Neil Versel's Healthcare IT Blog

'Meaningful use' explained

nversel@gmail.com (Neil Versel) — Wed, 04 Nov 2009 22:13:43 PST

Halloween may be over, but the quest for meaningful use goes on.

I'm told that the source of this is Pat Wise of HIMSS.

EHRs in the public eye

nversel@gmail.com (Neil Versel) — Mon, 19 Oct 2009 18:15:47 PDT

I saw this ad in Terminal 3 at Chicago's O'Hare International Airport last week:

It's a simple and powerful message, but I wonder how many people truly understand it?

I don't know when this ad went up, but it could be something left over from HIMSS in April. I see a lot of healthcare ads at O'Hare since there are so many health and medical conventions here, but many are out of date, such as from last year's Radiological Society of North America event, generally held in late November. Few are this large or have such visibility, right between a gate and an in-terminal restaurant in the heart of a major hub for American Airlines. Perhaps Siemens is trying to influence people in town to meet with Allscripts downtown or GE Healthcare in the northwest suburbs, or maybe it's targeted at the many Obama-ites who shuttle between Chicago and Washington? Rahm Emanuel, please give me a call.

Telehealth at the VA

nversel@gmail.com (Neil Versel) — Thu, 15 Oct 2009 21:56:18 PDT

If you only follow me via this blog, I've been incommunicado for some time. But I've been extraordinarily busy the last few weeks, churning out issues of FierceHealthIT, FierceMobileHealthcare and FierceEMR each Monday, Tuesday and Thursday, respectively. I've just returned from covering the Medical Group Management Association's annual conference in Denver and, just for good measure, did a piece for my favourite British health IT publication, E-Health Insider.

The E-Health Insider piece is an in-depth interview with Dr. Adam Darkins, chief consultant for care coordination and telehealth at the U.S. Department of Veterans Affairs, about the vast telehealth infrastructure and programs at the VA. Darkins is scheduled to speak remotely to an EHI conference in Birmingham, England, next month, which explains EHI's interest in the story. I also happen to think it's an article people here in the States will find worthwhile.

New 'Fierce' stories

nversel@gmail.com (Neil Versel) — Tue, 06 Oct 2009 13:29:09 PDT

For readers of FierceHealthcare, FierceEMR and FierceMobileHealthcare, there's some good conference coverage up there right now. I submitted a story from last week's Healthcare Facilities Symposium to FierceHealthcare and in today's FierceMobileHealthcare, commented kind of tangentally on the Health 2.0 Conference going on now. Plus, publisher Wendy Johnson has submitted stories for FierceEMR from the annual AHIMA meeting down in Grapevine, Texas. The more someone else writes, the less I have to do!

Top healthcare bloggers

nversel@gmail.com (Neil Versel) — Sun, 04 Oct 2009 21:32:00 PDT

FierceHealthcare last week published a list of nine interesting healthcare bloggers. I didn't make the list, but I guess it would have raised some suspicion if I had, because I of course write the weekly FierceHealthIT, FierceMobileHealthcare and FierceEMR newsletters, published by the same company. As it turns out, I also contributed a story to last Friday's FierceHealthcare from the Healthcare Facilities Symposium in Chicago.

A couple of IT blogs made the list: HIStalk (of course) and Will Weider's Candid CIO blog.

By the way, this week's FierceMobileHealthcare week will have a list of interesting free apps for the BlackBerry. I'm in a good mood right now because the Bears and Redskins won and the Cowboys lost. That always makes for a good Sunday.

New 'CMIO' stories

nversel@gmail.com (Neil Versel) — Thu, 24 Sep 2009 13:18:56 PDT

The long-awaited second issue of CMIO is out, and now it's going to a regular, bimonthly publishing schedule. I tell you this because I have two feature stories in this issue, including the cover story on health information exchange.

I also wrote a feature on "meaningful use" of health IT. That, of course, is the standard for qualifying for federal EHR subsidies starting in 2011.

Kolodner retires from federal government

nversel@gmail.com (Neil Versel) — Tue, 22 Sep 2009 13:49:51 PDT

Former national health IT coordinator and longtime Department of Veterans Affairs informatics leader Robert Kolodner, M.D., is retiring from the federal government today.

Here's an excerpt of a note he sent out today:

I am writing to let you know that today is my last day as a federal employee, after 31 gratifying years in public service.

What started out for me as a one year transition from residency into private practice took an unexpected turned into the opportunity of a lifetime. Notwithstanding the occasional challenges along the way, there is no other career path I would rather have pursued.

I am humbled by the superb quality of the people with whom I have had the good fortune to know and work with in the federal government. And I have been very impressed that we have a “deep bench” in federal service, with excellent people stepping up again and again to carry on, and even surpass, the work and the vision of the previous wave of leaders and key staff.

I am delighted to not only to have had the honor to serve our nation’s veterans for almost three decades, and be able to help them in their time of need after so many of them put themselves in harm’s way on our behalf, but also to have had the privilege of participating in VA-wide and nationwide activities to improve the quality, safety, and efficiency of patient-centered health care. Hopefully, this time we will finally succeed in achieving sufficient health reform to trigger the transformations in health and care that we so desperately need in the U.S.

Over the years, I’ve done my best to reinforce and contribute to the understanding that the advances we have been pursuing in health IT have not been about technology, nor even primarily about health care, but instead have been – and are still – about improving the health and wellbeing of individuals and communities.

Thank you for your friendship and collegial contributions over these past years. It has been a pleasure to know and work with all of you over the years, and I hope that our paths cross again in the not too distant future. I wish all the best to you in your noble pursuits – especially those of you who are doing so as federal employees.

--Rob--

MedInfo paper deadline extended

nversel@gmail.com (Neil Versel) — Sun, 20 Sep 2009 22:03:10 PDT

The deadline for submitting papers for the 13th World Congress on Medical and Health Informatics, also known as MedInfo 2010, has been extended to Oct. 15. MedInfo 2010, the triennial meeting of the International Medical Informatics Association, is scheduled for Sept. 12-15, 2010, in Cape Town, South Africa.

This will mark the first time a global health IT conference has been held in Africa, and it comes just a few months after South Africa also becomes the first African nation to host the FIFA World Cup next June and July (you know, winter in the Southern Hemisphere).

I covered the last two MedInfos, in Brisbane, Australia, in 2007, and in San Francisco in 2004. I had stories to write for months after the fact. I also was the only professional journalist from either North America or Europe to make the long trip to Brisbane, and, if all goes as planned, I expect to be in Cape Town a year from now for all your coverage needs. (Subtle hint.)

Apple to make a push into healthcare

nversel@gmail.com (Neil Versel) — Fri, 11 Sep 2009 13:54:33 PDT

It seems inevitable, given the success of the iPhone in healthcare, but I'm hearing that Apple is getting ready to make a full-scale push into healthcare. I understand that the company invited several vendors to a meeting at an Apple office in Chicago this week. I have no further details on what was said or who was present, but I know that there are a couple of EMR vendors out there who have tailored their products for Macintosh, even if it's just optimizing the view over the Internet for the Safari browser.

There is this little matter of the billions of dollars in federal money being funneled into health IT over the next eight years, and Steve Jobs would be an idiot if he didn't go after some of the cash. Steve Jobs is no idiot.

Commentary on RFID

nversel@gmail.com (Neil Versel) — Tue, 01 Sep 2009 16:12:38 PDT

For those of you who subscribe to FierceMobileHealthcare, today's e-mail newsletter subject line, "RFID comes of age." That also was the title of my Editor's Corner column. The only problem was, I forgot to include the actual column in the newsletter. It's up on the site.

My bad.

I knew it: 'The Hill' blew it

nversel@gmail.com (Neil Versel) — Thu, 27 Aug 2009 13:38:39 PDT

As I write today in FierceEMR, consummate Washington insider publication The Hill made a rather glaring mistake in reporting earlier this week that the $1.2 billion in federal grant funding for health information exchange and regional health IT extension centers can't be awarded until HHS finalizes its definition of "meaningful use."

In fact, the Office of the National Coordinator for Health Information Technology is going ahead with establishing the extension centers. The reporter confused the two health IT parts of the stimulus. Oops.

I grew up in the Washington area. I spent my first year after college in D.C. working for an "insider" publication, starting with a whopping $18,000 salary in the summer of 1992, but I had my very own U.S. Senate press pass. Real special, right? At the time, all it took was $6 and a letter from your boss vouching for your affiliation to get one. The "we work on Capitol Hill so we're smarter than you" mentality of some colleagues got to me. I hightailed it to Chicago and never looked back.

Sometimes you need to step back from the supposed center of the action to understand what's really going on. This is one of those times.

Edward M. Kennedy, 1932-2009

nversel@gmail.com (Neil Versel) — Tue, 25 Aug 2009 22:51:03 PDT

As you've likely heard, Sen. Edward M. Kennedy (D-Mass.) died tonight of a malignant brain tumor at age 77.

I'm thinking that his death may be the impetus to get health reform passed this year. Whether that means liberals will try to ram something through without GOP support or Kennedy's friends on the Republican side like Orrin Hatch will force a bipartisan resolution, I have no idea. But this will be Teddy's legacy.

A first from ONC

nversel@gmail.com (Neil Versel) — Wed, 19 Aug 2009 19:12:54 PDT

Perhaps it's part of the Obama administration's new PR offensive on health reform, or perhaps he just wants to update the health IT community, but National Health IT Coordinator Dr. David Blumenthal has sent out an open letter to everyone on the Office of the National Coordinator for Health Information Technology's mailing list.

Here's what he says:

In my role as National Coordinator for Health IT, I have the privilege to be part of a transformative change in health care that will help to extend the benefits of health information technology (HIT) to all Americans. With the passage earlier this year of the Health Information Technology for Economic and Clinical Health (HITECH) Act, we have the tools to begin a major transformation in American health care made possible through the creation of a secure, interoperable nationwide health information network.

Of course, this system is not an end in itself. Rather, it will enable countless other improvements in the quality and efficiency of health care that will make Americans healthier and their economy stronger.

My personal belief in this transformation is not based on theory or conjecture. As a primary care physician for over 30 years, I spent the first twenty shuffling papers in search of missing studies and frequently hoping, during middle-of-the-night emergencies, that I knew enough about patients’ medical histories to make good decisions. All that changed when I began to have access to patients’ electronic medical records. It made me a much better doctor. I would never go back, and neither would the vast majority of American physicians who have made the leap into the electronic age.

In fact, it would be hard for any health professional today to escape the conclusion that the antiquated, paper-dominated system we now have in place isn’t working well for patients, creates added costs and inefficiencies, and isn’t sustainable. As we look at our nation’s annual health care expenditures of approximately $2.5 trillion, there are many ways our current system fails both patients and providers. It is clear that change is necessary.

But how and why is nationwide electronic health information exchange so critical to achieving such change? Most importantly, because it provides the best opportunity for each patient to receive optimal care. The technology will make patients’ complete medical information securely and reliably available to health care providers where and when it is needed – when clinician and patient are together facing medical decisions that can make a lasting difference.

Better, faster, more reliable and efficient care also ultimately reduces system-wide costs by delivering results that help to avoid expensive or prolonged hospitalization from delayed or ineffective treatment, avert costly and sometimes fatal adverse events and unnecessary procedures, and can help to eliminate the onset of disease by better informed management of each patient’s health.

The goal of assuring an electronic health record for every American is daunting. We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration.

We also recognize that we cannot achieve the benefits of a nationwide health information system unless we can assure all Americans that their personal health information will remain private and secure when this system exists. Putting into place safeguards for the privacy and security of this information, when it is in electronic form, will be an ongoing priority that influences and guides all of our efforts.

In the days, weeks, and months ahead, we will be rolling out a number of pivotal initiatives called for under the HITECH Act. I urge you to join and support us as we lay the foundation for every American to benefit from an electronic health record, as part of a modernized, interconnected, and vastly improved system of care delivery. We at ONC will be making every effort to keep you updated and fully engaged in all the steps of this national journey.

Sincerely,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

An EHR primer

nversel@gmail.com (Neil Versel) — Mon, 17 Aug 2009 21:32:11 PDT

You want an easy way to explain electronic health records to someone not familiar with the concept? The Forbes.com Video Network--something I never new existed until an hour ago--has this relatively simple, 4-minute primer.

NAHIT to shut down

nversel@gmail.com (Neil Versel) — Mon, 17 Aug 2009 09:59:37 PDT

The National Alliance for Health Information Technology is shutting down Sept. 30, citing massive changes in health IT.

"In a few short years, NAHIT has accomplished its mission: HIT has moved front and center in efforts to reinvent and reinvigorate the U.S. health system," NAHIT Chief Operating Officer Jane Horowitz says in a press release. "Going forward, the action is shifting from NAHIT’s focus on educating, advocating and building common ground to planning, implementing and using HIT to improving care, safety and efficiency."

Horowitz says that other groups are in a better position to help with HIT implementation now. "In particular, the American Hospital Association (AHA) has close ties with hospital chief executive officers while the College of Healthcare Information Management Executives (CHIME) is the leading industry association for chief information officers," Horowitz says. "They are devoting substantial resources for helping their members realize the potential of HIT and ensuring HIT is embedded in health care reform initiatives. We know that the AHA and CHIME will continue to advance the adoption of HIT."

I suppose the demise of NAHIT was inevitable when founding CEO Scott Wallace left more than a year ago. NAHIT never did name a permanent replacement.

The group was successful in publishing a list of definitions of HIT terminology, something that certainly has informed health IT policy decisions since, including the current push to define meaningful use.

NAHIT also was a co-founder of the Certification Commission for Healthcare Information Technology.

You want some commentary? OK

nversel@gmail.com (Neil Versel) — Tue, 11 Aug 2009 15:15:56 PDT

Looking for actual commentary from me? I've already generated in the last two hours more responses than I usually get in a week from a commentary I posted today at FierceMobileHealthcare. Perhaps the reaction was because I mentioned political lightning rod Sarah Palin, but I'd like to think that I offer something thoughtful on healthcare reform, namely that quality is getting left out of the debate.

For the record, I made a related argument in last Thursday's FierceEMR that political insiders and the ever-expanding pundit class are missing the point about EMRs. It's not always about money.

Conference listings updated

nversel@gmail.com (Neil Versel) — Mon, 10 Aug 2009 12:52:51 PDT

Take a look just below the blogroll in the right-hand column of this page and you'll see that I've updated the conference listings with many of the events I'm interested in this fall. That doesn't mean that I'll be going to all of them, but I expect to attend at least a few of them.

Am I missing anything?

Merge Healthcare opens its code

nversel@gmail.com (Neil Versel) — Wed, 05 Aug 2009 14:47:10 PDT

Merge Healthcare, a company that seems to be back on its feet after an accounting scandal, a trip through bankruptcy and a change of management, is opening up some of its proprietary code for outside development. The Milwaukee-based company announced today that it has released several SDKs for imaging technologies, including x-ray and tumor tracking.

Speaking of tracking, many of you probably are wondering where I've been. Yes, I was away on a semi-vacation for about eight days, though I was working while I was gone. I've been doing most of my commentary of late at FierceMobileHealthcare and FierceEMR. I hope not to neglect this blog as much in the future, but we'll see.

Video from Sebelius on 'The Daily Show'

nversel@gmail.com (Neil Versel) — Thu, 16 Jul 2009 21:55:29 PDT

As promised, here's the video from HHS Secretary Kathleen Sebelius' appearance on "The Daily Show with Jon Stewart" Wednesday night. Yeah, she and other pols have been all over the airwaves of late, but I find that a "fake" news anchor like Jon Stewart often keeps people more honest than the average TV talking head.

In the first segment, Sebelius discusses the "public option" for health insurance and touches on quality of care and outcomes, to which Stewart says it would be cheaper for society if smokers died by age 60. In Part 2, which focuses on competing health reform bills in Congress, Sebelius mentions prevention, wellness and quality. It's not very revelatory for those of us in the know, but it's entertaining.

Part 1

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

Kathleen Sebelius Pt. 1

www.thedailyshow.com

Daily Show
Full Episodes

Political Humor

Joke of the Day

Part 2

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

Kathleen Sebelius Pt. 2

www.thedailyshow.com

Daily Show
Full Episodes

Political Humor

Joke of the Day

On the much lighter side, earlier segments of last night's show parodied national health systems in Canada and the UK and the uninsured situation in the U.S.

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

Drag Me to Health

www.thedailyshow.com

Daily Show
Full Episodes

Political Humor

Joke of the Day

and

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

Drag Me to Health - Universal Health Care

www.thedailyshow.com

Daily Show
Full Episodes

Political Humor

Joke of the Day

Sebelius on 'The Daily Show'

nversel@gmail.com (Neil Versel) — Wed, 15 Jul 2009 23:04:01 PDT

FYI, HHS Secretary Kathleen Sebelius is the guest on "The Daily Show with Jon Stewart" tonight. In fact, the whole episode is dedicated to health reform. I'll embed the video once it's posted on Thursday, but you can still catch it tonight. There will be a rerun at 1:30 am EDT/12:30 am CDT and those of you out west can catch the first run at 11 pm PDT.

IT staffing issues

nversel@gmail.com (Neil Versel) — Mon, 13 Jul 2009 13:57:54 PDT

The newly published July issue of Hospitals & Health Networks includes a story I wrote about the worsening staffing crunch in health IT.

Between the rush to install EMRs by January 2011, tighter HIPAA privacy and security requirements and the transition to ICD-10 coding and ANSI X12 5010 transactions, it could be a tough next few years for IT departments. But you probably already knew that.

It's crunch time at Health Wonk Review

nversel@gmail.com (Neil Versel) — Fri, 10 Jul 2009 12:59:13 PDT

The latest Health Wonk Review went up earlier this week at the BNET Healthcare Blog, a site I've contributed to. Host Ken Terry, late of Medical Economics, focuses on the myriad opinions surrounding the comprehensive healthcare reform proposals that have gripped Washington.

My post about the American Medical Association's curious reaction to the national health IT push made the list of interesting reads not directly related to the reform debate.

Google vs. Bin Laden?

nversel@gmail.com (Neil Versel) — Mon, 06 Jul 2009 22:45:18 PDT

How's this for a headline? "Entrust my medical records to Google? I'd rather give them to Bin Laden."

That was the headline accompanying a column in Tuesday's London Daily Mail. Columnist Stephen Glover (no, not Steve-O of "Jackass" and "Dancing With The Stars" fame/infamy--and I only know his real name because his sister is an old friend of mine) is scared to death by the prospect of a company like Google storing medical records.

"People who deposited their medical records with Google would no doubt be given assurances that they would not be passed on to third parties. But Google would not go to the trouble and expense of storing such information unless it hoped to benefit from it in some way," Glover writes.

"Here is a company which, through a variety of means, is building up a profile of each of us - or at any rate those of us who use computers. I understand, of course, that it has no over-arching intention of ordering or controlling our lives, and that the information it holds about us is used for its own commercial gain. But it would be absolutely the last company in the world to which I would entrust my medical records. I would far rather stick them in an envelope and send them to Osama Bin Laden or Vladimir Putin," he continues.

Wow, I know I've been harsh on Google in the past, but never like that.

AMA and EMRs, continued

nversel@gmail.com (Neil Versel) — Mon, 06 Jul 2009 12:37:20 PDT

Last month, I wrote a rather scathing piece on the BNET Healthcare blog about the American Medical Association's annual House of Delegates meeting. I wrote another one for FierceEMR. Admittedly, I focused on a handful of fringe ideas, though one of the more audacious ones actually wound up in a resolution that the House of Delegates adopted as AMA policy. For BNET, I wrote:

[A]nother resolution directs the AMA to tell the federal government that the EMR incentive program "should be made compliant with AMA principles by removing penalties for non-compliance and by providing inflation-adjusted funds to cover all costs of implementation and maintenance of EMR systems."

It's one thing to ask for more money to cover ongoing expenses. It’s another thing altogether to conclude that the government is not in compliance with the principles of a private organization. Talk about the tail wagging the dog.

In FierceEMR, I wrote:

Delegates also took issue with the Medicare e-prescribing bonus program that passed during the Bush administration and began this year. They said the requirement that physicians write 50 percent of their Medicare Part D prescriptions electronically was too onerous, and recommended that the threshold be lowered to 25 percent.

Not surprisingly, the posts drew several comments and e-mails.

AMA Board Chairman Joseph Heyman, M.D., someone who actually does understand—and use in his own practice—EMRs and information technology, left a detailed response on the BNET post, attempting to clarify the organization's position on health IT. He's right in saying that the AMA did come out in strong support of the stimulus. My criticism was about a few delegates who spoke out rather loudly about the stimulus.

Heyman also discusses the AMA's online tools for physicians to learn about health IT, something I admittedly didn't mention in my post, though it wasn't completely relevant to my argument. I did interview Heyman at the meeting, and included some of his comments in a story I did in the July Physician Office Technology Report of Part B News. I'd like to extend an invitation to Heyman to do a podcast with me at some point in the future so we can discuss all of these issues, as well as his own practice's successful experience with an EMR.

Another, anonymous, commenter suggested that other organizations, like the American Academy of Family Physicians has an agenda that "more closely aligns with the big winners of the last election cycle, and helped buy them a seat at the table." Yeah, that would explain why some of the more conservative members of the AMA House of Delegates feel shunned. This person also says that "HIT providers"—vendors and consultants—are the real winners from the stimulus. That's certainly a risk of the massive program.

The comments on the FierceEMR piece were more supportive of my argument. "Smart Doc" said: "To call this organization an anachronistic dinosaur would not give proper credence to how out of touch it is, not only with the public, but with physicians themselves. Like others of their ilk, they're against government intervention except when it directly subsidizes them."

I'm not sure if I'd go that far, but I'm certainly on record as saying the AMA really does not represent the interests of all physicians, as the organization claims to.

My favorite exchange, though, came from Jack Smyth, the very pragmatic president and CEO of ambulatory EMR vendor Spring Medical Systems. After the FierceEMR commentary appeared, he e-mailed me to clarify the rules for the Medicare e-prescribing bonus program that took effect this year:

You commented about the 50% rule for getting the eRx bonuses this year and next. In your statement you mentioned that unless a physician prescribes controlled substances, they should be able to qualify.

The way I understand it, if a doctor enters the prescription in the eRx system, it counts. Even if they have to print it out and sign it, because it's a controlled substance, or even if the pharmacy doesn't accept eRx and it has to be faxed to the pharmacy. There are several "G" codes that can be added to an office visit or prescription refill that allow the various scenarios to qualify for addition to the numerator of the equation.

I'm very proud of my subsequent response:

Thanks again for writing. I think you're right about getting credit for entering it into an eRx system, regardless of whether it's controlled or if the patient simply wants a printout. In that case, I have no idea why the AMA thinks 50% is too high. You're either entering scripts electronically or you're not, unless perhaps you're Dr. House and you've stolen Wilson's prescription pad.

I also asked Smyth for permission to post our exchange. He then responded: "I love your "Wilson's prescription pad" comment! Yes you can use my email in your blog. I don't have time to post responses on websites and I don't like all of the banter (most of it useless) that a comment like this would create. I'll let you do that."

Consider it done.

EMR failures and uninstalls

nversel@gmail.com (Neil Versel) — Wed, 01 Jul 2009 12:57:47 PDT

Before I forget, I had the cover story in the May issue of MD Net Guide, on the subject of EMR failures and uninstalls in physician practices.

In a similar vein, Healthcare IT News last week had a story about a high number of EMR uninstalls in the Phoenix area.