The latest stab at "meaningful" use...the lynch pin term that seems to have every EHR vendor white knuckled waiting to see that their EHR provides this so that they can justify it's cost to physicians and promise physician reimbursement via Obama's Stimulus plan is...
"Demonstrates that the provider makes use of, and the patient has access to, clinically relevant electronic information about the patient to improve medication management and coordination of care"
This is the proposed definition by the Markle Foundation.
I would like to see it worded more strongly toward overall physician benefits....
It does focus on medication management but also hints toward the PHR.
As a physician, I would like to see a broader definition..one that includes...
I would propose adding the following for "meaningful" use criteria:
"To be meaningful, Physicians can either document one of the following paremeters: improved office efficiency, improved clinical responsiveness, improved clinical access, improved patient care, improved office administration functionality, improved documentation, improved record retrieval, improved billing, improved reliability and reproducibility of outcomes"
Monday, June 01, 2009
Saturday, May 16, 2009
Why doctors arent adopting electronic medical records and how to help them adopt electronic medical records
Okay, so here's the issue...we all know that there needs to be a government incentive to really drive the adoption of electronic medical records but until now (as recent as of today), there have been no real serious solutions. The problem is that the politicians are not really listening to the medical community...the proposed amount by Obama is not close to enough for a doctor to really slow down his practice with interruptions and create a new dependency on an unknown technology and a new dependency on what would be a required new position for any medical practice..ie technology consultant...Doctors by and large really dont have a clue about recurrent licensing fees, hardware, software, third party vendors, broad band, wireless, ethernet, local servers, remote servers, asp models, and more..they just dont have the time to learn all of the issues that accompany the implementation of a successful digital practice...as a result the doctors , understandably are extremely uncomfortable, with turning over the reigns of their practice, the very core of their practice..ie their patient's medical chart..to an unknown entity ie..the emr software vendor..or to the technology consultant or technology independent contractor they have to retain to implement all of the changes that would accompany their shift from the comfort of paper charts to the "promise" of electronic charts...so..bear with me..I will give you my thoughts on how we approach this..but for now...let me lay out what has been proposed by politicians to encourage adoption of emrs (electronic medical records) ..
1. Obama Stimulus plan...docs can get 44,000 over 5 years if they bring in electronic medical records into their practice. This is not nearly enough..granted it is a start but the real costs for a practice..per year per physician is realistically a minimum of 35-40K...so 5 year cost..taking into consideration hardware, additional third party software licensing fees, technology support fees, annual maintanence fees from software vendors, connectivity fees...and this doesnt equate given that productivity in the form of profit per patient visit does not increase for doctor...so this will never happen.
2. MAssachusetts SB 2863 - link medical school loan repayment to health IT competency...this is a good start..but addresses mostly the younger docs , ie those that have the greatest likelihood of adopting emrs anyways...
3. Wisconsin SB 40- tax credit for providers that purchase EMR's...again good start..but at the end of the day..it is pennies back against dollars spent.
4. New York SB 6808- offering incentive payments for porviders who use emr systems... a necessary implementation..and should be national...ie doctors that use emrs in their practice should receive bonus payments.
5. colorado SB 196- reimbursement to encourage services via telemedicine..again..good start but certainly wont jump start physician adoption of emrs.
So...all of these are better than nothing..but not much.
Here are my thoughts...If the government is really serious about having doctors adopt emrs than this is what must happen:
1. Medicare (as the leader for all insurance companies as it relates to setting fees for service) needs to do the following:
Medicare needs to reimburse physicians that have implemented emrs in their practice a separate fee above and beyond the standard fee for service..this code , not unlike a surgical tray code for supplies for a surgeon, or a facility code for an ambulatory care center, must be significant enough for physician to track and record..at least $5 extra per visit.
Medicare needs to pay the physician back for all expenses related to adopting emrs..not just software, but hardware, maintenance , other third party fees, and technology support and maintenance fees, back up and storage fees. It is not enough to say they will get back 44k after 5 years...as this is just not enough to make the change a reality...it is not worth a doctors time to institute this for the equivalent of 8.5 k per year for 5 years...since that number represents less than 2% of most physician's gross..and if you adjust for the expense benefit ...it is really much much less...
So, what does this mean..let me tell you..it means that our government does not have the means to allocate the funds sufficient to implement the change that the President is hoping for and promising...So then what do we do? Well I will tell you...
A great start was removing financial obstacles from private industry and pharma as it related to stark law exceptions. The Stark law technology exception and IT safe harbors to the anti-kickback statute enables hospitals to subsidize as much as 85 % of upfront ongoing costs for EMR software for physicians, so this exception needs to be more broadly applied and specifically more applicable to physician office setting, let the vendors and the hospitals fund this for the government without the concern of anti kickback penalties.
The one big mistake I see happening is tying implementation of healthcare IT to state licensure...that is surely a catastrophe waiting to happen. Stats like Massachusets and Minneosota have started this...but we all know , it will be delayed and eventually repealed..given that you cannot obligate the docs to do this until you have provided the financial means to do it as outlined above...if you force them and they are not ready or do not have the means to do this, or there is no infrastructure set up and tested in advance..then we will probably be visiting many of our old family docs as unlicensed doctors...
The last issue is my bias and for purposes of full disclosure...I founded and am CEO of PassportMD ( http://www.PassportMD.com ) ...a leading personal health record company...so the issue is..at the end of the day..when politicians realize it is not financially feasible to push the doctors to adopt..they will realize what I believe and that is that the easiest way to get adoption (and probably the cheapest as noted after reading my above comments) is to have the consumers push it to the doctors..so in this scenario, the quickest path to get health records digitized is through web based applications like PassportMD and Healthvault , mostly because it is without costing physicians a penny, but must have insurance payors incentivize the consumer/patient/beneficiary to adopt a web based online health record. And then let the consumer brin/push this to the doctor and have the doctor add to this via web access without incurring implementation , technology, hard ware, software and support fees.
http://twitter.com/PassportMD
1. Obama Stimulus plan...docs can get 44,000 over 5 years if they bring in electronic medical records into their practice. This is not nearly enough..granted it is a start but the real costs for a practice..per year per physician is realistically a minimum of 35-40K...so 5 year cost..taking into consideration hardware, additional third party software licensing fees, technology support fees, annual maintanence fees from software vendors, connectivity fees...and this doesnt equate given that productivity in the form of profit per patient visit does not increase for doctor...so this will never happen.
2. MAssachusetts SB 2863 - link medical school loan repayment to health IT competency...this is a good start..but addresses mostly the younger docs , ie those that have the greatest likelihood of adopting emrs anyways...
3. Wisconsin SB 40- tax credit for providers that purchase EMR's...again good start..but at the end of the day..it is pennies back against dollars spent.
4. New York SB 6808- offering incentive payments for porviders who use emr systems... a necessary implementation..and should be national...ie doctors that use emrs in their practice should receive bonus payments.
5. colorado SB 196- reimbursement to encourage services via telemedicine..again..good start but certainly wont jump start physician adoption of emrs.
So...all of these are better than nothing..but not much.
Here are my thoughts...If the government is really serious about having doctors adopt emrs than this is what must happen:
1. Medicare (as the leader for all insurance companies as it relates to setting fees for service) needs to do the following:
Medicare needs to reimburse physicians that have implemented emrs in their practice a separate fee above and beyond the standard fee for service..this code , not unlike a surgical tray code for supplies for a surgeon, or a facility code for an ambulatory care center, must be significant enough for physician to track and record..at least $5 extra per visit.
Medicare needs to pay the physician back for all expenses related to adopting emrs..not just software, but hardware, maintenance , other third party fees, and technology support and maintenance fees, back up and storage fees. It is not enough to say they will get back 44k after 5 years...as this is just not enough to make the change a reality...it is not worth a doctors time to institute this for the equivalent of 8.5 k per year for 5 years...since that number represents less than 2% of most physician's gross..and if you adjust for the expense benefit ...it is really much much less...
So, what does this mean..let me tell you..it means that our government does not have the means to allocate the funds sufficient to implement the change that the President is hoping for and promising...So then what do we do? Well I will tell you...
A great start was removing financial obstacles from private industry and pharma as it related to stark law exceptions. The Stark law technology exception and IT safe harbors to the anti-kickback statute enables hospitals to subsidize as much as 85 % of upfront ongoing costs for EMR software for physicians, so this exception needs to be more broadly applied and specifically more applicable to physician office setting, let the vendors and the hospitals fund this for the government without the concern of anti kickback penalties.
The one big mistake I see happening is tying implementation of healthcare IT to state licensure...that is surely a catastrophe waiting to happen. Stats like Massachusets and Minneosota have started this...but we all know , it will be delayed and eventually repealed..given that you cannot obligate the docs to do this until you have provided the financial means to do it as outlined above...if you force them and they are not ready or do not have the means to do this, or there is no infrastructure set up and tested in advance..then we will probably be visiting many of our old family docs as unlicensed doctors...
The last issue is my bias and for purposes of full disclosure...I founded and am CEO of PassportMD ( http://www.PassportMD.com ) ...a leading personal health record company...so the issue is..at the end of the day..when politicians realize it is not financially feasible to push the doctors to adopt..they will realize what I believe and that is that the easiest way to get adoption (and probably the cheapest as noted after reading my above comments) is to have the consumers push it to the doctors..so in this scenario, the quickest path to get health records digitized is through web based applications like PassportMD and Healthvault , mostly because it is without costing physicians a penny, but must have insurance payors incentivize the consumer/patient/beneficiary to adopt a web based online health record. And then let the consumer brin/push this to the doctor and have the doctor add to this via web access without incurring implementation , technology, hard ware, software and support fees.
http://twitter.com/PassportMD
Monday, May 04, 2009
Twitter and Blog for PassportMD
just added my twitter comments to the blog...
Keeping an eye on the real story regarding adoption of EHR based on government incentives...really believe that the stimulus falls short for the doctors...just not enough based on the disruption issue for MD's ...
In the end too costly for the docs and too costly for the government - see the push coming from the patient side...presenting digital data via MIcrosoft Healthvault platform, Google , or PassportMD.
Consumers will need to drive digital adoption by presenting this data to docs...docs will access ASP versions or web based versions of free data...no need to adopt expensive technology disruptive systems.
Keeping an eye on the real story regarding adoption of EHR based on government incentives...really believe that the stimulus falls short for the doctors...just not enough based on the disruption issue for MD's ...
In the end too costly for the docs and too costly for the government - see the push coming from the patient side...presenting digital data via MIcrosoft Healthvault platform, Google , or PassportMD.
Consumers will need to drive digital adoption by presenting this data to docs...docs will access ASP versions or web based versions of free data...no need to adopt expensive technology disruptive systems.
Thursday, February 05, 2009
Barack Obama's latest Comments
Yesterday, President Obama had the following comments after signing a health care bill to help cover an additional 4 million uninsured children..
"And -- and it is just one component of a much broader effort to finally bring our health care system into the 21st century. That's why the economic recovery and reinvestment plan that's now before Congress is so important.
And think about this: If Congress passes this recovery plan, in just one month, we will have done more to modernize our health care system than we've done in the past decade. We'll be on our way to computerizing all of America's medical records, which won't just...
It won't -- won't just eliminate inefficiencies. It won't just save billions of dollars and create tens of thousands of jobs, but it will save lives by reducing deadly medical errors. We'll have made the single largest investment in prevention and wellness in history, attacking problems like smoke and obesity, and helping people live longer, healthier lives."
Although the HHS appointment with Daschle was a small blunder...the train is out of the station on this issue...and with Medicare already involved in a pilot with PassportMD the government has made very clear it's position on personal health records. And that is, we all need them and they will help us get to the point where we all have them.
"And -- and it is just one component of a much broader effort to finally bring our health care system into the 21st century. That's why the economic recovery and reinvestment plan that's now before Congress is so important.
And think about this: If Congress passes this recovery plan, in just one month, we will have done more to modernize our health care system than we've done in the past decade. We'll be on our way to computerizing all of America's medical records, which won't just...
It won't -- won't just eliminate inefficiencies. It won't just save billions of dollars and create tens of thousands of jobs, but it will save lives by reducing deadly medical errors. We'll have made the single largest investment in prevention and wellness in history, attacking problems like smoke and obesity, and helping people live longer, healthier lives."
Although the HHS appointment with Daschle was a small blunder...the train is out of the station on this issue...and with Medicare already involved in a pilot with PassportMD the government has made very clear it's position on personal health records. And that is, we all need them and they will help us get to the point where we all have them.
Sunday, January 18, 2009
Personal Health Records going from step child to favorite son
Having lived in this space for several years, I can tell you that the PHR world has gone from sleepy "cottage" , "mom and pop" industry to the hottest sector in healthcare IT.
Why?
Several reasons...EMR's were the "favorite son" of every investment firm, government legislator and healthcare IT..the great promise of EMR's were highly tauted as the savior of the medical industry...for the last 20 years...everyone was betting on the EMR's to transition US healthcare from caveman record keeping to real world real time interoperable pie in the sky exchange...but the fireworks turned to a small fizzle...when the realism of pushing entrenched doctors, already squeezed by health insurers and liability issues and government regulations, to purchase expensive technology systems for their practice died. Why would a doctor spend another 25,000 a year per provider to interrupt his practice when he has watched his income go down, his hours go up, and regulatory burdens suck the pleasure out of practicing medicine? Well, the answer is..they wouldnt...would you?
So, after 20 years of promise..the industry went through major consolidation with very few little guys left...and at the end of the day...only 20% of docs in the best case scenario have picked up the cost of EMR's...
So, the wise men on the hill realized that the goal of healthcare IT transformation will not be through waiting for docs to adopt EMRs...The answer is PHRs or Personal Health Record Systems...neglected for years until lightening strikes last year...and standards for Personal health record systems int he form of CCR/CCD are adopted. That was the critical happenstance. As soon as the standards were adopted by the AMA, AAFP, the CCHIT mandated that all backend EMR systems accept the standard for certification and everyone soon realized that the way to drive the electronic healthcare revolution is through this piece...give it to the consumer...make it interoperable..if the consumer takes his record with him wherever he goes..or said differently if his record goes with him...then the record will be the piece that drives the adoption of the EMR. And I think the Medicare Pilot program is a testament to this, the government is ready to push this...So, the PHR goes through all the different disparate systems and the patient (rather than the physician) drives the adoption...I believe that is what is going to happen. The patient will be incentivized to adopt the phr via health insurance cost incentives..less costly premiums or covering the expense of the cost of PHR for the individual insured. (Recent study from Partners Healthcare in Boston shows health insurers save over $20 billion per year after giving phrs' to people). The last incentive will come from government and health insurers that push doctors to update the phr and read the phr through the CCD/CCR standard.
So, when we read in the NY Times, “Health information technology will succeed only if privacy is protected,” said Frank C. Torres, director of consumer affairs at Microsoft. “For the president-elect to achieve his vision, he has to protect privacy.”
Mr. Torres is correct except the privacy part is a given...just as bread is necessary for a sandwich...but what lies between the 2 pieces of bread is what really distinguishes the sandwich..and in my opinion the absolute , without question, necessity for health information technology to succeed and for Obama to reach his goals...the only answer and the only critical part is the incentive that must be provided to the doctor to participate and the patient to participate...without the incentive , it fails..I believe Obama knows this or they should read this..so they understand that they must properly incentivize the active participants or we will wait another 20 years ...
The good news is...the incentives are coming...(and I see EMR systems merging with PHR's as all ASP systems that dont cost anything for the doctor to use-will discuss in future blogs)
Why?
Several reasons...EMR's were the "favorite son" of every investment firm, government legislator and healthcare IT..the great promise of EMR's were highly tauted as the savior of the medical industry...for the last 20 years...everyone was betting on the EMR's to transition US healthcare from caveman record keeping to real world real time interoperable pie in the sky exchange...but the fireworks turned to a small fizzle...when the realism of pushing entrenched doctors, already squeezed by health insurers and liability issues and government regulations, to purchase expensive technology systems for their practice died. Why would a doctor spend another 25,000 a year per provider to interrupt his practice when he has watched his income go down, his hours go up, and regulatory burdens suck the pleasure out of practicing medicine? Well, the answer is..they wouldnt...would you?
So, after 20 years of promise..the industry went through major consolidation with very few little guys left...and at the end of the day...only 20% of docs in the best case scenario have picked up the cost of EMR's...
So, the wise men on the hill realized that the goal of healthcare IT transformation will not be through waiting for docs to adopt EMRs...The answer is PHRs or Personal Health Record Systems...neglected for years until lightening strikes last year...and standards for Personal health record systems int he form of CCR/CCD are adopted. That was the critical happenstance. As soon as the standards were adopted by the AMA, AAFP, the CCHIT mandated that all backend EMR systems accept the standard for certification and everyone soon realized that the way to drive the electronic healthcare revolution is through this piece...give it to the consumer...make it interoperable..if the consumer takes his record with him wherever he goes..or said differently if his record goes with him...then the record will be the piece that drives the adoption of the EMR. And I think the Medicare Pilot program is a testament to this, the government is ready to push this...So, the PHR goes through all the different disparate systems and the patient (rather than the physician) drives the adoption...I believe that is what is going to happen. The patient will be incentivized to adopt the phr via health insurance cost incentives..less costly premiums or covering the expense of the cost of PHR for the individual insured. (Recent study from Partners Healthcare in Boston shows health insurers save over $20 billion per year after giving phrs' to people). The last incentive will come from government and health insurers that push doctors to update the phr and read the phr through the CCD/CCR standard.
So, when we read in the NY Times, “Health information technology will succeed only if privacy is protected,” said Frank C. Torres, director of consumer affairs at Microsoft. “For the president-elect to achieve his vision, he has to protect privacy.”
Mr. Torres is correct except the privacy part is a given...just as bread is necessary for a sandwich...but what lies between the 2 pieces of bread is what really distinguishes the sandwich..and in my opinion the absolute , without question, necessity for health information technology to succeed and for Obama to reach his goals...the only answer and the only critical part is the incentive that must be provided to the doctor to participate and the patient to participate...without the incentive , it fails..I believe Obama knows this or they should read this..so they understand that they must properly incentivize the active participants or we will wait another 20 years ...
The good news is...the incentives are coming...(and I see EMR systems merging with PHR's as all ASP systems that dont cost anything for the doctor to use-will discuss in future blogs)
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