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Podcast: A quick chat with Farzad Mostashari

Friday is the last day on the job for departing national health IT coordinator Dr. Farzad Mostashari, who is stepping down after four years with the Office of the National Coordinator for Health Information Technology, including the last two years as head of ONC.

I was in Washington two weeks ago and stopped by the HHS headquarters for ONC’s Consumer Health IT Summit, the opening event of National Health IT Week, and got a few minutes with Mostashari. (I suppose that was good timing, because I imagine the government shutdown that took effect this week would have canceled the summit and even prevented me from entering the Humphrey Building.) I had the recorder rolling for a brief chat, which lasted less than 15 minutes before Mostashari’s handlers ushered him out to his next appointment. But I did get something.

The interview actually goes on a bit longer than what’s on this track, moving on to a discussion about Food and Drug Administration guidance on mobile medical apps. (You can read about that in this story I wrote for MobiHealthNews.) As it turned out, the FDA issued its final recommendations Sept. 23, which also happened to be the same day new HIPAA regulations—modifications called for in the HITECH Act—took effect.

I might get another chance to talk to Mostashari at the College of Healthcare Information Management Executives Fall CIO Forum at the end of next week, after he officially leaves government service and is allowed to discuss his future plans and perhaps be more candid about his tenure; CHIME has confirmed to me that he will keep his speaking slot. For now, enjoy this short interview.

Podcast details: Interview with outgoing national health IT coordinator Dr. Farzad Mostashari, Sept. 16, 2013. MP3, stereo, 128 kbps, 7.1 MB. Running time 7:44.
0:00 Why he’s leaving
1:20 Different “tribes” of health IT
2:25 Balancing competing interests and the pace of change
4:30 Difficulty of culture change
5:35 Patient control of data and confusion about HIPAA

 

October 2, 2013 I Written By

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DrChrono and Sermo, what are you thinking?

Free, mobile ambulatory EHR developer DrChrono made a minor ripple of news this week, claiming to be the first vendor to release an EHR for the new Apple iOS 7. But that’s not why I’m writing this post. I’m calling out DrChrono co-founder and COO Daniel Kivatinos for this tweet:

I was quick to respond on Twitter.  


Indeed, the HITECH Act and Meaningful Use are about the Triple Aim of producing safer care, improving population health and lowering overall healthcare costs. The incentive money isn’t supposed to make physicians rich or even cover the cost of the typical EHR. (Yes, “free” EHRs have costs in terms of changing physician workflows and interfacing with practice management systems, and the advertising may cause patients to lose trust in their doctors, as John Lynn seems to have found with Practice Fusion.) Frankly, I don’t want to go to a doctor who views Meaningful Use as “cashing in.” That’s not “meaningful” in the spirit of the incentive program.

I’m making a big deal out of this because this is not the first time DrChrono has made misleading and hyperbolic statements. As I wrote a couple years ago, the company claimed its patient check-in app was “groundbreaking,” despite a lot of evidence to the contrary. The same post also had a video from DrChrono in which the vendor explained to physicians how they could qualify for Meaningful Use “tax breaks.” The incentive payments aren’t tax breaks. In fact, the money counts as taxable income.

The video is still up on YouTube, and it’s been viewed more than 57,000 times. That’s 57,000 times people have heard a patently false statement. DrChrono, stop misleading clients or you won’t have any clients left to mislead.

Also from the “what were they thinking?” department, physician social network Sermo marked the start of the NFL season this month with the launch of the “Pro Football Injury Challenge.” I know this because I received this e-mail:

Sermo injury challenge

Yes, I know I’m not a doctor. Sermo sent a follow-up a few days later saying that I received the invitation in error. But actual physicians still are competing against each other in kind of a fantasy football injury pool. Do you find this as tasteless as I do?

 

September 20, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

I sense a delay in MU2

I have no evidence to back this up, but I have a sneaking suspicion that the feds are giving serious thought to delaying some of the timelines in Stage 2 of Meaningful Use.

The pushback has been building for some time, and advanced in the past couple of weeks with the opinions of three important industry associations.

The American Association of Family Physicians called for a one-year delay and proposed separating providers into “three distinct cohorts,” depending on what year they first met Meaningful Use standards. HIMSS wants the attestation period for the first year of MU2 extended to April 2015 for hospitals and June 2015 for physicians and other “eligible professionals.” The MGMA asked CMS not to penalize physicians who reach Stage 1 but can’t make it to Stage 2 when penalties are due to start in 2015.

All cited the short timelines for vendors to get their products ready and certified for Stage 2.

And then there was the big news this month, the resignation of national health IT coordinator Dr. Farzad Mostashari, seemingly without warning. I can’t take credit for this idea, but an industry insider I spoke with this week suggested Mostashari may have wanted out because he didn’t want to be in charge of a watered-down or delayed program. Again, I have no evidence to support the idea, but it sounds absolutely plausible.

I welcome your thoughts on this matter.

August 22, 2013 I Written By

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It’s not exactly official, but don’t count on MU3 starting before 2017

MADISON, Wis.—As the headline says, don’t count on Stage 3 of Meaningful Use starting before 2017.

Speaking at WTN Media’s annual Digital Health Conference on Wednesday, ONC’s deputy national coordinator for programs and policy, Judy Murphy, R.N., recalled that national coordinator Farzad Mostashari, M.D., and CMS Administrator Marilyn Tavenner said at HIMSS13 in March that there would be no more activity on Stage 3 regulations this year. “The focus this year is on helping people understand the Stage 2 criteria,” Murphy said.

Then she discussed how long it takes to go through the regulatory process, including issuing a proposed rule, taking public comments, reviewing the comments, then issuing a final rule. “If you do an extrapolation of that, 2016 would be a problem,” Murphy said.

That was not exactly an announcement that Stage 3 will be pushed back to 2017 — or three years after a provider gets to Stage 2 — but it might be the strongest hint to date. It’s not a huge surprise since so many entities have called for slowing down the program, but there you have a bit more evidence that the federal government is leaning that way.

Look for more coverage of this conference from me at Wisconsin Technology Network’s WTN News.

June 12, 2013 I Written By

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About that Friedman editorial

Did you happen to catch Thomas Friedman’s commentary in Sunday’s New York Times entitled, “Obamacare’s Other Surprise”?

On first read, I gave it a big “Duh!” for the explanation that the Patient Protection and Affordable Care Act (that’s how the law is officially known, Mr. Friedman) creates a “new industry” of innovation by encouraging the federal government to release of terabytes of health data — information already legally in the public domain — and then allowing the private sector to figure out how to structure, interpret and use the data. As you probably are, I’m well aware of digital health, Health Datapalooza, federal CTO Todd Park and some of the companies Friedman mentions. (Health Datapalooza IV is less than a week away.)

But on second read, I realized Friedman needed to write that column because America needs a lot of education about the Affordable Care Act, education that the Obama administration and its supporters don’t seem all that willing to provide. The public still thinks of Obamacare largely in terms of health insurance coverage. It’s much more than that, including, as Friedman points out, an attempt “to flip this fee-for-services system (which some insurance companies are emulating) to one where the government pays doctors and hospitals to keep Medicare patients healthy and the services they do render are reimbursed more for their value than volume.”

Coupled with the 2009 American Recovery and Reinvestment Act, which created the $27 billion EHR incentive program for “meaningful use” of electronic health records, the ACA takes some steps toward actual reform of actual care, not just insurance coverage. Friedman does not discuss Accountable Care Organizations, an experiment in realigning incentives around care coordination, nor does he mention the Medicare policy, dictated by the ACA, of not reimbursing for preventable hospital readmissions within 30 days of initial discharge for certain specific conditions, currently heart attack, congestive heart failure and pneumonia. Likewise, he fails to bring up outcomes research, another component of Obamacare. But at least he gets something out there that’s not about insurance coverage.

Unfortunately, many of the online comments posted in response to Friedman’s commentary predictably focus on insurance coverage or government control, but some actually discuss EHRs, population health, healthy behaviors and payment incentives. That’s good. Still, those are just people who read Friedman and the Times. Hyperpartisan conservatives — probably even some hyperpartisan liberals, even though the ACA is more centrist than a lot of folks wish to admit — and the less-educated won’t read the column and won’t comment on the Times site. Those are the people who misunderstand this imperfect but occasionally reform-minded law the most.

 

May 27, 2013 I Written By

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HIMSS CIO survey visualized

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.

March 7, 2013 I Written By

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Video: Live from HIMSS with Athenahealth CEO Jonathan Bush

NEW ORLEANS—I made my debut for the new Health Innovation Broadcast Consortium last night with a live webcast interview with Athenahealth CEO Jonathan Bush. As usual, I didn’t need to prepare much for the interview because Bush almost interviews himself, so I just decided to wing it. Also as usual, we kept it light, as each of us had a beer in our hand, since we were at the House of Blues in the French Quarter, where Athenahealth had its annual HIMSS party. (This year featured a jazz funeral marking the “death of software.”) But we did discuss some topics actually relevant to health IT, including meaningful use and Athenahealth’s recent acquisition of Epocrates. Enjoy.

Watch live streaming video from hibc at livestream.com

March 4, 2013 I Written By

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Podcast: HIMSS CEO Steve Lieber: 2013 edition

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
2:50        mHIMSS
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

March 1, 2013 I Written By

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Hotels open up for HIMSS13

Here’s a quick travel update for those of you still making plans for HIMSS13 in New Orleans next month. Today, OnPeak, the travel service that HIMSS has contracted with, seems to have released a number of hotel rooms for the week of the conference.

I had been waiting to book for a few weeks since I first heard that rooms would open on Jan. 30 or so after vendors, which apparently claimed big blocks of rooms months ago, had to give their final numbers. That didn’t happen, and I was starting to sweat a bit. But I made my reservation today, and am near enough to the Morial Convention Center that I don’t have to worry if I miss the last shuttle of the evening, which I’ve done plenty of times in past years. I feel bad for anyone staying out by the airport in Metairie or Kenner, because that’s a good 10-13 miles away. From my experience in other HIMSS cities, those bus trips can easily take 45 minutes to an hour during rush hour, and the buses don’t run all that frequently. HIMSS won’t be going back to San Diego anytime soon because so many people had to stay out by La Jolla the last time the conference was there in 2006, and that is closer to the San Diego Convention Center than the airport hotels are in New Orleans.

Back then,  seven years ago, attendance had swelled to a then-record 25,000, and stayed in that range for a couple of years. But then came the HITECH Act and meaningful use in 2009, and interest in health IT has soared. Last year, more than 37,000 people came to HIMSS12 in Las Vegas, where hotels are plentiful. The Big Easy might not be as big a draw as Sin City, but it might be for some people who prefer authentic culture to the manufactured kind. (For the record, I like both places.) I’ve heard registration was slower this year than last, but I didn’t get that directly from HIMSS.

If you do find yourself stuck, I did notice in the last couple of weeks that there are a good number of hotels with vacancies across the Mississippi River in Gretna and Marrero and points east, such as Chalmette and New Orleans East. But there is no HIMSS shuttle to those places, and good luck finding a car to rent unless you’re willing to spend $90 a day. Go ahead, search for a car rental with airport pickup and try to find one for less during the week of March 3. (You can get one from an off-airport location for about $31 a day if you’re willing to take a taxi into town first to pick it up.)

This leads me to wonder if this might be the last time for a while that HIMSS meets in New Orleans. I think a couple of extra shuttle routes could fix the problem. And if attendance does level off or even drop a bit since we’ve probably passed the peak of the Gartner Hype Cycle, then it’s all good. Given some of the recent pushback against the direction of meaningful use and the efficacy of current EHR technology, I think it’s safe to say we are in or headed to the trough of disillusionment this year.

I’ll have more later this week about HIMSS, including what I’m trying to get from the conference. Vendors, please pay attention. I’m finally about to start working on my schedule, but I will have specific objectives.

 

February 11, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Health Wonk Review gets hung up on insurance

The last edition of Health Wonk Review prior to the Nov. 6 presidential election falls into the familiar big-media trap of portraying the Patient Protection and Affordable Care Act, a.k.a. Obamacare, as being only about health insurance and of effectively equating health insurance to healthcare. Let me repeat: insurance is not the same thing as care, and having “good” insurance does not guarantee good care.

This installment of HWR is awfully heavy on the insurance aspects of the ACA in the context of politics the election, which is not surprising, though host Maggie Mahar of the HealthBeat blog does at least consider comparative-effectiveness research, thanks to a contribution on the esteemed Health Affairs Blog.

My post, which includes the infographic from the movie “Escape Fire” showing how medical harm essentially is the No. 3 cause of death in the U.S., is almost an afterthought, but at least Mahar also includes an entry from Dr. Roy Poses about medical harm in clinical trials.

There’s nary a word on health IT, which really is a shame in the context of the election, especially given that several Republican members of Congress, including Sen. Tom Coburn, M.D. (R-Okla.), have publicly questioned whether “meaningful use” so far has led to higher utilization of diagnostic testing and thus higher Medicare expenses.

By the way, Healthcare IT News is currently running a poll that asks: “With four GOP senators calling on HHS to suspend MU payments, would health IT remain bipartisan if Romney became president?” The poll is on the home page, but even after voting, I couldn’t find the results. In any case, I personally believe health IT has enough bipartisan support for MU to continue.

I also believe that no matter who wins the presidency, Congress probably will remain divided for the next two years, with Democrats holding onto the Senate and the GOP retaining control of the House, so I don’t expect any controversial legislation to pass. A Romney administration possibly could put a hold on future MU payments or revise the Stage 2 rules, but never underestimate the power of the hospital  and physician lobby.

 

October 28, 2012 I Written By

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