My Medical Informatics Blog

Healthcare IT News: A guide to telehealth vendors in the age of COVID-19

2020-04-17T17:21:00.003-05:00

Here's their list of telehealth vendors. It's useful considering the spur COVID-19 will give the industry.

I've just become a MyChart user and while not telehealth I've been interacting with my Primary Care Doc with email including sending pictures and attachments.

It's been a good experience and the only frustration has been closing care gaps with results from specialists. I need to scan the visit summary with the specialist and forward it to my Primary Care provider to get rid of the annoying and old care gap alert.

Even when the PC and Specialist are Epic users and I have multiple linked accounts they don't interact. I'll have duplicate alerts.

Frustrating... at least to a guy who thinks in terms of data that should all connect.

Unexpected Free Time

2020-04-17T16:35:00.001-05:00

Some unanticipated free time's lead me to dust off this blog. Seemed timely since we have medical models in the hands of Politicians and used for some economically draconian actions.

Here's Cathy O'Neal writing This Isn’t the Flattened Curve We Were Promised: The dying won’t be over anytime soon.

Writing about those bell curves we've seen talked about so much on the news she notes:

The notion of area-under-the-curve one I haven't heard discussed much (at all really) in the news or pressers.

I'll be spending my time with Python and R the next few weeks. I've always been a SAS guy but SAS's an expensive tool so it's time to learn the free stuff.

The Situation Report: Is the CIO Job at VA About to Lose Its Influence?

2017-04-07T11:39:00.001-05:00

The Situation Report: Is the CIO Job at VA About to Lose Its Influence?

VistA Watch

2017-03-23T08:53:00.002-05:00

I'll start collecting links to VA's EHR known as VistA. Politico had a history of it. They omitted some key names and I'll get back to that. Anyways, I'll be posting more on this procurement on a system the majority of Medical Residents work with at some point.

Halamka on MACRA Final Rule: “CMS is Listening and I Thank Them”

2016-10-21T15:46:00.001-05:00

Halamka on MACRA Final Rule: “CMS is Listening and I Thank Them” | Healthcare Informatics Magazine | Health IT | Information Technology

Thank them? They work for Americans and shouldn't be thanked for keeping the "burden" lighter than it could be. What's the payoff for Americans to the government imposing any burdens on providers off our care? I fear the policy wonks and theologians over healthcare have priorities and mission badly screwed up.

HHS finalizes streamlined Medicare payment system that rewards clinicians for quality patient care

2016-10-14T09:02:00.001-05:00

It's MACRAolypse.

HHS finalizes streamlined Medicare payment system that rewards clinicians for quality patient care

CMS Answers Family Physicians' Questions About MACRA

2016-05-12T08:46:00.001-05:00

CMS Answers Family Physicians' Questions About MACRA: CMS officials answered family physicians' questions about the Medicare Access and CHIP Reauthorization Act during a standing-room-only meeting at the 2016 Annual Chapter Leader Forum.

AMA Releases Value-Based Care, MACRA Resources for Providers

2016-05-03T08:12:00.001-05:00

AMA Releases Value-Based Care, MACRA Resources for Providers

Bundled Payments for Care Improvement (BPCI) Initiative: General Information | Center for Medicare & Medicaid Innovation

2016-04-18T08:53:00.001-05:00

Bundled Payments for Care Improvement (BPCI) Initiative: General Information | Center for Medicare & Medicaid Innovation

Just saving this to add to my list of links. Trying to start some threads on experiences with these bundled payment arrangements.

Data Governance as a Field of Study | David Raths | Healthcare Blogs

2016-04-04T14:03:00.001-05:00

Data Governance as a Field of Study | David Raths | Healthcare Blogs

Data Herding may make more sense than Governance....

...anyways, a link to the papers here: http://repository.edm-forum.org/egems/vol4/iss2/

Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine — NEJM

2016-04-03T08:46:00.001-05:00

Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine — NEJM: Perspective from The New England Journal of Medicine — Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine

Politico Morning E Health: Vanishing VistA

2016-03-07T09:27:00.002-06:00

My thoughts on this one coming...

VANISHING VISTA?: Rep. Phil Roe, who has seen plenty of twists in the VA-DoD EHR saga in his seven years on the Veterans Affairs committee, was not surprised to hear of another turn last week –“it’s the gift that keeps on giving,” he said. At an appropriations hearing, the VA’s CIO, Laverne Council, said the agency had pulled back $40 million from the budget of its VistA update program and was considering whether to ditch the fabled EHR.

— Roe, a physician from Tennessee and head of the GOP Doctors Caucus, thinks that might be a good idea. If the VA decides to go commercial, Roe said, “I hope they use the same system” as the Pentagon (that would be Cerner). Roe noted that the Cerner contract to replace the Pentagon’s EHR stands at less than $4 billion, despite earlier estimates of up to $11 billion. It may be cheaper, in the long run, to replace VistA rather than updating it repeatedly, he told us. This idea troubles many IT specialists who have worked with VistA. The EHR has pieces that need replacement, they say, but its basic functionality is as good as Epic, Cerner or any other hospital EHR, and it would be a shame to toss a system that has evolved over the decades to fit the needs of VA clinicians.

Read more: http://www.politico.com/tipsheets/morning-ehealth/2016/03/opioid-abuse-in-tech-crosshairs-213071#ixzz42EOTuAlp

Cerner Opens Smart on FHIR Developer Website | Healthcare Informatics Magazine | Health IT | Information Technology

2016-02-14T08:55:00.001-06:00

Cerner Opens Smart on FHIR Developer Website | Healthcare Informatics Magazine | Health IT | Information Technology

Hospitals Lagging Behind in Population Health Management

2016-02-09T15:45:00.001-06:00

Hospitals Lagging Behind in Population Health Management

Modern Healthcare: Obama administration's proposed insurance reforms incite industry backlash

2015-12-23T08:36:00.000-06:00

Re: The American Academy of Family Physicians asked the CMS to go a step further and build network standards for appointment wait times. found here.

I was the "Wait Times Guy" for Veterans Health Administration and can say this is no easy task. On any given day every Veteran using a VA Hospital had on average 2.5 pending appointments. Some were for that day, some the next day, or week, or month, or months but sorting out the "wait" from when the Vet wanted the appointment, and when the Vet needed to be seen for a followup appointment got very murky.

Make tinkering with those calculations a criminal offence and you've got quite a mess.

Texas Health Physicians Group Leaders Take on the Practical Data (and Process) Challenges of Population Health | Healthcare Informatics Magazine | Health IT | Information Technology

2015-10-12T10:18:00.001-05:00

Texas Health Physicians Group Leaders Take on the Practical Data (and Process) Challenges of Population Health | Healthcare Informatics Magazine | Health IT | Information Technology

With regard to IT development, strategically speaking, what do you need to do in the next year or two?

Adams: The Holy Grail for an IT-techie person like me—patient attribution remains one of the number-one challenges. People underestimate how hard it is to attribute patients to physicians. I think the Holy Grail is combining EMR and claims data. Because right now, we’re still in the world of, here are your gaps in care, but it’s in the EMR. So I may already have had a colonoscopy and Dr. Parsley if he’s my physician wouldn’t know it. So it’s combining outside claims data with EMR data, to provide a true picture of things. And claims data is 30-45 days behind. And in the next two to three years, it’s going to be real-time notification. We don’t have all those things in place yet. So for the next year, we’ve got to get better at patient attribution and risk stratification, and then be able to combine EMR and claims data.
Parsley: I agree: if there’s a report in an old file somewhere that shows the patient did get their colonoscopy in the timeframe needed, and if we had the payer data in a timely way.

Senate HELP Committee Chairman Once Again Calls for Stage 3 Delay in Latest Hearing

2015-09-17T11:07:00.001-05:00

Senate HELP Committee Chairman Once Again Calls for Stage 3 Delay in Latest Hearing

Joe Flower: Does Prevention Save Money for Hospitals?

2015-09-16T10:56:00.001-05:00

Joe Flower: Does Prevention Save Money for Hospitals?

Social, Behavioral Data Must Be Included in EHRs, Nurses Say - HealthITAnalytics

2015-09-16T10:54:00.001-05:00

Social, Behavioral Data Must Be Included in EHRs, Nurses Say - HealthITAnalytics

Rick Wicklin:The relationship between toothlessness and income

2015-08-25T11:14:00.001-05:00

Interesting post on the relationship between toothlessness and income. Rick ought to throw smoking prevelance into the mix because I expect it will explain more than income would.

And of course the graphs are nice!

Attribution Identifies Physician-Patient Relationships

2015-08-12T11:05:00.001-05:00

Attribution Identifies Physician-Patient Relationships

Something on my mind worth saving. Attribution not as simple as you'd think.

Join Us At Valence Health’s Value-Based Care Conference

2015-08-07T05:46:00.005-05:00

Needless to say, my blogs represent my views and not those of my employers past or present, but below is a plug from my current job about what I think will be a very useful conference.

Please join us for further 2015, our annual industry conference dedicated to value-based care and reimbursement models. From clinical integration, to shared risk, to provider-sponsored health plans, further 2015 explores the financial, operational and clinical aspects of all types of value-based care and “risk-based” contracting. Learn more about the expert-led discussions designed for provider-organization executives here: http://go.valencehealth.com/further2015

Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients — NEJM

2015-01-19T08:34:00.001-06:00

Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients — NEJM

Regardless of how the MOC issue is resolved, the recent focus on the ABIM has shed a bright light on how medicine is regulated in the United States. The ABIM is a private, self-appointed certifying organization. Although it has made important contributions to patient care, it has also grown into a $55-million-per-year business, unfettered by competition, selling proprietary, copyrighted products. I believe we would all benefit if other organizations stepped up to compete with the ABIM, offering alternative certification options.

More broadly, many physicians are waking up to the fact that our profession is increasingly controlled by people not directly involved in patient care who have lost contact with the realities of day-to-day clinical practice. Perhaps it's time for practicing physicians to take back the leadership of medicine.

A good start to regaining that leadership might be backing off support for the Affordable Care Act. Government's do-gooder effort giving us less care at greater expense.

Beyond a Traditional Payer — CMS's Role in Improving Population Health — NEJM

2015-01-19T08:28:00.001-06:00

Beyond a Traditional Payer — CMS's Role in Improving Population Health — NEJM

There are limits to CMS's statutory authority to fund services provided to people other than Medicare or Medicaid beneficiaries, but the agency can leverage its influence beyond the payment of claims. Whereas our approaches for providers focus on enrolled or attributed populations, SIM seeks to affect broader populations

I suppose CMS can leverage but I wonder if those funding limits suggest it shouldn't extend into something its unfunded and therefore ill equipped to influence for the good.

Julie Papanek: Healthcare Predictions For 2015

2014-12-31T11:16:00.002-06:00

This one's huge. Some excellant insights from Julie Papanek (@JuliePapanek). Someone I've started to follow!

Hospitals become a channel for peer-to-peer lending

If you understand the flow of payments in healthcare, you can predict the trends. Consumers and employers are purchasing insurance plans with high deductibles. As a result, the first dollar that hospitals earn is now coming from consumers. Actually, the first $17,000 is coming from consumers. With an average income of $55,000, most American consumers simply can’t pay their medical bills. When they don’t pay, it hurts providers financially. What consumers don’t pay shows up as accounts receivable on hospital balance sheets and eventually turns into bad debt. Since many hospitals are financed by debt and their credit worthiness is partially determined by the health of their balance sheet, the problem of getting patients to pay is urgent. This raises the question — how can we find the money to help consumers finance their health care payments? Many consumers are able and willing to pay their medical bills, they just can’t do it all at once. Peer-to-peer lending companies have paved the way for unsecured structure notes, where an individual’s loan can be financed by others. These have shown impressive growth. Peer-to-peer lending is already being used to finance plastic surgery and other cash-pay procedures. Now it could be used for the majority of medical expenses in the U.S.