Policy

Article – 9 ‘Cs’ lead to accountable care

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Here is part one of an article outlining 9 ‘Cs’—five that directly concern the patient and four that are focused more on providers. Check it out.

Cheat list for the patient criteria…

  • Contact
  • Comprehensive care
  • Continuous, longitudinal, person-centered care
  • Coordinated care
  • Credibility and trust

…the provider criteria will be published later.

Thought: Much of the article describes physicians interacting directly with the patient. This is not common for Radiologists tucked away in a reading room.

Article – AMA: EHRs create ‘appalling Catch-22’

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I enjoyed this article.

Often, policymakers and executives debate the merits of an initiative. What is often lost in the shuffle are the important lessons and optimizations that make the program a success.

In the article, a number of folks discuss the implications of an EMR after implementation, including the possibility of fraud, or the incorrect perception that it has occurred.

My thoughts…

  • Fraud is easier to detect the more the information is electronic and coded. In fact, any pattern is easier to detect if extensive, well-structured data is available. Algorithms that detect possible fraud patterns will emerge, just as they did for credit card transactions. I recall a investigative news show on Medicare fraud where the agent stated that the move to electronic transactions and ‘smarter and smarter’ alogrithms have made their job easier. False positives will be a problem for a while until they get it right.
  • Coding of records is about to become a huge push. Beyond regulations for coding of data, there are several initiatives to provide codes for orderable procedures, lab/clinical observations, medical terms, diseases, medical/surgical/diagnostic services, and even imaging workflow concepts. Other groups are working to provide practical guidance on how to best use these codes in different contexts. This article talks about the need for better and more coding.

And here is an article on a Web site where EMR users can rate their EMR. There are some interesting comments in the article.

Also, an Accenture survey finds a significant increase in the use of EMR and HIE technology by physicians.

Article – CHIME seeks Stage 2 delay, defends MU

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So, the U.S. government—CMS/ONC and some Senators—and CHIME (College of Healthcare Information Management Executives) are “discussing” the merits and best timing of HITECH and Meaningful Use.

This article provides a good summary of the questions and recommendations posed.

Some key points from the article and my thoughts…

  • The Senators are fairly looking for evidence of results from the significant investment of taxpayer dollars. The reality is that this change is large and multifaceted. It will take time to reap the benefits once operations are normalized and productivity is enhanced.
  • CHIME believe that there are merits to the government’s programs, but wants to slow the pace of change. I know from personal conversations with smart, effective folks working for respected providers that they are reeling from the number of implementation projects driven by ACO, MU and other initiatives that they have going right now. The troops may indeed need a short break and to reflect on lessons learned from the initial change.
  • “CHIME also urged Congress to request an update from ONC regarding what technologies, architectures and strategies exist to mitigate patient matching errors” …it is interesting that CHIME is looking for this, as MPI (Master Patient Index)—also known as PIX (Patient Identifier Cross-Referencing) in the IHE Technical Framework—has been around for years and used in many projects to enable sharing of patient records across patient ID domains

Article – ONC chief: Regulation fuels innovation

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This article debates the impact regulation has on innovation.

My 2 cents: Regulation provides consumer protection; standards provide access to data, which often leads to innovation.

More thoughts and notes…

  • Mobile “apps” seem to always be cited as examples of innovation, but I believe  the Web services (based on REST) that enable mobile and Web access are the key to innovation—the client will change over time (browser, smartphone, downloaded app, HTML5 app, tablet, etc.), but a secure, flexible and reliable API makes the change less painful. Thankfully, standards bodies (DICOM, HL7) are focusing efforts in this area. The Web services and the clients don’t need to be from the same vendor, or even use the same technology—that is the beauty of REST.
  • I like how people that issue regulations make statements about the benefits of these rules, such as driving innovation (they claim). Shouldn’t we ask the people that have to operate (and attempt to innovate) within the interpretation of these guidelines? I intentionally used the word “interpretation”, as different regulatory  professionals seem to have different opinions on what burden of process needs to be met for medical devices.
  • The FDA’s eagerly-anticipated guidance on mobile apps and devices “should be out by October.”

Article – HIStalk Interviews Keith Figlioli, SVP Healthcare Informatics, Premier

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A friend shared this interview with me. Worth the read.

Some thoughts…

  • Keith (BTW, I have never met him) has a unique perspective having spent time on the vendor side, then the provider side, and is now also involved in policy. I think his points are spot on.
  • I believe that some of the EMR monolith disruption will come from HIE vendors. They are slowly taking more parts of the EMR, and generally have newer architectures than most EMR systems. This will allow them to adapt to new standard APIs and protocols, such as those being defined in HL7 FHIR. They are also more open—they have to believe in openness, because without data sharing, they have no business.
  • HIE vendors also typically have some form of clinical data repository, which can act as the data warehouse that Keith mentions. Adding moderns APIs to these can open the door to information freedom (without compromising security and privacy, BTW), without waiting for EMR vendors to do it.
  • I like the analogy to the transformation that the travel industry went through. I make this comparison often. I also look at how banking and telecommunications have transformed themselves to provide new and improved services. The lessons for healthcare are all out there—we just need the leadership.

Article – MITA: Obama Budget’s Imaging Provisions Threaten New Medical Technology Development and Patient Care

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The medical device manufacturers’ industry association, MITA, says Obama Budget’s Imaging Provisions Threaten New Medical Technology Development and Patient Care.

Key notes…

  • President Obama’s proposed 2014 budget …includes a recommendation for a prior authorization system through for-profit radiology benefit managers (RBMs).
  • Several recent independent analyses have shown a decline in utilization of imaging technologies. The Medicare Payment Advisory Commission’s (MedPAC) annual report to Congress in March 2012 confirmed that imaging services fell by 2.5 percent in 2010, while non-imaging utilization increased 2 percent. These data are consistent with an analysis commissioned by MITA which found that Medicare spending per beneficiary in the field has dropped 13.2 percent since 2006 and imaging utilization declined by 3 percent. This contrasts markedly with the overall Medicare program, in which spending per beneficiary increased by 20 percent and non-imaging utilization rose by 2 percent.

Article – Mostashari, policy committee take critical look at CommonWell

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Mostashari, policy committee take critical look at CommonWell

Something to watch as it evolves in the coming months and years, but here is an excerpt of the alliance’s goals…

  • Enabling providers to unambiguously identify patients – but not with a national patient identifier;
  • Providing a way to match patients with their healthcare records as they transition through care facilities;
  • Using existing unique identifiers (salted/hashed) such as cell phone number, email addresses or driver’s licenses for identity management;
  • Enabling patients to manage consent and authorization;
  • Creating a HIPAA-compliant and patient-centered means to simplify management of data-sharing consents and authorizations, focusing initially on the most common treatment situations;
  • Helping providers to find the location of patient records across care locations via a secure nationwide records locator service;
  • Enabling providers, with appropriate authorization, to issue targeted (directed) queries that provide for peer-to-peer (e.g., EHR to EHR) exchange.