2009 in Retrospect

Another good read that supports that significant shifts are taking place is over at the Health Care Blog:

December 06, 2009
2009: A Year of Surprises and Change for the EHR Technology Market
By DAVID C. KIBBE and BRIAN KLEPPER



Below are the bullets from that post that discuss the shifts that have taken place in 2009:

• Payment for Meaningful Use of EHR technology, not for the software and hardware itself.
• It's become PC to ask tough questions about EHRs, quality, and health care costs
• CCHIT's loss of invulnerability and the displacement of its monopoly on EHR certification
• The Power Shift Away from Legacy HIT Firms
• Interest in HIT by Big Technology Companies

I am in strong agreement!
As a strong advocate of Patient-Centered Collaborative Care, these developments are the most promising I have seen in more than 2 decades. Transformation to PCCC is simply not possible without these shifts. Much more needs to take place, but these are definitely steps in the right direction. These shifts contain many validations of what I have felt compelled to be blogging about this year.

Meaningful Use Rules Due this Month

Below are more good quotes from:

Reading the Tea Leaves: CMS to Release MU Rules this Month

December 2, 2009 by John Moore, Chilimark Research

1) "HIT vendor pronouncements and promises that they will meet any and all MU criteria are extremely misleading.
Yes, HIT vendors may put in the minimum feature set to become a “certified EHR” (we still do not know what a certified EHR is yet) and they will likely have the capabilities embedded in their solution to meet MU criteria (especially in 2011), but the challenge is not so much the software, but how it is implemented. Implement it poorly and physicians/hospitals will struggle mightily to demonstrate meaningful use of their EHR.

2) CMS will release MU rules with very low barriers to entry in 2011, but 2013 will have much higher barriers/hurdles to jump and same holds true for 2015.

3) The biggest challenge in 2011 and for that matter the entire HITECH Act is the successful implementation of certified EHRs that have a glide path leading the adopter on a clear upgrade and workflow optimization path for meeting MU criteria in 2013 and 2015.

4) The infrastructure for data exchange in support of care coordination is simply not there."

The points about vendor pronouncements and the implementation challenges are spot-on!

More Good EMR Implementation Advice Coming from the Top

Standards group offers 10 guidelines to make HIT adoption easier
November 20, 2009 | Diana Manos, Senior Editor
HeathcareIT News

Below are the main points from the above reference:

1. Start small and simple.
2. Don't let perfection be the enemy of 'good enough.'
3. Keep cost as low as possible by eliminating royalties, licensing fees and other expenses.
4. Make adoption easy for providers from small practices.
5. Don't try to create a one-size-fits-all system that adds burden and complexity.
6. Separate content and transmission standards.
7. Create publicly available vocabularies and code sets that can be easily downloaded.
8. Leverage standards that already work on the Internet.
9. Position quality measures so they motivate standards adoption and strive for the automation of quality reporting.
10. Support the implementation. – give HIT adopters readable guides and open-source reference implementations.

It is thrilling to see more and more of these more practical and effective approaches in the press. The current alternative that most enterprises are selecting appear to be just about the opposite.

1. Start with too much functionality and complexity so that the technologies interfere with patient care.
2. Choose systems that match the most functions in an RFP rather than select systems that best serves patients and the physicians deservng of their trust.
3. Purchase exorbitantly expensive solutions that silo health information and makes interoperability unaffordable.
4. Make adoption a nightmare for small practices lacking implementation resources.
5. Try to force an inflexible approach to workflows (primarily driven by non-clinicians) into the point of care.
6. Buy into a vendor's initial sales pitch that they can provide whatever information transfer is needed.
7. Choose products that can only update their vocabularies and code sets via expensive and intrusive, bulk upgrades.
8. Adopt systems that are only supporting awkward and overly complex, standards that are proprietary to the current, medical-industrial complex, rather than those that are widely used by all other industries on the Internet.
9. Try to force clinicians to change their workflows to capture data that theoretically will allow "quality reporting" tomorrow while degrading the patient care process today.
10. Expect EMR vendor training, alone, will be adequate to on-ramp clinicians into the systems.

Laying bare the ARRA Stimulus Bill and its pitfalls

John Moore at Chilimark Research has again summed up the current situation

PHAT: Mash-Up on Healthcare IT

November 19, 2009 by John

I want to include one of his quotes, below...


Bell: “There has been plenty of talk on HIT standards but woefully little on implementation guidance, i.e., how to bring data in, incorporate it into workflow, make it actionable and facilitate efficiencies in care.” Amen.

He pretty much sums it up by implying that it may likely end up being the taxpayers that end up out in the cold when the health information technology industry's emperors are discovered to have no clothes.

Meanwhile, hundreds of doctors are being forced into purchasing lots of expensive EMR pumpkins that will never make it into any meaningful use pies. The insanity will only end when the doctors get more involved in the process and demand a more sane and proven approach that improves, not impairs, their ability to care for patients.

What’s in a Metaphor :-?

In an earlier blog post, I alluded to a metaphor that the fashion in which many clinicians are currently transitioning to using EMR’s are akin to going from walking to riding bicycles at a time they need airplanes. The fashion of use of most EMR’s is little more meaningful than moving paper to be behind glass. This certainly has some advantages, and there is some evidence that many users of these systems are often quite happy. After all,they have transitioned from walking and obtained “airplanes” of sorts. These clinicians tend to report amazing cost savings compared to what others are spending on airplanes.

It appears I was also in error by implying that today’s more “comprehensive” EMR offerings tend to expect clinicians to walk out on the tarmac, jump into a plane, and take off with often disastrous results. I have found evidence of clinicians literally powering through their charts using comprehensive systems. It appears that some implementations that are limited to “training” are sometimes adequate for flight after all. It has been widely reported, with comprehensive systems, that younger physicians tend to go higher and further. Some of these systems even facilitate that all scripts can be transferred electronically at the same time that general electric bills in the practice actually fall. Why wouldn’t all practices partner with one of these?

To top it off, some appear to believe there is a wise, Greek goddess somewhere that can almost magically guarantee to deliver meaningful information technology use to clinicians at the point of care. Unfortunately, being unable to find any evidence, in the real world, I will assume it to be myth.

Health Data Exchange - The New Health Internet vs. the Old NHIN Models

November 16, 2009
The Health Internet vs. the NHIN -- A Matter of Control, Cost, and Timing
By DAVID C. KIBBE and BRIAN KLEPPER
The Health Care Blog

Below are summary quotes from the above blog post:

“…Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a "network of networks" that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO's policies for access to their health information. It was also a massively expensive and time consuming - think decades - way to build a health data network…”

“…The Health Internet, on the other hand, has the obvious advantage of not "re-inventing the wheel." As former Intel CEO Craig Barrett famously said, "We already have a network for health data, it's called the Internet." Proponents of the Health Internet argue that, while health data and privacy and security are very important, the data themselves are inherently no different from financial data or the kinds of personal information routinely -- and very securely -- transported over the Internet using fair market encryption and other security technologies to protect it from intrusion, capture, or breach. So why go backwards to create the equivalent of Prodigy or AOL in every state? It could take forever.

We want to give credit to David Blumenthal, the Obama health team members and the folks at HHS who are taking a hard look at how best to create a secure and efficient method for health data transfer in this country…”

Also, see - Covisint Jumps onto PaaS Bandwagon by John at Chilimark Research.

Another article showing little benefit in current EMR implementations

Little Benefit Seen, So Far, in Electronic Patient Records

By STEVE LOHR
Published: November 15, 2009
New York Times

More of the same… the current approaches to EMR in the U.S. deliver little benefit. Some quotes from the article


…“The way electronic medical records are used now has not yet had a real impact on the quality or cost of health care,” said Dr. Ashish K. Jha, an assistant professor at the Harvard School of Public Health, who led the research project…”

“…The differences, Dr. Jha said, were “really, really marginal.”
To Dr. Bell, the results of the study suggest that government policies should focus on helping physicians, hospitals and the public health system use the technology more effectively.
“It’s not going to be easy or quick,” Dr. Bell said, “but the better information at the point of care, the better health care we will have.”

How much more evidence is it going to take?

Physicians… take your time and beware.