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 – Hospital Billing Varies Wildly, Government Data Shows

dondennison Financials

One of the thorns in the side of payers is the wide disparity of money charged for the seemingly same procedure among different hospitals—even among those in the same city.

This New York Times article explores some U.S. government data that was recently released, showing procedures at one facility costing multiple times more than the same procedures at another.

If you go through the multimedia widget (the little map on the left), you can explore what specific hospital’s charge for a given procedure, how many cases were in the sample size, and the variance to the norm. The authors did a good job designing this tool.

Article – Can a smartphone do what your doctor does?

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This article provides a summary of medical devices and apps that connect to your smartphone and collect physical examination information. The author is a doctor and provides a good explanation of the utility and necessity of the different tests.

The devices assessed by the article’s author include…

  • Blood Pressure Monitor by Withings and Blood Oxygen Monitor by iSp02
  • ECG Cellphone Case by AliveCor
  • iExaminer by Welch Allyn
  • SpiroSmart

From her assessment, it seems that the medical tricorder is slowly becoming a reality. I do agree that having a separate app to view the results from each device is a PITA, but this should not last long. With Bluetooth and WiFi connected devices wireless tethered to the smartphone, and new data formats and protocols popularized in HTML5, the shift to storing the collected information into the EMR or HIE will be soon.

Article – MRI Payment Cuts Having Dramatic Effect on Radiology Groups

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Last month, I posted about reimbursement cuts to two popular MRI exams.

In this article, the impact of these changes to Radiology groups are explained fairly clearly. Worth a read if you make your living (directly or indirectly) from Radiology services reimbursement.

Thoughts on Telemedicine

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In reading some of the comments from Lynn Britton, president and CEO of Chesterfield, Mo.-based Mercy at the ATA’s (American Telemedicine Association) 18th Annual International Meeting & Trade Show from this article, it reminded me of some comments I made in this post.

The quote from the article that stood out to me…

“If we had thought about the classic return on investment around the infrastructure we built, we would have had second thoughts about it,” he said. “But the return is there, because that infrastructure is robust and sound, because we can provide those services in every one of those communities you saw on that map.”

Message to providers: expand your network, expand your services, lower your costs …or fall behind.

Here is another article titled “3 things that will help telemedicine go mainstream and win over pessimists” based on ideas shared at the ATA’s annual meeting.

And here is an article titled “3 ways telemedicine is helping Wyoming”, which describes how telemedicine is providing valuable services to the people of the 2nd least densely populated state (only Alaska has fewer people per square mile).

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 – Outpatient services will dominate 2013, survey says

dondennison Financials ,

Healthcare providers are shifting their focus from providing inpatient services to providing outpatient services—and their investment priorities reflect this, according to a survey.

Some key stats from this article…

  • 69% of survey respondents projected an increase in outpatient volume for 2013, while only 35% predicted an increase in inpatient volume
  • 43% of respondents plan to make health IT their biggest capital investment in 2013, up from 21% two years ago
  • 22% of respondents were part of an Accountable Care Organization, and 55% planned to be part of one by 2014

Article – Radiology Staffing: How to Do More with Less

dondennison Radiology , , , ,

A lot of people are talking about using analytics to make operational improvements (read as: lowering costs while improving quality of service), but this article describes some specific ways to do this within a Radiology practice.

Examples (from the article)…

  • Use actual procedure data to determine the specialty needed, as well as the number of staff needed in each facility/location. It also helps determine if full-time or part-time staff are needed.
  • Adapt the daily shift schedule based on hourly exam volume peaks.

The article also explains how technology is used to improve efficiency…

  • Cloud based image sharing, integrated with PACS, to distribute reading of exams among distributed Radiologists.
  • Shared worklist across facilities

Blog – FHIR Version 1.0

dondennison Healthcare IT , , , , , ,

Check out this blog discussing FHIR. While the initial post seeks to simplify the intent of FHIR to a practical application (essentially a summary document), if you read the author’s own comments on their post, they are already starting to realize the real value of FHIR.

FHIR creates the platform, and the summary document is an application of the platform.

Innovation and Investment

dondennison Technology , ,

This article is about a VC (Venture Capital) fair at the ATA meeting.

Though it is in context of telemedicine and mHealth, the points and comments are generally applicable to any start-up.