Omaha, Omaha, Yay Putin?

As always, the opinions expressed here are mine and nobody else’s. 

What a wild ride this year has been so far. As my son and I watched the Broncos -Panthers game, it dawned on me that I’ll never hear the famous words from the just retired Peyton Manning anymore. The young next generation QB on the Broncos team though didn’t do too badly though and seemed to keep his cool as he faced the Panthers and end up getting the better of them in the end. Flipping to the wacky Presidential election we’re going through, apparently Vladimir Putin is the new standard of excellence in leadership. 
I always look at our nation’s Declaration of Independence and focus on the words “We the people ” in the Constitution therafter, in the 18th century, those were indeed revolutionary words to even think about,  let alone write as a declaration. 

In our world we need to think ever more about empathy and healthcare as never before. Working at Healthcare Providers for some time now, I see the need for a better more efficient and effective way to care for people and believe truly that a combination of collaborative project management, appropriate resource allocation and technology that enhances patient care and safety has the ability to transform patient care in a positive way. 

I’ve also seen of late, the return of racist elements I’m society that were previously kept at bay which disappoints me greatly. 

Stay focused on the real substance of the world, the care and empathy that we all should have to better understand the human connection that makes us live a more harmonious existence. 

If you’re reading this blog post, just look around you and realize all of the good that is in your life and appreciate the ability to be able to give more of yourself for causes such as better patient care through information technology. 

Go get ’em!

We don’t “Lobby” in Healthcare IT, we “Advocate”

As someone who grew up in other countries before becoming a naturalized American, there’s always been some kind of fascination when it comes to what is called “lobbying” in the United States. I’ve never been able to understand it as it always seems that it goes against the grain of what I’ve always thought of the United States through history books and the Founding Fathers, whom I so admire for their simple vision that has overcome the tests of time. Yet, hiring professional lobbyists in the United States is perfectly legal and healthcare has been leveraging this legal loophole for sometime now. Just this year as an example, lobbying has come into the news through the change in the regulatory date for ICD-10 from October 1st, 2014 to October 1st, 2015. Most believe that this was the result of pressure from care delivery professionals that wanted more time to get their act together (I for one was against this).

Recently, it was reported in “Modern Healthcare” (September 10th, 2014) that Epic retained a lobbyist and as it was reported the filing said that it was “to educate members of Congress on the interoperability of Epic’s healthcare information technology.”

Last week, HIMSS delegates from across the country had their yearly visit to Washington D.C. for their HIMSS Policy Summit, held during National Health IT week where (as reported by Healthcare IT News) HIMSS had certain asks of the nation’s representatives, which were:

  • Minimize disruption in our nation’s health delivery system emanating from federally mandated health IT program changes.
  • Fund the National Coordinator for Health IT to achieve interoperability, improve clinical quality and ensure patient privacy and safety.
  • Expand telehealth services to improve patient access and outcomes and decrease healthcare costs.

The role of politics and healthcare will remain inextricably tied to one another. As we continue to move through this paradigm shift, these areas will ultimately focus on the future of our country’s care delivery and outcomes and the way that we, the patient, will receive our care.

The Tide is HIE, but we’re moving on…

CCD Example
CCD Example found online

Ok, so I was a “Blondie” fan in the 80s, I mean, who wasn’t really? During a breakfast meeting with some healthcare leaders on Friday, we discussed the need for an HIE and what it would mean to executive leaders in the region if they pulled out of the local healthcare information exchange when Meaningful Use requires that not only do you need to be interoperable with another healthcare provider organization that has the same electronic health record you have installed, but one that is different from your EHR as well that you can interface with. What is the need for an HIE then if CMS stipulates that you need to do this in order to attest to MU 2 anyway? In a HIMSS document, they mention that while working with Stage 1 objectives and measures, “an organization should keep in mind that future rule making around Stage 2 and Stage 3 requirements will include HIE capabilities”.

Many healthcare IT executives wonder whether it is worth the money to pay an HIE to follow their patients and make sure that CCDs or Continuity of Care Documents can initiate (see the generic example I found on the left). As of now, if my healthcare provider wants me to go to get a blood test, and the lab that I have gone to is the same one close to my house for the last 12 years (currently owned by a different provider in this day and age of acquisitions and integrations), I am happy that half a day after I get my blood drawn, I have the results on my smartphone app. A far cry from when I had to wait for days without knowing the result and that too, if my provider got it, saw it and then mailed it or faxed it to me (or I asked to come in to meet him for an appointment, pay co-pay, review the result with him, he makes a copy and then I took that copy home and filed it in my healthcare folder). Fewer trees cut down, less wait, less suspense. Patient Engagement at it’s finest.

As was noted in a Government Health IT News article, many of the measures in MU stage 3, such as sharing care summaries and care plans, rely on health information exchanges and while exchanging data remains expensive, with the core problem being standards, for data, transport and identification of patients. With underlying costs for long term interface development, support and maintenance remaining high, not to mention safety issues and the inability to have secure data when moving between different standards and processes at each care delivery provider.

We are getting to be more educated about our healthcare as patients and consumers of healthcare and we want to be. I watched CNN’s GPS with Fareed Zakaria on the April 20th episode and he discussed the study in which the US was found to be ranked #16 in terms of Social Progress by noted Harvard scholar (and committed Capitalist Michael Porter). America ranks poorly by a team that Porter has put together. Fascinating GPS episode and a must watch. It takes social aspects, community and your quality of life in a country and captures it in a framework that measures social progress in quantitative terms. In Health and wellness, the US ranks 70th and we spend more money in the world than many other countries. Access to information and communication, we are behind Jamaica at 23. These numbers surprised me. The penetration and access to information (like the mobile telephone subscriptions, we are 83rd) and we do better at access to basic knowledge at 39th (behind Cuba). Something to think about.


Comprehensive Primary Care Initiative

One on the ways in which the healthcare paradigm changed was when CMS Announced the practices for the Beacon Communities  for the Comprehensive Primary Care Initiative (CPCI) in August of last year. A document from CMS says that “CPC is a 4 year multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care.”

In order to support  a more effective and affordable quality of health care, approximately five hundred and two primary care practices in seven regions had been selected to participate in a new collaborative model. My home town of Cincinnati is one of seven regions that has been selected to participate in this new partnership between payers from the Centers for Medicare & Medicaid Services (CMS), primary care providers, health plans, state Medicaid agencies and businesses that were self-insured. The other regions were statewide in Arkansas, Colorado, New Jersey and Oregon, in the capital District and Hudson Valley region of New York and in the greater Tulsa region of Oklahoma.

In the CPCI Fact sheet it indicates that CMS will work with private and public payers and offer bonus payments to primary care doctors who are able to better coordinate care for their patients. Practices that participate in this initiative will be given resources to better coordinate primary care for their Medicare patients. These resources will assist physicians to work with their patients so that they can i) manage care for patients with high health care needs ii) ensure access to care because healthcare needs and emergencies are not restricted to office operating hours iii) be able to deliver preventive care so that they can proactively assess their patients to determine their needs and provide the appropriate and timely preventive care iv) engage patients and caregivers so that PCPs have the ability to also engage their patient’s families in active participation in their care and v) coordinate care across the medical neighborhood as the PCP is the first point of contact for many patients and takes the lead in coordinating care as the center of the patient’s experience with medical care by collaborating with other care providers that deliver medical care to the patient as a team. In addition, “CPC Clinical Quality Measures (CQM) population is CPC practice site based and should include all patients (not just Medicare patients) who have had at least one or more visits at the CPC practice site location during the “Measurement Year” and who meet the denominator inclusion criteria for the CQM.”

Needless to say, that collaborative and meaningful access to EHR’s is an important highlight in this process and should be seen as the basis for long lasting quality of care.

Nationwide Health Information Network News

Recently, I received word from one of the several HIMSS emails I receive that the ONC is going to be asking for public comment on its RFI for “Governance of the Nationwide Health Information Network”. This up on public display from May 11th by the Office of the Federal Register’s Public Inspection.

The information I received about the components of the proposed governance approach are below and include:

1) Focus on entities that facilitate electronic health information exchange 2) A set of conditions for trusted exchange (CTEs) in three areas: safeguards, interoperability, and business practices. 3) A voluntary validation process for entities to demonstrate conformance to the CTEs and to increase provider confidence that the exchange entities meet these requirements 4) A processes to regularly update and improve CTEs 5) A process to classify the readiness of technical standards and implementation specifications to support interoperability CTEs; and 6) Approaches for monitoring and transparent oversight

In order to receive the best input from all stakeholders on governance issues that HHS is considering, the RFI includes many questions about these proposals. The public comment period closes 30 days after the date of publication in the Federal Register. The expectation is for publication in the Federal Register to happen May 15th, 2012. Stakeholders, including consumers and patients are requested to provide feedback on these proposals. Please keep yourself informed and educated about this.