CMS RESPONSE

Readers of my last commentary will be pleased to hear of the very quick response I received from CMS regarding the exclusion of California from the new Electronic Health Record Grant announcement.

 

" 

Thank you for your inquiry about CMS' new EHR demonstration.

This demonstration is being conducted by Medicare’s Office of Research, Development & Information. The EHR demonstration is one of many demonstrations across the country that the Demonstrations Program Group is conducting to examine ways to improve how care is provided to Medicare beneficiaries. Such initiatives are conducted to inform policy decisions about the Medicare program.  Because these are research projects, it is often important not to have multiple demonstrations being conducted in the same area if one project could affect the results of another. In addition, as part of this research, areas where demonstrations are being conducted are often compared to similar areas where there are no special projects going on.  When planning new demonstrations, we try to stay away from areas where there are similar existing projects or areas serving as comparison regions for these projects so as not to confound the results of those demonstrations and influence the integrity of the evaluation of these initiatives. Therefore, the list of states and counties excluded from applying to participate as community partners for the EHR demonstration reflect areas where Medicare already has similar projects and evaluations underway.

California is excluded from the EHR demonstration because primary care physicians in that state are already participating in another, similar demonstration: the Medicare Care Management Performance (MCMP) demonstration. This 3-year demonstration began last July and over 200 small to medium-sized primary care practices in the state are participating. Therefore, the decision was made not to implement this new demonstration in California or any of the other states where this or similar demonstrations are being conducted.

If  we can answer any other questions for you regarding this demonstration, please do not hesitate to contact us.

Jody Blatt

Debbie Van Hoven

Project Officers, EHR Demonstration

Medicare Demonstrations Program Group  "

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A LETTER TO CMS

Inland Empire Regional Health Information Organization

Gary M. Levin MD, Coordinator

20032 Sweetbay Road

Riverside, Ca.

Email: gmlevinmd@gmail.com

Tel: 951-746-9145

Press Release: A Letter to CMS regarding Electronic Health Records

CMS Demonstration Project: Electronic Health Records Demonstration 2008

Dear sirs;

For the past four years I have been involved with promoting and developing a regional health information exchange for the Riverside and San Bernardino County region of Southern California. This is a rather large geographic area east of Los Angeles and includes some rural and remote desert communities as well as urban and suburban areas.

I also publish a weblog devoted to information technology as a resource for area physicians and interested parties regarding RHIO progress in our area, which I might add has had dismal response. http://healthtrain.blogspot.com .

Despite the encouragement of the California Regional Health Information Organization and their “framework” for developing such entities there has yet to be made any significant progress, with multiple failures as we have seen in other RHIO efforts.

In my search for funding I was very encouraged to see the projected CMS Electronic Health Record Demonstration Project that was announced several weeks ago. However your recent email update surprised me and discouraged me greatly. The entire state of California is excluded from applicants and eligibility for these grant(s).

I am curious as to how and why this decision was made by policy makers? California represents a spectrum of health providers and has a large population as well as regional diversity. There is also a significant taxpayer base here, as well as CMS recipients. While there are several large health care entities who are adopting electronic heatlh records here, the adoption of EMR in smaller practices is very low. There also remains no connectivity between these groups and individual providers as well as academic medical centers.

California in the past has been on the forefront of developments in healthcare. Our state is certainly stressed in regard to healthcare for all its’s citizens. It’s hospital system has been decimated by reduced reimbursement as well as caring for uninsured as well as undocumented aliens. Our chaotic health insurance underwriting is chaotic and discriminatory for those who lose employment or have pre-existing conditions. The secondary economic toll is staggering and saps our potential wasting many lives.

The impact of granting CMS grants to our region would be great. The funds would do the greatest good for the most people. Most CMS grants seem to go to rural, underserved, or disadvanated counties or subsets of health issues. There has been a definite bias against the vast majority of insured and seemingly independent citizens who are imagined to be able to produce a system for Health Information Exchange.

The recent increased interest has produced a “feeding frenzy” amongst IT vendors whose main interest is “great profit” from medical providers . Numerous health care interests, insurance providers, CMS, have projected enormous savings and improved quality of care from health IT. Yet, some studies have failed to demonstrate this as true.

The adoption of EMR and HIE is much more than installing systems. It requires “change management” and few smaller practices have these resources available. Estimates for cost effectiveness fail to include training expenses, nor maintenance of systems which can amount to 15 or 20 percent/annum of the initial investment.

I and all the other health care providers will be interested in your important response to my question

Very truly yours,

Gary M. Levin MD

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WHO ARE THE 'WE'S?

Can physicians make the changes necessary to continue to provide quality care, while at the same time beseiged by increasing demands on the part of insurers, CMS, patients,etc.

 

There is no doubt there are many others willing to "steer" the boat, and relatively few physicians participate in organized medical associations. We are divided, fractured and all but trampled upon.  Chaos reigns supreme....mostly because we are not pro-active. 

Our political leaders are all chanting "CHANGE"  !!

The initial phases of information technology and how it applies to the medical industry has just begun.  Although it has not yet reached critical mass the "growth curve" indicates a steady incremental increase in the number of users of health information systems, of which  EMR is only a part.

The Annual HIMSS meeting which is taking place this week has progressively increasing attendance, a reflection of the market potential of this technology.

Many "hospital systems", large groups have or in the rollout phases of their EMRs. 

There can be no doubt that once a "critical mass" is obtained, those providers who do not utilize this tool will be at significant risk of economic and referral disadvantage.  As true of most decision-making it is much better to be proactive and be on the leading edge rather than the trailing adopter.

Adopting EMR is far more than purchasing a system. It requires "change management" of how your support system flows.

For those using EMR, despite the transitional challenge, most say they would  "never go back ".

So, who are the We's?? In my opinion it is YOU and I.

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A Word of Caution

 

I have read that some physicians are acting proactively in installing EMR to preclude the possibility of having their reimbursement reduced by payors and CMS for not having electronic health records.

Payor and CMS requirements have not defined what they consider as electronic health records. They do not define how inclusive or what data needs to be in the EMR.  Does a document manager of scanned files fulfill their requirments??

I maintain that providers need to do what is best for THEIR PRACTICE, and not jump off an expensive cliff to satisfy some " entity", which wants data for their  own ends. 

If EMR grows and takes hold it must be led and driven by providers.

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Good News

Mike Leavitt, the head of HHS announced the privatization of the AHIC group. He also announced the steady increase in the number of EMR vendors who are complying with, and becoming certified by CCHIT. This is no small accomplishment because it requires a substantial fee, for the smaller vendors. According to Leavitt about 75% of EMR vendors are now CCHIT certified.

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What didn't Occur in 2007!

As 2008 begins I started out to clean house. This included defragmenting my hard drive, checking on my windows updates, deleting about 1 GB of uneeded files, running my AV program, anti-spam program, tuning my router, checking my download speeds, and other mundane tasks.

I also updated my list of goals for 2008 and beyond. Looking back on 2007 and further beyond I realized a great number of things had not occurred.

1.Universal Health Care. Except for Massachussetts, had not occured.

2. The number of uninsured  had not decreased.

3. There still was no worldwide epidemic of SARS virus. The pandemic event that was predicted to "thin" the human population still lurks.

4. RHIOs had a very dismal year.

5. Adoption of EMR has failed to "take off" as predicted.

5. CMS and Social Security had failed to go bankrupt, However the bean counters, statisticians and others continued to "see the future" as bleak.

6. The annual SGR adjustment did not go into effect on January 1, 2008 as scheduled.

7. Physicians have not stood together regarding opposition to pay for performance, (or reporting).

8. The number of medical school applicants stopped it's five year decline.

9. I did not quit practicing medicine. (I still like patients)

10 I did not get recertified

11. I did not lose my medical license.

12. I did forget to renew my DEA.

13. HMOs and insurance carriers did not raise my reimburment but did warn us that they will reduce our reimbursement if we don't adopt P4P and HIT.

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Merry Go Round or Roller Coaster??

Happy New Year to all.

2007 was a year of up and downs for RHIOs and EMRs in the United States. A small number of RHIOs have made some progress and some group practices and hospitals have adopted or are moving toward  EMRs.  Many RHIO efforts have stalled due to lack of stakeholder enthusiasm.

Analysts like to point out how far behind the U.S. lags in EMR implementation.  Their statistics are flawed and reveals how statistics can be manipulated to prove almost anything.

First of all European nations have healthcare systems which are much more socialized and run by central governments.. If one analyzes their EMRs, they are focused on complications, adverse reactions and limited to primary care.

This article from Health affairs expands on my statements:

 

""UK practices best for IT to track medical errors

20 Nov 2006, e-Health Insider Primary Care

GPs in the UK are well ahead of colleagues around the world in having information systems which track medical errors, according to a survey of primary care doctors in seven countries.

The survey of primary care doctors’ office systems in seven countries, the 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, reveals striking differences in primary care practice internationally.

Family doctors in Holland are the most likely to have systems that enable sharing of records electronically with other clinicians and New Zealand doctors were the most likely to say that they can access records when outside the office although even in New Zealand only one-third reported such access.

A total of 79% of UK GPs questioned for the survey reported that they have systems to document all adverse events compared with 7% to 41% in all other countries. More than 6,000 physicians took part in the survey from Australia, Canada Germany, Holland, New Zealand and the US as well as the UK.

The study found that Canadian and US primary care physicians lagged well behind doctors from other countries in terms of access to electronic medical record (EMR) systems. Top performers were again Holland where 98 % of family physicians said they use EMRs followed by New Zealand (92%), the U.K. (89%), and Australia (79%). A total of 42% of primary care physicians in Germany said they used EMR compared with only 28% of US doctors and 23% of Canadian doctors.

Canadian and US doctors were also the least likely to have systems that provided decision support. Only 10% of Canadian doctors and 23 % of US doctors receive computerised alerts compared with 93% in the Netherlands and 91% in the UK. At least two of five US and Canadian doctors also find it "very difficult" or "impossible" to identify patients overdue for a test or preventive care, versus one out of five or fewer in the other countries.

The researchers commented that while Germany and Canada lag behind the leading countries on EMRs, each has national plans to move forward. Germany is planning an “e-health smartcard” capable of including information about medications, allergy and blood type and Canada working on a project to link clinicians and provinces across sectors.

The researchers state that to date the US has built IT capacity by relying mainly on market-driven individual care systems such as Kaiser Permanente or that developed by the US Department of Veterans Affairs, together with physician investment. They add: “The United States appears to be the only country without a national plan to support expanded primary care IT capacity. “

This last statement is flawed and untrue. By order of the executive branch of the United States,  ONCHIT (The office of the National Coordinator for Health Information Technology) was established in 2003.  Congress has mandated Health IT, but has failed to fund it for several years.

The "Golden Rule" applies here.  "He who has the Gold rules!!"

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