Tuesday, June 17, 2008

It's Not all in the DATA


Quote of the day:
For a list of all the ways technology has failed to improve the quality of life, please press three. - Alice Kahn

I was sent a survey last week from the Harvard Business School, by Julia Adler-Milstein, of the Harvard Business School.  It was a query on the status of the Inland Empire HIE, or RHIO.

It was an online 'Survey Monkey' which one the surface looked nice, simple format and was enjoyable to fill out. My first, second and third attempts resulted in an error message. I gave up in frustration, but did email JAM that it didn't work. (no reflection of  HIT, here.  I was sent another link which did work well.

At the end of the day  I sent along an email with some attached comments.... I appreciated her response to my 'footnotes'.

 

"Thank you Gary. I'm relieved that it worked and very much appreciate you taking the time to add "footnotes", which, for those us in the academic world, are very helpful to understand some of the details that aren't easily seen in the data. I'll check out your blog too!"

Tuesday, June 10, 2008

The Failure of RHIOs and ONCHIT

 

Quote of the day:
In a time of universal deceit, telling the truth is a revolutionary act. - George Orwell

Today' iHealthbeat reveals why government is inept in many regards.  What starts out with innovative ideas quickly becomes bogged down on internal machinations, politics and the inability to adapt to rapidly changing market forces.  As I stated fouryears ago HIT and RHIOs could not be produced from the top down, rather it would develop from the bottom up as we are witnessing now. Ihad compared the development of our national telephone network as an example.  The many 'Bell' companies eventually merged into one company serving the majority of the United States.

Perhaps the most important item to come from ONCHIT was it's stimulus to develop CCHIT standards.  David Brailer's vision may come true but in a different manner than proposed.

As I had stated and predicted it would not be necessary to 'reinvent the wheel', that many of the requirements already existed in the market place.  ONCHIT chose to ignore this fact and became involved and invested in it's own thought process.

During the last four years I became the principal involved in an attempt to develop a "RHIO" in Southern California. The outcome was less than devastating.  The REPORT  written by David Kibbe and published on The Health Care Blog (Matthew Holt) articulates the absolute failure of RHIOs except for one or two which existed prior to ONCHIT' arrival on the scene.

During the past three years I worked with a multitude of vendors at the grassroots level.  Except for large to medium sized groups and IPAs the market remains very fragmented. 

ONCHIT has largely ignored the present market.

"It's as though these people and institutions never heard about medical search, health social networking, wikipedia, Google Health, Microsoft HealthVault, or the Continuity of Care Record standard. To read the ONC Strategic Plan you would never know of the existence of HealthGrades and the other quality and transparency reporting sites on the Internet; the SureScripts network that was used for 100 million ePrescriptions last year,; the hundreds of  thousands of lab results delivered to medical practices over the Internet using Web applications every day; or the thousands of medical practices that have deployed Web-based technology for billing and claims administration, Web portals for communications with their patients, and clinical systems for helping with care management. " (from the report)

 

"The second biggest misstep taken by ONC has been to entirely remove the consumer from the equation, and to ignore the force of the analogy that is powering consumer/patient impatience, even anger, at the calcified hairball our health care industry has become. That is the analogy with consumer experiences of convenience, affordability, and service excellence from companies across a wide spectrum of industries that have effectively integrated the Internet and the Web into their DNA, from FedEx to NetFlix, from Southwest Airlines to L.L. Bean, and from CNN to iTunes. Education, commerce, banking, the financial services, and personal communications are all online.

Too much of health care is still offline, and nothing in ONC's obsolete strategic plans reflects this reality or recognizes the progress that is being made despite ONC's befuddled time warp.

Will somebody, please, push the "reset" button on health IT policy inside the Beltway?"

June 10, 2008 in Policy, Technology, The Industry, Web/Tech | Permalin

What Doctor's Think


Quote of the day:


Three may keep a secret, if two of them are dead. - Benjamin Franklin

Here is what fuels our "health train"

Doctor Insights

Doctors directly influence more than a third of the entire USA health care economy. Consider these important facts:

  • 902,000: number of physicians in the USA in 2005
  • $2.1 trillion: USA healthcare expenditures in 2006
  • $274 billion: sales of physician-prescribed medications in 2006
  • $587 billion: cost of various patient services and devices ordered by physicians and healthcare providers in 2004

These figures are from  What Doctor's Think.

Monday, June 9, 2008

Health Train Express -- Derailed

“It is better to know some of the questions than all of the answers.”
James Thurber (1894 -1961)

 

When I named my blog several years ago I did not quite realize the analogy would have so many applications to health care.

Our "train" is certainly not travelling a straight line on the track. In fact at times the train seems to have left the track.

One unfortunate observation is that like our country overall there is no  ten year or twenty year cohesive plan. Healthcare has become a hodge podge of entities and chaos.  In fact if we can plan beyond next month  running our medical practices we are lucky.

A train with a locomotive at each end pulling in opposite directions won't move very far.

Sunday, June 8, 2008

Hijinx 101

Enough gloom and doom with healthcare, medicare, universal care, dental care, heart care, bone care, who cares, an NO CARE for this week.

Norman Vincent Peale decided for the rest of us that "laughter is the best medicine".  Now that is not on  medicare part D., so Idon't know how to order it, or if it requires a special RX pad.

The sad fact is that most of you "intelligient" docs got where you are due to you ability to adapt, work hard, and check off the boxes that your teachers wanted you to check off.   Creativity has been smashed beyond recognition in clinical care.

So, to cheer you all up I am including some links to stimulate the "other" side of your brain. 

I am saddled with being left handed, which it turned out has been a boon to my career as an ophthalmologist. ( I never could play the ukelele.)

Sit back, relax on this fine Sunday morning and enjoy the hijinx of the Y and Z generation.  There  is still hope if we "old guys" get out of the way.  This one's for you....Buckeye Surgeon, Surgeons blog,Panda Bear ( I miss your blogging), Kevin MD, THCB, and more.

Revision 3.0

Twit.tv

Future in Biotech

Queen

I am a Twit

You Tube--Healthcare

Pirates of the Healthcare-I-bean  (very funny)

Burf

Progenitorovox

Ecstasy

Marrying for Healthcare

Remix Mayday

Light up Your Lighter

The Future (may load slowly..be patient)

There is hope!!!!

Saturday, June 7, 2008

The Flawed SGR Formula

When more is less...............


Quote of the day:
Democracy means government by discussion, but it is only effective if you can stop people talking. - Clement Atlee

 

Usually before I start my blog writing I do some surfing around for current news in the blogosphere. Buckeye Surgeon has a few interesting links that are germane.  The Wall Street Journal blog cuts right to the Chase.  It's not difficult to see how payors enjoy playing us against one another....divide and conquer techniques which have been demonstrated to be quite effective thus far. No specialty or primarycare physicians should take glee in reaping benefits as a result of these tactics.  Remember, first they came for "them" then they came for "me". 

 

To quote Buckeye Surgeon,

"There's plenty of money to go around. The discrepancy in pay between the GI doc and the PCP is not the reason why health care is so expensive. The giant HMO's and the pharmaceutical conglomerates would love to have you believe that. There's a reason both are multi-billion dollar industries. Let's not nickel and dime each other. A united front is our only hope of ensuring that the backbone of the American health care system, i.e. the physicians, does not deteriorate into a collection of second- rate, infighting, backstabbing special interests."

Monday, June 2, 2008

Conductors for the Health Train Express


Quote of the day:
Politicians are the same all over. They promise to build a bridge even where there is no river. - Nikita Khrushchev

 

It's been a very long time since I have been on a train. I remember them as walking down the aisles of passenger cars punching your ticket.  Do they still exist?

I think "Health Train Express"  needs fewer ticket punchers.

When was the last time you thought about a Surgeon General?

The last one I remember was  David Satcher , before that the memorable  C. Everett Koop .   I am not certain why but the most memorable Surgeon Generals  had beards.

image

The complete List of Surgeon Generals is here.

Another Surgeon General was Jocelyn Elders,  who I like to call the "equal opportunity"  Surgeon General.  She was both a woman and an African-American . General Elders was a very outspoken leader....she was however politically incorrect, a proponent for sex education, introducing Condom in public school.  She was summarily drummed out...

Condom rolled

Some of these "Generals" actually were Admirals...but I have not heard of any called "Surgeon Admirals".

Whatever  has happened to our current  surgeon general?

Rear Admiral Steven K. Galson, M.D., M.P.H.

photo of RADM Steven K. Galson, M.D., M.P.H., Acting Surgeon GeneralSince October 2007, Rear Admiral Steven K. Galson, M.D., M.P.H., has served as the Acting Surgeon General of the United States. As the nation's top public health physician, the Surgeon General communicates the best science, evidence, and data to the American people in order for them to make healthy choices that impact their health, safety, and security. Additionally, he serves as the operational Commander of the Commissioned Corps of the United States Public Health Service, a uniformed force of 6,000 health professional officers dedicated to promoting, protecting, and advancing the health and safety of the people of the United States.

I am sure he is an excellent Surgeon General, but why has been "acting"  for so long.  Is this a rehearsal, or Audition for the part?

Now you ask what does any of this have to do with caring for patients.....???Nothing, nada...............just like most of what we read, or hear about medical care.

 
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