It's fashionable these days to call every cluster of U.S. Senators a gang.
The Gang of Six. The Gang of Eight.
This week, six Republican senators, having formed their own grouping—let's call it the Gang of Carp—released what they called a “white paper.” In it, they carped about problems with the management and direction of several federal health information technology programs funded by the American Recovery and Reinvestment Act of 2009. They said we need to “reboot” the program, as if it had crashed. That assessment was unbalanced and unfair.
Also this week, a group of 10 healthcare IT cognoscenti—let's call them the Gang of Good Cheer—put out their own “discussion paper,” finding bliss in healthcare IT. Pangloss would have beamed at their grand vision of “an exponential rate of progress in the use of health and health-related data” as if there weren't serious shortcomings thus far. Their paper, too, was unbalanced; cheerleading bordering on euphoria.
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Where's Epic?
In his keynote address Tuesday, cardiologist and healthcare information technology futurist Dr. Eric Topol asked that question.
The context was a much-ballyhooed consortium of five health IT vendors announced Monday at the Healthcare Information and Management Systems Society conference in New Orleans.
They joined hands to launch a not-for-profit consortium called the CommonWell Health Alliance, with the stated aim of improving health information interoperability. The founding members of the consortium are Allscripts Healthcare Solutions, Athenahealth, Cerner Corp., Greenway Medical Technologies, and McKesson Corp., along with its connectivity unit RelayHealth. At the launch, the founders said the consortium is open to everyone.
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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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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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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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Sarah Krug, president of the Society for Participatory Medicine, had taken her stab at diplomacy before I spoke with her over the phone last week.
I had been reading news releases and calling people I know to put together a story about industry leaders' reaction to the massive, 1,354-page, three-rule phone book the feds dropped on the industry Aug. 23 and Aug. 24 when I received a hedged e-mail from Krug's group.
"Although we're disappointed this final rule does not give patients next-day access to their electronic medical record after they leave the hospital, we believe that on balance the Stage 2 meaningful-use requirements go a long way towards patient empowerment and feature a number of important patient-centered innovations," it said.
In a follow-up phone call, she was more direct: "Long story short, we're disappointed."
The goal of the New York-based not-for-profit, Krug said, is for patients to have immediate access to their updated records. They had been hoping for next-day access in the Stage 2 rule. Instead, the rule requires hospitals to make available online to more than 50% of their patients their information within 36 hours of discharge.
"It's definitely a step in the right direction,' Krug said, before adding, "I'm sure there are going to be a lot of patients that are going to be just as disappointed."
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Encryption is a standard security procedure for moving patient information over the Internet, but not so much for patient records just sitting there on a computer not going anywhere.
So one thing that jumps out in the CMS' new Stage 2 meaningful-use rule is the increased emphasis on encryption for so-called data at rest—that is, patient-identifiable records on servers, hard drives and portable devices.
Under Stage 1 rules, providers are required to perform a risk assessment, as they are required to do under the security provisions of Health Insurance Portability and Accountability Act.
Now under Stage 2, they must give serious consideration to encrypting that data (PDF, see pages 132-136).
Why the change in emphasis?
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HHS certainly backed up the old regulatory dump truck and pulled the lever, spilling out 1,354 pages of legalese in three separate health information technology-related rules.
One was the CMS' long awaited Stage 2 meaningful-use final rule affecting providers, running a sumo-sized 672 pages.
Another was a companion rule from the Office of the National Coordinator for Health Information Technology, coming in at a hefty 474 pages and targeting IT developers on certification criteria for electronic health-record systems.
Finally, the third rule, also from the CMS and weighing in at a comparatively svelte heavyweight 208 pages, does three things. It pushes back to 2014 the compliance deadline for ICD-10, tweaks an earlier rule on the national provider identifiers, and—after 16 years—establishes a set of health plan identification numbers first called for in the Health Insurance Portability and Accountability Act of 1996.
Like many of you, I'll be spending the weekend poring over the new rules, and I'll be giving you my take on them in the coming weeks.
A few things come to mind right now, one being that perhaps the feds got a few things right, based on the mixed criticism that quickly emanated from healthcare industry leaders tracking—and lobbying—the federal rulemakers.
For example, the American Hospital Association quickly fired off a summary, praising the feds and the CMS in particular for "a shorter meaningful-use reporting period for 2014," but quickly adding expression of disappointment "that this rule sets an unrealistic date by which hospitals must achieve the initial meaningful-use requirements to avoid penalties." The AHA also said that CMS "complicated the reporting of clinical quality measures and added to the meaningful use objectives, creating significant new burdens."
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The year the dot-com bubble burst, 2001, the three largest pharmacy benefit management companies launched RxHub, an electronic prescribing network, and the two main pharmacy associations created its rival, Surescripts.
While the two exchanges battled for supremacy, both promoted the common cause, e-prescribing, as a patient-safety issue and funded a grind-it-out marketing campaign that cost millions of dollars to sustain.
I had lunch the other day with physician information technology leader Dr. Harry Greenspun, who recalled those days, saying, for years "you couldn't swing a dead cat" in health IT circles without hitting Kevin Hutchinson, Surescripts' then-omnipresent CEO.
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