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AMA and EMRs, continued

Last month, I wrote a rather scathing piece on the BNET Healthcare blog about the American Medical Association‘s annual House of Delegates meeting. I wrote another one for FierceEMR. Admittedly, I focused on a handful of fringe ideas, though one of the more audacious ones actually wound up in a resolution that the House of Delegates adopted as AMA policy. For BNET, I wrote:

[A]nother resolution directs the AMA to tell the federal government that the EMR incentive program “should be made compliant with AMA principles by removing penalties for non-compliance and by providing inflation-adjusted funds to cover all costs of implementation and maintenance of EMR systems.”

It’s one thing to ask for more money to cover ongoing expenses. It’s another thing altogether to conclude that the government is not in compliance with the principles of a private organization. Talk about the tail wagging the dog.

In FierceEMR, I wrote:

Delegates also took issue with the Medicare e-prescribing bonus program that passed during the Bush administration and began this year. They said the requirement that physicians write 50 percent of their Medicare Part D prescriptions electronically was too onerous, and recommended that the threshold be lowered to 25 percent.

Not surprisingly, the posts drew several comments and e-mails.

AMA Board Chairman Joseph Heyman, M.D., someone who actually does understand—and use in his own practice—EMRs and information technology, left a detailed response on the BNET post, attempting to clarify the organization’s position on health IT. He’s right in saying that the AMA did come out in strong support of the stimulus. My criticism was about a few delegates who spoke out rather loudly about the stimulus.

Heyman also discusses the AMA’s online tools for physicians to learn about health IT, something I admittedly didn’t mention in my post, though it wasn’t completely relevant to my argument. I did interview Heyman at the meeting, and included some of his comments in a story I did in the July Physician Office Technology Report of Part B News. I’d like to extend an invitation to Heyman to do a podcast with me at some point in the future so we can discuss all of these issues, as well as his own practice’s successful experience with an EMR.

Another, anonymous, commenter suggested that other organizations, like the American Academy of Family Physicians has an agenda that “more closely aligns with the big winners of the last election cycle, and helped buy them a seat at the table.” Yeah, that would explain why some of the more conservative members of the AMA House of Delegates feel shunned. This person also says that “HIT providers”—vendors and consultants—are the real winners from the stimulus. That’s certainly a risk of the massive program.

The comments on the FierceEMR piece were more supportive of my argument. “Smart Doc” said: “To call this organization an anachronistic dinosaur would not give proper credence to how out of touch it is, not only with the public, but with physicians themselves. Like others of their ilk, they’re against government intervention except when it directly subsidizes them.”

I’m not sure if I’d go that far, but I’m certainly on record as saying the AMA really does not represent the interests of all physicians, as the organization claims to.

My favorite exchange, though, came from Jack Smyth, the very pragmatic president and CEO of ambulatory EMR vendor Spring Medical Systems. After the FierceEMR commentary appeared, he e-mailed me to clarify the rules for the Medicare e-prescribing bonus program that took effect this year:

You commented about the 50% rule for getting the eRx bonuses this year and next. In your statement you mentioned that unless a physician prescribes controlled substances, they should be able to qualify.

The way I understand it, if a doctor enters the prescription in the eRx system, it counts. Even if they have to print it out and sign it, because it’s a controlled substance, or even if the pharmacy doesn’t accept eRx and it has to be faxed to the pharmacy. There are several “G” codes that can be added to an office visit or prescription refill that allow the various scenarios to qualify for addition to the numerator of the equation.

I’m very proud of my subsequent response:

Thanks again for writing. I think you’re right about getting credit for entering it into an eRx system, regardless of whether it’s controlled or if the patient simply wants a printout. In that case, I have no idea why the AMA thinks 50% is too high. You’re either entering scripts electronically or you’re not, unless perhaps you’re Dr. House and you’ve stolen Wilson’s prescription pad.

I also asked Smyth for permission to post our exchange. He then responded: “I love your “Wilson’s prescription pad” comment! Yes you can use my email in your blog. I don’t have time to post responses on websites and I don’t like all of the banter (most of it useless) that a comment like this would create. I’ll let you do that.”

Consider it done.

July 6, 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.

‘Modest’ feedback

A couple of months ago, I posted, “A modest proposal,” my observations about a session on clinical decision support from the American Medical Informatics Association annual meeting. In it, I argued that medical informatics needed a rock star of sorts to help humanize the issue of clinical decision support and communicate the benefits of such technology to the general public.

I got three comments on that post—actually pretty high for this blog—as well as several e-mails. One correspondent said we need more than a rock star, we need the whole band. I passed that comment on to Dr. Bill Bria, CMIO of Shriners Hospitals for Children, who was part of the panel at the AMIA meeting, who told me that he once led an all-physician rock band called the Straight Caths. It still may take the Rolling Stones or perhaps an entire Woodstock to make some of the changes American healthcare needs. Then again, Thursday is Elvis’ birthday.

One non-physician wrote: “That was terrific. Thanks! Except, while I don’t disagree, maybe if they learned to speak English, too, it would help.” Actually, Joan Ash of the Department of Medical Informatics and Clinical Epidemiology at Oregon Health and Science University made a similar point in said AMIA session.

CareGroup Healthcare System CIO Dr. John Halamka, himself a rock star in health IT circles for his incredible ability to juggle so many responsibilities (and perhaps for his Johnny Cash wardrobe), pointed me to one of his blog posts about his idea for ASP-style “decision support service providers”

One vendor executive wrote: “Its a shame that these guys seem to believe that CDS just means medication decision support when there are many other steps that use and benefit from DS.” This writer said there should be more of a focus on diagnosis decision support. The e-mail also included a quote from Dr. Donald Berwick: “Genius diagnosticians make great stories, but they don’t make great health care. The idea is to make accuracy reliable, not heroic”

Just think, a well-implemented clinical decision support system could finally give Cuddy a reason to fire House. I think about that every time I watch that show. It’s sad that trial and error can produce such great television.

January 6, 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.

Telemedicine on ‘House’

Like most TV medical dramas, paper charts, handwritten prescriptions (usually for Vicodin) and lots of trial-and-error have been hallmarks of “House MD” since Day 1. Sure, there’s always a lot of advanced diagnostic equipment, but this week I finally find myself compelled to blog about one particular episode of one of my favorite shows.

A special episode airing Sunday night right after the Super Bowl (approximately 10 pm EST) features what looks to be some really cool, high-definition telemedicine. Specifically, House has to treat a researcher at the South Pole, played by Mira Sorvino. Go here and click “Watch Video” for three clips.

Now if only someone could convince Dr. House to try clinical decision support. Then again, the show wouldn’t be nearly as entertaining.

January 31, 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.