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All Things HIT

June 22, 2010  1:35 PM

Health Reform and HITECH: More than distant cousins!

Posted by: AllinHIT
Health Reform

I recently attended a “Power Breakfast”, on Health Reform, sponsored by the local Business Journal, for educating the local business community.  The 4 person panel included one local Hospital executive, and a local business owner, who has one of the largest medical billing operations, in the State.  In a past life, I worked closely with this biller, managing a PM VAR channel, of which they were a reseller.  The other panel members, not relevant to this blog, had legal backgrounds in healthcare. I listened for 45 minutes on what it means for an estimated 32 million patients becoming a part of the healthcare delivery system, due to health reform.  I listened to the ramifications of bringing this many more patients, with their silos of information into healthcare. I listened to the legal ramifications of the bill, increasing of premiums for business owners, tort reform wasn’t addressed and should of been …blah blah blah!

What I didn’t hear was the impact of ARRA/HITECH provisions, the future of our delivery system with programs like medical homes, Accountable Care Organizations, and how we are moving towards a quality model. Matter of fact, EHR’s, PHR’s, HITECH, Meaningful Use, and ALL THINGS HIT, were never even mentioned! Of course, being the advocate and educator I am, I wanted to be the first person to ask a question during Q&A, and I was!  I gave a brief explaination of HITECH, and its possible effect on the issues discussed. I addressed the panel, stating their omission of HITECH and the meaningful use of the technology it represents, is crucial when looking at health reform. These two are more than distant cousins, but more like faternal twins.

The hospital executive, recognized this error and quickly agreed and clarified its importance, mentioning what his hospital is doing in those areas (since, I’ve been invited, and have accepted, an invitation to meet with them).  I then asked the biller, my old compatriot, how does she feel about HITECH? How will it effect her business as a biller? Her answer was surprising to me.  She stated, and I’m paraphrasing, “my physician clients will not adopt the technology because of all the “issues around implementation, and EHR’s not really doing what they suppose too”!  Wow, I quickly wondered if I could be looking at a dinosaur, trying not be extinct!

June 14, 2010  8:05 AM

Meaningful Use: One step at a time!

Posted by: AllinHIT
CPOE, EHR, Meaningful use

Like most of you, I have reviewed, discussed, and pondered issues, centered around Meaningful Use (MU).  I was under the impression that EHR Adoption, was ONC’s primary goal.  However, based upon the initial 25 requirements in Stage 1, I must of been mistaken!

If adoption was the goal, the ONC should of given the first year of incentives (18k), just for implementing the technology! Vendor selection, then implementation, is disruptive enough to operations!  ONC’s fast and “in a hurry”  MU steps, disallows the physician to adopt using what I call a step-wise approach. Implementing in modules, versus all modules, lessens the impact on operations, workflow, and resources!

Ok…lets say the other goal besides adoption, was ONC wanted some assurance that physicians were using the systems.  I agree that CPOE, is at the top of the list, in terms of benefits and its ranking in meaningful use of the system.  However, I suggest some CPOE requirement changes!

The first change is too allow for designated MA’s, PA’s, and other staff members to directly input CPOE orders.  Having the physician requirement of physically inputing these orders, to the tune of 80%, puts an unneccessary burden on the physician!  Second, CPOE should only apply to lab and pharmacy orders!  Radiology, physical therapy, and other services should be further down the road, giving the physician and the vendors time to develop interfaces and interface engines, where non exist now. For example, I recently talked with the CIO of a large radiology company, about their efforts to create a “RAD Hub”.  This Hub would make it easier for physicians to meet this requirement, when it “go live” in the next year.  EHR Lab interfaces are commonplace, and due to the CMS 2% e-prescribing incentive, ePre exists more and more into a physicians workflow.  It will be easy to take the stand -alone ePre systems, and convert the process in an EHR with an ePre module.  These changes will increase adoption, lessen the burden to the physician and the practice, and lastly, put us on the road to true meaningful use.

June 14, 2010  8:03 AM

Health IT: A Metamorphosis I love!

Posted by: AllinHIT
EHR, HITECH, Meaningful use

Yes I said it…..I love Health IT, and all things related to HIT!  For the past 30 years, I have been involved with all things related to technology, However, its all things in HIT, that has capture my heart, and vigorates my mind!  Hence, I guess to some this sounds a little sadistical.  Why would you love an industry, where adoption of your technology is so low?  Where, your main physician targets, are earning less, but expected to do more  (sound familiar primary doc’s?).  An industry, whereas, your technology disrupts operations, the ROI is questionable, and results are mixed, and there is a mis-trust of getting government Incentives (have you gotten your PQRI or CMS ePrescribe incentive yet?) These challenges, ever-changing requirements, and possible new models of delivery, is what I love about HIT!! 

For the record, as a HIT consultant, sometimes I felt like a preacher, as I am pro HIT adoption.  Now, a new chorus is singing my tune of adoption……the ONC chorus!  Although, I embrace ONC’s efforts to increase adoption, I am very aware of the issues they have created (MU of course is the big one).  Physicians are scared, and I can’t blame them.  MU brings new challenges to adoption, but I continue to ask myself and others…What is best for the patient…a paper or electronic chart?  It is the answer that drives me to educate patients and physicians, address and voice their valid concerns, but ultimately advocating adoption.  The term “metamorphosis”, has a definition which states there is a conspicuous and relatively abrupt change, and the ONC, as a result of HITECH, has done exactly that to HIT. 

So…this blog will not just keep watch of this metamorphosis, but hopefully influence it.  Lets explore topics, such as adoption/implementation, MU, REC’s, Patient-centered Medical Homes, Integration (HIE’s), and ALL Things HIT.  I will tap my industry friends made up of physicians;Hosptial executives; ONC members(Gayle, I will be calling you), EHR and HIT vendors, payors, and last but not least, YOU!  For this inaugural blog and all to come, I officially invite you to read,  constructively respond, teach and learn ALL Things HIT!.

June 14, 2010  8:02 AM

RECs: Are they setup for failure?

Posted by: AllinHIT
Meaningful use, REC

I have been an adviser and was an adviser to a couple of REC’s directors and after many discussions with physicians and REC directors and/or awardees, I have come to a couple of conclusions.  First, some of the REC’s awardees are medical schools, which could be the problem right there.  I talked with many physicians, trying to convince them that a REC will provide the services they need for the selection, implementation, and assistance with MU compliance.  Some physicians have made it clear to me that they don’t believe the Medical school is qualified to consult on workflow, EHR selection, and the other services associated with adoption.  As one physician asked me, “When was the last time medical school directors and physicians, were in a 1doctor practice?”.  This was a valid question, one that made me think?

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