With the Department of Justice announcement of the $155 million dollar eClinicalWorks settlement (including personal liability for the CEO, CMO and COO), many stakeholders are wondering what’s next for EHRs. Clearly the industry is in a state of transition. eCW will be distracted by its 5 year corporate integrity agreement. AthenaHealth will have to focus on the activist investors at Elliott Management who now own 10% of the company and have a track record of changing management/preparing companies for sale. As mergers and acquisitions result in more enterprise solutions, Epic (and to some extent Cerner) will displace other vendors in large healthcare systems. However, the ongoing operational cost of these enterprise solutions will cause many to re-examine alternatives such as Meditech...
quality measures
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Halamka on MU3 Regs: The Good, The Bad, and the Ugly
On Friday March 20, CMS released the Electronic Health Record Incentive Program-Stage 3 and ONC released the 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. Perhaps the most important statement in the entire 700+ pages is the following from the CMS rule: "Stage 3 of meaningful use is expected to be the final stage and would incorporate portions of the prior stages into its requirements."
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Halamka on What's Next for Electronic Health Records
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Halamka's Recommendations for Effective Care Management
I recently joined the advisory board of Arcadia Healthcare Solutions, a leading provider of analytics, decision support, and workflow enhancement services. At my first advisory board meeting there was a rich debate about the marketplace for care management and population health tools. I’ve spent years studying such solutions at HIMSS and found most of the products are “compiled in Powerpoint”, which is a very agile programming language, since it’s so easy to change…
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Halamka's Reflections on US Health IT Policy Trajectory
I’m in China this week, meeting with government, academia, and industry leaders in Guangzhou, Shenzhen, Beijing, Shanghai, and Suzhou. The twelve hour time difference means that I can work a day in China, followed by a day in Boston. For the next 7 days, I’ll truly be living on both sides of the planet. I recently delivered this policy update about the key developments in healthcare IT policy and sentiment over the past 90 days. I’ve not written a specific summary of the recently released Quality Patient Program proposed rule which provides the detailed regulatory guidance for implementation of MACRA/MIPS, but here’s the excellent 26 page synopsis created by CMS which provides an overview of the 1058 page rule...
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Halamka's Report on The April 2015 HIT Standards Committee Meeting
The April 2015 HITSC meeting focused on the Certification Rule NPRM and a comprehensive review of the Federal Interoperability Roadmap. I suggested that a guiding principle for the committee’s work is to emphasize the enablers in the proposals while reducing those aspects that create substantial burden/slow innovation. As a federal advisory committee our job is to temper regulatory ambition with operational reality.
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Halamka: Advice to the New National Coordinator
Karen DeSalvo started as the new National Coordinator for Healthcare Information Technology on January 13, 2014. After my brief discussion with her last week, I can already tell she's a good listener, aware of the issues, and is passionate about using healthcare IT as a tool to improve population health...What advice would I give her, given the current state of healthcare IT stakeholders?
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It Is Time for Physicians to Fight Back. Now.
The American health care system is broken, but it is not really “health care” that is the problem. The science of medicine, the tests, and the treatments available are better than ever. It is health care bureaucracy that is the problem. But doctors, nurses, and patients bear the brunt of the dysfunction. Medical professionals are unable to practice, and patients are denied the care they need, even though it is readily available. Careers are being ruined, and lives lost along the way. It is time to fight back...
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Let Patients Read Their Medical Records
Sometimes, before I interview new patients, while I’m waiting for them to be transported from the emergency department to the medical floor, I play a game.
I look through their lab tests. I peruse their imaging studies. I read other doctors’ notes and recent discharge summaries. Then I guess what the diagnosis is. I know this is bad. It goes against most of what I learned about good doctoring in medical school — that the patient’s story is the core of medicine, that it’s essential for accurate diagnoses and therapeutic relationships...
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Not All Snake Oil Is Digital
A different take on "snake oil" in health care was a thoughtful piece in Health Affairs, by David Newman and Amanda Frost, discussing the quality measurement morass in health care. They cite a study that estimated we spend some $15.4b annually collecting several thousand different quality measures, few of which have any meaning to consumers and all-too-few of which seem to be used to actively improve quality. It isn't that they don't think we should be measuring quality -- far from it -- but, rather: "Patients should not be able to choose substandard quality care, and substandard quality care should not be allowed to be offered in the market." Now, there's a novel concept!
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Oroville Hospital CEO Tells the Story of their Successful VistA EHR Self-Implementation at VistA Expo 2011
One of most exciting presentations at the VistaEXPO 2011 conference was given by Robert Wentz, Hospital Administrator and CEO of Oroville Hospital, a regional hospital in the beautiful mountains of Northern California. Oroville Hospital has achieved a whole series of milestones in close partnership with the VistA community. These range from a full implementation of VistA in the hospital and most of its 20 clinics, to the achievement of full meaningful use certification.
Oroville Hospital's CMO Discusses VistA Implementation and CPOE - Part 1
On October 16, 2012, Oroville Hospital turned on the CPOE component of its EHR, becoming the first individual US hospital to successfully adapt the Veterans’ Administration’s highly regarded electronic medical records system. How did a small, 153 bed semirural California hospital serving a mostly Medicare and MediCal population arrive at this place? Read More »
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Oroville Hospital's CMO Discusses VistA Implementation and CPOE - Part 2
This is the second in Dr Fine’s two-part series describing Oroville Hospital‘s implementation of VistA, the open-source EHR developed by the Veterans’ Administration. In his first post, he discussed their strategic approach and initial experiences with electronic documentation. Here, he picks up with Oroville Hospital’s CPOE go-live. Read More »
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The HITECH Era in Retrospect
At a high level, the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 accomplished something miraculous: the vast majority of U.S. hospitals and physicians are now active users of electronic health record (EHR) systems. No other sector of the U.S. economy of similar size (one sixth of the gross domestic product) and complexity (more than 5000 hospitals and more than 500,000 physicians) has undergone such rapid computerization...
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Three Possible Measures for Quality Medical Care May Help Cut Deaths from Opioid Addiction by One-Third
Following three possible recommendations in providing medical care to people with an opioid addiction may cut deaths among such patients by as much as one-third, according to a new RAND Corporation study. Analyzing the care given to people treated in the Veterans Affairs health care system, researchers looked at whether receiving recommended medical care was associated with a lower risk of death. They found that deaths were much lower among patients with opioid addiction who were not prescribed opioids or common types of anxiety medications, those who received psychosocial counseling, and patients who had quarterly visits with a physician...
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VA Wait Times As Good or Better Than Private Sector: Report
VA health care is as good or in some cases better than that offered by the private sector on key measures including wait times, according to a study commissioned by the American Legion. The report, issued Tuesday and titled "A System Worth Saving," concludes that the Department of Veterans Affairs health care system "continues to perform as well as, and often better than, the rest of the U.S. health-care system on key quality measures," including patient safety, satisfaction and care coordination...
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