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APSO vs. SOAP, continued

A couple weeks ago, I had a story in Healthcare IT News about the growing use of the “APSO” notes for documenting patient encounters. APSO flips around the traditional SOAP format (subjective, objective, assessment, plan), ostensibly making it easier to view progress notes in electronic health records.

As I reported, APSO is in wide use at University of Colorado Health and at Lucile Packard Children’s Hospital in Palo Alto, Calif. Baystate Health in Springfield, Mass., found that hospitalists focused most of their attention on the “impression and plan” sections of patient records, essentially the AP part of APSO/SOAP. Physicians at Epic Systems, according to University of Colorado’s Dr. C.T. Lin, are recommending APSO as a best practice.

Yet, the inventor of the SOAP note, Dr. Larry Weed, still believes his format is superior. You saw his comments in the Healthcare IT News story. But every time I have the privilege of speaking to the nonogenarian Renaissance man, he always has more to say than I can fit into the average article. I often can’t keep up in my note taking, but, fortunately, in this case, Weed and his son/occasional co-author Lincoln, took the time to put their thoughts in writing for me.

I left most of their comments out of the story due to space limitations. I don’t have that problem here, so I present their entire statement to me:

The following represents our collective thoughts, including references to relevant portions of Medicine in Denial [their 2012 book].

The supposed advantage of the APSO alternative — that it begins with the physician’s assessment rather than data — is actually a failing. This sequence tends to make the note provider-centered rather than patient-centered, and judgment-based rather than evidence-based.  In contrast, beginning the progress note with data disciplines the provider’s assessment. The provider must think in terms of specific data, specific problems on the problem list to which the data relate, and the interrelationship of each problem to the other problems on the list. Moreover, it’s important to begin the progress note with subjective (symptomatic) data from the patient rather than so-called “objective” data,  As Medicine in Denial states (p. 168):
“… progress notes should begin with subjective data, because progress should be assessed from the patient’s point of view.  Practitioners should be alert to discrepancies between subjective and objective data (for example, where the patient does not feel better when lab results show improvement). These discrepancies may signal an error in data or misstatement of the patient’s problem.”
In short, provider thinking can be disciplined with problem-oriented SOAP notes as a standard of care. Yet, regulators and academics who are in a position to act on this issue have shied away from the whole notion of standards of care for organizing data in medical records. See our comments on ONC’s Stage 2 regs and our comments on the PCAST Report.
The need for standards of care in medical records goes far beyond the SOAP vs. APSO issue in progress notes. In fact, that issue is secondary. Two more fundamental issues for medical records are the following:
  1.  Determining initial inputs to the record. Initial inputs are determined by selection of data needed for the patient’s problem situation, and once the data are collected, analysis of the results.  Both selection and analysis are fatally compromised when determined by the physician’s clinical judgment. External standards and tools, based on a combinatorial standard of care, must govern the selection and analysis. Once that happens, then judgments of patient and practitioners (not just physicians) may supplement the combinatorial minimum standard.  See Medicine in Denial, pp. 53-61, 69-79, 136-37, 145-52.
  2.  Organizing the medical record around the problem list. Once initial data are collected and a complete problem list is defined, then care plans, orders, and progress notes should be problem-oriented, that is, labeled by the problem(s) to which they relate on the problem list. This disciplined practice is essential to justifying provider actions in terms of defined patient needs. Yet this practice is not followed or enforced with consistency. Indeed, some EHR systems do not even enable electronic links between the problem list and care plans, orders and progress notes. See Medicine in Denial, pp. 134-35, 144, 159-60, 166-67.
Like so much else in medicine, medical record practices are a Tower of Babel. Medicine need standards of care for managing clinical information (knowledge and data) no less than the domain of commerce needs accounting standards for managing financial information. This failing is a primary root cause of the health care system’s failures of quality and economy.

For that matter, Lin had more to say than what you saw in the story. He discussed the supposed importance of the subjective and objective elements. “That’s true in cases where there is diagnostic uncertainty,” Lin said. But he added that those components are still there for reference, jut not up front.

Lin called SOAP “a phenomenal innovation,” but suggested that EHR complexity sometimes makes it difficult to find the assessment and plan. For example, he said that a non-Epic EHR in the emergency department at UC Health has as many as 17 different screens for progress notes. “At least with APSO, you would collect the assessment or plan in the first half,” Lin said.

Because SOAP is so entrenched, Lin ran into much resistance when he proposed switching to APSO at 40 affiliated practices. He, of course, heard the tired, “But we’ve always done it this way” defense.

“I learned myself about culture change very acutely,” Lin said. “I was literally shouted out of the room by our physician leadership.” He had neglected to prepare the heads of various departments and clinics for the change in advance of the meeting where he announced the plan.

He subsequently had to have individual conversations with all 40 practice directors. And then Lin dropped a great quote from none other than Niccolo Machiavelli (speaking of Renaissance men): “Those who benefited from the old order will resist change very fiercely.”

Yes, that’s absolutely perfect for an industry as resistant to change as healthcare. But is APSO superior to SOAP? I’d love to hear your thoughts.

May 20, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Comprehensive coverage of WTN Media’s Digital Health Conference

As you may know from at least one of my earlier posts, I was in Madison, Wis., last month for a great little health IT event called the Digital Health Conference, a production of the Wisconsin Technology Network and the affiliated WTN Media. In fact, WTN Media hired me to cover the conference for them, so I did, pretty comprehensively. In fact, I wrote eight stories over the last couple of weeks, seven of which have been published:

I still have an overview story that should go up this week.

Why do I say it’s a great little conference? The list of speakers was impressive for a meeting of its size, with about 200 attendees for the two-day main conference and 150 for a pre-conference day about startups and entrepreneurship.

Since it is practically in the backyard of Epic Systems, CEO Judy Faulkner is a fixture at this annual event, and this time she also sent the company’s vendor liaison. Informatics and process improvement guru Dr. Barry Chaiken came in from Boston to chair the conference and native Wisconsinite Judy Murphy, now deputy national coordinator for programs and policy at ONC, returned from Washington. Kaiser Permanente was represented, as was Gulfport (Miss.) Memorial Hospital. IBM’s chief medical scientist for care delivery systems, Dr. Marty Kohn, flew in from the West Coast, while Patient Privacy Rights Foundation founder Dr. Deborah Peel, made the trip from another great college town, Austin, Texas. (Too bad Peel and Faulkner weren’t part of the same session to discuss data control. That alone would be worth the price of admission.)

July 2, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

CCHIT under fire

The Certification Commission for Healthcare Information Technology is on the defensive after a very scathing comment about it on the Wall Street Journal Health Blog last week. (I added the hot links and spacing between paragraphs, but otherwise the text is verbatim):

Why not pack CCHIT EHR certifications in Cracker Jack Boxes? If folks think CCHIT is a real organization and the certification is anything more then a stamp of approval from the HIMSS Circus they need to think again after looking at the facts.

Some facts are known about the Certification Commission for Health Information Technology.

The Certification Commission for Health Information Technology (CCHIT) is a defunct Illinois Not-For-Profit 501(c) 3, which operates to take money from the Office of the National Coordinator and Vendors by offering to sell a “Certification”.

DID I say DEFUNCT? Yes I said DEFUNCT…please read on.

The Not-For-Profit 501(c) 3, Certification Commission for Health Information Technology (CCHIT), operates a “Front” office located at 200 S. Wacker Drive, Chicago, Illinois.

CCHIT, as it is known, represents itself as a government recognized organization for certifying electronic health records. CCHIT has received monies from the United States Government (estimated over $2.5 million to date) and monies from vendors of electronic health records.

CCHIT was formed as a NFP in the State of Illinois and is an entity spawned by none other , HIMSS.org. CCHIT is no longer a legal entity existing within the State of Illinois effective April 11, 2008, but continues to engage business as a 501(c) 3 accepting payments as reported by J. Morrisey, Director of CCHIT Communications (February 3, 2009).

CCHIT continues to hold itself out to take money for the sale of “Certification” (a rubber stamp device the buyer can display on his product if the fee is paid), a contrived performance standards product label developed by its parent organization, Healthcare Information and Management Systems Society (HIMSS), a lobbyist, with headquarters at 230 E. Ohio St., Chicago, Illinois. CCHIT was also located within the HIMSS Headquarters at 230 E. Ohio Street in Chicago but moved to Wacker Drive apparently due to appearances of being too close to the lobbyist parent organization.

CCHIT, through the organization that spawned them—HIMSS.org, a lobbyist organization—recently asked for $25 Billion additional funds in an open letter to the Obama
administration (http://www.himss.org/advocacy/). HIMSS, through its agent H. Stephen Lieber, provided CCHT with $300,000 seed money in 2006 with which to fund a startup operation. HIMSS receives money from CCHIT as a subcontractor, as the payoff for seeding the startup. HIMSS provides public commentary through the use of its own members for certification criteria back to CCHIT. HIMSS is also the parent company for the Electronics Health Record Vendor Association (EHRVA), another Not-For-Profit housed at 230 E. Ohio St., Chicago, Illinois.

The Facts:
1. The Chairman of CCHIT is Mark Leavitt, MD, PhD. Mark Leavitt is also Chief Medical Officer with HIMSS.org. It is believed Mark Leavitt may be a relative of Mike Leavitt, former HHS Secretary.
2. CCHIT takes federal money, and money from vendors, in exchange for the sale of “certification”. CCHIT does not have a legitimate physical address where it conducts its testing. CCHIT has a “front” office at 200 S. Wacker Drive, Chicago, Illinois, with previous headquarters at 230 E. Ohio St., Chicago, Illinois. CCHIT is, in fact, now defunct.
3. CCHIT has no legitimate registration certificate of good standing with the State of Illinois, the state in which it is purportedly chartered as a 501(c) 3. It is, in fact, listed as “involuntarily dissolved” effective April 11, 2008, file# 65254336. Illinois State listing here: http://www.ilsos.gov/corporatellc/
4. CCHIT does not provide independent inspections of its facility or 3rd party reviews of its findings. “Certification” status of vendor products granted by CCHIT after the Illinois State’s involuntary dissolution date of April 11, 2008 appears to be without merit or bogus, and CCHIT operates deceptively to convey legitimacy.
5. CCHIT operates fraudulently within the State of Illinois and in the United States to take money from vendors of electronic health record systems and from taxpayers; the CCHIT business practice presents as a Pay-For-Play scheme; if the vendor pays, CCHIT certifies the product conveying a competitive advantage in the marketplace. There is no transparent certification testing for 3rd party review. The costs to certify are in the many tens of thousands per vendor. Officers and Directors of CCHIT have taken money in exchange for “Certification”, knowing its 501(c) 3 operational status to be defunct.
6. CCHIT, a dissolved entity and defunct 501(c) 3 Not-For-Profit, receives funding from the Office of the National Coordinator (ONCHIT) and is tied to a lobbyist organization that claims to be a Not-For-Profit, HIMSS.org—the organization that spawned CCHIT and which formerly housed the entity in its corporate headquarters located at 230 E. Ohio St., Chicago, Illinois.

Why does CCHIT continue to certify vendor products when its own corporation has been involuntarily dissolved? Does the word “MONEY” ring a bell?

CCHIT continues to hold itself out as a certifying entity when it can’t even certify to the state of its incorporation that it does in fact exist.

Closing thoughts:
The certification process and testing should be reviewed carefully, and those vendor companies whose products were certified after CCHIT’s involuntary dissolution should be contacted. Money should be returned to the vendors and the taxpayers- CCHIT is a bogus operation.

CCHIT should NOT be allowed to receive future Federal grants and monies from the United States Government as part of the stimulus package. CCHIT is defunct , moreover the cozy relationships between CCHIT, ONC, CMS, HITSP and others are bankrolled with taxpayer money and money from HIMSS.org and its others.

Through all the smoke and mirrors we the people are supposed to trust these Bozo’s and they actually think we are buying it?

There is no point in CCHIT holding itself out as a legitimate entity at HIMSS Annual Conference either, CCHIT is a defunct organization and has been since the beginning of 2008…DUH!

CCHIT has flown under the radar for a year and a half, the jig is up and the whistle has been blown.

CJ
Comment by cj – February 13, 2009 at 2:10 am

Oddly, this post actually was a comment in response to a post about the Mayo Clinic being caught in the Bernie Madoff scandal, and seemed to come out of the blue. I have no details about the identity of “CJ,” the person who makes these serious charges.

Clearly, though, the message got through, since CCHIT’s Sue Reber responded Sunday on the WSJ blog:

The “facts” in the previous post are deliberate misinformation from an anonymous source.
1. Mark Leavitt, chair of the Commission, is not employed by HIMSS as CMO nor is he a relative of Mike Leavitt, previous Sec. of HHS.
2. CCHIT conducts jury-observed and technical testing of vendor-submitted products, requiring that the products meet 100% of the compliance criteria published at http://www.cchit.org/certify/index.asp. It’s current administrative offices are at 200 S. Wacker Drive, Suite 3100, Chicago, Illinois.
3. CCHIT was founded originally as a LLC but has subsequently transitioned to a private, nonprofit 501(c)3 organization. That is its current status.
4. CCHIT operates with the oversight of both its board of trustees – managing its business functions – and board of commissioners, which provides oversight of its certification development programs and inspection processes.
5. CCHIT’s trustees and commissioners receive no compensation; they serve in a volunteer capacity. CCHIT operates with a paid staff of about 20 personnel who support the work of the Commission and it’s 15 volunteer work groups, administer the certification inpections and provide outreach to its diverse stakeholders
6. CCHIT now operates independently of HIMSS, AHIMA and NAHIT – its founding organizations – and no money provided by ONC for developent or by vendors for the conduction of inspections is returned to those organizations.

Any questions about CCHIT’s operations may be directed to me at the following email address.

Sue Reber, Marketing Director
CCHIT
sreber@cchit.org

The Health Care Renewal blog verified the allegation that the Illinois Secretary of State lists CCHIT as “involuntarily dissolved.”

I live in Chicago. Say what you want about Illinois government, particularly in light of the Rod Blagojevich circus, but Secretary of State Jesse White seems as clean as they get, so I will take the public record at its word.

Here’s what else I know:

  • The “J. Morrisey” that the accuser refers to likely is John Morrissey (note the different spelling), communication manager for CCHIT. Morrissey previously worked for NAHIT. That does not necessarily mean NAHIT has any control over CCHIT.
  • Mark Leavitt no longer works for HIMSS, nor is he related to former HHS Secretary Mike Leavitt.
  • CCHIT received a three-year, $7.5 million contract from the Office of the National Coordinator for Health Information Technology in October 2005. That means the contract expired in October 2008.
  • Though the procurement process for the certification contract ostensibly was open, CCHIT was the only bidder. Given that HIMSS, NAHIT and AHIMA originally started CCHIT, it does seem like this was a de facto no-bid contract.
  • Although HIMSS did provide seed money for CCHIT, I am not aware of any current “subcontractor” relationship.
  • The HIMSS EHRVA changed its name to the HIMSS EHRA last year, dropping “vendor” from the title. I’m not sure whether this is relevant to any of this discussion, but “CJ” mentioned it.
  • The relationships between HIMSS, CCHIT, NAHIT, HITSP, ONC, CMS and others may be “cozy,” and that’s something definitely worth looking into. HIMSS CEO Steve Lieber and John Loonsk, M.D., director of the ONC Office of Interoperability and Standards are on the HITSP board, but that does not necessarily mean anything.
  • There has been some pushback against the CCHIT certification process of late from smaller vendors, provider organizations and critics of the ONC strategy in general. But those are criticisms of the process, not CCHIT itself.

All of this makes the rumors of Healthcare Information Technology Standards Panel Chairman John Halamka, M.D., being under consideration for CMS administrator all the more delicious. But we’re still waiting for the president to nominate an HHS secretary, so it could be months before we get a permanent CMS administrator.

February 15, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Privacy, please

A weekend trip to Maine for a family wedding turned into a business trip (and a tax deduction) when I was reminded that the 16th National HIPAA Summit and related Privacy Symposium were taking place at Harvard University this week. Since I was flying in and out of Boston, I hesitantly forked over the $150 extortion—er, change—fee to American Airlines and sprung for a hotel room, mostly so I could attend a heated debate—er, “roundtable discussion” (even though the table was not round)—about whether patient privacy rules were effective.

I’m pretty sure it was worth the money. Boston usually is. While in the area, I also got a tour of athenahealth’s Watertown headquarters. I learned that “chief athenista” and new daddy Todd Park is on paternity leave for the next several months, is relocating to the west coast and will come back as a board member only while he dedicates much of his time to some new ventures.

But I digress once again.

The roundtable featured a couple of heavy hitters in the privacy world, namely Dr. Deborah Peel and Dr. Bill Braithwaite, as well as Partners HealthCare System Chief Privacy Officer Karen Grant, Linda Sanches, representing the HHS Office of Civil Rights, and, via telephone, Jodi Daniel, from the Office of the National Coordinator. Given the expense I just incurred, I wrote a story Tuesday about the Peel-Braithwaite debate for someone who actually will pay me, Digital HealthCare & Productivity.

In the interest of getting the news out and getting picked up by this week’s Health Wonk Review, I’m going to give you for free some notes from other Tuesday sessions.

On Friday, HHS released some proposed dates for transitioning to the next generation of HIPAA transactional code sets—otherwise known as ANSI X12 version 5050—as well as to ICD-10 standards for E&M coding. The proposal also includes the the National Council for Prescription Drug Programs standard version D.0 for electronic pharmacy transactions.

The full language is at http://www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp#TopOfPage and will appear in this Friday’s Federal Register to trigger a 60-day comment period, closing Oct. 21.

“This is not a do-over of HIPAA,” said Workgroup for Electronic Data Interchange Chairman James Whicker, who also phoned in to the HIPAA Summit. Whicker, director of EDI and e-commerce at Intermountain Healthcare in Salt Lake City, said that changes are necessary because the current version 4010A1 is more than six years old already and has significant shortcomings.

Among the changes he highlighted:

  • The 835 transaction for remittance advice adds an embedded link to payer URLs for some payment adjustment and denial codes.
  • 834 will allow ICD-10 to report pre-existing conditions and address some privacy concerns
  • 270 and 271 eligibility transactions bring what Whicker called “a significant number of changes and improvements” from the provider perspective. For example, he said, the new code sets clarify instructions for sending inquiries based on whether the patient is the health plan’s primary enrollee or a dependent. If the eligibility date, plan name or benefit effective date for a particular encounter is different from that of the overall coverage, the health plan must report it as part of the transaction. Version 5010 also requires alternate search options for 270 and 271 transactions so a provider can search by member ID, last name only or date of birth to help eliminate false negatives and phone calls, Whicker said.
  • 276 and 277 transactions for healthcare claims status have minor changes addressing privacy concerns over sensitive patient information that is unnecessary for business purposes.
  • Implementation guides will no longer be free when 5010 takes effect.

I personally don’t know what to make of the 5010 news, but I know that there is significant opposition to the proposed Oct. 1, 2011, compliance date for ICD-10. As Whicker spoke, I was reading a press release from the Medical Group Management Association denouncing the idea, and would wager a large sum that the American Medical Association thinks three years and two months is not long enough.

And now back to the privacy debate.

In a separate session, Sanches vigorously defended OCR’s record on HIPAA privacy enforcement, despite the fact the office has not assessed a single civil monetary penalty in the five years the rules have been in effect. “Our enforcement has resulted in changes,” Sanches said, a sentiment also expressed by Michael Phillips, a health insurance specialist in the CMS Office of E-Health Standards and Services regarding enforcement of HIPAA security regulations.

Sanches said most privacy complaints have either been dismissed or resolved with corrective action, while some, as with Providence Health and Services last month, have been settled with with “resolution agreements,” usually resulting in a fine. Sanches described the resolution agreements as “forward-looking,” since they require corrective action even though there is no admission of liability. “We will be monitoring their compliance,” Sanches said of Providence, which agreed to pay $100,000 as part of the deal.

Suffice it to say, OCR still has plenty of critics. Deven McGraw, director of the Health Privacy Project at the Washington-based Center for Democracy & Technology, said that enforcement clearly is lacking. “When you haven’t imposed a single civil monetary penalty, you are not sending a message that you are going to hit people in the pocketbook,” McGraw said during a joint session with Peel.

Those who don’t know Peel well might think she would wholeheartedly agree with this sentiment, but she says the August 2002 HIPAA privacy amendments that created the “treatment, payment and healthcare operations” exemption effectively neutered the rule. “We believe there is nothing for OCR to enforce because there isn’t a privacy law anymore,” she said, arguing that lack of privacy is keeping people from seeking treatment for some conditions, including Iraq war veterans who might suffer from depression or post-traumatic stress disorder.

As for HIPAA security enforcement, Phillips said OCR gets many more privacy complaints per year than CMS does for the security rule, largely because so many violations involve paper PHI and the security rule only applies to electronic information. He said that CMS has received 350 security rule complaints, to date, but, surprisingly, given all the attention paid to laptop theft, only 10 percent have involved lost or stolen devices.

Of those 350 complaints, 248 have been resolved and 102 investigation remain open.
Phillips also discussed the CMS contract with PricewaterhouseCoopers to conduct 10 compliance reviews this year, saying that the audit firm has done six reviews, including the well-publicized critique of Piedmont Healthcare in Atlanta. Phillips said CMS will share information about one of the 10 cases when all the reports are done.

Another conference session focused on the Piedmont case, and I think I will do a story for one of my publication clients in the next week or two. Stay tuned.

And finally, since anything involving David Brailer tends to generate a lot of traffic to this site, I shall call your attention to the following from former U.S. Sen. Dave Durenberger (R-Minn.), who founded and chairs the National Institute of Health Policy and sits on the Medicare Payment Advisory Commission:

DAVID BRAILER a few short years ago was the No. 1 name in American healthcare according to the annual Modern Healthcare survey of important people in the field. His job then was to be President Bush’s “Health Information Czar” to get the medical system moving toward automation and electronic information interchange.

Today he runs Health Evolution Partners out of San Francisco. He says HEP was founded to accelerate the best in the inevitable change taking place in the healthcare market. It will focus on redefining quality, efficiency and accountability of healthcare services to consumers and payers. He has developed a “Purchaser Value Initiative” as well, and raised nearly a billion dollars from CALPERS and from an additional four or five state public employees retirement funds (including Minnesota).

Susan and I enjoyed lunch with David recently at the Buckeye Roadhouse just off CA Highway 101 near Sausalito. David’s no. 1 interest these days is in his family, especially his seven-year old son and year old daughter. I listened to much of a fascinating discussion over elementary education in San Francisco and the merits of various institutions before we got to passion no. 2. How health system entrepreneurs will use the cost-quality-access quandary we face in this country, to innovate our way to better health, medical care and health management services.

Listening to Brailer, you get the impression that there may have been a lot not to like in the Bush administration’s approach to “consumer driven healthcare.” On the other hand, it focused us on a critical reality. Everyone in America is a potential consumer of better health, more appropriate medical services and, someday, good judges of value in the healthcare system. Entrepreneur innovators are doing it right now, and Brailer’s EHP team will help make sure they succeed.

August 19, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: Dr. David Kibbe on personal health information, medical homes, value in healthcare and more

This podcast pretty much covers the entire field. Dr. David Kibbe, senior advisor to the Center for Health Information Technology of the American Academy of Family Physicians, weighs in on health IT in primary care, consumerism, data standards, value-based healthcare purchasing and national IT policy, among many topics we cover in just over half an hour. We recorded this at the 2007 TEPR conference in Dallas last week.

Podcast details: Interview with Dr. David Kibbe at 2007 TEPR conference. MP3, mono, 64kbps, 16 MB, running time 35:09

0:40 Background on AAFP’s Center for Health IT and what he’s doing.
1:40 Personal health records and mobilization of personal health information
2:10 Continuity of Care Record
4:11 Continuity of Care Document and Clinical Document Architecture
5:25 CCR, PHRs and the Internet
6:20 Growth in CCR interest
7:00 PHRs based on XML
7:40
Google‘s healthcare plans
8:55 Reliability of health information on the Internet
10:00 Consumers having access to the same information as health professionals
10:45
Revolution Health
11:50 Web information and the physician/patient relationship
12:45 Higher expectations among patients
13:45 Consumerism and retail health clinics
15:00 AAFP’s involvement in retail clinics
16:28 Concept of the medical home
18:00 Health information and the elderly
19:12 Model of information homes in other service industries
20:20 Asynchronous communication to help manage patient care
20:46 Reimbursement problems with asynchronous care
21:20 Employers becoming more aware of value in healthcare
22:15 Advice to major healthcare purchasers
23:00 When major changes might happen
23:45 Framing the national debate
25:15 Stark exemption and primary care
26:57 AAFP advice to small practices on the Stark exemption
28:40 Awareness of Stark exemption
30:30 Awareness of the benefits of EHRs
31:42 Certification
33:57 Are products improving because of certification?

May 30, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.