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 broadband internet connectivity?

There are many pieces in the mix for a RHIO or Health Information Exchange.  Some of these are already provided by proprietary systems, such as clinical laboratories, hospital portals, secure messaging systems, Hospital PAC systems,etc.

The California Regional Health Information Organization provides a well structured outline and roadmap for developing governance; and also a library,   HIE toolkit  of documents for RFIs, RFPs, and other essentials for vendors, hospitals, providers and IT departments.

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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, said, "This project is an important first step in our journey toward testing and certifying the interoperability of health IT systems" (Merrill, Healthcare IT News, 11/9).
CCHIT and Mitre have undertaken this open-source project without government support, Government Health IT reports.
Developers will demonstrate the tool at the Feb. 12, 2008, CCHIT meeting (Government Health IT, 11/9).

Next Article

Readers are invited to send feedback to: ihb@chcf.org

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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 the already occurring commoditization of RPM devices.

When the RPM market started, many of the devices were priced in the $6-8 K range.  Today prices have dropped to $1-2 K, and will go lower. 

We have all heard stories where RPM devices eventually would become consumer purchases made at Best Buy and Circuit City, and that prices would be in the range of other consumer technology purchases.  That day will arrive in 2008 when Continua Alliance compliant offerings begin hitting the street.

The RPM market is moving from

• High unit prices rooted in the industry's early focus on medical device markets and business models
• Proprietary devices, proprietary IT,  non-interoperable data
• Low unit volume, moderate margins per unit
• Competition based on the vendor lock-in through high changing costs

To:

• Low unit prices as the technology evolves toward consumer markets and consumer business models
• Intereroperable devices, common IT platforms, and interoperable data
• High unit volume, low margins per unit
• Competition based on value and service

Where exactly commoditization and HV come together is not clear. The efforts of Continua will bring to market multi vendor interoperability, true plug and play connectivity. Microsoft can deliver plug and play interoperability with your personal computer, but little else.

 

What do you think?

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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 that they will adopt EHRs during 2008. However, by Jan. 1, 2009, any physician without a connection to the network EHR system will be removed from the network.
Mario Motta, a cardiologist in the network, said the mandate is a "two-edged sword" because the benefit of EHRs is higher reimbursement rates from insurers, although Partners is not providing any funds to help physicians adopt the systems.
Lee added that funds are available to improve Partners' EHR system and to train physicians on it (DerGurahian, Modern Healthcare, 10/15).

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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 include

"Healthy Circles", icePHR (In Case of Emergency),  these also interface with a blood pressure transduce, glucometer, spirometer,

There are several other websites one must go to to setup, enter, and read the data. Microsoft has developed a number of  "partners", which I will not mention here, just advise the reader to go to www.healthvault.com  Microsoft also has an interconnect program called "connect IQ", a portal that almost looks like a HIE, or RHIO.

For the patient, especially an elderly patient this will be difficult to setup, and use.  It will require a nurse or technical assistant to set it up and make it operational.  There will also be considerable expenses for the remote monitors.  The site also states that providers will be able to transfer medical records to the PHR as well. If all of this can be managed it does develop some slick looking tables and graphs of blood pressures, glucose levels,pulmonary function tests, and probably eventually a probe that will report CBCs and blood chemistries.....all from home.

The big question is will payors reimburse for all of this...Will this become part of P4P ?

This is not a patient oriented design.  Even for me it was a long pathway to download and figure it all out.  Setting up the actual vault took some time to complete, and then it was still an empty shell.  But then again I am only a doctor......more later....

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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 in EHRs, RHIOS, etc  Eventually the acquisition rate will flatten out. With diminishing returns will the vendors jack up maintenance contracts and costs for updates.

About 18 months ago Allscripts began offering a  "free eRx system which operates as a portal application. It is necessary to enter patient information in the system the first time it is used for a new patient.  Allscripts now offers "a bridge" to connect it to your PMS. They don't say much about interfaces for  EMRs.  Most of the interfaces cost about 300 dollars initially and 240 dollars each year afterward.  One interface was quoted at 695 dollars. There  are  many with "custom" as the interface quote.  Now I can see an upfront charge for an interface, but an annual charge is something else, unless there are some other changes in software after the initial installation. (sounds like Microsoft)...Windows "Live". I wonder what the rest of you thinks about this?

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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 through online video clips.

Other Web sites, such as PatientsLikeMe, offer people battling devastating diseases the ability to discuss and track in great detail the treatment options other patients in their disease group are trying.

OrganizedWisdom.com: Aligns doctor-reviewed and user-generated health content to help people make decisions.

ReliefInSite.comRelief in Site. com: Helps patients record and track their pain and medications and share it with their doctors, nurses, pain specialists, therapists, friends and family members

And I like this one the best:

NursesRateDoctors.com: Recruits nurses to give their candid assessment of doctors........for the surgeons who throw instruments.....

It seems Health Information Networks are developing in ways which we could not imagine.

 

Today  I came across a focused PHR solution for Lasik surgeons. Safeguard your Sight

Many times patients undergo refractive surgery on their eyes, and require enhancements or cataract surgery at a later date. Often times it is with a different ophthalmologist and the prior records are unavailable.  Ophthalmologists are able to upload their "data" before surgery, and after surgery. The data resides on a server. Patients can access this information for a fee and give the results to the new surgeon. 

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