I've written about plans to scrap the Veterans Affairs Department's VistA electronic health-record system and replace I've written before about plans to scrap the Veterans Affairs Department's VistA electronic health-record system and replace it with a whole new EHR system built from scratch, jointly, with the military, but it bears repeating—that idea, building a whole new EHR system, was worse than nutty.
Taxpayers have invested billions of dollars in VistA. The development effort, started in 1977, produced one of the best EHRs ever, maybe the best.
I was personally introduced to VistA in 2003 by Dr. Louis Coulson, who graciously gave me a demonstration at the Jesse Brown VA Medical Center in Chicago.
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Trade and professional organizations are warning the feds not to even think about acting on a new set of recommendations for Stage 3 of the electronic health records incentive payment program under the American Recovery and Reinvestment Act of 2009 until they take a good look at Stages 1 and 2 and fix what needs fixing.
The American Hospital Association, in a recent letter to acting CMS Administrator Marilyn Tavenner (PDF), alluded to problems with testing and certification of EHRs for reporting of clinical quality measures at the start Stage 1 of the program back in 2009 and 2010. Page 3 of the letter has a time table of five recent additions or changes in specifications and testing criteria to be used to certify EHRs for Stage 2 reporting of clinical quality measures since the Stage 2 final rule was published back in early September 2011.
Last month, the Electronic Health Record Association, an affiliate of the Healthcare Information and Management Systems Society, warned the feds that problems in its own development of EHR testing software was creating a bottleneck in the testing and certification of systems for Stage 2.
Presented with these examples of government fallibility, what should the response of the governed be?
Put yourself in their shoes. Be as patient with our brothers and sisters in government as you would have them be patient with you.
I've reported on the affairs of government and the private sector for 33 years. During that time, I've seen my share of knaves and incompetents mucking up the works in both spheres.
That's generally not the case, here. The people I've met and spoken with at the federal level and in the private sector who work in the health IT field are some of the brightest and most dedicated folks around.
It's just that this stuff is hard.
I was at the IHE Connectathon last week and saw more than 500 software engineers laboring away in the basement of a hotel in Chicago for the better part of a week. If this were easy, that much talent would have achieved total interoperability after the first Connectathon back in the 2000.
The U.S. healthcare industry didn't sink into its current IT deficit—compared with other industries—overnight, and so it won't dig its way out of this hole by morning.
In general, industry responses to the government's multiple requests for information and public comment have been forthright, but tempered, reflecting the needs and problems of their constituents, while wisely refraining from polemics. Keep it up. Feedback is vital, vitriol is not.
I also was impressed that Carol Bean, director of the EHR testing and certification efforts at the Office of the National Coordinator for Health Information Technology at HHS, made herself available and spoke candidly about the government's own problems developing testing tools. Keep that up, you federales. Transparency is what's needed to best get everyone through the many long days of trial and error to the ultimate success that lies ahead.
This is a marathon, not a sprint race. But no one sector, public or private, will be a winner without the other.
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I spoke with Dr. David Brailer last week and have been mulling over something he said ever since.
“The fight over the control of data will be an epic struggle,” he said. “I think it's going to be the reining battle of this decade.”
Brailer rephrased his statement to “a very large struggle” so as not to imply the fight will be between Judy Faulkner’s Epic Systems and everyone else, although the EHR wars are shaping up that way.
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Professionally speaking, I am a connoisseur of a certain kind of crankiness.
I like to listen to people who don't like the deal we've been handed and are willing to grump about it.
Decorum may make the world turn smoothly, but noisy people make it change. Often, they also make my job more fun.
A lot of people in leadership pay lip service to the ideal that they're open to new ideas, but we all know from experience that many are not.
In the magazine this week are short profiles on four of the squeakiest wheels in healthcare information technology—three physicians and a researcher with a doctorate in sociology. They are Dr. Lawrence Weed, Dr. Scot Silverstein, Dr. Deborah Peel, and Ross Koppel, Ph.D.
Each are self-professed fans of health information technology, but each have bones to pick with current systems and practices.
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Give RAND Corp. researchers Arthur Kellermann and Spencer Jones a gold star for integrity for pointing out the predictions in a totemic 2005 RAND report haven't quite panned out yet.
Their latest analysis of the value of health IT, published in the January edition of Health Affairs, notes that the billions of dollars in annual savings from the adoption of health IT systems projected by RAND peer Richard Hillestad in 2005 haven't materialized.
The Hillestad study was often cited by EHR advocates, including a few federal legislators, as an economic argument for promotion of health IT.
What seems to be getting lost in some recent news reports and follow-up discussions about both RAND reports, however, is that while the predictions of Hillestad and his team “have not yet come to pass,” it is not because their cost-savings projections were flawed, according to Kellermann and Jones, but rather because of “sluggish adoption of health IT systems,” EHRs that are “neither interoperable nor easy to use,” and providers who fail to re-engineer their care process to best leverage the IT systems they have.
Some analysts have interpreted Kellermann and Jones' report as RAND crawfishing.
Hillestad, now retired, says he has been keeping up on the controversy and is standing firm.
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Privacy, security rule update coming soon—honest.
The Office for Civil Rights at HHS is about to release its omnibus final rule on health information technology privacy and security—this time for sure.
“Stay tuned,” said Leon Rodriguez, director of the Office for Civil Rights, in a recent telephone interview. His office is the chief federal enforcement agency of privacy and security rules under the Health Insurance Portability and Accountability Act, and the lead rule writer for HHS of the HIPAA privacy and security rule amendments required under the American Recovery and Reinvestment Act of 2009.
“Stay really tuned,” Rodriguez said. “I would really watch closely in the coming weeks.”
But haven't we seen this movie?
Back in March 2012, the civil rights office shipped off its ARRA-mandated privacy and security rule update to the White House for what was then believed to have been only a perfunctory once-over by its Office of Management and Budget before its imminent release.
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Sometime before the end of March, the Office of the National Coordinator for Health Information Technology will be releasing new tools to help providers wanting to digitize the process of obtaining patient consent before releasing their medical records to regional or statewide health information exchanges.
The tools, developed in a pilot project in western New York, include educational videos that can be shown to patients on tablet computers, which also run software that enables patients to digitally record their consent (or not). The videos were developed following a random survey of western New Yorkers and several focus group meetings, with the aim of ascertaining what patients might want to know before they commit to making their electronic records available to the exchange.
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It should be an outrageous number—80,000 breaches—but crazy as it seems, that huge number might be a sign of progress.
I interviewed a group of health IT security specialists last week for a story we published about breaches and encryption.
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Private-sector healthcare leaders developing mobile health technologies should keep an eye on what's happening at the Veterans Affairs Department.
In April 2011, the VA and the Defense Department launched a stand-alone mobile application called PTSD Coach, a self-assessment tool and guide for people who have or who suspect they might have post-traumatic stress disorder. In its first 20 months, the app has been downloaded more than 90,000 times worldwide.
At the strong recommendation of a focus group of patients, PTSD Coach was designed to run without links to an electronic health-record system, with the idea being that more veterans and military personnel would seek treatment if, initially, they could anonymously download and use the tool for self-diagnosis.
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A reader was confused by an article we ran saying 48% of doctors were e-prescribing using an electronic health-record system. Another article, published Dec. 6, based on an annual survey of ambulatory care physicians by the National Center for Health Statistics at the Centers for Disease Control, placed "basic" EHR adoption at 39.6%. A basic EHR includes e-prescribing capabilities. That seemed like an 8-point spread in physician EHR use.
To make matters worse, the NCHS surveyors calculated two other EHR penetration rates (PDF) for ambulatory care physicians of 71.8% and 23.5%, while Dr. Farzad Mostashari, head of HHS' Office of the National Coordinator for Health Information Technology, quoted in a third article, said 31% of physicians and other eligible professionals have been paid federal EHR incentive money, which means they'd also have to be e-prescribers.
So, that leaves us with quite a range of physician EHR users—71.8% to 23.5%— and several rates in between.
Why so many?
Here's some background and an explanation.
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We probably won't know until late January the full-year numbers for 2012 on the EHR incentive payment program, but with three quarters of the year reporting, 2012 already is shaping up to be a banner year in health information technology.
Here's what I mean.
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