HIMSS Blog Carnival #2 – Value of Health IT – Part I

The #HIMSS14 Blog Carnival is managed by the HIMSS team and hosted by #HIMSS14 Social Media Ambassadors. For a collection of all the Carnival Round-Up posts from this year’s event, please visit the HIMSS Blog to find links to the posts from each of the Social Media Ambassadors.

The Value of HIT Lies in Getting Content Back Out, Not in Putting Content In – by Dr. Jon Handler, CMIO

I understand where Dr. Handler, CMIO of M*Modal, comes from. Dr. Handler’s clinical background stems from the emergency medicine.  Clinicians in emergency rooms do not have time to be scribers, especially in the fast-paced big city ones.

Content consumption is what clinicians need, but then, who creates the content.  We can’t scale down the Internet to the physician’s offices or the hospitals, someone, or something, in these locales have to capture the data.

Just like the nursing profession came to aid the physicians with the daily tasks a new role has to be created to aid the clinicians with the capturing of data, whether this role is human or robotic is yet to be determined.

Improving Patient Matching: Using Healthcare IT and Data Strategy to Create a Single Patient View – by Dan Carotenuto

Although Dan has some very good points and facts here, the patient matching  conundrum has long been resolved technically-wise.

We have no problem of matching to a patient healthcare information originated from external sources, probalistically or deterministically, with at least some identifying data; we can even do fuzzy matching if needs be.

We tend to surround politics around everything healthcare and this is what has gotten us in the huge mess where we are now.  Let’s keep the government out of the patient-matching conversation because, if not, it will become a cluster of conundrums.  Just wait and see.

Most healthcare organizations have a lack of data governance policy and hence a lack of data quality.  This is why they have a big mess in their demographics databases.  Those of us whom have spent years developing algorithms for demographic and account splits, merges and patient auto-matching fully understand this.  Adding to the lack of data governance these healthcare organizations have poor processes and workflows in critical areas.  Instead of Health IT having been used as a tool to correct this they tried to fit a square peg in a round hole, or was it a round peg in a square hole.  Go figure.

Anyways, having the government dictate a patient matching algorithm is a recipe for disaster.  We don’t need the government here.  All the government has done so far is to spend billions of tax-payers dollars to get us to where we don’t know yet.  HMOs anyone?

What is the Value of Health IT? – by Blair Butterfield

Blair’s blog really resonated with me.  I witnessed technology’s effectiveness while providing healthcare in remote areas like the Amazon Jungle.  Technology provided access to healthcare that saved lives.

I agree that Health IT will help increment quality but I don’t think it will do anything with the cost of delivering care.  Controlling costs in healthcare will only be realized with ending with the billing abuse.

Healthcare IT will not reduce the abuse that patients are subject to by the outrageous costs of medical treatment.  Recently, my wife had to go to the emergency room of a hospital belonging to a big group.  After 4 hours in the ER we received a $7000 bill!  The physicians conclusion was “only God knows what you may have”.  This hospital had all the latest technology you can find.  My wife doesn’t speak english but even the lack of an interpreter was no problem since they had a very sophisticated computerized interpreter.

I actually believe that the patients are going to get their bills stuffed with the cost of the investment in healthcare IT.

The Value of Health IT – by DICOM Grid

I wholeheartedly agree that the cloud could be very valuable for healthcare.  The question is: “Is the world ready for it?”.  Every time I embark in a project with the intent of using the cloud I witness one big pandemonium shortly after.  HIPAA paranoia is the greatest obstacle.

Those of us that have worked in projects where data is hosted elsewhere understand the complexities of them and we don’t try to oversimplify them.

There are many practical uses cases that can benefit from this and other advanced technologies but anything we plan to use has to consider the riddle of, sometimes senseless, rules and policies we are governed by.

The Value Proposition of EHRs – by Girish Navani

Way to go Girish!  Very short, concise and full of wisdon.  Girish is simply saying that Health IT is only valuable if it is meaningfully used.  And this is the big question: “are doctors meaningfully using the EHRs they have purchased with the generous tax-payers incentives?”.  I guess this will be answered only with time.  Or maybe audits?

The Value of Health IT: Perspectives from “Bizzle Fo Shizzle” – a Healthcare Rap Instigator – by Susan Biddle

Just what the doctor ordered, a rapping #HealthChick!

Enjoy this short video with Susan Biddle from Juniper Networks.  Susan also tells her compelling story of why health IT is important for her.

Coming later today – HIMSS Blog Carnival #2 – Value of Health IT – Part II

A Cluster of Conundrums – Why Many Software Companies are Turning #HealthIT into a Disaster

5 HOT TOPICS IN HEALTHCARE INTEROPERABILITY by Chad Johnson

Chad Johnson from the HL7 Standards blog reached out to interview me for his “5 Hot Topics in Healthcare Interoperability” post.  It resulted in an outstanding article.

Continue reading …

The Outrageous, the Outraged and the Courageous: Another Attempt to Halt the Healthcare IT Evolution

The Outrageous

On February 2^nd 2011 the American Medical Association wrote to the Secretary of the U.S. Department of Health and Human Services, Kathleen Sebelius, to urge her to immediately halt the Health Insurance Portability and Accountability Act (HIPAA) mandate to implement ICD-10.

The AMA wasn’t only asking to immediately halt an endeavor that had officially started on January 16, 2009, over three years ago, when HHS published one of several final rules but they are also asking to re-evaluate the penalty program timelines related to Meaningful Use (MU) of Electronic Health Records, e-Prescribing and Physician Quality Reporting System (PQRS).

I would have been more amenable to read something like “reassess the timeline or extend the timeline due to significant concerns of our constituent members” but to immediately halt the program?  Could someone please explain to me why we should halt any national Healthcare IT project?

They should have asked to immediately halt incentive payments as well!  Why?  Because we, the U.S. taxpayers, are actually paying physicians across the entire United States to implement and meaningfully use an Electronic Health Record system to keep our health data in a digital format that can be easily and safely transmitted between myriad providers and so that we, as patients, can have access to it as well.  It’s not financial aid from the government that is paying for the Meaningful Use of Electronic Health Records but it’s us the People of the United States that are paying for it.

From what I also understood by reading between lines they want to be paid to implement ICD-10.  Sorry docs, us rabbits are running out of carrots!  Under the same reasons why shouldn’t we go ahead and pay for their mobile tablets as well because in my opinion it would abide to the same logic?

The AMA claims the difficulty of transitioning from the ICD-9 13,000 diagnosis codes to the ICD-10 68,000 diagnosis codes.  Maybe the five-fold arithmetic expression raises eyebrows to some but the truth is that the scarce 13,000 codes used by ICD-9 have created an undecipherable conundrum of clinical data throughout several decades.  Most clinicians and clerical staff would choose a diagnosis code based on the expected reimbursement amount and not on the actual clinical diagnosis and how could this be considered sane in a scientific realm?  A lot of healthcare data used in claims processing is absolutely unauditable.  It’s actually a toss and start over rather than a transition.  We don’t want to deal with the cluster of conundrums created by all the garbage that has gone into the databases since garbage in=garbage out (GIGO).

AMA is clear to state that it’s not just a technology project and that’s because they are well aware that the Health IT technologists can solve the problem and I know this because I am a Health IT technologist and I know there is no technical impediment to solving the ICD-9 to ICD-10 transition.  There may be semantic interoperability issues in the conversion but that can happen with any transition from any coding system to another.

Another outrageous event was the unclear response by the acting CMS Administrator, Marilyn Tavenner, who on Tuesday, February 14^th indicated to the reporters that the CMS will re-examine the time-frame.  Further exacerbation came along when the Secretary of HHS announced the intent to delay the ICD-10 compliance date on February 16^th.  Responding so quickly to pressure from one letter seems like a sign of weakness from a leader.

The Outraged

Many of us are outraged.  Many of us stood mostly silently and briefly tweeting 140 characters at a time what we were thinking in protest to the unfolding of the ICD-10 debacle.  Most of us were expecting the HHS Secretary to adopt a strong position defending the interests of her Constituents, We the Patients of the United States of America.  What was perceived was that there is some extra-caution due to the re-election climate in the air, there is fear to uphold the interests of the Constituents.

Many of us are outraged as citizens, tax-payers, patients or relatives of seriously-ill patients.  We should be since it’s our hard-earned money going to waste.  We have never had an opportunity to transform our wasteful healthcare system as the one we are living today.  We don’t want to miss this opportunity since it may take decades before it could happen again.

We are outraged because it’s always the same story.  Powerful groups of healthcare in the US will claim many reasons they have to not implement technology.  They’ll claim too much work, workflow disruption, physician <-> patient intrusion, not enough reimbursement, no incentives, etc …

But the truth is that many have made great strides in ICD-10 conversions so who is the AMA actually advocating for?

Continuing the use of ICD-9 is continuing to put the lives of many at risk.  Who is responsible for the deaths or injuries caused by improper coding?

I wanted to write this blog before but I was also waiting for some other organizations with muscle to cry-out loud and they finally did.  I call these groups “The Courageous”.

The Courageous

When I first read The American Health Information Management Association’s (AHIMA) request to urge HHS to move forward with ICD-10 plans and to not delay the compliance date I finally felt relief from my outrage.

HIMSS also raised their voice and recommends not delaying the ICD-10 implementation.

There is too much to lose here.  Meaningful Use stages 2 and 3 depend on quality data and ICD-9 does not fulfill this requirement.

Many will start speaking up in defense of the ICD-10 transition and hopefully HHS will listen to our shouts.

Readers, we are paying for the transformation of the U.S. healthcare system out of our pockets.  Don’t let special interest groups steal this opportunity from us.

Courageous, raise your voices!