Healthcare Informatics 7/17/12

Healthcare Infrastructure Data Models
Option 3 — Health Record Banks

Option 1: The Centralized Repository is described here.
Option 2: The Federated Model is described here.

Think Google Health or Microsoft HealthVault with an actual business plan. The patient controls access to their data and pushes it or allows it to be pulled at their request. Admittedly, I hadn’t heard of this concept until the founder of the Health Record Bank Alliance told me about it, so I can’t say this model is just around the proverbial corner.

When we philosophize from our arm chairs about how healthcare should be, one particular theme always bubbles up: the patient should control their health and their health information. But have we accomplished that, even with the concept of a Patient-Centered Medical Home?

Right now, our healthcare system is centralized. This means that if we go to a well-organized institution, our information and services will center around us as long as we don’t leave. But if the industry follows the disruptive innovation pathway laid out by Clayton Christensen in The Innovator’s Prescription, we will eventually arrive at a decentralized model of healthcare. That means the hospital-centered healthcare will become passé. It also means we need to find a way to deliver patient health information to the practitioner on demand. As in, it is stored with the patient, not the provider.

Personal Health Records (PHRs) would seem to be the obvious solution to this. Due to a lack of record portability and motivation, they have turned out to be duds even to data geeks like myself. I once logged every time I picked at my fingernails and what I was thinking about at the time in order to figure out how to break the habit (willingly), but I logged into my Google Health account (RIP) exactly twice.

The portability issue will be resolved, and thank Meaningful Use for that. Motivation, though? Most of us don’t actively track our health status. We wake up, we subconsciously determine whether we have it in us to survive the day, and then we get moving. A Health Record Bank could potentially provide motivation in the form of payment opportunities.

Let’s say you received a micropayment every time an organization queried your health record for research, public health assessment, or even marketing information. Not enough revenue to generate a career, but it could buy you coffee every now and then. All you’d have to do is maintain your record like you do your checking account. Would that be something you’d be interested in?

Record portability? Yes. Public Health assessment? Yes, with payment. Consider it an incentive payment going to the right people.

Given these three models — the centralized repository, the federated query, and the health record bank — which is the one that will be used moving forward? Even though the proponents of these models act like they are competing models, are they not complimentary in some fashion? Centralized repositories are great for in-depth analysis once the data is actually gathered. Federated queries are good for a small network to share data. Health record banks motivate the originator of information (the patient) to give up the data and spread it in addition to establishing ownership.

An EHR in the hands of the majority is the first step to setting down this path, where these models can interact. But make no mistake, it is not the last. Eventually, EHRs will become the processing tools to send information for expert analysis, not from which to extract information.

Aaron Berdofe is an independent health information technology contractor specializing in Meditech’s Medical and Practice Management Suite and EHR design and development.

News 7/17/12

Cloud-MDs announces plans to integrate its PM/EMR solution with DrFirst’s e-prescribing  software.

Aprima Medical Software releases Aprima Mobile, a smartphone app that provides physicians with access to to key functions and patient data in Aprima EHR.

CMS releases a guide for EPs to walk them through all phases of the Medicaid EHR program.

Greenway publishes a cool infographic that includes a ton of stats and an overview of the complete MU program. Even if you think you have MU all figured out, I recommend taking a second to check out the full graphic.

MGMA offers encouragement to practices interested in creating a social media presence, particularly Facebook:

Participating in social media takes considerable time and effort, so do your research before taking your practice online. And once you’re there, enjoy interacting with your community in another way. It’s a new avenue for sharing information and engaging with your audience outside the office walls.

I found that at least one of my doctors has a Facebook page (above) and an impressive 1,341 likes.

The Washington Post reports online ratings of physicians by patients are generally positive. Nevertheless, most doctors are leery of the more than 50 Websites that permit patients to post online reviews of their doctors.

E-mail Inga.

DOCtalk by Dr. Gregg 7/13/12

Clubbing EHRs Religion

Clubbing, EHRs, and religion: not exactly a triplet of terms that is commonly grouped. But, I see it almost everywhere I look in EHRdom these days. Lemme ‘splain, Lucy…

Taking each as they were writ:

Clubbing

Not the ear-popping, soulless electronic drum beating, Ecstasy-riddled type of clubbing. And, not the too-cute-to-be-believed, little white baby seal murder trade tool, either.

The kind of clubbing to which I refer is the kind that involves people’s predilection to form into Us vs. Them units. We club. We group. We team up and then we team up against.

Little boys do it in tree houses with “No Girls Allowed” signs. Sorority sisters and frat fellows do it. Bloggers do it. Facebookers do it. Republicans and Democrats love to do it. Tea Partiers do it with gusto. Sports teams do it, thrive by doing it. Nations need to do it, especially during an Olympic year or time of war, any war.

Steve Jobs and Apple did/do it best, having turned clubbing into an art form.

Clubbing and EHRs

Almost every EHR I’ve ever come across has a strong element of clubbing. “Our system is the smartest” or “Our system is the most physician-friendly” or “Our system is designed with you in mind, more so than any other system out there” or “Our system will get you the ROI the others only talk about” – these are all themes which seem to have become almost genetically encoded in the current EHR mindset.

Whether they are free or cheap, minimally draining or bank-bustingly expensive, pretty much every EHR company I’ve ever come across thinks they have the best system. Most of them also trash talk the other EHR systems – the opposing “clubs” – almost as much as they up talk themselves, not unlike opposing sports teams. (Take your pick for an example; Browns/Steelers and Ohio State/Michigan are my favs.) Most EHRs try to build more than brand loyalty; they sell a lot of laced Kool-Aid.

EHRs club… a lot.

Clubbing and EHRs and Religion

It probably doesn’t take much ‘splaining to see the connection with religiosity and EHR clubbing. Few things have brought more people together than religion. And few things have brought more people together to assail other similarly grouped people with a differing opinion more than religion. Few things have caused more good and more harm, throughout the entire course of human history, than religion. (This likely being the reason John Lennon tried to “Imagine”.) Religion doesn’t have to lead to harm; it just often gets contorted and ends up there.

Religion is sort of the pinnacle of clubbing… well, aside from Apple.

Clubbing EHRs Religion

In the first sentence, I placed commas between these words though I didn’t in the title. There’s a good reason for that: discussing “clubbing”, “EHRs”, and “religion” is not the same as “clubbing EHRs religion”. (To be PC, Punctuationally Correct, I should have an apostrophe after the “s” in EHRs, but I liked the way it looked without it!)

Face it. No EHR does “EHRing” that much better than any other. Most every single one that I’ve seen does some thing or things really well, maybe even uniquely well. Most every single one that I’ve seen also does some thing or things (usually things, plural) really, really poorly. None of them are worth religiosity. Few are even worth a club.

“Imagine” there’s no EHR religion. Imagine an EHR company telling you the full truth. Imagine EHRs working to build the best solutions and foregoing the paranoia that someone else might copy what you’re doing. Imagine EHRs learning from each other and getting best of breed capabilities shared across the sandbox.

Imagine EHRs remembering that jacked up prices and humongo corporate facilities are a part of the skyrocketing healthcare cost crisis. Imagine EHRs all remembering that we’re in healthcare, that caring is an integral part of what we do. (Many, maybe most, EHRs were started with caring at their core, but it seems as if that has gotten a little lost, a little contorted, in development.)

Imagine buying an EHR made as simple as choosing which type of paper you prefer. All paper works, but some is smoother, some is heavier grade, and some is just fine for the price. The nice thing with paper, though, is you can actually know what you’re getting before you buy. (Plus, I’ve seen very little clubbing in the world of paper, except perhaps for Levenger.)

CEHRR

I’d like to club the clubbing, club the religion, right out of EHRs. “Clubbing EHRs’ Religion” (CEHRR) is a new club I’m starting. I’ve got “I’m a CEHRR” (pronounce it “kûr”, as in “cur”, as in mongrel) t-shirts, coffee cups, and buttons plus a cool little clubhouse. It’s better than any other club. It’s the best club ever! Wanna join?

From the trenches…

“I do not feel obliged to believe that the same God who has endowed us with sense, reason, and intellect has intended us to forgo their use.” – Galileo Galilei

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 7/12/12

Memphis Obstetrics & Gynecological Association (TN) selects MED3OOO’s InteGreat EHR for its 24 providers.

The 80-center MedExpress Urgent Care implements athenaCollector and athenaCommunicator.

Allscripts partners with biopharmaceutical services company Quintiles to jointly develop solutions that leverage de-identified longitudinal data to improve the drug development process.

South Hills Radiology Associates (PA) contracts with McKesson Revenue Management Solutions for billing services for its 14-physician practice.

Arthritis Associations of South Florida implements Anoto Group’s digital pen and paper technology to import clinical data directly into the practice’s NextGen EHR.

University Physicians (CO) expands its investment in GE Centricity Business to include payer contracting, document scanning, and integration with the hospital’s EMR.

The TriZetto Group names former Onlife Health CEO Chris Hunter SVP and president of Trizetto’s physician market group.

New payment methodologies may have helped primary care physicians increase their 2011 compensation by more than five percent. Also impacting physician compensation: the shift from private  practice to employment by integrated delivery systems and hospitals.

You may have read on HIStalk that I am taking a bit of vacation this week, so today’s post is a bit sparse. Back to the grindstone soon!

E-mail Inga.

News 7/10/12

From Deacon “Re: Michael Stearns. As a former e-MDs employee, I really don’t believe Dr. Stearns did anything that was listed in the email to e-MDs clients and on their Website. e-MDs is a good company that can’t get out of its own way, but Dr. Stearns was the least of their worries. He probably would have been a better CMO and working with product challenges than a CEO working on business challenges.” I’m sure I am not the only one surprised by the seemingly swift removal. Just one week earlier, the company hosted its annual user conference and symposium and posted photos (now removed) on Facebook showing Stearns to be large and in charge.

HHS announces the selection of 89 new ACOs, bringing the total number of organizations participating in Medicare’s shared savings initiatives to 154.

Southwest Community Health Center (CT) selects NextGen EHR, PM, and electronic dental record products for its 12 location FQHC.

CMS issues a proposed rule that would increase Medicare payments to family physicians by about seven percent and by three to five percent for other primary care providers for the 2013 calendar year. The same proposed rule includes new hardship exemptions and an informal review process for the e-prescribing program and recommendations for increased alignment between the PQRS reporting program and the MU use program.

The AMA offers advice for physicians who wish to remain in private practice but also want to facilitate better care coordination by becoming part of larger clinically integrated organizations. Critical elements for success include connectivity to other providers and access to data from EHRs and claims databases.

The 10-provider OrthoKC (KS) contracts with SRS for its EHR.

The California Primary Care Association and Arcadia Solutions develop Health Home Accelerator, a program to help primary care practices transform their organizations into a Patient Centered Medical Home and earn NCQA recognition.

Manet Community Health Center (MA- above) and Community Health Programs (MA) select athenahealth’s athenaClinicals, athenaCollector, and athenaCommunicator for their FQHCs.

E-mail Inga.