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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What am I thankful for today?
The usual stuff. A loving family. My faith and my church home. Good health. An interesting job where I can put my skills to good use.
And—as a professional skeptic, this is weird for me to say—I'm also grateful for our government, or at least some aspects of it.
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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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I had an opportunity last week to speak with a number of folks caught in the middle of dealing with Hurricane Sandy.
Not to go all Nietzsche on you, but what doesn't kill you at least gives you the opportunity to take some pride in being resilient—and maybe, if you're into healthcare IT, to figure out whether your disaster plan was adequate, and if not, how to do things better next time. And, oh yes, when facing disaster, be sure to keep a couple of reams of paper and a few old folks on hand.
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The great thing about data is if you play with it, it tells you stories.
Then the question is, are the stories true?
We know from several empirical studies that a digital divide exists between large and urban healthcare providers on one hand and small and rural providers on the other.
What we don't know quite yet—empirically—is whether the federal electronic health-record system incentive payment program has begun to bridge that divide. My somewhat educated guess would be, yes, but that's not good enough. We need to know for sure.
Last week, after downloading and analyzing data from the CMS and the Office of the National Coordinator for Health Information Technology about Medicare meaningful users and the EHRs they use, what jumped out at me was that Computer Programs and Systems Inc., or CPSI, had taken over the top spot from Epic Systems among all vendors to hospitals that have used complete EHRs to meet their meaningful-use targets. CPSI focuses on small hospitals.
Toss in No. 5 on the list, Healthland—another vendor serving small hospitals—and between the two of them they provide health IT systems to 382 hospitals, or 28% of the 1,381 hospitals that have become Medicare meaningful users with complete EHRs. Add in Meditech, which also markets to small hospitals, although not to the degree that CPSI or Healthland does, and you account for 574 hospitals and 42% of the complete EHR category.
Those numbers should not be surprising, given that a little more than half (2,561) of all non-federal community hospitals (4,985) have fewer than 100 beds, according to American Hospital Association statistics.
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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 want to say something quickly about outsourcing mobile app development.
At the Health 2.0 conference this week in San Francisco, HHS and the Advisory Board Co. announced the winners of their competitions for apps using the Blue Button technology developed by the U.S. Veterans Affairs Department.
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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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