I already reported the results of the annual HIMSS healthcare CIO survey in a story I wrote for InformationWeek the other day. Since everybody seems to love infographics these days, HIMSS produced one visualizing some of the highlights, including the finding that two-thirds of U.S. hospitals already have met Stage 1 meaningful use. Based on this, I’m guessing that close to 90 percent should be there by the end of the year, which means that CMS and ONC will have achieved their objectives for Stage 1, at least on the hospital side. (Of course, the physician part is proving to be much more difficult.) Someone in the know at ONC told me last night that people in that office are expecting 80 percent hospital success by the time fiscal year 2013 closes Sept. 30.
Once again, as has become custom, I sat down with HIMSS CEO Steve Lieber at the organization’s Chicago headquarters the week before the annual HIMSS conference to discuss the conference as well as important trends and issues in the health IT industry. I did the interview Monday.
Here it is late Friday and I’m finally getting around to posting the interview, but it’s still in plenty of time for you to listen before you get on your flight to New Orleans for HIMSS13, which starts Monday but which really gets going with pre-conference activities on Sunday. At the very least, you have time to download the podcast and listen on the plane or even in the car on the way to the airport. As a bonus, the audio quality is better than usual.
Podcast details: Interview with HIMSS CEO Steve Lieber about HIMSS13 and the state of health IT. Recorded Feb. 25, 2013, at HIMSS HQ in Chicago. MP3, stereo, 128 kbps, 46.0 MB. Running time: 50:17.
1:00 Industry growth and industry consolidation
3:45 Why Dr. Eric Topol is keynoting
6:00 New Orleans as a HIMSS venue
6:50 Changes at HIMSS13, including integration of HIT X.0 into the main conference
8:55 Focus on the patient experience
9:35 Global Health Forum and other “conferences within a conference”
13:00 Criticisms of meaningful use, EHRs and health IT in general
17:00 Progress in the last five years
20:45 Healthcare reform, including payment reform
22:30 Why private payers haven’t demanded EHR usage since meaningful use came along
23:50 Payers and data
26:28 Potential for delay of 2015 penalties for not meeting meaningful use
29:15 Benefits of EHRs
30:40 Progress on interoperability between EHRs and medical devices
32:52 Efficiency gains from health IT
35:27 Home-based monitoring in the framework of accountable care
36:55 Consumerism in healthcare
39:40 Accelerating pace of change
41:10 Entrepreneurs, free markets and the economics of healthcare
43:25 Informed, empowered patients and consumer outreach
46:30 Fundamental change in care delivery
This may have made the rounds a month ago, but I just starting to dig myself out of a major work hole I’ve been in for a good six months, thanks to the terminal illness and subsequent death of my father that caused me to put off working on a major project for a long time. I’ve finally finished my part and it’s in the hands of the editors, so I spent most of my flight from Chicago to LA Thursday reading hundreds of e-mails, including this one I received Sept. 6.
HealthPoint, the health IT Regional Extension Center for South Dakota, based at Dakota State University, produced this infographic explaining the major differences between Stage 1 and Stage 2 of the “meaningful use” EHR incentive program. As far as I can tell, it’s accurate.
Feedback is welcome. Read more..
In a rare turn of events, I’m the one being asked the questions on a podcast by Sivad Business Solutions, which hosts regular audio discussions on a variety of business topics. I give kind of a high-level view of health IT and offer my very strong opinions on patient safety and healthcare reform. There’s an interesting discussion about EHRs being designed to maximize reimbursements rather than assure safety.
Interestingly, we recorded this via Skype. I like the audio quality, if not the nasal quality of my own voice, more than usual that day.
Hopefully the embedded audio works. If not, click here.
I’ve spent a lot of time on social media since Thursday morning debating the meaning of the Supreme Court’s rather stunning decision on the Patient Protection and Affordable Care Act. It was stunning in that Chief Justice John Roberts, a George W. Bush appointee, sided with the four liberal-minded justices, but also stunning in that the court went against conventional wisdom by upholding the individual mandate on the grounds that it was a legal exercise of Congress’ constitutional right to levy taxes.
I had to remind a lot of people that this decision neither solves the crisis, as supporters have claimed, or turns us into the Soviet Union, as some on the lunatic fringe have suggested. Expanding insurance only throws more money at the same problem. This was my first tweet after I learned of the decision:
The cynic in me likes to point out that the individual mandate was an idea first conceived by the conservative Heritage Foundation and championed in Massachusetts by Mitt Romney. Both somehow now oppose the idea. The law that ultimately passed Congress was written by Liz Fowler, a top legal counsel to Max Baucus’ Senate Finance Committee who previously was a lobbyist for WellPoint. Her reward for doing the bidding of the insurance industry was for Obama to appoint her deputy director of the Office of Consumer Information and Oversight at HHS. This was insider dealing at its finest, as much a gift to insurers as the 2003 Medicare Prescription Drug, Improvement and Modernization Act was a gift to Big Pharma.
Of course, I initially was misinformed about the Supreme Court ruling because CNN jumped the gun (as did Fox News) and erroneously reported that the court had struck down the individual mandate on the grounds that it violated the Interstate Commerce clause of the Constitution. But so were millions of others.
I suppose that was fitting, since the national media have for more than two years been misinforming the public about what is really in the law. There are small but real elements of actual care reform — not just an insurance expansion — in there, but very few have been reported. The actual reform has been drowned out by ideologues on both sides. Here’s a handy explanation of most of what’s really there (it’s a good list but not exhaustive). The insurance expansion, the only thing people are talking about, really is just throwing more money at the problem. There is a lot more work to be done to fix our broken system.
What I consider real reform in the ACA includes accountable care organizations and the creation of the Center for Medicare and Medicaid Innovation. Along with the innovation center, CMS also gets the power to expand pilot programs that are successful at saving money or producing better outcomes. In the past, successful “demonstrations” would need specific authorization from Congress, which could take years.
Notice that there isn’t a whole lot specific to IT. That’s because the “meaningful use” incentive program for EHRs was authorized by the 2009 American Recovery and Reinvestment Act. Another key element of real reform that also is not part of the ACA is Medicare’s new policy of not reimbursing for certain preventable hospital readmissions within 30 days of discharge.
We need more attention to quality of care. Many have argued that tort reform needs to be part of the equation, too, because defensive medicine leads to duplicative and often unnecessary care. Perhaps, but lawsuits are a small issue compared to the problem of medical errors. Cut down on mistakes and you cut down on malpractice suits. Properly implemented EHRs and health information exchange — and I do mean properly implemented — will help by improving communication between providers so everybody involved with a patient’s care knows exactly what’s going on at all times.
All of these facts lead me to conclude that true healthcare reform hasn’t really happened yet. Look at this Supreme Court ruling as a beginning, not an end, to reform.
One of the more interesting figures in health IT is Evan Steele, the outspoken CEO of ambulatory EMR vendor SRSsoft. For years, Steele pushed his Montvale, N.J.-based company’s “hybrid” EMR as a product that won’t slow down “high-performance” physicians. After passage of the American Recovery and Reinvestment Act in 2009, Steele openly boasted that his customers—mostly specialists—were prepared not to receive bonuses for “meaningful use,” a program he believes is skewed toward primary care.
Recently though, Steele has shifted his stance. SRSsoft has rebranded “hybrid” EMR as SRS EHR and now is seeking certification so customers can qualify for the federal incentive program. What makes Steele tick and what led to his change of heart? This podcast provides some answers.
I apologize for the audio quality. I was using a new telephone recording device, and clearly don’t have the settings right. I edited this on an airplane, and the recording was tolerable. Just listen with a bunch of background noise and it’ll be fine. :)
Podcast details: Interview with Evan Steele, CEO of SRSsoft. MP3, stereo, 128 kbps, 27.8 MB. Running time 28:22.
0:57 “Hybrid” EMR and physician productivity
1:40 Change in direction for the company with certification
2:15 What has and hasn’t changed with the product itself
3:10 Still targeting “high-performance” physicians
5:25 Why he says SRS EHR won’t slow physicians down
6:40 Documentation options
7:30 Why he believes Stage 1 meaningful use is skewed toward primary care
9:40 Changes in final regulations that focus on specialists
10:35 Why SRS is seeking certification now
13:00 Differences between SRS and other vendors
14:00 Physician confusion about meaningful use
15:40 “Unnatural” elements for specialists in meaningful use
16:30 Innovation being “sapped” from marketplace
17:00 Gamble of the stimulus
18:15 How SRS is innovating within the confines of the new rules
20:00 Expectations for HIMSS11
22:05 What SRS gets out of going to HIMSS
23:30 SRS’ niche among large, enterprise systems vendors
26:20 Message for HIMSS attendees
Here, Extormity senior executive Frederick “The Colonel” Youngblood testifies before a panel investigating EHR implementation practices. Gotta love movie parodies!
Seriously, though, if Extormity is such a profit machine, how come this video isn’t even available in high quality, much less high definition? Even I have an HD camera.