The high ways of medical #marijuana: Not to be confused with the Massachusetts medical information highway #HIT #EMR

This funny post from BIDMC health info chief John Halamka:

The Massachusetts Health Information Highway is abbreviated the MassHIway. Its phone number is 1-800-MassHIway.
Unrelated to IT (or so we thought), Massachusetts legalized medical marijuana. This is an actual transcript of a call we received today

Sean – “Hello, Mass HIway – how may I help you?”

Caller – “Yes, can you tell me how I become a marijuana grower/dispenser?”

But, seriously folks, HIT is in the news. Dr. Halamka is testifying in DC before the HIT advisory panel. If you don’t know what the term “meaningful use” is, it might be a bit too wonky for you.

And, the Globe reports, behind its paywall, that Westboro-based eClinical Works is expanding into the “patient engagement” business. Here’s the press release.  The high-way caller needs to check out this Globe story, also behind the paywall: New Mexico marijuana program a guide for Mass. Strict model may help Bay State shape its rules

For some reporting on the downside of HIT, check out the Center for Public Integrity investigation. They suggest the rise of electronic medical records has led to a jump in upcoding – threatening any savings that promise to come with HIT.

The series documented that thousands of medical professionals steadily billed Medicare for more complex and costly health care over the past decade — adding $11 billion or more to their fees — despite little evidence that elderly patients required more treatment.

The series also exposed a wide range of costly billing errors and abuses that have plagued Medicare for years — from confusion over how to pick proper payment codes to apparent overcharges in medical offices and hospital emergency rooms — and strongly suggested these problems have worsened with the rapid growth in the use of electronic medical records and billing software.

Here in Massachusetts, the effort is well underway. Here at the expected connections. Again, an HIT jargon alert.

ACO to ACO transmission – two large healthcare systems breaking down silos and exchanging lifetime summary records for care coordination

Provider to Registry transmission  - EHR data sent to a third party for computation of quality and performance metrics

Provider to Plan transmission – EHR encounter data sent from a provider organizations to a payer for care management

Pediatric Care Coordination – EHR transmission between a community provider and a tertiary referral hospital

Suburban to Urban Specialist referral – A PCP at a community site sends referral data to an urban specialist, electronically closing the loop between the two

Patient empowerment and the digital revolution

Forgive the budding clichés. If you are at all interested in patient empowerment and the many other ways the the digital revolution is changing health care, check out the tweet stream from the Connected Health conference. 

I find it kind of hard to follow tweetstreams because they read backwards. But, you can click on each tweeter’ site from the stream and start from the top.  NatNetBoston was there yesterday, tweeting live.

Or try #chs10.

The future for computers and health care

 Partners’ Kedvar asks – What is the future of The Center for Connected Health?

 I was recently asked to predict what our Center would be like 10 years hence.  Stated another way, the question was: “What is your ten year vision for your Center?”  My initial reaction was, “Of course I should be able to articulate that.” After all, our very capable team does all of the work here, so the most effective way for me to add value is to articulate a clear vision.  However 10 years is a long time and lots of intervening forces can influence the world.

 For a more technical take on a related question, John Halamka, also of Partners, asks:

 What do we need to ensure innovation and progress in clinical informatics?

 …(W)e have policy, technology, and funding initiatives which are sufficient to ensure innovation and progress in clinical informatics. Governance and a pipeline of trained professionals will ensure the foundation built today evolves to meet future needs. It’s a great time for clinical IT. Never before in history have so many factors been aligned for success.

 

HIT: Gearing up for computerized health care

So far, the “The Huffington Post” series on health information technology has pointed out some serious problems and potential complications – including a tech industry feeding frenzy and medical errors linked to computer or data entry glitches.  

Their most recent piece focuses on the upside – improving care. And, it offers a clear-eyed overview of intended benefits and the barriers to achieving them. They also explore whether HIT will have success in managing chronic diseases where some other approaches have failed.

Many experts contend digital systems not only will help doctors cut costs, but also improve care by reducing medical errors and waste. However, critics argue that the benefits are being oversold and that the stimulus plan provides a windfall to the technology industry. Others are calling for tighter government oversight to make sure that computerized systems marketed are safe and perform as promised.

They look at “Beacon Communities” : 15 medical groups nationwide – Brewer, Maine and Providence, R.I. among them – taking part in a $220 million government program designed to show how digital records technology promotes better health care and cuts costs. Twelve of the 15 centers awarded grants—some rural and others in major cities—will focus at least partly on diabetes, a disease that is both debilitating and expensive to treat.

For more Bay State HIT news, check out this radio piece on the effort to wire three Massachusetts towns. Can Computers Save Health Care?  (Note that the$50 billion  federal investment is now down to about $27 billion. Also, click here from more HIT news on BHN, including a video interview with John Glaser, for head of IT at Partners who recently moved to Siemens.

Finally, note that the feds last week rolled out their final rules on what they want to see in subsidized HIT systems.  Video here.

Artist and activist Regina Holliday represented the patient’s point of view. She spoke about her frustration with lack of access to her late husbands records during his unsuccessful cancer treatment. She offered a key reminder :”We’re all patients in the end.”

More on Holliday and the announcement here from the Health Beat Blog.

What is striking about her story is that Holliday is not complaining that the hospital didn’t “save” her husband. She is objecting to how little information she and her husband received: “the terror of not being told what was going on.” In other words, this is less about what treatment he did or didn’t receive than it is about how he was treated. Holliday is calling for “patient-centered care” that includes the patient in the decision-making loop, giving him the information he needs to make an informed choice.

The Healthtrix: Free your medical records

If BHN decides to write a screenplay based on the ongoing roll-out of health information technology, should it be a comedy, a sci-fi soap opera or corporate-feeding-frenzy thriller?

The Healthtrix: (Free your medical records.)

Invasion of the EMR Snatchers?

Doc Hollywood Goes Digital?

Start with a federal agency called “Office of the National Coordinator” and it has to be a Cold War thriller.  Or somehow link the BIDMC staff working with the ONC to the ongoing drama back home and we get the scandalous romance ripped from the headlines. Or find buff superheroes could to swoop in and save the health care system from that melting glacier called paper. (Don’t get us started.)

Perspectives vary.

Today’s Boston Globe yells in a staff editorial – Bring out your dead files!

In addition to offering the carrot of billions of dollars in stimulus-bill subsidies, the Obama administration is wielding the stick of reduced Medicare payments to doctors who do not make the change by 2015. Already, some medical professionals believe that date is too soon. But if anything, the deadline gives medical providers too much time to put off the inevitable. Under no circumstances should the administration backtrack on its threat.

The conversion to electronic medical records will be a headache, especially for small practices led by physicians who got their training before the digital revolution. The federal government should assist not just with subsidies but also with technical guidance to ensure that doctors and hospitals have software options that achieve a range of goals, including interconnectibility and the capacity to transmit prescriptions directly to pharmacies.

The Globe cites studies that find medical errors kill 100,000 patients nationwide. But the piece notes that only 10 of the state’s 73 hospitals had a computerized system for doctors’ orders. According to the study, 1 in every 10 patients at six community hospitals in the state suffered serious medication mistakes. The editorial argues that the system will prevent errors like these.

But, reporting for  the Huff Po warns of  quite the opposite — Bring out your dead patients!

Scores of reports on file with the Food and Drug Administration detail consequences to patients when an electronic medical record system fails. Those reports, reviewed by the Huffington Post Investigative Fund, show that a central function of the record systems, known as computerized provider order entry, or CPOE, has been linked to instances in which patients died or suffered serious injuries.

Sounds kind of alarming. It is. Read the stories for details. At the same time, the feds pretty much admit to the potential problem with HIT and promise to do something about it.

So, does HIT prevent or cause medical errors?  Looks like it prevents some and causes others. Not a big surprise. Stay tuned.

One thing is sure — going digital seems to be a major problem for an industry that is otherwise in love with futurist technology.

In December, BHN’s Tinker Ready reported  how three Massachusetts towns struggled to wired for medicine.

More from BHN on HIT.

HIT safety and Boston-based “dream team”

Healthcare IT News reports:

WASHINGTON – If Donald Berwick, MD, is confirmed as administrator of the Centers for Medicare and Medicaid Services, he and David Blumenthal, MD, the national coordinator for health IT, would be a “dream team” in pursuing a coherent national healthcare and health IT strategy.

At least that’s the assessment of Kerry Weems, who spent 25 years in senior roles at the Health and Human Services Department and was acting administrator of CMS from Sept. 2007 until the Obama administration took over.

At the same time, reporters at The Huffington Post continue to raise questions about HIT and patient  safety that the above team will have to address.

Despite mounting concern over safety risks posed by digital medical records systems, government officials are years away from starting to track hazards stemming from use of the devices.

A federal advisory panel wants to create the first national database of medical software malfunctions and problems as a part of the Obama administration’s drive to spend billions of dollars in economic stimulus money helping doctors and hospitals adopt the technology. 

But the proposed system wouldn’t be up and running before 2013—even though a growing chorus of technology experts is warning that rapidly converting paper records into digital formats can unleash new types of medical errors.

Does the Feds strategic plan address safety?  Read their latest update. It mentions the issue, but not with the same urgency.

…(T)here are several key areas that will need continued discussion. Among the topics discussed during the development of this Framework were the following:

 

 Transparency and Access – ensuring that patients have access to information and knowledge to make informed decisions about their care;

 Personal Choice – finding the right balance between patient privacy and patient choice i.e., some patients do not want their data shared whereas some patients do not mind sharing or want to share their information for research, improved care, and/or for the betterment of society;

 Public Engagement – allowing for continued public discussion and debate on current and emerging health care issues that cannot be resolved easily or through easy technology solutions;

 Technology Innovation – learning from the impact that the internet and social networking has had on our daily lives, and leaving flexibility for how technical innovations may change the delivery of health care; capitalizing on the promise of emerging new technologies while preserving the rights of individuals;

 Support for Research – putting in place appropriate policies and technical infrastructure to allow researchers to access data to support new discoveries and treatments while protecting individual privacy; and

 Unintended Consequences – allowing for processes to capture and learn from unanticipated adverse consequences of HIT use, and developing actions to mitigate and prevent untoward effects.

 

Health reform, wired and unwired

There was a State House hearing scheduled today on bill to establish  a single payer health care system in the state. BHN missed it and can’t find any reports. We’ll keep looking. Here’s the background from Mass Care.

We are going to try to hit this wired health care meeting,  which takes place tomorrow and Friday at the Park Plaza.    

Up from Crisis: Overhauling Healthcare Information, Payment and Delivery in Extraordinary Times

Healthcare will have its renaissance when it moves beyond the hospital and clinic and into the day-to-day lives of patients and consumers. The Connected Health Symposium asks how information technology — cell phones, computers, the Internet and other tools — can help people manage chronic conditions, maintain health and wellness, and age with independence. Please come to Boston in the fall, as all of us join the issues of real change in 2009

We’ll try to get the low down on this early morning speech.

Healthcare Reform, Payment Reform, and the Implications for Connected Health by Stuart Altman, of the Heller School at Brandeis University. He’s been up close for health reform efforts through at least five presidents.

 

 

ONC: “Meaningful use” for HIT will evolve

 A panel deciding what kind of computerized health information systems will get stimulus money was sent back to do some more homework yesterday, according to Healthcare IT News.

 Companies that make these systems and providers who use them have been waiting for a definition of the “meaningful use” requirement  so they canplan to  get in on the $20 billion in stimulus money set aside for HIT. Looks like they may have to wait a while for a precise RFP-type definition. This HIT News story was entitled “ONC goes back to the drawing board on meaningful use“: 

After a “lively discussion [on the criteria] and considerable input on meaningful use, we decided to send the workgroup back to work on another set,” David Blumenthal, MD, national coordinator for health information technology, said during a media call…. According to Tony Trenkle, director of the CMS Office of e-Health Standards and Services, CMS expects to have a proposed final rule on payment issues – including the definition of meaningful use – by the end of the year.

But Dr. John D. Halamka, CIO of CareGroup, which includes BIDMC, says on his Geek Doctor blog that:   

 After months of anticipation, the definition of Meaningful Use has arrived. 

Sort of. As he points out, the HIT Policy Committee meeting in DC did produce a framework that will help steer docs and geeks in the right direction.

 The meaningful use matrix is organized into specific meaningful use goals to be achieved by 2011, 2013, and 2015. It also lists metrics for these goals to evaluate hospital and clinician progress in meeting them.

 You can check it out here on the Health IT Policy Committee page.

Or, you can read the story that was posted later in the same HIT news, which read: “Officials outline criteria for meaningful use“

 Beside Blumenthal, Bostonians at yesterday’s meeting include:

•  John Glaser of Partners
•  Micky Tripathy, of the Massachusetts e-Health Collaborative, which got three Mass towns started on HIT
•  David Bates of Partners

 

Health Wonk Review: Bosstown edition

Today, BHN hosts the Health Wonk Review, the floating web digest of health policy blog posts.

Guy Aceto/ Backstreets.com

This is Boston, but we already had a baseball theme. Summer reminds me of growing up on  the Jersey Shore. So, this week — the Boss-town edition. Dedicated to Danny Federici,  Bruce Springsteen’s organ player.  He died of melanoma last year.

 For a round up of recent Boston news,  see my fresh posting on Mass Device.com. I blog weekly for this device industry news site.

The Price You Pay

Healthcare Technology News offers a post on the health industry meeting with President Obama: “What We Call Health Care Costs, They Call Income.” The group’s proposed $2 trillion in reductions in the rate of growth of health care costs. They also pledged to reduce the growth in costs by 1.5% each year for ten years. “It’s not enforceable and there are plenty of reasons to view this cynically,” HTN asks. “But is it a signal that health care reform has a real chance this year?”

Joseph Paduda at Managed Health Matters reports on a health reform meeting sponsored by pharmacy benefits company Medco. Of the dozen meetings and press conferences on health reform each week –“This was one of the better ones I’ve (remotely) attended,” he said.  Why? “Because the conversation was realistic, pointed, and quickly got into the reality of health care reform – it’s about cost.” Special extra: retro anti-health reform graphic featuring Ronald Reagan.

Living Proof?

MedicaidFrontPage takes on reform’s hot topic. In “The Public Plan…Balance is the Key to Life,”  Brady Augustine offers updates, thoughts and links on the debate over the public insurance option. He points out that some some states already have public plans for employees or Medicaid recipients.

At the Health Affairs Blog, Harold Luft  proposes a risk pool as an alternative to the public plan in “Beyond The Public Plan Debate: A Pathway To Transform The Delivery System.”  Luft discusses the “weaknesses of the competing visions for a public plan option.” He outlines his proposed alternative: “a publicly chartered major risk pool that eliminates the need for the problematic behaviors of private health plans while enhancing choices for providers and patients.”

Reason to Believe

Kaiser Family Foundation’s head, Drew Altman, sees big differences in opinion between experts and the public on health care.

 Dave Williams at the Health Business Blog doesn’t think Altman has it quite right. He looks at the Kaiser survey point by point and tells us where he thinks the public stands on issues like HIT, quality and unnecessary care. A post on New Health Dialogue by Joanne Kenen  offers more thought on Altman’s ideas. 

Cadillac Ranch

Julie Ferguson gathers up reports on the potential impact of Chrysler and GM’s bankruptcies on state workers’ comp systems over at Workers’ Comp Insider. For example, she notes that Ohio’s Attorney General Richard Cordray has filed a "limited objection" to the pending sale of Chrysler, claiming the new owner won’t be required to meet workman’s comp obligations. WCI gives a nod to Roberto Ceniceros of Business Insurance for his thorough coverage of the issue.  

 Devil’s Arcade

Photo by Dop Deep

The Health Care Renewal blog offers a post entitled From the “Era of Cyber Hospitals to an Unfinished “Pipe Dream”There, Brown University’s Dr. Roy Poses notes that testimony in the ongoing civil lawsuit against corrupt HealthSouth hospital CEO Richard Scrushy cautions against buying into innovation hype. The “digital hospital” idea HealthSouth trumpeted in 2001 is an empty building. At the trial Scrushy testified that the hospital was a “pipe dream.”

 Dr. Poses digs way back and finds a lot of cheerleading for this failed digital hospital project. “We are constantly bombarded with publicity about the latest health care ‘innovations.’ We are warned, however, that any new regulation of health care corporations may dry up the pipeline of ‘innovations,’ imperiling us all.  Yet how many of these “innovations” actually improve health?” he writes   

 

Are you tough enough to play the game they play? 

Maybe this was an excuse to play video games, but David Porter at the Health Disparities blog explains how researchers are using the World of Warcraft and other “virtual worlds”  to study natural experiments. In this case, he talks about a virtual virus – the kind that attacks player in the game, not the computer.

 For the uninitiated, this involves a using a virus-infected virtual pet to attack the enemy. Porter described it as “an excellent example of a natural experiment and how people may act during a pandemic…” He said researchers analyzed data supplied by the game developer and cites two papers one Epidemiology and another in The Lancet Infectious Diseases.

 

Working on a Dream

Anthony Wright presents Getting to universal… posted at Health Access WeBlog.  He agrees with with the CBO that an individual mandate by itself won’t get us to universal coverage, but disagrees with other supposed barriers to that goal.

 BNET Healthcare asks “Thought Leaders Propose Health Reforms, But Will They Work?”  The authors of New England Journal of Medicine article favor "accountable care organizations" that would enable healthcare providers to improve quality and reduce cost growth.  BNET thinks their view of physicians and the health care business is “too idealistic to offer a practical road map to reform.”

 Colorado Health Insurance Insider reports that the governor has signed Colorado Senate Bill 88 granting dental and health insurance benefits to domestic partners of gay and lesbian state employees.

 

Spare Parts  

The Health Care Blog offers a post by Mark Leavitt, head of Certification Commission for Healthcare Information Technology, or CCHIT. "Certifying Health IT: Let’s Set the (Electronic Health) Record Straight." In this post, Leavitt responds to accusations that CCHIT is too close to the HIT industry to act as a certifying agency. The charges emerged in stories from the The Washington Post, including one entitled “Group Seeks Sway Over E-Records System.” The Post also reported on the dispute. 

 Neil Versel at Healthcare IT Blog comments on an “outrageous statement” by the CEO of Epic Systems “Vendors, this is your wake-up call”

 

 The Big Muddy

Sam Solomon of Canadian Medicine describes a medical crisis triggered by a nuclear accident. “When nuclear nonproliferation is the problem” He describes his post as “an article about the potential consequences, both clinical and political, of the recent shutdown of the nuclear power plant in Ontario that produces about half of the world’s supply of a certain critical radioisotope used in diagnostic imaging exams.”

 In a post entitled Death Form a Thousand Cuts Outside of the Patient Centered Medical Home,  Jaan Sidorov notes “that while health reform may be on the way, there are a surprising number of day to day hassles that are bleeding primary care physicians dry.” From the The Disease Management Care blog

 

Don’t get caught on the wrong side of that line

Mike Feehan at Insureblog contemplates the difference between medical care and health care. “In order to reach meaningful conclusions about the direction of health care reform, we need to understand the relationship of health care to wellness… We can exercise (free). We can get adequate sleep (free). We can steer clear of substance abuse of all kinds (free). We can keep a reasonable diet (free). We can always wash our hands (free). We can hold it down to 85 on the Interstate (free). We can stop smoking or never start (better than free). To a great extent we already have free health care in the U.S.”
  

Better Days

Jason Shafrin at Healthcare Economist notes that Medicare Part D plan was supposed to provide a prescription drug benefit for those who did not have it. The Healthcare Economist reviews a paper that that asked how well the program is working. It found that after the enactment of Medicare Part D,  only 7% of seniors lacked drug coverage, compared to 24% before the launch of Part D.

Glenn Laffel at Pizaazz tell us: “It’s been a long strange trip for Dendreon, the makers of Provenge a new immune therapy for prostate cancer. No one seemed to take the stuff seriously, but now the definitive trial has been completed and lo and behold, it works! No one could be happier than its shareholders.”

Growin’ Up

Philip Zorn presents guest blogger Robert Nelb on Effortless Enrollment Saves Taxpayers $ and Helps Uninsured Children Access Medicaid and CHIP posted at Say Ahhh! A Children’s Health Policy Blog. Nelb talks about a Brookings Institute paper on the need for effortless enrollment in CHIP and Medicaid programs. He makes the case that automatic enrollment would not only save taxpayers money, it could save lives.

 

Spirit in the Night

Find Clearing the Haze – Is Marijuana Addictive?  at Brain Blogger. ”America’s most popular illegal drug has remained largely a scientific mystery. It is a drug that millions of Americans have been using regularly for years, and, from a clinical perspective, it remains the least studied illicit drug of all.”

Fun with Health Information Technology — An “Interoperetta”

The actual title of this bit of wonky fun:  ”HITECH:An Interoperetta in Three Acts.”  Also on You Tube.

Here, Maryland doctor Ross Martin finds true harmonization. He also comes up with rhymes for two Boston heavies — Obama HIT man David Blumenthal and John Halamka, the CIO at Beth Isreal Deaconess Medical Center. 

 Dr. Blumenthal, Won’t you give me a call/

So I can work at the ONC (Office of the National Coordinator of HIT)…

  We’ll work for Jon Halamka / As for lunch we’ll always comp ya.

I found it this on BIDMC CIO Paul Levy’s “Running a Hospital” blog.