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Understanding ObamaCare and HIT Data Breaches

[By Darrell K. Pruitt DDS]

1-darrellpruittTwo current topics in the HIT industry: (1) A dishonest 2005 RAND study set up lawmakers for disappointment in electronic health records, which are essential to Obamacare, and (2) I told you so.

The Reports

Just the other day, there were reports of two data breaches of EHRs involving over 734,000 patients in Texas and California.

http://www.ihealthbeat.org/articles/2013/10/23/health-facilities-in-california-texas-report-health-data-breaches

For reasons like this, the wisdom of an ambitious mandate for paperless healthcare by 2014 is beginning to be questioned by the same lawmakers who were sucked in years ago by RAND’s tainted 2005 study.

According to the vendor-friendly results gleaned from vendor-friendly data supplied by vendors, EHRs should have started saving 100,000 lives and $77 billion a year, years ago. Predictably, that has not happened. Far from it!

The Findings 

The happy findings – discredited even by RAND in January of this year – were paid for by Cerner and GE, who profited immensely from their RAND investment. Since nationwide adoption of EHRs became a bi-partisan goal with bubbly beginnings and millions of campaign dollars, the costs and danger of healthcare IT didn’t appear to bother conservatives until three months after RAND admitted the study was garbage.

In April, six GOP senators, led by Sen. John Thune (R-S.D.), released a detailed report criticizing HHS Secretary Kathleen Sebelius’ execution of a $35 billion initiative to promote EHRs as part of the ARRA stimulus package. (See: “GOP senators raise concerns with push for electronic medical records,” by Sam Baker, April 16, 2013, The Hill).

http://thehill.com/blogs/healthwatch/medicare/294273-gop-senators-raise-concerns-with-push-for-electronic-medical-records

Wither ARRA?

Have you ever wondered why ARRA was passed as a jobs bill rather than as part of healthcare reform? Any ideas?

More recently, with the conservatives’ failure to stop Obamacare even by shutting down government, EHRs have become recognized as the ACA’s next best weakness. Yesterday, Greg Scandlen, writing for RightSideNews.com, posted “The Tyranny of Electronic Systems.” It goes downhill from there.

http://www.rightsidenews.com/2013102333379/life-and-science/health-and-education/the-tyranny-of-electronic-systems.html

Even More

Also yesterday, Michelle Mailkin writing for Townhall.com, an ultra-conservative website similar to RightSideNews, posted, “Don’t Forget Obamacare’s Electronic Medical Records Wreck.

http://townhall.com/columnists/michellemalkin/2013/10/23/dont-forget-obamacares-electronic-medical-records-wreck-n1730172?utm_source=TopBreakingNewsCarousel&utm_medium=story&utm_campaign=BreakingNewsCarousel

Assessment 

Conservatives found traction: Without the anticipated healthcare savings from EHRs, Obamacare will not survive. These times are not as happy for EHR stake-holders as RAND led them to expect.

Conclusion

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Confusion About “Meaningful Use” Reigns

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Are Doctors Embracing or Ignoring ARRA?

By D. Kellus Pruitt DDS

pruittAre physicians embracing ARRA Meaningful Use cash incentives or ignoring them? That depends on whom one asks.

Doctors versus the Feds

National progress towards Meaningful Use of expensive EHRs depends on whether one talks to federal employees whose jobs depend on the stimulus mandate, or doctors who purchase EHRs to improve care rather than to use them … Meaningfully.

The Feds

Today, Joseph Conn, writing for ModernHealthcare, posted a rosy outlook for MU adoption according to researchers working for HHS’ Office of the National Coordinator (ONC). They base their optimism for job security on a recent National Center for Health Statistics (NCHS) survey:

“A growing number of office-based physicians are using more-robust EHRs that have higher-level functions needed to help the doctors qualify for federal EHR incentive payments [for Meaningful Use] and assist them in providing better, safer care for patients, the researchers reported.” (See “Researchers: More doctors using more-sophisticated EHRs”).

http://www.modernhealthcare.com/article/20121212/NEWS/312129956/researchers-more-doctors-using-more-sophisticated-ehrsJust

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The Doctors

However, yesterday, in an InformationWeek article by Ken Terry titled, “Meaningful Use Doesn’t Drive Doctors’ EHR Selection,” doctors suggested a more depressing future for MU sophistication based on the same NCHS survey:

“Jason Mitchell, MD, assistant director of the Center for Health IT at the American Academy of Family Physicians (AAFP), told InformationWeek Healthcare that he found [the lagging adoption of MU-capable EHRs] puzzling. While there’s no doubt that Meaningful Use has driven much of the increase in EHR use, he said, it seems strange that so many physicians would buy and implement EHRs that could not be used to show Meaningful Use.”

http://www.informationweek.com/healthcare/electronic-medical-records/meaningful-use-doesnt-drive-doctors-ehr/240144093

Assessment

Whom should doctors believe – HHS employees who give away billions of stimulus dollars for Meaningful Use, or family physicians who have determined that the subsidy isn’t worth the cost and effort?

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Doctors’ Use of For-Profit Algorithms Considered UnSportsManLike Conduct

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On Protecting Medical Coding Jobs

By Darrell K. Pruitt DDS

The US government moves quickly to protect tedious upcoding jobs from being taken over by upcoding software.

Medical Billing and Coding for Dummies

In coding expert Karen Smiley’s July 2012 book, “Medical Billing and Coding for Dummies,” she writes: “It really does pay to be a certified medical biller/coder, no matter what designation you choose to pursue. Surveys conducted by the AAPC [American Academy of Professional Coders] indicate that coder salaries have continued to increase despite economic downturns. One possible reason for this is that getting payers to pay claims is becoming increasingly difficult.”

Call me cynical, but to me, her defense of the coding profession confirms that healthcare’s increasing demand for highly-paid coders (who have nothing to do with directly providing care to patients) is artificial, and originates with an administration which complicates providers’ payments in order to create new, high-paying jobs in the HIT industry – quietly adding to the cost of healthcare to cosmetically boost employment figures before an election. Who ultimately pays the bill for all non-productive healthcare costs?

Amazon Morphs

Less than 3 months following the appearance of “Medical Billing and Coding for Dummies” on Amazon for under $25 (paperback), EMR software suddenly changed or morphed the entire game, and the administration reacts by changing the rules to protect political investments.

Similar to algorithmic trading’s proven advantage over low-tech investors on Wall Street, the computation capabilities of modern EMRs allegedly provide an unfair advantage to doctors and hospitals, and at taxpayers’ expense – according to HHS and Justice Department officials.

Enter Eric Holder and Kathleen Sebelius

“On Monday [September 24], Attorney General Eric Holder and HHS Secretary Kathleen Sebelius sent a strongly worded letter warning that the Obama administration will not tolerate hospitals’ attempts to ‘game the system’ by using EHR systems to boost Medicare and Medicaid payments.” – iHealthBeat, September 26, 2012.

http://www.ihealthbeat.org/articles/2012/9/26/stakeholders-react-to-warning-on-use-of-ehrs-for-upcoding.aspx#ixzz29fYzjPUH

This was followed by an article posted yesterday, also on iHealthBeat titled, “Mostashari To Launch Review of Using EHRs for ‘Upcoding,’”

http://www.ihealthbeat.org/articles/2012/10/17/mostashari-to-launch-review-of-using-ehrs-for-upcoding.aspx#ixzz29fDElIKL

Enter the NCHIT

“National Coordinator for Health IT Farzad Mostashari MD plans to launch an internal review to determine whether electronic health record systems are prompting some health care providers to overbill Medicare by selecting higher-paying treatment codes, a process known as ‘upcoding,’ the Center for Public Integrity reports.”

Apparently, it only recently occurred to lawmakers that the EMRs they promote greatly simplify Medicare’s intentionally tedious and time-consuming reimbursement requirements mentioned by Karen Smiley – making profits much easier for providers without having to hire even more staff just to get paid for work done long ago. In addition, the alleged upcoding software threatens to eliminate the need for recently-graduated coding professionals – whose education was backed by ARRA stimulus (taxpayer) money. While our nation’s leaders might wink at institutional investors’ highly-profitable algorithmic trading on the stock market, unemployed coding specialists with outstanding college loans would only increase the potential embarrassment for the administration should doctors and hospitals be permitted to computerize billing decisions – leading to payment for services previously given away because they weren’t worth the hassle and expense of documentation!

Assessment

Unlike investors playing the stock market, according to Medicare’s emerging rules, doctors’ use of algorithms to increase profits is considered unsportsmanlike conduct. With the election only days away, can you blame them?

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The “Whole Tooth” Blog Talk Radio to Interview Dr. Darrell Pruitt on eHRs

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Plugging my Interview and Otherwise Clogging Things

[By D. Kellus Pruitt DDS]

Where are the EDR cheerleaders when I need them? On Tuesday May 31st, I’ve got a show to put on!

http://www.blogtalkradio.com/thewholetooth

Where are the EDR Cheerleaders?

Every now and then I still come across EDR vendors on the internet who would mislead naïve dentists about their product to make a sale. Today, I held FirstEMR representative Robert Evans accountable for self-serving misinformation he posted on EMR and HIPAA forum. (My dad would be proud that I told him “Get that garbage out of here!”). Then, remembering my manners, I invited Mr. Evans to please call into The Whole Tooth Blogtalkradio program on May 31 to further discuss the future of EHRs in dentistry. Unfortunately, because of things like the reflexive “garbage” statement, I don’t think he’ll show.

I try my best to be “collegial,” but I simply cannot pretend unethical sales techniques are acceptable in my neighborhood, and I want to help my friends easily recognize them… so what if I have a little fun.

http://www.emrandhipaa.com/emr-and-hipaa/2010/11/18/emr-stimulus-q-and-a-emr-stimulus-money-and-dentists/comment-page-1/#comment-133132

Of Robert Evans

Thanks for your response, Robert Evans.

As I read your list of 6 rationalizations for electronic dental records here on the EMR and HIPAA forum , it occurred to me that you haven’t had a chance to read my detailed post on this thread from November 22 (Number 14) in which I de-bunked 28 similar myths – substantially including your 6. But since I never tire of doing this, let’s once again go through the details of a popular national blunder in dentistry you and other well-intentioned stakeholders in the HIT industry were sucked into.

“My personal background is medical administration and operations.” That would explain your misconceptions about EHRs in the unique field of dentistry.

For your first mistake, you say “Dentists can qualify as eligible providers for ARRA incentives” You really should have gone on to explain that for a dentist to qualify for the stimulus money, 30% of his or her practice has to be from Medicare/Medicaid. Since you surely should have known that, to fail to mention it could easily be interpreted as deceptive.

This is just a guess, but I’d say less than 10% of the dentists in the nation in private practice would make it on that qualification alone even if it made business sense to accept government money and the expensive demands that come with it. Since you are in the EHR business, you may have more accurate figures on that. What’s more, our grandchildren’s money will be gone long before the stimulus makes it to dentistry. You should already know that as well.

“All of our clients, including Dentists, Endodontists, Periodontists, Implant Surgeons and more are extremely pleased that they made the transition “ All of them, Robert? Really?

The ME-P Forum 

This ME-P forum right here is full of stories about disappointed providers – perhaps other than your clients – who are finding huge problems with the transition. De-installations are far too common. It seems like a while back it was close to 30%. Then again, since you are in the business, you probably have more accurate figures for that as well.

Even the stimulus money isn’t sufficient subsidy for physicians to realize a return on investment in EMRs. And virtually nobody is interoperable as planned. That means the office tools you sell raise the cost of healthcare rather than lower it. What’s more, physicians stand to benefit from interoperability much more than dentists regardless of stimulus money. And if a dentist can’t expect ROI from an office tool, it’s called a hobby.

By the way, have you looked at the Stage 2 Meaningful Use requirements that stand between dentists and disappearing ARRA money? Well-meaning outsiders with plans for the common good just don’t realize that someone has to enter every piece of irrelevant detail about dental patients that CMS requires in order to receive full payment.

It’s a trap, Robert. And it’s not very well hidden. Dentists don’t take candy from strangers.

The Benefits

“The benefits to your office are numerous and too many to mention here; but, please take into account the following”:

1. Never having to worry about compliance issues, as we are 100% compliant with all standards and formats that CMS is mandating.

– You are 100% scary. As long as a provider stores or transmits electronic PHI he or she clearly must be concerned about HIPAA compliance issues. What’s more, as a Business Entity for the dentists you serve, if your computer system is hacked or someone on your end otherwise fumbles or steals 500 or more of a dentists’ patients’ PHI, all of the dentist’s patients must be notified of the danger of identity theft. In addition, federal law stipulates that news of the data breach must be broadcast as a press release in the dentist’s local media. This can easily bankrupt a dentist… You just had to know about this before today.

Your compliancy claim is not only wrong, but it is irresponsible and unethical advertising. You are not 100% compliant. Since the Rule is intentionally vague, nobody is. Get that garbage out of here!

2. Greatly reduce or even eliminate human error. Some offices have brought back billing into their control and terminated the outsourcing.

– Are you kidding? Eliminate human error? Someone put you up to this didn’t they. And “outsourcing”? Once again, this is misleading and irresponsible information, Robert. What about keystroke errors? Only frustrated vendors wish computers would replace human intelligence.

3. Facilitate lab and prescription orders. Offices using e-scribe services are already on board into accepting the benefits of an EMR.

– So does this mean that when the lab delivery person comes to my office to pick up plaster models of a patient’s teeth, the prescription for the restoration must be sent separately by email instead of inserting a short hand-written note in the package… with the relevant patient’s models?

– I don’t sign enough prescriptions to make e-prescribing worth it. I really, really don’t. So how expensive would you make dental care?

4. Simple and efficient scheduling. The reception and schedulers are not tied to the telephone, fax and charting tasks as well as insurance verifications.

– That’s never before been a significant problem. Dental offices were run surprisingly efficient for decades before computers were around. Since dentistry is intricate handwork, the bottleneck in dental offices isn’t the front desk. It’s the dentist.

– What’s so wrong with telephone and fax, by the way? One doesn’t have to be a HIPAA-covered entity to use those tools.

– As for insurance verification, is the EDR intended to help the patient or the insurance company?

5. No fumbling for charts, paperwork, etc. (significant cost savings)

– Prove it.

6. Gain 15+ hours per week, back!

– Where did find this chunk of information? Please don’t insult us with wild, irresponsible statements to improve sales of your product. That would be unethical.

“Again, there are too many to list here, but contact me anytime for a quick on-site or online demonstration and let us prove to you that FirstEMR is the most appropriate solution to meet your required EMR needs.”

eDR Mandate? 

Did you intentionally say my “required” EMR needs? You wouldn’t be implying that EMRs are somehow “mandated” in dentistry are you, Robert? That would be called a rookie mistake and you would be about a year behind information published in the ADA News, which was wrong to mislead members on this point in 2008.

http://www.ada.org/5348.aspx

Rather than contacting you for a quick on-site or online demonstration, I’ll do you one better. I am to be interviewed on “The Whole Tooth” blogtalkradio on May 31 concerning the future of EHRs in dentistry. It promises to be an unprecedented discussion about the obscure topic, and is certain to be educational to thousands of dentists who have been misled for years about HIPAA and EDRs.

http://www.blogtalkradio.com/thewholetooth

Assessment

When the time comes, a telephone number will be provided for live questions. I invite you to call in, Robert, and we can discuss EHRs in dentistry before an audience of around 15,000.

Conclusion

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Is HI-TECH Dead?

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You Decide!

[By D. Kellus Pruitt DDS]

Yesterday, Don Fluckinger, Features Writer for SearchhealthIT, posted “Blumenthal: Building national health network could take decades”

“When Dr. David Blumenthal was national health IT coordinator, he focused on 2015, the HITECH Act’s original target date for meeting meaningful use criteria. Now that he’s back in civilian life, he’s taking a longer view of the initiative to create a national health network triggered by the HITECH Act’s cash incentives to physicians and hospitals using electronic health record (EHR) systems.”

http://searchhealthit.techtarget.com/news/2240035845/Blumenthal-Building-national-health-network-could-take-decades

Even though Fluckinger assures us that post-ONC, Blumenthal is still a “HITECH Act champion,” I’m not so sure. Perhaps in spirit only!

A Multi-Decade Project?

Last week, Dr. Blumenthal was the keynote speaker at the Massachusetts annual health IT conference. According to Fluckinger, he told the audience that building a secure, national, interoperable health information system “was always going to be a multi-year, maybe even multi-decade project.” That’s not what I remember. I remember being told that if I didn’t purchase a network-ready EHR for my dental practice by 2014, I wouldn’t be paid by insurance companies.

What Happened?

So, what happened to President Bush’s 2004 Executive Order of “interoperability (even with dentists) by 2014”? Is it too soon to say that he failed? So who is going to tell the thousands of HIT stakeholders who have been attracted by the smell of stimulus billions? Blumenthal?

Assessment 

I can only imagine that now that Dr. Blumenthal left his job as head of the ONC for a new job as a health policy professor at Harvard School of Public Health, the openness of life outside government makes him uncomfortable with the lame talking points he once pushed as part of his job, without cracking a smile.

Conclusion

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On Track for Meaningful Use?

Are we on track to be a huge disappointment to our children’s children – or What?

[By Darrell K. Pruitt DDS]

When our grandchildren get the bill for the Obama administration’s subsidies benefitting primarily the health information technology industry, I bet they’re going to be really, really pissed at us for allowing today’s lawmakers to blow their 28 billion dollars to please HIT advocates who mislead consumers as well as lawmakers about the benefits of EHRs.

The Doctors Speak 

According to physicians who actually do the hard lifting in healthcare, the “meaningful use” requirements that they must prove in order to qualify for stimulus money will arguably increase both the cost and danger of healthcare – all for the benefit of stakeholders rather than principals. For one thing, “meaningful use” is meaningless if it fails to help physicians treat their patients. I think HIT stakeholders’ grandchildren should somehow be held accountable to my grandchildren.

Opposing Opinions  

Just days apart this week, two HIT reporters, Rich Daly from ModernHealthcare.com and Joseph Goedert from HealthDataManagment.com described two opposing letters the Office of the National Coordinator for Health Information Technology (ONC) recently received: One from doctors and one from patients (et al).

On Monday, here is how Daly’s article “AMA to ONC: EHR program doesn’t work for docs” began:

http://www.modernhealthcare.com/article/20110302/NEWS/303029950/1153

“Many physicians—specialists in particular—will not participate in the federal electronic health-record adoption incentive program because it requires them to include patient data that they do not otherwise collect, according to a Feb. 25 letter from 39 medical organizations letter to the Office of the National Coordinator for Health Information Technology”

On Wednesday, Joseph Goedert, writing for HealthDataManagment.com began “Consumer Groups: Hold Strong on MU” with this:

http://www.healthdatamanagement.com/news/meaningful-use-criteria-comments-consumers-42080-1.html

“A coalition of 25 consumer groups and unions is asking federal officials to hold firm on more stringent criteria for Stage 2 of electronic health records meaningful use, and expressing support for going further. For instance, because patients still trust their providers more than other information sources, holding providers accountable for actual usage of a patient Web portal ‘is entirely appropriate and we strongly urge ONC to resist pressure from the provider community to absolve them from responsibility for making these services available and useful to their patients,’ according to a comment letter to the Office of the National Coordinator”

  • AARP
  • Advocacy for Patients with Chronic Illness, Inc.
  • AFL-CIO
  • American Association on Health and Disability
  • American Hospice Foundation
  • Caring from a Distance
  • Center for Democracy & Technology
  • Childbirth Connection
  • Consumers for Affordable Health Care
  • Consumers Union
  • Families USA
  • Family Caregiver Alliance
  • Healthwise
  • Mothers Against Medical Error
  • National Alliance for Caregiving
  • National Coalition for Cancer Survivorship
  • National Consumers League
  • National Family Caregivers Association
  • National Health Law Program
  • National Partnership for Women & Families
  • National Women’s Health Network
  • OWL – The Voice of Midlife and Older Women
  • SEIU
  • The Children’s Partnership

Like the “Record Demographics” MU mandate, this is all for the “common good” I suppose. Consumer Advocasy groups wouldn’t mislead patients, would they?

I doubt many Americans represented by these 25 organizations ever imagined a new federal requirement that doctors record each patient’s demographics. (Notice of Proposed Rulemaking: Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Federal Register / Vol. 75, No. 8 / Wednesday, January 13, 2010 / page 1861; RIN 0938-AP78).

This means that the 25 stakeholder groups are doing their best to help American taxpayers hold physicians accountable to record and share their patients’ demographic information with the US government – private information about me and my family members that I personally don’t trust the government to be given – even if I’m in vulnerable need of health care.

Daly’s Article 

According to Daly’s article, the demands of MU are distractions for increasingly busy doctors and staff whose focus, I believe, should include eye-contact with patients with specific health problems rather than irrelevant data needs of third parties, including consumer advocacy groups.

On the other hand, if consumer advocacy groups have successfully defined for the federal government what clueless patients allegedly need, who will the mandate really benefit? 25 consumer advocacy groups don’t equal one consumer, so their letter isn’t grass roots at all. It’s deception wearing lipstick. Gullible and vulnerable patients are again being misrepresented by HIT stakeholders for a cut of our grandchildren’s 28 billion.

Assessment

Finally, if MU requirements are an arguably expensive and dangerous distraction for physicians, how can the law possibly be any less absurd for dentists? I’ll look at meaningful use as well at the ADA’s apparently flagging commitment to EHRs next. The ADA is abandoning state informatics departments – leaving them exposed to ADA members’ questions they are unable to answer. It looks to me that intra-ADA relationships are deteriorating quickly, but nevertheless, traditional stoicism still hasn’t been broken. “Image is everything” – ADA/IDM slogan.

Dentists

Here’s a teaser, dentists: Chances are, your state ADA organization hasn’t yet shared with you how the MU requirement of CPOE (Computerized physician order entry – page 1858) will change your practice communications. If you are a HIPAA-covered entity with an NPI number and you don’t email instructions to your denture lab rather than include a hand-written note with the relevant patient’s plaster models, you won’t qualify for stimulus money. What can possibly go wrong with that meaningful idea?

Conclusion

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Is Informatics the The Curse of Healthcare Reform?

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Medical Coding Complications and Greed

[By Darrell K. Pruitt DDS]

Coding complications in government healthcare ALWAYS favor the house — CMS guarantees it with lawsuits and whistleblower rewards that could attract dishonest employees. Are you careful who you hire?

Complications 

Complications in healthcare informatics – including 5-digit CPT® code mistakes as well as foul-ups that involve physicians’ “voluntary” 10-digit National Provider Identifier numbers – ALWAYS grant insurers more time to pay past-due bills owed to their clients and their clients’ doctors.

Call me Cynical 

Call me cynical, but if interest rates climb ever higher as predicted, watch for unexplained, proportional increases in coding errors to help fund insurance CFOs’ bonuses while raising the cost of healthcare even more without improving value. Is it any wonder why Americans don’t get the quality of healthcare we purchase compared to citizens in other countries? Tax-payers in my neighborhood are begging for in-network providers who put their patients’ interests ahead of insurers’ as much as allowed by insurers’ self-serving rules – without committing fraud. As a general rule, healthcare stakeholders accommodate parasites more than principals.

CPT® Codes and Patient Care 

Accurate CPT® coding may have nothing to do with patient care, but CMS makes it nevertheless important to physicians. Whereas the most innocent NPI foul-ups reliably delay payment and never turn out well for providers, the new fraud and abuse provisions of the Patient Protection and Affordable Care Act [ACA] can cause an innocent coding mistake on a Medicare claim to land the doc in court with charges of fraud depending on the quality of employees one hires – but only if the error favors the provider and not the payer. In June, David Burda posted “Attorney tells audience to brace for a storm of whistle-blower lawsuits” on ModernHealthcare.com.

http://www.modernhealthcare.com/article/20100623/NEWS/306209989/-1

Of Whistle-Blower Lawsuits

Burda reports that healthcare attorney Joanne Judge, a partner with Stevens & Lee in Reading, Pa., predicts a significant increase in whistle-blower lawsuits simply because the new law makes it far too easy for a dishonest employee to file an unwarranted lawsuit. No longer is there a requirement for the whistleblower, who stands to win money from his or her patriotic effort, to directly witness the crime. That kind of idea could catch on in this economy.

computer-hardware1

“The new law also converts accidental Medicare overpayments to providers into potential false claims, Judge said. She said the law considers an overpayment as fraud if the overpayment isn’t identified by the provider and returned to the government within 60 days. Judge said that will require providers to beef up their internal billing systems to detect an overpayment as soon as possible and then send Medicare back its money.”

Assessment 

What can possibly go wrong with that plan? Thorough background checks on all new employees is increasingly important, doc. For my employment security issues, I’ve learned to depend on Richard at Investigation Resource Service out of Dallas. He’s never let me down (This is not a paid ad).

Conclusion

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The Rising Tide of EHR Vendors

Electronic Health Records (EHRs)

By Don Fornes

[Founder & CEO, Software Advice]

EHR software vendors aren’t churning out profits like you might expect. You’d think that the Federal subsidies for EHR implementation would create a rising tide that lifted all boats in the EHR software industry. In reality, some vendors are about to capsize.

Based on data points I’ve observed in the market over the past few months, I think some vendors are facing a cash flow crunch. They’re thrilled to have the wind at their backs for once, but the pace is proving hard to maintain as market evolution has accelerated under the unnatural effect of government subsidies.

Here’s the problem.

EHR Vendors Are Spending Money Like Crazy

Most software markets evolve over a twenty or thirty-year period. Consider the enterprise resource planning (ERP) market: the first ERP vendors were founded in the early 1970s, but rapid growth and innovation continued until about the year 2000. The EHR market, however, will mature in the next five years. This is because healthcare providers are buying EHR systems sooner than they otherwise would, to make the most of massive federal subsidies and avoid penalties. Consequently, EHR vendors are in a mad rush to gain market share.

Those that win will own a massive customer base paying recurring support fees. Those that lose will become irrelevant from a market share standpoint and will be ingested into a larger vendor (if they’re lucky; some will just go broke). As a result, EHR vendors are increasing their R&D budgets to develop new features and meet meaningful use criteria. Their marketing colleagues are spending heavily on demand generation and brand building. These vendors have no choice but to win today’s market share battle.

But Medical Providers Are Gun Shy

Almost a year and a half passed between when the American Recovery & Reinvestment Act (ARRA) was signed in 2009, and the final definitions of “Meaningful Use” and “Certified EHR” were issued in July 2010. Certainly that process was no small task, but during that time, most providers took a wait-and-see approach to EHR adoption. There have been tens, maybe hundreds, of thousands of practices out kicking tires, but fewer than expected are writing checks to buy an EHR system. Furthermore, a disproportionate share of these deals – I’m estimating >60% – are going to the top ten market leaders, which is typical of enterprise software markets.

With meaningful use criteria now defined, I believe demand trends have improved. Providers now have the clarity necessary to make purchase decisions with confidence. That can’t happen soon enough, however. EHR spending has to catch up with the investments these vendors have been making over the past two years.

And Subscription Pricing Constrains Cash Flow

To complicate matters further, the software industry as a whole is shifting to cloud computing. Providers have not yet embraced the Cloud en masse, but they have embraced the subscription pricing model popularized by Cloud vendors. Why make a large, up-front investment in a perpetual license when you can just pay monthly for what you consume? Subscriptions are even more logical in light of a five-year subsidy payout.

To meet physician demands, the major EHR players are now offering low monthly pricing and publishing it right on their home pages. EHR vendors love this recurring subscription revenue, but their cash flow is spread out into the future as a result. It takes a healthy balance sheet to withstand this transition.

So what do we have so far?

  • EHR vendors are investing lots of money;
  • providers are writing fewer checks than expected; and,
  • checks that are written are smaller and spread out.

The result is a very difficult cash flow scenario for many, but not all, EHR vendors. Lately, I’ve seen some EHR vendors stretching their payables out 90 or even 120 days. Meanwhile, I’ve been surprised to hear that some leading vendors are operating between breakeven and just a few points of profit margin. Both practices represent good financial discipline considering the pace of market evolution. In reality, however, some vendors are struggling – “taking on water,” to stick with our nautical imagery.

Buyers Beware

The EHR and practice management markets have always been highly fragmented into hundreds of software vendors, largely as a result of the need to service small and demanding local practices. As a result, providers have seen plenty of vendors fail to reach critical mass, then close up shop or sell out. Anecdotally, I also know that some of the leading EHR vendors grew their top line 30% to 60% last year, while laggards foundered. Gaps between winners and losers are expanding quickly, so expect to see more consolidation.

Vendor size is important, but isn’t the deciding factor for success and viability. In this intense market, success will result from execution. The winners and losers will be determined by the competency and discipline of their management. EHR vendors must spend with discipline and generate a strong return on their investments. It wouldn’t hurt to raise capital, either, but not all vendors will need to take this step.

It’s tough for providers to assess the financial viability of private EHR vendors. Software Advice offers our Guide to Assessing Medical Software Vendor Viability, but the industry really needs a trusted third-party to evaluate the 400 plus vendors. Organizations like CCHITInfoGard and ICSA Labs are all certifying EHRs against functional criteria. However, buyers also need the equivalent of an A.M. Best orMoody’s to rate the financial health of EHR vendors. Okay, maybe without the negligence and bias the later demonstrated during the mortgage bubble.

Assessment

Link:  http://www.softwareadvice.com/medical/electronic-medical-record-software-comparison/

There will be some big EHR winners within the next five years and consolidation will be a net positive for the industry. However, buyers must be careful not to become collateral damage as the fierce battle for market share plays out. It’s important to determine which vendors are closing businesses, growing their revenue and building a sustainable, profitable business. Providers should keep in mind that their success is tied to the success of the software vendor that will enhance and support their EHR system in years to come.

Conclusion

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Inviting Debate with eDR Stakeholders

An ME-P Exclusive – Almost

By D. Kellus Pruitt DDS

I really, really love being provocative in my neighborhood that I know so well. It just doesn’t seem fair. In fact, for five years, I’ve watched the electronic dental record [eDR] market very closely, and I tell you, something big is moving under the radar. If you recall, in the last couple of weeks I brought your attention to unexplained interest blips appearing on the Medical Executive-Post www.MedicalExecutivePost.com concerning eDRs. I suggested that Internet interest in the topic following years of silence from even the ADA, could be a sign that important news about electronic health records in dentistry may be breaking soon.

CCHIT Seeking Comments 

Just a couple of hours ago, Andis Robeznieks posted “CCHIT seeks comments on specialized EHRs” on ModernHealthcare.com.

http://www.modernhealthcare.com/article/20101119/NEWS/311199996/#

Robeznieks writes: “The Certification Commission for Health Information Technology has opened a public comment period for its proposed oncology and women’s-health electronic health-record certification criteria and test scripts. The comment period will end December 10th at 5 pm CT.”

Meaningful Dental Use 

Is it possible that following the establishment of “meaningful use” guidelines for these specialists, dentistry could be next in line? The nature of the approaching bolus of news concerning eDRs is pure speculation, but rest assured I’ll be right in the middle of it – which brings me to the next sign that eDR stakeholders are getting restless: An almost unheard of conversation about eDRs appeared today on the Internet. Since the only news about eDRs on the Internet are press releases from Dentrix – the largest vendor in the nation – conversations about value of electronic dental records only rarely break out. But, when they appear, I always try my best to be provocative – just to tease out new rationalizations I might have otherwise missed.

I think I found promising opportunity this morning following an article by “John” titled, “EMR Stimulus Q and A: EMR Stimulus Money and Dentists.” It was posted yesterday on the EMR and HIPAA blog.

http://www.emrandhipaa.com/emr-and-hipaa/2010/11/18/emr-stimulus-q-and-a-emr-stimulus-money-and-dentists/comment-page-1/#comment-126257

My Comments

I’ve looked into whether stimulus money will be available to dentists. Many in your audience won’t like it, but here’s your answer: 

Dentists will not receive any ARRA stimulus to help pay for electronic dental records – even if a practice is 30% Medicaid as required. For one thing, it’s already too late to collect on the biggest portion of our grandchildren’s money unless the practice can prove utilization of an ONC-certified eDR in a “meaningful” way by this time next year. And, that’s simply impossible because there are no ONC-certified eDRs, and meaningful use has still not been defined by HHS – with help from the ADA. Eventually, someone from the ADA will either have to promote computer busywork as meaningful use, or concede that meaningful use of eHRs in dentistry simply does not exist.

Example

For example, do you want to log on to a password-protected, HIPAA-compliant computer just to notify the lab that you have a pick-up? For dental practices, speed-dial on the telephone – or fax machine – is much more meaningful, and neither requires the dentist to be a HIPAA-covered entity. In addition, none of the conventional ways of communicating put patients’ identities at risk like digital records on a stolen or hacked computer. That’s Hippocratic meaningful.

Digital Drawbacks 

Here’s another drawback to digitalization: Even though electronic dental records are cutting-edge cool, they have yet to show a return on investment for dental practices, and data breaches will continue to make them more and more expensive. Without ROI, paperless is a hobby paid for by clueless patients in higher fees. Bet you haven’t heard that chunk of honesty very often. Honesty about hi-tech non-solutions is repressed even in the ADA because it is so politically incorrect to admit that our dental leaders who misled members were misled themselves by HIT stakeholders and Newt Gingrich. It’s really difficult for high officials inside and outside dentistry to stand up and say, “Oops! We were wrong.”

See: “Is ARRA Stimulus Money for Dentists?”

https://medicalexecutivepost.com/2010/11/16/is-arra-stimulus-money-for-dentists/

Assessment

I happened to post the article on the Medical Executive-Post two days before John’s article was posted here on the EMR and HIPAA forum. I invite you to read it, and tell me what you think. Other than here, nobody talks about these issues. That can’t be good for dental patients.

Conclusion

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Is ARRA Stimulus Money for Dentists?

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Now is the Time to Say “No Thank You” to the ADA

[By D. Kellus Pruitt DDS]

A few days ago on Twitter, @techguy said: “@Dentrix, Are you guys helping dentists get access to the ARRA EHR Stimulus money?” This morning I “retweeted” his question to the electronic dental record giant: “That’s a great question, @Dentrix. What are you doing to help dentists receive stimulus money?

Of Faded Promises  

Dentrix officials no longer shop faded promises of free stimulus money to help dentists purchase their software. The truth is, without taxpayer help, Dentrix’s product offers dentists no return on investment, and it’s unlikely that the profession will ever see a cent of stimulus money. In fact, if American Dental Association President Raymond Gist wants to be a national hero, now would be the time to purchase a press release to tell the nation, “American dentists graciously decline your offer of stimulus money, taxpayers. We say, let our grandchildren keep it for themselves.” The deficit-weary public is very interested in that kind of good news these days. But, the ADA’s PR opportunity has a shelf life. The sooner they jump on this minor deception the more generous American dentists will appear. A year from now, the chunk of faux-generosity won’t work.

Too Late for Cash Give-Aways 

For one thing, it’s simply too late for dentists to take part in the cash giveaway. And even if there was time for a significant number of dentists to convert from paper to digital before September 2011, to receive promised stimulus money, a dentist’s practice has to be 30% Medicaid. That qualification rules out almost all dental practices right off, and here in Texas last week, Governor Perry threatened to opt my state out of Medicaid (and stimulus money) completely. A year ago, Perry threatened secession from the Union. It sounds to me like you are softening him up, Washington.

Meaningful Use Requirements 

That’s not all. Before a dentist can qualify to be reimbursed up to $44,000 dollars, the practice must show “meaningful use” of certified electronic dental records. However, meaningful use of digital records in dentistry has not yet been determined and perhaps does not actually exist. Nevertheless, the best minds in the ADA and HHS are searching for the next best thing – humorous rationalizations. For example, imagine the convenience of the speed-dial on the telephone compared to logging on to a highly secure, password-protected, HIPAA-compliant, encrypted computer just to tell the lab you have a pick up – just to show the Department of Health and Human Services that you are making “meaningful use” of your Dentrix product and spending taxpayer money wisely.

Assessment 

Do you know what is scary about the leadership in my profession? I’m apparently the only dentist in the nation who dares admit that as far as ARRA stimulus money goes, American dentists are out of luck and clueless. Even @techguy is in the dark for crying out loud!

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Front Matter BoMP – 3

On the Election Results of November 2010

Gauging the Impact of the Affordable Care Act?

Question:

ME-P readers and others have been asking us – what does the election outcome mean for health care and the ACA?

Answer:

In short, not as much as many think, according to Steve Pizer JD and Austin Frakt PhD of the Incidental Economist.

Link:

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A Voting Poll on eMRs as a Balance Sheet Item?

A Real or Economically Stimulated Need?

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Many doctors – and their CPAs – view an in office electronic medical record [eMR] system as a balance sheet item to purchase for a medical practice; much like any other piece of business equipment or medical instrumentation.

Of course, ARRA and the HITECH Acts also treat eMRs like an asset that the Federal government can motivate doctors to purchase thru their “meaningful use” economic stimulus and rebate program … sort of a social engineering fiscal health policy for medical professionals. 

And so, the question for doctors really is: do you believe in eMRs as a stand-alone item above and beyond their rebate earning capacity?

THINK “cash for clunkers”, or the first time home buyer “mortgage credit rebate program”.

In other words, sans this Federal economic rebate program externality, would you purchase an eMR system despite the HITECH Act? Will you purchase one once the rebate period has expired. Are eMRs a depreciating or appreciating asset?

Please opine with your vote!

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Health Information Privacy Breaches

Breaches Affecting 500 or More Individuals

By Staff Reporters

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As required by section 13402(e)(4) of the HITECH Act, the DHHS Secretary must post a list of breaches of unsecured protected health information affecting 500 or more individuals. The following breaches have been reported to the Secretary.

www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/postedbreaches.html

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The Pros and Cons of eMRs

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Delving Deeper into the Historic Origins of Debate

Dr. Mata

[By Richard J. Mata MD, CIS, CMP™]

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According to Wager, Ornstein, and Jenkins, in 2005, the perceived advantages of an EHR system include the following:

  •  Quality of the patient records (legible, complete, organized) — 86%
  •  Better access to patient records (available, convenient, fast) — 86%
  •  Improved documentation for patient care purposes — 93%
  •  Improved documentation of preventive services — 82%
  •  Improved documentation for quality improvement activities — 82%

Items viewed as an advantage by fewer respondents include the following:

  •  Administrative cost savings — 38%
  •  Improved efficiency — 61%
  •  Security of patient records — 64%

Nothing directly was said about cost savings or increased medical care quality. These topics have become more contentious issues during the past few years.

The Gurley Opinion

According to HIT expert Lori Gurley, in 2006, of the American Academy of Medical Administrators:

“The EHR provides the essential infrastructure required to enable the adoption and effective use of new healthcare modalities and information management tools such as integrated care,  evidenced-based medicine, computer-based decision support, care planning and pathways, and outcomes analysis” (Schloefell et al).  Although the benefits that support implementation of an EHR are clear, there are still barriers too, therefore the concept is still not accepted. “However, this could also be said of almost every other area of positive change and improvement within healthcare systems […]” (Schloefell et al).  There must be more involvement by the government and the private sector “to make changes where possible to instigate, motivate, and provide incentives to accelerate the development of solutions to overcome the barriers” (Young).

THINK: ARRA and HITECH, today. Of course, there are obviously advantages and disadvantages to both the paper medical record and the EHR.

Multi-Factorial Issues

Many factors must be considered before any healthcare organization or medical practice should implement an EHR.  The organization must first obtain as much information as possible about this new concept, and then the information must be carefully reviewed and the pros and cons discussed. Only then should the organization make their decision about this very important issue.

“The [EHR] as a part of a Clinical Information System (CIS) is a powerful tool which ties together documentation of the patient visit (clinical information), coding (diagnosis, and treatment procedures), which then translates into more accurate billing processes, reduces reprocessing of medical claims, and that translates into increased customer satisfaction with a provider” (Koeller). Although the technology is available, progress towards an EHR has been slower than expected. “Widespread use of [EHRs] would serve both private-and public-sector objectives to transform healthcare delivery in the United States” […] EHRs would also “enhance the health of citizens and reduce the costs of care” (Dick, Steen, and Detmer).

The MRI Study

According to a 2005-07 survey by the Medical Records Institute, the following factors are driving the push towards EHR systems within medical organizations:

Motivating Factors 2005 Ambulatory
The need to improve clinical processes or workflow efficiency. 89.3% 91.2%
The need to improve quality of care. 85.0% 85.3%
The need to share patient record information among healthcare practitioners and professionals. 81.1% 66.9%
The need to reduce medical errors (improve patient safety). 76.1% 69.1%
The need to provide access to patient records at remote locations. 67.9% 65.4%
The need to improve clinical documentation to support appropriate billing service levels. 67.1% 76.5%
The need to improve clinical data capture. 64.6% 61.0%
The need to facilitate clinical decision support. 60.7% 50.7%
The requirement to contain or reduce healthcare delivery costs. 54.6% 61.8%
The need to establish a more efficient and effective information infrastructure as a competitive advantage. 53.6% 53.7%
The need to meet the requirements of legal, regulatory, or accreditation standards. 50.0% 44.1%
Other 5.7% 5.1%
Totals 280 136
Margin of Error +/- 5.8% +/- 8.4%

Now, compare this with the results of the 2007 survey that focused on the factors driving hospitals to expand their use of EHR.

Driving Factors in a Hospital 2007
Efficiency and convenience, e.g., better networking to the medical community and patients and remote access 57.8%
Satisfaction of physicians and clinician employees 42.2%
The need to survive and thrive in a much more competitive, interconnected world. 41.0%
Regulatory requirements of JCAHO or NCQA. 35.6%
Savings in the Medical Record Department and elsewhere, including transcription. 24.0%
Value-based purchasing/pay for performance 17.7%
Pressure from payer groups, such as Leapfrog Group 15.2%
Possibility of subsidized purchase of HER, e-prescribing systems, etc. by purchasers/payers/large health systems. 8.8%
Totals 329
Margin of Error +/- 5.4%

Assessment

How have these motivating and driving factors changed today; have they really changed in 2010?

Does this deeper dive reveal any other truths; political, social, business or economic? Is this historical review helpful in understanding the reluctance or eagerness for EMR acceptance, or not?

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About Regional Health Information Organizations

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The RHIO Concept – Defined

Dr. Mata

[By Richard J. Mata MD, CIS, CMP™]

Regional Health Information Organizations (RHIOs), or data exchanges, are multi-stakeholder organizations.  They might include groups of hospitals, medical societies, payers, major employers, and other healthcare organizations.

Generally, these stakeholders are developing RHIOs with the goal of affecting the safety, quality, and efficiency of healthcare as well as improving access to healthcare by expanding the use of health information technology.  It is expected that RHIOs will be responsible for motivating and causing integration and information exchange in the nation’s revamped healthcare system

Assessment

Regions in the U.S. continue to use various definitions of “multi-stakeholder organizations.”  For instance, in Wichita, Kansas, the Clinics Patient Index is a software architecture as well as support environment that facilitates integration among outpatient clinics and hospital emergency departments.

And, what will be the affect of [HR 3590], or the Patient Protection and Affordable Care Act, on RHIOs?

Conclusion

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Sevocity® Announces Free Electronic Health Records (EHR) System

For Educators and Regional Extension Centers (REC)

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By Catherine G. Huddle

VP, Market Development

www.Sevocity.com

Ph: (210) 412-5653

True Internet / Cloud EHR System Ideal for Educating Providers, Clinical Staff, and REC Support Staff

San Antonio, TX –Sevocity, a division of Conceptual MindWorks, Inc. (CMI), today announced Sevocity U, its Internet-based Ambulatory Electronic Health Records (EHR) program for Regional Extension Centers (RECs), Local Extension Centers (LECs), Management Service Organizations (MSOs), Technical Colleges, Universities, Medical Schools, and other organizations needing a turn-key EHR for training.

The Program

Under the program, educational organizations will receive free use of the fully functional Sevocity EHR for up to 20 users (teachers and students) through a demonstration clinic specifically for the educational organization.   Because Sevocity is a true Internet-based EHR, these organizations will not need to purchase, install, or maintain any servers or special software.  All that is required to access the system is a standard personal computer and an Internet connection, making student access for training and practice easy for the educator.  Sevocity U demonstration clinics will use the fully functional production version of Sevocity EHR.

CCHIT Certified

Sevocity 08 is CCHIT Certified® by the Certification Commission for Healthcare Information Technology (CCHIT®) and meets the Commission’s ambulatory electronic health record (EHR) criteria for 2008.  Sevocity will release its next version of Sevocity EHR this summer, at which time the company will apply for CCHIT 2011.  Sevocity is also committed to “meaningful use” certification and plans to apply as soon as certification is available.  Sevocity’s customer agreement includes a commitment to certification and any other requirements for providers to receive EHR incentives under the American Reinvestment and Recovery Act of 2009 (ARRA).

“We developed this program because we recognize the tremendous challenge Regional Extension Centers and other educators have teaching clinicians and others about Electronic Health Records in a very short period of time and with limited funding,” stated Catherine Huddle, VP of Market Development with Sevocity.   “While more standardization of EHRs is coming, today most systems have the same basic functionality.  Because Sevocity is a true Internet-based EHR and is very easy to use, it provides the ideal platform for educators providing EHR training.”

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Assessment

Sevocity is rolling out this program in phases. Phase I begins today with the availability of Sevocity to the first ten (10) educational organizations that apply. Interested organizations should contact Sevocity at 877-777-2298 or EHReducation@Sevocity.com.

About Sevocity

Based in San Antonio, Texas, Sevocity empowers physician practices and health centers to embrace electronic health record (EHRs) by providing an easy-to-use, Internet-based electronic health record system. Because Sevocity EHR is an Internet-based (or cloud computing) product that provides secure access to clinical information via the Internet, practices and health centers avoid the expensive upfront capital expenditure and ongoing maintenance costs associated with client/server offerings. For more information about Sevocity, visit www.sevocity.com or call (877) 777-2298.

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Seeking ME-P Readership Opinions on eMRs

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An Exercise in Crowd-Sourcing

By Chris Thorman

Senior Marketing Manager
www.SoftwareAdvice.com

I just finished an essay about market share in the EMR industry and I wanted to give ME-P readers a heads up about it.

Here is the link: http://www.softwareadvice.com/articles/medical/ehr-software-market-share-analysis-1051410/

Essay Content

In the article, I break down:

  • The size of the outpatient EMR market;
  • What EMR vendors have the most physicians using their system; and,
  • What EMR vendors have the most practices using their systems?

Assessment

As I’m sure you can imagine; it was a tough project to get accurate numbers on. And, I’d like to get more eyes on it so we can clear up any discrepancies.  Sort of a ME-P reader “crowd sourcing” project if you will. So, all thoughts on our findings are appreciated. I can be contacted directly here by email, or below: chris@softwareadvice.com

(512) 364-0118 
(800) 918-2764 (toll free)
(360) 838-7866 (fax)
Contact: MarcinkoAdvisors@msn.com

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eHRs and Clinical Trials

An Oft Neglected Topic

By Chris Thorman

I wanted to give the ME-P a heads up on an article I just finished about a neglected topic in the eHR debate concerning clinical trial participation.

It’s called: Electronic Health Records and Clinical Trials: An Incentive to Integrate.

The Argument

In the article, I make the argument that clinical trials should play a bigger role in whether or not to purchase eHR software because:

  • The potential profit from participating in clinical trials is so large that it dwarfs the HITECH Act incentives;
  • eHRs make clinical trial participation much easier than in the past; and,
  • eHR software has the potential to solve many of the problems that clinical trials face.

Editors Note: So, let’s try to spark some discussion on this oft-ignored topic. And, feel free to contact the author.

Chris Thorman
Senior Marketing Manager
Software Advice
(512) 364-0118

chris@softwareadvice.com

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Electronic Medical Records and Dentistry

A Note to Diane Rehm

[By Darrell K. Pruitt; DDS]

Dear Diane Rehm,

I always enjoy your show.

You add value to my drive to work.

As a dentist, I was especially interested in your March 10 show “Electronic Medical Records.”

http://wamu.org/programs/dr/10/03/10.php?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+WAMU885DianeRehm+%28WAMU%3A+The+Diane+Rehm+Show%29&utm_content=FaceBook#30598

In all the excitement that surrounds the 19 billion dollars our grandchildren have unwittingly granted to physicians and hospitals for “meaningful” adoption of certified eMRs, you probably haven’t noticed that nobody is talking about including dentistry in the conversion from paper to digital. Do you find that odd?

Small and Mid Sized Practices

Like small and mid sized physicians’ practices, small dental practices are intended to be part of the federal mandate for interoperable eMR adoption – even without the help from stimulus money that physicians receive. You probably weren’t aware that the stimulus money will run out before HHS gets around to defining “meaningful use” of eMRs in dental office. That would be impossible, but nevertheless, I anticipate that the attempts will be entertaining. Physicians in small practices typically have tens of thousands of paper charts as thick as phone books. On the other hand, a busy solo dental practice, like the majority of practices in the US, might have 5,000 files that are very thin in comparison to files that involve the whole body instead of just the bottom third of the face. That makes sense, doesn’t it?

Marginal Benefits May Not Exceed Marginal Costs 

I listened to your guest Dr. Carol Horn, who practices internal medicine in private practice, as well as others involved in the actual delivery of healthcare. They list not only the benefits of eMR adoption, but in fairness, they also described the expense and liability of digital records that continue long after the tedious and dangerous conversion from paper to digital. In other words, it appears that the benefits for physicians barely make the effort worth the price, even with 19 billion dollars in help.

Editor’s Note: In economics, we say that the marginal benefits may not exceed the marginal costs; all things being equal.

Assessment 

And so, it occurs to me that if dentists are to be included in the plans for digital interoperability, we will be very, very slow adopters for natural reasons: like eMRs in physicians’ offices, eMRs in dentists’ offices are more expense and trouble than they are worth – even before considering the bankruptcy-level liability of a data breach.

Most of those who champion eMRs for the entire healthcare system in the nation don’t realize that the bottleneck in dental offices isn’t the front desk. It’s the dentist who is hopefully taking his or her time providing care with those hands instead of working a keyboard.

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About Medical Clinical IT Groupware

What it is – how it works

By Staff Reporters

According to Bill Crounse MD of Microsoft,

clinical medical groupware is a new and evolving model for the development and deployment of health IT platforms and applications, the characteristics of which include use of the Internet and the Web as a platform, explicit design for health data exchange and online communication among providers and patients/consumers, a modular or component architecture upon which applications can be aggregated to meet specific clinical and workflow tasks; while allowing interface standards and protocols for data exchange to emerge in a market-driven manner.  

Distribution Platforms

Clinical medical groupware applications can be distributed as software-as-as-service, and are intended to support today’s mobile health care environment by supplying the right information, at the right time and the right place.

Link: http://blogs.msdn.com/healthblog/archive/2009/09/14/learn-more-about-clinical-groupware.aspx

Assessments

Advocates of the clinical medical groupware approach are not limited to software developers and technologists, but also include practicing physicians, executives and managers from health care provider organizations and care management companies, patient advocates, and leaders in life sciences, home monitoring, and medical device manufacturing firms.

Conclusion

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Is the HITECH Act Unconstitutional?

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Parts 1 and 2

[By Alberto Borges; MD]

Is the HITECH Act Unconstitutional? – PART 2

Is the HITECH Act Unconstitutional? – PART 1

Dr. Borges is a ME-P thought-leader in private practice. He is an associate clinical professor of medicine at the George Washington University in Washington, DC.

Assessment

Check out his website at http://msofficeemrproject.com

Conclusion

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Defining “Provider” for Medicare Incentive Payments?

Ask a Medical Practice Management Advisor

Staff Reporters

HR 1 of ARRA states:

“The term ‘health care provider’ includes a hospital, skilled nursing facility, nursing facility, home health entity or other long term care facility, health care clinic, community mental health center (as defined in section 1913(b)(1)), renal dialysis facility, blood center, ambulatory surgical center described in section 1833(i) of the Social Security Act, emergency medical services provider, Federally qualified health center, group practice, a pharmacist, a pharmacy, a laboratory, a physician (as defined in section 1861(r) of the Social Security Act), a practitioner (as described in section 1842(b)(18)(C) of the Social Security Act).”

For Ambulatory Surgery Center’s

HR 1 of ARRA includes ASCs in the definition of “provider” (see above), but the CMS seems to indicate otherwise CMS’s site.

For Pharmacists

HR 1 of ARRA includes pharmacists and pharmacies as “providers.” New information on phamacists’ eligibility for IT loans was recently announced – see the Healthcare IT News coverage on this.

Assessment

What was missed; please advise?

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Prominent Politician Views on Health Information Technology

A Guest Thought-Leader Op-Ed Piece

Ann Miller; RN, MHA [Executive-Director]  

By Alberto Borges; MD

In this review, ME-P thought-leader and colleague, Al Borges MD dissects and presents the political views of HIT by several prominent politicians.  WHY?

He believes that only a handful of politicians are questioning whether the cost of HIT will actually improve healthcare as promised, which can end up in wasted taxpayer money, and worse, become a slow-moving HIT blunder which puts patient lives at risk. Even President Obama’s staff quietly admits that these statements are unproven.

Assessment

For example, Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel and the current health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research stated last year that:

“Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely ‘lipstick’ cost control, more for show and public relations than for true change.”

Link: Politician Views of HIT [updated November 2009]

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The “Real Facts” about eMRs with .ppt Presentation

A Guest Thought-Leader Presentation

Ann Miller; RN, MHA [Executive Director]

By Alberto Borges; MD

In this colorful MSFT PowerPoint presentation, ME-P thought-leader and colleague, Al Borges MD dispels a plethora of eMR myths. He discusses the true cost of eMR implementation, and presents his views on the dark side of the eMR certification process.

Assessment

He concludes with an opinion on insider C-eMR politics in the USA.

Link: The Real Facts about eMRs [last updated April 2009].

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Dear Doctor – “I’m from the Government and I’m Here to Help”

Only-in-America

By Staff ReportersGetting Squeezed

CMS Cuts Medicare 21% for Doctors Unless Congress Acts

The Centers for Medicare and Medicaid [CMS] just reported to the American Medical News that the final 2010 Medicare physician fee schedule confirms 21.2% pay cut starting Jan. 1, 2010, unless Congress adopts legislation to avert it.  

So, enter John Kerry to the Rescue

Kerry Bill Helps Physicians Borrow Money for eMRs

But to qualify for electronic health record government subsidies, to be paid in increments over five years starting in 2011, physicians must lay out a substantial sum, take a lease, or borrow the money. So, to make it easier for doctors to purchase eMR systems, Sen. John Kerry (D-Mass) has proposed legislation that would allow small practices to get loans backed by the Small Business Administration (SBA).

Moreover, a press release from Kerry’s office stated that the money could be spent on “computer hardware, software, and other technology that will assist in the use of electronic health records and prescriptions.” 

Link: Continued at BNet Healthcare.

Assessment

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Yet, health economist and ME-P Publisher-in-Chief Dr. David Edward Marcinko opined:

“Is this sleight-of-hand chicanery akin to stealing from Peter to pay Paul”?   

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Update on HIPAA Administrative Simplification

New Enforcement Rules

Federal Register: October 30, 2009 [Volume 74, Number 209]

Rules and Regulations – Page 56123-56131

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

DOCID: fr30oc09-12typewriter

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary

45 CFR Part-160 [RIN 0991-AB55]

HIPAA Administrative Simplification: Enforcement

AGENCY: Office of the Secretary, HHS.

ACTION: Interim final rule; request for comments

SUMMARY:

The Secretary of the Department of Health and Human Services (HHS) adopts this interim final rule to conform the enforcement regulations promulgated under the Health Insurance Portability and

Accountability Act of 1996 (HIPAA) to the effective statutory revisions made pursuant to the Health Information Technology for Economic and Clinical Health Act (the HITECH Act), which was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA).

More specifically, this interim final rule amends HIPAA’s enforcement regulations, as they relate to the imposition of civil money penalties, to incorporate the HITECH Act’s categories of violations, tiered ranges of civil money penalty amounts, and revised limitations on the Secretary’s authority to impose civil money penalties for established violations of HIPAA’s Administrative Simplification rules (HIPAA rules). This interim final rule does not make amendments with respect to those enforcement provisions of the HITECH Act that are not yet effective under the applicable statutory provisions. Such amendments will be subject to forthcoming rulemaking(s).

Assessment

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Doctors versus Retail Bankers

Understanding Modern Reality

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Dr. David E. Marcinko MBA

Doctors often carry notoriously heavy debt loads. Beyond the costs of a medical education are substantial costs for equipping, launching and staffing a practice. Technology changes fast these days and capital is required frequently. And, the era of eMRs, ARRA, HI-TECH and Obama-Care is upon us!

“I‘m a Banker – I’m Here to Help”

Unfortunately, retail bankers are now very conservative by nature; and the liquidity squeeze and financial meltdown of 2008-2009 makes credit even more difficult to obtain. It may be increasingly difficult to borrow money, especially since modern bankers know that a medical degree is no longer the guarantee of a steady and high income that it once was in the past. As more than one banker has often opined to me,

“We don’t usually loan money to doctors who really need it.”

Nevertheless, the more business a physician does with a bank, the better the terms that can be obtained; even thought hey may also not have a clue about what the practitioner can do to better compete in the managed care arena.

Why Big-Banks Hate Customers

http://articles.moneycentral.msn.com/Investing/JubaksJournal/why-big-banks-hate-banking.aspx

Local Community

Some bankers do have a good concept of local community politics however, for those not familiar with a practice venue. They frequently can provide references to more focused advisors, and bankers generally do not charge a fee for their advice. But, banks selling products are doing so according to their governing regulations as “prudent experts” under ERISA, and are not necessarily held to a fiduciary standard in any broader sense.

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Criticizing Electronic Medical Records?

By Brent A. Metfessel; MD, MS

By Staff Writers

www.HealthcareFinancials.comHOFMS

Despite ARRA and the HITECH initiatives, eMRs are not without drawbacks. And, with apologies to USCTO Aneesh Chopra, we list the following.   

List of Drawbacks

The following are some of the more notable negatives:

  • Operator dependenceThe term “garbage in, garbage out” applies to eMRs as well. The computer only works as well as the data it receives. If one is resistant to computing and works begrudgingly, is not well-trained, or is rushed for time, the potential exists for significantly incomplete or error-prone documentation.
  • Variable flexibility for unique needs — When one sees a single hospital, one sees just that — a single hospital, with unique needs unlike any other facility. A “one size fits all” approach misses the target. Even within a hospital, needs may change rapidly over time given the continued onslaught of external initiatives and measurement demands. Systems vary in flexibility and the ease with which they can customize options. More flexible systems exist but cost much more.
  • Data entry errors — Although data items normally only have to be entered once, data entry errors may still occur and be propagated throughout the system. Most notably, patient data can more easily be entered into the wrong chart when there is an error in chart selection. In general, simple double-checking and “sanity checks” in the system usually catch these errors, but if the error goes through the system the impact can be significant.
  • Lack of system integration — Interconnectivity of systems becomes more important with eMRs than with any other system. Personnel use the data in many different areas. If there are isolated departmental systems without connectivity, redundant data entry occur leading to confusion in the different departments. Appropriate and intelligent clinical decision support systems can make the job of the physician easier through education, real-time feedback, and through the presentation of choices that allow for clinical judgment.
  • Costs of implementation — Intelligently applied eMR implementations may also be cost saving; long term. For example, one large east coast hospital found that eMRs saved $9,000 to $19,000 annually per physician FTE. This savings was achieved through a decrease in costs for record retrieval, transcription, non-formulary drug ordering, and improvements in billing accuracy. And, in radiology, storage of digital pictures and the use of a picture archival and communication system significantly [PACS] decreased the turnaround time for radiology image interpretation — from 72 hours to only 1 hour. However, there is significant front-loading of costs prior to achieving such costs savings. 

Link: WSJ_Letter_3M_Company_2009-10-16

Assessment

At the American Health Information Management Association [AHIMA] October 2006 conference,  panelists suggested that developing, purchasing, and implementing an EMR would cost over $32,000 per physician, with an outlay of $1,200 per physician per month for maintenance.  This is larger in economic scope, today. Also, there exists no national standard that would require compatibility between the numerous competing eMR vendor systems that may need to communicate with each other, which can escalate costs and frustration in systems that attempt to integrate the features of multiple vendors.

Some recent HIT fiascos:

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=3090

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=1905

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=5286

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=3891

 http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2009/10/12/newscolumn3.html#

Conclusion

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Ask an Advisor about “Meaningful-Use”

Do dentists qualify for “meaningful use” incentives under ARRA?

By Ann Miller; RN, MHA

[Executive Director]

Chairman's Seat

A simple and direct query asked by an ME-P subscriber.

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Encrypt or De-identify PHI

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Which One Just Might Work?

[By Darrell K. Pruitt; DDS]pruitt

The United States’ advancement in Healthcare Information Technology, which has the potential to lead to wonderful money-saving cures through research using trustworthy interoperable health records, is currently stopped cold by patient security problems that are only getting worse. Our lawmakers cannot get around the security obstacle without resorting to authoritarian means using CMS’s power to withhold providers’ discounted payments and threats of obscene fines from the HHS and the FTC. History shows that tyranny is not tolerated well in this part of the world. Lawmakers can get their butts voted smooth out of office in my neighborhood.

HITECH  

Here is something nobody mentions: Despite the current hope in a thick, political fantasy called HITECH, encryption of patients’ Protected Health Information [PHI] is a non-starter in the land of the free. Everyone knows that resourceful, cynical Americans will simply never trust encryption to protect their secrets, and will reliably withhold important information from their eMRs – one way or another. Doctors as well as patients can be expected to go out of their way to sabotage technology they fear. We all intuitively know this is true, don’t we? We aren’t so naïve to think all the players will happily play by the rules, are we? And I think we can all agree that an untrustworthy digital health record in an emergency room is worse than no patient information at all. Security is a grand problem with eMRs that started with HIPAA changes in 2003 that made eHRs so slippery. And the problem is clearly not being resolved. Not yet.

Public Lacks Trust 

Regardless of the campaign donations which follow him, there is nothing Newt Gingrich and his entrepreneurial friends in high places can do about the public’s lack of trust in encryption. It gets worse: Encryption hasn’t a chance of isolating PHI from dishonest employees in doctors’ offices, and slippery digital patient data can be moved soo easily. Everyone knows that as well, don’t they? It is estimated that two-thirds of the identities stolen in the nation are lifted from doctors’ offices. That’s us, Doc. HIPAA is not only irrelevant, it is an expensive distraction – it gives future ID theft victims a false sense of security.

HIPAA Approved 

De-identifying digital records is not mentioned in HITECH as a HIPAA-approved method of security. Yet it is the ONLY solution that promises to be even more secure than paper records. Because of heavy stakeholder stakes in hospital care, it will take longer for CEO-types to embrace patient-friendly de-identification. Other than identifiers such as names, social security numbers, birthdates, addresses and other items that have street value, NOBODY cares what is in a dental record. I actually think this opens a tremendous opportunity for someone courageous in the Texas Dental Association to discuss the feasibility of de-identification of dental records. Otherwise, instead of leading the nation in solving security problems, the TDA will look just as stupid as the ADA.

Encryption would also provide a dangerous false sense of security in eMRs – that is if it had a chance in the marketplace. But encryption will never go far because consumers simply won’t buy it. That is a marketplace fact that stoically optimistic HIT stakeholders are trying hard to avoid. They also know they are running out of time. Deadlines are quickly approaching for both HIPAA and the Red Flags Rule that providers are far from prepared for.

Former Attorney Speaks 

Bill Lappen, a former attorney and author of the ad I copied below, as well as a partner with his brother David in the de-identified health record venture says: “Since no identifying information is ever entered, a hacker can’t determine whose information is shown.”

So in addition to protecting one’s practice against dishonest or vindictive employees, de-identification of dental records would make hacking a dentist’s computer a complete waste of time, and hackers wouldn’t endanger dental patients and bankrupt dentists.

My Confidence 

I confidently tell you that soon, someone smart will come upon the unprecedented idea that the ultimate answer to our security problem in healthcare will be de-identification of medical records, not encryption. De-identification allows a compromise of privacy for only a miniscule percentage of physicians’ patients. We cannot allow that to stand in the way of better health for everyone else. Those special cases are so few that I am confident that they can be dealt with individually. We simply must move forward. I’ll have to retire some day. I may need help from Medicare.

Encryption gives us only danger and protects nobody but a thief with a key.

Assessment 

We’ve wasted enough time on HITECH and HIPAA, as well as CCHIT. It’s time to say no to stakeholders and pay attention to patients’ needs instead of those who would needlessly increase the cost of their care. Stimulus money attracts cockroaches.

In the name of Hippocrates, disregard the tainted HIPAA mandate. It is dangerous, and especially absurd in dentistry.

Link: http://www.theopenpress.com/index.php?a=press&id=58568

Life-Saving Patient Information can be Online, Anonymous and Usable

Published on: September 26th, 2009 12:19am

By: blappen

Los Angeles, CA (OPENPRESS) September 26, 2009 — Hospital Emergency Rooms need instant access to patient medical information. Allergic reactions and dangerous drug interactions can be deadly. Time is critical. Until now, privacy was a large concern. Two brothers, who have developed medical software over the past 15 years, think they have a simple first step towards moving patient information on to the internet.

“The ER doesn’t need to look up the information by patient name” said Bill Lappen, a former attorney. “We have implemented secure systems in the past, but no matter how secure we make the site, we have to assume that it will be hacked” added David Lappen, a computer design engineer from Stanford. “But providing instant access to life-saving information is too important to ignore”, he added. To protect patient privacy, their system does not know to whom the medical information belongs. Since the person’s identifying information is never on the system, it can’t be stolen. “By enabling anonymous entry, we have protected people’s privacy while allowing them to put their life-saving information in a place where it can be instantly accessed when needed”, added Bill Lappen.

www.AMCC.me is the public service website they created. It allows anyone to enter medical information anonymously. The site provides a random ID which the user carries in his/her wallet. For someone to see that user’s medical information, they merely enter the ID into the site. Unless the user has given them their ID, the information shown is meaningless. That same information, when associated with a patient, can save their life.

Since no identifying information is ever entered, a hacker can’t determine whose information is shown. “Secure patient-controlled Electronic Medical Records are now available on the internet” said David Lappen. A sample ID has been set up on the site to allow users to evaluate the concept before setting up their own free ID.

Contact:

Bill Lappen

Bill@AMCC.me

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Whither Health Information Technology – Seriously?

Is it Really About Quality Improvement?

By Staff ReportersSurgeons

Health information technology (HIT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of HIT has the potential to improve health care quality, prevent medical errors, increase the efficiency of care provision and reduce unnecessary health care costs, increase administrative efficiencies, decrease paperwork, expand access to affordable care, and improve population health.

Improving Patient Care

  • Interoperable HIT can improve individual patient care in numerous ways, including:
  • Complete, accurate, and searchable health information, available at the point of diagnosis and care, allowing for more informed decision-making to enhance the quality and reliability of health care delivery.
  • More efficient and convenient delivery of care, without having to wait for the exchange of records or paperwork, and without requiring unnecessary or repetitive tests or procedures.
  • Earlier diagnosis and characterization of disease, with the potential to thereby improve outcomes and reduce costs.
  • Reductions in adverse events through an improved understanding of each patient’s particular medical history, potential for drug-drug interactions, or (eventually) enhanced understanding of a patient’s metabolism or even genetic profile and likelihood of a positive or potentially harmful response to a course of treatment.
  • Increased efficiencies related to administrative tasks, allowing for more interaction with and transfer of information to patients, caregivers, and clinical care coordinators and monitoring of patient care.

Assessment

Link: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1327&parentname=CommunityPage&parentid=112&mode=2&in_hi_userid=11113&cached=true A Letter from David Blumenthal, MD.

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The VistA Client Server System

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What it is – How it works

By ME-P Staff ReportersME-P Rack Servers

According to Dr. Richard Mata MS, a client-server system configuration occurs when one or more “repository” computers [ known as “servers”] store large amounts of data but perform limited processing. Communicating with the server(s) are client workstations that perform much of the data processing and often have graphical user interfaces (GUIs) for ease of use.

High Functionality

Both customizability and resource use is high, depending on the desired sophistication. Many clinical medical information systems that process data directly related to patient care use this configuration.

VA Example

For instance, the Veterans Health Administration, which has implemented what is likely the largest integrated healthcare information system in the United States, uses client-server architecture. Known as the Veterans Health Information Systems and Technology Architecture (VistA), this system provides technology infrastructure to about 1,300 care facilities, including hospitals and medical centers, outpatient facilities, and long-term care centers. VistA utilizes a client-server architecture that links together workstations and personal computers using software that is accessed via a graphical user interface.

Assessment

Overall, for hospitals that have the financial and manpower resources for a significant investment in IT, client-server architectures are the fastest-growing and typically the most preferred of the system architectures, due in large part to their local adaptability and flexibility to meet changing hospital and medical center needs.

Conclusion

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List of Healthcare IT Trade Associations

Advancing Medical Practice Success with Strategic Relationships

By Staff ReportersHDS

To be efficient in healthcare delivery today, doctors must partner and understand the resources and affiliations that are available to them. Here is a brief list of several healthcare trade associations and leading industry vendors submitted for your review.

AHIMA
The American Health Information Management Association (AHIMA) is the premier association of health information management professionals. AHIMA’s 51,000 members are dedicated to the effective management of personal health information needed to deliver quality healthcare to the public. Founded in 1928 to improve the quality of medical records, AHIMA is committed to advancing the health information management profession in an increasingly electronic and global environment through leadership in advocacy, education, certification, and lifelong learning.

EHRA
HIMSS EHRA is a trade association of Electronic Health Record (EHR) vendors that addresses national efforts to create interoperable EHRs in hospital and ambulatory care settings. HIMSS EHRA operates on the premise that the rapid, widespread adoption of EHRs will help improve the quality of patient care and the productivity of the healthcare system. The primary mission of the association is to provide a forum for the EHR vendor community relative to standards development, the EHR certification process, interoperability, performance and quality measures, and other EHR issues that may become the subject of increasing government, insurance and physician association initiatives and requests.

HIMSS
HIMSS (Healthcare Information and Management Systems Society) is the healthcare industry’s membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology and management systems for the betterment of human health. Founded in 1961 with offices in Chicago, Washington D.C., and other locations across the country, HIMSS represents approximately 17,000 individual members and some 275 member corporations that employ more than 1 million people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems’ contributions to ensuring quality patient care.

HITSP
The Healthcare Information Technology Standards Panel serves as a cooperative partnership between the public and private sectors for achieving a widely accepted and useful set of standards specifically to enable and support widespread interoperability among healthcare software applications, as they will interact in a local, regional, and national health information network for the United States. Comprised of a wide range of stakeholders, the Panel will assist in the development of the U.S. Nationwide Health Information Network (NHIN) by addressing issues such as privacy and security within a shared healthcare information system. The Panel is sponsored by the American National Standards Institute (ANSI) in cooperation with strategic partners such as the Healthcare Information and Management Systems Society (HIMSS), the Advanced Technology Institute (ATI), and Booz Allen Hamilton. Funding for the Panel is being provided via the ONCHIT contract award from the U.S. Department of Health and Human Services.

HL7
Health Level Seven is an American National Standards Institute (ANSI)-accredited Standards Developing Organization (SDO) operating in the healthcare clinical and administrative data arena. It is a not-for-profit volunteer organization made up of providers, vendors, payers, consultants, government groups, and others who develop clinical and administrative data standards for healthcare. Health Level Seven develops specifications; the most widely used being a messaging standard that enables disparate healthcare applications to exchange keys sets of clinical and administrative data.

MSHUG
Microsoft Healthcare Users Group (MS-HUG) unified with the Healthcare Information and Management Systems Society (HIMSS) as part of the HIMSS Users Group Alliance Program in October 2003. The unification strengthens the commitment of HIMSS and MS-HUG to better serve their members and the industry through a shared strategic vision to provide leadership and healthcare information technology solutions that improve the delivery of patient care.

WEDI
The Workgroup for Electronic Data Interchange [WEDI’s] goal is to improve the quality of healthcare through effective and efficient information exchange and management. They aim to provide leadership and guidance to the healthcare industry on how to use and leverage the industry’s collective knowledge, expertise, and information resources to improve the quality, affordability, and availability of healthcare.

Assessment

As the health information technology industry evolves, we will continue to contribute our expertise to foster ideas that shape the future of healthcare by offering more examples similar to the above.

Conclusion

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Borges versus Kvedar Video eHR Debate

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The Great HIT Debate

[By Staff Reporters]Boxing Gloves

All ME-P subscribers and readers are invited to watch a debate between Dr. Alberto Borges and Dr. Joseph Kvedar. In the original broadcast, by HCPLive, both participants were asked some very interesting questions about health information technology [HIT] when posed to them. And so, if you were unable to attend the live event, it is now re-broadcasted in podcast form for your review.

About Alberto A. Borges; MD

Al Borges is Founder and CEO of the MS Office eMR Project http://www.msofficeemrproject.com He is the project author, visionary and main content developer for the independent website. As a board certified physician, he practices oncology, hematology, and internal medicine in Arlington, Virginia. He is also a clinical professor at the George Washington University Medical School. Dr. Borges is a colleague and thought-leader for the ME-P

About Joseph C. Kvedar; MD

Joe Kvedar is the Founder and Director of the Center for Connected Health http://www.connected-health.org The Center is known for applying communications technology and online resources to increase access and improve the delivery of quality medical services and patient care outside of the traditional medical setting.  A division of Partners HealthCare; the Center for Connected Health works with Harvard Medical School-affiliated teaching hospitals, including Massachusetts General and Brigham and Women’s Hospitals. Dr. Kvedar is also a board-certified dermatologist and Associate Professor of Dermatology at Harvard Medical School

Podcast Link: http://www.hcplive.com/hcplive/great_debate

Assessment

Feel free to email questions, or to post follow-up comments, for all our viewers to consider and respond. The principals are asked to weigh-in, as well.

And the Winner is … ?

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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About EHRWatch.com

A New Online Virtual Collaborative 

By Staff ReportersNurse Paper MRs

www.EHRWatch.com is a new online community dedicated to developments in electronic health records [eHRs], including practice, funding, product integration, standards developments and trends in implementation. The new site features blog posts, polling, commenting and a weekly e-newsletter.

A Collaborative

www.EHRWatch.com is designed to encourage community participation, interaction, collaboration and reaction. Whether you need to select and implement an EHR solution or make sure your current system meets the requirements and timeline necessary to receive the Obama Administration’s ARRA, and HITECCH,  stimulus incentives, the site may offer the products, information, services and expertise to help.

Assessment

Visit www.EHRWatch.com to read the latest posts and join the virtual community. Just give em’ a click, today!

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think of this new site? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

About MeaningfulUse.org

Join Our Mailing List

A Dedicated Terminology Website

By Staff Reporters

Understanding and defining the new era of healthcare information technology in America.

The ARRA and HITECH concept of “meaningful use” for e-MRs is nebulous and ill defined. This new website is intended to be a collaborative destination site in order to promote the national dialogue and education around the term, “meaningful use”, by providing the HIT community a single-central location to access resources, influence and discuss the definition of “meaningful use” and learn how to take advantage of the HITECH stimulus funds.

HDSAssessment

According to the site, registration for the www.MeaningfulUse.org discussion board is only used for the purpose of posting and will not be used for any marketing purposes. The site is supported by the Association of Medical Directors of Information Systems (AMDIS) and sponsored by Compuware Corporation.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Interview with Jack Levy of Securebill, Inc

President – Securebill, IncMeeting

What: An Interview and Special Report Exclusively Prepared for the ME-P
Who: Mr. Jack Levy, CISSP [President – Securebill, Inc]
Topic: Physician Selection of eHRs
Reporter: Amaury Cifuentes; CFP®
Where: Internet Ether

Although skeptics of eHRs abound, President Barack H. Obama’s signing of the American Recovery and Reinvestment Act [ARRA] of 2009 has created a massive push for their implementation. The Act provides $19.2 billion, including $17.2 billion for financial incentives to be administered by Medicare and Medicaid. This assistance of up to $40 to $65 thousand per eligible physician, and up to $11 million per hospital, begins in 2011.

Link: https://healthcarefinancials.files.wordpress.com/2009/05/jack-levy-interview.pdf

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

American Recovery and Reinvestment Act Primer for Physicians

Free ARRA Webinar Series

By Staff Reporters

Resident LaptopAre you ready to maximize American Recovery and Reinvestment Act (ARRA) opportunities in your medical practice?

The Webinar Series

This webinar series is designed to support physician practices as they prepare for a new health care environment. As new information becomes available, experts and health care leaders representing diverse sectors will review key components of ARRA and offer insights on the impact to the physician community.

Topic: Stimulus 101: Basics of the Health Information Technology Provisions

When: Thursday, May 21, 12:00 PM CST

Presenters:

  • Glen Tullman, Chief Executive Officer – Allscripts
  • Margaret Garikes, Director of Federal Affairs – AMA

Assessment

Plus, hear from practices using eHR systems and how they made the transition.

Registration: https://cc.readytalk.com/cc/schedule/display.do?udc=1ip8sqjax7frw

Conclusion

And so, your thoughts and comments on this Medical Executive-Post, and webinar series, are appreciated; especially from seminar participants. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

On the HITECH Act of 2009

The American Recovery and Reinvestment Act

By Staff Reportersdigital-signature2

On February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act [ARRA]. According to some, the law provides an opportunity to transform healthcare in the United States.

HIT

The law also provides $19 billion in health information technology [HIT] funding to ensure widespread adoption and use of interoperable HIT systems like the electronic health records funding provision. But, as ME-P readers are aware; this is not apparently for electronic Dental Records [eDRs]; and CCHIT is no advocate of professional diversity.

Link: https://healthcarefinancials.wordpress.com/2009/03/02/cchit-is-prejudiced-and-lacks-diversity-%e2%80%93-an-indictment

HITECH

Obama’s signing of the Health Information Technology for Economic and Clinical Health (HITECH) Act [a portion of the stimulus package] recognized the importance of HIT as the foundation for health care reform and cost savings.

Assessment

Is this report correct? Read all 187 pages and decide.

Link: HITECH http://democrats.science.house.gov/Media/File/Commdocs/HealthIT%20Bill.pdf

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest Medical E-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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Office Based EMR Cost Report

A Preliminary BC/BS Cost-Benefit Analysis

By Staff Reporters  Stethoscope

BlueCross-BlueShield of Massachusetts recently announced that it will not require physicians to install or use electronic medical records [EMRs] to participate in its new bonus program. The health plan came to the conclusion that the financial benefits of office-based electronic medical records systems are just not worth the cost to doctors.  

Little Office-Based Value 

Relying on information from past studies, the American Medical Association [AMA] estimated that office-based doctors see only 11 cents of every dollar saved through the use of information technology, according to AMNews reports. 

More Hospital Value 

But, the Massachusetts Blues did find value in health information technology [HIT] that physicians would need to use, as its own cost-benefit analysis concluded that computerized physician order entry makes financial sense in the hospital and enterprise-wide healthcare setting. 

Assessment 

The MA-Blues will require hospitals and health systems to install computerized physician order entry systems [CPOEs] by 2012, in order to participate in the bonus program.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

 

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