Predictions for 2008 (And beyond)

It's that time of year for resolutions and futurist's predictions. I am a frequent reader of Medinnovations blog by Richard Reese, M.D. Dr Reese is a far more eloquent and articulate writer than I could ever hope to be. As a retired pathologist he sees the big picture from afar.Amongst his predictions at his website, www.medinnovationblog.blogspot.com/ are commentary about RHIOs and EMRs. Despite the fact that I have been a proponent for RHIOs, HIEs and the like I have seen little progress for connectivity. There has been slow adoption of EMR. Physicians do need portals to access lab and imaging results from other sources. No doubt the physician wannabees and other "controllers" of our medical destiny (as well as the health IT sector) want to see all of this put into place. Physicians, while...

Read more »

THE STATE OF RHIO

In a recent article from "DATA WATCH"  Adler, et al have surveyed the activity, success and failure rate of RHIOs across the United States.  The article can be found at "Health Watch". Electronic clinical data exchange promises substantial financial and societalbenefits, but it is unclear whether and when it will become widespread. In early 2007 wesurveyed 145 regional health information organizations (RHIOs), the U.S. entities working toestablish data exchange. Nearly one in four was likely defunct. Only twenty efforts were ofat least modest size and exchanging clinical data. Most early successes involved the exchangeof test results. To support themselves, thirteen RHIOs received regular fees fromparticipating organizations, and eight were heavily dependent on grants. Our findings...

Read more »

THE CHIEF MEDICAL INFORMATION OFFICER

CLINICAL INFORMATION EXCHANGE A  White Paper on the rise and role of the CHIEF MEDICAL INFORMATION OFFICER Clinical Information Exchange is pleased to present this timely review of the role of physicians in deploying EHR, EMR and clinical information systems such as CPOE, Lab reporting, and connectivity. Physician leadership is a critical success factor for health information technology initiatives, but best practices for structuring the role and skills required for such leadership remain undefined. The authors conducted structured interviews with five physician information technology leaders, or Chief Medical Information Officers (CMIOs), at health systems which broadly used health information technology. The study aimed to identify...

Read more »

Happy Holidays to All

It's been some time since I last posted here. Busy season with other priorities have engulfed me. I have been working on a white paper regarding the rise and role of the CMIO, Chief Medical Information Officer.  I have a deadline to post this before Christmas descends upon us....

Read more »

Recent Developments

Quote of the Day:We are always getting ready to live, but never living.--Ralph Waldo Emerson   Health Train Express has recently become acquainted with a Canadian solution to RHIOs search for the "ultimate" application for their interconnectivity needs.  It bypasses the problems of "governance issues" and the thorny issues of "who owns what". Many of these issues ignore the primacy of information transfer, efficiency, accuracy, and quality of healthcare delivery in this country.  In addition to that concern, it is not necessary to re-invent a "wheel" that already exists. What we need has been well established by many consortiums, RHIOs and health information exchanges.  Do we all need all of it? The answer is profoundly "NO". What about those providers who do not have...

Read more »

SELF CERTIFICATION ???

Groups To Launch No-Cost EHR Interoperability Testing Software A no-cost, open-source software tool for testing the interoperability of electronic health record systems will be available to vendors March 21, 2008, Government Health IT reports.The tool, which is being jointly developed by the Certification Commission for Healthcare IT and Mitre, will allow vendors to ensure that their EHR systems can exchange information on patients treated by more than one provider. The tool, called LAIKA, also will initially support testing of the Health Level 7/ASTM Continuity of Care Document, a core set of patient information including: Name; Address; Health problems; and Medications (Ferris, Government Health IT, 11/9).Mark Leavitt, chair of CCHIT,...

Read more »

RPM or Remote Patient Monitoring

Microsoft has launched it's Health Vault application. With this announcement comes a large list of positive and negative reactions in the marketplace.  The most positive aspects are the "commodization" and accessibility of these devices to consumers at affordable prices.   RPM data can and should enter the consumer electronics mainstream.  In addition, RPM data should be viewed as just one more type of medical data, similar to lab data, pharmacy data, physician notes, etc., that is equally plug and play. But...There are Tradeoffs Depending on whether you are a user or a seller of RPM, you probably reacted differently when reading Bill Crounse's casual reference to devices and services becoming "commoditized".  Regardless of your reaction, he's right.  HV will hasten...

Read more »

Economic Advantage????

This news from iHealthbeat: Do we have a choice about EHR?   October 17, 2007 Boston Health Network Requires All Physicians To Adopt EHRs by 2009 Partners HealthCare System in Boston is requiring all of the physicians in its network to adopt or agree to adopt electronic health records by Jan. 1, 2008, or else they will be removed from the network, Tom Lee, CEO of Partners Community HealthCare, said, Modern Healthcare reports.Partners expects to lose between 15 and 20 primary care physicians this year because of the mandate, and it could lose some patients if those physicians stop referring patients to Partners hospitals, Lee said. To retain their network status, about 5,000 physicians in the network will be required to adopt either Partners' or GE Healthcare's EHR or sign an agreement...

Read more »

Microsoft Health Vault

from iHealthbeat, "Microsoft has launched its HealthVault program, which offers consumers online personal health records. The company hopes that individuals will let health care providers directly transmit prescriptions, test results and other medical information to their HealthVault accounts. PHRs will be stored in a secure, encrypted database, and patients will be able to set the privacy controls" Seeing this post I raced to find the "Vault"... First of all, it is complicated to set up, requiring a download of the basic program, and then and number of "connect" interfaces.  It is not designed for patients to enter their medical history, so it is not a true PHR, or personal health record. In addition, the patient must download a number of drivers for "devices".. These devices, so far...

Read more »

The "Monkey on your Back"

I think one of the issues most providers are grappling with in regard to HIT and EMRs in their office is not only the initial investment of capital, but the ongoing "relationship" between the practice and the vendor(s).  Will you have a "tiger by the tail?" The daily operation of the practice will be entirely dependent upon your PMS and/or EMR system. Witness the recent "crash" of the entire West Coast VA CPRS system. A recent iHealthbeat article quoted that it was the worst incident effecting quality and safety of care in the VA system. The vendors have their "business model" for profitability, and they are not about to let providers interfere with that fact. Keep in mind we are in the early phase of EMR and  HIT "buildout" There will initially be a "bubble" as providers invest...

Read more »

Whose Network is it, Anyway??

The San Francisco Chronicle featured an article highlighting Health 2.0 and the wave of consumer (patient) oriented web sites. DailyStrength.org people can choose among 500 support groups - from celiac disease to pulmonary fibrosis - create an online journal to chronicle their disease and send electronic hugs to other members. ZocDoc.com lets patients book physician and dentist appointments online, similar to the way OpenTable.com allows diners to make online reservations for restaurants RateMDs.com takes a page from consumer rating sites like Yelp and RateMyTeachers.com - a popular site that allows students to "grade" teachers and administrators - by allowing patients to anonymously praise or pan their doctors. Dubbed the YouTube of health care, ICYou.com allows patients to share their stories...

Read more »

Featured Interview

This week I had an unplanned interview with Heather McGuire of Within3.   It started out for me as a "show and tell" regarding RHIO development and my "new" self sustaining business model, which frankly still is not a proven model.  Heather reciprocated and introduced me to  Within3. The site is based upon social networking of research scientists and clinicians. In order to gain access one must be recommended by a peer.  Members are thoroughly vetted to be listed on their site.  You can see their site by clicking on Within3 above.  The site has a search function as well.  You can search by disease and it will take you to a number of authorities on the subject, not only that but it will search Pubmed and bring up their articles as well under their name....

Read more »

Part II - Science of Spread Change

I left off last time.....Sarah Fraser is a consultant to health care organizations in the U.K. She points out "that innovators are not normal people, and look for and enjoy change, while most people are wary of change. " For this reason innovators are poor messengers for spread change. The majority of the people are those that hold the organizaton together, go to work at 7AM and not to a conference. They care for patients from day-to-day. If innovators cast aspersions on this group, then spread change is dead. Spreading innovation must also reduce costs, and there must be a return on investment for the organization that is making change. The organization (or stakeholder) must see financial gain for adopting the "new thing".The article (which I highly recommend to IT people, vendors, RHIO developers...

Read more »

The Science of Spread

Quote of the Day:Resentment is like taking poison and hoping the other person dies.--St. Augustine   Batten down the hatches....this post is going to be rather long, not a sound byte.  Thomas Bodenheimer  M.D.wrote for the California Health Care Foundation a treatise on this subject which bears reexamination at this juncture in the development of Health IT and the proposed NHIN. Dr Bodenheimer is on the faculty at UCSF. He summarizes the literature on "spread theory" by Everett Rogers (1962), and Malcom Gladwell's "Tipping Point" . Paul Plesk cites Rogers and Gladwell "to argue that once 10-20% of the target population has adopted an innovation the tipping point has been reached."  Plesk than goes on to discuss "stages of change", "precontemplation", contemplation and action,...

Read more »

Health 2.0 Conference Results

Three years ago I had no idea how blogging would provide a platform for everyone and anyone interested in health care. The spectrum of participants ranges from physicians, payors, patients, political pundits, and others.This forum lies outside the framework of "officialdom"; It has become the water cooler and allows much intercourse. Early on there were some disputes and "retaliation" against employees when their opinions reached "management".....However I believe freedom of speech issues prevailed as long as there was no libel or slander involved.This year's Health 2.0 was planned for 200 participants, and over 400 registered. The introduction piece was very impressive. I am providing the link here. Health 2.0 Intro-http://www.icyou.com/events/health-2-0-conference?folder=AllThe video by...

Read more »

Alternate Road to Health Information Exchange

Saturday, September 22, 2007Roadmap (Alternate) to Health Information ExchangesRHIO and HIE development is a highly complex undertaking and not for the weak of heart. As I was driving into Los Angeles the other morning I encountered one of the routine "sigalerts". For those of you who have never been in California and live in a rural area I will explain this is a system of alerts from the Callifornia Transit Authority whereby notifications are sent out by television, radio and internet about blocks in traffic due to "events" such as accidents, toxic waste, police activities, construction activites, etc. Recently my oldest son, who has rapidly passed me by in the world of high tech (he has smaller thumbs than I do) and I were in the car together and as we bogged down and did not move for several...

Read more »

The view from Here

Just a reminder to take a look at my "parallel blog" at http://anyviewfromhere.blogspot....

Read more »

Health Train Express is Slowing Down

As I travel on the health train express I have noticed the "local trains" which are stopping along the way at each station. Of course I am on the express track, or the high occupancy vehicle lane. In my 'rush' to reach my destination I am missing a lot of interesting places.I may be posting less here and if you miss my meanderings you may find me at my new blog,The View from Here (http://anyviewfromhere.blogspot.com/ It seemed apropos for a name for an ophthalmologist's commentary about matters of "great significance"For those of you going to Health 2.0 enjoy!!And thank you to Dimitriy for his great expose on Google....

Read more »

EverythingHealth: Katrina Nursing Home Owners Aquited

EverythingHealth: Katrina Nursing Home Owners Aqui...

Read more »

Roadmap (Alternate) to RHIO and HIE

  RHIO and HIE development is a highly complex undertaking and not for the weak of heart.  As I was driving into Los Angeles the other morning I encountered one of the routine "sigalerts". For those of you who have never been in California and live in a rural area I will explain this is a system of alerts from the Callifornia Transit Authority whereby notifications are sent out by television, radio and internet about blocks in traffic due to "events" such as accidents, toxic waste, police activities, construction activites, etc.  Recently my oldest son, who has rapidly  passed me by in the world of high tech (he has smaller thumbs than I do) and I were in the car together and as we bogged down and did not move for several minutes, the GPS asked if we wanted to plot...

Read more »

Surfing on the Labor Day Weekend

The long labor day weekend is upon us all. I plan to spend mine with my feet up, and with a cold drink sightseeing on the hot sands of the Southern California beach.  I even invested in a cell card, so I can now find the internet whether I am floating on my raft, in a dark hole, in a green swamp, or whatever. I realize I am surrounded by   the "can you hear me now" guy and the helicopter flying overhead (Verizon). As far as health information exchange goes, this weekend, my network is down....

Read more »

The Caboose

I suppose the health train express should not have a caboose because that implies the end of the train. However I missed an important addendum from Mike Leavitt's blog which he writes as he travels through Africa, attempting to analyze Africa's challenges, clinical overload, a far cry from the paperwork overload providers face in our country. Mike makes some comments about HIE and RHIOs, the subject of which motivate my original blog. The post which follows here is an important link for you to understand what has been done and what will take place over the next five years. Don't miss the TRAIN !!!http://www.hhs.gov/healthit/community/background/ from Mike Leavitt's blog:"Today we had an important meeting at HHS related to electronic medical record standards. The development of standards...

Read more »

Hot Weather and HotTopics

Stop, don't click away just because you think you have arrived at the wrong site. As I promised there were going to be some fresh changes at Health Train Express. Not only has Elvis left the building, but so too has Health Train Express.Every summer at this time of August I mention how fast the summer has gone by. Well, just when I think it's over...it's not. The forecast for the next week is 100-107 degrees. As Yogi Berra has said "It ain't over until it's over".So too is my forecast about P4P, RHIOs, and EMRs. No one can easily predict the outcomes in this arena. However it certainly fuels entrepeneurial minded providers, third party administrators and a variety of industry vendors into a fury of Category 5 storms.One of my favorite blogs is that of Phillipa Kenneally, The Entrepeneurial...

Read more »

Transitions

Fellow bloggers: When I first began “blogging” about three years ago I intended it to be a newsletter for a RHIO that I was heading up in my area of the country. About a year ago I chose to rename it “Healthtrain Express”. The term recently coined by others came to my mind in 1989 (that definitely dates me) It was in the pre-DRG, pre RVU, pre managed care (ie, the “golden days”) that my residents often wistfully mention..I often tell them that no “age in medicine” is trouble free. It’s the nature of the “beast”. Healthtrain express conjures up the rapid changes that constantly occur in medicine. For those of you who have read “Future Shock “ by Alvin Tofler , this has always applied to medicine. I highly recommend this reading. It also denotes a vehicle...

Read more »

Change in Direction

For the past three years I have been beating the drum about the development of HIE and RHIOs. I have not come to any final conclusions about the destiny of this "visionary" prospect. There are a great deal of positives and negatives regarding HIE and EMRs.I will deal with some of the negatives first.1. Most providers complain about the complexity and bureaucracy of practicing medicine, in regard to regulatory requirements, the hurdles of reimbursement, and exponential increases in business overhead.2. The burden of Health IT may outweigh the benefits.3. HIT is very expensive4. Automation and the impersonal nature of IT does not really fit in to the paradigm of medical care. Despite patient enthusiasm for all things technical most providers are reluctant to introduce an infrastructure that...

Read more »

Mike Leavitt Sec HHS joins blogger world

HHS Secretary Leavitt Launches Blog To Boost Health Care DiscussionHHS Secretary Mike Leavitt this week launched a blog to foster public discussion and exchange ideas on health care issues, The Hill reports."If I can do it justice, we will continue," Leavitt said, adding, "If not -- we won't." Leavitt, who plans to write all his blog entries himself and read "as many of the comments as time allows," said he will "wade in a little deeper into blogdom" this month.Unlike some blogs, all comments will be screened prior to being posted, The Hill reports.One day after his first blog posting, Leavitt already had received more than a dozen comments, including one that had to be removed because it was inappropriate or offensive, according to a spokesperson (Retter, The Hill, 8/1...

Read more »

News from Rhode Island

Providence, RI —July 30, 2007—Rhode Island is now one step closer to implementing a health information system that will allow physicians, with their patient’s permission, to access important patient health data from a variety of sources when and where it is needed. The State has chosen Electronic Data Systems Corporation (EDS), and its subcontractor InterSystems Corporation, to build and integrate the necessary technology and software.National and local efforts have been underway for the last several years to computerize medical records and develop secure methods to share records electronically. Governor Carcieri has prioritized making health information electronic for the majority of Rhode Islanders by 2010. “Anywhere, Anytime Health Care Information” is one of five elements that make up...

Read more »

One Step Forward Two steps Back

Report: Health IT Bills Will Not Affect U.S. Health CareCongressional measures to boost health IT adoption would not go far enough to make a significant difference in U.S. health care, according to a Commonwealth Fund report released Thursday, Government Health IT reports.The report, which analyzed major health IT and other health-related bills introduced between 2005 and 2007, found that none of the bills "would commit the funds and central leadership required to realize the potential benefits of a health information system.""There's just not enough funding to get us to a paperless health system in five to 10 years, in my judgment," Commonwealth Fund President Karen Davis said, adding, "If the U.S. is to close the health information technology gap with other leading countries, it will need...

Read more »

Curing Healthcare: Knowledge, Standards and the Healthcare Crisis: Part 10

Curing Healthcare: Knowledge, Standards and the Healthcare Crisis: Part...

Read more »

The Train Coming Down the Track

Is your information technology structure from the ‘90s? 1890??In the next five years we will see a catalytic innovation take hold, and I don’t just mean electronic medical records, personal health records, or web 2.0 applications.In the past several months we have seen several states release morbidity and mortality statistics from hospitals performing certain procedures. Most of these were selected based upon their high per capita cost. The figures are prominently announced and displayed on easily found web sites. This of course is quite controversial and is resulting in angst of both hospital administrators and physicians alike. Payers want the most “bang” for their “bucks”, that is to say the best possible outcomes for beneficiaries. (i.e., they are not going to pay for “bad results”.Providers...

Read more »

Reality Check

I recently navigated over to the "TOP 100 HEALTHCARE BLOGS" ranking, and found that my blog was down in the 300s. The top 3 were "Random Acts of Reality" "Medgadget" and "Bad Science"I also noted that technorati seemed to play a significant role in popularity of the "winners"In the past I have written a great deal about health information exchange and RHIOs. From what I learned in the past three years I have altered my course and given up on the idea of "warp speed" and will depend upon "Impulse engines".There certainly appears to be no impuslivity as it pertains to EMRs nor HIEs.I sent out letters this past week regarding the "NEW PLAN" to bring EMR and HIE to our region of Southern California. Today is a clear day and I can look out over most of it and see all the way from Mt Wilson to...

Read more »

Google me

Google Health (GH) could be the event of the decade in advancing health care reform — not just healthcare information technology (HIT) reform,The "ultimate" PHR????Google Health (GH) could be the event of the decade in advancing health care reform — not just healthcare information technology (HIT) reform, but health care system reform. GH promises simultaneously to create AND dominate the market for next generation personal health records (PHRs). There is nothing else in our solar system or in the entire universe like it.II. GH’s Anticipated Technology ModelWe’ve been provided a number of clues about the technology model that GH is likely to develop:Patient centricA personal health URLAutomated data mechanisms to gather and store PHIInteroperable technical standards: XML and the Continuity...

Read more »

Posted in: public social engineering,rhio

THE GLOSSARY

My apologies for the delay in getting this posted. It is a rather long one, but contains a lof of information for "newbies" I suggest you copy and paste it into a word document.....then if you have google desktop you can search for "glossary".GLOSSARYAccess: The process of obtaining data from, or placing into a computer system or storage device. It refers to such actions by any individual or entity who has the appropriate authorization for such actions.American National Standards Institute (ANSI): ANSI is a broad based agency charged with overseeing voluntary standards development for everything from computers to household products. ANSI accredits standards development organizations (SDO) based on their consensus process, then reviews and officially approves the SDO recommendations.American...

Read more »