Be sure to read Peggy's post this week: Health Insurance 101: A Primer on Where We’re Going for Those of Us Who “Remember When." She takes a look at health insurance "back in the day" and contrasts it to what it's become (and becoming).
Be sure to read Peggy's post this week: Health Insurance 101: A Primer on Where We’re Going for Those of Us Who “Remember When." She takes a look at health insurance "back in the day" and contrasts it to what it's become (and becoming).
Peggy Salvatore, HealthSystemEd.com
When I turned 18, my parents did what all my friends’ parents did: they cut us loose to start paying for our own stuff. Even those of us who went to college were
supposed to kick in and help carry the load – we got jobs on weekends and in the summer to help out with expenses.
I paid my first health insurance bill for myself before my 20th summer. The bill from Blue Cross and Blue Shield was for $59.60 a month. My parents had always been self-employed and paid our family health insurance premium every month, “just like our mortgage. It wasn’t anything we even thought about, it wasn’t optional. You have to have health insurance,” my mom said.
Having grown up with that kind of thinking, I paid my own health insurance every month.
When I had kids, health maintenance organizations (HMO) became popular and I could take all my babies for their doctor visits for $5, shots included. I lost some of the choice of providers I had back with Blue Cross and Blue Shield, but the HMO was good, solid coverage. When a baby had to go to the hospital, it was covered. When a child needed surgery, it was covered. And those trips to the emergency room for stitches from falls, they were covered, too. We had comprehensive coverage from a strong corporation that gave my husband good union benefits. We had great suburban providers near our home.
Insurance companies charged us, or our employers, what they needed to charge us to cover the cost of care, including whatever shots and drugs we needed, and to make enough to cover administrative overhead. The money they spend on care for their members is called the Medical Loss Ratio (MLR); from an insurer’s perspective, when you have to pay out, it is a loss.
Typically, insurance companies paid about 80% to 85% of their premiums in MLR and the rest to administration. Health insurance companies charged rates based on the profile of the customer, so when I was young and healthy, my rates were low. When we had a family, rates went up. And as we are getting older, our premiums are rising. It makes sense; those things are determined by actuaries who do underwriting and determine the likelihood that you will draw on your insurance for care.
Back in the day, employers paid benefits to attract and keep good workers, and the coverage was good. Private sector coverage was distinguished from public sector coverage such as government-subsidized Medicaid plans. Medicaid was available to people who were seriously ill and indigent, and you had to meet very strict income and asset limits to qualify.
Where We Are Going:
Today, with all health insurance coming under federal regulations, the distinctions are blurred between private and public coverage. Under the provisions of the new health reform law that fully kicks in next year, health insurers are required to take all comers, and charge premiums for mandated packages. Actuarial tables be damned, Scarlett! Insurers must cover mandated populations with mandated packages and deliver mandated services in ways that are friendly to the population. Premiums will be subsidized with public funds based on income according to a sliding scale. And by the way, remember that MLR where insurers’ liabilities determine what percentage goes for overhead and administration? That percentage is mandated now, too.
When insurance is mandated for everyone, when packages are written according to law and not according to what is logical according to age and utilization, when the amount you can spend for administrative expenses is mandated, the basis for the whole concept of insurance is undermined. It’s like defying the laws of gravity.
When health insurance is written while ignoring the logic of actuarial tables and underwriting principles, it isn’t really insurance anymore. The government is just mandating that a private, third party pay for healthcare for its citizens, and premiums will be subsidized by the government for those who can’t pay. The third party becomes an extension of carrying out the government rules for who is covered, what they get, and even whether they get it.
Yes, those of us who have been watching managed care since the mid-90s have certainly seen that insurance companies have been “rationing” care under depth and breadth of coverage in contracts with employers and private individuals all along. However, it is a rationing system that the purchasers have agreed to within those private contracts. If I get denied coverage, the insurance company can point to the plan that I bought (i.e., the private contract which I entered into with them) and show me that benefit wasn’t included in the coverage I purchased from them.
Within that private contract framework, the insurance companies had discretion regarding the customers with whom they entered into contracts. Some health insurance companies chose to deal in the private insurance market and contract mostly with large employers. Others became specialists in government-subsidized programs like Medicare or Medicaid. They built their premium pricing structure and contracts around their selected markets and the amount of risk they chose to assume with certain populations.
Under health reform, insurance companies are regulated so they have to write packages according to federal regulations, offer insurance to mandated groups, and charge rates that under normal underwriting rules defy the laws of simple arithmetic. Some interest groups would have us believe that insurance companies are evil entities that should not be in the business of healthcare; that they are profiting from premiums and denying care because they are the third party standing between the patient and the provider.
In reality, they have assumed the lion’s share of the responsibility in case you have a catastrophic illness, and they also cover preventive care like vaccines because, if for no other reason than simple good business sense for them, it is cheaper to prevent a disease than to treat it. Based on that logic, most health insurance companies are concerned about keeping their members healthy. And when they are mandated to cover certain populations and conditions, they are going to be even more concerned about keeping those populations healthy.
When I was paying $59.60 a month for Blue Cross and Blue Shield, it was wholly voluntary on my part and theirs. I chose them as an insurer and they agreed to write coverage for me. I went to the doctor when I was sick and they held up their end of the deal and paid 80% of my bills. I’m not sure what the business model is going to look like when that contractual arrangement is no longer voluntary by either the patients or the insurance company. I suspect it will get expensive for both parties, as the covered populations will not be chosen by the insurance company as part of their business strategy, and the members will be getting a mandated package of services that they will be required to pay for.
It doesn’t sound exactly like a government-run healthcare system, but then again it doesn’t not sound like a government-run healthcare system, either. And it makes me wonder, armchair health economist* that I am, at what point we just cut out the middle man and eliminate the charade.
*For the record, even though I am a self-declared armchair health economist, I have had the privilege to watch this from a professional perch for awhile. In one particular meeting in the late 90s, academics and government think-tankers gathered to figure out how to rewrite the tax laws to encourage coverage within the free market system. If you are looking for a mental image, think Upton Sinclair’s The Jungle.
Thanks to Louise Norris at Colorado Health Insurance Insider for hosting this week's edition of Health Wonks Tackle New Questions in Healthcare Reform.
Be sure to read Peggy's post this week. In her post, Cost, Compliance and Safety: Are They Mutually Exclusive?, Peggy compares the aviation industry and the healthcare industry, and wonders if we might be heading down the path towards over-regulation in healthcare.
In aviation, safety has always been the primary concern. In fact, aviation’s safety record is so stellar that it is considered a model for healthcare. That is quite a testament.
However, a retired pilot friend recently bemoaned that FAA rules and regulations have overtaken concern about safety, and he postulates that aviation is not better for the change.
“Now we’re only concerned about compliance…we have a cast of thousands as support staff. When I started flying in 1964, Part 91 federal regulations were about 30 pages. You could memorize it. Today, it is hundreds, if not thousands, of pages and nobody can possibly know everything that is in there. We are less safe today than we were 50 years ago,” he complained.
Making and keeping track of all those regulations costs aviation a lot of money. It requires a boatload of federal regulators to oversee them, and costs private carriers a bundle of money to hire people to monitor every jot and tittle of the laws. And, he concludes, the passengers and the airline employees do not benefit from this over-regulation.
Will Healthcare Follow Aviation Again?
Just about everyone in healthcare knows about the vaunted aviation checklist, and how it has become standard procedure in many operating rooms today. Books are written and consultants make good livings just teaching the checklist method of philosophy. The checklist is a great tool. Healthcare is better for following aviation down that path.
But is healthcare going to benefit by following the FAA down the road to over-regulation? We can trip on our path toward safety by using regulations as stumbling blocks instead of paving a smooth road to improved quality and performance.
One Example From a Pharmaceutical Client
Just last week, I was observing a training class that I wrote for a major pharmaceutical company. We were training hourly line employees on procedures that affect product safety. To a person, they had one complaint: standard operating procedures (SOPs) were becoming downright cumbersome. That makes it very difficult to follow, let alone implement them.
One veteran employee said when an incident occurs, someone writes another procedure to address that specific event and adds it to the book of procedures. With each new addition, nothing else in the book is deleted or changed, and so it is becoming nearly impossible to follow. In fact, the employee complained that SOPs are written in response to each incident, meaning that many new SOPs only relate to one isolated event. The SOPs are losing their meaning and rationale. It is just a jumble of unrelated knee-jerk reactions to individual events.
The employee concluded that this practice was creating more problems than it was solving by having a procedure manual that could not be followed. There are now so many rules to follow, she said, the rules can no longer be followed.
Is All of Healthcare Headed Toward Unwieldy SOPs?
With the passage of the Accountable Care Act, known colloquially as ObamaCare, many believe that we are headed down a path of over-regulation. Where common sense and good medical practice once dominated the industry, healthcare practitioners (once called nurses and doctors) are overwhelmed with rules regarding how they practice, to which the actual art and science of medicine is taking a backseat.
At a recent visit accompanying a friend to a physician’s appointment at a hospital center, we observed that we were two of only four people sitting in a new waiting room with 25 chairs. There were two large semi-circular reception desks – one with four and another with 12 stations – in this cavernous waiting room. Most of the stations were empty. While we were waiting, a physician accompanied by a nurse and two receptionists carried a brochure rack around the waiting area deciding where to place it. Let me say that again. A highly-skilled physician specialist carried around a brochure rack with his nurse and two receptionists trying to find a place for it...for about 15 minutes.
In this brand-spanking-new facility where our doctor’s office had been moved since our last visit (from a very modern, extremely functional office building now sitting vacant in the parking lot), we also observed not one, but two printers behind the smaller receptionist desk flanked by a wall of paper files. We filled out our medical information on a clipboard, which we have done for each of his visits for the last three years.
The Trend Is…
By personal experience as well as professional observation, the trend is toward more regulation, more staff to track our compliance with the rules, and an ongoing steady stream of paperwork to track our patients. Are cost, compliance and safety mutually exclusive? They don’t have to be and ideally shouldn’t be. But with the trend toward over-regulation, we may be missing an opportunity to streamline and cost-cut while serving patients better.
Instead of continuing to ramp up our regulatory oversight into the stratosphere, perhaps it is time to – if I can paraphrase my retired pilot friend – throttle back and re-evaluate what we are really trying to accomplish.
Don't miss Peggy Salvatore's addition to the HWR on the HIMSS13. Peggy encourages us to stay patient on cost savings from health IT adoption.
Read the entire post.
“Technology usually brings with it a falling cost curve. But the reality is, for now, we are still undergoing the transformation stage and the transition is rocky and costly.”
Last week I was reminded about how far we’ve come in electronic patient records in just three years, when the annual signature event in health IT, the Health Information Management Systems Society conference known as HIMSS (pronounced HIM-Z), was held. Three years ago I spent the week at HIMSS10, and at that time we hadn’t even started up the Meaningful Use hill, let alone crested MU2.
Since then, we also have seen uptake rates for electronic patient records and CPOE topping 50% in most provider venues without even breaking a sweat. And, in my humble opinion, the leading news out of HIMSS13 was the fact that six leading electronic patient record systems will be working together on establishing standards to advance interoperability. Whew! Never thought we’d see that in the first half of the 21st century…
The progress is commendable. And as a long-time observer and analyst in this field, while the cynic in me often says, “We wrote white papers about that 20 years ago…it’s about time!”, the realist knows that fully integrated electronic patient records requires a kind of sea change in the way we provide service to patients – and that will only come over time with changes in culture, which is why I have been talking about change management and training as absolutely essential for a smooth transition – something that studies are bearing out (see my Healthcare Talent Transformation blog post from last month).
But probably the biggest single factor in moving the needle on uptake is the more than $10 billion we spent in incentives over the last few years to encourage doctors and hospitals to purchase the software systems. Unfortunately, after those billions have been spent, only now are the top vendors getting together on establishing standards for interoperability. I haven’t read the fine print, but I will guess that those are probably not going to be free upgrades to those systems the tax payers already bought and paid for. I would love somebody who knows about the interoperability effort to post here with more details since time to publish does not allow me to do the research. In the meantime, I might do a little looking and report back in a few weeks, so stay tuned.
But the bottom line on the advantages of electronic patient records boil down to a few major points, and at HIMSS13 it is clear we have finally started to move the needle on some of these:
The Falling Cost of Technology – Except in Healthcare
As envisioned by the planners, when we can capture the full picture of a patient, and all providers have access to it, theoretically the cost of healthcare should fall quite a bit. No more duplicate tests, the cardiologist will know what the psychiatrist prescribed so we won’t have the drug-drug interaction issues that currently cost us at least hundreds of millions a year in adverse events and the attendant morbidity and mortality rates, we won’t be writing and re-writing scores of sheets of repetitive patient documents for each provider and patient encounter and having to physically store and transfer them. And, the icing on the cake, when we have valid, comprehensive data on full populations, we should know what works in which patients which will narrow our treatment options to the ones most likely to succeed the first time.
Technology usually brings with it a falling cost curve. But the reality is, for now, we are still undergoing the transformation stage and the transition is rocky and costly. The culture is still changing, the records are still isolated in single offices or hospital systems, and we haven’t completely solved how to interact with patients using an electronic interface in the room, and especially, we haven’t solved how to take and capture complex notes in an electronic record.
We aren’t there yet. But reports out of HIMSS13 suggest we are getting there.
If you were at HIMSS13, we’d love to hear from you in the comments section. And if, like me, you missed it, let me shamelessly hustle what sounds like a great deal which is a three-hour debrief today, Wednesday March 13 from 11 a.m. to 2 p.m. CST and access to full sessions online until June, Here’s the link: HIMSS13 Online Sessions
And, what’s more, the online sessions are eligible for CE credits.Let me know what you think about HIMSS13, and I’ll be reporting back when I learn more.
By Peggy Salvatore, MBA
Healthcare Talent Transformation blog contributor
Readers note: All images in this blog were taken from the web and are in the public domain. No proprietary images were used.
Our intimate relationships are a lot like our nation’s healthcare system. Okay, maybe not, but this is, after all, the Valentine’s Day edition of HWR, so how about if you play along and we pretend to find analogies anyway?
Dependable, strong, with a firm foundation and a bright future: If this describes our healthcare system to you, here’s your heart:
Not everyone is enamored with the way our health system is run today or is looking forward to the changes anticipated by health reform. Bob Vineyard at Insureblog registers his skepticism in HIX and ObamaCare where he sounds unsure whether the government can deliver on its promises. If you’ve been burned and are worried about getting burned again, here’s your heart:
More developments on aspects of healthcare implementation, as Louise at Colorado Health Insurance Insider tell us that a move to repeal the health insurance exchange in the Rocky Mountain state fell far short of the support needed to undo it. Louise writes, "Given all of that, and given the progress that Colorado has made over the past two years in creating the state’s marketplace and implementing various other healthcare reforms (both state-based, like maternity coverage and gender-neutral premiums, and ACA-related, including the recent push to expand Medicaid), I would say that Colorado is on track to greatly improve its overall healthcare outcomes. Efforts to set the state back to square one in terms of reform efforts are probably politically motivated rather rooted in any real attempts to bring about real healthcare improvements for the people of Colorado."
Challenges to Obamacare are wending their way through the courts. Maggie Maher at Healthinsurance.org tells us in her post IRS ruling a ‘disaster for Obamacare?’ Not quite. The claim that – as a result of an IRS ruling – “millions” will be left uninsured under Obamacare is “fear-mongering, pure and simple,” says blogger Maggie Mahar. In her posts, Mahar rejects the arguments of a February 4 Forbes article that she says plays right into the conservative claim that Obamacare is "a disaster."
For the young and young-at-heart, at California Access Health the opinion on Obamacare is more positive as Anthony Wright tells us that despite a recent infamous article in Buzzhead, there are some obvious and non-obvious reasons why Obamacare is a boon to young adults.
For more on Obamacare, John Goodman at Health Policy Blog wants to take a balanced approach to health reform and try to find something for everyone. Here is John Goodman’s piece, Why I Am More Egalitarian Than Most Liberals on Health Care. John offers solutions to health care reform that meet the criteria of both liberals and conservatives.
Do you need help sorting through the fine points of the doc payment debacle brought to you by the Resource-Based Relative Value System Update Committee, or RUC, that arcane AMA committee that sets physician rates? Then here’s your heart, as Dr. Roy Poses over at Health Care Renewal explains how the committee is weighted toward specialists who value procedures and devices over the cognitive services delivered by primary care physicians. This week he discusses the negative affect that has on reimbursement rates for PCPs. It’s a thorough discussion of a difficult issue.
Julie Ferguson at Worker’s Comp Insider states, "A worker's first day at work shouldn't be his last day on earth." Studies show that approximately 27 percent of job-related fatalities involve employees who have been on a new job for less than 90 days. Julie talks about the case of an untrained temporary worker who suffered a gruesome death on his first day on the job in a Bacardi bottling plant in Florida.
Also on the labor front, the NLRB has issued a series of reports based on its decisions in cases regarding employer regulation of the use of social media by employees. Now that the validity of recess appointments to the NLRB has been upended by the DC Circuit Court of Appeals, these – and many other – NLRB rulings are technically invalid. Should health care employers therefore ignore the NLRB precedents on regulating social media? David Harlow of HealthBlawg says no – the contours of the rules should still be followed in sensible social media policies.
Over at Disease Management Care Blog, Dr. Jaan Sidorov warns his fellow physicians that non-physician professionals and lay-persons are managing to achieve a remarkable degree of medical expertise. He strikes a neutral tone with this controversial topic, but in the meantime wonders if "care management" is one way for consumers to sort it all out.
Disease management, testing and drugs go hand-in-hand, and at Health Affairs Blog, David Rothman analyzes studies that show people are unwilling to forgo testing and drugs in the interest of appropriate utilization, even when experience shows no real benefit to higher levels of utilization. In his post, he talks about the reluctance of Americans to consider evidence that certain medical tests and screenings might be unnecessary, harmful, and not worth the money (although he points out that Americans are more suspicious of drugs): "When we asked [focus group participants] about specific recommendations by professional medical societies and the U.S. Preventive Services Task Force that, for example, women between the ages of 40 and 49 should forgo mammograms or that older men might not want to take a PSA test, participants were not merely dismissive but disdainful...These kinds of recommendations, many of them believed, were part of a plot to save money and they refused to give them credence."
Stretching our Valentine’s Day metaphor nearly to the breaking point, we ask the question: Is nursing home patient care better when the nursing home is doing it for the love, not the money? More accurately, do non-profit nursing homes really provide better care than their for-profit counterparts? Jason Shafrin at Healthcare Economist analyzes a study that shows that, when controlled for proximity to the patient’s home, non-profit nursing homes fare better, using measures like changes in ADL functioning and hospital readmission rates, than for-profit nursing homes. For those nursing homes that aren’t in it for the money, here’s your heart:
You might have other kinds of concerns of the heart. If you suspect that your loved one is inclined to deceit, perhaps this blog will strike a chord for you. Joe Paduda in IRS, Health Care Premiums Under ObamaCare and Right-Wing Distortions at Managed Care Matters dissects inaccuracies in the press accounts of the projected cost of health insurance under health reform. That $20,000 price tag for health insurance for a family of four being thrown around in the press just ain’t so, says Joe. If you’re wondering who might be hiding something, here’s your heart:
As you’ll see from our next entrant, Brad Flansbaum at the Hospitalist Leader, I had a tough time deciding who would get the question mark heart. In Blink Twice, Rub Eyes: QI Floaters and Spots, Brad has literally assembled a collection of snapshots from studies that show how some of our most touted and expensive efforts to improve patient care are, at best, inconclusive and, at worst. totally useless. It’s an impressive collection of unimpressive results. Since Brad’s question mark heart went to Joe Paduda, I guess we’ll call it a wrap.
From those of us at Healthcare Talent Transformation to all our fellow HWR bloggers, here’s your heart:
Take a look at my last blog post on the effect of training and change management on meeting federal standards for health IT here, Training and Change Management Maximize Our Investment in Health Information Technology.
Thank you for the opportunity to host Health Wonk Review. I can be reached at Peggy.Salvatore@healthsystemed.com or email@example.com.
I love a good think tank study. So here we go: a KPMG survey suggests training and change management are bigger barriers than technology implementation in achieving federal health IT standards.
Let’s look at this study in light of two other headlines this morning, February 11, from Healthcare IT News:
“Sebelius: ‘Speed up the rate of change’” and “EHRs top priority for CIOs”
We are partway there, but can we get there faster and work out the bugs?
Sometimes an analogy is helpful, so let’s break down the rapid, billion-dollar deployment of electronic patient records throughout one-sixth of our economy into a simple multi-million dollar story of a small company.
Let’s pretend you own a company, a few hundred employees, and your company is 40 years old. You make the hypothetical widgets, you are the Widget King. You’ve been operating your business – the books, the customers, the vendors, the employees – on a terrific old mainframe that has served you well. It’s not quite as old as Eniac but you are still printing out reports on tractor printers – and it’s getting darn hard to get the paper these days. The times, they are a-changing and so must you.
As your faithful, long-time machinists, bookkeepers, manufacturing assembly workers and shippers are retiring, you are bringing new people into this tightly held, well-run organization that has been your baby since you were in your 20s. Some of these freshly minted MBAs and IT whizzes say you can get a lot more done in a much quicker way with a fresh infusion of cash – say $5 million – in new technology to make your company more competitive and nimble in the new economy. It’s an easy sell. You’ve noticed that the market seems to be getting away from you. The MBAs and IT analysts say you can maximize your impact and increase revenue exponentially by collecting the data you have and analyzing it to segment your market, streamline your processes and create new connections among employees, customers and vendors. You’re sharp, you became successful because you can read the tea leaves.
So you spend the $5 million.
But your staff is still heavily populated by veteran employees. They are not very happy with the way the new technology changes the way they do their jobs. There is resistance to new hardware and software. There is reluctance among your older customers that you are changing some of the ways you invoice and market to them, and some of your long-time vendors just aren’t quite comfortable with the new way of relating to your company. Sure, some of your customers and vendors have been waiting for you to catch up to them, but there remains some resistance internally and externally. Newer might be better, but it’s different.
What’s a sharp CEO like you to do? You’ve spent $5 million, it was money well-spent IF the new technology is used well. If not, you can’t really go back to Son-of-Eniac. So you need to bring your people along with you.
Your MBA recommends bringing in an Organizational Development specialist. The OD person says:
The inventor of the widget realized the $5 million in new technology was just the first step; now he needed to invest in the people who will make the $5 million technology work. Soon, the company was humming along again, and moving gracefully into the 21st Century.
Take the story of the Widget King and extrapolate that a gazillion times over in dollars, complexity, products and people to one-sixth of our economy that is heavily populated by staff that has been used to doing business the old way rubbing up against people heavily invested in doing things a new way.
In health IT, the upfront investment in hardware and software is being made, much of it by our government so this is your tax dollars at work affecting the quality and cost of your healthcare. There is no turning back. So perhaps it behooves us to help this large and complex machine we call our health system move gracefully into the 21st Century. Let’s throw good money after good and invest in training and change management to reap the benefits of the billions that we’ve spent, to get things running smoothly sooner – all for the better.
KPMG Study: KPMG survey suggests training and change management are bigger barriers than technology implementation in achieving federal health IT standards.
Sebelius: 'Speed up the rate of change'. By Mary Mosquera, Senior Editor.
EHRs top priority for CIOs. By Diana Manos, Senior Editor.
After a hiatus, it’s nice to be back in the rotation in the Healthcare Talent Transformation blogging fold. Thank you, Jonena.
In scanning the headlines to find the latest news and reports on health IT, it is clear that while health IT uptake is moving along nicely since I last blogged here almost two years ago (!), actual health IT *integration* is slogging along.
On the plus side of the ledger, the feds have doled out millions in Meaningful Use incentives to Medicare and Medicaid doctors who bought patient record software and met some abbreviated version of compliance with Meaningful Use criteria. On the minus side of the ledger, the Meaningful Use criteria had to be abbreviated so providers could qualify for the incentives.
Just why is that? Two answers leap to mind. Either a.) the Meaningful Use criteria are too stringent to be met in the timeframe required or b.) providers and software are not prepared to meet them. My money is on a and b. An outtake from an article on Meaningful Use Stage 2 in the December 27th edition of InformationWeek Healthcare explains:
Nearly half -- 47% -- of hospital and health system leaders are "somewhat confident" of their ability to meet the Meaningful Use Stage 2 requirements, according to a new KPMG survey. The respondents included 140 healthcare executives who completed a webcast poll.
In addition, 36% of the survey respondents said they were "confident," 4% said they weren't confident at all, and 11% didn't know what their level of readiness was to meet the criteria, which are part of the government's electronic health records (EHR) incentive program.
When asked to identify the biggest challenge in complying with the standards, the largest group of respondents (29%) cited training and change management...
… Jerry Howell, a principalin KPMG's healthcare consulting practice, in an interview with InformationWeek Healthcare…said he and his colleagues weren't surprised that so many respondents saw training and change management -- rather than technical aspects of implementation -- as their top challenges in Meaningful Use Stage 2. "We always felt reasonably confident that the leading software vendors would successfully create the technology capabilities to meet the Meaningful Use requirements," he said. Also, he noted, the transition from Stage 1 to Stage 2 is mainly about "using the technology effectively. That's contingent on the processes and people being right, which is all about change management."
The message in this blog feels as familiar as a favorite old sweater. The old sweater is this: Until we provide training to move providers up the curve to adopting health IT in a meaningful way (there’s that word again), we’ll be overlaying 21st Century solutions on a 20th Century mindset. And it will take a generation, instead of a few quick years, to integrate a fully functional electronic patient record system into our healthcare system, leaving us to continue to grapple with the inefficiencies and duplication that our paper-based system begets.
A vignette from a recent experience with a family member’s emergency care made it clear that things aren’t quite moving apace as we’d like to believe. A member of my family had a serious health scare over Thanksgiving, one that led us to seek an opinion at a top – some might say *the* top – healthcare institution in the US. We filled out paperwork on clipboards at several visits to inpatient and outpatient facilities. The provider did not have access to the records of the other caregivers in this person’s life in another state, and there are at
least three relevant ones, so they relied on us to provide that information either from memory or physically contacting them and providing it ourselves. We carried paper files from another “modern” facility to this hospital. We required a paper prescription to be carried in our pockets for an MRI back home, after which the physical MRI film had to be sent overnight via FedEx to be read at said top healthcare institution by their expert. Huh?
I am going to say something that nobody at the General Accounting Office wants to hear, let alone the people at Health and Human Services, which is that you just spent hundreds of millions of taxpayer dollars encouraging use of electronic patient record systems that aren’t quite ready for primetime by providers who aren’t quite ready to use them. We’re peering over a fiscal cliff and staring at spending this money all over again sometime in the future on systems that are fully integrated by providers who are game to make them work.
It’s nice to be back.
Update: New government numbers out today show we've spent more than $10 billion in EHR incentives so maybe we can add an editor's note to the blog in the interest of accuracy.
Posted by: Peggy Salvatore, www.healthsystemed.com
The news could not be sadder. Premature baby boy Genesis Burkett was given an IV dose of sodium chloride 60 times greater than the physician ordered. The fatal infusion has professionals and loved ones all around the situation looking to place blame. It’s only natural. It is the worst of human tragedies and people need answers. Sometimes answers contain a kernel of peace – sometimes.
For the details, the READ MORE.
In any case of error, medical or otherwise, there is usually some responsibility to go around, no matter how well intentioned or trained the people involved. I don’t know every detail and will try to refrain from passing any sort of judgment on a situation this sensitive to which I am not intimately privy. I do have, however, a few general thoughts on the issues as presented in the article. Those issues:
The initial interface with any electronic health record is the human who enters the data. Humans can only enter data they can accurately interpret or believe to be true. The hospital involved, Advocate Lutheran General Hospital in Park Ridge, Ill., apparently has reached the HIMSS Analytics Stage 6 of its health IT implementation, out of a possible 7, meaning it should have computerized physician order entry (CPOE) integrated into its system. In this particular case, it appears the relevant parts were not online and this prescription was outside that loop.
My gut reaction to this (and I’d like to hear yours, so please comment from your perspective) is that electronic health record systems are being asked to carry a lot of water when the bucket is still full of holes. A fully integrated and implemented health IT system, with well-trained staff and backup systems, may very well be positioned to avert tragedies such as these.
But we will never – and I use that term sparingly – be able to completely rely on any fully automated system in the care of human beings. The best health IT systems will accept, transfer, organize, analyze and process data that healthcare professionals enter. Electronic patient record systems will not have the capacity to look at the patient in front of them, determine that it is a frail infant that can fit in the palm of its father’s hand, and conclude that the dosage prescribed is far in excess of what is reasonable. Highly educated professionals, interacting with well integrated and fully implemented electronic health records, can deliver state-of-the-art care with the assistance of meticulously kept records and perfectly metered doses that match treatment protocols appropriate for the profile of the patient in front of them.
Medicine is yet an art as well as a science. And it is the most caring and skilled human beings, working in concert with finely tuned equipment, that will deliver quality care. In this imperfect world, under those conditions they will deliver it almost every time.