Category Archives: Digital Physicians

Kaiser’s Long and Winding Road

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Health Data Management  Reviews Kaiser’s EHR Lessons
In August 1, 2009 issue of Health Data Management Magazine, Executive Editor Howard J. Anderson reports extensively on lessons learned as “Kaiser Permanente is entering the home stretch in what’s turned out to be a seven-year drive to implement comprehensive EHRs, personal health records and related systems at all of its hospitals and clinics.” Lessons focus on cost centers, training, deployment, and ongoing process.
http://www.healthdatamanagement.com/issues/2009_69/-38718-1.html
Learned of story from daily AHIP Solutions SmartBrief e-newsletter published July 28, 2009.  AHIP is America’s Health Insurance Plans association.

HIT Standards Committee Deliverables: July 21, 2009 – More ‘Meaningful Use’ Details

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Standards panel aligns interoperability specs with ARRA
Added July 24, 2009: – Healthcare IT News reported by Editor Bernie Monegain that ”The Healthcare Information Technology Standards Panel has approved new interoperability specifications for electronic health records, data exchange and architecture that align with the federal government’s stimulus package for healthcare IT.”

Standards Mapped to ‘Meaningful Use’ by HIT Standards Committee
John Halamka, MD, vice chair of the committee, reports July 21, 2009, on his blog, Life as a Healthcare CIO, the deliverables of the HIT Standards Committee and its workgroups on Clinical Quality, Clinical Operations, and Privacy and Security with links to the report and a matrix for each workgroup. These documents add critical details to the plans,  including “the approach used to specify the 27 performance measures for 2011 which support meaningful use.”

HITS staff writer Jean DerGurhian reports on quality updates.
FederalComputerWeek’s Alice Lipowiscz reports on Clinical Quality Workgroup’s  recommendations for “31 performance and data capture measures,” including “26 benchmarks already endorsed by the National Quality Forum.”

Rough Draft Transcript Of July 21, 2009 HIT Standards Committee produced by Brain Ahier.

Health IT Standards Committee Meeting July 21, 2009: Meeting Agenda and Presentations
DOCUMENTS DIRECT FROM HIT Standards Committee Meetings Page:

  • Agenda
  • Meeting Minutes from 6/23/09 mtg
  • Meaningful Use Workgroup Presentation to HIT Policy Committee on July 16, 2009
  • Report of the Clinical Quality Workgroup
  • Quality Workgroup Update Grid for Meaningful Use
  • Clinical Operations Workgroup Report
  • Clinical Operations Workgroup Recommendations
  • Summary of HITSP Capabilities
  • Privacy and Security Workgroup: Recommendations
  • Privacy and Security Standards Applicable to ARRA Requirements (handout)

    • ‘Meaningful Use’ Recommendations Approved by ONC Health IT Policy Committee

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    Health IT Policy Committee Approves ‘Meaningful Use’ Recommendations
    Healthcare IT News reported on July 16, 2009     that the “ONC policy committee accepted its workgroup’s complex matrix of qualifications that will define “meaningful use” of health IT, a pivitol aspect to being a candidate for reimbursement bonuses and avoiding penalties under the American Recovery and Reinvestment Act of 2009 (ARRA).” ONC will finalize recommendations to Center for Medicare and Medicaid Services (CMS), which will have final say on rules that will be published by end of year and subject to public comment.

    As reported by Joseph Goedert in HealthData Management on July 16, 2009 in “Meaningful Use Definition Gets Initial OK,” the committee recommends that the ”2011 criteria would be considered Adoption Year 1 criteria” enabling  applicants in later years to roll in additional requirements over three years.  Committee also recommended Personal Health Records should have real-time access to data by 2013, two years sooner than originally proposed. This article details the revisions from initial recommendations.

    iHealthBeat‘s summary of these articles

    Direct from
    ONC’s HIT Policy Committee’s Meeting site: July 16, 2009            
     Agenda (pdf)

  • Meaningful Use Workgroup Recommendations (ppt)      
                   Meaningful Use Matrix (pdf)
                   2011 Draft Measures (pdf)
  • Clinical Operations Workgroup (ppt)

    • Clinical-decision support gains attention at AMDIS

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    “Clinical-decision support”: how many mentions in ARRA?
    Joseph Conn, HITS Staff Writer, on July 16, 2009, reports on a “meaningful use” question and comment by Charles Friedman, deputy national coordinator in the Office of ONC for Health IT, who was connected by phone to a panel discussion in California of Association of Medical Directors of Information Systems (AMDIS).

    Aligning Health IT and Health Reform

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    On July 15, 2009, “Markle Connecting for Health, the Engelberg Center at Brookings, and the Center for American Progress co-host a forum in to explore critical junctures between current health reform efforts and health IT investments” at the Center for American Progress in Washington, DC.

    Led off by ONC Coordinator, David Blumenthal, speakers are Zoe Baird and Carol Diamond of Markle Foundation; Mark McClellan, Director, Engelberg Center for Health Care Reform and Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution; and Todd Park, Center for American Progress. Panel discussion includes representatives from American Academy of Family Physicians, Consumers Union, National Partnership for Women & Families, Pacific Business Group on Health, and Vermont Health Access.
    Archived video of two-hour session.        
    Press release (pdf)

    Roundup of Comments About ‘Meaningful Use’

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    ‘Meaningful use’ reviews show qualification concern
    Joseph Conn, HITS staff writer, writes a roundup of comments submitted by a range of organizations on July 2, 2009: Consumer Partnership for e-Health (includes 17 organizations such as AARP, Consumers Union, National Partnership for Women & Families), Federation of American Hospitals,American Hospital Association, 82 medical societies including American Medical Association, Association of Medical Directors of Information Systems, and American Health Information Management Association.

    CHIMES adds it Comments on ‘Meaningful Use’
    The College of Healthcare Information Management Executives (CHIME) President and CEO Rich Correll said in comments dated June 26, 2009, ”given the diversity of (hospital) environments … flexibility in complying with meaningful use is essential to ensure that as many patients as possible reap the benefits of safer, more effective health IT-enabled care.” CHIME  is made up of 1,300 CIOs.
    Press release summary.
    Full letter and recommendations. (pdf)

    Docs to Feds: Go Slow on Meaningful Use

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    HDM Reports on “Go Slow” Comments to ONC
    Joseph Goedert of HealthData Management reported on June 29, 2009, that while 80 physician organizations, including the AMA, support the federal EHR initiative, they submitted comments on “Meaningful Use” that “We are concerned, however, that the committee’s timeline to meet the proposed measures is too aggressive given that we continue to lack the necessary infrastructure, standards and systems.”  The recommendations point out specialties for which no certified EHR products are on market: “e.g., oncologists, dermatologists, opthalmologists, obstetricians.” Recommendations also note major transitions to HIPPA Version 5010 by January 1, 2012, and  ICD-10 codes by Otober 1, 2013.
    Here are the recommendations these organizations submitted(pdf).

    HIMSS Comments on Meaningful Use: Need to Differentiate Hospital and Physician Practices
    HIMSS Board of Directors approved comments on June 26, 2009 which “coalesced around three categories: Implementation Timeline & Structure, Adoption Sequence, and Workforce.” Summary Comments start by saying ”Overarching all of HIMSS’s comments, we express out strong concern that the Committee does not distinguish clearly enough between hospital and physician practices.”
    Here are the actual comments (pdf).

    Association of Medical Directors of Information Systems submits comments
    Here are the comments (pdf).

    UPDATE: HIT Policy Committee June 16, 2009 Meeting 
    OFFICIAL  Documents/Audio & Slides Added

    CCHIT explores ‘meaningful use’ in certification process

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    Certification: CCHIT process evolves
    Thoughtful wrapup by Joseph Conn of  Modern Healthcare’s HITS on June 26, 2009, of evolving Certification process with comments by Mark Leavitt, MD, chair of CCHIT, and Steve Waldren, a physician and director of the AAFP’s Center for Health Information Technology. More review of CCHIT processes by this blog next week.
    http://www.modernhealthcare.com/article/20090626/REG/306269994/1153

    A Lifeline for Primary Care

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    NEJM Perspective Calls for More Technical Assistance to Reorganize Primary Care Practices
    NEJM notes that HIT Regional Extension Centers called for in ARRA to assist practices and hospitals in implementing HIT are based on Department of Agriculture’s Cooperative Extension Service which combines federal, state, state university experts, and farmers. In June 25, 2009 issue of New England Journal of Medicine, Thomas Bodenheimer, MD, and Kevin Grumbach, MD, from University of California, San Francisco, School of Medicine; and Robert A. Berenson, MD, Urban Institute; present three areas of focus needed to revitalize primary care with the goal of transforming primary care practices into “modernized medical homes.” Authors state that national policies are required to rescue primary care from its inability to attract enough primary care practitioners due to lower pay, stress of “more work at less pay,” and “medical education favors training in non-primary care fields.”
    http://content.nejm.org/cgi/content/full/360/26/2693

    Primary-Care Doctor Shortage May Undermine Reform Efforts
    Washington Post’s Ashley Halsey III reported on June 20, 2009, that “Fixing the problem (of a shortage of primary care physicians) will require fundamental changes in medical education and compensation to lure more doctors into primary-care offices, which already receive 215 million visits each year.”

    Blumenthal Pledges EHR Support for Small Physician Practices
    “National Coordinator for Health IT David Blumenthal said the federal government would pay special attention to individual physicians and small group practices as it works to implement the health IT provisions of the federal economic stimulus package,” based on reporting from CongressDaily that iHealthBeat summarized on June 25, 2009. Blumenthal also discussed regional extension programs to support implementation of EHRs and said he would set up listening sessions nationwide.
    Here’s the the orginal reporting from Andrew Noyes, CongressDaily on nextgov.com, a National Journal Group site.  Hearing by “the House Small Business Regulations and Healthcare Subcommittee, which heard from pediatricians, optometrists and others who fear they could be disadvantaged when the government doles out about $17 billion in Medicare and Medicaid bonuses, grants and technical assistance.”

    Do Small Practices Lack Resources for Quality Upgrades?
    iHealthBeat     also pointed out reporting from John Commins for HealthLeaders Media on June 24, 2009: “Small medical practices provide nearly 75% all ambulatory care in the United States, yet many lack the resources to improve the quality of care delivered or install electronic health records to serve an increasingly diverse patient mix, according to a report released today by the National Committee for Quality Assurance.”

    National Committee for Quality Assurance (NCQA) Report on Small Physician Practices
    Recommends HITECH Act Regional Centers should give priority to “certain types of providers including individual or small group practices focused on primary care and providers that serve uninsured, undreinsured and medically underserved individuals.”
    Supporting Small Practices: Lessons for Health Reform Topic Page
    Press Release
    Report
    Presentation Slides pdf

    Physicians: Prepare to meet “meaningful use”

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    Advice to Physicians: Prepare to meet “meaningful use” EMR requirement
    Pamela Lewis Dolan, of     American Medical News, reporting June 15, 2009 on the experts’ answer to whether physicians should wait until all the rules have been clarified. The experts told her “Don’t wait to buy or upgrade just for want of a definition. There are enough clues in the legislation to estimate the definition of ‘meaningful use.’”  http://www.ama-assn.org/amednews/2009/06/15/bica0615.htm

    Scenario: How do you keep the patient at the center of the medical interview?
    On the American Medical News site on June 8, 2009, Frederic W. Platt, MD, answered the question: “Given the high-tech trend in patient encounters, how do you conduct the medical interview in a way that does not interfere with the patient relationship?” Dr. Platt is clinical professor of medicine, University of Colorado, Denver, School of Medicine, and regional consultant for the Institute for Healthcare Communication. The post is part of AMedNews.com’s Ethics Forum.
    http://www.ama-assn.org/amednews/2009/06/08/prca0608.htm
    Dr. Platt’s quide to the essence of physician-patient communications:
    Field Guide to the Difficult Patient Interview, 2nd Edition. Co-authored with Geoffrey H. Gordon.

    AMedNews.com’s Current and Archived Articles on EMRs
    Ready source of articles written for physicians about Electronic Medical Records
    http://www.ama-assn.org/amednews/site/topic.htm#emrs