Thanks to Joe Paduda at Managed Care Matters for hosting this week's edition of Health Wonk Review: Healthcare Cost Trends, Reform Implementation and Motivations.
Don't miss Jonena's post this week: The Billing Codes Merry-Go-Round
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- We address healthcare reform and the business intelligence required to make strategic decisions that positively affect performance management, employee engagement and process effectiveness. We'll dabble in current trends, news, training and business acumen and issues. Our desire is that you learn from the talented people who contribute to our blog. Please leave comments so we can learn from you!
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03/12/2013
HIMSS 13: Progress on uptake and interoperability, so when do we see the cost benefit?
Peggy Salvatore, MBA
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:
- Uptake rates for physicians, hospitals and computerized order entry (pharmacy, radiology, etc)
- National (international would be *really* nice) standards for interoperability
- Fully integrated patient record including dental, vision, mental health (we’re a looooong way from this one, but it is critical to getting a good end-to-end snapshot of the patient in front of us. Only ONE booth at HIMSS10 even offered software for mental health providers and, no, it wasn’t integrated into the major software packages)
- Ability to pull aggregated, de-identified data for research for full population studies and post-approval FDA studies
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.
02/28/2013
02/13/2013
Health Wonk Review – Valentine’s Day Edition: Here’s Your Heart!
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:
But seriously, for the rest of us, let’s look at what’s
really going on.
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 peggy.salvatore@gmail.com.
02/12/2013
Training and Change Management Maximize Our Investment in Health Information Technology
Peggy Salvatore, MBA
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:
- Sara in bookkeeping is complaining that she doesn’t understand the new screens and fields on her desktop – perhaps some software training for her?
- The shipping department is getting behind because they are spending an inordinate amount of time trying to figure out the new system – perhaps some process modifications
supported by training shipping department supervisors in the new systems and teaching them how to coach their employees on the new processes - Water cooler and lunchroom chatter is turning negative because the new system is slowing things down – perhaps some team building
- And then there is the tension between the old guard and the infusion of new talent and ideas – how about some cross-generational leadership training
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.
Sources:
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.
08/16/2012
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