The Nov/Dec 2011 issue of Healthcare Executive includes an article I wrote for the Satisfying Your Customers column, titled Engaging Staff with Social Media. In the article I describe how successful leaders will prepare for the shifts occurring in the healthcare workplace; including the push for efficiency and new generations. I also include a few examples of where social media is contributing to a more effective workplace in hospitals.
Social media technologies are tools that can help increase customer, physician and employee satisfaction. I hope you will take the time to read the article and share your thoughts.
Another blog post that includes a few great workplace examples is list of 20 hospitals with inspiring social media strategies.
I was interviewed for a recent article in Becker's Hospital Review that explores the common belief that older adults have more difficulty accepting and using technology. It includes some great comments about "digital natives" and "digital immigrants" by the other interviewees.
Speaking for myself, as a late Boomer, I can say that I certainly am a digital immigrant who has embraced technologies as I have found value to my work and life. And, I believe that this applies to older adults in general. There are differences in the generations and the oldest may need the most convincing and support, but it isn't that they can't incorporate technology into their daily life.
I remember older adults thinking it was a bit silly for people to carry around a cell phone. But, once they began to realize value - they feel safer because they can call for help -- then older adults start using the technology just as anyone else. If I'm correct, I also I believe this is how telephone adoption went. It took a long time for it to catch on and for people to find value in the technology.
Health IT is just one more advancement that needs to progress through the adoption cycle.
I've posted on the subject of volunteers, young people working in hospitals and those considering a career in healthcare administration, previously. However, this last week, I've been specifically researching Candy Stripers, who are sometimes referred to as Junior Volunteers.
Candy Stripers at Doctors Memorial Hospital, FL
I'd love to here your thoughts or stories about the youngest of our hospital workforce! If you prefer something more personal, send me an email: Christina {at} cthielst {dot} com
I'm thinking I should also start researching the Pink Ladies, too!
The American College of Physicians has released an update to its Ethics Manual and new or expanded sections include, among others, confidentiality and electronic health records, health system catastrophes, boundaries and privacy, social media and online professionalism. I really appreciate the manual and have pulled out a few key points based upon the topics I cover often on this blog.
All Changes to the Manual since the 2005 (fifth) edition
Healthcare-associated infection data on all hospitals in Califorinia has been released by the California Department of Public Health (CDPH). This means anyone can see the nosocomial infection rates of their local hospital by unit. But, I urge some caution among consumers with comparing rates of different hospitals and units. Instead, this data should be used to prepare questions and for a discussion with your physician or the hospital. Hospitals may be interested in using this data to benchmark themselves against other hospitals.
Healthcare-associated infections (HAIs) are infections that patients develop during the course of receiving healthcare treatment for other conditions. They can happen following treatment in healthcare facilities including hospitals as well as outpatient surgery centers, dialysis centers, long-term care facilities such as nursing homes, rehabilitation centers, and community clinics. They can also occur during the course of treatment at home. They can be caused by a wide variety of common and unusual bacteria, fungi, and viruses.
HAIs are the most common complication of hospital care, occurring in approximately one in every 20 patients. The following HAIs occurring in hospitalized patients are required to be reported to the CDPH by all California general acute care hospitals:
Data is also available on a couple of hospital practices that that contribute to a reduction in HAI rates and length-of-stay.
I participated in this morning's Gartner Worldwide IT Spending Forecast. Gartner, the technology research giant, brought together some wonderful speakers who shared information that I feel is important to healthcare -- especially at this moment in time. The issues will have major revenue implications for vendors (perhaps leading to service changes) and could delay current and planned IT initiatives (EHR adoption, HIE, etc) of healthcare organizations.
The floods in Thailand in October of 2011 severely impacted fabrication facilities and this has lead to a shortage of hard drives. It is predicted that it will take at least until the 3rd or 4th quarter of 2012 for the industry to get back to meeting demand. There is some uncertainty about this timeline.
This means:
One lesson that comes from this situation is to have multiple geographic locations for the manufacturing of components to help prevent business disasters like this one. In this case all of our (the world's) eggs (hard drives) are manufactured in one basket (Thailand).
PC and software spending is down due to the downturn in the economy. But, there was one bit of good news that I pulled from the discussion on software. Spending on software (tools) for collaboration is increasing. Companies are investing in technologies that will help them stay competitive and this means tools that will help their employees collaborate will reduce the need to bring on additional people.
Now, I've been seeing this in other industries and have started to see it trickle into healthcare. With health reform upon us, I hope my friends in the hospital start thinking a little more out of the box and how they too can leverage collaborative tools (aka social media) to improve efficiency and effectiveness in the workplace.
The American College of Physicians has a YouTube video that demonstrates the impact of low health literacy on the healthcare delivery system and costs. Healthcare administrators and clinicians should view this video to see the challenges for themselves. Notice the potential for medication errors alone!
It reminds me of Louise, the discharge advocate!
This video hits a little close to home since LSU Shreveport seems to have been involved and a few of the accents were familiar. However, this is an issue across the US.
A look ahead at healthcare data points to increased risks, regulatory expectations and reputational fallout. So it was a pleasure that I could contribute to a list of the top 10 trends for 2012 in healthcare data. And, I really do appreciate so may news organizations carrying the story.
My hope is that by increasing awareness of the risk among both healthcare providers and consumers, the necessary safeguards will get implemented. The top 2012 predictions in healthcare data are:
See PR Newswire for the complete release.
The NIMS objectives for hospitals have been reduced from 14 to 11 and there is some new clarification and guidance. The changes, effective July 1, 2012, include:
Combining Object s 8 & 10: Promote and ensure that hospital processes, equipment, communication and data interoperability facilitate the collection and distribution of consistent and accurate information with local and state partners during an incident or event
Combining Objectives 11 & 12: Manage all emergency incidents, exercises, and preplanned (recurring/special) events with consistent application of ICS organizational strucutres, doctrine, processes and procedures.
Combining Objectives 13 & 14: Adopt the principle of Public Information, facilitated by the use of the Joint Information System (JIS) and Joint Information Center (JIC) ensuring that Public Information procedures and processes gather, verify, coordinate and disseminate information during an incident or event.
Revised guidance for personnel requiring NIMS related training (reduced emphasis on IS 800 for hosptial staff and clarification of staff needing IS 100, 200 and 700) Note: From reading the Implemention Guidance I'm not reallying seeing a reduced emphasis on IS800. I'll follow-up on this one and report back.
Each of the 11 objectives are important, because compliance is a condition to receive Federal Preparedness Assistance, such as receipt of funds from the Hospital Preparedness Program. These funds are to be used to maintain, refine and enhance healthcare organization capabilities, as well as, exercising and improving preparedness plans for all hazards.
In addition, compliance with NIMS is also required for receipt of some FEMA funds after a declared disaster has impacted a healthcare organization.
I'm preparing to audit several hospitals in 2012 for compliance with the NIMS Objectives and welcome you to contact me if I can do the same for you. Write to Christina {at} cthielst {dot} com.
When will our employees learn not to identify patients on Facebook or any other social media site. This recent example goes beyond a simple error in judgment to a complete disregard for patient privacy and respect by the employee of a staffing agency working at a hospital in Southern California.
The patient involved sought treatment for an STD and the employee took a picture of her medical record and posted it on his Facebook page with the comment: "Funny, but this patient came in to cure her VD and get birth control."
I've read the article a couple of times and discussed it with other healthcare leaders. The following come to mind:
1. First, there is the policy and staff training/education that must occur by all providers on social media in the healthcare setting.
2. Beyond the policy and training, we need to consider the character of the person we are hiring or bringing into our environment of care. They may be the best ER nurse in the world, but if they have a complete disregard for patient privacy and respect, you may not want them working with your patients.
3. Clues may come from looking at what it is like to work with someone. This agency employee's response to the post is that he would leave the post up and he writes:
"People, it's just Facebook... Not reality. Hello? Again...It's just a name out of millions and millions of names. If some people can't appreciate my humor than tough. And if you don't like it too bad because it's my wall and I'll post what I want to. Cheers!"
Is this his attitude with co-workers about other disagreements? Is this really someone we want working in healthcare or any other caring profession?
4. Contracts with vendors, including staffing agencies, should already address their employee use of social media ... in line with your organization's policy. And, their staff should be trained before they are allowed to begin working with your patients and in your healthcare environment.
5. The younger generations of healthcare workers are using social media, especially on mobile devices, on a daily and hourly basis. As healthcare leaders, we need to educate and guide them in understanding the boundaries between their personal and professional lives.
6. As Thomas Friedman states in his book, The World is Flat, "we {as healthcare leaders} really do have to find ways to affect the imagination of those who would use the tools of collaboration to destroy the world that has invented those tools."
7. Disbarment: The Feds have a list of disbarred individuals who have inappropriately used federal funds. I think it is time that they create a new list of individuals who are disbared from ever caring, treating or working around Federal beneficiaries. This guy should be first on the list!
Ed Bennet has a really cool map displaying social media use by hospitals. If you haven't already, you should visit his blog Found in Cache, which includes some great hospital social media resources.
Thanks for sharing your list and the map, Ed!
Here is a new example of where having a comprehensive social media policy will come in handy for minimizing risks and associated legal costs. It involves an employee who left an Internet company and took a Twitter account being used for business purposes. This includes all of the followers that had been built-up over his tenure -- who are now receiving tweets from a competitor business. So now, there is a lawsuit over ownership and value of the followers.
Having a policy that clearly stated that the account was the property of the business and implementing appropriate steps to secure the account at the time of the employee's departure would have saved much grief for both parties. For those who have authority to engage on the healthcare organization's social media channels, changing passwords to secure the account should occur at the same time you are collecting ID badges, keys and other property.
I've been hearing a push for have simple one page social media policies and I agree that a concise policy is best. However, I fear some healthcare organizations will eliminate important details in an effort to keep the policy short. It all comes down to negotiating the language with risk management and legal advisers.
My guest blog post for Health IT Exchange made it onto their list of top 7 community blogs of 2011. Telehealth, the cloud and BI — oh my! includes my post on the importance of connecting health IT with disaster planning and others addressing some of my favorite topics - telehealth, meaningful use, health information exchange, the cloud and medical devices.
Their list of top 2011 blogs also also includes something new for me - voice commands on mobile devices. I've been watching my teenage daughter, who has a form of dyslexia, speak into her new phone (Christmas present) to text her friends. It has gotten me thinking...
To all of my readers, I wish you a very happy and healthy new year!
Thousands of earthquakes occur in the United States each year; most are too small to significantly affect businesses and communities. However, large and very damaging earthquakes have occurred in the past and could happen again at anytime. In general, many businesses (and healthcare providers) have invested in emergency management and continuity of operations planning. However, most businesses have not conducted earthquake mitigation measures to protect their assets, staff, and business operations. During an earthquake, buildings—or their components or contents—can be collapsed, toppled, broken apart, tossed around, or rendered inoperable or unusable.
Therefore, as part of addressing all-hazards emergency management, it is critical for businesses (and healthcare providers) to also incorporate actionable earthquake mitigation solutions into their planning and business decisions. By doing so, businesses protect the organization’s assets (people, property, operations); sustain the capability to provide goods and/or services to the community; maintain cash flow; preserve competitive advantage and reputation; and provide the ability to meet legal, regulatory, financial and contractual obligations.
To help businesses (and even healthcare providers), the Federal Emergency Management Agency (FEMA) National Earthquake Hazards Reduction Program (NEHRP) has released FEMA P-811 CD: Earthquake Publications for Businesses (QuakeSmart Toolkit).
This QuakeSmart Toolkit (FEMA P-811CD) provides business owners, managers, and employees with basic guidance and ready-to-use tools that can be tailored to the specific needs and requirements of the user. The guidance and tools focus on the importance of earthquake mitigation and the simple things they can do to reduce the potential of earthquake damages, injuries, and financial losses at work…AND also at home and within their communities.
The toolkit walks you through the following 3-step QuakeSmart process:
These resources are especially timely for California, because the 2012 Statewide Medical and Health Training and Exercise will be an earthquake scenario. View or download the QuakeSmart Toolkit (FEMA P-811CD) or order CD copies of the QuakeSmart Toolkit from the FEMA Publications Warehouse by calling (800) 480-2520. Or fax your request to (240) 699-0525. All orders will be shipped in January 2012.
Other FEMA materials and earthquake guidance are also available.
My latest article for HIT Exchange Magazine, titled EHR Pitfalls, is drawn from a lively HIMSS LinkedIn Group discussion (via social media) that has lasted for over two years.
It all started with a fairly straight-forward question -- "what are the top ten reasons why EMR/EHR implementations are failing?" Since then, there has been a great deal of technical discussion, a couple of disagreements and even one or two heated debates. But, the body of work that continues to grow is truly amazing.
The EHR Pitfalls article pulls some of the pearls of wisdom together and blends key themes to present an overview. As always, I welcome your comments and feedback on this article.
By Sheldon Needle
The real problem of an established medical practice moving into the realm of EHR is not the cost of the medical software package; it is not the training necessary for staff; and it is not security and backups.
The real problem of moving into EMR/EHR is the problem of unstructured medical data.
If you are involved in a new or relatively new practice, this is a no-brainer. Begin with a serious search to compare medical software vendors who are available to answer your questions honestly. It is not truly so difficult to get on a friendly medical screen to enter your patient’s blood pressure or lab test values. You can get used to that.
Neither is it difficult to take notes on a notebook that upload to the EHR system.
The real problem is taking your notes and dictation on a patient that go back 15 years and finding a way to get his possible symptoms, his worry about IBS, his headache history, and his worries over his children into a metrically available rendition that that does not take you or a member of your practices days to decipher. These notes are usually on dictation, hand written notes, and referral letters.
The concerns are many: this can take what feels to be forever, and the anxiety issues and unclear symptoms may not translate easily into metrics but may be critically important in future diagnoses.
There are two critical questions here:
In the long run, it doesn’t even matter if it is worth it. It will happen. Medicine as well as the rest of our cultural world, is becoming electronically-based whether we like it or not. But in the long run, it is worth it. Think of a patient going in to the hospital after a car accident, all by himself, and having all his data available to the admitting doctor in an instant: blood type, history, etc.
Think of a patient being referred to you, the specialist, and having all his patient history available in less than a minute. What a time saver! What insight!
Medical informatics has a number of methodologies it is using to translate unstructured data into useful and structured data.
Three basic methodologies exist to accomplish this:
These methods will be refined, utilized, and integrated in some way into most decent medical vendor software packages over the next few years. For you the physician or practice manager, this may start to pay off in a while, but you still have to get from hand written records into the database.
The obvious way to proceed makes use of our culture idea of, “going forward”:
The real message to practitioners moving to electronic health records is, don’t look at the top of the mountain when you start climbing, just put one foot in front of the other. Delaying the climb will not get you anywhere, but starting the march will move faster than you think!
Source:
Having recently spent time as an observer in a hospital setting, I was struck by the lack of intelligent planning and forethought made for doctors trying to move into an EMR / EHR environment.
Though I saw a well-known EHR panel on the computer screens within an ICU, and the EHR being used to record certain patient data, doctors were taking their notes in long-hand. Later on the same day I saw the same doctors transcribing their notes onto their computers. The doctors, doing double duty on note taking were not available to their patients because they were acting as secretaries.
When a large clinical environment is incorporating an EHR it has to be done in a modular way that does not impact productivity any more than it has to. The task is hard enough. If you are using an EHR to record point of care patient information, give your doctors a Notebook so they can take their notes electronically. In fact, insist on electronic note-taking. Incorporate change with some forethought to peoples’ time and effort.
This real-life observation just underscores the need to plan for transition to an EMR rather than throwing an institution into the chaos of change for its own sake, or for the sake of Meaningful Use incentive payments. As in all things, the old US Coast Guard motto holds true: Semper Paratus! Always be ready and prepared.
Most good EMR / EHR systems can offer medical clients some guidance as to best practices in incorporating EMR / EHR systems within their practices.
By Sheldon Needle
The prospects for EHR in the coming year are exciting but more than a little daunting. The issue is really how to find an EMR/EHR system that will organize and centralize the functions of your practice, without bankrupting you and throwing your staff and yourself into turmoil.
If you look at the websites for EMR vendors today, you can see that the functions they describe within their system –the integration of clinical records with practice management data, e-prescription, patient portals — could conceptually do wonderful things for you and for your patients in the way you handle their individual cases, but many of the details are still not working smoothly.
Here are some of the things to be aware of:
Remember, always read the fine print and ask every question you need to. Know that EMR software decisions is a very competitive business. The vendors need you just as much as you need them!
By Sheldon Needle
5010 is not only a date 3,000 years in the future: ANSI 5010 is the newest version of the HIPAA transaction standards regulating electronic transmission of medical and healthcare transactions. The existing standard is called 4010, and 4010 does not support ICD-10 coding.
The current coding standard for diagnosis and procedure coding is the ICD-9, and it has outlived its possibilities –it limits the number of new procedure and diagnostic codes that can be created.
This is how the CMS.gov (center for Medicare and Medicaid services, at: http://www.cms.gov) defines the ICD-10:
About ICD-10
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System) consists of two parts:
ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.
The transition to 5010 is supposed to happen by January 1, 2012. This means that electronic transmissions including claims, eligibility inquiries and remittance advices must be made in a 5010-compliant format. Healthcare providers, health plans and clearinghouses for transactions are all expected to upgrade their transmissions. Non-compliance may result in claims denied or slower payment.
Systems that are certified as ONC-ATCB for 2011/2012 are already 5010 compliant. If you are contemplating buying a system that is so certified, you do not have to worry about the software compliance, but you do need to educate your staff, including yourself, if you are the physician or the P.A., on what the differences between 4010 and 5010 mean to their everyday work.
If you are using old medical software that has not been updated, or are contemplating installing software that is not certified as ONC-ATCB for 2011/2012, you need to update to a newer version, or face delays and uncertainties in your billing and claims submission. In other words, do some serious upgrading, or else!
By Sheldon Needle
November 30, 2011: Today HHS Secretary Kathleen Sebelius announced incentives to speed the adoption and use of health IT in the form of meaningful-use qualified EHR in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.
The new administrative actions announced today, which will be made possible by provisions of the HITECH Act, will loosen requirements for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.
“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius. “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”
The press release continues to state: “HHS also announced its intent to make it easier to adopt health IT. Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.”“ (The italics are ours.)
We need to understand what acting quickly means: buying in 2011? Incorporating EHR within the next month, so that meaningful use occurs in 2011? This is not yet clear.
HHS is redoubling its effort to reach out with information, education, and the possibility of incentive payments to doctors and hospitals and vendors about stepping up the pace of transitioning practices and HER software to meet standards of Meaningful Use. What Meaningful use means to the individual practice depends on size, degree of implementation of the EHR, and the nature of the client base (how many Medicare or Medicaid patients, for instance, figures into the formula of Meaningful Use.
The Obama Administration is working to create a nationwide network of 62 Regional Extension Centers, comprised of local nonprofits, to help eligible health care providers learn how to participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.
See the HHS press release, at: http://www.hhs.gov/news/press/2011pres/11/20111130a.html to learn more.
Keep your eyes on the newspapers, government announcements and on this blog to learn about EMR and EHR news and updates.
By Sheldon Needle
You know that your medical practice will have to bite the EMR bullet sooner or later (actually, sooner). The digital handwriting is on the tablet, isn’t it? So what is it stopping you from moving ahead at a planned pace rather than being forced into converting your medical practice to an EMR at the 11th hour?
Here are some of the most common obstacles people face in converting their practices to the use of electronic medical record software, and here are some strategies to deal with them or get the process going:
1. How will we migrate from paper to digital images? Conversion of paper medical records to digital format: If you have your eye on an EMR, learn how tolerant it is of varying formats: does it accept PDF files? JPG format? Ascii text files? Extracts from excel files?
Don’t bit off more than you can chew to begin. If you are practice with reams of folders full of paper files to convert, decide how many years back you need to go in getting your EMR up and running. Perhaps you can start with one year of files via EMR? Or perhaps you need to go much further back?
Look into the possibility of having a consultant specializing in data conversion take charge of your files. There are companies that specialize in just such medical data conversions. If you are really desperate, hire your responsible college students, make the specs clear, and pay her decently!!
2. How will we train everyone in such a new system? Training your self and your staff: Once you have chosen your EMR system, engage the company’s own training staff; that way, you are sure you are being oriented in the current system, using the right documentation. Before you chose your EMR, see what kind of training options the company offers. You might go for a short orientation up front, with a good help desk that is available 24/7. Check reliable Electronic medical records ratings to see which companies provide good in person and on the phone / online support
3. Do we have to set up all the hardware and maintain the software? I don’t think we can manage that. Consider a cloud-based EMR solution: If you are reluctant to invest in a server and commit to the upkeep of hardware and software, consider a Web-based EMR solution, in which you log onto an EMR that worries about security, and updates to hardware and software.
4. How can I compare products so that my practice knows what it is getting into? How much can I trust referrals from other practices? Don’t put all of your EMR decision eggs into one basket: While personal referral are extremely helpful and reassuring, not all are meaningful for your unique EMR practice situation. There are many good EMR products to choose from, and each has its strengths, and its weaknesses.
The right choice will depend as much on the nature of your medical practice and the answers to many questions: What is your medical specialty? How many employees do you have? How expensive is the EMR, per year? How much money can you dedicate to investing in your EMR annually? Can you integrate your medical billing software with your proposed new EMR? Can you afford to hire a dedicated IT employee? How comfortable you and the others in your practice are with using an electronic device as the main source of medical input to your system. These are just a few of the many questions you need to ask yourself.
Talk to people in other practices, yes; but learn to ask the right questions and compare apples to apples and oranges to oranges. Great EMR comparison tools are available to you at no charge, and they can educate you to ask the right questions and maintain a solid baseline for comparison when choosing an EMR.
Many EMR experts — both on the user side and the training side – agree that comprehensive training in the specifics of EMR software — or the absence of it, can be one of the most costly aspects of the transition from a paper based medical practice to an EMR /EHR.
Making the move to an EMR, and failing to train your staff adequately, can sour your entire staff, top to bottom, on the use of the EMR. You certainly need to avoid such a situation.
Here are some considerations and precautions to keep in mind and to discuss with your EMR vendor when evaluation the purchase or leasing of an EMR / EHR: Some of them will surprise you:
By Sheldon Needle
No one can promise you that Implementing an EMR, however good, can be easy and without false starts and problems. The changes you are planning to make – both in the way your practice does business, the workflow, and the change from paper trail to electronic documentation – are so major. Finding the right intersect between the needs of your medical practice and the features and strengths of a particular EMR/EHR will make this implementation go more smoothly. But it helps to know which EMR implementation problems you can surely anticipate, and which you can hope to avoid .
Here are some ideas to help avoid major disasters within your implementation:
There are so many critical planning and training factors to keep in mind in planning for your EMR/EHR, but these are critical ones. Look at the CTS Demos Scorecard to help you compare EMR/EHR software and find the right fit for your practice. Your practice – and your patients – stand to gain the most from a good EMR/HER fit and a semi-calm implementation.
Come back to this blog for additional EMR implementation and integration ideas and planning issues
By Sheldon Needle
Should you consider integrating your current Medical Practice Management System with a new EMR, or must you shift to an EMR that includes medical practice management functions?
Practices which are relatively new to software as a management tool sometimes do not realize the very different functions that a PMS (medical practice management system) and an EMR system offer:
A PMS is used for managing administrative, billing, scheduling, and budget related (financial) information, and an EMR is used for managing clinical, patient related information How feasible is it to integrate these two functions to produce reliable information for your practice, and to fulfill government reporting requirements.
Let us assume that you are a practice ahead of the wave, and you transitioned long ago to a medical billing software and medical scheduling system. You are very happy with it. It works for you and for your patients. Now the world, and the government, are at your door, and is pushing for a more total solution: an EMR / EHR.
Do you have to ditch the practice management system that you worked so hard to install and to customize to your needs and replace it with a total solution – an EMR that incorporates financial and billing capabilities? Or is there a way to keep you medical Practice Management System and integrate it safely with an EMR minus its billing and scheduling capabilities?
Here are some issues you must consider before you can answer this question:
Read the complete article at CTSGuides.com.
By Sheldon Needle
EMR’s come loaded with options, medical practice modules, streamlining techniques. But, unless your employees – physicians included –learn to harness (if not master) most of the modules of the EMR and tailor them to the work-flow of your practice, you will lose the advantages the EMR can bring.
Thus, training in the use and management of the EMR is almost as crucial as your choice of EMR. In fact, when you compare EMR software be sure to investigate the training options the EMR manufacturer, and the consultants who install it offer to a practice like yours. The training and support offered by an EMR vendor is as important as the quality of your EMR software. If you can’t use it correctly, and it doesn’t save you time and effort, it will make your whole practice miserable.
Here are some critical tips to keep in mind regarding training:
1. Understand the workflow of your practice. Chart it out on paper, for starters: who does what? Who follows up on a task. Just charting the progress of a medical prescription from the doctor’s pen to the patient’ pharmacy is a multi-person task. See what tasks may be eliminated or cut short by the use of your prescription module, for instance.
2. Understand who needs to be trained in what: Unless you are a 1-physician doctor’s office, different people generally perform different functions within the practice. Everyone doesn’t do everything, and doesn’t have to be trained in the use of all modules.
If you are dealing with a reputable vendor, the people who are installing your EMR will talk to you first about your workflow and your needs, and tailor and help customize the EMR to meet those needs. They and you will recognize the need to train different people in the use of different modules.
For instance, the people who handle medical practice management and medical insurance claims processing do not need to be expert in the Prescription Drug Tracking Modules. They may need to know how to access the module for reporting purposes, but they do not need to know all of its ins and outs as the doctors and nurses do.
3. Don’t try to implement the whole EMR at once. Virtually all EMR’s are modular, and handle different functions discretely. Since functions are often pretty complex, allow your employees to master a number of critical modules before they move on to others.
Read the complete article at CTSGuides.com.
Researchers from the University of Tennessee Space Institute are developing a device which should make eye exams in children a whole lot simpler. The device is called the Dynamic Ocular Evaluation System (DOES) and it can screen the eyes for abnormalities, while the children watch a cartoon or play a computer game. Here’s how it works:
“DOES is low-cost, high-quality, and operator- and child-friendly. It takes about a minute to train someone to use it. The test is done as the child watches a three-minute cartoon or plays a computer game. Infrared light is used to analyze the binocular condition and the assessment is reported on-site within a minute. Neither eye dilation nor verbal response is required.
Hidalgo out of Cambridge, England has released its new wireless Equivital EQ02 LifeMonitor that can continuously record ECG, respiratory rate, skin temperature, and activity levels in patients. Data is analyzed using special software for PCs, web and mobile devices and can provide real-time results that can be immediately acted upon by clinicians.
Hidalgo’s technology has already been in use by UK’s Cambridgeshire Fire and Rescue, Addenbrooke’s hospital, and the US Marine Corps in Iraq where wireless, mobile, and easy to use devices save the day.
Agfa received FDA clearance for its DX-M digitizer with needle-based detectors for use in mammography and general radiography. It features the firm’s MUSICA2 advanced image processing software, three image resolution modes (50 μm pixel pitch (20 pixels/mm), 100 μm pixel pitch (10 pixels/mm) and 150 μm pixel pitch (6.7 pixels/mm)), a “drop-and-go buffer” for cassettes so you don’t have to wait for the digitization, and a number of other features that improve workflow.
The system can support both needle-based detector cassettes and standard phosphor plate cassettes, and the two types are colored differently to eliminate confusion.
While joint arthroplasty has become impressively advanced over the past few decades, the essence of the procedure still ultimately boils down to trial and error. Using pre-operative X-rays and intra-operative sizing guides, joint surgeons pick from a pre-set list of joint replacement “sizes.” Then, once the bone cuts have been made, temporary implants called “trials” are used to see how the fit is, and the best fit is selected. Rarely are these pre-determined sizes a perfect fit, but they are usually more than sufficient and function quite well.
However, in the quest for perfection, patient-matched custom implants are beginning to increase in popularity. Stanmore Implants just announced the launch of their custom matched unicondylar knee replacement system dubbed “Savile Row,” after the famous Tailoring destination. Unicondylar knee replacements are used in patients with isolated arthritis in one part of their knee and only replace the damaged portion.
Laser eye surgeries like LASIK and especially photorefractive keratectomy (PRK) can be painful on the eyes for a few days following the procedure. To alleviate the pain anesthetic eye drops are used, which have to be regularly administered by the patient. Not only is that inconvenient, but one can actually overdose a bit on them drops.
Now researchers at University of Florida are reporting that they developed a way to load topical anesthetics into contact lenses to provide extended delivery of pain relief in a uniform fashion. And since many of the patients that undergo eye procedures have been wearing contacts prior, they’re already used to putting them on.
Medtronic announced receiving European approval for its Endurant II AAA Stent Graft System and will be making it available globally.
The device provides a minimally invasive (endovascular) option for addressing abdominal aortic aneurysms and includes a few improvements on the previous model:
Roche received FDA clearance for its ACCU-CHEK Nano SmartView blood glucose monitor, a device the face of which is smaller than a credit card. Furthermore, this glucometer doesn’t require any code entry to calibrate the device to specific test strips and will be made available in the U.S. in the coming months.
The ACCU-CHEK Nano SmartView blood glucose monitoring system offers a small, sleek and discreet design with easy-to-use operating buttons on top of the meter. It is the first single-strip no-code meter in the ACCU-CHEK product family. This means it does not require any coding previously needed to calibrate the meter to the respective test strips and will use the maltose-independent ACCU-CHEK SmartView test strips. The ACCU-CHEK Nano SmartView system is part of the same product line as the ACCU-CHEK Aviva Nano and ACCU-CHEK Performa Nano systems that have already been launched successfully in many markets in the EMEA, Latin-American and APAC region.
Medshape out of Atlanta, GA is bringing to market its ExoShape Soft Tissue Fastener for anterior cruciate ligament (ACL) reconstructive surgery.
The device was offered to a limited number of sports medicine surgeons last year for evaluation and for refinement of the procedure.
We all know that the ear is a multifunctional, anatomical marvel. We often take for granted its ability to allow us to eavesdrop, to rock out to the latest beats, to hold up our spectacles, and to be pierced over and over again. Last week at CES 2012 in Las Vegas, Raleigh, NC-based Valencell announced their sensor technology that uses the ear’s unique physiology to gather vital health and fitness data.
The technology is called V-LINC, and it’s being built into the ubiquitous set of earbuds that you probably use every day. According to Valencell, “V-LINC technology comprises the only earbud-based continuous heart rate monitoring technology proven accurate during virtually any exercise in virtually any physical environment or condition.” According to the V-LINC website, its earbud sensors are able to measure the following biometric data:
Researchers from Purdue University have developed a “microtweezers” instrument for manipulating micrometer-sized objects. Details of the micromanipulator were published online in the December issue of Journal of Microelectromechanical Systems. The entirely mechanical instrument comprises three parts: a two-pronged tweezers made from silicon, an adjustable knob from a standard micrometer and a graphite interface, which couples the micrometer knob with the tweezers’ prongs. One advantage of the microtweezers is its simple compliant structure which the researchers suggest is easier to manufacture and operate relative to more complex thermal, magnetic or electrical microtweezers designs.
According to the researchers, their new tool should facilitate the assembly of Micro-Electro-Mechanical Systems (MEMS) such as the gyroscopes and accelerometers which reside in many of the activity monitoring devices which often grace the pages of Medgadget. Other applications are also possible in the field of microparticle manipulation, coating, weighing and measurement.
“The National Consortium of Breast Center's Board of Trustees has given their consent to the following position statement reflecting their stand on the issue of mammographic screening, in response to the recommendations made by the US Preventive Services Task Force.
National Consortium of Breast Centers, Inc.
Position Statement regarding the Mammography Screening Recommendations of the United States Preventive Services Task Force (USPSTF)
The National Consortium of Breast Centers (NCBC), the largest national organization devoted to the inter-disciplinary care of breast disease, requests the USPSTF rescind their new position on mammography screening.
The U.S. Preventive Services Task Force (USPSTF) published a paper detailing model estimates of potential benefits and harms to women screened for breast cancer with mammography.1 They provided an updated USPSTF recommendation statement on screening for breast cancer for the general population that alters currently accepted guidelines for women over 40 years old.2
The NCBC opposes the new guidelines as written. We cite specific evidence that screening mammography leads to early detection which leads to improved survival.3 In every country starting population screening, mortality declines coincide with onset of screening, not systemic therapy. These USPSTF models are not based on sound data, namely different denominators in the “harms” vs. “benefits” groups leading to invalid comparisons. Recent data from randomized controlled trials reveal significant mortality reductions evident approximately five years after screening programs were initiated. The reductions in age-adjusted, disease specific mortality (30-40%) since 1990 define screening program benefits not seen in the prior six decades. In the United States, these mortality declines continue at a rate of approximately 2% per year. 4 This mortality improvement counts as a remarkable public health achievement.
In addition, the USPSTF panel (comprised almost exclusively of primary care physicians) did not include breast imaging specialists nor was it represented by any of the multiple other specialists who collaborate to optimize patient outcomes. These specialists include pathologists, surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, technologists, geneticists, nurse navigators, educators and others.
The NCBC does not understand the assumptions used by the USPSTF to value human life. We note the cited literature was selective and failed to acknowledge equally powerful and credible peer-reviewed literature, which supports currently accepted breast cancer screening guidelines.
We would also like to note that quality of life has a significant value, not just survival. It is well established that if we discontinue mammography for women in their 40’s, the cancers eventually detected will be larger, more likely need more aggressive surgery, more likely need chemotherapy and more likely lead to other significant socio-economic concerns.
The NCBC requests input into future guideline development and vows to work with government, scientists and industry to keep the process transparent and keep the focus on the patient. We recommend further efforts target screening, risk assessment, education and awareness regarding the implications of positive and negative screening findings. Funding for further research is imperative and supported by the controversy these articles have generated.
Finally, we note the USPSTF article states, “whether it will be practical or acceptable to change the existing U.S. practice of annual screening cannot be addressed by our models.”1 The NCBC agrees with this comment and finds their screening guideline suggestions unacceptable. The NCBC believes many women’s lives will be placed at risk if current screening guidelines are altered. We respectfully request the Task Force rescind their position on this specific women’s healthcare screening policy.
# # # #
About NCBC: The National Consortium of Breast Centers (NCBC) is the largest national organization devoted to the inter-disciplinary care of breast disease. In keeping with our mission, to promote excellence in breast care through a network of diverse professionals dedicated to the active exchange of ideas and resources including: 1) To serve as an informational resource and to provide support services to those rendering care to people with breast disease through educational programs, newsletters, a national directory, and patient forums; 2) To encourage professionals to concentrate and specialize in activities related to breast disease; 3) To encourage the development of programs and centers that address breast disease and promote breast health; 4) To facilitate collaborative research opportunities on issues of breast health; and 5) To develop a set of core measures to define, improve and sustain quality standards in comprehensive breast programs and centers.
References:
1. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 738-747.
2. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 716-726.
3. Tabar L, Vitak B, Chen HT et al. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast cancer mortality. Cancer 2001; 91: 1724-1731.
4. American Cancer Society, Breast Cancer Facts and Figures, 2009-2010.
All content and design © 2009 by the National Consortium of Breast Centers, Inc.”
2. Know who you are selling to
3. Sell through the Gatekeeper
Finally, when it comes to choosing an EMR solution make sure it is one that will fit your practice. This goes for price and for functionality. ARRA is giving away 44k to adopt a system. Most large vendors cost much more than 44k so where is the incentive? It's like someone giving me 1 million to put down on a G5, where is the other 58 million coming from?
I know all small companies are not the same, but I have to go off of what I know. (And no, this is not a plug for my company). Most smaller vendors are practically giving their applications away. We are cheaper because we have less overhead....simple stuff. Our company has no marketing dept...we have developers, physicians, surgeons, customer support and sales.
From what I have heard from other physicians who have already implemented a branded EMR, they hate it. There is no customer support, or at least what I have heard is "too little, too late". I'm not knocking the large vendors here, but why would they get back to a 2 physician practice when they have large hospitals to keep happy.
I believe large vendors are perfect for larger organizations. They have the support and can be afforded. In my opinion, smaller vendors have the advantage on large vendors when it comes to smaller practices. There is less red tape and quicker results. Speaking for myself, if a customer calls in and wants a special report done that's not already in our system, it typically takes only a day and costs our customers nothing.
I have heard of implementations taking months, ours takes about 10 days.
In these tight times, people have to do their homework. Ask your vendor the hard questions and be secure in your final decision because once you implement a system, there is almost no turning back.
Have you taken the challenge yet? “What challenge?”, you ask. The Health 2.0 Developer Challenge or those on Challenge Post. These sites take advantage of the recent US initiative to make health databases available to the public.
Since 2010, both sites have hosted challenges sponsored by organizations, corporations, and the government. Some have monetary prizes, some just offer recognition. The goal is to bring software programmers, designers, and health care experts together for rapid application development. There are two types of developer projects: 1) challenges, which overseas team collaboration to build specific requested tech solutions, and 2) code-a-thons. Code-a-thons are typically one day or weekend events that spur teams to rapidly create new applications and tools to improve health care.
Health 2.0 and Challenge Post make it easy to form teams with their community boards and resources. Check out the wide array of challenges posted on their sites. Compare goals, deadlines and prizes. Make new contacts, enjoy the thrill of creativity, and the pride of helping find real solutions to health care issues. Several have December 31, 2011 deadlines, so check out the fun and competition, and register today!
containers that ring, play music and send emails to remind people to take sixteen different medications when loaded only once in two or three months. Another medication lid glows when it is time to take a pill and then records the time the bottle is opened and the pill was taken.
Multiple pedometers and sensors track steps, galvanic skin response, brain waves, and pulse and are easily synched with smartphone apps that forward reports to your doctor. Sensors can be placed in carpets, slippers, kitchen drawers and refrigerators to track movement of elders living alone. Reports can be sent to specified caregivers. One sensor tracks sleep patterns when placed in an arm band and then placed under your smartphone in the morning to sync and download and email the report. Airstrip Tech links doctors with EMTs in ambulances to follow monitors as the patient travels to the hospital. Two 5 minute Rapid Fire product demo sessions reviewed over 25 new products.
Several websites help patients track their medical information. Patients determine what they want to share and with whom. Some are open source; some are created by private companies. Patient groups like ePatient Dave and Patients Like Me encourage sharing collective medical information to foster a faster learning curve to how to best treat patients and diseases in the US and abroad.
I had the distinct honor of speaking on a panel about game play.
My expertise comes from creating and consulting on multiple smartphone apps related to food and nutrition. Gamification was a hot topic in multiple sessions, mentioned frequently as a terrific means to engage and educate patients. Interesting to me was the fact that some telemedicine products and apps already include game play. This is mostly in the form of Q&A or true/false questions. To celebrate Breast Cancer Month in October, a colleague, Nadine Fisher, MS RD LD, and I created the Apple app Breast Cancer Care. We included five true/false games and one food photo match game.
Many of the products I saw at Connected Health are first generation this year. One company rep said there were only a handful of tech vendors exhibiting last year. This year there were five exhibitor rows lining a hotel ballroom. This business is exploding. I have seen the future of medicine, and it is exciting and often fun. Games are a great hope to advance the health of the world for patients, caregivers, and professionals.
Here’s a link to a blog post about the panel on which I spoke. I was the only RD on the program.
http://mobihealthnews.com/13977/add-health-to-games-or-games-to-health
Games for Health Project originated in the United States in 2004.
Ben Sawyer was instrumental in its foundation and development into the force that it is today. It’s annual meeting draws hundreds of global participants each year in Boston.
So it was exciting news this year when Games for Health announced a European partner. It’s first meeting will be held in Amsterdam on October 24 and 25. The central theme is: How games and simulations can improve health(care) and make it affordable. The program is dynamic includes topics on five core tracks:
Cognitive and emotional health
Participatory health
Exergaming, active gaming and fitness
Rehabilitation games
Medical/Education and training
So if you are looking for an excuse to visit Amsterdam, the Games for Health Europe conference is a must do. It will be exciting to watch this innovative group develop and deliver fresh ideas and research on health games for the European health community.
Register today!
www.GamesforHealthEurope.org
Nick Yee, PhD, a research scientist at the PARC (the Palo Alto Research Center) has published studies that show how people’s behaviors change when they use avatars. One study notes how players engage when offered tall, attractive avatars, versus shorter, less attractive ones. He suggests that people will exercise longer and better when offered fit looking avatars.
James Watt, PhD is a serious games researcher at the University of Connecticut. He explains that social interaction is relative to masked identity. Group communication is best when there is also social interaction. So how about creating an avatar-likeness with body movements that still provides anonymity? Microsoft Xbox recently released Avatar Kinect that scans participants and then creates a general look-alike avatar of themselves – including body movements.
Players might not mind sharing personal attributes with friends, but would players feel comfortable revealing their size, hair color, and mannerisms to strangers, too? This remains to be seen, as medical professionals brainstorm about health applications. Consider in-home avatar group therapy sessions, patient education classes, addiction support groups, or parent clubs. Now layer on a health gaming twist. How about a virtually engaging game of Nutrition Jeopardy? The possibilities are tremendous! What kind of avatar health games do you envision? This field is wide-open for development. Game on!
Strong research is the foundation of the health professions, and health game development is no different. When a person’s health is being manipulated, then people expect the method or product to be well researched before being recommended. After all, the physician’s oath is, “First, do no harm …”
From the start, early thought-leaders recognized that progress in this emerging industry needed to rely on health professional collaboration based on sound, scientific research to prove efficacy. This is what researchers call, “the scientific method.” Developers, designers, funders, and players want to see supportive data. Multiple colleges and universities have stepped up to take the task, and many privately funded developers eagerly share their methods and results to further the cause. Unfortunately, researchers publishing their results has been a problem. Traditional scholarly journals do not target video games for health — until now.
Mary Ann Liebert, Inc, publishers of scores of well-respected peer-reviewed scientific journals have announced plans to publish Games for Health: Research, Development, and Clinical Applications this fall. Games for Health will be a peer-reviewed journal and has a stellar editorial board line-up. The Liebert press release stated the journal would be published bi-monthly and would be “dedicated to the development, use, and applications of game technology for improving physical and mental health and well-being. The Journal breaks new ground as the first to address this emerging, widely-recognized, and increasingly adopted area of healthcare.”
The Games for Health journal and it’s accompanying online presence is a welcome home for the health video games community. For more information check out www.liebertpub.com
Organized by the the IU School of Informatics at Indiana University–Purdue University Indianapolis (IUPUI), the 2nd annual Midwestern Conference on Health Games conference will be held in Indianapolis on October 28, 2011. Abstracts are being accepted now. The submission deadline is June 1. 2011. For more information please contact Vicki Daugherty at vdaugher@iupui.edu or 317-278-4123.
Back in 2010 we were introduced to the “Wii-killer,” aka the Kinect for Xbox 360. Microsoft’s initial lineup of exergames revealed great health gaming potential. Others, such as Dr. Bill Crounse who writes for the Microsoft Health blog, speculated that the Kinect could be used in healthcare for even bigger purposes due to its set of special characteristics. This includes:
Innovators in the medical community have been able to take these special characteristics and far surpass initial expectations for the ways the Kinect can be used in healthcare. I doubt that Microsoft expected their new controller-free gaming device to have such an impact in such a variety of ways. Here are just some of the many examples:
I’m sure there are many other ways the Xbox 360 Kinect is being used in medicine today, whether in testing or in practice. Feel free to share your knowledge with the group by leaving a comment.
One of the health game products I’ve been watching very closely is Zamzee. Not a whole lot has been written about this innovative new company yet, especially when one compares it to previous HopeLab products like Re-Mission. However, they have really geared up for an impressive product, and it will be very interesting to see how well it does in clinical testing and in the market.
Zamzee is an online rewards program for teens based on their recorded physical activity. Users wear a three-axis accelerometer specially calibrated to record short bursts of movement and vigorous activity. Increased movement increases website status which can then be converted into spendable Zamz, a virtual currency used to purchase virtual and tangible rewards.
Zamzee was established in 2010 with an initial investment of $1M from the HopeLab Foundation. The creators of Zamzee hope to make it into a profitable business with the added benefit of getting teens more physically active.
Although Zamzee has some characteristics that make it completely unique, some of its features do remind me of other products, many of which haven’t done so well in the market.
I have to say that one benefit Zamzee has over probably many of these others is the strong team they’re building. Back in February, Zamzee announced that they finally established a solid executive team including Jonathan Attwood as CEO and Lance Henderson as COO.
However, not all of the available positions have been filled. This is excellent news for all of you job hunters out there as it is very rare for health game positions to be available. Take a look at their careers page to see if you might be a good fit for one of these openings. Good luck out there!
It’s that time of year again where the best and brightest in the games for health field gather together for the Games for Health Conference. The 2011 conference will be held at the Hyatt Harborside Hotel in Boston, MA from May 18-19 with a pre-conference May 17.
This year, the chosen keynote is an interesting one for Games for Health. Ben Sawyer announced that the founding father of Positive Psychology, Dr. Martin Seligman, will be taking the stage. You can read Dr. Seligman’s full bio on the U Penn Positive Psychology Center page.
Dr. Seligman will help Games for Health attendees understand the opportunities that positive psychology presents for games. His opening talk “Positive Psychology>Positive Computing>Positive Videogames” is one of over 60 talks planned for the three day event will provide the basis for a conference long discussion about how video game developers and researchers can create “PERMA Power Ups” forged by a collaboration between the documented interventions of positive psychology and interactive entertainment.
I’m actually very excited about this keynote. Several years ago I did a little series on healthGAMERS called “What Makes a Great Health Game Great.” One of the many things required for a good game is the ability to help players reach that feeling of flow or losing oneself through enjoyment. Perhaps Dr. Seligman will be able to expand upon this.
Additional speakers and presentations are available on the full schedule block page for the conference. This is constantly being updated so if you don’t see something here for you just yet, keep checking back. There are over 60 talks planned this year.
To register, visit the Games Beyond Entertainment Week registration page. Prices range from $199 to $999 depending on how early you sign up and how many events you choose to attend. Us the code BOST11 to receive 10% off registration!!
I received a very nice note from Dr. Sylvester Arnab of the Serious Games Institute requesting leads on researchers and practitioners interested in helping contribute to a new book called Serious Games for Healthcare: Applications and Implications. Hopefully you healthgamers can be of assistance!
Similar to the DIVERSE Conference call for eHealth papers, this is a great opportunity for those of you with experience in games for health research to step up to the plate and get your knowledge in print.
Below is a summary of the general needs:
Researchers and practitioners are invited to submit on or before April 15, 2011, a 1-2 page chapter proposal clearly explaining the mission and concerns of his or her proposed chapter. Visit the Serious Games for Healthcare: Applications and Implications for full details about the requirements. Inquiries and submissions can be forwarded electronically (Word document):
Dr. Sylvester Arnab
Serious Games Institute
Coventry University
CV1 2TL, UK
Tel.: +44(0)24 7615 8205
E-mail: s.arnab[at]coventry.ac.uk
President Obama speaks to the nation about healthcare reform (AP photo)
Tonight, President Obama spoke to the nation about his plans for healthcare reform. He outlined how he plans to reform the current system and how he plans to pay for it including cutting over $100 billion worth of subsidies to insurance companies as part of Medicare.
Few key points:
He also touched upon the need to increase health IT and move way a fee for service system to a team-based approach to deliver healthcare.
Full Video:
Full Text: Obama’s Remarks on Health Care
(without question/answer session)
Following is a text of the prepared remarks by President Obama before his White House news conference on Wednesday, as released by the White House.
Good evening. Before I take your questions, I want to talk for a few minutes about the progress we’re making on health insurance reform and where it fits into our broader economic strategy.
Six months ago, I took office amid the worst recession in half a century. We were losing an average of 700,000 jobs per month and our financial system was on the verge of collapse.
As a result of the action we took in those first weeks, we have been able to pull our economy back from the brink. We took steps to stabilize our financial institutions and our housing market. And we passed a Recovery Act that has already saved jobs and created new ones; delivered billions in tax relief to families and small businesses; and extended unemployment insurance and health insurance to those who have been laid off.
Of course, we still have a long way to go. And the Recovery Act will continue to save and create more jobs over the next two years – just like it was designed to do. I realize this is little comfort to those Americans who are currently out of work, and I’ll be honest with you – new hiring is always one of the last things to bounce back after a recession.
And the fact is, even before this crisis hit, we had an economy that was creating a good deal of wealth for folks at the very top, but not a lot of good-paying jobs for the rest of America. It’s an economy that simply wasn’t ready to compete in the 21st century – one where we’ve been slow to invest in the clean energy technologies that have created new jobs and industries in other countries; where we’ve watched our graduation rates lag behind too much of the world; and where we spend much more on health care than any other nation but aren’t any healthier for it.
That is why I’ve said that even as we rescue this economy from a full-blown crisis, we must rebuild it stronger than before. And health insurance reform is central to that effort.
This is not just about the 47 million Americans who have no health insurance. Reform is about every American who has ever feared that they may lose their coverage if they become too sick, or lose their job, or change their job. It’s about every small business that has been forced to lay off employees or cut back on their coverage because it became too expensive. And it’s about the fact that the biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid.
So let me be clear: if we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket. If we do not act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction. These are the stakes of the debate we’re having right now.
I realize that with all the charges and criticisms being thrown around in Washington, many Americans may be wondering, “What’s in this for me? How does my family stand to benefit from health insurance reform?”
Tonight I want to answer those questions. Because even though Congress is still working through a few key issues, we already have agreement on the following areas:
If you already have health insurance, the reform we’re proposing will provide you with more security and more stability. It will keep government out of health care decisions, giving you the option to keep your insurance if you’re happy with it. It will prevent insurance companies from dropping your coverage if you get too sick. It will give you the security of knowing that if you lose your job, move, or change your job, you will still be able to have coverage. It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. And it will cover preventive care like check-ups and mammograms that save lives and money.
If you don’t have health insurance, or are a small business looking to cover your employees, you’ll be able to choose a quality, affordable health plan through a health insurance exchange – a marketplace that promotes choice and competition Finally, no insurance company will be allowed to deny you coverage because of a pre-existing medical condition.
I have also pledged that health insurance reform will not add to our deficit over the next decade – and I mean it. In the past eight years, we saw the enactment of two tax cuts, primarily for the wealthiest Americans, and a Medicare prescription program, none of which were paid for. This is partly why I inherited a $1.3 trillion deficit.
That will not happen with health insurance reform. It will be paid for. Already, we have estimated that two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health care programs. This includes over one hundred billion dollars in unwarranted subsidies that go to insurance companies as part of Medicare – subsidies that do nothing to improve care for our seniors. And I’m pleased that Congress has already embraced these proposals. While they are currently working through proposals to finance the remaining costs, I continue to insist that health reform not be paid for on the backs of middle-class families.
In addition to making sure that this plan doesn’t add to the deficit in the short-term, the bill I sign must also slow the growth of health care costs in the long run. Our proposals would change incentives so that doctors and nurses are free to give patients the best care, not just the most expensive care. That’s why the nation’s largest organizations representing doctors and nurses have embraced our plan.
We also want to create an independent group of doctors and medical experts who are empowered to eliminate waste and inefficiency in Medicare on an annual basis – a proposal that could save even more money and ensure the long-term financial health of Medicare. Overall, our proposals will improve the quality of care for our seniors and save them thousands of dollars on prescription drugs, which is why the AARP has endorsed our reform efforts.
Not all of the cost savings measures I just mentioned were contained in Congress’s draft legislation, but we are now seeing broad agreement thanks to the work that was done over the last few days. So even though we still have a few issues to work out, what’s remarkable at this point is not how far we have left to go – it’s how far we have already come.
I understand how easy it is for this town to become consumed in the game of politics – to turn every issue into running tally of who’s up and who’s down. I’ve heard that one Republican strategist told his party that even though they may want to compromise, it’s better politics to “go for the kill.” Another Republican Senator said that defeating health reform is about “breaking” me.
So let me be clear: This isn’t about me. I have great health insurance, and so does every Member of Congress. This debate is about the letters I read when I sit in the Oval Office every day, and the stories I hear at town hall meetings. This is about the woman in Colorado who paid $700 a month to her insurance company only to find out that they wouldn’t pay a dime for her cancer treatment – who had to use up her retirement funds to save her own life. This is about the middle-class college graduate from Maryland whose health insurance expired when he changed jobs, and woke up from emergency surgery with $10,000 in debt. This is about every family, every business, and every taxpayer who continues to shoulder the burden of a problem that Washington has failed to solve for decades.
This debate is not a game for these Americans, and they cannot afford to wait for reform any longer. They are counting on us to get this done. They are looking to us for leadership. And we must not let them down. We will pass reform that lowers cost, promotes choice, and provides coverage that every American can count on. And we will do it this year. And with that, I’ll take your questions.
The ONC policy committee on meaningful use has published an updated matrix on the subject. It can be found here.
Someone in the GOP needs to learn how to use Microsoft Visio, or the Democrats need to come up with a better plan for improving our healthcare system.
Republicans imagination of the Democratic Healthcare plan
If you believe this nightmare chart created by Congressman Kevin Brady’s office (R-Texas 8th District), then you’ll need a PHD in obfuscation to figure out what the Democrats are planning. More likely, however, is that Brady is painting an overly bleak picture of what a government plan might look like.
Jokes aside, as this battle continues to play out, both sides are sticking to their guns; however, the Obama administration believes it has the trump card: 60 votes. Bloomberg News is reporting that “Obama Open to Partisan Vote on Health-Care Overhaul.”
We’ll follow how this plays out, and keep you apprised of any interesting happenings.
UPDATE July 22, 2009:
Corrected Visualization of the Democratic Healthcare plan (PDF)
A graphic designer, Robert Palmer, took it upon himself to “correct” the republican nightmare chart and made it significantly easier to understand. The updated chart, along with a PDF can be found on Mr. Palmer’s Flickr page. He also penned a note to Representative Boehner:
Dear Rep. Boehner,
Recently, you released a chart purportedly describing the organization of the House Democrats’ health plan. I think Democrats, Republicans, and independents agree that the problem is very complicated, no matter how you visualize it.
By releasing your chart, instead of meaningfully educating the public, you willfully obfuscated an already complicated proposal. There is no simple proposal to solve this problem. You instead chose to shout “12! 16! 37! 9! 24!” while we were trying to count something.
So, to try and do my duty both to the country and to information design (a profession and skill you have loudly shat upon), I have taken it upon myself to untangle your delightful chart. A few notes:
- I have removed the label referring to “federal website guidelines” as those are not a specific requirement of the Health and Human Services department. They are part of the U.S. Code. I should know: I have to follow them.
- I have relabeled the “Veterans Administration” to the “Department of Veterans’ Affairs.” The name change took effect in 1989.
- In the one change I made specifically for clarity, I omitted the line connecting the IRS and Health and Human Services department labeled “Individual Tax Return Information.”
In the future, please remember that you have a duty to inform the public, and not willfully confuse your constituents.
Sincerely,
Robert Palmer
Resident,
California 53rd District
The Certification Commission for Healthcare Information Technology (CCHIT) has responded to the Office of the National Coordinator’s recently released Meaningful Use matrix [pdf]–and responded with a vengeance.
The bottom line: “CCHIT recommends that meaningful use measures be either simplified for 2011, or postponed until 2013.” CCHIT Annotations to the ONC's Meaningful Use Matrix (PDF)![CCHIT Annotations to the ONC's Meaningful Use Matrix [PDF]](http://healthcareitblog.mtbc.com/wp-content/uploads/2009/07/cchit-annotations.png "cchit-annotations")
Its recommendation was formed by comparing the CCHIT 2008 criteria against the meaningful use matrix prepared by the National Coordinator’s Workgroup on Meaningful Use and finding that while many of the 22 proposed objectives are fully supported by the current certification, at least 8 have minor to major gaps with the CCHIT 08 criteria.
Why Postpone?
The commission argues that “the lag between a decision to invest in EHR technology and its full, meaningful use in a provider organization is 1 to 2 years at best, and more typically, 3 to 5 years,” and for this reason it recommends postponing the 2011 measures until 2013. It isn’t that some EHRs do not currently meet the standards drafted for 2011 (MTBC’s EMR does), it’s that CCHIT criteria does not currently cover or test for all of the proposed 2011 measures. Additionally, CCHIT does not believe that the marketplace is fully ready to support some of the reporting standards outlined in the draft.
CCHIT has prepared an annotated response to the ONC’s matrix which highlights the actual points in contention for 2011. CCHIT’s letter to the ONC further clarifies CCHIT position on the topic.
As always, we will continue to cover this story as new developments arise and as key shareholders continue to weigh in with comments and responses.
Why don’t you let us know what you think? Should the 2011 measures be postponed until 2013?
When you buy a car, the manufacturer usually offers some kind of warranty on your purchase e.g. bumper-to-bumper coverage for 50,000 miles or 5 years, whichever comes first. Or coverage for 100,000 miles for the power train and 50,000 miles bumper-to-bumper. Some are now offering oil changes for life, free car washes, dry cleaning, or the salesman will pick up your kids from soccer practice if you make a purchase now. Ok, maybe they won’t pick up your kids, but you will please! buy now?
Francois de Brantes
Francois de Brantes, a nationally known advocate of health care quality, is hoping to bring warranties to healthcare. He and a few associates penned an article in Health Affairs describing the benefits of a new payment model for physicians which may inspire physicians to improve patient outcomes by putting their skin (and money) in the game.
The warranties which de Brantes proposes–Prometheus Payment as he’s called it–flip the current medical billing payment model on its ear. Prometheus Payment offers set fees to providers for recommended services, treatments and procedures. However, unlike the current system where all fees are covered by third-party payers, the provider now becomes a party in the payment process by assuming fiduciary responsibility for outcomes–should patients develop an avoidable outcome, providers become responsible for half the costs. The warranty is based on the costs of these avoidable outcomes and is risk adjusted for elderly or frail patients.
de Brantes and his co-authors explain that “the warranty concept has filtered into the self-pay portion of health care, such as corrective eye surgery, general cosmetic surgery, and dental care, which are often based on a global fee that includes any necessary rework by the provider. But it has taken much longer for warranties to appear in the third-party payer system.” They argue that with this global-fee model, overall costs in the healthcare can be reduced while improving outcomes for patients by making (and paying) the provider for any expenses before, during, and after the procedure.
The abstract to the Health Affairs article reads:
How health care providers get paid has implications for the delivery of care and cost control; the topic is especially important during an economic downturn with persistent growth in health spending. Adding “warranties” to care is an innovation that transfers risk to providers, because payment includes allowances for defects. How do such warranties affect patient care and bottom lines? We examine a proposed payment model to illustrate the role of warranties in health care and their potential impact on providers’ behavior and profitability. We conclude that warranties could motivate providers to improve quality and could increase their profit margins.
I find two points interesting.
This whole idea adds a new wrinkle to medical billing. As your billing service, we’d not only be incentivized to help you collect more money but also provide you tools to provide better patient care. Great news for you, we have a CCHIT-certified EMR which provides just the tools you need. Find out more here.
We will keep you posted if this model crops up at any payers near you.
Read more about Prometheus Payment:
On June 16 the Workgroup on Meaningful Use presented its recommendations on the definition of Meaningful Use. They prepared a preamble describing their overall path to this definition and a matrix to organize their recommendations for each year. For those who have been under a rock for the past 6 months, “meaningful use” is the defining measure by which the incentive payments included in the American Recovery and Reinvestment Act (ARRA) will be determined.
With this working definition, vendors, physicians, and hospitals can better plan for implementation and delivery of technology and services to achieve the measurable goals outlined by the Workgroup.
HITECH Act Incentives as outlined by the American Recovery and Reinvestment Act (ARRA)
Meaningful Use for Whom?
First it is important to note that “meaningful use” will have different meanings for hospitals and for groups in private practice. The preamble states “some features and capabilities will be recommended as required in an ambulatory setting before similar functions are expected to be widely used in the hospital.” This means that proving “meaningful use” will be a more rigorous exercise for private practices than it is for hospitals. However, private practices have a broader range of options and lower barriers of entry (cost, availability of technology, shorter implementation time frames, etc) when it comes to implementing technologies which can deliver “meaningful use.”
The Details
Let’s go over some of the measures which are planned for 2011 and look at some examples of each item. More details for each of the items below can be found in the matrix. John Halamka, MD of the CareGroup Health System of Harvard Medical School and the chairman of the US Healthcare Information Technology Standards Panel (HITSP) said in Healthcare IT News that this matrix still needs to be populated with the most up to date standards and an implementation guide. These details will help vendors and physicians alike ensure that their software meets these measures. Expect this in July.
Each of the items below has associated metrics which will need to be reported to verify meaningful use; for example, one of the objectives calls for reminders to patients for preventive/follow-up care. In order to prove meaningful use, the EMR application must be able to provide a reporting of the percentage of patients over 50 with annual colorectal screening. Keep in mind that each of the items below has an associated measure (found in the matrix) which will require reporting to an authorized agency.
Items marked with a Yes! indicate that the MTBC EMR helps your practice meet or exceeds these measures.
What Now?
Now that you know the definition of Meaningful Use what should you do now? The answer is simple: get an EMR. Ok it is not that simple, but you will be happy to know that you have plenty of options in the marketplace. Dr. Halamka writes, “Hospitals and Clinician offices now know what is expected for 2011, so the time is now to begin your software implementations.” Never before have there been so many EMRs which provide such a high level of functionality and interoperability. Today’s major differentiators are not function, but price and service.
MTBC Can Help
MTBC’s CCHIT certified EMR (free to MTBC medical billing clients) can help your practice meet the goals of 2011. Click here to find out more about MTBC’s unified medical billing and practice managagement services.
However, if “free” is not your bag, you have plenty of other options beginning at the $1,000 range and your imagination as the only limit. Vendors have become very creative in their pricing with new options emerging such as monthly subscriptions, charges for each fax sent from the EMR, hosting fees for web-based applications, fees for technical support by email, server replacement plans (a la replacement plans sold by big box stores), 50¢ per 100MB of storage, and many others.
MTBC’s EMR rivals those of its competitors because it is implemented, supported, and updated completely free of charge of its premium medical billing clients. To find out more about how MTBC’s EMR can help you meet the goals of Meaningful Use, request a demo today and, if you are not currently an MTBC billing client, find out how you can download a free trial.
Watch this space for more information regarding meaningful use and its impact on the healthcare IT.
You maybe asking yourself why MTBC, a medical billing company, pursued and received CCHIT certification. What does medical billing have to do with electronic medical records? The answer for us is simple: improving our clients’ work flow improves their collections. The only way we could find to help improve our clients’ work flow was to provide them a great EMR software, free of charge. Click here to see how MTBC’s EMR can improve your work flow, and improve your collections.
Why CCHIT? Why Now?
Providing a free EMR is one thing, providing a certified EMR which is also free is entirely different. CCHIT, the Certification Commission for Healthcare Information Technology, is the recognized certification body in the United States for EMR applications. As per our knowledge, we are the only company providing a completely free CCHIT certified EMR. The software is free and we service it for free as part of our 5% premium medical billing service.
With the new ARRA incentives as a carrot ($44,000 to use an EMR? Thanks Dr. B!), many EMR vendors are promising that a costly EMR investment will pay for itself. This has yet to be seen and the government is still working out the details. MTBC clients no longer have to worry about such costly investments for the chance at the incentives starting in 2011. CCHIT certification is almost certainly one of the prerequisites to receiving these incentives, “meaningful use,” is another. Its not enough to simply spend a boat load of money on an EMR, you must begin using it as well.
With MTBC, physicians have a dedicated partner that is committed to providing the best EMR software that meets current and future requirements for certification and meaningful use while exceeding client expectations.
Watch this space for upcoming videos, downloads, and MTBC EMR client testimonials.
In the June issue of The New Yorker magazine, Dr. Atul Gawande contrasts 
the high-cost health-care system in McAllen, Texas, with the lower-cost systems at the Mayo Clinic and in Grand Junction, Colorado. McAllen, Texas is one of the most expensive health-care markets in the country. Only Miami spends more. He explores why costs in this Texas town have spiraled out of control while those in other parts of the country have remained fairly stable.
This article has become a must read for healthcare policy wonks and all those interested in the astronomical costs of medicine.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?yrail
We are thrilled to announce that MTBC EMR v 4.0 has received the prestigious CCHIT 2008 Ambulatory Certification. The Certification Commission for Healthcare Information Technology is the Recognized Certification Body in the United States for certifying health information technology products.
MTBC’s new, upgraded Version 4.0 of our EMR is already being praised for its intuitive design, making clinical training optimally efficient while enhancing patient care.
Moreover, MTBC’s EMR 4.0 is free and supported free for clients of our Premium Plan, an unrivaled package of comprehensive practice management services. Our remarkable commitment to value removes the financial and administrative barriers that have prevented more than 90% of private practices from fully using an EMR.
MTBC’s EMR 4.0 is certified by the Certification Commission for Healthcare Information Technology (CCHIT), the gold standard for EMR usability, functionality and interoperability.
Request a copy, more information and a preview today!
UnitedHealth Group is again at the leading edge of technology and the delivery of healthcare services to patients and providers. Today UHC announced a new product designed to help patients secure medical insurance in the event they are no longer covered by another carrier.
In a way, UHC is offering insurance for your existing insurance. This first of its kind product is called UnitedHealth Continuity. It allows patients the right to purchase an individual insurance policy at some point in the future–even if the patient gets sick.
Patients who enroll in it will pay “20 percent each month of the current premium on the individual policy to reserve the right to be insured under the plan at some point in the future” (NYT). A typical Continuity plan is expected to average approximately $32 per month.
If the promised reforms of the incoming Obama administration materialize this service may become obsolete and in fact may become a free offering by all major insurance carriers. However, until that time, and with the job market collapsing, there are many people who may consider this a very welcome product. Additionally, if the Obama administration is unable to deliver on campaign promises to reform the purchase and delivery of healthcare insurance in the US, more insurance carriers maybe following in the footsteps of UHC.
UHC has been at the forefront of service delivery in the insurance space. It was among the first carriers to provide real-time claims adjudication–a service whereby physicians and their staff are able to immediately determine the patient responsibility on new claims.
Currently, MTBC is one of the only companies in the country providing this service for physicians who participate with UnitedHealth. Read more about MTBC and UnitedHealth here.
Ahem….what do we say about privacy and data selling…bingo it appears as if you read through the entire article why else would this type of data be shared with Wall Street Investors to make a market for selling some new analytic algorithms. Now get this the investors got to see this “private” information that a patient can’t even get access to see. This reminds me of ePatientDave, “give me my damn data” and this is a total abuse here as the data is not being used for better care but for “better money”. 
Now this also says something about access to revenue cycling too, payers and integrators might want to visit this scenario and make sure that it stays on a server for one and what levels of access will be granted. Now this gets worse as the types of information and patients were related to mental health, HIV, Parkinson's and more. How many investors glazed over these records? Accretive gets paid on the revenue boost is provides. There are a lot of these types of 3rd parties around in healthcare and here’s another one used by Blue Cross who had some bad algorithms.
Actually when it comes down to payer disputes you wonder did the hospital bill erroneously on purpose or did they get some bad algorithms and a bunch of promises? If I were one of these patients, court might be on my mind and I would want to know what investors on Wall Street potentially or did see my data! On their website they talk about bringing increased discipline to the revenue cycle so is that 
the revenue cycle on Wall Street?
Well Fargo just dumped one of these types of companies recently and remember the big data breach at Stanford, also the fault of a 3rd party, so with history being built here who wants to trust a 3rd party today if you don’t have to as patient records end up on the web and in the hands of investors on the street. The 3rd party folks are the algorithm makers though that promise better profits and use of money. This whole scenario though is kind of sad as they were supposed to be helping a couple non profits boost their revenue but the hospitals probably had no clue on the methodologies like showing patients records was in the plan.
“The screen shot also includes numeric scores to predict the “complexity” of the patient and the probability of an inpatient hospitalization, and a box to describe
the “frailty” of the patient.”
Tine to start licensing and taxing those data sellers and have a federal disclosure site so we all know what’s going on, beginning to make more sense every day! The link below will describe a bit of this brainstorm. BD
http://www.myfoxtwincities.com/dpp/news/stolen-laptop-debt-collector-lawsuit-jan-19-2012ST. PAUL, Minn. - Minnesota Attorney General Lori Swanson has filed a lawsuit against a debt collector accused of failing to protect the confidential information of 23,500 hospital patients after a company laptop was stolen from a rental car parked in the Seven Corners are of Minneapolis.
The lawsuit filed Thursday alleges Accretive Health, Inc., a debt collection agency that is part of a New York private equity fund conglomerate, failed to protect the confidentiality of patient health care records and failing to disclose its involvement in their health care.
Last July, Accretive lost a laptop computer containing unencrypted health data of about 23,500 patients of two Minnesota hospital systems -- Fairview Health Services and North Memorial Health Care.
Under both contracts, Accretive controls and directs the work of hospital employees and “infuses” its own employees into the staffs of the hospitals. Accretive gets base compensation and incentive pay for helping the hospitals boost revenue or cut costs.
“The debt collector found a way to essentially monetize portions of the revenue and health care delivery systems of some nonprofit hospitals for Wall Street investors, without the knowledge or consent of patients who have the right to know how their information is being used and to have it kept confidential,” Swanson said.
The state seeks an order requiring Accretive to fully disclose to patients:
- What information it has about Minnesota patients
- What information it has lost about Minnesota patients
- Where and to whom it has sent information about Minnesota patients
- The purposes for which it amasses and uses information about Minnesota patients.
One more the mergers and acquisitions speak out again on how health insurance companies have diversified their portfolios and are no longer “just an insurance company” with numerous subsidiaries both in the Health IT area and even others in what you might consider “unrelated” businesses. Here’s one example below with a 
diversified interest with a new division created to distribute hearing aids and offer incentives for those in certain areas of the us to sign up for insurance plans. I sometimes wonder how other insurers view this?
Here’s another example of what one might consider a business outside of what we might normally consider a related business with low incoming housing investments in New Mexico. One thing to keep in mind today is all the aggregated data that flows and the algorithms and SQL statements that bring some of this together. Data is big business.
Just a couple weeks ago we read about the investment with mobile health and again we venture down into the data business here again as the Optum division which has many subsidiaries has a huge focus on data, and part of the renamed group was the old “Ingenix” company that has consulted and provided data services for years and last year settled their case with the AMA with short paying providers for out of network services.
This kind of brings me around again to what I call the “Alternative Millionaire’s Tax” with companies that buy and sell data and this seems to be a good place for a mention here as the Optum Division has been making money for years with aggregating and selling prescription and other data. With big profits as such we certainly could entertain a license and tax situation for those making billions on the data selling business. As a short comparison from another Healthcare company, Walgreens has estimated their data selling business to be valued at just under $800 million, so again something to give some thought to as hospitals, providers, and patients struggle to afford medical care today.
Another good article to read about the over sell and naïve and gullible nature of the US with both government and consumers, read what Nanex has to say as they are the folks that monitor and study rogue algorithms in the stock market and look for indicators of the “next flash crash”. A couple paragraphs are below and will the SEC be suckered in to this huge expense of programmers who want to make big dollars writing code convince a naïve and gullible SEC? It’s all over the place with digital illiteracy, steroid marketing and algorithms for huge profits only and they have teeth. At a certain point in time we might need to REALLY think about the value of some of the data we analyze today and the cost and this is worth a mention as this is the big growth area for United, algorithms and software analytics via consulting services. It is also worth a note that United last year hired the former Assistant Attorney General for the State of Minnesota for their general counsel.
Below is one example of the algorithm/software business as the company created a clearinghouse business and collaborated with an medical records company to integrate the services with Epic and of course this means more data revenue for the company and puts a bit of stress on other smaller existing clearinghouse businesses in the US as well.
One more thing too is let’s not forget that they also own a bank with over $1 billion on deposit with health savings accounts and I would guess this also leaves them open to lend money on monies held here and somewhat compete with other banks. As you can read in the quote below the funds are largely generated by employers, in other words large US corporations so they seem to go hand in hand, right?
“OptumHealth offers three types of HSAs, as well as tax-advantaged health care 
savings and spending accounts, debit-card services, benefits administration services, and payment products. About three-quarters of the bank’s 1.6 million accounts are employer-generated, while the other quarter are individual accounts.”
There’s also the Chinese investment the company bought early in 2010.
If you were to stop and look you might also notice one more subsidiary that can consult with biotech and device companies to introduce new products to the FDA and you know when you think about it they might just have a subsidiary to handle the entire process from FDA approval all the way down to provider reimbursement too. 
One other related item too is the purchase of physicians groups which is growing and the acquisition of Monarch in Orange County is one big example of buying a huge managed care group.
Again, in summary with such large profits and a lot coming from the data end of the business, this looks like one company where licensing and taxing the data sold for huge profits could fit and there are many more as Hedge Funds, Facebook and tons of other companies are cashing in royally and this all leads to bottom line profits for running algorithms on servers 24/7 that you can’t see, touch or talk to as far as the consumer is concerned, but automated algorithms for data mining and selling are yielding huge profits for corporate USA while as consumers we are becoming “data chasers” to fix a lot of the flawed data that is out there today. It’s a good idea today to read up and see how the corporate USA scene has changed tremendously due to the huge array of mergers and acquisitions as companies are not the same ones they were 2 to 3 years ago by any means. BD
UnitedHealth Group (NYSE:UNH) today reported fourth quarter and full year 2011 results, highlighted by strong enrollment and revenue growth in each of UnitedHealthcare’s benefits businesses and strong revenue growth at all Optum business units. Full year and fourth quarter 2011 net earnings were $4.73 per share and $1.17 per share, respectively. Cash flows from operations were $7 billion in 2011.
The Company continues to estimate 2012 revenues in the range of $107 billion to $108 billion and net earnings in the range of $4.55 to $4.75 per share.
Is there money in those algos? This story might answer that. Why would this employee who was a contracted programmer take this code? It’s worth money and if you read often enough you know I discuss those algos and software is nothing more than a group of algorithms, words of Bill Gates. 
A co-worker said the employee said the accused confused he lost the drive containing the code and get this, it’s the software (aka algorithms) that cost $10 million to develop to track the billions of dollars that the US government dispenses “daily” to government agencies..these are some pretty commanding algorithms…so the programmer apparently took the code and who knows where it would go next? A lot of government code is open source but don’t think that is the case here…what’s the next security breach to occur? BD
Bo Zhang, 32, of Queens, New York, worked as a contract programmer at the bank. He was accused of illegally copying software to an external hard drive, according to a criminal complaint filed in U.S. district court in Manhattan.
Authorities said the software, owned by the U.S. Treasury Department, cost about $9.5 million to develop.
A New York Fed spokesman said in a statement that the bank immediately investigated the suspected breach when it was uncovered and promptly referred the matter to authorities.
Zhang told investigators he took the code "for private use and in order to ensure that it was available to him in the event that he lost his job," the complaint said.
The code, called the Government-wide Accounting and Reporting Program (GWA), was developed to help track the billions of dollars the United States government transfers daily. The GWA provides federal agencies with a statement of their account balance, the complaint said.
This is kind of an alarming incident but when you read further it does not stop the treatment process and the secondary outbursts are surgically removed. This affects about half of those treated to be on alert, but not all of those develop the secondary skin cancer, only about a quarter of the 50% risk group.
This sounds like a big step in recognizing undesired side effect with oncology treatments. BD
Press Release:
Drug Used to Treat Melanoma with One Mutation Sets off a Cascade that Results in a Different Type of Skin Cancer in Cells with Another Mutation
Patients with metastatic melanoma taking the recently approved drug vemurafenib (Zelboraf®) responded well to the twice daily pill, but some of them developed a different, secondary skin cancer.
Now, researchers at UCLA’s Jonsson Comprehensive Cancer Center, working with investigators from the Institute of Cancer Research in London, Roche and Plexxikon, have elucidated the mechanism by which vemurafenib excels at fighting melanoma but also allows for the development of skin squamous cell carcinomas.
The very action by which the pill works, blocking the mutated BRAF protein in melanoma cells, sets off a cellular cascade in other skin cells if they have another pre-disposing cancer mutation and ultimately accelerates the secondary skin cancers, said Dr. Antoni Ribas, co-senior author of the paper and a professor of hematology/oncology.
About 50 percent of patients who get melanoma have the BRAF mutation and can be treated with vemurafenib, Ribas said. Of those, a fourth of the patients develop skin squamous cell carcinomas. The squamous cell carcinomas were removed surgically, and vemurafenib was not discontinued for this side effect.
“We wondered why it was that we were treating and getting the melanoma to shrink, but another skin cancer was developing,” said Ribas, who studies melanoma at the Jonsson Cancer Center. “We looked at what was likely making them grow and we discovered that the drug was making pre-existing cells with a RAS mutation grow into skin squamous cell cancers.”
The 18-month study appears in the Jan. 19, 2012 edition of the New England Journal of Medicine.
The combined research team performed a molecular analysis to identify the oncogenic mutations in the squamous cell lesions of patients treated with the BRAF inhibitor. Among 21 tumor samples studied, 13 had RAS mutations. In a different set of 14 samples, eight had RAS mutations, Ribas said.
“Our data indicate that RAS mutations are present in about 60 percent of cases in patients who develop skin squamous cell cancers while treated with vemurafenib,” Ribas said. “This RAS mutation is likely caused by prior skin damage from sun exposure, and what vemurafenib does is accelerate the appearance of these skin squamous cell cancers, as opposed to being the cause of the mutation that starts these cancers.”
Ribas’ group found that blocking the non-mutated BRAF in cells with mutated RAS caused them to send signals around BRAF that induced the growth of the squamous cell cancers.
The discovery of the squamous cell cancer mechanism has led to strategies to inhibit both the BRAF mutation with vemurafenib and block the cellular cascade with a different drug, a MEK inhibitor, before it initiates the secondary skin cancers, said co-senior author Professor Richard Marais from the Institute of Cancer Research in London, who developed the animal model for the study.
“By understanding the mechanism by which these squamous cell cancers develop, we have been able to devise a strategy to prevent the second tumors without blocking the beneficial effects of the BRAF drugs,” Marais said. “This may allow many more patients to benefit from these important drugs.”
Ribas said that this is one of the very few times that oncologists understand molecularly why a side effect to cancer treatment is happening.
“The side effect in this case is caused by how the drug works in a different cellular setting,” he said. “In one case it inhibits cancer growth, and in another it makes the malignant cells grow faster.”
Studies currently are under way testing BRAF and MEK inhibitors in combination in patients with metastatic melanoma, Ribas said.
“Our data provide a molecular mechanism for the clinical toxicity of a targeted oncogene inhibitor that apparently contradicts the intended effects,” the study states.
The study was supported by Roche, Plexxikon, the Seaver Institute, the Louise Belley and Richard Schnarr Fund, the Fred L. Hartley Family Foundation, the Wesley Coyle Memorial Fund, the Ruby Family Foundation, the Albert Stroberg and Betsy Patterson Fund, the Jonsson Cancer Center Foundation and the Caltech-UCLA Joint Center for Translational Medicine.
UCLA's Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2011, the Jonsson Cancer Center was named among the top 10 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 11 of the last 12 years. For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu.
Jon goes back to Foxconn-revisited…in his usual style and he says we need to make our factories look more like those in China. Workers live in dormitories and don’t know each other, cuts down on commuting and friendship. 
Workers are finding ways of improving their conditions, hotlines with trying to stop suicide and put nets around buildings to catch jumpers…I think we remember this from a year ago and he says in the US we call this “treating the symptoms”.
“It’s me, Siri, in your pants pocket working on giving you testicular cancer”…If it works for those factories, electronics would cost more..modern work fare…a game to the rescue…this is great humor but there are somethings I does make one ponder…there’s just one level and this is it…(the middle class) as algorithms are marketed and designed and sold to consumers.
He shows the work of the algorithms in place for sure in a humorous way. Why are health insurance companies getting into the low income housing business though? I hope this is not a Foxconn plan to create communities with jobs that pay little and have medical care on campus? What is up with this?
The same company owns a subsidiary that will basically give you a free hearing aid made in China if you sign up for their health insurance…more below…and the subsidiary they built to distribute and coming to Walmart soon as I understand…
He moves on to the next part, a game that has one level…hmmm…we another insurance company banking on this too…data to sell? Will this make you healthy? I prefer real knowledge.
I just ask is there where we are headed with mining and selling data today and big corporations taking over our day to day decisions? The more information they have to judge and discriminate, the ability to control and humiliate the middle class grows. 
At any rate with the use of algorithms today that have teeth and the amount of flawed data out there, are we going in this direction? I put this out for an awareness and perhaps to generate some though processes. I like technology and the good things it brings but am not oblivious to how it can also be abused as well and a NYU professor says it even better than me, read and listen up.
I sure hope Richard Cordray understands math and the power of the algorithms when used both in an intuitive and good manner and the reality of those who design for pure profit that hurts consumers. You can see, smell or touch them, but they are running on server 24/7 every day making like impacting decisions, crafted by some of the smartest programmers and developers that the money on Wall Street can buy.
Another good article to read about the over sell and naïve and gullible nature of the US with both government and consumers, read what Nanex has to say as they are the folks that monitor and study rogue algorithms in the stock market and look for indicators of the “next flash crash”. A couple paragraphs are below and will the SEC be suckered in to this huge expense of programmers who want to make big dollars writing code convince a naïve and gullible SEC? It’s all over the place with digital illiteracy, steroid marketing and algorithms for huge profits only and they have teeth. BD
“Wall street hires the best software developers money can buy. They write clever algorithms. These algorithms will only get more clever as time goes on. Which means they will always be changing. Now, writing software to detect what other 
software is doing is 100 times more difficult. Which in the software world means 100 times more expensive. Which means hiring people that do not exist, since Wall Street already snapped up the best, and you need the best times 100 (you can't make it up in quantity and just get 100 times more wizards, because many will have poor social skills, and you need these people to communicate).”
“You see the folly of trying to regulate the markets in real-time? Real-time raises the cost exponentially times a million. To a level that all the kings in the world couldn't afford. It would be one thing to track in real-time, things that had known behavior. Like your checking account being overdrawn. Maybe credit card fraud in the making (which, by-the-way, hasn't been perfected yet, despite lots of money and time thrown at the problem). “
http://www.thedailyshow.com/watch/mon-january-16-2012/fear-factory
To go back a little bit in time the chip was also set up to communicate with personal health records like Healthvault. The latest development on the chip was the ability to 
communicate real time glucose readings. The FDA has approved the product and the HealthLink software.
In addition, Medcomp who makes vascular access catheters will use the chip in vascular ports for identifying the port in a patient for proper medication dispensing. As it read here though the use with Medcomp still needs to secure FDA approval. This chip keeps coming back around with many lives. BD
DELRAY BEACH, Fla., Jan 17, 2012 (BUSINESS WIRE) -- VeriTeQ Acquisition Corporation ("VeriTeQ" or "Company"), a marketer of implantable, radio frequency identification ("RFID") technologies for patient identification and sensor applications, announced today it has acquired the VeriChip implantable microchip and related technologies, and Health Link personal health record from PositiveID Corporation. VeriTeQ is majority owned and led by Scott R. Silverman, former Chairman and CEO of PositiveID and VeriChip Corporation. PositiveID has retained an ownership interest in VeriTeQ.
VeriTeQ will focus on three main areas: patient identification and personal health record (PHR) access through the VeriChip implantable microchip and Health Link web-based PHR; implantable sensor applications; and identification of medical devices within the body. VeriTeQ will also focus on identification and sensor applications for animals.
VeriTeQ's acquisition also includes the rights to a Development and Supply Agreement with Medical Components, Inc. ("Medcomp"), a leading manufacturer of vascular access catheters. Under the terms of the agreement, Medcomp will embed the VeriChip microchip in its vascular ports to facilitate identification of the port in a patient and proper medication dispensing.
I am curious about this as a year ago blood levels were at the lowest in 10 years and maybe it’s just me, but instead of big fine, would improving the system and getting more folks on board to get donations help? 
The Red Cross relies on donations and is a non profit right and does fining them fix anything? BD
“An average of 91 cents of every dollar the Red Cross spends is invested in humanitarian services and programs. The Red Cross is not a government agency; it relies on donations of time, money, and blood to do its work.”
The American Red Cross, the biggest U.S. supplier of donated blood, failed to correct violations of blood-safety rules, raising the risk that ill-suited blood will be used in transfusions, U.S. regulators said.
The U.S. Food and Drug Administration fined the Red Cross $9.59 million, according to a letter from the agency to the Red Cross made public on Jan. 13. The organization has been cited 14 times since 2003 and fined about $46 million for similar offenses.
The Red Cross didn’t ensure that all staff had adequate blood-safety training and hasn’t created a complete list of prospective donors who were disqualified from giving blood, according to the letter. The Washington-based consumer group Public Citizen this month urged the agency to levy sanctions.
The organization is “fully committed to meeting all FDA standards, has made significant progress in working with the FDA to comply with their regulations,” according to the statement.
Everyone needs to watch this video and you will see both pros and cons and the pro folks are promoting as the algorithms used to mine this data brings in additional revenue and sells algo services. How much information “do we really need”? Those selling this business will tell you that you can never have enough. Those on the other side will tell you it’s an invasion of your privacy and you know what, that side has more going for it by far with reality.
If you listen to the attorney here she makes good points that there are folks not paying bills for a reason, divorce is one that comes to mind. You have to realize that all of the information they mine via public information may not be accurate. I have written about this before and the “flawed data” that is out there. One state has all but barred CoreLogic due to the fact that their bots were slowing down the servers and they and other mining companies were not paying for quarterly updates, so when you as a consumer do get a record rectified, you can’t get rid of any blemishes.
Welcome to the world of discrimination by the algorithm….
Watch the video here and learn about how much digging they are going to do.
Aggregated information contains flaws…this is the problem. Score would not agree to go on camera the video states. Again I said I do hope our new Consumer Financial Czar knows about math and the Attack of the Killer Algorithms. What a big part of the problem is that that cookie cutter employees are told to use what is on their computer screen for their decision making processes and if it is flawed…well you get that picture. Right now due to the overload put on servers and the Wild West effect of unproven algorithms here…it’s time to license and tax those folks like CoreLogic who make huge profits from mining free taxpayer data, give something back. Why should data mining companies be allowed to make billions, tie up governments servers to where states have to install software to block their bots and then dump a load of flawed data on consumers?
Those algorithms have teeth and watch the video below as Kevin Slavin tells you how it all works with rogue algorithms that go out of control and lead to things like flash crashes. I used to write code and I know what folks are capable of with mismatching data for profit and it hurts the consumer. We need some data sources to check but not to this level as it is going to make everyone mad and crazy as the flawed data will flow and the middle class will become nothing but data chasers fixing everything corporate USA has loaded in the data.
AND THERE’S MORE….
Just wait until this kicks in, CoreLogic has formed a partnership with FICO who is already in the process of selling algorithms with mismatched data which connects public information about you and combines it with your credit score to tell if you as a medical patient will take your prescriptions.
Somebody needs to start calling some of these folks on “mis matched data” the discriminates as now we have “Discrimination by the Algorithm” and it’s showing in more places all the time. Last time I wrote about the FICO mismatched data it all ended up over at the Daily Kos via another publisher as an awareness. As far as I am concerned the FIOC Medication 
Adherence Scoring is nothing but mismatched data analytics created to sell software and is the work of some “underground” think tanks on how to generate more money and profits. You can find my comments too on the Daily Kos on this as another author included them in her column who was in total agreement. Do you know how common flaws are? Look at this link and see about the 31k that are “living” but Social Security says they are dead.
Also give a listen here to NYU Professor Siefe as he tells you how the numbers are spun and marketed and how naïve and gullible we are. He’s a mathematician and makes sense and get his book, Proofiness, the Dark Side of Mathematical Deception” too. After watching the video I think the folks promoting this service are pretty gullible and naïve too and have never written a stick of code or SQL query and they just gob on to make money and the consumers get hurt.
This mis use of data and selling it all over is starting to turn normally peaceful folks into those who are not so peaceful. In healthcare they just put the doctors medical claim information out there for digital illiterates to work with and it is flawed to the hilt! Why should Hedge Funds, Facebook and tons of others out there be able to make billions with free data and cause extra expense to the States for slowing down their servers and have the state governments put blocking software in place to stop the bots? Do read Part 7 here as I cover a ton of flawed data situations that are out there to include a nice interview with the AMA on all the dead doctors I found out there:) That firm HealthGrades merged with a PR company I guess to help them market some of the flawed data and dead doctors? You figure that one out….
The link below has parts 1-7 on the Attack of the Killer Algorithms series and again some of my wishes that Richard Cordray understands math and algorithms or we are completely sunk as the middle class if not.
The thanks we get today is becoming data chasers as consumers to fix all the flawed and corrupted information that has been compiled and used against us. If everything is ok, then nothing to chase; however, “cookie cutter” employees today are not trained on how to work with flawed data and see everything as a blemish and thus there’s no level of forgiveness and understanding. If they challenge or ask questions, they might get fired and are told to rely on that computer screen.
This risk assessment scoring is not just limited t consumers…see what a bank is doing to small businesses in Wisconsin and even stating that a “church” is not showing enough profit! This will make your hair stand on end and again we need learn to work with flawed data and honor consumer privacy and license and tax the data sellers.
If you have not had enough yet, companies like this are now coming to the rescue of the consumer for shopping for insurance…total lack of respect with the name with providing services for consumers…. InsureMonkey….It may be a new way of selling insurance and pricing with focus on just pricing but do we have to be called “monkeys” now…with current economic conditions the name is not very cute right now.
Are we all just monkeys now and are insurers going to just eat up the additional flawed data and require consumers to prove their innocence? …There’s a lot more out there than you think and again we will be chasing and fixing flawed data forever as well as reaching a new level of discrimination against the middle class. BD
All of this information helps the company look deeper into payment histories, and most of it is available through the public records system.
CoreLogic says the idea is to supplement what the major credit bureaus find. Experian, Equifax and TransUnion only search public records for bankruptcy, tax liens and judgments.
The added information has the potential to hurt consumers with previously undetected blemishes.
Not everyone is comfortable with the extra information being shared. Attorney Chi Chi Wu with the National Consumer Law Center says there is often more to the story than numbers on a screen.
With even more personal information being shared, experts agree, consumers should check for errors that may hurt loan possibilities.
Well this is good news on the CIO store front in the fact that when the burn out there’s new life at the end of the road and a new on begins. From what I read and heard he was kind of stuck when working for the government and I understand that completely. Dealing with a bunch of “non participants” and digital illiterates that won’t at least try is not fun. 
As he said in post CIO interviews, the execution was the difficult part of the job, in other words getting folks to move on project and he saved a few billion for the government with his projects. Our US CTO is stuck on the word innovation and touts it all the time like tons of other do, but in the CIO area it’s more about collaboration and not the innovation dog and pony show. Where’s Salesforce.com going to use his talent, developing more business outside the US…a bit of an irony but everyone has a job to do. If you happened to catch the Oracle event this year, Larry Ellison called Salesforce.com the “roach motel” of the clouds, and there was quite the showdown but they have a good service to sell but the competition in the public is so Larry Ellison and why we all watch him. Practice Fusion uses Salesforce.com to host their free medical records service as well. BD
Salesforce.com, best know for its sales, customer service and collaboration software for business, is raising its ambitions by aiming at the international businesses and sales to foreign governments that have been the mainstays of companies like I.B.M.
On Monday, the company named Vivek Kundra its executive vice president of emerging markets. Mr. Kundra was the country’s first chief information officer from March 2009 until August 2011. His job was to move the government’s computer infrastructure spending — $80 billion a year — toward cloud computing. Mr. Kundra has extensive experience in technology at several levels of government, and has been a frequent visitor to the technology industry’s conferences.
http://bits.blogs.nytimes.com/2012/01/16/salesforce-hires-vivek-kundra-and-looks-overseas/
The plan gives employees the option of using a telehealth visit in the situations to 
where the patient's regular doctor may not be available, after hours and so on. In addition the medical records from MDLiveCare will also integrate with Microsoft PHR HealthVault. I am guessing this is the ability to import your video or telehealth visits with the doctor. This is not the first company to provide this service and one thing you can say for sure is that teleheatlh is on the move.
MDLiveCare work with LabCorp as well if a lab test was needed. BD
SUSSEX, Wis., Jan 16, 2012 (BUSINESS WIRE) -- QuadMed, a nationwide leader in employer-sponsored healthcare solutions, will deploy state-of-the-art telehealth technology across its network of worksite healthcare clinics through a new partnership with MDLiveCare.
MDLiveCare offers access to a national network of board-certified physicians and licensed therapists, in conjunction with QuadMed's network, providing quality healthcare services via secure video, telephone, and email communication.
Under an exclusive agreement, QuadMed will utilize MDLiveCare's proven telehealth technology to create a 'Virtual QuadMed' approach that significantly expands the scope of its clinics, giving employees and their family members another way to access QuadMed providers and services.
The new telehealth capabilities will also allow QuadMed, which operates clinics for nationwide companies like MillerCoors, Northwestern Mutual, Briggs & Stratton Corp. and STIHL, Inc., to provide more convenient care to smaller employers and employers with a distributed workforce.
I grew up in Arizona and there’s a lot of land out there with no civilization present for miles, especially on the Indian reservations. The project as this states below incorporates many different cultures in northern Arizona. On the Indian reservations consumers may have to travel a short distance to get to a “hot spot” to transmit their data but a short drive to a hot spot could be a lot more convenient than a long drive to the hospital Rural area really stand to benefit with remote monitoring. 
What is also nice here is that you know who’s getting the information and the purpose as it gives more information than a voice phone call with actual data being looked at and transmitted. What is also good here is winning the trust of the Indian community to try the service. This a trial program and it will be evaluated in a year’s time to see how well it is working and if nothing else, the reservations are getting better wireless service and coverage, which they need anyway. BD
Gisele Sorenson knew where each person with congestive heart failure lived. With a map in hand, she set out driving in northern Arizona — across tribal land and to the Grand Canyon — to find out whether the former Flagstaff Medical Center patients had wireless access.
The answer was key to determining whether patients could be remotely monitored via Bluetooth technology to help reduce their chance of being readmitted to the hospital. What Sorenson found is that not everyone would be able to use a cellphone to immediately transmit medical data, but many were close enough to a hot spot to send the information within a few days.
"Just having them come into the hospital isn't the answer anymore for a lot of reasons," said Sorenson, the hospital's telemedicine director.
The devices send the readings straight to the phone, which sends them directly to Kelly DeGraff, a hospital nurse. She then can look at the data and determine whether a follow-up call or text is needed. One patient she's been in contact with is Joe Alini, who has been dealing with kidney failure and heart problems.
The project is backed by the National Institutes of Health, Verizon, Qualcomm Incorporated and Zephyr Technology. It isn't specifically aimed at American Indians, but they will benefit. Nearly 30 percent of patients at the Flagstaff Medical Center are American Indian, the majority being Navajo. Seven percent of them have had congestive heart failure, compared with 4 percent of non-Native patients.
The association of course is slated to look at cost and then secondly improve the market place and this is not new. Private insurers have seen some golden opportunities to make money with insurance exchanges and the government 
exchange for consumers has been halted according to the statement made in this article from the Governor’s office. They are not the first state as Kansas is yet another state who has backed away from the idea, even though under reform this is mandatory by 2014. Sure there are parts of the reform bill that need some change and this is just simply due to current economics and changed times, especially with technology. We have seen leaps and bounds since the law passed with Health IT and somethings need amending.
Wisconsin with their new governor has not been very happy with a lot of what has occurred since taking over and I am guessing the recall action is still alive and well. Just a couple days ago another company called “InsureMonkey” (which I hate the name) put out a video for online shopping for insurance. I guess we are all monkeys now when we don’t have insurance from employers. It’s just one more effort to aggregate data and they earn the same as any commissioned sale rep for selling policies and their privacy policy is a bit unclear to me, but that’s not unusual today as we see this quite commonly with legal terminology written beyond the understanding of the average layman.
I said a while back if a platform is all we are looking for, use the one at EBay for goodness sakes and save some money. It’s still the same old race as to who can create the most “saleable” algorithms for consumer use and of course the branding and marketing enter here as well and thus so why I think branding with the name “monkeys” sucks.
Again, I think HHS is ready for major overhauls here as they are not keeping up with regulating insurers and big business plays the business intelligence and algorithm game to the max for profits and we end up with some unintentional consequences due to that fact. I said back when Sebelius was nominated that we needed a leader that had some Health IT in their background and over the last two years the job has expanded to where about 70-80% of the decision making processes for that job would involve Health IT and we are certainly at that point today. We need more than just figureheads for executive departments. BD
Six of the largest health insurance companies in Wisconsin have formed a new trade association, including four that used to belong to another group that includes Dane County's main insurers.
The new Alliance of Health Insurers is led by board president James Riordan, president and CEO of Madison-based WPS Health Insurance. Other members are Anthem Blue Cross and Blue Shield in Wisconsin, Humana, Managed Health Services Insurance Corp., UnitedHealthcare of Wisconsin and WEA Insurance Corp.
The alliance, announced Friday, "will advocate for essential and effective industry regulations that serve to foster innovation, eliminate waste and protect Wisconsin health care consumers," the group said in a news release.
As the article mentions we are all pretty much aware of the daVinci robot for many 
surgical procedures and now the university has some open source action taking place with research and will be providing a few other universities including Harvard and Johns Hopkins. After distribution has been made to to all, the robots will be connected via the internet for data sharing and collaboration.
The daVinci is not going away any time soon but through collaboration we might see some new innovation and research and the ability to share and perhaps create additional options for surgical robots. BD
The cost and complexity of commercial robot surgeons has meant slow penetration in the market and to only one player–Intuitive Surgical’s da Vinci.
But that could all change if researchers at the University of Washington (UW) carry out their plans to accelerate innovation in surgical robotics.
UW researchers will do final testing and then ship their latest version of robots named Ravens to five universities, including Harvard University, Johns Hopkins University, and the University of Nebraska-Lincoln.
The software running the robots is interoperable with the Robot Operating System, a popular open source robotics code. Once installed at each campus, the Robots will be connected to each other via the Internet to allow for data sharing and collaboration.
http://www.zdnet.com/blog/emergingtech/robotic-surgeons-get-open-source-boost/3101
Not only is the Department of Managed Care requesting payment, but they want interest paid too. Blue Cross said they settled matters on claims back in 2010 but perhaps this is another new issue as they paid fines a couple years ago.
Yes we are back to those nasty algorithms again that determine payment and if the 
code doesn’t run write or is not written correctly we have flaws. The full amount due is waiting a full audit of all the claims. Back a couple years ago Blue Cross used this ugly algorithm…again processes to where no human usually touches the claims and the servers running 24/7 make the decisions. Here’s a 3rd party along with Blue Cross that got caught on a stress test algorithm. This one was pretty blatant and Med Solutions shut down the website back when I wrote the post over this.
We might still have this court case tied up too where Blue Cross used Ingenix 
(division of Untied Healthcare) algorithms to short pay. The AMA settled a suit with all carriers using the United/Ingenix algorithms a couple years ago for almost 15 years of short pay on out of network claims.
Insurance companies live off of their algorithms for every step of business they conduct and why we need to get into the math and algos.
This particular algorithm was pretty nasty to where parameters set in the code cancelled women who had breast cancer too. The word “fraud” detection is used and sometimes with the way the SQL statements are written, you false positives.
You know we go through all this trouble to certify and make sure medical records software is compliant and accurate but look what happens with the payers here and they have rogue algorithms running making decisions and denying care or money every where you turn around.
Now you can see why I was motivated to write about the “Attack of the Killer Algorithms” in healthcare and in the financial world too. Check all 7 part at the link below. All I can wish for is that our new Financial Consumer Chief doesn’t sit in denial in this area as we need help auditing corporate USA algos. BD
The California Department of Managed Health Care ordered Anthem Blue Cross of California to pay health care providers for services provided dating back to 2007 after a financial claims audit discovered alleged errors in how the company paid claims. Under the order, the company will be required to pay interest on any claims that are found to have been improperly paid.
The order stems from an audit conducted by the DMHC in 2008 that examined claims payment practices at the seven largest health care providers in California. The department launched the audit after it saw an increased number of complaints from providers about payments that were either late or inaccurate. In some cases, claims were inappropriately denied, the department said in a statement.
The DMHC required the plans to pay providers the money they were owed and to demonstrate improvements to the plans' claims processes to prevent future errors. Carriers also entered into settlement agreements to pay administrative fines for their allegedly improper claims practices. To date, six of the seven plans have undertaken provider remediation efforts.
Rodger Butler, a spokesman for the department, said as many as 2.6 million claims submitted to Anthem Blue Cross have been called into question. Butler said the department has not assessed a total for how much Anthem Blue Cross may owe because it is awaiting the results of a review of those claims.
http://insurancenewsnet.com/article.aspx?id=325961&type=lifehealth
I like all the new technologies but again we need consumer trust to have ideas take off and become beneficial. If a consumer can be assured that their information is 
safe and the fact that they are not generating data for additional corporate greed, as much of this information is ending up at hedge funds, social networks and so forth then we could have a winning situation. Technology and what it can do and where will continue to evolve and present itself, and then it is up to the consumer as to whether or not to buy in. For someone with chronic conditions to monitor, this could be great, but it still need to be a matter of “choice” and not force fed for profits to sell data. We see so much of that today and this is one of the reasons that mHealth is having a slow go in many areas.
Why should a consumer have to contribute via their data to big corporate profits to adapt a healthier lifestyle or why should one be forced as it’s not getting any better for the consumer today with data being sold right and left, and we continue to read about corporate profits based on this fact and we have no transparency of what is really being mined and sold as there’s no real laws that provide a place for public disclosure but rather we have these finely crafted privacy statements that sometimes are very confusing and when you use certain services, you agree in a round about way to release your data, so it’s mixed bag.
A couple years ago I would have never seen myself making a post like the one below but marketing and selling data today is on steroids, so much to the fact that state servers are slowing down to a crawl with data mining bots and some states have had to put software in to keep 
the bots out so consumers like you and me can have access, why the sites were created in the first place. Again, the consumer loses again as corporate greed in one way or another locks us out, give that some thought.
A good comment made here too is that the companies are not going to try to use such monitoring systems for diagnosis but will remain with monitoring as the FDA would need to become involved if diagnosis were a model here. If you have not seen the video at the link below, check it out as there are some good examples that show how consumer data is used, and again corporate USA gets all of this for free and makes billions.
Implementation is important today and I see a lot of bad ones out there, again tossed in the face of a consumer without full explanations of how the entire circles work. If something like the car was forced upon consumers rather than remaining a choice, then we at some point reach a conclusion of “who wants a car” that’s going to be a vehicle to promote corporate greed and profits? Of course that would create a whole new market for “old cars” that do not have this built in for the sake of privacy <grin>. The same can be said for a pen or pencil you use too, will there be cheap monitors there too? From earlier this year you can read more about biometric monitoring with Ford and Medtronic.
There’s also a lot of work with cars that drive themselves too so think about this one if you were to add health monitoring here? The car could be a bit scary when it comes to the data and who gets it as someone will hold you accountable perhaps at some point with a risk analysis report. If one were a diabetic could they only get car insurance on vehicles that monitor? That’s the way as an example that risk assessment works for profit and cherry picking would continue.
So what’s next, dialysis in the car while one drives:)
Again technology will continue to evolve and how we use and implement is the key to success without giving away “free taxpayer data” for bigger corporate profits and items as such should always be a choice along with transparency and disclosure other than the jumbo we are presented with today. Our new consumer financial chief’s area of responsibility is going to grow quickly and I hope he understands algorithms, math, deception and has a tiny bit of IT in his background to fully investigate what needs to be done to help protect consumers today, or we do have “The Attack of the Killer Algorithms” in any direction we will turn.
Richard Corday has his hands full and will need his own group of geeks and engineers to keep up with what corporate USA is doing today and determine when discrimination by algorithm occurs. The link below contains parts 1 to 7 on my viewpoints on the Killer Algorithms that have teeth and live amongst us. Information is running on servers 24/7 with no real consumer transparency today and thus I believe this is the ultimate factor that actually created the “Occupy” movement out of sheer frustration as you can’t see, talk or touch those algos that make life changing decisions that affect all of us in split seconds with data and sometimes severely flawed data that we have to chase and correct. BD
Ford Motor Co. is building on its in-car health monitoring initiative by teaming with Microsoft and Healthrageous to research how people can monitor their health and promote wellness with connected devices while in their vehicles. The companies are taking advantage of the spotlight at the massive 2012 International CES trade show in Las Vegas this week to show off a prototype called “the car that cares.”
Healthrageous, a Boston-based producer of online and mobile apps for self-management of chronic diseases and preventive health activities, is embedding its “digital coach” technology into the Microsoft-powered Sync communications and entertainment system now common in Ford vehicles.
“Sync will be Ford’s key technology supporting activities in the health and wellness sphere,” Gary Strumolo, manager of “infotainment,” interiors, health and wellness in the Ford Research and Innovation division, said Wednesday at the CES Digital Health Summit.
Novartis was also in the news for the recall of several over the counter drugs in the last week and has closed one factory in the US until corrections are made.
The changes in restructuring and layoffs are slated to begin in the second quarter of this year, not that far away. There was also a clinical trial that failed to prove it was lowering blood pressure as patients who took the medication actually did worse so it appears that drug in it’s current formulation is not going to offer any relief in the immediate future. BD
ZURICH (Reuters) - Novartis AG is cutting nearly 2,000 jobs in the United States ahead of the patent loss of top-selling blood pressure drug Diovan as it braces for tough market conditions and a slump in sales of another key drug.
Novartis is the latest in a long line of global drugmakers to cut their sales forces as the industry faces its biggest wave of patent expiries in its history.
The group will book a one-off charge of $900 million in the fourth quarter after a clinical trial showed patients taking its blood pressure pill Rasilez actually did worse, meaning sales of the treatment, previously tipped to rake in sales of more than $1 billion, are likely to plunge.
The Swiss drugmaker is currently in talks with regulatory authorities on both sides of the Atlantic about whether this drug, once seen as a Diovan successor, could end up being pulled from the market, a spokesman said on Friday.
The Basel-based group has already cut thousands of jobs and shut several sites, notably in Britain. It has also shifted its focus to specialty medicines in a bid to boost profitability and protect its bottom line.
http://news.yahoo.com/novartis-slash-nearly-2-000-u-jobs-070115452.html
This case beyond the ugly pornography charges get even more interesting with the new charges added on. Somehow when the company billed for their services someone forgot that there are audit trails. 
The doctor was a medical director of a company that provided monitoring services surgical procedures using the Internet. It appears that even when the web was down at certain locations, the service was billed anyway. Doctors were not able to monitor either due to no connection or tech issues with getting the service live.
The charges are that the billing took place whether or not the monitoring by physicians took place or not, and, this is a big and here, employees posed as doctors to monitor and now we have crossed another line here with employees logging on to monitor a procedure to where a doctor was promised and should be there as part of the service. On top of that the type of surgeries were neurophysiologic, so complex and specific in nature. Modern technology does a lot for healthcare but it also has to be present to create a billing. BD
Dr. Daniel Joachim, 51, was charged Wednesday in federal court along with Maryland company Physicians Analytical Services Inc., according to U.S. Attorney Jim Letten's office. Joachim and the company are accused of fraudulently billing insurance companies and pension and benefits programs for surgical monitoring services.
Joachim was first charged in federal court with receipt of child pornography in August 2010. He is accused of trying to receive sexually explicit images of children and faces a mandatory minimum sentence of five years in prison if convicted, according to court records.
The superseding bill of information handed down Wednesday retains the child pornography charge but adds the health care fraud charges, Letten's office said.
http://www.nola.com/crime/index.ssf/2012/01/health_care_fraud_charges_adde.html
Here we go again, more flawed data except this time it’s on the side of research and not on the the consumer side of aggregated data. The research was very popular as of course it talks about the benefits of red wine and Resveratrol. Even back in 2009 Dr. Oz and Oprah went after the Anti-Aging Scammers that were using their names.
There’s a lot of flawed data out there whether it is created or gets put in place with aggregating data that is either erroneously input or combined with other data and this is an awareness warning for all. I go after the flawed data that haunts consumers all the time with data mining and actually we should charge and license those folks who sell this data as much of it mined from the web is erroneous and yet we are grilled at the stake over those assuming all is accurate. Hershey even jumped on the bandwagon back in 2008 with saying chocolate was healthy with 
the resveratrol compound.
This is a good audio broadcast to listen to as Professor Siefe from NYU explains some of how the research and journals gets fabricated with marketing fogging up the horizon all the time. BD
There’s a ton of healthcare addressed here.
The University of Connecticut, in what clearly seems like an attempt to get ahead of damaging news, has announced an “extensive” investigation into research misconduct involving one of its scientists, Dipak K. Das.
According to a press release, the university has notified 11 journals that published Das’ work about the alleged fraud. One area of interest for Das, a government-funded professor of surgery and director of the Cardiovascular Research Center, has been resveratrol, a substance in red wine that has allegedly been linked to improved cardiac health
The abuses in one lab do not reflect the overall performance of the Health Center’s biomedical research enterprise which continues to pursue advances in treatments and cures with the utmost of integrity,” he added. “We demand full compliance with all research standards and policies by our faculty and staff.”
According to the release, the 11 journals where Das may have published fabricated data are:
American Journal of Physiology – Heart & Circulatory
Antioxidants & Redox Signaling
Cellular Physiology & Biochemistry
Free Radical Biology
Free Radical Research
Journal of Agriculture and Food Chemistry
Journal of Cellular & Molecular Medicine
Journal of Nutritional Biochemistry
Journal of Pharmacology and Experimental Therapeutics
Molecular & Cellular Cardiology
Molecular & Cellular Chemistry
This is good news as I have ranted about mobile apps that do “one thing” for a long time and with what is written here, device agnostic software along with 
agencies leveraging each other’s gains is nice. We have way too much glut and too many “me too’s” out there and not only in healthcare but even at CES this was mentioned as well. We have device fatigue. If you read the link below I did a little out of the box commenting with software used for medical records and then some.
Now if he can just slowly break Aneesh away from the “I” word above and talk more about collaboration things will work better I think. I kind of got tired of hearing Chopra talk about how programmers could get rich to stimulate them into writing code. Some got stimulated alright but not enough for the government as many went to work writing algorithms that mine social data instead. As mentioned, a government mobile apps store would be great and again with sharing between agencies with some APIs and scripting one agency can benefit from another. BD
Federal Chief Information Officer Steven VanRoekel launched an interactive dialogue on government mobile policy on Wednesday that he said would be the first step toward a government wide mobile roadmap due out in March.
That roadmap, VanRoekel said, will address a range of issues from ways the government can save money -- such as by buying smartphones in larger quantities -- to serving citizens more effectively through public-facing apps.
As things stand now, too many agencies and bureaus are putting time and effort into mobile projects without leveraging each other's gains, he said.
It also will include information about building internal mobile applications to help federal field officers, such as U.S. Forest Service workers and Border Patrol agents, do their jobs more efficiently.
VanRoekel's office is considering something along the lines of a governmentwide apps store so one agency can adopt or retrofit an app another agency has developed, he said. Apps placed in that store would probably be required to be "device agnostic," he said, so the government wouldn't become overly dependent on a particular provider of mobile devices.
http://www.nextgov.com/nextgov/ng_20120111_3812.php?oref=topnews
He likes most of what technology has done but says not to use it a surrogate for 
caring for patients He talks about how fast we are and out of the hospital and how technology has given us better quality of life.
The videos were done by the discover channel and are short and answer one question. BD
One more…what is integrated medicine?
This look very promising and the technology is pretty fascinating. In the video you see a couple children who could benefit without the needle stick, and adults for that matter could benefit too. Similar efforts have been made too with an implant under the skin but if the contact lens could do it all, much more convenient. 
Maybe the CES show was not very exciting, but this make up for it. This is still work in process but the lenses would work and could send information to an insulin pump, done in real time. The video is great and explores a few other potential uses of monitors creating information with contact lenses. BD
Millions of people worldwide live with type 1 diabetes, a chronic medical condition that requires constant, daily vigilance to maintain proper health. People who have type 1 diabetes must check their blood sugar (glucose) levels multiple times a day, which can be an unpleasant, painful process. Researchers at the University of Washington are developing a solution that would painlessly monitor glucose levels through tears rather than blood and provide feedback to the patient immediately, should a problem begin to develop.
Diabetes is a potentially devastating disease with no known cure. The pancreas of a person who has type 1 diabetes does not produce insulin. The failure to strike the right balance between food and insulin intake can lead to extreme physiological reactions—from crying jags to loss of consciousness. The long-term effects of uncontrolled blood glucose imbalances can be even more devastating.
Non-Invasive Blood Glucose Monitoring
Today, people with type 1 diabetes use needles to prick their fingers multiple times throughout the day, every day, including meal times, to collect blood samples that allow them to monitor and maintain healthy glucose levels, which is critical to reducing the impact that diabetes has on the patient’s health. The never-ending, daily blood draws are not only unpleasant for the person with diabetes, but they also provide limited information.
http://www.microsoft.com/casestudies/Case_Study_Detail.aspx?CaseStudyID=4000011273
The one doctor below makes a very good comment as to why this went so long as several ER doctors had flagged his prescribing methods, and yet if there’s bad record keeping, the medical board is all over a doctor. 
!2 patients died since 2006 and he was known as the Candy Man by some patients. When you look at the one example of a patient being prescribed over 2000 pills in six weeks, I think that’s a flag. The other issues at hand were female patients with drugs for sex. This should prove to be an interesting case and all the traffickers are not on Florida. For 15 years the DEA had complaints about the doctor. This was pretty bad when other doctors get in touch with the DEA to report you and looks pretty obvious. BD
(SANTA ANA, Calif.) — Emergency room doctors at a Santa Barbara hospital saw a disturbing trend for more than a decade — patient after patient hooked on prescription drugs shared the same physician.
Despite their complaints to state medical authorities and federal law enforcement, Dr. Julio Diaz continued practicing even though 12 patients had died since 2006.
His arrest Wednesday on federal drug trafficking charges came as no surprise to some who knew him. What stunned them is that it took so long.
"I don't really understand what happened there," said Dr. Chris Lambert, an emergency physician at Cottage Health System who was one of the doctors to flag Diaz's prescribing patterns. "Physicians these days get censured for bad record keeping — the medical board is on them immediately for making an error in a chart. But what happened in this case? How did it slide along?"
Diaz hasn't been charged in connection with the deaths, which remain under investigation. He is accused of illegally prescribing large amounts of painkillers to patients who didn't need the drugs and for accepting sexual favors as payment from some women.
Lambert said the complaints about Diaz date back roughly 15 years, and doctors reached out to the DEA about four years ago. DEA spokeswoman Sarah Pullen said the investigation into Diaz began in mid-2009, but she was unaware of any prior complaints against him.
http://www.time.com/time/nation/article/0,8599,2103834,00.html
This is pretty amazing that the man had a spinal injury and could not walk for 3 years and now is out of the wheelchair 
and moving around just fine. The device blocks pain receptors which allows him to move. When you look at the alternative of just under 300 pain tablets a month, what change.
The device actually learns how much stimulation he needs for the pain, we have “device” learning here. BD
Jeff Hardick shot up from his chair in the waiting room at St. Luke's Hospital in Fountain Hill, strode over to neurosurgeon Steven Falowski and wrapped the man in a bear hug.
A month ago, that would have been impossible."I gotta give you a hug," Hardick, 51, of Bangor, said, "because you saved my life."
Hardick spent the last three years in bed, slumped in a wheelchair or stooped and grimacing while tottering around with the aid of a cane. He struggled due to constant, crippling pain from a back injury. He was prone to blacking out and falling down. He couldn't work or drive and was mired in depression.
Falowski placed a device onto Hardick's back that sends an electrical current to block pain receptors. It is one of 13 devices available nationwide after the manufacturer, Medtronic, gained Food and Drug Administration approval in November. Hardick is the second person in the nation to have the device installed, Falowski said.
The Hardicks said the road to the new device was littered with doctors who told Hardick he would spend the rest of his life in a wheelchair. Jeff said one doctor even told him to wear a helmet because of his blackouts. He took 270 pain pills a month, plus antidepressants and a sleep aid.
He hasn't touched pain medication since the surgery.
http://www.lehighvalleylive.com/bethlehem/index.ssf/2012/01/bangor_man_benefits_from_new_m.html
It does look like a site where one would book travel and they make a commission 
from the policy that is sold. All information is aggregated by location and a consumer can shop from there, but maybe this is more like “Cheap Flights” <grin>.
Below is an image that shows a Co-Pay Saver from United and it has pop up windows that describe whether or not you are getting first class or coach.
The name is correct as this seems like a bit of a zoo just like shopping anywhere for insurance. They license the technology out to health insurers as well. You know not too long ago I sad Ebay would be the place for insurance exchanges but perhaps they have a better search agent going here, but no word on if you can use PayPal.
If this doesn’t work here you might be venturing to Walgreens soon as it has been mentioned they could be considering selling insurance too, but hey they might just put a kiosk in the store and collect the commission from InsureMonkey, ok you heard that speculation here first.
The government has a page too that helps folks search for insurance and the company does not do any ratings yet but outsources that part of the business to another company. BD
InsureMonkey allows consumers to compare insurance providers online to find the best rates.
http://www.youtube.com/watch?v=zCeGP_4obyw
Imagine getting your Excedrin bottle out and getting a lot more pain killer for the buck? There could be a run on the products before they all get pulled from the 
shelves for those who may abuse pain killers. On the other hand when one needs a strong pain killer like after surgery, you only get Excedrin. The opioid drugs are sold by Endo Pharmaceuticals as Percocet, Endocet, Opana and Zydone.
I have been on this kick for at least 2 years now with my bar code campaign for FDA recalls for both drugs and devices and we have nothing yet except a whole lot of inconvenience for consumers.
You can read more here….and here...
In addition, the factory being closed will produce shortages possibly, so this is no win all the way around.
In addition it’s getting easier and more secure with bar codes too if you read the article about about Microsoft Tags being able to create QR codes as well and these can go through an encrypted server. Below is an article I wrote about a man who died because he was mistakenly implanted with a “recalled” device that was missed from being pulled, so enough is enough with pharma and device companies not doing something here as things will happen but no plan for a disaster is a disaster. BD
CBS/AP) The Food and Drug Administration and Swiss drug maker Novartis warned yesterday that over-the-counter medications may be
mixed up with powerful painkillers.
Officials advised consumers to stop using the products following hundreds of complaints about broken or incorrect tablets winding up in pill bottles.
Novartis recalled 1,645 lots of drugs including Excedrin, Bufferin, NoDoz and Gas-X. These drugs may have accidentally been packaged at the Lincoln, Neb., facility with powerful prescription painkillers made at the same facility. The opioid drugs are sold by Endo Pharmaceuticals as Percocet, Endocet, Opana and Zydone.
During an inspection, FDA inspectors uncovered a manufacturing problem that could allow pills to become stuck in the machinery and carry over to the packaging of other products, Cox said. The agency says the investigation is ongoing and would not comment on potential penalties against Endo or Novartis.
The FDA and Endo Pharmaceuticals recommend patients examine their prescriptions to make sure all the tablets are similar in shape, color, size and marking. If one or more of the tablets look different, patients should return the medicine to their pharmacist.
Consumers should visit www.novartisOTC.com for a full list of recalled products, and they can call Novartis at 1-888-477-2403, Monday through Friday, 9 a.m. to 8 p.m. EST. Patients can also call Endo Pharmaceuticals' call center at 1-800-462-3636.
Doctors’ adoption of health information technology doubled in two years, according to a new report, Department of Health and Human Services Secretary Kathleen Sebelius released Wednesday. Sebelius also announced extension of the meaningful use qualification date to 2014. See link for more info – http://www.healthcareitnews.com/news/hhs-extends-mu-stage-2-deadline-spur-faster-emr-adoption?topic=01,08
The survey I posted earlier has now been completed – here are the results.
http://blog.softwareadvice.com/articles/medical/benefits-of-emr-software-survey-1081611/
High physician fees, rather than factors such as practice costs, volume of services or tuition expenses, were the main drivers of higher U.S. healthcare spending and physician income, according to research presented in the September issue of Health Affairs.
The study, conducted by Miriam J. Laugesen, PhD, and Sherry A. Glied, PhD, both of the Mailman School of Public Health at Columbia University in New York City, found that in some cases, physicians in the U.S. are paid as much as double their counterparts in other countries. There is also a larger gap between fees paid for primary care and fees paid for specialty care, particularly orthopedic surgeons, in the U.S. compared to other countries evaluated by the study.
Fees paid by public and private payors for primary care office visits and hip replacements were compared in six countries: Australia, Canada, France, Germany, the U.K. and the U.S.
Laugesen and Glied found that primary care physicians in the U.S. were paid, on average, 27 percent more by public payors for an office visit, and 70 percent more by private payors for an office visit, compared to the other countries. The largest difference in fees paid between countries was for hip replacements. Physicians in the U.S. were paid 70 percent more by public payors and 120 percent more by private payors for these procedures as compared with physicians in the other countries.
Across the fees analyzed by the study, the biggest disparities in pay to U.S. physicians existed on the private side. Fees paid by private insurers in six markets in the U.S. averaged about 33 percent above Medicare rates for primary care and 50 percent above Medicare rates for hip replacements.
“Our analysis suggests that policymakers in all countries need to consider how differential prices paid by both public- and private-sector payors to specialists influence specialty choices,” wrote the authors. “Furthermore, this analysis suggests a need for greater standardization of cross-national data on the nature of physician services provided, fees, education and incomes to allow ongoing comparative research on the relationship between prices and healthcare spending growth.”
Incomes were also higher for U.S. primary care and orthopedic physicians compared to their foreign counterparts.
The authors said other factors thought to contribute to physicians’ fees, such as high medical education tuition costs for American physicians or increased work volume, could not fully explain the disparity in fees when compared across the countries.
“Although the tuition cost of medical education in the U.S. borne by individuals is substantial, it cannot fully account for the observed differences between the earnings of U.S. physicians and physicians in all other countries,” wrote Laugesen and Glied.
For the services examined by the study, higher physician incomes did not appear to be due to a higher volume of services, though the authors acknowledged the rates of other procedures not studied may be higher and contribute to the elevated fees and incomes.
One possible explanation offered by the authors for the high U.S. physician fees was the notion that higher fees may reflect the cost of attracting highly skilled candidates. When physician fees in each country were compared to the mean incomes of the top 1 percent of households within that country, the results were broadly consistent, suggesting higher U.S. fees were the result of a “society with a relatively more skewed income distribution,” according to Laugesen and Glied.
The New York Times (9/6, B1, Freudenheim, Subscription Publication) reports, “Under heavy pressure from government regulators and insurance companies, more and more physicians across the country are learning to think like entrepreneurs.” One result is the rapid growth in joint M.D./M.B.A programs to 65 at present with an estimated 500 students. Some intersperse business courses with medical courses while others have students complete their medical training and add a year or more of business education. “Dr. Barry R. Silbaugh, chief executive of the American College of Physician Executives, a professional society that provides medical education courses and career counseling, said more start-ups were being run by doctors.” He explained that some “are focused on adapting technology to health care, not just electronic medical records,” adding, “The use of social media is of great interest to many younger physicians, and so is health care analytics.”
The Minneapolis Star Tribune (9/7, Crosby) reports, “Finding ways to keep a lid on the pressure is becoming ever more difficult for doctors-in-training, according to a new Mayo Clinicstudy ” published in the Sept. 7 issue of the Journal of the American Medical Association. “Large numbers are burned out, depressed and becoming increasingly cynical about their work.” In addition, “they’re deep in debt and finding it impossible to balance work and life.”
HealthDay (9/7, Doheny) report that after evaluating the “results of surveys and exams given to nearly 17,000 internal medicine residents, who were said to represent about 75 percent of all US internal medicine residents in the 2008-9 academic year,” asking them about their quality of life, work-life balance, amount of educational debt, and whether they experienced burnout, researchers found that 46% “said they were feeling emotionally exhausted at least once a week,” while over 50% admitted to at least one symptom indicative of burnout.
Medscape (9/7, Lowes) reports, “Internal medicine (IM) residents experienced more symptoms of burnout and scored lower on a standardized medical test if their educational debt was higher.” Notably, “the same pattern emerged for two manifestations of burnout: emotional exhaustion and depersonalization, which presents itself as a calloused, cynical mindset.” In fact, “these scores climbed in tandem with educational debt.”
On my way to Nashville for “ACE”. The Allscripts annual conference. Check out the cool iPhone app – ACE2011. A packed agenda. Should be fun.
Catching up on all the PCMH stuff- lots to learn. Anyone out there going through the PCMH process? Let me know your thoughts.
Please click on this link to take the survey – only takes 2-3 mins. Thanks!
http://www.softwareadvice.com/articles/medical/benefits-of-emr-software-survey-1081611/
Like the dot-com bubble, the EHR bubble—nurtured by the government incentives—will not last. As I look at what’s happening in the market, it becomes apparent that at some point in the not-too-distant future, the EHR bubble will pop and many vendors will face financial challenges that will lead to their demise.
Several market factors will come into play, including:
To understand how these factors will affect EHR vendors, it is important to understand how such companies typically raise money and what kind of “hockey-stick” growth projections they made to attract investors.
Missed growth projections; continued expenses for implementation, support, and ongoing upgrades; and diminishing government incentives will leave many companies unable to find investors willing to fund their future growth.
There will be market consolidation, and financially strong companies will acquire distressed companies for pennies on the dollar.
…To read the full story, see HIStalk Readers Write.
Related posts:
HHS has made it official—Stage 2 of meaningful use will be pushed back to 2014. The announcement by HHS Secretary Sebelius came as no surprise, following as it did the recommendation made by the HIT Policy Committee and the endorsement by ONC head Farzad Mostashari. The change only affects providers whose first incentive payment year is 2011, since they are the only providers who would be subject to Stage 2 regulations in 2013 had the delay not been implemented—everyone was already entitled to 2 years of meaningful use at Stage 1.
What I find interesting about all the hoopla that has accompanied the announcement is the spin the government put on the decision. According to the press release from HHS, “To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.”
Isn’t it a bit late for a provider to decide to adopt health IT this year? In reality, this announcement is too last-minute to change any adoption-related behavior or to accelerate EHR adoption. The announcement continued, “Perhaps most importantly, we want to provide an added incentive for providers attesting to meaningful use in 2011.” Apparently, the goal is to accelerate attestation rather than adoption—to encourage physicians who were already using certified EHR technology in a “meaningful way” to attest and to collect an incentive payment this year, instead of holding off attesting until 2012. This would create a potential PR benefit for the incentive program, which currently boasts nearly 115,000 registered providers, but reports that only 10,155 (9%), have successfully attested.
The benefit of the schedule delay accrues only to the early adopters, who now can earn 3 years of incentives under the less stringent requirements of Stage 1 (only, however, if they are willing to forego their 2011 Medicare ePrescribing bonuses—not a worthwhile trade-off for high-revenue physicians with large Medicare volumes). In its statement, HHS acknowledged the pushback from providers regarding how challenging even the Stage 1 requirements are. Perhaps, it would truly spur program participation and EHR adoption if all providers—not just the early adopters—were entitled to 3 years of meaningful use under Stage 1 rules. Also, if CMS has so little confidence that physicians will succeed at Stage 2, shouldn’t it reconsider how much it plans to raise the bar?
Related posts:
Last week’s EMR Straight Talk post, “Are EHRs Being Oversold,” hit a nerve, judging by the number of readers and the volume and intensity of comments submitted by physicians. Sadly, for every one of the physicians who took the time to write, there are scores of others enduring similar experiences. The following excerpts from their comments are reflective of their frustrations:
Every one of these stories breaks my heart as a staunch EHR proponent—particularly since the situations could have been easily avoided.
The Root of the Problem
The problem lies in the EHR selection process. When it comes to dispensing medications, for example, no physician prescribes without knowing the success rate for that particular drug for that particular type of patient and problem being addressed. Yet, typically, physicians do not make EHR purchase decisions in the same way that they make clinical decisions—using empirical evidence and data to predict outcomes.
I’d wager that for each of the disillusioned physicians above, the EHR selection process was nearly identical:
Why does such an exhaustive and time-consuming selection process so often lead to failed EHR implementations?
Preventing an EHR Failure in Your Practice
To prevent an EHR failure in your practice, the flawed selection process must be altered. The first thing to understand is that the rosy experience of one or two handpicked vendor references will not guarantee a similar experience for you and your colleagues. If a vendor has sold its EHR to 100 practices and has as few as 5 successful implementations, you will be referred to one of these 5 practices. A visit to 1 or 2 of these 5 successful practices may leave you with a warm and fuzzy feeling and the expectation that, because they were successful, your success is virtually assured. In this case, however, your real probability of success would only be 5%.
Separating the Wheat from the Chaff
So how do you quickly eliminate vendors with lackluster success records before you and your staff waste hours watching slick sales demonstrations of sexy software with “must-have” features? Separating the wheat from the chaff is simple—just ask all your initial set of EHR vendors for lots of references. If a vendor cannot produce at least 2 references for each year they have been in business, run the other way. Do not accept any excuses for being unable to provide you with the number of references that you seek. (A common excuse is that the vendor wishes to protect the privacy of its clients.) If they had lots of references, they would give them to you in a heartbeat—happy customers are always willing to show their successes to others.
Many of the initial vendors chosen will not be able to produce a satisfactory number of references. This should narrow down the number left for you to consider, and it will save a tremendous amount of valuable physician and staff time.
Statistically Significant Reference Checking
At this point, your list of vendors will likely include just the one or two that have provided you with a meaningful reference list. You may have to accept the bias created by the fact that the references are carefully handpicked by the vendor(s), but it is imperative that you do not limit your inquiries to the specific physicians identified by the vendor. Typically, these are the practice administrator and one or two physicians who had spearheaded the EHR purchase for the practice; as a matter of pride, they are more likely to paint a rosy picture of the EHR than to acknowledge its shortcomings. The only way to avoid this trap is to speak with other physicians at the reference practices. This is easy to do. When you get the reference list from an EHR vendor, ask them to include the practice websites, then randomly choose physicians to call from the physicians’ bio pages. These physician-to-physician calls should be short (only 10 minutes each) and you should ask specific questions about cost, efficiency, and number of patients seen. The American Society of Cataract and Refractive Surgery (ASCRS) has an excellent set of questions on page 5 of their EMR selection guide .
How much of your time should this type of random reference checking take? Not much! Ten 10-minute calls (less than 2 hours of time) to randomly chosen physicians will yield more valuable data on your chances of success than having a slew of vendors demo their products to your doctors and staff for hours on end. Only after having conducted the due diligence described above will you be able to derive real value from spending your time seeing demos—because you will only be seeing demos of the one or two EHRs that you now know are likely to deliver success.
Related posts:
I am a firm believer in the tremendous value that the right EHR can deliver to physicians, so the historic dissatisfaction with the EHR industry—as reported in studies and anecdotal conversations—has long disturbed me. The alarming intensity of this dissatisfaction was brought home by visitors to my company’s booth during the recent AAO (American Academy of Ophthalmology) meeting.
I was truly appalled by the abject frustration and anger expressed by numerous physicians about their EHRs. One visitor described his experience by saying, “It has taken the joy out of practicing medicine.” Another said that he felt like he should put a picture of his face on the back of his head so that his patients could see him—because he was forced to focus on the computer and enter data while the patient provided information. Physicians universally complained about the “productivity-killing” impact.
Why is this so? I know there are good EHR products in the market that physicians enjoy using and that enhance, rather than reduce, their productivity. Why are physicians not more successful in finding these?
The answer is that EHRs are being oversold. There are many EHRs that are marvels of software, capable of doing incredible things, but the selection process that physicians typically employ is flawed, and the sales process capitalizes on this shortcoming. The salesperson dazzles them with a demo, or they take prospective purchasers to see a physician—typically just one or two—who adeptly uses the software. This creates a false sense of ease-of-use, and the physician prospect leaves the site visit expecting that he or she will be able to use the EHR just as successfully. But not all physicians are alike—they may all be very intelligent and have tremendous medical expertise, but they are not all equal in technological inclination or skills. Their success—or lack thereof—with a particular EHR will vary significantly.
This brings us back to the importance of doing due diligence—something I have talked about before. Call and/or visit a variety of physicians who represent a wide spectrum of proficiency. Go to the reference practice’s website and select physicians on your own—don’t rely on the vendor’s selection. Ask the kind of questions listed in the last EMR Straight Talk. This is the only way to increase the odds of a successful EHR experience, and to avoid making a painful and costly mistake.
Related posts:
I’ve written frequently about the unique needs of specialists and how these have been overlooked by the government and by EHR vendors. Since many ophthalmologists are heading off this week to the AAO (American Academy of Ophthalmology) Annual Meeting in Orlando, I thought it appropriate to comment on the proactive advocacy and advisory role that this particular professional society has adopted on behalf of its members, and to encourage other academies to step up their efforts similarly.
AAO has been quite active on the meaningful use front. This week’s HIT Policy Committee’s Meaningful Use Workgroup meeting focused on how make meaningful use more meaningful for specialists in Stage 3. AAO was one of only two specialty societies represented in the public comments at the end of the meeting—the Academy’s representative pleaded that measures irrelevant to ophthalmology be replaced with those that would add value for these specialists, and offered the Academy’s assistance to accomplish this.
In addition to providing its members with otherwise unavailable, ophthalmology-specific direction on how to meet meaningful use, AAO has also offered much-needed guidance regarding the selection of an appropriate EHR for ophthalmologists—meaningful use aside. Recognizing that their unique specialty-specific workflow and data needs are not effectively addressed by most EHRs—because of the typical primary-care focus—AAO charged its Medical Information Technology Committee with the identification of a set of ophthalmology-relevant EHR specifications. A group of authors led by Michael Chiang, M.D., identified a set of features and attributes that ophthalmologists would find particularly valuable, and published their recommendations in an article titled “Special Requirements for Electronic Health Record Systems in Ophthalmology.”
While features and functionality are important, feedback from colleagues who actually use the EHRs is even more critical. The advice that AAO has given its members on how to make the most out of site visits will serve all physicians well, regardless of their specialty, and I am therefore sharing it with you below. It is reprinted from the publication “Electronic Medical Records: A Guide to EMR Selection, Implementation, and Incentives.”
ASK COLLEAGUES THE RIGHT QUESTIONS:
EHRs are here to stay, and will play an increasingly important role in medical practices. A major investment, EHRs can dramatically impact practice operations and productivity—positively or negatively. It is my hope that, like AAO, the medical academies will use their clout and speak out more aggressively to protect the interests of their members.
Related posts:
| Healthcare IT, also known by the acronym HIT, is all about using information technology solutions such as hardware, networking, and software to help improve healthcare, save lives, reduce costs, and improve profit margins for healthcare organizations. Healthcare IT has always been important but recently it has been receiving more attention because the government and consumers (patients) | are demanding better service from care providers and healthcare IT is a good way to improve service.The healthcare system, especially in the USA, has some critical problems such as nurse and physician shortages, spiraling costs, poor consumer (patient) service, and lower revenues which lead to mergers | or acquisitions. Healthcare IT is in even worse shape because outdated infrastructure, legacy architectures, and monolithic applications prevent positive change from occurring. Healthcare IT can, if used properly, help reduce costs, improve care provider productivity (which can then alleviate some of the shortages), and significantly improve customer service to patients. |
