Web-Tones

EMR Pain is Real!

Obama and Congressional Leaders Can’t Overlook EMR Failure Rates | EMR and HIPAA. This post raises some not only interesting, but ultimately quite useful, points regarding the level of resistance that might be encountered as the nation attempts to move to electronic records.

As the post suggests, failures en masse cannot be ignored without the risk of a backlash that could prove debilitating, or worse. There will be resistance to almost any change. The history of the IT industry itself is a history of resistance: from mainframes to client server and from client server to the cloud.

However, the mass resistance to forced change, as may soon be prevalent in the healthcare industry, may be unprecedented. Yes the industry is in desperate need of innovation and computerized, shareable electronic records, but mere cheer leading and new laws will not be nearly enough to achieve the objective.

Providers will need real incentives, and lots of help, in making the kinds of painful changes that need to be made. The real incentive are likely to come by changing compensation schemes in order to create a truly competitive industry. The "lots of help" aspect will require a creative multi-disciplinary approach in order for the industry as a whole is to avoid the many traps and pitfalls that await unsuspecting practices.

It really doesn't matter if often (or usually) the practices themselves are to blame, the system as a whole simply cannot tolerate mass failure. The Obama administration simply cannot afford to ignore this challenge.

Looking for a best of breed HIPAA Compliance Tracking System?

To stay current on the HITECH Act and its quickly changing regulatory scheme visit the HITECH Survival Guide website and/or sign up for our free monthly compliance newsletter. Also, check out our FREE EHR Checklist.

If you need tools that will help with your compliance initiatives then check out the HSG Store.

 

Why Knowledge Management?

We forget. That's one of the key reasons for using knowledge management technologies. We all know stuff, but unless that stuff is organized in a manner that is readily accessible (and "searchable") then for the most part it is fugitive.

We all get frustrated by not finding the stuff that we need and often it is the same stuff we have searched for and found in the past. So what do we do? Well if you live on the web then you bookmark stuff. But that strategy quickly gets out of control because bookmarks are too crude an approach for what we need.

Enter Wikis (we use Google Sites), or if you live in a Microsoft universe, then Sharepoint. In any case there are a number of low cost (or free) tools that can dramatically improve our ability to find stuff if we just get started. You don't need a perfect taxonomy (i.e. organizational scheme) because there is no such thing, and likely never will be. Many have tried this approach and failed miserably after investing millions.

What you need is a Niki strategy. Just create some "buckets" where you can put stuff (links, contextual text, notes, documents, etc.) and add to it "organically" a little at a time. Get in the game. If you do you may find that in a reasonable amount of time you have a better knowledge base than most of your competitors.

Why? Because they are waiting for a magic solution to emerge and you are busy creating your own magic, a little bit everyday.

The Pope Goes to YouTube

Here's the Vatican's YouTube channel. There's a rumor (far as I know) about how Jesse James answered when someone asked him "Why do you rob banks?" The answer was purportedly "because that is where the money is."

I suspect that the Pope might give an analogous answer about YouTube "because that is where the people are." The ones that he needs to reach. It is as simple as that.

I am not comparing, mind you, Jesse James to the Pope. I am simply pointing out that both answers would be stating the obvious. It is a brave new world. The WhiteHouse is on YouTube. The Pope is on YouTube.

If anyone still believes that the Internet has not changed the planet then there is no sense in trying to convince them. We may not know where we are headed but I can assure you (for what that is worth) it won't be more of the same.

Gov 2.0 & Health 2.0

White House 2.0 is indicative that there is a new sheriff in town and what may have been partly missed in all the discussion regarding race and history is the fact the Obama is clearly looking forward to engage with a new generation of Americans as he attempts to alter the thinking of the greatest generation.

The Health 2.0 consumer led healthcare "movement" is also looking forward to a radically more engaged patient population than has EVER existed. These are patients that will not be reticent challenging the status quo, nor stand idly by as the healthcare industry inevitably attempts to assert control, albeit a different/modified kind of control.

In short, there is going to be a push from the top to alter old industrial healthcare thinking (no small feat), but in fact there may be an even stronger push from the bottom as more and more patients become "sickened" (literally) by our current system.

The old tired arguments of "free market" versus "socialism" are simply non-starters. For the most part, there is no "free market" in healthcare. A market that functions well AND manages to provide some protection for all, is what we need. In order to achieve that we are going to have to think differently about the problem.

All of this will take a multi-disciplinary approach, because the insular healthcare appears incapable of going it alone. This is true despite the fact that there is no shortage of smart people within its ranks. The problem is too complex and mission critical/proven ideas and process methodologies need to be borrowed from elsewhere.

Looking for a best of breed HIPAA Compliance Tracking System?

To stay current on the HITECH Act and its quickly changing regulatory scheme visit the HITECH Survival Guide website and/or sign up for our free monthly compliance newsletter. Also, check out our FREE EHR Checklist.

If you need tools that will help with your compliance initiatives then check out the HSG Store.

 

Full EHR by 2014?

Obama Wants Full EHR by 2014 | EMR and HIPAA. Full EHR by 2014 is certainly an ambitious goal but if we do not put a stake in the ground it will be 2050 and there will be little or no progress. Heathcare, and dare I say it, healthcare IT professionals, have significantly more than the usual number of naysayers ready to pipe in with a million reasons why something can't be done. With that kind of thinking we would have never gotten to the moon.

As far as there not being enough healthcare IT professionals to fill the demand, that may be true, but it also highlights another healthcare (and healthcare IT) red herring. The professions, especially law and medicine, have been drinking their own kool aide for far too long. Yes, there are unique differences between industries, but IT professionals that work across industry verticals have been meeting these challenges for decades now.

EVERY industry believes that they are so much different than everybody else and every industry requires the "learning of a new language." Healthcare may be more challenging than other industries but only incrementally so. Healthcare's challenges have more to do with antiquated thinking than with antiquated technology, although admittedly the industry is in a desperate need to upgrade both.

It is going to take a multi-disciplinary team "Manhattan Project" to get the job done and that, by definition, is going to require that healthcare open up to outside help.

Looking for a best of breed HIPAA Compliance Tracking System?

To stay current on the HITECH Act and its quickly changing regulatory scheme visit the HITECH Survival Guide website and/or sign up for our free monthly compliance newsletter. Also, check out our FREE EHR Checklist.

If you need tools that will help with your compliance initiatives then check out the HSG Store.

 

Healthcare Poised for a Business Revolution?

Building a Healthcare Bubble « Remaking Healthcare. Expect to see a significant amount of entrepreneurial activity in the healthcare space over the next few years. Anyone that remotely follows this industry gets this sense on a daily basis. The signs are everywhere. There are several reasons for this including the fact the healthcare, both from a technology and process perspective, is long over due for a transformation.

Couple that with the fact that healthcare laws are certain to change and that the U.S. government may be pumping billions of dollars into the industry and you have the recipe for innovation. As I have said on a number of occasions, we are going to innovate our way out of this mess and you can bet your last dollar that good 'ole American entrepreneurs are going to lead the way. It's what we do.

Looking for a best of breed HIPAA Compliance Tracking System?

To stay current on the HITECH Act and its quickly changing regulatory scheme visit the HITECH Survival Guide website and/or sign up for our free monthly compliance newsletter. Also, check out our FREE EHR Checklist.

If you need tools that will help with your compliance initiatives then check out the HSG Store.

 

The cloud? It's Just Economics 101.

That is the argument that Nick Carr makes in The Big Switch with respect to cloud computing. Here's the money quote:

A hundred years ago, companies stopped generating their own power with steam engines and dynamos and plugged into the newly built electric grid. The cheap power pumped out by electric utilities didn’t just change how businesses operate. It set off a chain reaction of economic and social transformations that brought the modern world into existence. Today, a similar revolution is under way. Hooked up to the Internet’s global computing grid, massive information-processing plants have begun pumping data and software code into our homes and businesses. This time, it’s computing that’s turning into a utility.

The cloud is inevitable and the buzz will only increase in 2009. When businesses both large and small can purchase secure and reliable computing power and storage for pennies on the dollar (available today), it is game, set, match for client server computing. RIP. The total cost of ownership comparison of the two alternatives is not even close. The video below is a testimonial from Genentech on why it moved to the cloud for email and collaboration. I posted about Eli Lilly using Amazon's S3 here. If it is good enough for the big boys then, to quote Dylan "Don't think twice it's alright."

It is not a question of features and functionality. Any advantage client server has with respect to the latter is quickly eroding and the real driver is raw economics. You do not need to be a techie to understand why the cloud will win, you just need to understand economics 101.

Law Practice on the Cloud and Amazon's S3?

We host our entire law practice on the cloud: matter management, document management, email & calendaring, accounting, phones & fax (VOIP), etc. Well, not exactly everything, we still create and store client documents temporarily on local devices, as well as other administrative information.

Complete and final drafts are always stored on the cloud where they are readily "searchable" and accessible, anywhere, anytime. The reality is that we are mostly on the cloud from an operational perspective but we do not believe that our use of local storage will go away anytime soon. What does all of this have to do with S3?

I will get to that in a minute. First what is S3? It is Amazon's Simple Storage System. It allows any organization to store "objects" (i.e. data) on the cloud using the same technology Amazon uses to store data for millions of customers. Amazon charges 0.15 cents per GB/month and even less depending on your volume. In short, it is an extremely cost effective way of doing electronic off site storage.

We just implemented S3 to synchronize our critical law office data to the cloud in real time. Upon first use all data identified as critical (e.g. a set of file folders on your local storage system) is copied to the cloud. After that, only documents that are new/modified get copied/synchronized. So far so good. We are quite happy with the service.

Here's the drawback (assuming that you can overcome the security red herring), it takes a different third party utility to talk to S3. S3 is literally a service to be used by other product developers to leverage and not a complete solution in and of itself. We purchased a relatively inexpensive synchronization program from SuperFlexible and it was relatively straightforward to implement.

That said, relatively straightforward does not mean easy because we first needed to decide on a front end vendor (somewhat time consuming) and then we had to implement. Total time to decide and implement was approximately 4 hours, but we are "geekier" than most firms. Amazon and other vendors need to make it more straightforward to move backups to the cloud if they hope to get anything but end user/geeks adopting their service.

BTW, this service scales and is not only for small businesses. Eli Lilly is currently using S3 in a significant way. Amazon expects that many more large companies will soon follow suit, in addition to the early adopters such as Lilly (and others). This is world class technology that all companies can leverage, but the little guys are going to need some help. Still, we now sleep better knowing that we have an instant backup available should disaster strike, either on our local system or on the cloud.

New Laws for Electronic Medical Records?

HealthBlog : Electronic Medical Records--just part of needed transformation. The Obama administration is apparently putting a stake in ground with respect to electronic medical records (EMRs). This is a welcome development but not surprising since there is widespread consensus that providers cannot begin to compete based on outcomes until EMR's are in place. Until then we are left with the archaic fee for service payment structure (see this post).

It should be clear that the only way EMRs will be implemented industry wide is through sweeping legislation that encompasses both technology initiatives as well as privacy concerns. You can also expect some government incentives to small primary care providers that are on the front lines and will need economic assistance to achieve the objective. There will be more than a few naysayers but this investment must be made, without getting primary care provider "onboard" we cannot hope to make much progress.

Looking for a best of breed HIPAA Compliance Tracking System?

To stay current on the HITECH Act and its quickly changing regulatory scheme visit the HITECH Survival Guide website and/or sign up for our free monthly compliance newsletter. Also, check out our FREE EHR Checklist.

If you need tools that will help with your compliance initiatives then check out the HSG Store.

 

Health Care Fee For Service is Dead: RIP

OK, maybe it's not dead yet but it is on its way out if you read between the lines. I caught Stuart Altman on the NewsHour tonight and he gave a nod in that direction. For those of you who don't know who Stuart is, he is one of the hundred most influential people in health care (according to the link above) and Obama's health care architect.

What is fee for service? It means that doctors get paid for doing work, but not for results. Talk about Soviet style corporate welfare. In no other American industry that I know of is their anything remotely comparable to the idea of fee for service. You hire a mechanic to fix your car and he runs a bunch of tests but when you get the car back the brakes still don't work. In fact, he didn't even look at the brakes, just ran some tests. Can you get your money back? Maybe. At least a court of law would entertain it.

What about doctors? Nope. For the most part they just do stuff and get paid. Don't get me wrong, I don't have anything personally against doctors. I don't do medical malpractice work and have no intention to. What I am against is a system that rewards a concept like fee for service. It has to stop. We desperately need to introduce the idea of competition into healthcare and start rewarding doctors that produce verifiable outcomes (i.e. real benefits to patients measured by results pertaining to a specific medical condition).

Our current system is corrupt and broken. The only discipline today is imposed via malpractice suits and that is just a sorry excuse for a valuable check and balance. I am not opposed to these suits mind you. If you are incompetent and negligent then you pay. That's the way our tort system works, doctors don't get a free pass. But what I am against is such a wickedly stupid way of imposing discipline. We need a bigger carrot and a smaller stick. The bigger carrot is pay for performance.

I for one will not mourn the day fee for service dies. RIP.

Looking for a best of breed HIPAA Compliance Tracking System?

To stay current on the HITECH Act and its quickly changing regulatory scheme visit the HITECH Survival Guide website and/or sign up for our free monthly compliance newsletter. Also, check out our FREE EHR Checklist.

If you need tools that will help with your compliance initiatives then check out the HSG Store.