November 25th, 2009

U.S. health IT money going to community colleges

Posted by Dana Blankenhorn @ 8:58 am

Categories: General, Government, Hospital IT, Medical IT, Medical Office IT, Medical Records, Physician Information, U.S.

Tags: Information Technology, Health Care, Training, Workforce Management, Vertical Industries, Training And Certification, Benefits, Healthcare, Human Resources, Dana Blankenhorn

National Coordinator for Health Information Technology (NCHIT) David Blumenthal has launched his own blog, where he announced this week $80 million in grants for health IT training, mainly to community colleges.

The money was authorized as part of the Obama stimulus, specifically the $19.2 billion HITECH Act.

Administrators can apply for a total of $70 million in community college grants, which would go into programs aiming to train health IT professionals. The hope is that 10,500 people can be trained annually in the use of health IT systems through the program.

These are not programming jobs. Among the “exciting job opportunities” the money hopes to create are:

• Practice workflow and information management redesign specialists;
• Clinician/practitioner consultants;
• Implementation support specialists;
• Implementation managers;
• Technical/software support staff;
• Trainers

This follows common medical practice, where a hospital or medical practice has a number of people trained at different levels of depth to perform different roles.

In addition to the training money, there’s $10 million available to create the training materials for these programs.

It will be interesting to find out just what is going to be taught, given the wide differences among all the various EHR systems now on the market.

Will Community Colleges align themselves with specific vendors in order to stretch their dollars, thereby giving those products market advantages? Or will the curriculum be more general, based on technical standards and legal requirements?

Stay tuned to Blumenthal’s blog for more. We’ve put it on our blogroll.

November 24th, 2009

What open source can teach medical practice

Posted by Dana Blankenhorn @ 7:34 am

Categories: Consumer Information, Ethics, General, IT Management, Internet, Medical Office IT, Medical Records, Networking, Open Source, Research

Tags: Gender And Diversity, E-health, Open Source, Human Resources, Healthcare, Dana Blankenhorn

It is frustrating whenever personal medical questions become political questions.

This happens all the time. Example A, ripped from the headlines, is the kerfluffle over mammograms.

Women, doctors and politicians who hate having to go through the procedure are now screaming bloody murder over the non-existent “threat” to halt access to it.

Let’s go back to where this started. It was a population study, done on behalf of the U.S. Preventive Services Task Force,  which concluded that the risk of unnecessary treatment exceeds the risk of death from annual screenings for the disease.

It was a science paper, and it was complicated, couched in the words scientists use to describe their work with precision.

Every profession has its version of this language. Engineers do, lawyers do, even software developers do. Learning the language gives a journalist entree into these professional worlds, but it’s not an exercise most of us will, or should, go through.

Thus this study, like so many, was filtered through the lens of journalism. A flood of words failed to answer the questions women wanted answered

• What are the chances I will die from a late diagnosis?
• What are the chances I will suffer from over-diagnosis and over-treatment?

Calculate the threat to me so I can make a rational choice.

This is where technology comes into play. An Electronic Health Record (EHRs) can show you your own history, we can take your family history, we can analyze your genetic history, and we can estimate based on that.

If, that is, we have access to the larger pool of data. That’s our baseline. It’s what we need to compare your own data to before we can give you the answer you seek.

In scientific studies like this one we don’t have access. The data is locked away somewhere. Mass adoption of EHRs is going to unleash a firehose of data, and the question should occur, very soon, what to do with it.

I’m not talking here about your record. I’m talking about the gross data, this warehouse of numbers describing everyone’s condition, what is being done for us, and what the results are.

An open source attitude toward that data, within the realm of science and throughout the medical community, can help patients gain access to the benefits of that data and answer the question they ask — what should I do?

Unfortunately medicine, health IT, and medical data all suffer from a proprietary attitude born of paranoia, the fear that you may be identified in this data mountain, that your needle will appear in this haystack, and that giving everyone access to data means giving them access to you.

A database, stripped of personal information, consisting of millions of records, is safe for use by software code. The data, and the code, are what we need to provide real answers.

We are collecting the data. We need to unlock it. We are writing the code. We need to share it.

This is what open source can teach the practice of medicine.

November 23rd, 2009

The medical home is reform without objections, so far

Posted by Dana Blankenhorn @ 10:13 am

Categories: Aging, Ethics, Finance, General, Government, Home Health Care, Hospital IT, IT Management, Internet, Medical IT, Medical Office IT, Medical Records, Wellness

Tags: Team, Patient, Health Care, Home, Doctors, Team Management, Management, Dana Blankenhorn

There is one type of health reform that, so far, has received little publicity and no political objections.

It’s called the medical home. (Picture from the American Academy of Family Physicians.)

Physicians have been talking up the concept since the 1960s, and at its heart it is pretty simple. Charge for wellness and create a team, headed by a physician, that can deliver it.

When people like Larry Green, who heads the American Board of Family Medicine, talk about moving toward a “blended payment” model he’s advocating for this team approach to care.

Many doctors’ groups support the medical home, but getting from here to there is not easy. Doctors are basically being asked to create a new business, with a new set of employees, and to do this they need start-up capital.

The AAFP magazine Family Practice Management published an article last month with 10 suggested steps for getting that capital.

These start with using existing medical codes to generate more revenue from each patient visit, hiring more nurses and medical assistants, then using these people to increase the number of patients you “see” each day. Wash, rinse, repeat.

If this sounds like gaming the system to generate revenue, it reads like this to me, too. But this revenue has a purpose. The article suggests that capital go into an Electronic Health Record (EHR) system, a “patient portal” through which customers access health data, and links to other helpful electronic resources.

One idea of the $19.2 billion HITECH stimulus cash is that it helps doctors pay for these computer resources so they don’t need to game the system to get the money. But they still have to build scaled businesses.

Only after doctors have their office and systems right should they focus on high-cost patients, the article continues. A lot of alligators need to be slain before you drain this swamp.

From the patient point of view, you’re going to be given a lot more control over your care, you’re going to have a lot more appointments with people other than the doctor, but you’re going to get more face time with people trained to help you.

It’s that face time that can end disputes like the present one over pap smears and other tests. You will have people you can discuss these issues with, people who have access to your medical records, people who will have the time to listen to you as well as talk.

Now that you know the good news, here is the bad news:

1. The financial success of a medical home is based on nagging. You get the data, you get access to the people, but money is only saved when you take the advice.
2. It takes money and business transformation to get from here to there. Running a team takes money and organization. Either doctors become businessmen or go to work for people who are. Either they buy and build systems they need or they associate with others who have them.

A health policy based on the medical home is going to be a lot more intrusive than the present fee-for-service model. The team will know if you smoke, how much you drink, what you eat, even what you’re likely to die of, based on a whole lot of data.

If the medical home is to save money, and lives, that team will need power to enforce what’s good for you. It could come from an adjusted insurance rating, based on your observed lifestyle, with the higher fee going to your medical home.

Or the medical home needs the power to force you out for non-compliance.

The medical home, in the end, offers the promise of lower costs and personal attention, in exchange for your willingness to be bound by your doctor’s advice on what’s good for you.

Do you still like the medical home?

November 18th, 2009

Why electronic health records have far to go

Posted by Dana Blankenhorn @ 7:30 am

Categories: Finance, General, Government, Hospital IT, IT Management, Internet, Medical IT, Medical Office IT, Medical Records, Physician Information, U.S.

Tags: Electronic Health Record, Training, Health Internet, Moore, E-health, Healthcare, Dana Blankenhorn

It’s easy to seize on word that electronic health records (EHR) are not yet saving money and call everything the Obama Administration is doing in health care bogus.

That would be unfair to the technology.

Ashish Jha of the Harvard School of Public Health offered the report this week as a scene-setter for the school’s Public Health and Technology (PHAT) conference, whose speakers’ list is a who’s who of EHR advocates. (Picture from Dr. Ashish Jah’s home page at Harvard.)

Rather than being a hit piece at the current Administration’s aims, the report focuses on the best practices of groups like Kaiser Permanente and the Cleveland Clinic, which have spent years adapting their work to the technology. Do these things and you can make things work, as proven in areas like heart care, he writes.

Rather than focusing on paying for the computers and software, he says, emphasis should be placed on training people, and adapting practices to take advantage of what the data can do. As in any business a failure to adapt means you’re wasting money.

Dr. Jha made this point in the School of Public Health’s in-house publication last month. Speaking at a University-sponsored public forum in September, he said this:

The money in the stimulus bill is going to help a lot in terms of getting systems adopted. You’re going to see this entire field change dramatically in the next several years. You’re going to see new vendors getting into this field who haven’t been there before. I’m hopeful this will mean better products that will require less training. There’s no doubt in my mind that five years from now, we are going to have far more widespread use of electronic health records.

Whether we are going to get to 90% as President Obama has said he wants, I’m not sure. But the bottom line is that this train has left the station. We’re moving towards electronic records. The only question is whether we can do it well. The big challenge for us is to make sure we adopt these systems effectively, that we remember the prize is not electronic records; the prize is higher quality at lower cost. And that’s only going to happen if we really think through how to adopt these systems in a more organized and effective way.

Those are the words of an EHR enthusiast, not a skeptic, and certainly not a cynic.

Fact is the EHR revolution has barely begun. The Health Internet is still being implemented. Barely one hospital in 10 has a functioning EHR system. Moore’s Law of Training (there is no Moore’s Law of Training, we learn as fast as we learn) has barely kicked in.

The health IT revolution will not happen like the turning on of a light switch, as people in every other industry that has been touched by computers, including journalism, will tell you.

It’s a long-term process.

November 17th, 2009

Keep your genes to yourself after this weekend

Posted by Dana Blankenhorn @ 9:03 am

Categories: Curioisities, Ethics, General, Government, IT Management, Medical Records, U.S., genetics

Tags: Insurance Company, Health Care, Genetic Information Nondiscrimination Act, Family History, Insurance, Vertical Industries, Healthcare, Benefits, Business Operations, Corporate Insurance

The Genetic Information Nondiscrimination Act (GINA) goes into force this weekend, and the regulations will impact more than the mere collection of genomes.

The Act was passed last year and signed by then-President Bush.

It makes it illegal to base insurance eligibility or even rates on genetic data, including family histories. Some insurers had been giving discounts to people who completed family history questionnaires. No more.

Employers are already complaining. Some say common health risk assessments will no longer be legitimate. Some complain that wellness programs will be hurt.

Some employer groups and insurers wanted the law’s implementation delayed. Lawyers are already going ka-ching. People who don’t like lawyers are wringing their hands.

The American Medical Association has told its members that physicians should no longer participate with insurers on genetic testing, and even limit disclosures of genetic data to law enforcement.

Basically the new law puts your family history, including your genetic make-up, under requirements similar to those of HIPAA. Just as doctors can’t share your medical data with outsiders, they can’t share your family history either. This may require changes to Electronic Health Record (EHR) software, especially on the server side.

The New York Times says the law will have some unintended consequences. If a CEO’s father and grandfather died of heart attacks at age 50, and the board refuses to promote him to the top chair at age 49, he could have a tort.

Some data can still be collected. There’s a “water cooler” exception, so if you tell the boss about your mom’s breast cancer they can hear that. Or if they later read her obituary in the paper. Or if they ask why you took family leave and you say it’s because your dad has pancreatic cancer.

GINA may be impacting you right now, because many companies are engaged in “open enrollment programs” for next year’s health insurance. There are no longer discounts for giving the insurer data. Some analysts think the new law is America’s definitive statement that they don’t want insurers playing their present expansive role in the health care system.

As with everything, there are unintended consequences. Some baseball teams have used genetic tests to identify (and set the age for) players from Latin America. One basketball team refused to re-sign a player without a genetic test. Perhaps, as Roberto Duran once said, no mas.

One more thing. The blog Queerty notes that if they ever find the the “gay gene” employers can’t test for it, nor discriminate against you based on it. They’ll have to rely on finding your two tickets to “Gypsy”, or meeting your companion at the company picnic. (Hey, I love “Gypsy.”)

November 11th, 2009

CCHIT going on almost as if nothing happened

Posted by Dana Blankenhorn @ 8:53 am

Categories: General, Hospital IT, IT Management, Medical IT, Medical Office IT, Medical Records, Physician Information, U.S.

Tags: U.S. Department Of Health And Human Services, Electronic Health Record, Health Care, Standards, CCHIT, Blumenthal, E-health, Quality, Healthcare, Vertical Industries

One of the big controversies early this year was over the role CCHIT was playing, certifying vendors to sell Electronic Health Record (EHR) software.

CCHIT (Certification Commission for Health Information Technology) was formed in 2004 out of HIMSS (Healthcare Information and Management Systems Society), an industry group, and began certifying EHR systems in 2006. Until this year you entered the EHR market by first undergoing CCHIT certification.

Was their approach right, or was it too rigid? Was it really helping buyers, or just pointing them toward expensive solutions from members of the HIMSS industry group?

When we last left the story the good guys seemed to have won. The standards under which software will be approved for stimulus cash are functional, requiring meaningful use. They’re not programmatic. It’s not what the software does, but whether it’s used, and for what, that counts.

So what happened to CCHIT? They’re going along pretty much as before.

In an extended interview with Healthcare Informatics, CCHIT head Mark Leavitt (above) said the group has added a new Preliminary ARRA 2011 Certification to its suite of products.

“It doesn’t really matter” what the National Coordinator of Health IT, David Blumenthal, or his policy committee come up with, Leavitt told Anthony Guerra.  CCHIT’s “Get Certified” seminar in October drew an overflow crowd.

Blumenthal’s policy committee called its government standard “HHS certification.” Leavitt called the same set of criteria “Preliminary ARRA Certification” because the Department of Health and Human Services (HHS) may give it yet-another name, and because the rules on all this don’t go out until next month in any case.

Even after that there will be time for CCHIT and others to comment, and for those comments to be digested, before they are final. Then certifying authorities must be appointed, and CCHIT has applied to be one. Meanwhile hospitals and doctors are having to make decisions that may haunt them through their professional lifetimes.

In his interview, Leavitt called the ARRA rules “basic” and his own rules “comprehensive,” but in fact one is the government standard and the other CCHIT’s private one.

What has happened is that CCHIT has been forced to take a step back, from being the gatekeeper of market entry to being one of perhaps several groups looking to be certification authorities under the new rules.

This is not Leavitt’s spin on the matter:

We’ve heard from provider groups, we’ve heard from the specialties that the marketplace was not making adequate progress in making the products they needed with all the features they needed.

There’s more than just federal standards, there are other requirements they have as providers, such as supporting workflows and maintaining a legally adequate record. They really thought CCHIT was a way to have a community conversation and move the entire marketplace forward.

We’re not a gatekeeper. We’re a community conversation. The CCHIT “comprehensive” standards aren’t for the  “sophisticated CIO,” in Leavitt’s words, but for small hospitals, for small practices, the people who need help in making an informed choice.

Maybe, but these same customers also have the most constrained budgets, and fairly basic needs. Do they need something a private industry group has deemed meets “comprehensive” standards or not?

That is a question the market will have to decide. Will hospital administrators and practice managers insist on the comprehensive CCHIT-approved label, or will they accept any solution that brings them that sweet, sweet stimulus cash?

November 5th, 2009

What the Google Privacy Dashboard can mean for health

Posted by Dana Blankenhorn @ 8:34 am

Categories: Consumer Information, General, Home Health Care, Hospital IT, Insurance IT, Internet, Medical IT, Medical Office IT, Medical Records, Wellness

Tags: Google Inc., Privacy, Dashboard, Health Care, Personal Health Record, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

If you have checked out the Google Privacy Dashboard, you may not have noticed that it covers all Google products.

This includes Google Health, the company’s Personal Health Record (PHR).

The media focus here has been on what Google knows about you, and the oh noes that Google will use that data against you.

But with the Dashboard’s access to Google Health, it occurs there might be another use for it.

What if you could find out where all your health data is? What if you could learn just which doctors, which hospitals, which insurers have what types of electronic data on you?

Knowing what’s out there, and knowing the rules for releasing that data, you can have full control of your privacy as we move from paper records to electronic records.

Given the trend within health IT toward more open standards, and more standards generally, it should not be too hard to provide support for this capability within, say, the NHIN-Connect system, which the Administration now calls the Health Internet.

There are lots of ways for this to go down, but the most efficient might be for the Health Internet to support a spidering technology that lets service providers offer a full health dashboard to consumers. Where within the NHIN system are what types of data on you. Not the specific data, but who has stuff, which is information we should all be entitled to.

I’ll bet that would be an incredibly valuable service, because it’s something we don’t have right now. The availability of such a service might even drive consumer acceptance of the Health Internet itself.

Take my case, for instance. In addition to my regular doctor, I have an eye doctor, I’ve seen an orthopedist, I have an insurance company, and a guy who did my colonoscopy. I also have a pharmacist. All that data, in time, is supposed to feed my Personal Health Record, along with data I might create, like my workout data.

Knowing who has what puts me in charge. Computers can tell me that. This encourages me to embrace computers, and powers the movement toward PHRs.

Did I mention Google Health is a PHR?

November 2nd, 2009

Obamicans rebranding NHIN-Connect as the Health Internet

Posted by Dana Blankenhorn @ 7:45 am

Categories: Curioisities, General, Government, Hospital IT, Insurance IT, Internet, Medical IT, Medical Office IT, Medical Records, Open Source, U.S.

Tags: Health Care, Obama Administration, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

The Obama Administration has a new brand for the NHIN-CONNECT service that debuted earlier this year.

The Health Internet.

(The button to the right is currently on the CONNECT home page.)

CONNECT is a set of open standards and protocols, originally developed under contract by Harris Corp., primarily using technology from Sun Microsystems (soon to be part of Oracle).

Among the open source tools in NHIN-CONNECT are the GlassFish application platform, the Java Composite Application Platform Suite (CAPS) SOA Platform, and the Sun Java Identity Management suite.

Since its April launch the Department of Health and Human Services has been hosting a series of “code-a-thons” where programmers can dissect and improve the software. About 100 participated in the first such event in August.

The frame of a health Internet is drawing effusive praise from Robert Kolodner, who was the last National Coordinator for Health IT under the Bush Administration, and who recently went to Open Health Tools.

All this is part of an important policy turn by the Obama Administration which, as Kolodner’s support for it indicates, really has nothing to do with politics.

Under the Bush Administration, policy favored contractors, who kept their work proprietary. The hope was that privatizing development would save government money in the long run. The Veterans Administration even lost control of its own lab software, after decades seeking to develop it internally under its VistA system.

Now the VA’s CIO thinks VistA is the bees knees, and the open source movement has even invaded the Defense Department, which appears to welcome its new penguin overlords.

Having health records moved nationwide under a set of open, accessible standards is also great news for Personal Health Record (PHR) systems like Microsoft HealthVault and Google Health, which may soon have a single set of open standards every proprietary system is writing to.

The pitch that NHIN-CONNECT is a “health Internet” reflects all these changes. Ordinary citizens won’t access the system, but they will be able to gain its byproducts, including PHRs delivered through tech companies, insurers or hospitals.

It’s real health reform, and it cost nothing that wasn’t already being spent under the previous Administration.

October 30th, 2009

Health IT discussion overtaken by policy

Posted by Dana Blankenhorn @ 6:35 am

Categories: General, Government, Hospital IT, IT Management, Medical IT, Medical Office IT, Medical Records, Physician Information, U.S.

Tags: Health Care, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

NCHIT David Blumenthal (right) went across the country to get a discussion going on health IT this week, but it was quickly overtaken by health reform policy disputes.

What he wanted to talk about at the Southern California Health Summit in Ontario, Calif. was the nearly $20 billion allocated for health IT in the HITECH Act passed as part of the stimulus, and the $700 million already allocated to create a network of “local healthcare geek squads” across the country, to help doctors and hospitals with automation.

Instead, reporters were quick to identify him with his past policy work for the late Sen. Edward Kennedy, his political work for 1988 candidate Mike Dukakis, and his role as a policy advisor to the Obama campaign.

Reporters also swarmed around any speaker who preferred to talk about policy, and the reform bill now before Congress. Whether it was the cost of emergency rooms, or the unfairness of some bill drafts to California, the real meaning of the meeting was lost.

That meaning bears repeating. The automation of health records is going to happen. The money has been authorized, and is now being allocated.

Electronic Health Records (EHRs) are going to transform medicine, making it easier to conduct longitudinal studies, allowing the re-use of common tests, and reducing the paperwork burden on both patients and medical offices.

How that act is implemented will say more about the pace of reform than whether government or private insurers are paying the bills but, for now, few are willing to listen to that discussion.

October 23rd, 2009

Windows 7 will shine in medicine

Posted by Dana Blankenhorn @ 10:34 am

Categories: General, Hospital IT, IT Management, Medical IT, Medical Office IT, Medical Records, Windows

Tags: Touch Screen, PC, Doctor, Health Care, Microsoft Windows, Microsoft Windows 7, Tablets, Keyboards, Notebooks, Monitors & Displays

Windows 7 is finally here, and your doctor couldn’t be happier.

Thanks to its full support of multi-touch touch screens, Windows 7 is perfect for a tablet PC any doctor can use to record, update, and analyze your health records.

The big phrase you will hear this year is All In One. It means instead of choosing among a notebook, a tablet and a touchscreen, they are all one thing. As the standard PC becomes an All In One, the price drops toward the $500/unit level seen in standard laptops.

But wait, there’s more. Because the touchscreen is now supported within the operating system, applications will also get that support. This will also drop the price of solutions dramatically.

One problem doctors have long had with computerizing health records was the sloppy interface, when compared with clipboards. The clipboards always had the form they needed to use, and if it didn’t they could also slip another form into the clip and go.

Clipboards also support a doctor’s own handwriting. So now will standard PCs, once their optical character recognition software is trained. Nurses who “know what that scrawl means” will do the training, asking no more follow-up questions than they do . (Was that Percocet or prerequisite?) As the software learns the patterns, these annoying questions will start to go away.

Support will be needed to lead docs and nurses through the menus, so they can reach the right form, the right report, the right image. As with any PC application your mileage goes up as you get familiar with it.

But a virtual page is being turned here. There are no longer any excuses for doctors to have tablet PCs equipped with a pen-like stylus, an interface just as good as the clipboard and, over time, better.

This won’t overcome all objections. There is still a sort of protection in that bad handwriting. (No, your honor, I didn’t order Percocet — I asked what was the prerequisite.)

But now we will know where the objection comes from.