their comments are reflective of their frustrations:
Every one of these stories breaks my heart as a staunch EHR proponent—particularly since the situations could have been easily avoided.
The Root of the Problem
The problem lies in the EHR selection process. When it comes to dispensing medications, for example, no physician prescribes without knowing the success rate for that particular drug for that particular type of patient and problem being addressed. Yet, typically, physicians do not make EHR purchase decisions in the same way that they make clinical decisions—using empirical evidence and data to predict outcomes.
I’d wager that for each of the disillusioned physicians above, the EHR selection process was nearly identical:
Why does such an exhaustive and time-consuming selection process so often lead to failed EHR implementations?
Preventing an EHR Failure in Your Practice
To prevent an EHR failure in your practice, the flawed selection process must be altered. The first thing to understand is that the rosy experience of one or two handpicked vendor references will not guarantee a similar experience for you and your colleagues. If a vendor has sold its EHR to 100 practices and has as few as 5 successful implementations, you will be referred to one of these 5 practices. A visit to 1 or 2 of these 5 successful practices may leave you with a warm and fuzzy feeling and the expectation that, because they were successful, your success is virtually assured. In this case, however, your real probability of success would only be 5%.
Separating the Wheat from the Chaff
So how do you quickly eliminate vendors with lackluster success records before you and your staff waste hours watching slick sales demonstrations of sexy software with “must-have” features? Separating the wheat from the chaff is simple—just ask all your initial set of EHR vendors for lots of references. If a vendor cannot produce at least 2 references for each year they have been in business, run the other way. Do not accept any excuses for being unable to provide you with the number of references that you seek. (A common excuse is that the vendor wishes to protect the privacy of its clients.) If they had lots of references, they would give them to you in a heartbeat—happy customers are always willing to show their successes to others.
Many of the initial vendors chosen will not be able to produce a satisfactory number of references. This should narrow down the number left for you to consider, and it will save a tremendous amount of valuable physician and staff time.
Statistically Significant Reference Checking
At this point, your list of vendors will likely include just the one or two that have provided you with a meaningful reference list. You may have to accept the bias created by the fact that the references are carefully handpicked by the vendor(s), but it is imperative that you do not limit your inquiries to the specific physicians identified by the vendor. Typically, these are the practice administrator and one or two physicians who had spearheaded the EHR purchase for the practice; as a matter of pride, they are more likely to paint a rosy picture of the EHR than to acknowledge its shortcomings. The only way to avoid this trap is to speak with other physicians at the reference practices. This is easy to do. When you get the reference list from an EHR vendor, ask them to include the practice websites, then randomly choose physicians to call from the physicians’ bio pages. These physician-to-physician calls should be short (only 10 minutes each) and you should ask specific questions about cost, efficiency, and number of patients seen. The American Society of Cataract and Refractive Surgery (ASCRS) has an excellent set of questions on page 5 of their EMR selection guide .
How much of your time should this type of random reference checking take? Not much! Ten 10-minute calls (less than 2 hours of time) to randomly chosen physicians will yield more valuable data on your chances of success than having a slew of vendors demo their products to your doctors and staff for hours on end. Only after having conducted the due diligence described above will you be able to derive real value from spending your time seeing demos—because you will only be seeing demos of the one or two EHRs that you now know are likely to deliver success.
Related posts:
I am a firm believer in the tremendous value that the right EHR can deliver to physicians, so the historic dissatisfaction with the EHR industry—as reported in studies and anecdotal conversations—has long disturbed me. The alarming intensity of this dissatisfaction was brought home by visitors to my company’s booth during the recent AAO (American Academy of Ophthalmology) meeting.
I was truly appalled by the abject frustration and anger expressed by numerous physicians about their EHRs. One visitor described his experience by saying, “It has taken the joy out of practicing medicine.” Another said that he felt like he should put a picture of his face on the back of his head so that his patients could see him—because he was forced to focus on the computer and enter data while the patient provided information. Physicians universally complained about the “productivity-killing” impact.
Why is this so? I know there are good EHR products in the market that physicians enjoy using and that enhance, rather than reduce, their productivity. Why are physicians not more successful in finding these?
The answer is that EHRs are being oversold. There are many EHRs that are marvels of software, capable of doing incredible things, but the selection process that physicians typically employ is flawed, and the sales process capitalizes on this shortcoming. The salesperson dazzles them with a demo, or they take prospective purchasers to see a physician—typically just one or two—who adeptly uses the software. This creates a false sense of ease-of-use, and the physician prospect leaves the site visit expecting that he or she will be able to use the EHR just as successfully. But not all physicians are alike—they may all be very intelligent and have tremendous medical expertise, but they are not all equal in technological inclination or skills. Their success—or lack thereof—with a particular EHR will vary significantly.
This brings us back to the importance of doing due diligence—something I have talked about before. Call and/or visit a variety of physicians who represent a wide spectrum of proficiency. Go to the reference practice’s website and select physicians on your own—don’t rely on the vendor’s selection. Ask the kind of questions listed in the last EMR Straight Talk. This is the only way to increase the odds of a successful EHR experience, and to avoid making a painful and costly mistake.
Related posts:
I’ve written frequently about the unique needs of specialists and how these have been overlooked by the government and by EHR vendors. Since many ophthalmologists are heading off this week to the AAO (American Academy of Ophthalmology) Annual Meeting in Orlando, I thought it appropriate to comment on the proactive advocacy and advisory role that this particular professional society has adopted on behalf of its members, and to encourage other academies to step up their efforts similarly.
AAO has been quite active on the meaningful use front. This week’s HIT Policy Committee’s Meaningful Use Workgroup meeting focused on how make meaningful use more meaningful for specialists in Stage 3. AAO was one of only two specialty societies represented in the public comments at the end of the meeting—the Academy’s representative pleaded that measures irrelevant to ophthalmology be replaced with those that would add value for these specialists, and offered the Academy’s assistance to accomplish this.
In addition to providing its members with otherwise unavailable, ophthalmology-specific direction on how to meet meaningful use, AAO has also offered much-needed guidance regarding the selection of an appropriate EHR for ophthalmologists—meaningful use aside. Recognizing that their unique specialty-specific workflow and data needs are not effectively addressed by most EHRs—because of the typical primary-care focus—AAO charged its Medical Information Technology Committee with the identification of a set of ophthalmology-relevant EHR specifications. A group of authors led by Michael Chiang, M.D., identified a set of features and attributes that ophthalmologists would find particularly valuable, and published their recommendations in an article titled “Special Requirements for Electronic Health Record Systems in Ophthalmology.”
While features and functionality are important, feedback from colleagues who actually use the EHRs is even more critical. The advice that AAO has given its members on how to make the most out of site visits will serve all physicians well, regardless of their specialty, and I am therefore sharing it with you below. It is reprinted from the publication “Electronic Medical Records: A Guide to EMR Selection, Implementation, and Incentives.”
ASK COLLEAGUES THE RIGHT QUESTIONS:
EHRs are here to stay, and will play an increasingly important role in medical practices. A major investment, EHRs can dramatically impact practice operations and productivity—positively or negatively. It is my hope that, like AAO, the medical academies will use their clout and speak out more aggressively to protect the interests of their members.
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| Healthcare IT, also known by the acronym HIT, is all about using information technology solutions such as hardware, networking, and software to help improve healthcare, save lives, reduce costs, and improve profit margins for healthcare organizations. Healthcare IT has always been important but recently it has been receiving more attention because the government and consumers (patients) | are demanding better service from care providers and healthcare IT is a good way to improve service.The healthcare system, especially in the USA, has some critical problems such as nurse and physician shortages, spiraling costs, poor consumer (patient) service, and lower revenues which lead to mergers | or acquisitions. Healthcare IT is in even worse shape because outdated infrastructure, legacy architectures, and monolithic applications prevent positive change from occurring. Healthcare IT can, if used properly, help reduce costs, improve care provider productivity (which can then alleviate some of the shortages), and significantly improve customer service to patients. |
