Of course, you’d never see this type broad support for centralized EHRs in the U.S.

Is this good or bad? You can decide for yourself…but at the very least this caught my attention as illustrating communitarian vs. individualistic tendencies in different world nations.

The Twitter hashtag for the event is #HCU10.

The Medicare MAPCP (Multi-Payer Advanced Primary Care Practice) demo promised to be Medicare’s Biggest Change in 40 Years…

…but the emerging reality isn’t living up to the promise.

In this post, we’ll discuss:

1. The Promise
2. An Overview of the MAPCP Demo
3. Our Main Takeaway: Emerging Reality Suggests Medicare Will Be a “Difficult” Partner
4. Conclusion: Think Twice Before Signing Up

1) The Promise

The sandbox metaphor was first used by the National Academy for State Health Policy:

For the 10 or more states that are active stakeholders in multi-payer medical home initiatives, the promise of Medicare getting in the sandbox with them and playing (a.k.a. paying) is an exciting proposition. The addition of Medicare as payer to some of these state initiatives may be the critical tipping point that results in widespread primary care delivery system reform in states by involving more practices, payers and patients. (more…)

(click on the graphic to download the document)

Depending on the nature of the payment changes which are made, physicians may need to enhance their capabilities in some or all of the following sixteen areas:

1. Achieving sufficient patient volume to support a new or improved service.
2. Having sufficient upfront capital to design and implement a new or improved service.
3. Having the skills/experience to efficiently/effectively implement a new/improved service.
4. Having the ability to obtain and analyze data on the quality of services.
5. Having the skills/experience to improve the quality of services.
6. Having adequate resources to support high-quality service delivery.
7. Gaining access to external resources to support patient adherence and health improvement.
8. Obtaining and analyzing data on the variation in services per episode or per patient.

(more…)

Pop quiz: Among early-stage companies that are successful, what percentage are successful with the initial business model with which they started (Plan A) vs. a secondary business model (Plan B)?

Harvard Business School Professor Clay Christensen studied this issue.  He found that among successful companies, only 7% succeeded with their initial business model, while 93% evolved into a different business model.

So let’s take this finding and reexamine our human nature. In light of these statistics, what makes more sense:

• Defending Plan A to your dying breath?
• Assuming Plan A is probably flawed, and anticipating the need for Plan B without getting defensive?

We question many of the assumptions underlying HITECH Plan A. We also want to talk about the need and content for Plan B in a constructive way.

In this essay we’ll discuss:

1) The Need for HITECH Plan B

2) Questioning Assumptions — Issues to Reconsider in Plan B

a) Rewarding Incremental Progress
b) Addressing Root Causes for Non-adoption of EHR Technology
c) Questioning Health Information Exchanges (HIEs) as Building Blocks for the Nationwide Health Information Network (NHIN)
d) Catalyzing Movement Toward Modular EHR Technology
e) Focusing Incentives on High Leverage Physicians
f) Recalibrating Expectations for EHR Technology Adoption
g) Getting Bang-for-the-Buck in Achieving Meaningful Use Objectives
h) Comprehensively Revamping Privacy/Security Laws vs. Tweaking HIPAA
i) Maximizing Sync Between HITECH and PPACA
j) Leveraging Potential for Patient-Driven Disruptive Innovation
k) Promoting EHR Adoption Beyond Hospitals and Physicians, e.g., long-term care, home health, behavioral health, etc.
l) Dumping Certification

3) Summing Up

(more…)

The Delineation of Home Healthcare: The Natural Evolution of a Healthy Industry
Wyatt Matas & Associates (investment bankers), April 2010
This whitepaper discusses the opportunity for home healthcare to become the center of chronic care disease management and identifies a particular business model that some more advanced companies are implementing.

EHR Software Market Share Analysis
Chris Thorman
Software Advice; May 14, 2010
A substantive analysis of a tricky market – physician EHRs.

Disease Management: Does it Work?
Jill Bernstein, Deborah Chollet, and G. Gregory Peterson
Mathematica Issue Brief; May 17, 2010
Mathematica revisits a debate that’s raged for over a decade:

• Not yet consensus that DM works
• Relatively effective disease management programs have some characteristics in common:
  • They use individualized case management.
  • They contact patients in person, not just by phone.
  • They focus on hospital discharges as key opportunities to improve health outcomes.
  • They encourage patients to use effective treatments by reducing cost-sharing for these treatments.

(more…)

.

….or to be more specific, HITECH is synergistic with payment reform that could come from the recently passed national health care reform legislation — the Patient Protection and Affordable Care Act (PPACA).

We’ll keep this post fairly short and try to avoid many of the more divisive aspects of this topic. The need for healthcare payment reform is well understood on both sides of the aisle:

Realizing the full potential of health IT depends in no small measure on changing the health care system’s overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide. Only then will they be motivated to take full advantage of the power of electronic health records. Dr. David Blumenthal,  New England Journal of Medicine, April 9, 2009

(more…)

by Dave deBronkart (e-PatientDave), Vince Kuraitis, and David C. Kibbe

So far this series has looked at HITECH participation by hospitals (grumbling but in the game) and physicians (wary, on the sidelines), kudos for ONC’s three major policy points, and how HITECH is already moving the needle on the vendor side. Today we’re going to look at the reason the whole system exists: patients.

It’s possible to look at the patients issue from a moral or ethical perspective, or from a business planner’s ecosystem perspective. In this post we’ll simply look at it pragmatically: is our approach going to work? It’s our thesis that although you won’t see it written anywhere, the stage is being set for a kind of disruption that’s in no healthcare book: patient-driven disruptive innovation.

We’ll assert that in all our good thinking, we’ve shined the flashlight at the wrong place. Sure, we all read the book (or parts), and we talk about disruption – within a dysfunctional system.

If you believe a complex system’s actual built-in goals are revealed by its actual behavior, then it’s clear the consumer’s not at the core of healthcare’s feedback loops. What if they were?

We assert that to disrupt within a non-working system is to bark up a pointless tree: even if you win, you haven’t altered what matters. Business planners and policy people who do this will miss the mark. Here’s what we see when we step back and look anew from the consumer’s view:

1. We’ve been disrupting on the wrong channel.
2. It’s about the consumer’s appetite.
3. Patient as platform:
   • Doc Searls was right
   • Lean says data should travel with the “job.”
   • “Nothing about me without me.”
4. Raw Data Now: Give us the information and the game changes.
5. HITECH begins to enable patient-driven disruptive innovation.
6. Let’s see patient-driven disruption. Our data will be the fuel.

(more…)

Most of the press coverage and attention to HITECH has been to the “buy” side of the market:  The central question here has been: “Will doctors and hospitals buy and use EHR technology?”

Meanwhile — and much more quietly — the sell (vendor) side of the EHR market is already dramatically different than it was a year ago. We observe change occurring at at least three levels:

1. HITECH as Policy Change
2. HITECH as Mindset Change
3. HITECH as Technology/Business Model Change

(more…)

While this might sound like a criticism of the way HITECH has been implemented, it’s not intended that way — it’s a commentary on 1) the complexity and scope of change that will be required to make HITECH successful, and 2) the level of protective entrenchment existing American health care today.

Rather, we believe that the Office of the National Coordinator (ONC) for Health IT – Dr. David Blumenthal and his staff — have done a superb job in interpreting and defining key aspects of HITECH legislation. We’re big fans.

For those of you who have been following our writings over the past 18 months, think of this post as a summary and status report on the extensive incumbent (cat) vs. innovator (dog) dialogue:

1. A Recap  — The Stagnant Electronic Medical Record (EMR) Market Before 2009
2. ONC Gets It Right In Three Major Interpretations and Definitions of HITECH

a) Meaningful Use (MU) Emphasizes “Meaningful”, Not “Use”

b) Vendors Get a Level Playing Field With Certification

c) Lightweight, Open Standards Promote EHR Interoperability and Modularity

(more…)

First, the good news: There are a lot of pilot and demonstration projects potentially involving the Patient Centered Medical Home (PCMH) in newly enacted Federal health care reform legislation – the Patient Protection and Affordable Care Act (PPACA).

Then, the bad news: There are a lot of pilot and demonstration projects potentially involving the PCMH in the PPACA.

…so many that the PCMH risks being drowned in an ocean of opportunity.

I’d like to make a few simple points in this essay:

1. The number of authorized pilots and demos in the PPACA is staggering
2. This creates both opportunities and challenges
3. PCMH focus will be required to navigate the ocean

(more…)

(click on any of the above graphics to be linked to the orginal source)

by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA

In the previous post in this series on “Is HITECH Working?”, we straightforwardly noted that hospitals are playing in the HITECH game. The issue of whether physicians will play is MUCH thornier.

As the headlines above succinctly convey — we conclude that for now there is too much fear, uncertainty, and doubt (FUD) to expect significantly increased EHR technology adoption by most physicians from the HITECH incentives and penalties.

Here are topics we’ll cover today:

• Fear, Uncertainty, Doubt
• Little Risk by Waiting a Year or Two
• A More Granular View — Segmenting Physicians
• Is There Another Side to the Story?
• How Important is Physician Adoption to the Success of HITECH?

(more…)

by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA 

The rationale for hospitals having to play in the HITECH game is straightforward: the financial carrots through 2015 are helpful, and the financial sticks after 2015 will be very painful.

We’ll discuss:

• Financial Impacts on Hospitals
• Survey Data Showing Hospitals Will Play
• Why Success is Not Guaranteed

Financial Impacts on Hospitals

Even prior to HITECH, most hospital executives already had passed the threshold decision and concluded that they need to implement EHR technology. Thus, the issue for most hospitals isn’t “whether” to implement EHR technology, but “when”, “at what cost”, and “how”. (more…)

by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA

If you’re like many folks we talk with, you understand the importance of the HITECH Act legislation — yet feel overwhelmed by the complexity and details.

This series of blog posts is for you. We address the question “Is HITECH working?” with seven straightforward observations. We’ve worked hard to boil down the complexity and make it understandable to the casual industry observer.

Is HITECH Working? Summarizing the Seven Observations

Our 7 Observations are:

(more…)

More information and registration here.

I’m honored to be a guest presenter, along with collaborators Lyle Berkowitz MD, Brian Klepper PhD, and Matthew Holt.

Answer:

• “demonstration” — 312 mentions
• “pilot” — 80 mentions

This weekend I’ve been trying to wrap my head around the question “Just what are these demos and pilots in the PPACA all about?” I have been boggled by the sheer number and complexity, and thought I’d share some findings from my first dive.

Why are These Pilots and Demonstrations Important?

(more…)

Certification Programs NPRM (Notice of Proposed Rulemaking)

Health IT, U. S. Department of Health and Human Services; March 2, 2010

Certification NPRM

Facts-At-A-Glance

FAQ

Bookmarked version of Certification NPRM (much easier to navigate)

U. S. Department of Health and Human Services; March 2, 2010

Via OCCAM Practice Management blog, March 3, 2010

Commentary and Analysis

Proposed EHR Certification Rule Changes Game

HDM Breaking News; March 2, 2010

“The rule mentions the Certification Commission for Health Information Technology, but does not grant it any grandfather status…. So, while CCHIT appears to be able to continue its operations under the proposed temporary certification program, its future isn’t clear in the proposed permanent program.”

Certification NPRM: A Statement from Alisa Ray, Executive Director, Certification Commission for Health Information Technology (CCHIT)

EHR Decisions; March 3, 2010

“…we feel confident about our prospects of becoming accredited…. We feel confident about the future, and we look forward to the opportunity to continue playing a role in accelerating the adoption of health IT.

 Why Rush Vendor Certification of EHR Technologies?

The Health Care Blog; March 08, 2010

“David Blumenthal and his staff have unveiled two separate plans to test and certify EHR technology products and services. We don’t think this is a good idea…this recently-announced two-stage EHR technology certification plan bears all the marks of a hastily drawn up blueprint that, if rushed into production, could easily collapse of its own bureaucratic weight.”

HIT Leaders React to Proposed EHR Testing and Compliance Rule

HealthLeaders Media; March 4, 2010

• “They got it exactly right.” Simeon Schwartz, MD, president and CEO of WestMed Medical Group.
• “It’s going to be interesting to see how much the vendors got out ahead of this and how much they’ve hedged their bets” Eric Saff, CIO of John Muir Health
• “…no matter where you are in the chain of this market, you can in fact certify those modules as opposed to waiting until you meet complete meaningful use to be certified. So I think that’s great. I think that’s really considerate of the ONC.” Luigi Leblanc of Solink

(more…)

However…I can’t help but comment on John’s misleading story “CCD Standard Gaining Traction, CCR Fading” in The Health Care Blog. He writes:

In a number of interviews with leading HIE [Health Information Exchange] vendors, it is becoming clear that the clinical standard, Continuity of Care Document (CCD) will be the dominant standard in the future.  The leading competing standard, Continuity of Care Record (CCR) appears to be fading with one vendor stating that virtually no client is asking for CCR today.

I have four beefs with John’s essay:

1. It’s no news that HIEs prefer CCD.
2. HIEs are not representative of the broader health IT market.
3. The narrow findings don’t justify the broad conclusion.
4. The CCD and CCR standards are more complementary than competitive

Let’s look at these one at a time.

(more…)

“If the needs for health care are to be met, the health care system must be organized to employ its resources with more wisdom and effectiveness. The two areas which appear to offer the greatest potential for improvement are (1) reducing unnecessary (or unnecessarily expensive) medical care and (2) increasing efficiency in the provision of hospital care.”

It will not be easy to carry out this recommendation.

Who said this? …and when? (more…)

I’d describe the app as Garmin-like but running on the iPhone. You type in the address at which you’re going to start your drive and then you type in the address of the location where you want to drive to. The iPhone displays a map and step-by-step directions. Want to zoom in on a section of the map? …just put your fingers on the screen, spread them, and instantly you see the map in greater detail. The app uses the GPS built into the iPhone to display your current location and progress on the map.

A few years ago you would have had to purchase a separate Garmin or Garmin-like appliance to get this type of functionality. Is this iPhone app as good as the Garmin? For many people, the answer might well be “No”, but that’s not the point.  For many people the iPhone app WILL be good enough — and having that choice is what creates a vibrant marketplace.

So what does this have to do with health care? A lot.

To date, health care has not had an iPhone like platform on which to run multiple high value applications. If you wanted specific functionality, you had to buy an independent appliance. For more on the appliance vs. platform distinction, start reading at Chapter 2 of Harvard Law Prof. Jonathan Zittrain’s excellent (and freely available) book, The Future of the Internet and How to Avoid It.

If you rethink health care, just about ANY technology or service can be reconceptualized as an app that COULD run on a common platform. Mull this over for a while…

(more…)

Thank you for being a loyal user of the Revolution Health Personal Health Record. Unfortunately we will be discontinuing this service as of the end of February 2010 and removing all records, information, and data from the Revolution Health Web site.

So that you don’t lose the information you’ve entered into the system, we strongly suggest that you download your personal records as a PDF to print and save for future reference. To do this, simply follow these instructions:

1. Log in to your Personal Health Record.
2. From any page of your record, click on the “printable version” link on the top right corner of any page. When you see a pop-up box asking you to “Select the following sections to include in your print out,” simply make sure that the sections you want to print and save are checked and then click the “Submit” button.
3. Once the PDF is created (this only takes a moment), you can print directly from it and/or save it to your computer. To print the PDF, click on the printer icon at the top left of the page. To save it, click on the disk icon to the right of the printer icon.

If you encounter a problem printing or saving your records, please e-mail our customer service department at CustomerCare@revolutionhealth.com for assistance. Even after the Personal Health Record is no longer available, Revolution Health and our partner sites will continue to offer you the same great health information and community pages as always. We hope you continue to visit Revolution Health often to take advantage of our offerings.

Thank you,
The Revolution Health Team

What happened here????  what’s the lesson?

“So Mom, are you learning to talk like a pirate? …like ‘aye, matey’”?

“I baby?” she asked.

“No, aye matey’”

“I-80?”

“…er, never mind Mom…how’s Benji?”

Vince’s mom (sans eyepatch) and Benji

Descriptive Summaries and Documents

 *Dissecting the Meaningful Use Proposed Rule PowerPoint

eHealth Initiative Policy Webinar; January 8, 2010

*What You Need to Know About the Meaningful Use Proposed Rule, Standards and Implementation Specification, and Interim Final Rule Certification Criteria PowerPoint

HIMSS Webinar; January 6, 2010

*Meaningful Use, Certification Criteria and Standards, and HHS Certification Process

HIMSS, frequently updated material, some members-only

Source Documents (Bookmarked)

Notice of Proposed Rulemaking (NPRM), Medicare and Medicaid Programs; Electronic Health Record Incentive Program; December 30, 2009

Warning: 536 pages of barely intelligible gobbledygook; stay away from this unless you are a lawyer, accountant, actuary, consultant, geek or wanna-be thereof 

Interim Federal Rule (IFR), HIT: Initial Set of Standards, Implementation Specifications, and Certification Criteria For EHR Technology; December 30, 2009

NPRM and IFR Tables in Spreadsheet Format

Healthcare Standards; January 9, 2009

Centers for Medicare & Medicaid Services (CMS) Website, Fact Sheets, Links

Updates on Meaningful Use, Certified EHR Technology and the Stimulus Bill

Software Advice; January 10, 2010

Analyses

*Urgently Needed: Useful Meaning of Meaningful Use

The Health Care Blog; January 9, 2009

*Now Reading: Proposed CMS Rule for EHR Incentives (from a patient access perspective)

Ted Eytan MD; January 10, 2010

(more…)

Gawande retorts: “Is that a bad thing?”

…and he answers his own question by describing the value of pilot programs contained in both the Senate and House versions of health reform legislation.

Is Gawande correct?  Yes and no….

(more…)

by Alexandra Drane and the Engage With Grace team

Last Thanksgiving weekend, many of us bloggers participated in the first documented blog rally to promote Engage With Grace — a movement aimed at having all of us understand and communicate our end-of-life wishes. It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations our closest friends and family. Our original mission to get more and more people talking about their end of life wishes hasn’t changed. But it’s been quite a year so we thought this holiday, we’d try something different.

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We?ve included them at the end of this post. They’re not easy questions, but they are important. To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer:  (more…)

Medicare announced today that it is extending its Personal Health Record (PHR) pilot project for residents of Utah and Arizona.

This is a waste of time and taxpayer dollars. Those of you who read my blog know that I’m a big fan of PHRs, but you have to know when you’re backing the wrong approach.

What’s wrong with this pilot project? A lot:

(more…)

• Keep it simple; think big, but start small; recommend standards as minimal as possible to support the business goal and then build as you go
• Don’t let “perfect” be the enemy of “good enough”; go for the 80% that everyone can agree on; get everyone to send the basics (medications, problem list, allergies, labs) before focusing on the more obscure
• Keep the implementation cost as low as possible; eliminate any royalties or other expenses associated with the use of standards
• Design for the little guy so that all participants can adopt the standard and not just the best resourced
• Do not try to create a one size fits all standard, it will be too heavy for the simple use cases
• Separate content standards from transmission standards; i.e., if CCD is the html, what is the https?
• Create publicly available controlled vocabularies & code sets that are easily accessible / downloadable
• Leverage the web for transport whenever possible to decrease complexity & the implementers’ learning curve (“health internet”)
• Position quality measures so that they will encourage adoption of standards
• Create Implementation Guides that are human readable, have working examples, and include testing tools

Commentary:  These new guidelines are the right answer…let’s hope they are Dr. Halamka’s “final” answer.

Feedback from the community has been mixed:

(more…)

In that post I touched briefly on the potential for MAPCI to create effective networks at multiple levels — contracting networks, health IT networks, social and collaborative care networks.  I’d like to expand a bit today…

So, why is Medicare’s participation in MAPCI  and other regional collaboratives such a big deal? Here’s my hypothesis:

Medicare’s non-participation (to-date) in regional payer/provider collaboratives has been a rate limiting factor in the potential to achieve high levels of network effects that drive adoption.

(more…)

Dear Dr. Blumenthal,

I was honored to receive a personal email from you today. However, after reading it, I conclude that you must have intended to send this email to Judith Faulkner, CEO of Epic Systems.

I really liked what you said about working toward interoperability:

The HITECH Act calls for the “development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that…promotes a more effective marketplace, greater competition…[and] increased consumer choice” among other goals.  (Section 3001(b))  This means we cannot support arrangements that restrict the secure, private exchange of information required for patient care across provider or network boundaries.  Some of these arrangements may improve care for those inside their walls.  But ultimately, they have the potential to carve the nation up into disconnected silos of information, and thus, to undermine the vision of a secure, interoperable, nationwide health information infrastructure, which the law requires us to establish.  Consumers, patients and their caretakers should never feel locked into a single health system or exchange arrangement because it does not permit or encourage the sharing of information.

So you will probably just need to resend your email…

Vince

Why aren’t primary care physicians expressing similar laments about  the shelving of the MMHD (Medicare Medical Home Demonstration) in favor of the MAPCI (Multi-Payer Advanced Primary Care Initiative).

My colleague Jaan Sidorov, MD and I pick up on no signs of discontent.  Read our essay “Three Years of Medical Home Demonstration Preparation Down the Drain?” on Dr. Sidorov’s blog.

Dr. John Halamka — Vice Chair of the HIT Standards Committee of the ONC and one of the most vocal and influential figures in health IT — writes a blog post this morning entitled “The Genius of AND”. Halamka reasonably summarizes the essence of the debate about standards and interoperability as being between “the healthcare informatics crowd” (cats) and the “Internet crowd” (dogs):

He notes that the debate shouldn’t be about one or the other POV prevailing (“either/or”), but about integrating both points of view (“and”):

..we need to embrace both approaches – the right tool for the right job depending on what you want to achieve.

For provider to provider communication which requires the exchange of documents with non-repudiation as the medico-legal record for direct clinical care, the CDA/CCD has great metadata and the ability to support structured data as well as free text discharge summaries/operative notes/history&physicals.

For a summary record that represents a snapshot in time of problems, medications, and labs for transmission between EHRs and PHRs, the CCR and other formats such as Google’s CCRg or PDF can do the job.

I’m absolutely stunned…and speechless.

(more…)

Today’s blog post will tackle:

• Medicare’s biggest change in 40 years?
• The rise of MAPCI
• The fall of MMHD
• Implications/discussion

Medicare’s Biggest Change in 40 Years?

(more…)

Tinker Ready hosts the Halloween edition of Health Wonk Review at Boston Health News.

Read about the “the undead public option” or as Jon Stewart said, “It’s alive!”

10/26/2009 – In Washington, the efforts to reform health care and health insurance include proposed legislative language that would have an impact on the Medicare Medical Home Demonstration as described in section 204 of the Tax Relief and Health Care Act of 2006 and amended by section 133 of the Medicare Improvements for Patients and Providers Act of 2008. Specifically, section 1302 of House Bill 3200 contains a provision to repeal this demonstration and replace it with an independent practitioner-based medical home pilot described further in the bill. In addition, the House bill includes a second medical home pilot to evaluate community-based medical home models.

At this time, CMS believes it would be impractical to pursue clearance of the Medicare Medical Home Demonstration, which has been under review at the Office of Management and Budget, given the pending legislation that would repeal it and replace it with a similar pilot. CMS is moving forward with an Administration-initiated demonstration announced by Secretary Sebelius on September 16, 2009, whereby Medicare would partner with existing multi-payer medical home pilots to improve the delivery of care. This demonstration, titled the Multi-Payer Advanced Primary Care Practice Demonstration, would be implemented in 2010.

What does this mean? As one who has followed the MMHD closely, here are some of my top-of-mind reactions:

(more…)

The letter is directed at 10 EMR (electronic medical record) vendors, and asks very pointed questions about whether the vendors have been negligent in not addressing patient safety issues in their technologies.

Senator Grassley, you have the scent and you’re on the trail.  There are several other questions you should be asking these vendors: (more…)

Compare the proportions that “users pay” for desktop Internet services vs. mobile Internet services (the area inside the red lines — click on the graphics to see larger versions).

What do these slides tell us?

(more…)

BrightTALK is sponsoring a complimentary Electronic Health Record Summit this Tuesday, October 20, 2009.

David C. Kibbe MD, MBA and I will be presenting “Introduction to Clinical Groupware and the Clinical Groupware Collaborative”

Clinical groupware is a new and evolving model for the development and deployment of health information technology (HIT) platforms and applications having the following characteristics:

• Use of the Internet and the web for EHR technology.
• Explicit design for information sharing and online communication among providers and patients/consumers.
• A modular or component architecture upon which applications can be aggregated to meet specific clinical and workflow tasks.
• Patient/consumer engagement tools that facilitate ongoing health management and care coordination.
• Interface and data exchange standards for information sharing that emerge in a market-driven manner.

The Clinical Groupware Collaborative is in a formative stage organization. To date, representatives from over 50 companies have expressed interest. We are working to be formally incorporated in November 2009.

To register, attend live, or view afterward on-demand, click the following link:  http://www.brighttalk.com/webcasts/6114/attend  

Here’s a full listing of the other Electronic Health Record Summit presentations:   

Kaiser Permanente’s Journey and Ultimate Success with Health IT, Andrew M. Wiesenthal, The Permanente Federation

Prescribing the Best Security for Your EHR System, Andrew Klein, Product Management at SonicWALL

Business Associates Now and Then: HIPAA, EHRs and the HITECH Act, Susan Miller, Security & Privacy Workgroup Chair, WEDI

Fraud & Abuse in the EHR, Jean Bishop, J Bishop Consulting

New HIPAA Rules and EHRs: ARRA & Breach Notification, Raj Goel, Brainlink International; Jim Sheldon-Dean, Lewis Creek Systems

Three Forcing Factors of Electronic Healthcare Records, Kim Singletary, McAfee

How Great EHRs Empower Participatory Medicine, e-Patient Dave deBronkart, Society for Participatory Medicine co-chair

How big a network will the Health Internet (aka National Health Information Network) be?

My BOTE (back-of-the-envelope) calculation is that this network could consist of about 301 million nodes.  Here’s my math (pls. clarify or amplify):

• 300 million individuals in U.S.
• 700 K doctors
• 5 K hospitals
• 295 K — other B2B healthcare entities

Very rough…but I hope you get the point.

So let’s put into perspective press releases from Google or Microsoft announcing that they have developed new “partnerships” (i.e.nodes in the network) for Google Health or Microsoft HealthVault. As an example, today Google announced partnerships with APWU Health Plan and Harvard Pilgrim Health Plan.

(more…)

ACOs of various types are being proposed in national health reform legislation. For all you ever wanted to know about ACOs, read How to Create Accountable Care Organizations from the Center for Healthcare Quality and Payment Reform.   I spent an hour and a half poring over the details of this excellent report written by Harold Miller.

My mistaken impression has been to focus on the organizational form of ACOs, rather than their objectives.  Organizational form is relevant in understanding ACOs, but primarily as a means toward creating accountability, not the end in itself.  Thus, expect to see many varying types of ACOs emerging based on local needs and characteristics.

I initially approached reading the report with a number of top-of-mind tactical and programmatic questions about ACOs:

• What kinds of organizations can serve as ACOs?
• What do primary care practices need to do differently to become ACOs?
• What’s the difference between a medical home and an ACO?
• Can small primary care practices become an ACO?
• Should all physicians in a geographic area be included in a single ACO?
• What is the role of specialists in an ACO?
• Should hospitals be part of an ACO?
• Are integrated delivery systems the ideal model?
• How many payers need to support an ACO?
• Accountability for all or some costs?

The answers to these questions are important, but primarily because they go to how an ACO can achieve accountability…

… and the short answer to every one of these questions is “It depends”. 

Depends on what?

To the maximum extent possible, an organization’s ability to serve as an Accountable Care Organization should be determined by its success in improving outcomes – controlling costs, improving quality, and providing a good experience for patients – not on its organizational structure or even the specific care processes it uses. 

Let me try to explain the big idea of accountability from a couple of other angles.

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Here’s a copy of our PowerPoint slides…

and here’s DMAA’s writeup:

Helping physicians and hospitals meet the “meaningful use” criteria for federal support for health information technology under recently passed legislation represents a keen opportunity for the population health management industry, presenters at this session said yesterday.

Vince Kuraitis, JD, MBA, of Better Health Technologies, LLC, and Don Storey, MD, of RMD Networks, presented a look at the evolution of HIT and the electronic medical records systems from a strongly proprietary model with little interoperability to new model of integrated, modular applications from various vendors sharing common languages and platforms.

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The part that’s puzzling to me is the statement that LifeMasters owes $125 M to CMS.  That’s hard to figure…the company only participated in MHS for a few months, and to my knowledge MHS is the only Medicare demo that required guaranteed savings (i.e., payback if targets aren’t hit).  

I really have to stretch my imagination to compute how CMS ran the tab to such an astronomical number. It raises questions around CMS’ good faith as a business “partner”.

Let’s do the math.

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I’m writing to extend a warm personal invitation to learn more about the Clinical Groupware Collaborative (CGC).  To-date, purely through word-of-mouth over 40 companies have expressed interest in the CGC, and we expect that you’ll be hearing a lot more about us over the coming months.

Our meeting will take place next Tuesday, September 22, 6 PM in conjunction with The Forum 09, the annual meeting of DMAA: The Care Continuum Alliance.  More details are provided at the bottom of this post.

I’ll address a few questions that might be on your mind.

Q. What is Clinical Groupware? 

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One bad deal can ruin your day.

Today, LifeMasters filed for Chapter 11 bankruptcy protection.  According to its press release:

“The Chapter 11 filing is the most efficient path for the company to restructure liabilities that are a result of Demonstration Projects previously performed under contracts with the Centers for Medicare and Medicaid Services (CMS), ” said George D. Pillari, President of LifeMasters. Mr. Pillari, named President of LifeMasters today, is a Managing Director of Alvarez & Marsal Healthcare Industry Group, LLC and had been working with the company and its board as a restructuring advisor prior to the filing.

During the last four years, LifeMasters participated in three CMS Demonstration Projects aimed at testing certain disease-management techniques in fee-for-service Medicare and Medicare/Medicaid dually eligible populations. Eight other disease management, health insurance and pharmaceutical companies also participated in these projects. LifeMasters’ involvement in the CMS projects ended earlier this year.

CMS contends that LifeMasters, like other participating organizations, was unable to demonstrate success based on CMS’ study design and measurement methodologies. Similar to its claims against other Demonstration Project contractors, CMS contends that LifeMasters is required to repay to CMS any fees earned in excess of savings generated during the multi-year projects. “Rather than endure a costly and time-consuming legal path to challenge CMS, we have chosen to restructure our CMS and other liabilities through the Chapter 11 process,” Mr. Pillari added.

LifeMasters expects no disruptions in its services to clients and believes it has ample cash on hand to emerge from Chapter 11 as a viable health improvement company.

A Modern Healthcare article contains a link to the bankruptcy filing:

• In one checkbox, the company estimates it has $10 to $50 million of assets
• In another checkbox, the company estimates it has $100 to $500 million of liabilities (to all creditors, not just CMS)
• It lists CMS as it’s largest creditor — $125 million

What happened? First let me acknowledge that I don’t have first-hand specifics of the current bankruptcy filing.  However, many bread crumbs have been dropped along the trail…

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Two issues have rightfully surfaced front and center in the public’s understanding of HITECH Act implementation:

• ” definition of “Meaningful Use” of EHRs, and
• ” definition of “certification” process for EHRs

…and we applaud the progress of the workgroups and the HIT Policy Committee in addressing these issues constructively.

However…a THIRD issue lurks – “Data harmonization at the expense of data liquidity“, or put another way – “misplaced pursuit of one (and only one) language at the expense of practical communication.”

On August 20, the HIT Standards Committee approved recommendations to bring forward to the HIT Policy Committee meeting later this September. 

In this post, we will:

1. Summarize aspects of the HIT Standards Committee’s recommendations that are problematic
2. Develop an analogy to illustrate how the recommendations will limit innovation and increase barriers to communication.  Our analogy:

The Standards Committee recommendations are like mandating that everyone in the U.S. be required to speak Latin by 2013.

Dr. Blumenthal has wisely anticipated that there could be a situation where in his role as national coordinator that he should not follow a Committee’s advice:

“This committee does provide advice to the national coordinator, but it does not make policy,” Blumenthal said, with a noticeable emphasis on “not.” [iHealth Beat; August 18, 2009]

Dr. Blumenthal, this is exactly the situation you have anticipated. (more…)

Many of us have enjoyed a few good minutes of fun having our fortunes told by soothsayers who claim they can predict our future based on patterns of tea leaves in a cup or the playing cards we’ve pulled from a deck.

We pay a few dollars for the entertainment and if the fortune teller is skilled, we are temporarily impressed by his “insight.” But once we leave the carnival, we come back to our senses. Fortune-tellers can’t predict the future.

With its latest announcement, the Certification Commission for Healthcare Information Technology (CCHIT) appears to have entered the fortune telling business.

And if information provided on blogs published by its founders is to be believed, some EHR vendors plan to have their fortunes told by the former EHR certification monopolist.

Background

In June, ONC’s HIT Policy Committee released a Meaningful Use Matrix and proposed that it should serve as the basis for EHR certification as mandated by ARRA, the economic stimulus program signed into law last winter.

The Matrix consisted of five “Health Outcomes Policy Priorities” and associated Care Goals, Objectives and Measures. The Committee anticipated that the latter would be transformed into EHR certification criteria. (more…)

• Political reality dictates that the MMHD must save costs.
• As currently structured, the MMHD cannot achieve cost savings
  • In any given year, only a small percentage of patients account for the vast majority of costs
  • Lessons from previous Medicare disease/care management demonstrations has shown that effective care coordination interventions must be targeted at this population
  • Medicare has structured the MMHD so that any patient with one or more chronic condition is eligible; this includes 86% of all Medicare patients.
  • Physicians will be paid risk-adjusted care coordination fees for this entire population — the 86% of patients with one or more chronic condition.
    The MMHD cannot achieve cost savings. 

Dr. Randy Williams, MD — CEO of Pharos Innovations — has written Part II of this series: The Medicare Medical Home Demonstration: Crawling Out From Under the Rock. It’s insightful and provocative reading!

The Federation of American Hospitals (FAH) sent a letter to Dr. David Blumenthal (National Coordinator for Health IT) arguing that “Meaningful Use” funding should not be tied to achievement of quality measures.  The FAH is the trade association for for-profit hospitals; the letter is dated August 26 and a copy is available on the HealthHombre website, with a deserved hat tip.

First, let me concede that they make a reasonable point on p. 3 when they say “Under it’s framework, the Policy Committee has recommended that HHS should adopt a measure for 2013 requiring a 10 percent reduction in preventable admissions from 2012 to qualify as a meaningful EHR user.”  This measure deserves discussion.

Here’s the implicit threat of a lawsuit — the nuclear bomb: (more…)

This post is a foundational overview of characteristics of network industries.  Much of the terminology will deserve deeper discussion, but we have to start somewhere.

In his book The Economics of Network Industries, Professor Oz Shy lists four characteristics of network industries.

The main characteristics of these markets which distinguish them from the market for grain, dairy products, apples, and treasury bonds are:

1. Complementarity, compatibility and standards
2. Consumption externalities [network effects]
3. Switching costs and lock-in
4. Significant economies of scale in production

In this essay, I’ll quote from Dr. Shy in explaining each of these characteristics.  I’ll also offer a few thoughts as to how these characteristics apply to healthcare. More specifically, I’ll discuss physician adoption of EHRs (electronic health records) and patient adoption of PHRSs (personal health record systems).  

Why a PHRS instead of a plain old PHR?  Think of a PHRS as a PHR data repository platform bundled with multiple high-value applications. For a more detailed explanation, read here.   

Let’s look at the characteristics of network industries one at a time.

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There’s a double meaning to the title of this new series: Healthcare Crosses the Chasm to the Network Economy

At the level of technology, it’s a reference to Geoffrey Moore’s bestselling business/technology book — “Crossing the Chasm”. The Chasm here is the huge gap between early adopters of technology and mainstream users. The book describes the process of bringing specific technologies into mainstream usage.

At the level of clinical care, its a reference to the landmark 2001 report by the Institute of Medicine — “Crossing the Chasm”.  Here, the Chasm is a reference to the quality/safety gap existing in American healthcare, with major systemic recommendations for how to cross the chasm toward clinical improvement.

In this series, the “Crossing the Chasm” is a reference to both technology and clinical care — and to the interdependence between them. I believe we’re entering a new era in healthcare, marked by passage of the HITECH Act Federal stimulus legislation, but of which HITECH is only the beginning . While to a casual observer HITECH Act might seem focused on electronic health records (EHRs), it goes far beyond that.   

Over the past several years, I’ve had the privilege to work with many leading-edge clients who understand that health IT interoperability, networks, and platform/application technologies and business models will reshape health care over the coming years.  This has given me a chance to do a deep dive into understanding companies, business models and literature from outside health care, and then thinking through implications for health care companies (much blogging and book forthcoming).

This series will pull on concepts, terminology and lessons from two disciplines:

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Between the initial recommendations in July and the adopted recommendations in August, one critical word was added to the definition of “certification”.  That one word is “minimum” — and this one word expresses the correct approach and philosophy for the government’s role in the certification process for EHRs.

In this post I’ll address why a “minimum” approach toward certification makes sense: 

• Why “Minimum” Certification is Right: More Like UL
• Why Current CCHIT Certification Based on Functionality Risks Irrelevance or Lock-in to Outdated Technology

Why “Minimum” Certification is Right: More Like Underwriters Laboratories

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Over the past several years, many diverse initiatives have arisen offering partial solutions to systemic problems in the U.S. health care non-system. 

We see Meaningful Use Criteria recommended by the HIT Policy Committee as a unifying force for these previously disparate initiatives. These initiatives have included:

• Patient Centered Medical Homes (PCMHs)
• Regional Health Information Organizations (RHIOs)/Health Information Exchanges (HIEs)
• Payer Disease/Care Management Programs
• Personal Health Record Platforms — Google Health, Microsoft HealthVault, Dossia, health banks, more to come
• State/Regional Chronic Care Programs (e.g., Colorado, Pennsylvania, Improving Performance in Practice)
• Accountable Care Organizations — the newest model being proposed as part of national reform efforts

Today

While there are some commonalities and overlap, to-date these initiatives have mostly arisen in isolation and are highly fragmented — they’re all over the map. Here’s a graphic representation of the fragmentation that exists today:

Tomorrow

The HIT Policy Committee recently recommended highly detailed Meaningful Use criteria for certified EHRs.  Doctors and hospitals who hope to receive HITECH Act stimulus funds will have to demonstrate that they are meeting these criteria; the criteria are not yet finalized.

The Committee website describes the central role of the Meaningful Use criteria:

The focus on meaningful use is a recognition that better health care does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care.

The HIT Policy Committee also is recognizing that there are multiple routes to achieving Meaningful Use beyond the traditional EMR 1.0, e.g., modular Clinical Groupware software.

While some might view the Meaningful Use criteria as limited to the world of health IT — something happening “over there” — we see much more going on. We believe the Meaningful Use criteria are becoming a powerful unifying force across the health system, with potential to converge previously disparate initiatives.  Here’s our conceptual representation:

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Over the past few days, several of my respected colleagues have written excellent blog posts essentially asking “Does Google Health have life?”

• Scott Shreeve — CLEAR! Shocking Google Health Back to Life
• John Moore — Is Google Health Irrelevant?
• Will Crawford — Future of Google Health

I share their observations and sentiments.  I see Microsoft HealthVault as a serious business strategy while Google Health is more like a hobby (one of probably hundreds at Google).

Are there reasons Google should stick around healthcare? Absolutely!  Off the top of my head, I can think of five:

1. Google brings unique competencies to health care information seeking.
2. Google Health is doing a good job on a shoestring budget.
3. Healthcare is ripe for disruptive innovation.
4. Microsoft needs competition.
5. Microsoft HealthVault and Google Health are more complementary than competitive.

Let’s take these one at a time. (more…)

Be sure to savor every word of Dr. Jaan Sidorov’s masterful witticisms!

Medical homes probably do save money in very controlled settings, where the entire team is literally or at least figuratively under one roof, such as Kaiser.  However, the belief that one can overlay a traditional medical home model across an entire state and save money in the process turns out to be total fiction.

The poster child for that fiction, North Carolina’s Community Care program, turns out to cost state taxpayers probably $400 million a year, rather than save them $300 million, as the state’s self-serving and blatantly incorrect analysis claimed.    A more extensive analysis is available for review, and any state is welcome to the backup data as well.

Here’s a press release with more details.

Highlights of the head-scratching implausibilities claimed would be as follows:

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• As a political matter, the MMHD must save money
• As currently structured, the MMHD cannot save money

Please read my guest post

The Medicare Medical Home Demonstration (MMHD): Between a Rock and a Hard Place

over at Pharos Innovations new blog: The Collaborative Forum.

Is there a way out from between the rock and the hard place?  In Part II of this series, Dr. Randy Williams will discuss options.

Disclosure: Pharos Innovations is a client of Better Health Technologies, LLC.

Economists call it “The Penguin Problem”  — No one moves unless everyone moves, so no one moves. 

The role of user expectations is crucial in getting penguins to move off of ice floes and in the successful adoption of new network technologies.  I’ll cover two main points in today’s essay:

• How “The Penguin Problem” Helps Explain Low EHR (electronic health record) Adoption To-Date
• How Recent Federal Actions Are Setting Higher Expectations for EHR Adoption

The Penguin Problem and Low EHR Adoption To-Date

While not the only factor, the role of user expectations is a crucial element in explaining the adoption of new network technologies. Harvard Business School Professor Tom Eisenmann explains:

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As demonstrated by e-CareManagement blog readership, there has been a lot of interest in LifeCOMM.  My first blog post on LifeCOMM in 2007 has been single the most commented on post and the second most widely read blog post.

It’s taken me a while to sift through my thoughts and feelings about saying “Goodbye” to LifeCOMM. At first I was deeply disappointed, but after further reflection think that LifeCOMM wasn’t the right type of platform for today’s consumer mobile health market.

Disappointment

My first reaction was one of disappointment. (more…)

…and the title of the eHealth Initiative’s Sixth Annual Survey of Health Information Exchange says it all:

Migrating Toward Meaningful Use

What’s happening here?

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Interoperability has multiple dimensions — and I’d bet that most of us have never thought of interoperabilty as involving “process” — people working together and collaborating; I know I hadn’t.

The Interoperability Work Group of HL7’s Electronic Health Record (EHR) Technical Committee was formed in April 2005 to attempt to define the concept of interoperability. The group examined 100+ definitions of interoperabilty. Their work is summarized in their report: Coming to Terms: Scoping Interoperability for Health Care, February 2007.

3 Types of Interoperability: Technical, Semantic, Process

Through work group consensus, three principal types of interoperability were identified: technical interoperability, semantic interoperability, and process interoperability. Here’s an overview:

Type 1: Technical Interoperability

The most basic, hardware-based form of interoperability. IEEE-90 defines interoperability as, “The ability of two different systems to exchange data so that it is useful”

The focus of technical interoperability is on the conveyance of data, not on its meaning. Were it not for the fact that computers tend to use written language, this would be similar to the level of interoperability provided by voice communications, e.g., via a telephone.

Type 2: Semantic Interoperability

the ability of information shared by systems to be understood… so that non-numeric data can be processed by the receiving system.

HL7 also defined a quality that is necessary for optimal semantic interoperability to exist. The quality-based rationale of the HL7 semantic interoperability messaging standard asserts that health information systems will communicate information in a form that will be understood in exactly the same way by both sender and recipient.

Type 3: Process Interoperability

Process interoperability is an emerging concept that has been identified as a requirement for successful system implementation into actual work settings. It was identified during the project by its inclusion in academic papers, mainly from Europe, and by its being highlighted by an Institute of Medicine (IOM) report issued in July 2005 which identified this social or workflow engineering as key to improving safety and quality in health care settings, and for improving benefits realization.8 It deals primarily with methods for the optimal integration of computer systems into actual work settings and includes the following:

• Explicit user role specification
• Useful, friendly, and efficient human-machine interface
• Data presentation/flow supports work setting
• Engineered work design
• Explicit user role specification
• Proven effectiveness in actual use

Here’s another helpful angle on the three types of interoperabilty: (more…)

There is no question,” says Sterling “that the selection and implementation of an EMR is a ‘bet-the-practice’ proposition. If you fail, you end up with more costs and greater frustration.…” (emphasis added)

The real question that Joe the Doctor is asking himself is “…’scuse me, but WHY am I being forced to bet-my-practice on an EMR in the first place?  I’m not a gambler.”

The problem here is not in health information technology (HIT) per se, but in conceptualizing EMR 1.0 as an all or nothing proposition…pass vs. fail, white vs. black, bet the practice and win vs. bet the practice and lose.

This is exactly why a modular and incremental approach to HIT — clinical groupware, EHR 2.0 — makes more sense than the monolithic bet-the-practice approach of EMR 1.0. Physicians shouldn’t have to bet-their-practice on EMR implementation success.

Click on the graphic to download a copy of today’s BrightTALK webcast.

Here’s a full listing of the six eHealth Summit topics (Eastern Time).  Click on the links to attend any or all of the webcasts.  The series will be recorded for future on-demand access. 

EHR 2.0: Federal HITECH Act Creates Opportunities Beyond EMRs

8 Jul 2009 11:00 am

Presenting Vince Kuraitis, Principal Better Health Technologies

Data Convergence in Life Sciences and Healthcare

8 Jul 2009 12:00 pm

Presenting Greg Nelson, President and CEO, ThotWave Technologies

Continua Health Alliance – Interoperable Telehealth Solutions 

8 Jul 2009 2:00 pm

Presenting Rick Cnossen, President & Chairman of Continua Health Alliance

The Future of Disease & Care Management for the Chronically Ill 

8 Jul 2009 3:00 pm

Presenting Jaan Sidorov, MD, The Disease Care Management Blog

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The last article in this series — Time for EHRs to Become Plug-and-Play — used words to describe a major industry shift underway in health IT.

Sometimes pictures help to make a point. Here are several diagrams that you can also download as PowerPoint slides.

 Computer Industry 1983 to 2002

  Source: Venkatraman, N. Winning in a Network Centric Era, 2006

Blueprint for Health IT Shift

From EMR 1.0 — 2008…

…to Clinical Groupware/EHR 2.0 — 2012 (more…)

by Scott Shreeve, MD

We are entering an unprecedented season of change for the United States health care system. Americans are united by their desire to fundamentally reform our current system into one that delivers on the promise of freedom, equity, and best outcomes for best value. In this season of reform, we will see all kinds of ideas presented from all across the political spectrum. Many of these ideas will be prescriptive, and don’t harness the power of innovation to create the dramatic breakthroughs required to create a next generation health system.

We believe there is a better way.

This belief is founded in the idea that aligned incentives can be a powerful way to spur innovation and seek breakthrough ideas from the most unlikely sources. Many of the reform ideas being put forward may not include some of the best thinking, the collective experience, and the most meaningful ways to truly implement change. To address this issue, the X PRIZE Foundation, along with WellPoint Inc and WellPoint Foundation as sponsor, has introduced a $10MM prize for health care innovators to implement a new model of health. The focus of the prize is to increase health care value by 50% in a 10,000 person community over a three year period.

The Healthcare X PRIZE team has released an Initial Prize Design and is actively seeking public comment. We are hoping, and encouraging everyone at every opportunity, to engage in this effort to help design a system of care that can produce dramatic breakthroughs at both an individual vitality and community health level.

Here is your opportunity to contribute: (more…)

The remarkable report, “Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home,” published in the May/June issue of Annals of Family Medicine, the Nutting Report, makes this point about the state of primary care IT offerings:

Technology needed in a PCMH is not “plug and play.” The hodge-podge of information technology marketed to primary care practices resembles more a pile of jigsaw pieces than components of an integrated and interoperable system.

Surprise!  Well, actually, no surprise.  We all recognize that health IT implementation in family practices, even under the best conditions and with the best of planning, is difficult and can be an ongoing challenge.   

What is surprising to us, however, is that Dr. Nutting and co-authors make this comment in their recommendations section:

…[I]t is possible and sometimes preferable to implement e-prescribing, local hospital system connections, evidence at the point of care, disease registries, and interactive patient Web portals without an EMR. (more…)

What if the health care payer were re-imagined as a service to the primary care doctor – supplying the tools, information and funding primary care physicians needed to meet the call to reform health delivery?

The structure of physician payment is considered one of the most problematic aspects of our health care system.  Driven by volume instead of coordinated, proactive care and favoring procedures over cognitive work, the payment system has driven primary care into decline and stifled improvements in quality and efficiency.  Indeed, primary care physicians are overstressed and demoralized by demands, coming from every direction, that drive them only to see more patients, as quickly as possible.   In this state, primary care cannot attract new physicians at a time when an expansion of the primary care workforce is desperately needed.  Without new primary care doctors, how will medicine meet the future volume demands of the aging “baby boomers”, much less deliver the kind of comprehensive approach to patient health needed to correct the defects in today’s care?  Despite these growing concerns, little in the way of innovation is arising from payers.

So, what if the payer model was re-imagined?  What would such a payer look like?  At ESSENCE Healthcare, we have developed the Collaborative Payer Model (CPM), which takes the first steps at answering these questions. 

The CPM brings a new approach to address what is missing in much of health care reform, including: (more…)

The forthcoming definition of the “meaningful use” of health information technology will set the direction of the Obama administration’s strategy for health IT adoption, said David Blumenthal, the new national coordinator for health IT. Government HealthIT, April 28, 2009

…but not everyone sees eye-to-eye on the definitions of “meaningful use” and “certification”.  [See the first post in this series for a refresher on the dog (disruptive innovator) and cat (incumbent EHR vendor) points of view.]

Markle Foundation –  Best Articulation of the Dog (Disruptive Innovator) POV 

Achieving the Health IT Objectives of the American Recovery and Reinvestment Act
A Framework for ‘Meaningful Use’ and ‘Certified or Qualified’ EHR
Markle Foundation; April 30, 2009

HIMSS and EHRA — Best Articulation of the Cat (Incumbent EHR Vendor) POV 

HIMSS Publishes Its Definitions of ‘Meaningful Use’
HIMSS News; April 27, 2009

HIMSS Electronic Health Record Association Executives Testify at NCVHS Hearings on ‘Meaningful Use’ Criteria
RedOrbit; April 28, 2009

Many Others Weigh In…. (more…)

For those of you who have not seen earlier posts in this series, please understand that the reference to “goes to the dogs” is a great compliment.

In a joint press release, the American Medical Association and Covisint unveiled an agreement yesterday:

Compuware Corporation (NASDAQ: CPWR) announced today that its Covisint subsidiary signed an agreement with the American Medical Association (AMA) to deploy an innovative health information exchange solution delivering value to its 240,000 member physicians and the physician population at large….

Covisint will enable AMA physicians to have access to a variety of health information technologies via an AMA-branded, web-based solution.  The AMA said it will use the Covisint platform to deliver to physicians a variety of products, services and resources aimed at increasing medical practice efficiency and facilitating the adoption of health information technology (HIT), including help with implementing electronic health records (EHRs). Current product categories that the AMA is exploring include: practice management tools, resources for professional development and clinical management services. The new platform will provide personalized content, search capabilities and learning and networking opportunities, among other valuable offerings

The features of Covisint’s offering are described on its website.

This deal is a  slap in the face to incumbent EMR vendors who have been attempting to develop the electronic plumbing in physicians’ offices for the past decade. You could interpret it as a vote of no-confidence in EMR vendor abilities to develop these web-based collaboration and care coordination tools.  It’s at least a strong expression of “we’re not going to wait around to see whether you can extend your existing EMRs with these types of capabilities”.

…and it’s a strong validation for the technologies and business models of emerging, innovative companies enabling EHR 2.0 capabilities, e.g., RMD Networks, Shared Health.

What are some other possible implications?

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