Posted 12/27/12 on Medscape Connect’s Care and Cost Blog
My wife Elaine was hospitalized for 6 days recently with an array of ailments related to her advancing cancer, so diagnosing and addressing her problems required a multidisciplinary approach. In addition to the nursing and support staffs, she was tended by an emergency physician, two hospitalists, three gastroenterologists, a pulmonologist, an infectious disease physician and an interventional radiologist. With the exception of one specialist who had performed a procedure on her two weeks earlier, this episode was the first time any had met Elaine.
Each clinician was familiar with her status before visiting her, because the health system has an enterprise-wide electronic health record (EHR) that aggregates information into each patient’s chart. The hospitalists coordinated the care process and also touched base with Elaine’s primary care physician and her oncologist.
In other words, the system worked exactly like we hoped it would but often doesn’t. Especially in complex cases like this, the likelihood of a positive result is enhanced if the team members have access to the same complete information, and if someone – in this case the hospitalists – quarterbacks the activity.
Continue reading “An Archipelago of Health Information Islands”
Posted 1/23/12 on Health Policy and Marketplace Review
I will suggest that most of us believe the way to control health care costs, and at the same time maintain or improve quality, is to both use the managed care tools we have developed over the years, and perhaps more importantly, change the payment incentives so that both cost control and quality are upper most in the minds of providers and payers.
The Congressional Budget Office (CBO) has just released an important review of Medicare’s results in testing those ideas. The news is not good.
From the CBO’s blog post:
In the past two decades, Medicare’s administrators have conducted demonstrations to test two broad approaches to enhancing the quality of health care and improving the efficiency of health care delivery in Medicare’s fee-for-service program. Disease management and care coordination demonstrations have sought to improve the quality of care of beneficiaries with chronic illnesses and those whose health care is expected to be particularly costly. Value-based payment demonstrations have given health care providers financial incentives to improve the quality and efficiency of care rather than payments based strictly on the volume and intensity of services delivered.
In an issue brief released today, CBO reviewed the outcomes of 10 major demonstrations—6 in the first category and 4 in the second—that have been evaluated by independent researchers. CBO finds that most programs tested in those demonstrations have not reduced federal spending on Medicare.
Continue reading “Important Research From Medicare Demonstration Projects: Almost Nothing Works”
Posted 11/09/11 on the eCareManagement Blog
Yesterday’s announcement of “Standard Health Data Connectivity Specifications” by the EHR|HIE Interoperability Workgroup (EHR|HIE WG) is potentially earth-shattering.
My mom would not know what I mean by “Standard Health Data Connectivity Specifications,” so I’ll try to write this in plain English.
Who Are These Guys? The EHR|HIE Interoperability Workgroup
The workgroup consists of HIEs (Health Information Exchanges) representing seven of the largest states, eight EHR vendors, and three HIE software/services vendors.
Continue reading “The EHR|HIE Interoperability Workgroup — Potentially Earth-Shattering”
Posted 11/2/11 on the Disease Management Care Blog
The Disease Management Care Blog remembers when it was first introduced to an electronic health record (EHR). After many days of learning how to document, link, retrieve, order, manage, view, bill, sign-off and close patient encounters, it asked about retrieving summary statistics on its patient population. It wanted to know how many if its patients with high blood pressure were under control and how many of its patients with heart disease had low cholesterol levels. The practice administrator looked at the DMCB like it was crazy.
Continue reading “Finally, a Good EHR Anecdote”
Richard Reece, MD
Posted 10/07/11 on Medinnovation Blog. It originally ran in the 9/27/11 issue of Technology Review, an MIT Press publication.
Why are doctors so slow in implementing electronic health records (EHRs)?
The government has been trying to get doctors to use these systems for some time, but many physicians remain skeptical. In 2004, the Bush administration issued an executive order calling for a universal “interoperable health information” infrastructure and electronic health records for all Americans within 10 years.
And yet, in 2011, only a fraction of doctors use electronic patient records.
In an effort to change that, the Obama economic stimulus plan promised $27 billion in subsidies for health IT, including payments to doctors of $44,000 to $64,000 over five years if only they would use EHRs. The health IT industry has gathered at this multibillion-dollar trough, but it hasn’t had much more luck getting physicians to change their ways.
Continue reading “Why Doctors Don’t Like Electronic Medical Records”
First published 6/17/11 on Health Populi
Physicians who have adopted smartphones and tablet devices access online resources for health more than less mobile physicians. Furthermore, these “Super Mobile” doctors are using mobile platforms at the point of care.
Physicians adoption and use of mobile platforms in health will continue to grow, according to a survey from Quantia Communications, an online physician community. This poll was taken among 3,798 physician members of QuantiaMD’s community in May 2011. Thus, the sample is taken from the community’s 125,000 physicians who are already digitally-savvy doctors. QuantiaMD calls physicians with both mobile and tablet devices “Super Mobile” physicians.
Continue reading “The Implications Of Smartphones and Tablets in Patient Care”
First published 4/7/11 on Health Populi
About one-half of physician practices used an electronic health record (EHR) as of late 2010, with 36% of groups still storing health records in paper charts.
While 1 in 2 physician groups in the U.S. have implemented electronic health records, they confess that they haven’t yet optimized their use. Only 16% of medical groups have implemented EHRs and believe their practices have optimized their EHRs. But optimization has its rewards: over 1 in 3 groups that have had sufficient time to fully implement their EHRs report decreased practice operating costs. Furthermore, 41% of these fully-operational EHR environments have seen physician productivity increase.
Continue reading “There’s Hard ROI for Physician Groups That Fully Implement An EHR”
First published 2/17/11 at Simon Bramfitt Blog.
Brian’s Note: A pal passed this along. It struck me as a little geeky, though a good read, until I realized the author was talking about a revolution in how IT in small and mid-sized physician practices is underway. If you’re a doc or a practice manager, then I’d urge you to take a few minutes, bear with the author, and read this through.
Back in 1987 I spent a while working for a PC dealership, what we now call a Value Added Reseller. I don’t actually recall that the term VAR had been coined at that point, and besides the people I worked for tended to be referred to as “that bunch of bloody cowboys” more often than not.
Continue reading “Adapt or Die: How Desktop Virtualization Will Reshape the Value-Added Reseller”