Vol. 41 March 7, 2011 “Hey, PC Guys, Get Over It!”

March 7, 2011

Physicians are buying and using iPads and iPhones just like the rest of the world because EITHER:

“The iPad is intuitive, easy to use, reasonably priced, easy to carry around, and has a lot of apps that have been developed for the platform. People — not just doctors — love the experience of using an iPad.”
“Apple has developed a very appealing hardware platform in the iPad. Recognizing the market strength and lock-in to their walled garden they are creating with consumers, Apple is targeting key market segments to create new revenue streams and business models. Health care is the next target for Apple’s aggressive smarts.”

This “coincidence vs. conspiracy” theory was advanced in a recent Health Care Blog.

The Apple II that I bought for my middle school son decades ago looked like a typewriter and had mostly empty air inside its case. Granted it needed a fan and lots of air around it to keep cool, but I suspect that Apple knew that we would be much more comfortable buying something that looked and worked like a typewriter to replace our typewriter. Apple continues to appeal to our comfort zone. “Hey, PC guys, get over it!”

During my years as a hospital administrator a decade or so ago the weekly mantra from the hospital’s Chief Information Officer seemed to be, “The critical step for implementing EMR is to get over the hurdle of the physician/computer interface.” He was talking about the proprietary computerized information system in our hospital. At the same time, some cardiologists in our hospital were asking when would they be able to review lab results and write orders from their Blackberrys (then) and  (now) iPads and iPhones.  Then, the initial single, desk top computers at the nurse’s stations were quickly overwhelmed with people trying to use them. Clunky computers on mobile stands began to appear to decompress the nurses’ station, and the competition with IV poles, wheelchairs, and other medical devices for noisy “banging rights” began. Now, a physician standing quietly in the hall between patients can review office schedules, review an EKG record from his office, check for on-call nights next month, answer patients’ emails, and maybe review some labs. Of course, the physician could also be checking a stock portfolio, scanning the movie directory, or sextexting the new ER nurse she met last month. Who cares?  The physician wants to write orders, dictate a note, and review a discharge summary while standing there. “Hey, PC guys, get over it.”

A banker spending a day shadowing two physicians in an educational program sponsored by our local medical society summed up his impression of the day with, “The physician’s job is a day-long quest for credible data.” That quest can extend from home to office to hospital to lab to x-ray to nursing home to other’s offices, etc. Much of that time that physician will be on his/her feet literally moving around. Why do they like a light, thin, easy to read, easy to navigate, hand-held computer? “Hey PC guys, get over it.”

James Gleick, author of “The Information”, states that it is neither the media nor the type of technology that transforms human societies. It is the information, and the way in which people communicate with each other. “Hey PC guys, get over it.”

By the way, the future is here. My three-year-old grandson was shown how to swipe his father’s iPhone and touch an icon so that he could pick out his favorite music to listen to. (He is, of course, “above average” in both reading and music appreciation. All of my grandchildren are, of course, “above average” in something.) Soon after his iPhone lesson he went next door to play, saw that their TV was on, and swiped the screen a few times with no result. He turned and announced, “TV broke.”
OK, he could use a little help with sentence structure, but I’m sure “there’s an app for it”.

[This post is a week early because I will be on vacation and off the grid for a while, and I didn’t want to expose my sensitive iPhone to any salt spray.]

Vol. 25 July 15, 2010 “Meaningful Use” of Electronic Health Records (EHRs)

July 15, 2010

Incentive payments via Medicare and Medicaid reimbursements to hospitals and clinicians for implementing electronic medical records under the 2009 HITECH Act (Health Information Technology for Economic and Clinical Health) require the “meaningful use of EHRs to achieve specified improvements in care delivery”, not just adoption of a hardware and software system.

On July 14, 2010 the ONC (Office of National Coordinator) of HIT (Health Information Technology) of DHHS (Department of Health and Human Services) released “The Final Rule” of “meaningful use” criteria/regulations that will have to be met by both hospitals and clinicians to receive HITECH incentive money.

Number of pages of regulations/criteria in “The Final Rule”:  846

Number of years The Final Rule will actually “rule”: 2

  • The Final Rule is no where near “final”. It will merely govern the first two years of HITECH incentive payments and will be revised as the ratcheting up of EHRs standards and implementation occur over the 10 years covered by the HITECH Act.

Total amount of money estimated to be paid out over the 5 years of HITECH incentives: $27 Billion

Amount per clinician estimated to be paid out for HITECH incentives over 5 years by Medicare and Medicaid respectively: $44,000 / $63,750

Deadline for EHR implementation by clinicians to obtain the maximum incentive payments: October 2011

Year in which incentive payment is replaced by a reduction in reimbursement rates (“penalties”) for hospitals which have not implemented “meaningful use” of EHRs : 2015

Number of core measures (“data elements”) that are mandatory for “meaningful use”: 15

  • These measures are basic identification and demographic data elements that are essential to any medical record and represent a reduction from the original 23 measures. (ex. vital signs, allergies, medication list, problem list, smoking history, etc.)

Per cent of patient EHRs that must have these mandatory measures by 2011:  30 – 80% depending on the data element

  • This represents a major change from the initial draft that called for 100 % compliance in the first two years.
  • CPOE (computer provider order entry) will be required only for medication orders and the compliance threshold will be at least one CPOE medication order for 30% of the patients.

Number of optional measures to be chosen by the clinician or hospital for inclusion: 5 out of a list of 10

  • Ex. incorporate lab data as a structural data element, produce summary of care for referrals or transfers, summit immunization data to registries, etc. Many of these also have less than 100% compliance requirements.
  • Recording of advance directive status (Health Care Proxy) in 50% of patients 65 years or older is one optional measure specifically for hospitals.
  • Patient access to their records via PHR (Personal Health Record) or a Patient Portal is NOT a listed criteria yet.

Number of quality measures that are mandatory under HITECH to report to DHHS electronically in 2011-12: 6

  • The three mandatory ones, blood pressure level, tobacco use, and adult weight screening, and three additional ones chosen by the clinician from a myriad of “quality measures” represent a marked reduction in the “burden of quality reporting” contained in the initial draft.

Number of Regional Extension Centers to be established by DHHS to help hospitals and clinicians implement EHRs:  70

  • See article by Atul Gawande, MD proposing the application of the successful agricultural “extension agents” model of 1914 to health care reform of 2010 in New Yorker magazine 12/14/09. See also Alain Enthoven’s critical rebuttal of the model in Health Affairs 12/22/09.

Words from the letters of the acronyms of EHRs, ONC, and HIT:   “RECON THIs”

  • Loose translation: Keep your eyes posted for many future developments.
  • Also, better than “CHRIsT, NO!”

1. Health Care Blog, July 14, 2010, “Meaningful Use” Margalit Gur-Arie
2. NEJM online, Health Care Reform Center, “Meaningful Use Regulations”, July 13, 2010, David Blumenthal

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