I have been watching the unpeeling onion that is the scandal involving some of our top military and intelligence leaders with jaw-dropping wonder.
And in keeping, the other night I watched the DVD of the film adaptation of Graham Greene's romantic tragedy "The End of the Affair," with the always excellent Ralph Fiennes and Julianne Moore.
I'm a huge Graham Greene fan, for a couple of reasons.
For one thing, Greene and I both lived and worked in Sierra Leone—he as a spy in the 1930s and again during World War II and me as a Peace Corps volunteer in the 1970s.
For another thing, Greene is a master storyteller, with piercing insight into the emotional lives of his characters. The liaison in "The End of the Affair" was between the wife of a high-ranking government official and the official's friend, a relative unknown. It is something of a mirror image of what we have now, where the affair is between a high-ranking official and a friend, who is the wife of an unknown.
In both stories, the truth comes out and a lot of damage is done.
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Last month, the College of Healthcare Information Management Executives celebrated its 20th Fall CIO Forum "back home" where the first one was held, the Coachella Valley in the Southern California desert.
One major bit of post-convention news for CHIME was that there will be a change at the top. Perennially cheerful CHIME President and CEO Rich Correll is to become the new chief operating officer of the 1,400-member organization once the search for a new president and CEO is completed—expected by March.
Correll has headed the organization since its founding. "CEO" was added to "president" in his title in 2005. I've had the good fortune to have attended the past two CHIME fall events, which is the larger of its two semi-annual gatherings, and from personal experience I know Rich and his crew put on a solid, tightly run show with the right balance of social and educational programs. He'll continue heading the day-to-day operations of the organization going forward.
I had a chance to talk this week with Drexel DeFord, board chairman of CHIME this year and CIO of the multihospital Steward Health Care System, Boston.
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How can one respond to the news of four more Republicans writing another letter to HHS Secretary Kathleen Sebelius about the federal electronic health-record incentive payment program other than to invoke Ronald Reagan?
"There you go again."
In their Oct. 17 letter (PDF), Sens. Richard Burr (R-N.C.), Tom Coburn (R-Okla.), Pat Roberts (R-Kan.) and John Thune (R-S.D.) weren't as lopsided in their argument or as inflammatory in their rhetoric questioning the program as were their House counterparts, who, in an Oct. 4 letter accused the feds of "padding the numbers" of EHR adopters while alleging the program will squander taxpayers' dollars.
The senators in their letter also did what those House members should have done—in claiming thatthey didn't understand what was happening with the ongoing federal health information technology initiative, they asked for a meeting with the pros at HHS to try and get some answers.
That said, it's at least worth noting that, like their House counterparts, none of these four senators voted for the American Recovery and Reinvestment Act of 2009, which created the EHR incentive payment program.
And, like their House colleagues, their approach—inadvertently or intentionally, if anyone takes it seriously—could cause serious damage to the program.
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Four high-ranking members of Congress wrote a letter to HHS Secretary Kathleen Sebelius (PDF) last week urging her to halt federal electronic health-record incentive payments to hospitals and office-based physicians because of an alleged lack of interoperability spawned by weak rulemaking.
At the $7.1 billion mark in an estimated $27 billion program, what's up with that?
How about an honest difference of opinion?
Nope.
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I have to give a hat tip to Facebook friend Peter Groen for pointing me to this fascinating TED lecture by technology guru Clay Shirky.
Shirky, who holds several appointments at New York University, has never limited his futuristic gaze to the confines of healthcare, but he is well known among the health IT pundit class. In 2009, Health Affairs published an article on health IT that Shirky co-authored with Dr. Carol Diamond of the Markle Foundation and a then-promising young New York public health assistant commissioner, Dr. Farzad Mostashari.
Shirky is a familiar face at TED, too. His latest lecture, recorded in June but not posted until late last month, is “How the Internet Will One Day Transform Government.”
One element of Shirky's latest TED talk focuses on a new organizational structure for managing open-source software projects that could catalyze a democratization of democracy, making governments of democracies more responsive to their citizenry and less beholden to financial interests. The Empire will strike back, of course, but Shirky didn't go there in his 18 minutes on the TED stage, maybe to leave himself an opening for a sequel.
Groen, who was born abroad and grew up a globetrotter, consistently maintains an open, outward and upward worldview. He didn't retire in 2006 when he left the U.S. Veterans Affairs Department after working there for three decades, having last served as the VA's liaison to outside agencies wanting to use its public-domain VistA electronic health-record system in their own operations. He remained a VistA apostle, but broadened his open-source perspective and outreach as an educator and a blogger at OpenHealthNews.com, a website he helped launch.
Thanks for the link, Peter.
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Here's today's tip for healthcare website developers.
If you're like the CMS, and having just revamped your website, you feel compelled to issue a news release to explain how the site's frequently-asked-questions section actually works, you probably should have first asked yourself a few questions, such as this one from my colleague: "What the FAQ?"
The CMS release I'm talking about came today. It announced that the CMS has updated its system. So far, so good.
But then came trouble, under the headline: "Learn How to Directly Link to FAQs with the Updated System."
The CMS' FAQ on the electronic health-records incentive programs, which is what the e-mail was about, prints out to 10 pages and has 197 linked questions.
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This year, it seems, the Healthcare Information and Management Systems Society is taking a more subtle approach to lobbying for privacy and security regulation.
During its annual Health IT Week lobbying push earlier this month, HIMSS presented just three "asks" to Congress. Two dealt with privacy and security issues.
One asked legislators to study patient identification. A two-page letter from HIMSS spent a lot of verbiage discussing the history of a national patient identifier and how Congress has, since 1999, banned federal funds from being used to "promulgate or adopt" one.
Nonetheless, HIMSS is looking for wiggle room.
Its statement pondered whether studying a patient identifier is verboten, then postulated that a "lack of clear congressional intent . . . poses a huge impediment to the optimal adoption of health information exchange."
That's a slight softening of focus. In 2006, HIMSS and another organization it helped create, the National Alliance for Health Information Technology, pushed for a national patient identifier.
In another "ask" this year, HIMSS is lobbying Congress to support "harmonization" of federal and state privacy laws—again, an apparent softening of its position.
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How long did it take American farmers to widely adopt hybrid corn?
Honestly, I don't know, but I do remember what I was told about that kind of adoption—30 years.
I was age 22 at the time and had just started my agriculture extension training with the Peace Corps in Sierra Leone, where we learned the basics of rice paddy construction and swamp rice cultivation. It wasn't until later, when we were posted to our villages to serve our two-year hitches, that we learned just how hard it was going to be to convince wary farmers to abandon their familiar but ecologically destructive slash-and-burn cultivation techniques.
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Personal health records and health record banks are nothing new.
Then again, neither are data breaches, consumer surveys saying people want their privacy rights respected and provider surveys indicating, within limits, that they'd like to respect their patients' privacy desires.
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Healthcare providers, if I'm wrong, you can taunt me with this in 2013, but I'm going to predict that in a year's time, without government intervention, patients are going to jackhammer their way into your electronic health-record systems with data from their Apple or Android phones and tablets.
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In a story in Modern Healthcare magazine this week are some numbers from the CMS on electronic health-record systems that hospitals, physicians and other "eligible professionals" are using to meet their meaningful-use obligations under the Medicare EHR incentive payment program.
There were more than 77,600 records in the CMS database, with basic product information on "complete" EHR systems used by 1,027 hospitals and 71,183 EPs.
The CMS data shows that hospitals have used complete EHRs from 27 developers and EPs have used EHRs from 327 different vendors to qualify for federal payments.
Facing "a plethora of options" has long been the rule for office-based primary-care physicians shopping for EHRs, with variables including cost, functionality, service and vendor size, according to Dr. Steve Waldren director of the Center for Health Information Technology at the American Academy of Family Physicians.
Since 2007, the Leawood, Kan.-based medical specialty society has run a website with not only an EHR guide but also a library where members can post peer reviews of their EHRs.
"We've tried to educate our members on the key things they need to look at," Waldren said, adding that one of those is "creating a peer network of people" to help them in their decision-making.
Another is advising physicians to investigate in advance how they'll be able get their patients' records out of their EHR system when their developer goes belly-up.
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