By bruce on 5/5/2010 2:29 PM

• There is a lot of misunderstanding out there about the HITECH sections of the Federal stimulus package (ARRA), even by HIMSS members who have a great deal to gain from HITECH.  This includes how providers qualify, who gets paid stimulus funds, and who makes the rules.  Over the next few weeks, we'll provide some information that will answer these questions.
• The REC model is in flux, with the leaders of these regional extension centers scambling to identify their role.  With many EMR/EHR vendors offering end-to-end solutions - some of which are free (quick plug for our partner Practice Fusion) - the RECs aren't quite sure what to do, though they would never admit that.  Their job under HITECH is to evangelize physicians about the advantages of electronic records, provide group negotiating power in working with vendors, and line up consultants and vendors to provide installation and training, especially to solo practice physicians, rural practices and so on.  With free and low cost resources available, lots of vendors, integrators, and consultants already working with lots of docs outside this model, and the short time line they face, RECs in some state's are really late to the party.
• California state legislative staff are, on the whole, unaware of the Federal funds the state will be getting under HITECH, and less aware of where it will go.  This made for some fun lobbying efforts!  However, with the RECs already running late, any delay in states' getting these funds through the budget process, and pushed out to where they need to go, could have significant effect on the RECs' ability to do anything.  In California, where budget approval is an always-late, contact sport between legislators, this could really hinder the value of the state's RECs.
• Lots of people are worried about whether solo practitioners will get on-board with HITECH.  However, our admittedly anecdotal evidence points to the real hitch being multi-practitioner, parntership practices.  Mnay of these practices can't make a decision quickly, will want to evaluate multiple EMR/EHR products, and will have the most problems with integrating a new system b ... Read More »
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By bruce on 2/23/2010 1:17 PM

Data Entry & Quality Healthcare

Great article on why medical organizations should slow down on adoption of EHRs: click here for Readers Write -- issues with EHR design, impact on patient care, and concerns about whether the government will be able to fulfill its obligations under HITECH.

 

As an HIT consultant, I see another big reason to go slow with EMR adoption: many organizations rushing into electronic health records without recognizing the ways the software will impact their current operations and processes. After years of doing things a certain way, front and back offices are faced with the need to change how they bill, how they track patients, how they complete forms, etc. The failure to do adequate business process work on the front end often obviates any gain the electronic systems could bring, at least for the first year of implementation. And that’s the year that you have to perfect meaningful use.

 

By bruce on 11/30/2009 1:12 PM

As Micah shared in a previous post, we went to the World Health Innovations and Technology Congress (WHIT5.0) in Washington, D.C. last week. It was an awesome experience, and Micah gave a great overview of the conference.

I walked away with several clear impressions: one of them is that before we can make significant progress on health care reform, we need to engage patients (notice I'm talking about health care reform, not reform of the ridiculous financial system that surrounds it). In fact, both Bill Clinton and Newt Gingrich agreed on this point, and you can't get much farther apart than that on the political spectrum. Many other speakers and panelists at the conference said the same thing.

Why patient engagement? Because patient engagement in their own care will encourage lifestyle changes -- changes like losing weight, stopping smoking, exercising, managing diabetes more carefully. And these changes would result in big reductions in major illnesses: type II diabetes, stroke, heart conditions, and many cancers. In turn, besides increasing quality of life for millions of Americans, billions could be saved on treatment of these diseases -- diseases which are extremely high cost in both length and type of care.

Billions of dollars saved, which can be used to pay for health care for the un- and under-insured; to finance rural clinics; to reduce insurance premiums; to improve care of non-lifestyle-related illness. Okay, this is a little pie-in-the-sky, because some of that money will end up in the pockets of insurance companies; but the possibilities of freeing up that kind of money are pretty exciting.

What's next? Well, lots of companies are working on various platforms that will allow patients to be involved in their care. They range from Web applications that integrate directly with the patient's EHR (like Palo Alto Medical Foundation's PAMFOnline built on Epic's foundation) to Keas'  care plans and self-monitoring tools to Google Health's online records. All show promise in different ways, but my bet is on provider or payor driven (or funded) systems, because they have the most to gain by using these systems. Vendors like Keas will be successful only if they can pull in corporate users and figure out a way to be transparent to physicians. But there are definitely some changes going on in this space, and they bode well for health care reform and financing.

By bruce on 4/7/2009 10:47 AM

HIMSS and the struggle to understand the stimulus package

I recently joined HIMSS (the Healthcare Information and Management Systems Society). It's one of those action items that I knew I needed to do for a long time, but it kept getting pushed lower on the someday/maybe list (David Allen fans know what I mean!).

Anyway, finally got around to joining, and discovered that they have some killer resources regarding the Federal stimulus package and its impact on health care and on HIT/EHR in particular. If you have any vested interest in this stuff (and if you are even tangentially involved in health care IT, you should), check out the Economic Stimulus webinars and the Economic Stimulus resource page. Yes, you have to be a member to view the resources, but well worth the $129.

Of course, as an alternative, you can do what I did: download the stimulus package legislation, print out the HIT section (nearly 200 pages), and then try reading it. Nah, you'll want to join HIMSS -- trust me on this one.

By bruce on 3/10/2009 5:25 PM

Going Dark, Part 2

We talked last time about the increasing dependence of many businesses on cloud-based applications -- and about how a broadband outage can disable a company.  This time, let's talk about ways to safeguard against such business crises.

First, as I mentioned before, having a contingency route to the cloud is the best protection.  But keep in mind that just having two carriers doesn't necessarily fit the bill.  You can have two T1 lines coming into your facility, each from a different vendor, but a cut cable in your parking lot can take both down.  So focus not just on different carriers but different routes:  DSL and satellite; T1 and laser; wire and cellular; even (shudder) dial-up.  Even if your secondary connection is considerably slower than your primary, the value of having any connectivity during a service interruption is critical.

Second, make sure that your records can be accessed locally, even if they are in a text file or spreadsheet.  I described before how a potential vendor couldn't get in touch with me when their broadband went down -- they couldn't get to SalesForce to get my number.  If they had exported their contact list to a spreadsheet, they could have (at a minimum) been able to get my email address and phone number.  If you are using cloud-based applications, make sure you can access critical records locally -- dumping these records should be a part of your normal backup procedures (you DO have normal backup procedures, right?).

Third, follow the "mature application" rule:  don't trust your data to any application that is not mature enough to have a way to get your data out ON A REGULAR basis.  Applications from SalesForce, Google (via Gears), QuickBase, and other high end cloud applications allow for export, backup, or local versioning.  If your application doesn't, consider whether the value of the app is worth the risk of not being able to access it.

Finally, consider a simple trade-off:  is the value of having a cloud-based application worth the risk of entrusting your data to other folks?  Put another way, is the ROI and convenience of online apps worth the potential difficulties of having to backup data in unusual ways?  Before you commit to cloud computing, make sure you answer this question.

By bruce on 2/9/2009 11:45 AM

Going Dark In The Age of the Cloud

Julie, our CFO, was at a conference recently, and met a vendor she thought might be a potential partner.  She emailed the information to me, I contacted the vendor, and we set up a Go-To-Meeting appointment.  At the appointed time, I logged in, dialed in, and found myself as the first participant.  I listened to the inane waiting beeps (hey, GTM, is it really necessary to repeat the meeting ID every few minutes?), did some work, and finally hung up, wondering where everybody else was.  I went to my calendar, found the number of the vendor rep, and called him.  Wow... was he relieved!

Turns out that their Internet connectivity had gone down, and had been down long enough (on a Friday) that staff were heading home.  They had no way to get to the GTM session to let me know. 

Why didn't they call me, though?  One word:  Salesforce.  Their entire sales department relies on Salesforce, and like many small companies, they have no on-site, localized versions, no sync to local apps, etc.  So they couldn't find my phone number.  Add to this a Web-based email (don't know if it was hosted Exchange or gMail) and they couldn't even find my email message (which, of course, contained both my email address and my phone number) -- hence, their great relief that I called them, and their great embarrassment and frustration over being in this situation.

What could they have done differently?  What can you do so you don't find yourself in this situation?

First, recognize that bandwidth is cheap -- having a redundant provider, even if significantly slower than your first provider, will save you from going dark.  Even dial-up (shudder) is better than nothing.  A second DSL provider, emergency cell modems, etc. can keep you at least marginally connected.

Second, invest in smart phones.  Virtually every major smart phone platform has (or will have) browsers which can run Internet apps or has clients for major apps.  I'm using one of the new Android phones right now, and I'm amazed at the number of Web apps that, at a minimum, I can at least view on my phone.

Third, use a local version of the app.  Of course, this isn't always possible, but most major online apps have some kind of offline capability; even if they don't, have a dump of primary information to Excel, Access or SQL gives you emergency access.

That's the quick and dirty way to stay connected to the cloud and keep from going dark.  It doesn't address the underlying question of how dependent you should be on the cloud - ... Read More »