HHS: Another Petty Cash Mistake, Is it Working?

HHS’ $30B Interoperability Mistake May 08, 2015 03:04 am Anne Zieger in EMR and EHR Intelligence "Sometimes things are so ill-advised, in hindsight, that you wonder what people were thinking. That includes HHS’ willingness to give out $30 billion to date in Meaningful Use incentives without demanding that vendors offer some kind of interoperability. A staggering amount of money has been paid out under HITECH to incentivize providers to make EMR progress, but we still have countless situations where one EMR can’t talk to another one right across town. When you ponder the wasted opportunity, it’s truly painful. While the Meaningful Use program may have been a good idea, it failed to bring the interoperability hammer down on vendors, and now that ship has sailed. While HHS might have been able to force the issue back in the day, demanding that vendors step up or be ineligible for certification, I doubt vendors could backward-engineer the necessary communications formats into their current systems, even if there was a straightforward standard to implement — at least not at a price anyone’s willing to pay. Now, don’t get me wrong, I realize that “interoperability” is an elastic concept, and that the feds couldn’t just demand that vendors bolt on some kind of module and be done with it. Without a doubt, making EMRs universally interoperable is a grand challenge, perhaps on the order of getting the first plane to fly." The installed base of 'legacy software' required significant upgrading and even replacement. In addition to interoperability many health data exchanges had to be formed and a new sustainable business model had to be developed. Initially HITECH funding and other grants expired leaving the embryonic exchanges insolvent. It was and still is a complex problem. A critical component for providers was the totally unrealistic timetable and time pressure coupled with financial incentives to change.  Many are still resisting the MU process and would rather face a penalty for not adopting MU.  Instead of completing the process in three to four years it will most likely take ten or more years to mature.

Digital differences

Digital differences

When the Pew Internet Project first began writing about the role of the internet in American life in 2000, there were stark differences between those who were using the internet and those who were not.20 Today, differences in internet access still exist among different demographic groups, especially when it comes to access to high-speed broadband at home. Among the main findings about the state of digital access:

While most clinics and physicians have high speed internet, the opposite does not hold true for patients. Studies have shown (PEW Research Center)  

• One in five American adults does not use the internet. Senior citizens, those who prefer to take our interviews in Spanish rather than English, adults with less than a high school education, and those living in households earning less than $30,000 per year are the least likely adults to have internet access.  
• Among adults who do not use the internet, almost half have told us that the main reason they don’t go online is because they don’t think the internet is relevant to them. Most have never used the internet before, and don’t have anyone in their household who does. About one in five say that they do know enough about technology to start using the internet on their own, and only one in ten told us that they were interested in using the internet or email in the future.
• Surprisingly the 27% of adults living with disability in the U.S. today are significantly less likely than adults without a disability to go online (54% vs. 81%). Furthermore, 2% of adults have a disability or illness that makes it more difficult or impossible for them to use the internet at all. 
• The ways in which people connect to the internet are also much more varied today than they were in 2000.    
• Currently, 88% of American adults have a cell phone, 57% have a laptop, 19% own an e-book reader, and 19% have a tablet computer; about six in ten adults (63%) go online wirelessly with one of those devices. Gadget ownership is generally correlated with age, education, and household income, although some devices—notably e-book readers and tablets—are as popular or even more popular with adults in their thirties and forties than young adults ages 18-29.

• The rise of mobile is changing the story. Groups that have traditionally been on the other side of the digital divide in basic internet access are using wireless connections to go online. Among smartphone owners, young adults, minorities, those with no college experience, and those with lower household income levels are more likely than other groups to say that their phone is their main source of internet access
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• Even beyond smartphones, both African Americans and English-speaking Latinos are as likely as whites to own any sort of mobile phone, and are more likely to use their phones for a wider range of activities. Have you ever noticed most hispanics and africa-americans have a cell phone 'glued' to their ear? 
• The primary recent data in this report are from a Pew Internet Project tracking survey. The survey was fielded from July 25-August 26, 2011, and was administered by landline and cell phone, in English and Spanish, to 2,260 adults age 18 and older. The margin of error for the full sample is ±2 percentage points. For more information about this survey and others that contributed to these findings, please see the Methodology section at the end of this report.
  

African Americans and Latinos Rely Heavily on Smartphones for Health Info, Educational Content, Job Seeking

The Road Map to Value Based Reimbursement and Accountable Care Organizations

What is in the 2020 Road Map ?

There are a number of organizations that are transitioning to value based reimbursements, and organizing an accountable care organization..  Yet, the majority of providers are scratching their heads. We will depend largely upon 'experts' to make this conversion. 

Providers have been using volume based procedure codes since the beginning of time. No longer do physicians mail out a statement to a patient without some type of cpt code and an icd number.  Providers all operate in their own silo of codes relevant to their specialty. Openness and transparency thus far have been  non-existent from the powers that rule from above.

On Thursday, May 21, eHealth Initiative will convene a private meeting with executives focused on developing innovative partnerships to deliver high quality, value-based care. Because of your reputation as a thought leader, you were selected to participate in this event. This invitation-only meeting will include approximately fifteen C-level executives who will discuss their experiences in reaching beyond their own organizations as they partner to deliver value-based care on Thursday, May 21, 2015 from 10:00 am – 2:00 pm ET in Washington, DC.

Medical Home Models, and Accountable Care

Guided by a moderator, participants will learn from pioneers in accountable care and medical home models and discuss the key success factors and parameters that have allowed these new models to flourish. The discussion will inform development of a report on the value of collaboration in support of value-based care. We expect robust discussion and debate at this meeting. I believe you will take away actionable ideas that will add value to your own work.

eHealth Initiative is a non-partisan, non-profit, multi-stakeholder organization comprised of over 200 healthcare organizations committed to improving the quality, safety, and efficiency of health. eHealth Initiative is partnering with Philips on this unique initiative to conduct a series of exclusive in-person executive discussions on healthcare innovation and technology. This will be the first of a series of meetings.

This roundtable discussion will convene approximately twenty CIOs, CMIOs, CEOs, and clinical executives to discuss their experiences in reaching beyond their own organizations as they partner with others to deliver value-based care. Guided by a moderator, participants will learn from pioneers in accountable care and medical home models and discuss the key success factors and parameters that have allowed these new models to flourish. The roundtable discussion will inform development of a report on the value of collaboration in support of value-based care.

Your participation in this event is invaluable, and we hope that you or an appropriate colleague will be able to join us. 

Please confirm your attendance by rsvping online or replying by email byMonday, May 11.  If you have any questions, please contact Alex Kontur atalex.kontur@ehidc.org.

• eHI In the News: Check Out the Following Articles for the Latest Coverage on eHI
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• HIEs Continue to Face Barriers to Interoperability - Health Data Management
• Survey: HIEs Still Face Tech, Cost Barriers to Interoperability - iHealth Beat
• Survey: HIEs Still Struggling With EHR Interfaces - Healthcare Informatics
• Interoperability remains a barrier for health data exchange organizations - 

Health Care at the Speed of Data

The early goal of establishing electronic health records as a more accurate and legible recording of patient visits has been ecclipsed by the stream of data within the systems of EHR and Health data.

For some time the health insurance industry has been the leader in using data for actuarial information to maximize their profit and avoid losses in their lines of business.

Except for managed care organizations and those participating in shared-risk reimbursement, there has been little attention paid to outcomes and quality metrics by individual providers, and small group practices. These smaller entitites do not have adequate resources to scrub data and analyze it.

Big data now has become even bigger data.

Most providers are now aware of this fundamental change in medicine.

The new way

The potential for using high speed Internet technology to help expand access and quality of health care in the United States is becoming commonplace.. The use of advanced communications technology to transmit medical data and imaging in real-time, while linking patients to providers for direct consultation, removes geographical barriers and allows people to receive the medical care they need when and where it’s needed.

In the face of rising medical costs and increasing gaps in insurance coverage, the cost-cutting efficiencies of telemedicine – the delivery of quality health-related services and information using telecommunications technologies - are more valuable than ever. Universal high speed Internet access would help bring the prospect of affordable and quality health care for all Americans closer to reality.

Except for rural areas internet speed is fairly good.  The flow of data increases the amount of information available for analytics.

High Speed Internet and Health Care

The potential for profit is not unnoticed, as evidenced by considerable investment in health data warehousing.

Slideshare Presentation

Healthcare 2.0 The Age of Analytics (Slideshare)