Web-Tones

Healthcare, Technology & Innovation?

2010-03-10T19:24:18-05:00

Why yes, of course. Don't believe that healthcare innovation is real then read this interview where David Harlowe has a great discussion with John Glaser CIO of Partners. Here's one of many money quotes from the interview:

So there are a lot of demands on the systems, there are a lot of demands on the implementation process and the workflow change process and there are a lot of demands on support, and obviously there are a lot of demands on the practice who goes through this. Nonetheless once you get through that we have never had any clinician of any form say I wish I could go back to paper..

Sure, once an organization goes through the pain and starts to see the gains then you NEVER hear providers saying "give me back my paper." It is only the "pain part" that providers want to avoid and there is simply no avoiding it. Everyone wants painless change and change doesn't work that way.

Here's another money quote regarding the ROI argument, and it is directly on point:

So I think we will see a return broadly speaking - realizing how tangible or intangible, how dollarizable or not dollarizable it is, to the sort of settings in which it’s delivered. I think at the end of the day it is one of those things which you say listen, this is a given. It is hard to imagine that we would sit here today and say if ten years from now we ran our health care system on paper that would be okay or a good thing.

Electronic records are just the way healthcare will be done in the 21st century. It's a cost of doing business. The ROI will be real (and significant) in the mid to long run. This return will be manifested in a number of ways, not the least of which will be a gain in market share? Why? Because providers that choose to go through the pain now will be (much) better positioned to use the technology in ways they can't even imagine today. This is true across industries and healthcare will be no different.

To stay current on the HITECH Act and its quickly changing regulatory scheme visit the HITECH Survival Guide website and/or sign up for Digital Business Law Group's free monthly compliance newsletter. Also, check out a FREE EHR Checklist and a FREE Online Backup Checklist, both are provided from HSG affiliates.

HITECH Act: Burn the Boats!

2010-03-07T11:36:22-05:00

Legend has it that when Cortes landed in Mexico in the 1500s, he ordered his men to burn the ships that had brought them there to remove the possibility of doing anything other than going forward into the unknown. While the link speaks to the world of old media (i.e. that is by all accounts dying a death of thousand cuts) the same holds true for healthcare providers that want to compete in the 21st Century.

Burn those boats and commit to a new world, because this is not your daddy's healthcare industry any longer. There are only two viable options: 1) do nothing and retire; 2) commit. Anything in between will likely lead to certain failure and the burning money to boot. Burn the boats instead.

To stay current on the HITECH Act and its quickly changing regulatory scheme visit the HIPAA Survival Guide website and/or sign up for Digital Business Law Group's free monthly compliance newsletter. Also, check out a FREE EHR Checklist and a FREE Online

The HITECH Act One Year Later: Real Healthcare Reform? Part V

2010-02-26T13:08:42-05:00

Why HITECH is Disrupting Healthcare?

You don't really need a crystal ball to pontificate as to why HITECH has been so disruptive. All you need is to be an educated observer of past disruption cycles in other industries (i.e. mainframe computing, print media, search, social media, etc.). The pattern repeats itself. Healthcare is not all that different, except for the fact that it is the last of the great American oligopolies.

While healthcare may not meet the academic definition of oligopoly, it certainly possesses many characteristics that would qualify it as such. The industry has no shortage of sellers (i.e. providers) but it does have a small number of players that control the market (i.e. the insurance companies), and therefore control the industry.

Why has healthcare reform been a fight to the death? It's clear that the incumbents prefer nothing more than the status quo and they have the money, and the reach, to fight the fight; billions of greenbacks are at stake and these "boys" ain't going down without a fight. But what has that got to do with HITECH? Directly, not much, and the proof is that HITECH has gotten little or no mention in the debate. The players, the commentators, and the industry stakeholders see the two as completely separate issues, and they are partly right.

However, here's the kicker, disruption almost always happens when the incumbents are caught asleep at the wheel (e.g. IBM in computing, Microsoft in search, almost everyone in tech regarding social media, the entire print media regarding the Internet, etc.). In short, real disruption comes from left field and takes the conventional wisdom completely by surprise. That is, until some start-up changes the rules of the game and becomes dominant (or appears dominant, since the rest becomes a self fulfilling prophecy).

Even when incumbents are on guard for this type of disruption, the Innovator's Dilemma prevents them from reacting fast enough to prevent the rules from changing, or to profit from said changes. Their legacy success gets in the way. HITECH created an environment that forced providers, and the vendors that service them, to start thinking about change. It loosened up the structural impediments that had become ossified in the healthcare industry over the last 150 years.

Sure, the old system was arguably phenomenally successful in its time. It produced the best educated and most qualified providers in the world. But it has been showing signs of aging for well over 30 years now, sans any meaningful reaction at all to a changing marketplace. Why? Because there was no profit based reason to change. HITECH provided regulatory reasons to consider change. The Internet, and the enabling technologies that underpin it, provided patients (and providers) a platform wherein they could demand change (i.e. refusing to be bystanders in a service so critically important to them and their families). The tech industry began to smell money.

In aggregate, all of these forces began to align, and the result is that change is coming to healthcare. The exact form it will take cannot be predicted, but this perfect storm of forces can no longer be resisted. Part of that change is the need for a dramatically improved privacy and security environment. The new healthcare system simply can not function without it.

The HITECH Act One Year Later: Real Healthcare Reform? Part IV

2010-02-25T16:18:24-05:00

What is the state of the HITECH enforcement regime?

We are certain that all of our readers will be happy to hear that HITECH's enforcement regime is alive and well, thank you very much. We don't enjoy (per se) being the bearer of "bad news" but here's a news flash: Privacy and Security regarding PHI will remain of paramount importance going forward!

There is simply NO WAY that either the Federal Government (read HHS and the FTC), and the tech giants who are "ramping up to seize the moment" can tolerate anything less than the security standard set by the online banking community: 1) the former because tolerating less is bad public policy; and 2) the latter because tolerating less is bad PR (news travels fast on the Internet 24/7 365).

We have yet to see the new sheriff flex her muscles, but rest assured that Doc Holiday and Wyatt Earp will be riding your way any day now. The HITECH sections labeled Improved Enforcement and Audits are a harbinger of things to come. This article does a good job at getting at some of the "willful neglect" issues that will trigger the biggest fines.

OK, here's our "cliff notes" version of what "willful neglect" means in unambiguous English: willful neglect means "clueless." Here are some examples that illustrate our definition:

Your organization is simply unaware; just dusting off your old HIPAA documentation will no longer suffice (the ONLY reason you believe that you are currently in compliance now is because HIPAA was a paper tiger that was never enforced). In short, you are clueless if the world has changed and you don't know it. It's like missing the invention of the telephone and the Internet.
You are clueless if you don't have any processes in place to support your policies and procedures. Having well written (and current) policies and procedures in place will not help you much if you can't show that you are following them. The only way to ensure compliance is to have a process in place that enforces it.
You are clueless if you are a CE that does business with a number of BAs and have no contracts in place with them, or if you are still using your old contracts.
You are clueless if you are a BA and have no contracts in place with third parties that touch the PHI that has been entrusted to you by a CE.
You are clueless if, as a CE or BA, you think you can outsource liability by doing business with partners that are not directly subject to U.S. law, and assume therefore, that those partners need not comply (while arguably true you are still on the hook for having contracts with said partners).

OK, here's the bottom line: if you can't show visible demonstrable evidence (over time) ("VDE") that you are in compliance then you are clueless. If you know that you are not in compliance and don't have a plan in place to get into compliance, you are clueless. Forget about all the legal niceties that may distinguish "reasonable cause" from "willful neglect." Without VDE (and a strategic plan) there is not a lawyer on the planet smart enough to help you. You (and your lawyer) will need both VDE and a plan to make a "good faith" argument to a federal agency or a court of law. Period.

We can assure our readers that most of you are not in compliance because, for the most part, you have NOT figured out (yet) what that really means. Remember, whatever you have in place now is probably inadequate. It was never subjected to an audit and therefore never validated. HHS is going to have a field day handing out fines once it figures out its methodology for conducting the audits that are mandated under HITECH.

Your CEO is not likely to be a happy camper if you end up on HHS' publicly available list of organizations that have experienced a breach, especially if said breach was not handled well and/or you were found to be in willful neglect. On the other hand, you are not going to be able to make much process unless the compliance budget supports the initiative(s). We don't have any empirical data but would venture a guess: most compliance budgets are nowhere near sufficient to meet HITECH's requirements today.

The HITECH Act One Year Later: Real Healthcare Reform? Part III

2010-02-24T09:33:53-05:00

What is the state of Meaningful Use?

One thing that can be said for certain: Meaningful Use ("MU") remains a wicked problem, despite the fact that HHS has recently issued its Interim Final Rules in an attempt to clarify. Well, there is also the HITECH Act mandate that requires them to do so, but lets not get hung up on the details. Just how wicked a problem is it? On January 13th, 2010 Dr. John Halamka posted the presentation below on his blog. It describes the requirements of the Interim Final Rule and Notice of Proposed Rulemaking.

Now, those of you who know Dr. Halamka understand that he is one of the most knowledgeable HIT personalities in the nation. He has a special gift for taking a complex topic and breaking it down into understandable "chunks." The effort below does not disappoint. There are lots of good healthcare blogs, however Dr. Halamka's in one of the best.

That said, we "live and breathe" HITECH, and are constantly surprised by the breath and depth of what it encompasses. Reviewing Dr. Halamka's presentation brought that point home once again. We encourage our readers to read (and study) the presentation, but do not be surprised if it raises as many questions as it answers, that is simply the nature of the beast.

The Standards Rule and the NPRM for Meaningful Use

This post contains links to many of the standards referenced in the presentation. The adoption of these standards as mandated by HITECH, and as proposed in the HHS Interim Final Rules, gives them the force of law. However, implementing the standards, as daunting as that may seem, is only a subset of what is required to demonstrate MU, even in Stage 1. The last slide above contains the money quote:

There are about 25 required projects to achieve meaningful use - a major organizational commitment.

The phrase "a major organizational commitment" is clearly an understatement. While MU will continue to evolve, and in the short run may even be scaled back (a little), given some of the feedback that HHS is receiving, it will nonetheless remain daunting. At a minimum, we strongly urge covered entities and business associates to start climbing the MU curve, even if there are no immediate plans to adopt an EHR in the short run. The risk is not simply whether government will impose MU requirements that you can't meet, but rather that the market fundamentally shifts from market pressures, in a way that destroys your competitive advantage.