The digital health space refers to the integration of technology and health care services to improve the overall quality of health care delivery. It encompasses a wide range of innovative and emerging technologies such as wearables, telehealth, artificial intelligence, mobile health, and electronic health records (EHRs). The digital health space offers numerous benefits such as improved patient outcomes, increased access to health care, reduced costs, and improved communication and collaboration between patients and health care providers. For example, patients can now monitor their vital signs such as blood pressure and glucose levels from home using wearable devices and share the data with their doctors in real-time. Telehealth technology allows patients to consult with their health care providers remotely without having to travel to the hospital, making health care more accessible, particularly in remote or rural areas. Artificial intelligence can be used to analyze vast amounts of patient data to identify patterns, predict outcomes, and provide personalized treatment recommendations. Overall, the digital health space is rapidly evolving, and the integration of technology in health
Showing posts with label reimbursement. Show all posts
Showing posts with label reimbursement. Show all posts

Friday, May 6, 2016

Mental Health Data Missing from Electronic Health Records

Mental Health Data Missing from Electronic Health Records


The article in HealthLine underscores the issues of developing a total electronic health record. 

Despite federal desires (CMS & HHS )to totally wrap medical records into an electronic format there remain several critical issues important to guarding privacy of patient mental health information. The Federal Definition of an EHR is extends beyond the aspects of recording patient data. They define an EHR with a broad pen including capabilities of meaningful use capturing data for analytic purposes.

By convention, and a long ethical history, providers have always guarded the privacy and protection of patient’s medical records, especially for emotional disorders. The physician has always been the health information collection agent in a fiduciary manner.  If the emotional and behavioral aspects were put into the EHR it would greatly endanger patient’s reputations, employment, and even  discrimination by health plans.  The Affordable Care Act  has markedly reduced the risk of non insurability by law. The other issues have not been addressed.



There is a spectrum of behavioral disorders ranging from severe organic brain disease resulting in schizophrenia and bipolar disorders to mild neurosis and anxiety disorders.  It is a gray playing field and somewhere in the middle it crosses over from ‘medical disorder’ to ‘behavioral disorder" in the reimbursement system. (What's in an ICD code?)



Health Plans discriminate between the two on a reimbursement basis as well. Co-pay for visits to a psychologist are higher than medical visits. In some cases even when an MD psychiatrist is involved the visiit is not treated as a medical visit even if medications are managed by the psychiatrists.

Often the staff at a ‘behavioral clinic’ do not discern the difference and bill improperly.



The federal government is interested in interoperability for purposes of data analytics. The experts who advise congress and HHS are misguided and naive, positing that developing this system will improve the quality of health care.  

Mental health issues should have a higher level of privacy protection. Not every provider should have access to the mental health record of every patient. That is a shot gun approach prone to much collateral damage. Mental health records should only be in the EHR in a higher level of protection with additional access granted only by the patient. The level of emotional dysfunction will be a major determinant in the importance of the information.

In a time when medical care has become patient centered the patient will have the final word on release of potentially harmful behavioral information. It is now established that the patient owns his own data even while it resides in the EHR program. He owns it and no one can take it without the patient's permission. (case precedence ?)


There was a time when public figures could enter a hospital and/or a provider's office and be certain the visit would not be made public. . Politicians, celebrities and other high level people expected this as the normal course of the day.  So too should it extend to all patients with equanimity. Placing this information in the EHR in an unrestricted fashion is not a good thing to consider.

Neither can a metric be applied in this gray zone. Most of it is ‘judgment’  The word that EBMers do not have in their vocabulary.

Unexpected release of protected information either medical or emotional can result in a serious alteration of a patient’s life, and/or employment. Employers like to have this information to determine suitability for employment. Allowing employers or any non medical person not directly involved in the patients health care would be akin to opening Pandora's box.

The Feds are wrong about this, as they have been in most health quality and reimbursement issues. There is no real necessity for inclusion in the EHR the Feds would like it but they are not going to get it unless providers cave in and are once again blackmailed and extorted by another carrot and stick scheme so common to our corrupt system of governing.


Monday, January 27, 2014

Radiology One of the Highest Paying Medical Specialties

Contributions to this post are from:
Mike Bassett, 



One of the   principal determinants some medical specialties is salary. However, that is not the only factor in specialty selection by trainees.  Some of the other factors are:

Relatively good hours and call schedule
Flexibility of work locations
Group Practice insulated from  financial issues
Hospital based employment, an option
Support as consultant for most specialties
Technological advancements in CT, MRI, PET and other new imaging techniques

Fierce Medical Imaging reports that although Radiology reimbursement has flattened out and perhaps decreased there are an abuncance of job seekers in Radiology.



  1. Study: Two job seekers for every new radiology position
An analysis of the American College of Radiology job board suggests that for every job posted there are two radiologists seeking jobs, according to a study published online in the Journal of the American College of Radiology.

According to Anand M. Prabhakar, M.D. of the department of radiology at Harvard Medical School and Massachusetts General Hospital, while the general impression of the radiology job market has been "grim," there has been little research done tracking employment statistics. 
The researchers found that the during the study period, the mean number of new job seekers was 168 per month--twice as many as the 84 job postings found on average per month. 

No appreciable difference in the number of new job postings between 2011 and 2012 was found, while the number of newly registered job seekers ranged from 80 in May 2012, to a high of 418 in October 2010. October through November of 2010 represented one of the peak periods of job competitiveness (represented by the number of newly registered job seekers), along with August through November of 2011 and October and November 2012.
Consequently, the researchers concluded that there is a seasonal variation in interest in the ACR jobs board coinciding with the July 1 start date of fellowship training programs.

The study is a relatively short term study and in a period of rapid change with the Affordable Care Act and the imminent development of Accountable Care Organizations.

Radiology suffers from the same pessimism stimulated by reductions in earnings. 

In the face of what appears to be a shrinking job market, practicing radiologists have an obligation to those just starting their careers "to help them get through this difficult time," write David Levin, M.D., and Vijay Rao, M.D. in an article published in the April issue of the Journal of the American College of Radiology.
report last year by physician recruiting firm Merritt Hawkins illustrates how job prospects have declined for prospective radiologists over last several years. According to the report, demand for radiologists--Merritt Hawkins' most requested specialty in 2003--ranked just 18th last year.
The reasons for the fall in demand, according to Levin and Rao? Slowdowns in utilization and reimbursements; longer radiologist hours to maintain compensation levels (consequently decreasing the need to hire new radiologists); current radiologists deferring retirement; and the advent of picture archiving and communications systems and other digital enhancements that have increased efficiency.