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The Cost of Early [HIT] Adopters

An eHR Lesson for Physicians?

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With the rapid change in technology, such as eHRs, knowing when to purchase a truly innovative product is becoming increasingly more difficult. With promises of changing our lives or saving time and money, more often than not, the initial release doesn’t live up to these expectations – at least not right away.

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Assessment

However, many of us – doctors included – wait in long lines to be the first adopters, understanding that we most likely will pay more and have to deal with problems. Even with these known hurdles, being an early adopter does have its benefits.

Conclusion

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On HIT Continuity Planning

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Setting Up Your HIT Security System

Dr. MataBy Richard J. Mata, MD, CIS, CMP™ [Hon]

In order for a healthcare organization to thrive, it must be able to continue to function no matter what the circumstances are.

When disaster strikes, the organization must mobilize all the talent and resources needed to continue their operations and return to a normal state as soon as possible.

Time is money, and in today’s economy, an hour could be worth thousands of dollars.  Every department in an organization has responsibilities during a disaster.  Planning for a disaster and then dealing with it is a team effort by all parts of an organization.

Phases of Healthcare Business Continuity Planning

A system is required to realize this objective, and part of this system is healthcare entity business continuity planning (BCP).

Phase One: Set up a BCP Project

The first step is to set up a BCP project, which includes feedback from key members from all departments.  Appoint a project manager who has a solid background in the clinical and financial systems and functions that the organization deploys or services it provides.  The project manager can work with business and system analysts to document business flow and interactions with computerized systems that may go down, and how the organization will function on a manual system until service returns.

Phase Two: Review Emergencies and Assess Business Risk

The second phase involves reviewing the different types of emergencies that can arise and assessing the risks to the various business processes already documented.  This is accomplished following a system or service function.

Phase Three: Prepare for Emergencies

The third phase includes identifying of back-ups and recovery strategies to mitigate the effects of an emergency.  A storage area network (SAN) or redundant server could be used as back-ups.

Phase Four: Plan for Disaster Recovery

The fourth phase involves the development of procedures to be followed by a Disaster Recovery Team where human life may be at risk.  A disaster might be caused by weather, sabotage, or electrical power and be specific to the particular organization and its business and IT infrastructure.

Phase Five: Plan for Business Recovery

The fifth phase is critical, and involves developing detailed procedures for the recovery of the business.  Again, the BCP project manager could use each business or service procedure that was documented in phase two and detail which financial or clinical systems are involved, what would be done if the systems were down, and what the plan for recovering the system might be.

Phase Six: Test Business Recovery Procedures

The sixth phase involves simulating authentic emergencies and testing of the business recovery phase.  For example, how would business processes or services be affected by an electrical outage?  How fast can a power generator pick up the outage – and what might happen after a timely pause?  How would patients who were receiving mechanical support be affected?  What would happen to the clinical laboratory?

Phase Seven: Train the Staff

Phase seven covers the training of all employees in the procedures necessary to manage the business recovery process.  These are the procedures tested in phase six, which may require modification.

Phase Eight: Maintain the Currency of the Plan

Phase eight includes treating BCP as a dynamic project to be kept up to date to reflect all changes to business processes and employee structure.

Conclusion

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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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Kelly Mclendon RHIA censors D. Kellus Pruitt DDS

By Darrell K. Pruitt; DDS

Dateline: 8.15.09

pruitt

Dear Kelly Mclendon, Registered Health Information Administrator

You are beginning to make me feel insulted, and I will not have that. I just noticed that the last two comments I submitted to your Website, www.spacecoastmedicine.com, on August 9 and 10, are still “awaiting moderation.”

http://www.spacecoastmedicine.com/2009/08/electronic-records-for-all-patients-mandated-by-2014.html#comment-89 

(For clarity, the comments which scared Mr. Mclendon are copied below) 

Over five days have passed, and I want you, your readers and my readers to know that I spent a lot of time preparing those two pieces exclusively for you at your invitation for comments. You are as sincere as I am, aren’t you? 

When I’ve caught others in the squeeze you might be experiencing, several have pleaded that the censorship was an innocent oversight, and did the right thing immediately by posting everything I send them (include this comment, please). And then again, there are a few slow-learning, command-and-control types who think they cam still somehow control the content of their Websites. Like you, Kelly, an anonymous dentalblogs.com editor whom I call “Nancy” by default, also informed me that my comments were awaiting indefinite moderation. What a foolish, rookie mistake that proved to be. For example, if you google “dentalblogs.com,” my article “Dentalblogs.com hates D. Kellus Pruitt DDS” is their 4th hit. It seems to be very popular. 

How’s this for the title of a comment that should make it to your first page by Monday: “Kelly Mclendon RHIA censors D. Kellus Pruitt DDS”? Please, no phone calls. 

D. Kellus Pruitt; DDS 

Dateline 8.9.09 

I’m sure physicians’ businesses are no different than dentists’ when it comes to the liability of data breaches – especially considering the giddy, mindless momentum of HITECH-empowered HIPAA. If a computer is stolen in a burglary, compromised by a dishonest employee who sells IDs on the side, or otherwise hacked, and the dentist reports the tragedy according to the letter of the law, it inevitably means bankruptcy even before the feel-good fines are levied by HHS (HIPAA) and the FTC (Red Flags Rule) for not having required irrelevant documentation of administrative trivia in order. What were our lawmakers thinking? 

I guess the HIPAA blunder proves that when politicians, insurers and healthcare IT entrepreneurs get together in vendor clubs like CCHIT, the only government-approved eHR certification authority, they can mandate damn well any law that suits their needs. 

Allscripts CEO Glen Tullman, who is an influential friend of Barack Obama as well as a Trustee of CCHIT told Bloomberg.com reporter Alex Nussbaum in an interview almost a year ago that providers should make the financial commitment “to ensure that doctors have some skin in the game.” 

Glen Tullman is only one reason our nation’s healthcare IT industry stinks from the top down. 

D. Kellus Pruitt; DDS

Dateline: 8.10.09 

Thank you, Kelly Mclendon, for providing a rare venue to possibly clear up a few items of uncertainty about eHRs in dentistry. First of all, if a technological advancement such as eDRs does not pay for itself, even with government subsidies, who pays for it? That seems like a quick way to increase the costs of dental care – and for what? How do dental patients benefit from expensive HIT solutions when the telephone, fax machine and US Mail serve us fine? 

Digitalization of records offers no benefits to dental patients. Only stakeholders who would grab our patients’ money benefit from HIT. Everyone else loses. Trusting, naive dental patients lose the most. 

Electronic dental records are expensive hazards. If you can think of a lame reason for them, please let me hear it. You can bet I’ve crushed it before. I’ve been down this road with others many, many times. 

Within a week, the government will price computerization smooth out of dentistry. Over 90% of dentists have patient identities on their computers today. If HIPAA is enforced, with or without the Red Flags Rule, I predict that less than half of the nation’s dentists will be computerized a year from now. 

As for your argument that eHRs somehow provide up-to-date and otherwise superior medical histories for dental patients, think about this: If someone changes a paper medical history, it leaves a paper trail. If an insurance thief alters allergies on a digital record to suit his or her own needs, nobody in the emergency room can tell. Whoever said “Paper kills,” lied. It is a catchy PR pitch, though.

Conclusion

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About HealthCareTownHall.com

The Great eHR Debates

By Staff Writers

US CapitolMilliman hosts this blog to encourage an informed dialogue about healthcare reform. Healthcare is complicated, and there is no single, silver-bullet answer to the question of “How do we best improve the current system?”  But thoughtful discussions will help move reform in the right direction and mend the fractured system.

Assessment

A shout-out of thanks, for this link, goes to Jeremy Engdahl Johnson of Healthcare Town Hall.

Link: http://www.healthcaretownhall.com/

Conclusion

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Reviewing Medical PDAs

Physician Use Growing Slowly

By Carol S. Miller; RN, MBAbiz-book10

Handheld personal digital assistants (PDAs), such as Palm Pilot M130, 500 or 515, Sony Clie, Visor Prism or Pro, Psion, RIM Blackberry, Zaurus, iPhone, Zune and other comparable PDA OS platforms, have revolutionized the communication world this past decade. PDAs and their future counterparts are becoming the catalyst for physicians to use information technology, are becoming the intro for physicians into the world of the electronic medical record software, and becoming the virtual office tool, enabling providers to communicate away from the desktop as well as away from his office practice. The reasons for increased utilization with physicians are portability, pocket-size, provides easy access to information at point of care and regardless of location, improves practice efficiency and workflow, improves drug related decisions and decreases adverse drug events.  

PDA Components

The common uses of PDAs by physician practices are:

 

  • Personal applications such as scheduling, telephone directories, dictionary, “to-do lists” and others
  • Drug databases
  • Clinic suite that ties into the hospital information system
  • Charge and procedure capture
  • Communications, from provider to provider, provider to hospital, provider to office, and vice versa

Palm Operating System

Palm OS still represents the standard in handheld computing, assisting individuals to manage and access information at any time, at any location.  Handhelds are easy to use.  Physicians are using the Palm OS and/or compatible PDAs to access their office schedules, receive downloads of clinical information on their patients, and enter clinical services and charges when performing services at remote locations.

PDA Selection

In selecting not only the PDA but also the software, the physician needs to answer the following questions:

 

  • What would you like to use the PDA for – clinical reference data, patient information, non-clinical applications, personal data, etc.?
  • What information do you need to know about the patient that the PDA can simplify?
  • What is the connection route between the hospital, managed care, or lab and your practice? In other words, how do you get access to the data?
  • What are your price considerations?
  • Do you need a color or black and white screen?
  • What is the system support and warranty?
  • How do you plan to connect to the office or hospital? 
  • Do you want to go wireless or obtain information via a telephone connection?
  • Do you plan to render care outside of your office practice, such as in the home, a clinic, hospital setting, etc?  If so, what would you like included on the PDA that would improve communication with the office and save time at point-of-service in documentation?

HIPAA

HIPAA regulations do not specifically address the specific term PDA, but the regulations do include guidelines for protecting patient information and transmission of this data that can impact the use of PDAs.  Physicians are utilizing handheld digital assistants whether they contain clinical information; or just resource data, may be or not are password protected, and may or may not be officially supported by hospitals or clinics.  Providers as they prepare for future applications and usage of PDAs involving patient information must understand the scope of the new HIPAA regulations as it impacts on patient data collected, stored or transmitted.  Any application involving patient identifiable data must be HIPAA compliant.  The key issues are how to protect the patient information stored on the device, i.e., if lost or stolen, and second how to protect patient information transmitted during a synchronization or wireless transaction.  Probably the most vulnerable aspect is the loss rate with recent studies indicating at least 30%.

Security

Most providers using PDAs for patient data utilize a user ID or password level of security. To maintain security, the provider should be required to re-enter their user ID or password every time they enter the application. Likewise, each PDA should have a “time out” feature, requiring a provider to re-enter his ID or password again. This feature will not prevent individuals with technical skills from accessing this information – the only mechanism is encryption.

Synchronization versus Wireless Applications

1. Synchronization transfers information from the enterprise database to the PDA, i.e., hospital lab or x-ray results, patient demographics, consultative notes, and others.  It is important that the hospital or hospital system authorize and approve the physician for using and transmitting this information and in turn, the provider authenticates and validates his agreement with the hospital before data is transmitted.  In addition for protection, an audit trail of who synchronized and what data was transmitted should be maintained by the hospital system.

2. Wireless providers have immediate real time access to patient data; however this process of transmission is more vulnerable than synchronization.  Wireless solutions can utilize a public or private network. HIPAA require encryption for the transmission of data over the public networks – Encryption is optional for others. Sharing data from a wireless over the Internet represents potential security issues; however, more and more technical firms and providers are using a wireless VPN that allows PDA users to connect securely from remote locations just as laptop users do today.

Other Issues

The other issues are who owns the PDA. If the provider does, he or she should be responsible for the security; however if the hospital does, the hospital should be responsible.  More current applications of Palm OS will include built-in modems for easier wireless communication, improved secure transactions, and ability of greater resolution for graphics, and other Web-based services. In addition, current and future applications will include refined voice dictation.  As an example, MDEverywhere’s package called Everynote allows the provider to digitally record notes and in turn links with MDEverywhere’s coded patient encounter.

The Blackberry

A very versatile product is the Blackberry.  It has web browsing capabilities, embedded wireless modem and can (1) write, send receive and respond to messages right from the unit, (2) access web information, (3) has nationwide coverage with no roaming fees, (4) has voice mail message capabilities, and (5) can be the size of a pager or PDA. The next feature with Blackberry will be its text messages to cell telephones.  New units start around $150-$300 with monthly service charges of $20-$50 depending on the plan.  The wireless Internet connection can be accomplished through Go.Web. 

Assessment

The typical cost for a PDA averages between $300 and $600 – depending on color or black and white – plus the cost of additional software and accessories.  For wireless connectivity, the physician will need to connect with a communication partner. Reference sites for PDAs are: www.handheldmed.com (for clinical, reviews, and news), www.pdamd.com (PDA resources), www.freewarepalm.com (free software programs), www.palmpilot.com, www.handspring.com.  The active shopper can refer to www.zdnet.com or www.palmblvd.com

Conclusion

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Military Health System Records

Expanding PHR Pilot Testing

By Staff Reporterscomputer-hardware2

According to Paul McCloskey, on April 08, 2009, the Military Health System [MHS] will extend its test of personal health records at Madigan Army Medical Center in Tacoma, Wash., to two additional health care venues in an attempt to test the technology in larger populations and more diverse care settings.

MiCare PHR Focus

The new projects will focus on using the MiCare Personal Health Record [PHR] as a tool for care coordination and a mechanism for patients to share health records across a mix of military and commercial providers and payer organizations, according to Col. Keith Salzman, chief of informatics at Madigan, which is hosting a pilot test of MHS’ MiCare PHR.

Assessment

Link: http://govhealthit.com/articles/2009/04/08/phr-pilot-testing.aspx?s=GHIT_140409

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The Health Dictionary Series

dhimc-book13Meet a ME-P Sponsor

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The “Dictionary of Health Information Technology and Security” was recently released.

It was edited by our own Dr. David Edward Marcinko and Professor Hope Rachel Hetico, as a collaborative and wiki-enabled, peer-reviewed, print publication.

Link: Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Terms and Definitions

It contains over 10,000 entries, including 5000+ definitions, 3000+ abbreviations and acronyms, and 2000+ resources and readings. The book provides a comprehensive, handy, and up-to-date guide to this rapidly expanding area of the health care industry. The dictionary covers the language of every healthcare IT industry sector:

1. Software, codes, and operating languages–hardware, PDFs and peripherals, legislation and policies.

2. PCs; LANs, WANs, Internet/intranet, T1, Ethernet and cable lines, and notable HIT industry icons.

3. Security, WiFi, WiMax, tele-medicine, tele-radiology, tele-surgery and HIT security and risk management concerns

Assessment

It also highlights new terminology and current definitions, and explains confusing acronyms and abbreviations. It is global in coverage addressing international tech standards as well as those used in the US, and is arranged in a simple A-Z format.

www.HealthDictionarySeries.com

Conclusion

Two other dictionaries in the series are also available:

1. Dictionary of Health Insurance and Managed Care

2. Dictionary of Health Economics and Finance

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  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Medicare and Medicaid Health IT Network Proposal

Governmental Initiative for the Elderly and Poor

By Staff Reporters200298593-001

According to Nancy Ferris of Government Health IT, on Mar 18, 2009, a rapid learning health information data network could close some gaps in medical knowledge and cut costs for Medicare and Medicaid recipients.

A Congressional Letter

In a letter to Congress, a group of health policy experts urged creation of a network to share information on Medicare and Medicaid patients in order to improve treatment received. In particular, Lynn Etheredge, one signatory of the letter, wants information to be shared on “dual eligible’s”. This term is defined as low income, elderly patients who receive money for medical care from both Medicare [Federal] and Medicaid [State] sources.dhimc-book6

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According to Etheredge, there are 7 million such dually-eligible patients in the US, which represents 40 percent of Medicaid spending, and 25 percent of Medicare spending. Etheredge and the others suggest that a network backed by government policy would hasten treatments for everyone.

Assessment

Others who signed the letter include Kenneth Kizer, who created the health-records system for the Department of Veteran Affairs; Commonwealth Fund President Karen Davis; National Quality Forum [NQF] President and CEO Janet Corrigan and National Committee for Quality Assurance [NCQA] President Margaret O’Kane. 

Link: http://govhealthit.com/articles/2009/03/18/network-for-data-on-medicaid-medicare-patients.aspx

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. One conclusion of this letter was that“[Researchers] spend way too much time simply acquiring data.” Do you agree, why or why not? Please opine. Will networked eHRs, eMRs and eDRs really save money and time; or cost money and time? Can they be inter-operable and connected on a nationally networked basis that is cost-effective, secure and available to all providers? What about CCHIT, and other vendors?

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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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The Build or Buy Decision in HIT

Out-Source or In-House?

Staff Writers

ho-journal6An important consideration when looking at the development of new health information technological functionality is whether to obtain the system from an outside vendor or build the system using primarily internal staff.

 

Criterion

Basically, according to healthcare Chief Information Officer [CIO] Richard Mata MD MIS, such a build or buy decision depends on the following aspects:

· Availability of internal resources to hire the highly skilled staff needed to create a new system;

· Availability of vendors with proven expertise in the area of technology relevant to the new project; and

· Flexibility of the vendors to customize their products, for hospitals or health entities, with unique needs.

Consultants versus FTEs

The temptation to use consultants rather than FTEs to develop and implement the new system needs exploring.

Advantages

On the positive side, finding consultants that have highly specialized expertise relevant to the project is often less difficult than finding such expertise in people willing to come on board as FTEs. Such expertise in clinical informatics may be critical to the success of the project.

Disadvantages

On the negative side, the cash outlay for multiple consultants can be staggering, especially if multiple consultants come on board with long-term contracts and retainers. Specialized consultants may charge up to $150 to $200 dollars per hour, quickly draining the most robust of IT budgets. Consultants should be used for just that — consulting. They exist on the project for their expertise and transfer of knowledge to the rest of the staff. To use consultants to do the hands-on tasks of actually building the system is generally not an optimal use of the consultant’s time. Consultants, if used at all, should typically be used on a temporary basis to share their expertise and advice during critical parts of the project.

Off the Shelf Applications

Overall, buying an application off the shelf may be favored for more sophisticated healthcare applications. For example, computerized order entry and eMR systems have a number of dedicated vendors that are vying to achieve market share. For major projects, distributing request for information (RFI) packages to selected vendors enables physician-executives and senior management to critically evaluate the different vendors in parallel, in the end selecting finalists and the vendor of choice. A critical requirement when evaluating vendors is that they have a strong client reference base. The best predictor of future success is past success, and thus multiple existing satisfied clients are essential in the chosen vendor.

Hospitals and Healthcare Systems

Larger academic or tertiary care systems, however, tend to have more access to expertise and more significant customization requirements. Consequently, building a home-grown system rather than outsourcing the work to a vendor may be the best strategy for such institutions.

Vendors

When working with vendors, one should be strategic in price negotiations. One suggestion is to link part of the vendor compensation to the success of the implementation. This puts the vendor partially “at risk” for project success and thus provides additional incentive for vendor cooperation. Additionally, one should not purchase a system or services from the initial bid. It is critical that more than one vendor bids for the project to provide a pricing and negotiation advantage.

There is nothing that states only one vendor can be chosen for a project.

Best-of-Breed

Although obtaining everything from one vendor can lead to a more seamless integration and prevent the juggling of multiple vendor relationships, using more than one vendor may in some cases lead to a higher quality end product. This is known as the “best of breed” approach and is a viable option, in particular for complex projects where a single vendor does not adequately meet user needs.

For more basic administrative systems, there are also off-the-shelf products from vendors that may be applicable. Where there is less need for customization, a single vendor may work out very well. Where there are significant unique needs that require customization, once again it may be best to develop the system internally or outsource the work to multiple vendors.

Assessment

There is also the issue of small or rural hospitals that have limited resources. For such institutions, investments in more complex information systems may be difficult. Consequently, many vendors offer “stripped down” versions of their systems at a more affordable price, specifically tailored to the small hospital. The ability to customize the system for unique needs, however, is significantly more limited.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. When launching a health information technology systems, how do you decide the question; in-source or outsource?

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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High-Tech Infection Tracking

The Hershey Experience or High-Tech Gamble?

Staff Reporters

gambling

At Hershey Medical Center, in Pennsylvania, a sophisticated computer program now serves as a watchdog for infection outbreaks.

 

 

Internet Enabled Health 2.0

According to the Associated Press, December 30 2008, with a few mouse clicks on a Web browser, the hospital’s infection-control staffers can quickly generate reports with charts and graphs illustrating how many patients within a particular unit are infected, and which lab specimen contained the germs; etc.

Assessment

Some Pennsylvania health officials view the nascent technology as a critical tool for helping hospitals reduce health care costs by identifying potential systemic infection-control problems sooner than is possible by reviewing paper records by hand. Other pundits may not agree!

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Will the data be reported for hospital quality improvement initiatives; or cloistered from stakeholders? And, will infection tracking and rate reporting finally become something more than a high-tech gamble?

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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ADA – Can You Hear Me Now?

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The Sounds of Institutional Silence 

[By Darrell K. Pruitt DDS]

pruitt2

Hey you, American Dental Association.

What do you have against talking with us members?

Do you fear the questions we might ask, or something?

Who I Am 

I am one of a growing number of dentists who believes that our profession, as well as all US health care, urgently needs transparency through communications – hair and all – bottom to top.  That means accountability from leadership.

Government Similarity 

President-elect Barack Obama has the same idea about government. Over a year ago, candidate Obama promised that all his Cabinet Secretaries would maintain weblogs to promote two way communication with all citizens. Even before he takes office, his website has been busy for weeks with interactive conversations with average citizens … yet I cannot get an official from my own professional association to respond to me online at all. I pay dues to the non-profit organization. How good is that?

The Naked Conversations 

Over two years ago, I read about weblogs in “Naked Conversations,” written by Robert Scoble and Shel Israel. I quickly became a fan of networks. A few months later, I offered to help start an ADA weblog – in a conversation with ADA Senior Vice President Dr. John R. Luther. I suggested that if ADA members could interact online with ADA officials or their representatives in real time, the transparency would empower the organization like never before in history. He was not interested.

An ADA Weblog 

Dr. Luther dismissed my idea outright and refused to discuss it further. He specifically told me that when the ADA was ready for a weblog, “the ADA leadership would let me know.” If you don’t recognize it, his was a variation of a typical conversation-ending response often used by leaders of traditional top-to-bottom, command-and-control business models like the ADA’s. Other door-closers are “Just because,” and “Anyway, it’s mandated so we have no choice.”  In my opinion, the ADA and in turn, the dental profession, are hobbled by an archaic model that no longer works and is recently vulnerable to trouble-makers like me who not only don’t play by their self-serving rules – but have a hell of a good time flaunting them. 

So-Called Authoritarian Dismissals 

By the summer of ’06, I was already accustomed to authoritarian dismissals from Dr. Luther.  On a separate issue I had raised earlier concerning the NPI number, he used a nuclear door-closer when he suggested that I write a letter to the editor if his committee-approved non-answer didn’t satisfy me … which he knew didn’t come close. If I had gone through my ADA publications with my question, the turnaround – if it were even considered for publication – would have been at least six weeks. 

Chain of Command 

That is how the leaders of the ADA used to conveniently handle those who didn’t respect proper chain-of-command representation, which normally shelves tricky questions on local dental society levels long before they reach Headquarters in Chicago. Very soon, officials in the ADA will be demanded to explain what’s wrong with responding to members immediately, or their silence will look more and more suspicious. It is not a good time in history to be a dinosaur. Barack Obama’s team finds the time to talk to underlings. What makes the leaders of the American Dental Association so special?

Internal Rules

Oh yea! Here is another internal ADA rule. “Let’s not wash our laundry in public.”  That means laundry never gets washed. Now, Dr. Luther isn’t the only ADA official who won’t venture onto the Internet.  I have tried to attract past Presidents, current Presidents and future Presidents as well.

For example, when one Google searches “Dr. Ron Tankersley,” who will be our next President of the ADA, my article on the PennWell forum titled “An invitation to Dr. Ron Tankersley, President-elect of the ADA” – appears on his first page.

http://community.pennwelldentalgroup.com/forum/topics/an-invitation-to-dr-ron

Here is the invitation that has been ignored for two months

Dear Dr. Tankersley,

I too am a member of the ADA. Congratulations on your election to the highest post in our professional organization. It is an esteemed compliment when so many colleagues put so much faith in a fellow professional, especially in these challenging times for dentistry.

As a dentist, I am excited about the miracles of discovery that will become possible when we begin applying Evidence-Based Dentistry to a vast network of interoperable computers in dentists’ offices across the nation – creating real-time research.

  • How soon do you foresee this happening?
  • Can we expect to see the beginning of it during your reign?

Your response is appreciated by dentists and patients alike.

Assessment

Does anyone else found institutional silence odd these days? Or, am I unprofessional to demand information that I consider is owed me?

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

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.

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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

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Using Fraud Detection Software to Review Medical Claims

MDs May be Slow HIT Adopters – CMS and Insurers are Not!

Staff WritersShadows

Did you know that Medicare and private health plans increasingly have been “mining” medical claims data for potential fraud – for some time now – and with the help of sophisticated computer technology? 

Yes, it seems true – and such IT may be needed more than ever in 2008!

How Much Fraud? 

Fraud accounts for an estimated 3% to 10% of the $2 trillion spent annually on healthcare in the U.S. Within the past few years, companies including Fair Isaac, IBM, ViPS and Ingenix, a subsidiary of UnitedHealth Group, have developed software that detects suspicious patterns in claims data.  

“Spider-Web” Technology

According to the CMS, their technique is called “spider-webbing. 

IOW: Find one common denominator and follow the thread. 

“Red flags” indicating possible fraud include medical providers charging more than peers; providers who administer more tests or procedures per patient than peers; providers who conduct medically “unlikely” procedures; providers who bill for more expensive procedures and equipment when there are cheaper options; and patients who travel long distances for treatment. 

Private Insurers to Follow CMS

For example, Aetna reported its fraud-detection software helped the insurer prevent more than $89 million in fraudulent reimbursements from being paid last year, compared with $15 million it was able to recover after fraudulent payments were already made.

Companies are able to save far more money by detecting fraud before claims are paid than recovering the money after the fact. 

Conclusion 

And so, what are your thoughts on this HIT initiative? Are the private insurance companies and CMS taking advantage of the slow HIT adoption of medical providers? Who is to blame, if anyone? 

Please comment: 

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Original source: USA Today 11/07/06

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Physicians Expanding HIT Expenditures for 2008

A New Study from the Gantry Group

Staff Reporters

 

According to a new study from the Gantry Group, physicians and medical providers will be spending more money on health information technology tools and applications this year. And, their statistics suggest that healthcare providers are allocating forty percent or more of their current technology budget to clinical technology, in 2008.

This includes health information technology [HIT] expenditures for digital medical imaging, medication management, e-prescribing, RFID solutions, electronic medical records, patient care planning tools, patient documentation and various mobile applications.

Generally speaking doctors, physician-executives, CTOs, CIOs and most all organizational CXOs are moving away from custom, in-house created applications and looking for commercial packages that suit their needs.

By the end of 2008, over 80 percent of facilities will have invested in key clinical technologies, the Gantry Group predicted. The costliest items on provider budgets were digital medical imaging and electronic medical records, which in combination, ate up 64 percent of medical providers’ clinical technology budgets. 

Conclusion

And so, what does your HIT budget look like for 2008; is it fixed, flexible, hybrid, zero-based or some other type? 

More information: www.HealthcareFinancials.com 

Related information: www.HealthDictionarySeries.com

 

A New EMR Consortium

Boost for EMR Security?

Staff Writers

 

Nine companies in the health care industry have banded together to create a set of security standards to better protect the information in electronic medical records [EMRs].  

The companies, including HCA, Humana and Highmark Inc., have committed to use the security practices which they will develop along with Health Information Trust Alliance LLC (Hitrust), a Texas- based organization created to oversee the project. To date, Hitrust has received 40 more applications from other companies hoping to participate; with a goal of 155 by the end of February, 2008. 

Although health care companies are currently required by HIPAA to secure protected health information (PHI), the law is vague and each organization is allowed to determine what steps to take on its own. This often requires health entities to audit the data protection practices of business partners and related covered entities.

And so, will this new consortium be a boon to HIT, or just another “new” consortium boon-dongle?

More info: http://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=pd_bbs_sr_4?ie=UTF8&s=books&qid=1197123377&sr=8-4

HIT and Virtual Medical Visits?

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Compensation for e-mail – A New Payment Model for Doctors?

By Staff Writers

It’s been a long wait, but we have recently learned that – ever so slowly – some health plans are beginning to pay doctors for ‘virtual visits’ with patients.

Vendors like McKesson-owned RelayHealth, Epic Systems and Web portal vendor Medfusion have offered the technology for some time, but payer acceptance has been slow. However, a consensus is building that such visits may be a good idea, despite lingering questions over billing and the ability of physicians to legally offer e-care from out of their home state. These visits might save substantial amounts of money while keeping patients healthy–including a Kaiser study concluding that it saves $70 to $120 on each virtual visit.

  1. And so, are hospitals to follow this physician trend?
  2. How about CMS and the various state Medicaid systems?
  3. What about private insurance companies, HMOs and MCOs, etc?

Please opine!

The Moderators 

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NPI Numbers

The Impending NPI Deadline 

By Staff Reporters

www.HealthcareFinancials.com

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Most of us know that until now, hospitals and other healthcare organizations had until May 23, 2008 to implement the National Provider Identifier (NPI) scheme for Medicare claims; but we were apparantly wrong! 

CMS said today that hospitals must get their NPI in place for submitting Medicare fee-for-service claims by January 1, 2008. If not, CMS will begin rejecting such claims. (CMS is will still accept non-NPI claims from professional services providers like doctors, labs and clinics).

CMS officials say they’re moving up the deadline because most providers are already on board with the NPI.

Really! Are they sure? Not from my view of the universe!

To be sure, providers who aren’t using the NPI are already technically in trouble already, as the original deadline is long past. However, as part of the transition to full NPI rollout, CMS has been letting them slide if (in essence) they promised to work on it by filing a contingency plan.

Anyone caught off guard with this announcement?

– A Healthcare CTO

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