How Relevant is CCHIT in the HITECH era?

  Chris Thorman in an article on CCHIT and HITECH elaborates on the 'new issues' posed by HITECH. For nearly four years, the Certification Commission for Health Information Technology (CCHIT) has been the lone entity recognized by the federal government to certify electronic health record systems. Since being named a recognized certifying body by Health and Human Services (HHS) in 2006, CCHIT has awarded certifications to nearly 200 EHR software products based on CCHIT’s standards of functionality, interoperability, usability and security. However, CCHIT’s role in the EHR market is changing. The Office of the National Coordinator of Health IT (ONC) and the Center for Medicare & Medicaid Services (CMS) announced in early March 2010 that they would name more than one organization...

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Amazing Technology

No doubt, health information technology is the "Penicillin" for the business and record keeping digital age. Some of us seem to be 'allergic' to the technology, so they keep an ampule of epinephrine in the form of pens and pencils in their pockets to prevent anaphylaxis. HIT, EMR, HIE are truly the amazing outgrowth of silicone wafers, printed circuit boards, integrated circuits, mosfets, microprocessors, RAM, ROM,hard drives, solid state drives, LCDs, LEDs, engineers, software, and cheap labor in Asia. We have gone through several decades of explosive technology in diagnostics and therapeutics. Some of the latest 'gadgets" are outlined below,  THE LAB ON A CHIP A new microfluidic device from the University of Southampton, called...

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Health Reform....Disappearing Ink

OP-ED  by John Goodman      President Obama with Erskine Bowles, left, and Alan K. Simpson, co-chairmen of the commission on debt reform, before speaking in the Rose Garden on Tuesday. Will there be real health reform?? Why is that man on the left smirking? What is the man on the right saying?? How serious is this? Well here are the facts, based upon Wikipedia regarding Alan K. Simpson;   "The June 7, 1994, edition of the now-defunct supermarket tabloid Weekly World News reported that 12 U.S. Senators were aliens from other planets, including Simpson. The Associated Press ran a follow-up piece which confirmed the tongue-in-cheek participation of Senate offices in the story. Then-Senator Simpson's spokesman...

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Eye Stimulus Package

  One of my colleagues,  Alan Carlson MD, and ophthalmologist at Duke University offered some humor for physicians,   ophthalmologists and others here. He also mentioned on a post on one of our specialty listserv, the fact that he was surprised to see how much political commentary appeared on this 'scientific forum'.  I thought I would post here, his modifications of procedure to satisfy the requirements of health reform.  At the end I have added a few of my own quips. During the 2008 pre-ARVO Advanced Surface Ablation meeting in Ft. Lauderdale, I was stimulated by Dr. Dan Durrie’s suggestion that LASIK is perhaps an outdated term. Noting that our patients deserve and expect an updated term, one that reflects several...

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Incentivization and Cautionary Tails

It seems  we will only do things with monetary rewards Wander off to this website, dedicated to spending the tax payers money for the purpose of installing and using electronic health records in provider offices.  The rule making is only 169 pages long. The devil is in the details.     It is apparent that most providers want nothing to do with EMR, but have been convinced by 'others' that we must do it, because they know better than we do what is 'good for us'. Another factor in the equation is that EHRs can be considered to be medical devices, or even 'biomedical equipment".  I think most  of you can see where this is headed.  The Food and Drug Administration (FDA)regulates medical devices as well...

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The Yo-Yo Effect

The past several months reveal how disconnected the plan for health care reform has evolved. There was little transparency regarding the evolution of the bill, except for political posturing. The present administration has no experience in business leadership, nor basic economic theory. The fact that the flawed SGR formula, hastily conceived in the early 1990s, was not addressed in the health reform bill attests to the simple fact that cost is a major factor in the legislation. Universal care was never a top priority except to assuage the proletariat.  SGR was and is held out as a bargaining chip and as a diversion for most  physicians. The effects of the SGR impact very severely on ophthalmologists, urologists, geriatricians,...

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Health Train Surfing on the Web

One of the great things about the internet is how rapidly one can research topics of interest. Today's posting is a collection of interviews with a number of politicians. Governor George Pataki on Health Care Reform from CMPI on Vimeo. The Center for Medicine in The Public Interest, or CMPI hosts a large number of video interviews on their website. This organization is very pro doctor....

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The Clothesline

I don't know about you, but I and most physicians are fed up with being hung out to 'dry'. Same old, same old. Doctors with Medicare patients will start seeing a 21 percent pay cut this week after Congress failed to defer the cuts by two more years. This Story appears today in the Washington Post. The Senate had until June 1 to avert the cuts. It is not expected to vote by Tuesday, when the Center for Medicare and Medicaid Services' temporary hold on Medicare claims expires. Some members of the American Medical Association signed white lab coats instead of a petition to voice their displeasure on Sunday at the group's annual meetings in Chicago. The coats will be delivered to lawmakers in Washington on Friday, a spokeswoman said....

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The Shadow over Health Care

Will quality heath care survive "the eclipse"??   However, there is still hope. Will EMR correct these entries in the medical record?? Are these "Never Events"? Will "time-outs" prevent these misfortunes?   1 . The patient refused autopsy. 2. The patient has no previous history of suicides. 3. Patient has left white blood cells at another hospital. 4. She has no rigors or shaking chills, but her husband states she was very hot in bed last night. 5. Patient has chest pain if she lies on her left side for over a year. 6. On the second day, the knee was better, and on the third day it disappeared. 7. The patient is tearful and crying constantly. She also appears to be depressed. 8 The patient has been depressed...

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Is Help on The Way?

  The issue of how much medical malpractice adds to the cost of healthcare in the United States has been on the front burner for physicians, yet legislators turn a deaf ear to this challenge. Medical malpractice adds to the cost of each patient encounter not only due to the premiums physicians pay, but the even more significant costs of practicing 'defensive medicine'.  This fuels the additional non medically indicated ordering of high tech laboratory and other expensive imaging and other tests.   By Katherine Hobson Today the government begins to hand out $25 million in funding for demonstration projects attempting to find some fixes for the medical malpractice system, the WSJ reports. The one- and three-year grantees...

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The Transformative Potential of Health IT

Mark Smith, MD President and CEO of the California Health Foundation discusses the potential of health information technology to transform medical care. It will transform medical care much in the same way that online travel agencies such as expedia and travelocity revolutionized the way people travel and plan trips. He remarks that Wal-mart knows more about that can of beans on the shelf...where it came from, where it is now, where it is going, who bought it, and what else they bought on that shopping excursion. I don't know beans about that but I do know that health IT has the potential to revolutionize the way we care for our patients. Our system is now based on 'visits' and coding.  Improving our efficiency and reducing patient visits by 10-20% will reign economic catastrophe upon...

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President Obama's EMR Fiasco

My morning cup of coffee included an email from SERMO where there was a post regarding EMR usage. I thought it worthwhile to include this commentary from Stan Feld, MD, FACP, MACE   "President Obama's goal for healthcare reform is to increase the quality of medical care, increase efficiency of medical care and decrease the cost of care. The goal is admirable. The route he is taking is wrong. In the process he might destroy the medical workforce. The route the electronic medical record (EMR) stimulus package should take should be flexible and educational for patients and physicians. It should use modern software technology instead of subsidizing old inflexible technology that is set up to be punitive to physicians and patients...

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ObamaCare

No one has ever said that Barak Obama was or is a champion for entrepeneurship.  He fails to follow the path of legislative changes and the consequential secondary impact of sweeping reform. Change itself is expensive. Nowhere in the legislation does he allow for the expensive overhead of change. The Patient Protection and  Affordable Care Act mostly presents edicts and commands about what the Secretary of Health and Human Services "shall do".  There is not much room for discussion or input from anyone else. (hard to believe our legislators would sign off on this. (Unless they had more important things to do and just did not want to be bothered.) My friend Greg Scandlen in  Consumer Power Report # 225 elaborates: "The impact of ObamaCare is already showing up in...

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A Good Guy or a Bad Guy?

President Obama has nominated Don Berwick MD to be head of CMS in his administration. Thanks to Todd Rubin of Doctors 4 Patient Care, I have reviewed and posted comments from a recent presentation of his to the NHS. Don Berwick is a controversial candidate  for being the head of the Medicare (CMS) system.  The name change several years ago from Medicare to CMS (Center for Medicare,Medicaid Services) was a subtle beginning for the projected changes in health care financing and administration. Dr. Berwick originates from the most socialistic health system in the U.S.   The Commonwealth of  Massachussets. He was an invited speaker  at the  (U.K.)  National Health Service's Live program. It is impossible...

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The Community Health Data Initiative

  Let there be no doubt about it. Health care and the delivery of care has become a process far greater than that of the individual practitioner. Transparency and open government comes at a time when informatics provides new avenues for health care, patient participation and hopefully increased efficiency and decreased costs. Initiative Launch The Community Health Data Initiative was launched in a Forum at the Institute of Medicine in Washington, D.C., on June 2, 2010. Opening speakers were IOM President Harvey Fineberg, HHS Secretary Kathleen Sebelius and HHS Deputy Secretary Bill Corr. About 15 new applications were demonstrated, making health data available in new formats. Press releases were issued by HHS and the IOM. The Forum can be viewed in the video below.   The HHS...

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Health 2.0

This week Health 2.0 is ongoing in Washington, D.C.  Another kudo to Matt Holt and Indu who had this visionary idea to promote many web based consumer directed systems for health education. The Health 2.0 Show with Indu & Matthew, June 1 from Health 2.0 on Vimeo. Much of this meeting will be broadcast via webinars. Much of the functionality of these systems meets the ONC's requirement to meet their definition of meaningful use. So its seems the market power for meaningful use overpowers governmental edicts for funding.  The feds are already behind in implementation for ONCHIT. One of the innovative sites is a cooperative agreement between the FDA. CDC, NIH and the National Library of Medicine. This new solution is called "PILLBOX".   It offers readibly accessible...

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EMR and HIT Usability

The Feds well meaning attempt to stimulate HIT development addresses only one aspect of the reticence of physicians reluctance to move toward using EMR. The other large stumbling block is 'usability'. How user friendly is the system?  Can the user enter data with the least number of key strokes and/or mouse movements and clicks?  Who analyzes and gathers this data?  I call for each vendor to produce this data. I know this to be a fact since I have used several EMR systems, AHLTA and VISTA/CPRS.  These perhaps are not the best indicators of usability.  Neither can usability be generalized for primary care, vs specialty care.  Each requires different indicators for successful implementation. Successful implementation in the ambulatory physician setting is not...

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