It takes some pluck to drive in West Virginia, probably to live there, too, amid the many mountains, valleys, hills and “hollers.”
As one plucky experiment in open-source health information technology ends in the Mountain State, another continues to thrive.
I wrote about both recently: the seven-year test by a consortium of community health centers using a remote-hosted version of the Indian Health System's EHR, the Resource and Patient Management System, or RPMS, which is winding down; and the deployment in another network of the VA's VistA EHR across a couple of ambulatory-care clinics and seven state-run hospitals and long-term care facilities, a project that's going strong.
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A public official in a small town in Maine claims there are links between the high costs of an electronic health records system and the decision to close tiny St. Andrews Hospital and Healthcare Center in nearby Boothbay Harbor. That may not be the case.
Officials last year announced St. Andrews, a 19-bed critical-access hospital owned by Portland-based MaineHealth, would be closed due to low volume, but that hasn't set well with the citizenry.
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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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Dear Jon Stewart,
I'm a huge fan of your “Daily Show,” but last week, with your segment, “The Red Tape Diaries,” you and your staff waded into the swamps of health information technology, made more dense and impenetrable by the Defense and Veterans Affairs bureaucracies.
By the sound of it, your hearts were in the right place, but you made a hash of a couple of things.
One topic covered by your segment was the alleged lack of interoperability between the VistA and AHLTA electronic health-record systems at the VA and DoD.
The other was the backlog of disability benefits claims at the VA, currently in excess of 900,000 claims and growing. A backlog, I might point out, that's exacerbated by the time it takes the Defense Department to round up and deliver to the VA all the medical records needed to document a service-related injury. It's a broken element that you didn't mention.
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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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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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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 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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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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