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5 pts.
 ONC final rule with respect to ambulatory practice size
ONC has announced its final rule for temporary certification of EHR technology.  With respect to technology for ambulatory practices, there is no distinction between large and small practices.  In other words, one size fits all.  It seems odd to me that to qualify as a meaningful user, a solo physician must use a product that is certified for use in a large practice.  Can someone explain the rationale for this situation?  Perhaps I don’t understand what certification implies…or is this game rigged in favor of the big kids?[o:p][/o:p]

ASKED: July 2, 2010  5:31 PM
UPDATED: July 11, 2010  6:09 pm

Answer Wiki:
While the actual certification of specific EHR systems and modules is still pending, and first requires at least one testing and certification body to be approved by ONC so there will be a way for vendors to get their products certified as compliant for meaningful use, there is no inherent restriction as to the size of the product or the market it which it's intended to be used. There are well over 200 EHR products in the market, some subset of which will seek certification and therefore help eligible providers qualify for incentive funding under meaningful use. It seems likely that in addition to products that will be installed locally within provider facilities, some certified EHR products will be provided as hosted or managed services that might be more attractive to small practices. ONC seems to be well aware that a large proportion of providers work in small practices, and in recent months has initiated new programs like <a href="http://nhindirect.org">NHIN Direct</a> that are focused on enabling health information exchange by small or solo practices. It's certainly fair to say that a small practice may not have the same resources to support an EHR implementation that larger practices might (not just money, but IT staff, technical support, etc.), but the EHR incentives available to eligible providers can be applied to any certified EHR system or module, and there will almost certainly be certified products in the market that are suitable for small providers. ---------------------------------------------------------------------- The certification final rulling is mostly focused on the application meeting the capabilities that are required for meaningful use. If you look at what the certification requires from a vendor stand point and how it would affect the solo or the large hospital, all the requirements seem to be relevant reguardless of size. Example: Wave 1 of the published certification tests focuses on things such as: maintain up to date problem list maintain up to date medication list maintain up to date active medication allergy list Record and chart vital signs Smoking status Computerize Order Entry. Ofcourse, there is the part for meaningful use, which does require the healthcare professional to use the system and capture specific peices of information based on the specialty. I can see how vendors will have additional costs to worry about (I wrote a post about the process here <a href="http://tiny.cc/m9dlp">Blog post here</a> ), which would mean higher licensing costs for practices, but the requirements seem to focus more on capture data and tracking specific things electronicly.
Last Wiki Answer Submitted:  July 8, 2010  4:38 am  by  SteveGonHIT   250 pts.
All Answer Wiki Contributors:  SteveGonHIT   250 pts.
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To understand where I am coming from, I have been in IT for 36 years and in Health Care IT for the last 11. The type of work I do involves setting up and or fixing infrastructures, software integrations/migrations and authoring/contributing to training curriculum for implementation efforts regarding EMR/EHR for medium to nationwide hospitals and clinics, and for pharmaceutical clinical studies world wide – so I get to hear and see many things.

The information being gathered is “personal medical” data and some financial. This information has for years been the target of those with interest in the world wide collection of such data since the late 1800′s. Folks forget or never knew that the first order of business by that subjugated body we call the United Nations in the early 1900′s was to sterilize “imbeciles” world wide. This may sound somewhat sinister to many people, but I assure you that the foundation for this response is based on most of my professional experience consulting to over ninety (yes – 93) clients, most of whom are outside of the community of health care systems, beginning my initiation with first generation IT for an international/national intelligence agency. (Soap box – It was the global bankers who sponsored the oil baron who donated the land for the United Nations).

The simple answer is yes. The next generation of doctors like the current generation of American citizens will have to comply with world wide (new order – lol – ?) edicts to assimilate to requirements that the small practice/individual has no say in, eventually. As an example, in April of 1992, a small not very well known project to collect all the financial transactions of everyone in the United States was funded by our politicians and headed by a former CIA director while posing as the elected president of this country – oops! People were distracted at the time by the high unemployment record not unlike that of today. This collection effort was to premise the introduction of our infamous “Credit Score” program that no one knew about and were never told was on the horizon which one day just quickly swept the nation without the approval or permission of the American people with regards to their “personal financial” data. Somehow the corporate sponsored media forgot to follow up on this event, not one politician ever murmured a word about it, and a shot was never fired for the battle of privacy by those on the side of the American people. The same thing is going to happen with medical records.

Although there is a junkyard dog’s howl by HIPAA and CFR officials, EVERYONE knows they really have no teeth. Here and there we have some examples to placate those who would otherwise out right refuse to be a part of this effort to centralize (world wide) patient medical data, but this too will pass, as each and every generation is born into the pleasant orderly world of subjugation. The think tank for personal medical record collection recognizes that the masses must be satisfied that efforts are being made on their behalf to maintain the integrity and privacy of their medical records without compromise by our powerful government agencies – and without ever really knowing what those efforts are and whether their data is being compromised already – news at 11! In the past I was approached to join such tanks, but the muzzle didn’t fit.

Now what are the recommendations. Those large executive boards with the billion dollar budgets are putting in place “affiliate” programs for the purpose of absorbing, oops! I mean, for the purpose of providing EMR/EHR IT system functionality that only hundreds of millions of dollars can provide. If a smaller “Joe” tries to come up with their own system you’re half right, the certification process alone will not be the culprit but the cost of liability insurance and maintaining such a system will blow them clean out of the water. The tail that wags the dog of privacy is the cost of doing business where the regulatory sheriffs of patient record compliance are elected by the global entities whose interests they serve. If the largest hospital in your area has not implemented their “affiliate” program yet, then wait for that to happen. There are some folks already providing first generation affiliate programs with overseas clients – very ambitious though and not all the bugs are worked as of this writing. Before joining, ask for the installed base – specifically for the installed base of the affiliate software vendor.

So, the answer is, if you are small and not tall, assimilate, resistance is futile. Prepare by getting some nice computers that are easy to use, they may seem to cost a lot at first but imagine having the same computer for 10 years! You save by not having to pay long-hairs in the dungeons to fix them – maintenance cost down by 70 to 90 percent. Pay good money for a fast in house computer network (Gigabyte not Gigabit) with the biggest bandwidth, some really nice printers, and supplies. Invest your hard earned dollars on great hardware pieces that you would otherwise not consider spending such high dollar amounts, rather than on vendor’s promises, attorney fees to review your compliance, or attending IT conferences purporting EMR/EHR systems you could never afford, not to mention all the training classes and certifications scams you’d have to put up with. I prefer Macintosh because I don’t like having to fix computers that I use. All the EMR/EHR technologies work on all systems but be forewarned of those with religious arguments concerning such matters. Don’t forget to have a disaster recovery strategy to guarantee your up time – this time around.

There are some major changes in the background of communications technologies that are actually already here and yet to be implemented. In layman’s terms, if I can speak to that anymore, affiliate programs run on the Internet which poses a current limit of 64,000 concurrent encrypted sessions – Wiki Extranet and Infranet. One user may have more than one encrypted concurrent session. What this translates to is that this feature will bring to its knees any full blown affiliate implementation. But since most are in their infancy as of this writing, the issue is relatively unknown to most regular folks and only to a few long-hairs in the geek world who are hard to hear no mater what their physical proximity is. The new technology requires very little configuration changes to hardware, operating systems or applications. The infrastructure supporting EMR/EHR, enterprise networks of all flavors use very similar network hardware. Once this feature is implemented on existing enterprise networks, the concurrent user limit for encrypted data will scale to four million (4,000,000) and due to the other geek parts, will have a reduced fragmentation by a factor of four, which translates to 12.3 times faster than today’s Internet. If and when you become a part of an “affiliate” program, this whole paragraph will be transparent to you and your network environment – like knowing the amount of fuel pressure on that car you drive everyday.

Now, chose the battle you can win.

 280 pts.

 

That does not make sense at all. There’s a good selection connected with what’s going on

 0 pts.

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