Thursday, December 27, 2012

Who's "We" Dr. Ashish Jha

I'm always unsettled when experts use We as Dr Jha does below, when he's quoted saying the Government's not going quite far enough with its new value-based purchasing program.

The CMS on Thursday released a list of hospitals' bonuses and penalties under the value-based purchasing program. Health policy experts have applauded such incentives, but some have questioned whether the money at stake will be enough to motivate hospital officials and doctors to adopt changes that will reduce waste and improve quality. "The purpose here is really straightforward and very reasonable," said Dr. Ashish Jha, an associate professor of Health Policy and Management at Harvard University. "Forever we have paid for a quantity of healthcare. We have not really paid for quality, and CMS has decided they want to change that." 
Explaining just who We are no easy task I suspect.  Whether the CMS that's decided they want to change that the We cited just before, a nice start Dr. Jha.  Who's the We you're talking about Doc and how do you read its mind?  Does We know CMS working its will on We's behalf?

Crains: Chicago medical records exchange falters

It all comes down to the dollars.
The price is too high for Loyola University Health System, says Arthur Krumrey, chief information officer at the Maywood-based hospital network.

Loyola, Evanston-based North-Shore University HealthSystem and Ann & Robert H. Lurie Children's Hospital of Chicago, which already use the same software system for their internal medical records, are discussing setting up their own exchange.

Advocate has not joined, but executives are “working on it,” says John Norenberg, a vice president at the Oak Brook-based system, with 11 hospitals statewide.

Mr. Norenberg, who is also chairman of MCHC's exchange advisory board, adds: “It's turned out to be a bit more difficult to get the players moving on this than I think anybody expected.”

Read more:
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HHS Stops Short Of Calling For Safety Regulation Of Digital Records – Capsules - The KHN Blog

HHS Stops Short Of Calling For Safety Regulation Of Digital Records – Capsules - The KHN Blog
The Obama administration Friday urged cooperation between software companies and caregivers to prevent patient harm caused by faulty electronic records. But it stopped short of calling for regulation or a federal requirement to report computer mistakes that pose a risk to patients.

“We are saying to the vendors: Step up and prove your ability to create a code of conduct that would be enforceable, that would bind you voluntarily to reporting safety events,” Dr. Farzad Mostashari, the administration’s coordinator for health information technology, said about the report. “And what we’re saying is: If you don’t step up, we can always look at more classic regulatory approaches.”
Sounds a bit collusional to me, but I'm not a legal sort.

HL7 versus CEN/ISO 13606

A question at Research Gate I can't answer at the moment for lack of approved membership there, Standards in medical informatics:
HL7 or CEN/ISO 13606 - can anyone explain it? What should be preferred in standardization of EHR ?  
The answer found here with a nice schematic.

The conclusion:
HL7v2.x messaging is an appropriate standard, at least for the short to medium term, for transmission of information from source clinical information systems to a Shared-EHR system. HL7 CDA may also be suitable for this purpose at some later stage. CEN EN13606 is an appropriate standard for the exchange of Shared EHR Extracts between different nodes of a multinode Shared-EHR system (e.g. the original national HealthConnect concept) or between different Shared-EHR systems
 'Nuff said.  Check the link for the diagram and full read of the standards.

Wednesday, December 26, 2012

Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality - Kaiser Health News

Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality - Kaiser Health News

They've got a nice link to a spreadsheet of winners and losers by state and referral region.  Note plenty of zeros in the readmission rates but the VBP rates fall into a nice normal curve.

Not sure what's going on there....  insights?

Friday, December 14, 2012

What’s Happening With the “Fiscal Cliff”? Premier’s Blair Childs Explains

Somehow, I don’t find this reassuring,

What other things are you hearing inside the Capitol?

You know, you go and talk to the members of Congress—and I’ve been talking to them in the past few days—and none of them know what’s going on. And these are fairly high-up people. And it’s because this really is a Boehner-Obama conversation [between President Barack Obama and John Boehner, Speaker of the House of Representatives]. And of course, Bohener is talking to McConnell [Mitch McConnell, Senate Minority Leader], and the President is talking to Reed [Harry Reed, Senate Majority Leader], and to a lesser extent, Pelosi [Nancy Pelosi, House Minority Leader]. Last week, I met with someone very senior in the Republican leadership in the House, and he really didn’t know what was going on.

Would you say this is unprecedented?

I would have said in 2011, when they did the sequestration solution  during the debt ceiling standoff, that that was equally unprecedented. And they put together a deal for that, and there was a fallback; and they could even potentially do the same kind of thing here. And if they pitch it to the committees, which I think is very possible, meaning the Congress has to work it out, then we’ll be back in the conflict between the House and Senate.

Read the whole interview here: What’s Happening With the “Fiscal Cliff”? Premier’s Blair Childs Explains

Thursday, December 13, 2012

More Signs of Rate Shock and Awe | The Health Care Blog

Robert Lazsewski writes,
Last week, I reported on my informal survey of health insurance companies and their estimate for how much rates will rise on account of the Affordable Care Act (“Obamacare”).  
Today, there are press reports quoting the CEO of Aetna with their estimate. The Aetna estimate is worse than mine.

The rest of it here: More Signs of Rate Shock and Awe | The Health Care Blog

 I think individual insurance just disappears alltogether, and soon.  It’s not worth selling and Insurers who saw big profits coming from these sales will be disappointed, the young folks are headed for Medicaid (a program ill equipped operationally or financially to accept them). Lazsewski writes further on,
I can also tell you that, so far, I have detected no serious effort on the part of Democrats to delay anything. Frankly, I think hard core supporters of the new health law and the administration are in denial about what is coming.  
I expect more health insurers to be echoing the Aetna’s comments in coming weeks. There is a real concern in the industry they need to get out ahead of this telling people why rates are shooting up to counter the “shoot the messenger” attacks that will be sure to come.

You bet the shoot the messenger attacks are about to come!  The Democrats who wrote this evolving law aren’t about to take ownership of the bad outcome. They’re bailing already.  Soon they’ll be looking for scapegoats.  The Blues, and Aetna are the targets.

Update: The reason why for sceptics.

Wednesday, December 05, 2012

Urban Versus Rural Performance by State Under Value-Based Purchasing

State-by-state comparison of scores between Urban and Rural providers.  Warmer and fuzzier in the country.

A state-by-state analysis of projected total performance scores (TPSs) for U.S. urban hospitals compared with those of U.S. rural hospitals under the Centers for Medicare & Medicaid Services’ Value-Based Purchasing (VBP) Program discloses some remarkable disparities between these hospital settings across the nation.

Overall, the TPSs are quite similar for urban and rural facilities. However, there is a clear trend for rural facilities to score higher than their urban counterparts with regard to patient-experience-of-care measures (PEOC). Meanwhile, to a lesser degree, there is also a trend for urban hospitals to have higher clinical-process-of-care (CPOC) scores.

Urban Versus Rural Performance by State Under Value-Based Purchasing

Tuesday, December 04, 2012

All-Payer Care Databases set stage for data-driven healthcare and big analytics - State and Local Connection

A nice post on predictive analytics.  Predictions don’t always pan out though, and I wonder if Healthcare not following the path of the Bankers’s Quants here.  One thing to have my 401k on the line; quite another to have my cracked chest on the predictive model.

All-Payer Care Databases set stage for data-driven healthcare and big analytics - State and Local Connection

SL Trib: Father of medical informatics, Utah’s Homer Warner dies

RIP Homer Warner,

Homer Warner, a Utah cardiologist widely recognized as the father of medical informatics, died last week from complications of pancreatitis. He was 90.

Warner’s research is still redefining medicine, colleagues say. Modern intensive care units can be traced back to the electronic systems he built to monitor heart patients in the mid-1950s. And his creation of one of the first electronic medical records in the ‘70s set the stage for a new academic field and multi-billion dollar health IT industry.

A Case of Medical Data Redesign | asc_Blog

As we go colorful and graphical, keep in mind the prevalence of red / green color blindness please.

In his TED presentation, Thomas Goetz, the executive editor of Wired and author of The Decision Tree, explained about the need to change the way medical data is currently represented. He believes that we need to start providing better medical information, to help people know about the choices and actions that are available to them for the improvement of their health.

The method he proposed in his TED talk is actually a relatively simple notion: change text-based data into easy-to-understand graphical data. But this notion could have a profound effect in health care. I honestly wonder how no one has ever came up with this idea before. I mean if you looked at lab test results, they are confusing even for physicians, when it should be the patients who need to understand these reports more. It is, the personalized data of their health.

A Case of Medical Data Redesign | asc_Blog

LIVE FROM RSNA 2012: Are Radiologists Facing Existential Threats—Or Exciting Opportunities?

File this under Living in Interesting Times….

As Dr. Shrestha notes, the vendors are still too locked into the old PACS idea. And though “VNA” (vendor-neutral archive) continued at this year’s RSNA to be as hot a buzz-term as it was last year, Joe Marion notes, “[I]t’s inevitable that because of the EMR integration, that imaging is going to have to expand beyond just radiology; it has to. And particularly so as it becomes more and more of a factor in meaningful use. So we’re moving towards an enterprise focus. “

LIVE FROM RSNA 2012: Are Radiologists Facing Existential Threats—Or Exciting Opportunities?