IHE Integration Profile Development – Vote Now (Voting Closed)

Update: Voting is now closed. Integration Profiles selected by the IHE committees for development in the 2016/2017 development cycle:

  1. Enterprise Scanner Protocol Management
  2. Critical Finding Follow-up and Communication
  3. Standardized Operational Log of Events

What healthcare use cases do you want addressed? What are the biggest interoperability issues facing our community today?

Provide your input to the IHE integration development process by completing the survey. Simply rank the six proposed profiles. It take 10 seconds.

Article – MU No More…Meet MACRA, MIPS and APMs

The death of Meaningful Use (MU) will not be mourned by many physicians.

While the overall program drove adoption of electronic medical record (EMR) systems, which is necessary for information accessibility, the measures required to be reported upon were viewed by many as misguided and not a reflection of the actual practice of medicine.

Also, many of the EMR systems implemented were criticized as being hard to use with limited capabilities to allow information interoperability with other systems.

Regardless of one’s views of MU, CMS is moving on.

With a keen focus on patient outcomes, CMS is looking to new models for reimbursement, such as the Medicare Access and CHIP Reauthorization Act (MACRA) legislation, introduced last year.

CMS is also intent on addressing the lack of interoperable patient record information.

“We’re deadly serious about interoperability. Technology companies that look for ways to practice data blocking in opposition to new regulations will find that it will not be tolerated.”

Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services

The MACRA site provides an overview of Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs), which are sure to be popular acronyms to fill the void created by the decline of the use of MU in discussions.

Here is another article on Slavitt’s comments. And another article by HIMSS.

My previous posts on healthcare payment reform are herehere and here.

Article – The Healing Power of Your Own Medical Records

This NYT article tells the story of a very bright young man that took control over has health data and probably saved his own life. Few of us have the knowledge to do what he did, but most would agree that having the choice to access our health data is the right approach.

I suspect that as long as the risk of uninformed patients misusing the information they access and the risk of unauthorized access of protected health information outweigh the demand for access to the information, progress will be limited. How do we balance freedom of information and data liquidity with effective access controls and reasonable assignment of liability?

Previously, I blogged about my thoughts on patient privacy and its use as an excuse for an non-interoperable patient record.

Article – Imaging Shift to Hospital Outpatient Facilities Concerns Radiologists

Following my post on consumer choice in imaging services, in which I asked how do we use quality—and not just cost—to help consumers make choices, I found some observations in this article on the shift of imaging being done in imaging centers to outpatient facilities to be quite interesting.

For example…

“groups at imaging centers may struggle to upgrade or get new equipment, which could affect image quality and interpretation”

So, how do I, as an imaging consumer know which provider has modern, safe, calibrated equipment, operated by qualified and skilled operators when making my choice of where to get imaging done?

I don’t ask my dry cleaner about what equipment they use, or when it was last serviced, or how much experience the person in the back doing the work has. Nor to I ask these questions about my car wash.

I often make choices in dry cleaning and cash washing based on cost, but more so convenience.

But this is my health and it is my body going through that device, not my clothes or my car.

I wonder how many people will simply trust that a friendly receptionist, flowers and nice magazines in the waiting room at a facility near where I work means quality and safe imaging. If I have a good experience during my imaging appointment, but they miss important findings due to low quality images (or lack of sub-specialty knowledge/training), how will I know?

Unlike a spot that doesn’t come out of my shirt or a still dirty section of my car, the consequences can be severe.

Putting the Power of Choice in the Hands of Healthcare Consumers

As reported in this Healthcare Informatics article, The Health Care Cost Institute, a non-profit organization based in Washington D.C., is making data on healthcare costs from 40 million insure individuals available for use by consumers to help them understand pricing information for common health conditions and services.

As I have blogged about in the past, providing the consumer, referring physicians and employers with tools to help them make choices about where to get affordable and market competitive healthcare services will be a growing trend.

Of course, to measure the value of something based purely on the cost assumes the product or service is a commodity. In the world of medical imaging, this is not the case.

Should an imaging service provider that has 15 year old equipment, no radiation dose tracking or optimization program, no sub-specialized Radiologists, and no peer review program (for quality assurance and ongoing learning) be paid the same for a procedure as a service that has all of these things (and more)?

Unless there is some consideration of quality in calculating the value of the money spent on a service, like medical imaging, then prices will be driven down to a commodity level and there will be no funds available to invest in the tools and resources required to provide quality. The math of economics is pretty unemotional about this stuff.

Creating Practical Value in Practice (of Radiology)

There is a lot written these days about the shift from volume-based to value-based in Radiology (and other medical specialties).

The thing is: volume is real easy to measure. And what gets measured, gets managed.

So, how do we measure value?

One can measure the time it takes to complete the report, sign it, and make it available to physicians and other members of the care team. Radiology practitioners call this Turnaround Time (or TAT). This is pretty easy to do.

We could try to measure whether the report is correct. In other words, is what the Radiologist concludes actually what is wrong (or not wrong) with the patient? This can be harder to measure, as it may take a lot of work to correlate many different data points, or a lengthy period of time for proof to be found.

There are a couple of activities that Radiologists, and other people working in the department, can do to improve the perceived value of Radiology.

In this article, a number of suggestions are made as to how to increase the visibility of Radiologists, as well as improve relationships and trust among other physicians and even patients.

And this WSJ article focuses on simply improving the clarity of the report by improving the language and writing skills of Radiologist. Seems obvious as to the value this would provide, when you read it, but how many Radiologists routinely attend training on how to communicate better?

While improving how Radiologists interact with the outside world—whether through better interactions or better writing—will help the Radiologist’s career, one would hope that it would also improve care. Better communication certainly couldn’t hurt.