News 3/17/09

From: Neil Finn.”Re: Specialists and EMR. The author kind of misses the point; these specialists have enough revenue and margin they can go EMR or not and being in Plano, their Medicare/Medicaid mix isn’t all that great.” Neil is referring to this article discussing how a group’s failed EHR experience is now causing them to be cautious about going down that road again – stimulus money or not. Neil claims the group struggled with the old A4 product years ago. How many other profitable specialists will snub their noses at stimulus money, either out of fear or because the money just isn’t enough?

Current and former physician employees of Medical Edge Healthcare Group (TX) file a suit against the company, charging them of improper billing and practices that violate state laws prohibiting corporate control over physicians. The doctors say Medical Edge used “deceptive accounting practicing” and charged them unfairly for taxes, benefits and other expenses.

A RAND Corporation study finds that California physicians given financial incentives to improve the quality of medical care are beginning to adopt new quality measures, including adding EMR and tracking physician performance. However, the financial incentives averaged between $1,500 and $2,000 annually per physician, which failed to stimulate significant change among most doctors. Those declining to participate suggested incentives needed to be two to five times higher in order to achieve quality improvements.

Fifty physicians are set to receive their first rewards for participating in New Jersey’s Bridges to Excellence Program, which is designed to recognize and reward providers that demonstrate safe, timely, effective, and patient-centered care.

Fair Lawn Diagnostic Imagining Center (NJ) selects IMAGINEris and IMAGINEradiology for practice management and RIS billing and collection.

Technology Partners, Inc. (dba IMAGINE Software), a leading provider of medical billing technology, announces that Fair Lawn Diagnostic Imaging Center (FLDIC) of Fair Lawn, New Jersey, has chosen IMAGINEris and the IMAGINEradiology™ practice management system for their RIS/billing and collection needs.

The LA Times publishes an article discussing how HIT has the potential to advance healthcare. The piece discusses some of the benefits realized by a 10-doctor family practice group, including the elimination of 6-1/2 FTE’s and tens of thousands of paper charts.

KLAS releases a report entitled “The Rise of eClinicalWorks: Separating Fact from Fiction.” KLAS examines why ECW is growing faster than any other EMR vendor and whether if it could sustain the grown and still provide effective support. While customers expressed strong satisfaction on functionality and cost, support was noted by many users as the worst aspect of their ECW relationship. Users also claim that integration with other clinical systems was a challenge.

If you read HIStalk you may have seen the notice that Mr. H is in the world of no Internet this week, so Inga is flying solo. I am awaiting encouragement.

USF Health, Allscripts Launch Paperfree Tampa Bay, an E-Health Pilot Program

USF Health and Allscripts initiate a pilot program called Paperfree Tampa Bay that aims to convert 100 percent of physicians in the Tampa Bay area to electronic prescribing. Program leaders view this as a first step toward the implementation of EHR in the region and is expected to create 100 jobs in the region.

We caught up with Allscripts CEO Glen Tullman and asked him for more details on the initiative.

So, what is in it for Allscripts?

First of all, let’s talk for one minute about the opportunity. What we see happening here is President Obama’s vision of an electronic, inter-connected health system is becoming a reality in Monday in Tampa Bay. This is really a pilot, if you will, for what can happen in the rest of the country. That’s important when you think about what could happen in the rest of the country. We have lined up wholes series of communities who are doing their own particular take on this. The take on this in Tampa is: “Let’s start with electronic prescribing, let’s get a coalition of organizations, including major hospitals, physician groups, the mayor. Let’s get Congressional support – and there is strong Congressional support: Congresswoman Castor, Congressman Young, and Senator Nelson are all strongly behind this – and let’s drive this forward.” What’s makes this unique is they are hiring 100 electronic “ambassadors” is what they are calling them, that are going to visit the 8,000 offices and train them on electronic prescribing, and then they are going to introduce them to the stimulus benefits for acquiring an electronic health record. And, hopefully they’ll see the market for the adoption of electronic health records. So, #1 it creates jobs for new-hires who, #2, are going to be trained by a curriculum designed at the University of South Florida, who was one of the original NEPSI members and who has already rolled out an electronic health record. They are designing a curriculum to train these people and presumably others. Then these people will start doing the office-by-office work. Dean (Stephen) Klasko calls its “changing the DNA of physicians, one office at a time.” Which I kind of think is a really brilliant analogy because physicians do require that. By the way, it’s a very interesting contrast to just yesterday, Wal-Mart comes out and says we are going to have this thing in the store, a physician will show up and spend 25K, take it back to their office and implement it. Those aren’t the physicians we know because we have been doing this 10 years. Physicians aren’t likely to do that. We say we know what model works and we are going to be out there doing it.

So what’s in it for Allscripts? When people ask as us about the NEPSI, our answer then and our answer now is getting physicians to adopt the tools is good for healthcare long-term, and good for patients and good for Allscripts. Why is it good for Allscripts? Well stage one is electronic prescribing and they will get that free. What we hope follows from that is the adoption of electronic health records. Once a physician is comfortable using electronic prescribing, we believe they will conclude they should quickly move to electronic health records. At that point, given we are the market leader, we should benefit. Will we get all those? Of course not. But we think we’ll get our fair share, maybe more than our fair share of that. The real goal, first and foremost, is to address this absolutely key patient safety issue that is saving lives and saving money by getting physicians to use electronic prescribing. And if that was all that happened I would be happy. Because imagine being a part of something where you can say, “This isn’t about making money. This is being able to say we helped make this happen in Tampa Bay.” If this works, we will absolutely save lives in Tampa Bay. Remember, every year 7,000 Americans are dying from preventative medication errors, and a million and half are injured every year. It cost billions of dollars, it has an enormous quality impact on people’s lives, and we can stop it, and we are going to do it now in Tampa Bay, beginning Monday. Very quickly thereafter In Hartford, Connecticut, Iowa, Pittsburgh, in HoagHospitals in Newport Beach. We have leaders coming up from all around the country who are saying, “We are going to do it and we are going to do it now under President Obama’s leadership, and the standards that CCHIT has set, and the substantial incentives that have been provided.” The CMS incentive of $3,000 to $5000 for electronic prescribing is available today as of January 1 of this year. The PQRI incentive of $3,000 to $5,000 is available right now, and of course, the $44,000 that’s from the stimulus package, $18,000 of which will come available next year if you are using a total electronic health record right now. Imagine if you are a physician in Tampa Bay and someone comes to the office and says, “Let me get you up and operating on this tool. If you use it you will qualify for between $3-5,-000 of funding from CMS and it is highly likely your own payer has additional incentives for you. What does it cost me? It doesn’t cost you anything. Pretty good deal. Now there’s someone standing there, an energetic, committed person who says, “I will help you do it.” That is how we will change healthcare, change the DNA of healthcare and the physician. One office at a time. As the rest of the communities see that there are going to say, “Wow, not only does it work, there is a good chance we might even get stimulus dollars to help us do these types of programs.” In Tampa Bay, Stage 1. In other communities they are saying, “We are going to push the development of the full electronic records and we are going to connect them.” Hartford is saying, “Connected Hartford,” instead of “Paperless Tampa. What does that mean? We have enough hospitals and major practices already using Allscripts that we are going to connect them all together connect very quickly and very cost effectively. We are committed to interoperability. We are happy to connect everybody. We are ready to start very quickly with demonstrations that will connect huge parts of the market. Why? Because it is safer for patients, more convenient for patients. That is the program. Not that I’m not excited about it…

What do you estimate Allscripts’ out of pocket costs will be for the Tampa Bay project?

From our perspective, #1, they are using NEPSI software, which is already based in all our numbers. And, #2, in terms of people commitment and the like, we will be deploying members of our teams, our e-prescribing teams, our connectivity teams, and, obviously used some of our promotional people, creative people. It is not about a dollar commitment per se. The big expenditure will come as USF and other members of this coalition hire people, and we are hopeful that this will in fact be one of the many programs that HHS and the Secretary decide to support through the HITECH provisions of the stimulus act. Remember that the government has basically said that we want to support programs that are furthering the aims of the HITECH act and the President’s objectives, but, we don’t them to be green-fields. We want them to be programs up and operating that we can see. All 100 people won’t begin Day 1. We are beginning to hire people; we are beginning to train people. Initially, some of our folks will fill some of those roles. Some of USF people will fill some of those roles. As we move forward, we have the commitment from the representatives in that area to take the Paperfree Tampa Bay program and present that as one of the many pilot programs that the Secretary may be interested in funding. If the Secretary chooses to fund the program, that will accelerate it. It will go forward under any set of circumstances. Whether it gets accelerated will in part be determined by the Secretary. But there is a commitment from the participating partners to move the program forward in any case.

So, there is hope that there may be some amount of funding that will filter down to fund some of the initiative?

To the initiative, yes. To Allscripts, no. From the initiative itself, there is no benefit from that. The benefit is longer term, to the extent that physicians decided to buy electronic medical records. Imagine the impact if every community says, “Hey, this works.” Take the top 100 communities, they each hire 100 people who are trained to talk to physicians about electronic prescribing, and also about the benefit of using a full electronic health records. Talk about the full benefits. Now you have 10,000 evangelists going out to convert these. Imagine the impact that would have, not just for us but also all our competitors. That’s what’s so exciting about this pilot program.

So the initial 100 people will be paid for by a combination of USF and Allscripts?

No, we will start with a smaller number of people that will be funded though a combination of USF, Allscripts, and the other constituents which will be announced on Monday. Those will include some state programs already focused on electronic prescribing. A variety of different participants will all be contributing people. The longer term goal is to have new-hires. We’re hopeful that our people will not have to be there longer term. But, we are committed with USF, with Baycare, and the other participants.

I hope you share with us the excitement of what this could mean. Do that math. Imagine if the top 50 communities in the county each hired 100 people, and you had all those people visiting physician offices. Imagine that kind of effort and what kind of change would occur. It would all be terrific for the industry. Hopefully this drives that kind of change, and we think it will.

News 3/12/09

Clearly the biggest news story of the day is Wal-Mart’s decision to market eClinicalWorks software and Dell hardware through its Sam’s Club stores. Mr. HIStalk had a short chat with Girish Kumar Wednesday and that interview is posted here and on HIStalk. The Sam’s Club package, which will be available later this spring, starts at under $25,000 for the first physician in a practice and $10,000 for each addition doctor. Ongoing costs will be $4,000 to $6,500 per year. The software will be provided in a SaaS set-up and the Sam’s package includes five days of on-site implementation. ECW representations will provide demonstrations (via Webinar) as well as configuration assistance. Props to ECW and Wal-Mart for an innovative strategy. Time will tell if this marketing approach will succeed, but we liked this comment posted on HIStalk by Steven Tremain: "History shows us that any idea the majority laughs at is one worth watching. Disruptive innovations are in fact the only leaps that have ever changed the world. It may very well fail, but we will all learn from this."

The medical director of O’Connor Family Health Center (CA) claims he doesn’t regret the decision to move to EMR, even though it cost $250,000, cost an army of people to install, and increased the patient backlog and decreased revenue. He is even okay with the fact that two years after implementing his vendor went out business and product support ends in two years.

A HIMSS survey finds that only about one-third of HIT professionals believe the HITECH stimulus plans will reduce healthcare costs.

A New Jersey oral surgeon is on the wrong end of a $10.2 million malpractice award after a 21-year-old patient dies during wisdom teeth extraction. The patient’s doctor had not cleared him for surgery and the lawsuit claimed a diagnosed immunity disorder caused his throat to swell after the surgery. The family’s dentist was also a defendant, but he was cleared.

We send out an e-mail link each time something new is posted on HIStalk Practice. If you aren’t getting them, just drop your e-mail address in the Get Instant Updates box to your upper right and click Subscribe. That ensures you won’t miss a thing.

Another study suggests that the HIT incentives will not be enough to convince many doctors to purchase an EMR system. As many as half the country’s doctors will take a pass on EMR because the average cost of a full EMR over five years is an estimated $124,000, and, government compensation is a maximum of $44,000. That’s a $14,000 a year deficit compared to a potential $8,500 Medicare reimbursement penalty for not automating. Someone will need to develop some quality ROI calculators to convince many physicians to take the plunge.

This American College of Physician Executives survey indicates more physicians are adopting technology, even though they may not like it. Most physician leaders find EMRs "clunky" and "unresponsive to their needs."  However, EMR use is up from 33% to 64% since 2004, 44% of the surveyed organizations use CPOE compared to 33% in 2004, and 38% use pharmaceutical bar coding, up from 20%.

Check out our latest HIStech Report interview with Cheryl Iseberg, COO of Renaissance Resource Associates (RRA).  RRA provides consulting services on GE Centricity Enterprise, Picis, Epic, and other systems.

Despite otherwise gloomy economic news, physician offices added 6,000 workers in February, according to the Bureau of Labor Statistics. Hospitals added another 6,800 jobs.

We gratefully acknowledge the support of McKesson, a new Platinum sponsor of HIStalk Practice. The company offers pretty much everything a physician’s practice needs, from technology (EHRs and practice management, including the Practice Partner system), consulting services, medical supplies, revenue cycle management, and connectivity solutions. More information here and a page dedicated to the opportunities provided to practices by the economic stimulus legislation is here. We thank McKesson very much for supporting HIStalk Practice and its readers.

A Baystate Medical Center (MA) anesthesiologist who wrote 21 journal articles in the past 13 years has admitted that he made up most of the data he cited. Pfizer paid for his research, which found that two Pfizer drugs were effective in post-op pain. He was caught when the health system determined that he was not approved to conduct human research.

DataMotion introduces a $99 secure email solution designed for the small office market. Preferred9 includes the ability to send email securely and thus meeting HIPAA security guidelines.

A new P4P survey reports that P4P payments have grown to over 7% of physicians’ total compensation and 4% of hospitals, with some physician programs producing 30% of physicians’ compensation. Since 2006, the percentage of programs reporting quality improvements due to P4P has doubled and more than half of P4P programs cite measurable increases in their providers’ clinical quality.

Availity promotes (warning: PDF) Russ Thomas to the role of President and COO. Thomas joined Availity in in 2008 as an executive VP and COO and served as president of Gold Standard before that.

E-mail Inga.
E-mail Mr. HIStalk.

eClinicalWorks To Sell PM/EMR Package Through Sam’s Club – Girish Kumar Interview

eClinicalWorks will sell its PM/EMR package in a pre-configured hardware, software, and services package through Sam’s Club. The offering will offer a fixed price package of Dell hardware (desktop PC or tablet), implementation, training, and maintenance.

Sam’s Club owner Wal-Mart will begin selling the package this spring, with prices starting at $25,000 for the first physician and $10,000 for each additional doctor in the practice. Maintenance fees will be $4,000 to $6,500 per year.

Wal-Mart said it approached eClinicalWorks after using its software in its own in-store clinics.

We interviewed Girish Kumar Navani, president of eCW.

If a physician buys from Sam’s Club, will it be the same product, implementation services, and support that eCW offers directly?

Absolutely. We’re trying to make it simple. Everybody says EMRs are hard and implementing change is hard. We realize that. We’ve been doing SaaS since 2003 and have invested a ton on a data center. We wanted system that is ready out of the box, configured, with content, although it will still require on-site implementation and services. It’s the same in terms of product, services, training, but faster and easier to deploy.

Why would a customer buy from Sam’s? Do they save any money? Can they choose a no-services option?

Wal-Mart used its Sam’s Club division because it has a lot of small business customers as corporate members. They buy ongoing stuff every month, not just simple things like gloves and bandages, but have a corporate account and buy copiers, payroll software, etc. They don’t have to go into Sam’s. You call a corporate number, get an assigned representative, talk to them about what you need, and the item is shipped.

eCW salespeople will still show the product and talk to the customer. There are packages we want to give them that are pre-configured. The customer will not pick blindly – they will still consult with an eCW person.

Will Wal-Mart do its own advertising and marketing?

There will definitely be a significant campaign. They have 200,000 healthcare professionals today as members, mostly as doctors.

Any projections on volumes?

I have to keep that confidential, but there was a lot of planning on the eCW side. Investments have increased, made the company even more ready. This can have a significant impact on how physicians look at, evaluate, and purchase EMRs.

We would like to see taking it away from being a niche sales process, where sometimes we confuse the customer, to make it a very streamlined process so that a customer can make an educated decision. They know how many days to go live, how many days training, cost, etc. eCW does 30 Webinars every week that every customer has access to with a live attendant and all Sam’s members will be able to avail themselves of that.

We believe we are the largest SaaS EMR in the country with 4,000 physicians. If we include hospital customers hosting affiliated physicians and RHIOs, that’s another 4,000. That’s 8,000 today of our 25,000 physicians. We’re trying to leverage that scale to make it easier and cheaper to deploy.

Do you anticipate any product changes?

For primary care, we spent two years working with New York City. We put into the product all the content needed to run a primary care practice – templates, order sets, clinical decision support. That is years of content that we jointly developed. That is all pre-packaged with the product – it’s not just the software any more. On the specialty care, we have about 50 specialty databases.

All of that will be available pre-configured when they sign up. When the trainer shows up, all the content will be there and if we want to change it, we can change it together. We will go live with a comprehensive data repository with clinical decision support at no extra cost for the content.

A primary care doctor can go live with the system as it is, with rich content.

What does this to do the competitive landscape?

We’ve always taken tremendous pride on our leadership on price and functionality. 97% of eCW customers surveyed said their total costs met their expectations when they bought and implemented eCW. 93% of physicians said the EMR met or exceeded expectations. I still have to worry about the 7% and I lose sleep about it more than I take advantage of the 93%, but if a package with those numbers is readily available, people will ask the question: if I’m able to get a comprehensive product that people are happy with at this price point with content and support, why should I spend more?

Price visibility will be black and white. No longer will you see those quotes saying an EMR will cost $300,000. You will see more informed questions, pricing pressure, and frankly, higher expectations if content is provided. I don’t want to take six months to implement PM and another six months for an EMR.

This is a unified product we’re offering, by the way, both EMR and PM. We’re offering five days of implementation on site with the Sam’s Club package and they can buy more for $750 a day plus travel, but our track record is that we can do it in five days.

What are the benefits to eClinicalWorks?

There are many benefits. We want to be a company with 100,000 physicians using our product and 100 million patients whose lives are positively affected by it. There’s a lot more work to be done, but this platform gives us more opportunity.

Intelligent Healthcare Information Integration 3/11/09

Step 2 of the “Official Grunt-in-the-Trenches Complete U.S. Healthcare System Overhaul and National Health Information Network in Five Easy Steps Disruptive Innovation Package”

EHR? PHR? Phooey! How about an IHR?

I know, I know. I’m out of step with my previously stated agenda. I was next going to discuss how we can achieve two thirds of the NHIN by 2010, but, after some inquiries I received and after Mark Anderson’s recent superb article, “Beware, The ICE Age is Coming,” I felt it would now flow more gracefully directing attention toward the foundation upon which we can achieve that near 70% NHIN integration.

First, a disclaimer or two:

1) Some of my favorite people are EHR vendors/developers/marketers/implementers/salesfolk. I enjoy and respect them and what they do immensely.
2) I love my EHR (usually.)
3) Mark Anderson and I, along with several other great folks, have worked together on a few of these ideas for some time now.
4) As yet, there are no financial entanglements which need disclosed. (Damn!)

Now, on with the show…

Unfortunately, the tremendous advantages of a capitalistic system in inspiring new innovation and diversity of product development has given us 3-400 EHRs, any one of which has very little ability to communicate directly with any one of the others. Then, of course, there are the multiple silos being created via RHIOs, HIEs, the old CHINs, etc. Diversity of offerings has led us away from, not toward, the NHIN. The complexity and sheer volume of offerings is intimidating even for seasoned geeks, no less the everyday doc who has trouble with a DVR. Few of the mass required to reach the proverbial tipping point for EHR adoption see it as even being a possibility in their career lifetimes. And, so far, I can’t say I blame them.

To reach the masses, we should be listening to their concerns. I wonder sometimes how many EHR developers actually bother to ask a non-techie-oriented consultant to review their work. If the only folks you ask about product development are those who already “get it,” how do design to entice those who are yet to? I doubt Apple would have survived if they hadn’t seriously taken “Joe Sixpack” into account.

So, as the medical “Joes” have rarely been consulted, is it any wonder most of them have had little, if any, interest in adopting EHRs – especially when what they are promised includes a major interruption in their workaday lives. Changing workflows is a horrendous undertaking, requiring enormous time, energies, and, often, income reduction, at least for a time. There are no “plug-n-play” systems, no turn-it-on-and-do-what-you-already-do EHR wonders. Most current offerings require an enormous effort, hence the prerequisite need for physician champions to cheerlead, coax, and cajole cohorts into the commitment.

I don’t think the majority of my medical colleagues should be treated as cattle, herded, prodded, and driven toward the auction house. (OK, maybe a few deserve that.) But, physicians, it is true, are generally not pioneers. The majority do not blaze trails. They do not lead movements. But, the tremendous attribute which can generally be stated about most physicians is that they respond to need. That’s why many, if not most, became health care providers in the first place. So why is it that this very basic truism has been so glaringly ignored by the world of electronic medical record developers?

If physicians, by their basic nature, respond to need, doesn’t it make ultimate sense to develop a motivational tool that engages this semi-Maslovian drive to entice them into a desire for EHR adoption rather than continuing to “push mules?”

If we’re to stop pushing mules, we must employ strategies that entice – i.e., carrots. We must avoid threatening or intimidating change, as change in and of itself is often frightening. We must utilize tools already familiar, comfortable. We must identify true needs and design strategies to both meet them and to take advantage of them in generating “adoption drive.”

This same argument plays equally well when discussing PHR adoption by the general public. The masses have not swarmed to their use. Why? I believe it is because, just as with EHR design, we have neglected to consider some basic human motivations. Consider the fact that Facebook reached 50 million users in 1/20th the time it took television to do the same. Why? It used a tool which many already owned, with which they had familiarity, AND it met several underlying needs including the desire to interact with others while giving users a little ego boost having a little “Look At Me, World” home on the Web. Basic human motivations: we need to engage them.

To address these oversights and to “stop pushing mules,” I suggest we consider a different approach to healthcare information integration, not focusing upon the technology aspect (very Web 2.0-ey) but rather spotlighting the needs, the use of currently proven tools, and the natural human motivations we can engage to help inspire adoption and continued use.

Thus, the “Grunt-in-the-Trenches Beyond EHR/PHR Grand Healthcare Digitization Project What Ifs:”

*************

What if…we start with a system designed for the end user, not the giant hospital or RHIO, but for that single grunt in the field so that he or she can provide the services he or she provides in the manner most comfortable for him or her with an electronic interface he or she can enjoy and adapt for his or her unique needs? (Big systems that attempt doing everything for everyone often have poor usability when they trickle down to us grunts.)

What if…we took that end user-friendly provider system, included a general populace-friendly tie in, and pivoted this patient-centered tool around an entire small community and its associated community hospital including everyone including doctors, hospital, EMS, home health, hospice, schools, long term care facilities, police, sheriff, fire departments, emergency management agencies, health departments, employers, and the general public – everyone who might have need for some small piece of healthcare data – utilizing the entire community as a multifaceted motivational driver for adoption? (Patient-centered, but community driven as communities drive individuals. Consider mob mentality, Facebook, soccer crowds.)

What if…we make the wild assumption that sharing health data among providers is no different electronically than it is “paperly,” that what a provider can get now through laborious effort, fax machine, and telephone is essentially the same – only much, much slower? (I know a company who says they can tie legacy systems into a new, integrated system so that even current end users don’t need to buy a new EHR or PHR to participate, identity management is enabled, and security is priority.)

What if…we use an open system (open, not unsecured) that doesn’t create silos and we help health systems and providers understand that patient health data is not “owned” by anyone except the patient, that sharing that info is not counterproductive to corporate profits but rather contributive once all are duly linked? (Healthcare giants must give up the notion that sharing a person’s health data is akin to a traitorous CIA leak. I can’t imagine an auto shop refusing to share someone’s car repair history.)

What if…we design the roll out to the community with something like Java applets (compatible with most cell phones and computers) using push/pull technology to acquire information and participation in small sips, instead of asking folks to drink from the fire hose most PHRs now do? (Of course we’ll use computers, but, cripes, American Idol uses cell phone data collection every week! As there are over 4 billion registered cell phones in use around the world today, doesn’t it make sense to use a tool people already have and one with which they are not intimidated?)

What if…we created several jobs within each community specifically to promote, educate, and assist end users in an ongoing fashion, instead of the two-to-a-few weeks training currently the industry norm? (If the entire community was “going live,” the need for support would justify and, indeed, require local help. Plus, who’d bitch about creating thousands of new jobs these days? FYI – there are some 2,000 such small communities and associated community hospitals across the U.S.)

*************

Mark Anderson laid out quite nicely some of the system requirements and benefits in more detail in his “ICE Age” article. While he limits his discussion to the integration of doctors and hospitals, something he has promoted for some time, here the discussion is for a COMPLETE community system, an entity for which the current lexicon has no definition. We’ve coined the process as Community Healthcare Integration (CHI) which achieves the Integrated Healthcare Community (IHC) utilizing the Integrated Health Record (IHR) – via each community’s own non-profit, by the way. See: http://worldchi.com.

To be clear, the IHR does not negate nor minimize any current EHR or PHR product. Rather, it is an overriding integration of that which currently exists into what I believe is a more accurate reflection of reality. We need specialty EHRs and PHRs; they are operationally helpful and discrete. But, personal health data is not separate and distinct from that data which a medical provider uses. The emphasis upon these two terms promotes a psychological barrier between providers and the general public. The last thing we need is for the application of technology to increase the gap and diminish the trust between providers and the public. There are far too many silos in healthcare already; the IHR model is designed to help eliminate separatization and promote integration. (Can you hear the NHIN segue?)

Still to come:

Step (now) 3: Two Thirds of the NHIN by 2010 (Yes, we will discuss funding & sustainability)
Step (now) 4: Equalizing the Playing Field (“Open” is not a Four Letter Word)
Step (still) 5: Verdant Health

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.