Politico Morning E Health: Vanishing VistA

My thoughts on this one coming...

VANISHING VISTA?: Rep. Phil Roe, who has seen plenty of twists in the VA-DoD EHR saga in his seven years on the Veterans Affairs committee, was not surprised to hear of another turn last week –“it’s the gift that keeps on giving,” he said. At an appropriations hearing, the VA’s CIO, Laverne Council, said the agency had pulled back $40 million from the budget of its VistA update program and was considering whether to ditch the fabled EHR. 

— Roe, a physician from Tennessee and head of the GOP Doctors Caucus, thinks that might be a good idea. If the VA decides to go commercial, Roe said, “I hope they use the same system” as the Pentagon (that would be Cerner). Roe noted that the Cerner contract to replace the Pentagon’s EHR stands at less than $4 billion, despite earlier estimates of up to $11 billion. It may be cheaper, in the long run, to replace VistA rather than updating it repeatedly, he told us. This idea troubles many IT specialists who have worked with VistA. The EHR has pieces that need replacement, they say, but its basic functionality is as good as Epic, Cerner or any other hospital EHR, and it would be a shame to toss a system that has evolved over the decades to fit the needs of VA clinicians.

Read more: http://www.politico.com/tipsheets/morning-ehealth/2016/03/opioid-abuse-in-tech-crosshairs-213071#ixzz42EOTuAlp

Cerner Opens Smart on FHIR Developer Website | Healthcare Informatics Magazine | Health IT | Information Technology

Cerner Opens Smart on FHIR Developer Website | Healthcare Informatics Magazine | Health IT | Information Technology

Hospitals Lagging Behind in Population Health Management

Hospitals Lagging Behind in Population Health Management

Modern Healthcare: Obama administration's proposed insurance reforms incite industry backlash

Re: The American Academy of Family Physicians asked the CMS to go a step further and build network standards for appointment wait times. found here.

I was the "Wait Times Guy" for Veterans Health Administration and can say this is no easy task. On any given day every Veteran using a VA Hospital had on average 2.5 pending appointments. Some were for that day, some the next day, or week, or month, or months but sorting out the "wait" from when the Vet wanted the appointment, and when the Vet needed to be seen for a followup appointment got very murky.

Make tinkering with those calculations a criminal offence and you've got quite a mess.

Texas Health Physicians Group Leaders Take on the Practical Data (and Process) Challenges of Population Health | Healthcare Informatics Magazine | Health IT | Information Technology

Texas Health Physicians Group Leaders Take on the Practical Data (and Process) Challenges of Population Health | Healthcare Informatics Magazine | Health IT | Information Technology

With regard to IT development, strategically speaking, what do you need to do in the next year or two?

Adams: The Holy Grail for an IT-techie person like me—patient attribution remains one of the number-one challenges. People underestimate how hard it is to attribute patients to physicians. I think the Holy Grail is combining EMR and claims data. Because right now, we’re still in the world of, here are your gaps in care, but it’s in the EMR. So I may already have had a colonoscopy and Dr. Parsley if he’s my physician wouldn’t know it. So it’s combining outside claims data with EMR data, to provide a true picture of things. And claims data is 30-45 days behind. And in the next two to three years, it’s going to be real-time notification. We don’t have all those things in place yet. So for the next year, we’ve got to get better at patient attribution and risk stratification, and then be able to combine EMR and claims data.
Parsley: I agree: if there’s a report in an old file somewhere that shows the patient did get their colonoscopy in the timeframe needed, and if we had the payer data in a timely way.

Senate HELP Committee Chairman Once Again Calls for Stage 3 Delay in Latest Hearing

Senate HELP Committee Chairman Once Again Calls for Stage 3 Delay in Latest Hearing

Joe Flower: Does Prevention Save Money for Hospitals?

Joe Flower: Does Prevention Save Money for Hospitals?

Social, Behavioral Data Must Be Included in EHRs, Nurses Say - HealthITAnalytics

Social, Behavioral Data Must Be Included in EHRs, Nurses Say - HealthITAnalytics

Rick Wicklin:The relationship between toothlessness and income

Interesting post on the relationship between toothlessness and income.  Rick ought to throw smoking prevelance into the mix because I expect it will explain more than income would.

And of course the graphs are nice!  

Attribution Identifies Physician-Patient Relationships

Attribution Identifies Physician-Patient Relationships



Something on my mind worth saving.  Attribution not as simple as you'd think.

Join Us At Valence Health’s Value-Based Care Conference

Needless to say, my blogs represent my views and not those of my employers past or present, but below is a plug from my current job about what I think will be a very useful conference.

 Please join us for further 2015, our annual industry conference dedicated to value-based care and reimbursement models. From clinical integration, to shared risk, to provider-sponsored health plans, further 2015 explores the financial, operational and clinical aspects of all types of value-based care and “risk-based” contracting.  Learn more about the expert-led discussions designed for provider-organization executives here: http://go.valencehealth.com/further2015

Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients — NEJM

Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients — NEJM

Regardless of how the MOC issue is resolved, the recent focus on the ABIM has shed a bright light on how medicine is regulated in the United States. The ABIM is a private, self-appointed certifying organization. Although it has made important contributions to patient care, it has also grown into a $55-million-per-year business, unfettered by competition, selling proprietary, copyrighted products. I believe we would all benefit if other organizations stepped up to compete with the ABIM, offering alternative certification options.

More broadly, many physicians are waking up to the fact that our profession is increasingly controlled by people not directly involved in patient care who have lost contact with the realities of day-to-day clinical practice. Perhaps it's time for practicing physicians to take back the leadership of medicine.

A good start to regaining that leadership might be backing off support for the  Affordable Care Act.  Government's do-gooder effort giving us less care at greater expense.

Beyond a Traditional Payer — CMS's Role in Improving Population Health — NEJM

Beyond a Traditional Payer — CMS's Role in Improving Population Health — NEJM

There are limits to CMS's statutory authority to fund services provided to people other than Medicare or Medicaid beneficiaries, but the agency can leverage its influence beyond the payment of claims. Whereas our approaches for providers focus on enrolled or attributed populations, SIM seeks to affect broader populations


I suppose CMS can leverage but I wonder if those funding limits suggest it shouldn't extend into something its unfunded and therefore ill equipped to influence for the good.

Julie Papanek: Healthcare Predictions For 2015

This one's huge. Some excellant insights from Julie Papanek (@JuliePapanek). Someone I've started to follow!

Hospitals become a channel for peer-to-peer lending 

If you understand the flow of payments in healthcare, you can predict the trends. Consumers and employers are purchasing insurance plans with high deductibles. As a result, the first dollar that hospitals earn is now coming from consumers. Actually, the first $17,000 is coming from consumers. With an average income of $55,000, most American consumers simply can’t pay their medical bills. When they don’t pay, it hurts providers financially. What consumers don’t pay shows up as accounts receivable on hospital balance sheets and eventually turns into bad debt. Since many hospitals are financed by debt and their credit worthiness is partially determined by the health of their balance sheet, the problem of getting patients to pay is urgent. This raises the question — how can we find the money to help consumers finance their health care payments? Many consumers are able and willing to pay their medical bills, they just can’t do it all at once. Peer-to-peer lending companies have paved the way for unsecured structure notes, where an individual’s loan can be financed by others. These have shown impressive growth. Peer-to-peer lending is already being used to finance plastic surgery and other cash-pay procedures. Now it could be used for the majority of medical expenses in the U.S.

The Trouble with Putting Care Management in a Box

The Trouble with Putting Care Management in a Box



About the above box (please go read it).

I was struggling once with implementations of clinical pathways and an MD told me the solution, really only solution, was an educated patient.  The patient was the only one who could tell us if he or she was on the pathway so to speak.  Technology and the cell phone over the means now to empower patients.  They're seldom mentioned as participants in these discussions and they're really central to making management work.  The reality is the patient does it and the technology should be built on that foundation.

My Favorite Quotes of 2014

My Favorite Quotes of 2014

What Hadoop is Not

From the wiki....  probably the most useful one page I've read on Hadoop.

Are EHRs Life Savers? Maybe So, According to Preliminary Research

Are EHRs Life Savers? Maybe So, According to Preliminary Research

Clearly a proponent of EHRs, Skinner says that those who criticize the technology for not providing clinicians enough value might not be accurately measuring what the “value” really is. “It may be that a specific clinician hasn’t found much value to him or her, but that doesn’t mean his or her use of the EHR hasn’t proved value to the patient, to the institution as a whole, or to other parts of the institution,” he says.

Skinner notes that the case is easier to make at the organizational level than it is than it is at the individual physician level. “Providers do have a point in that they are being asked to do more and put their hands on a tool they never had to worry about. So there’s no question they have acquired added burdens. But the real question is, ‘Has the institution and its patients gotten sufficient benefit to justify that extra burden?’”

Suppose so but when I'm on the table on what to see the value to me.

Midwest SAS Users Group Conference 2014 in Chicago

I'll be there for the entire conference. Feel free to stop me and say hello. A list of papers to be presented can be found here. SAS Conferences always good opportunities to learn and much of it happens out in the halls between sessions. cya

SAS University Edition

About time SAS did this....

SAS University Edition isn't a watered-down version of our software. You get the most recent releases of the same world-class analytics software used by more than 70,000 business, government and university sites around the world, including 91 of the top 100 companies on the Fortune Global 500^® list. That means you'll be using the most up-to-date statistical and quantitative methods whenever and wherever – right on your own PC, Mac or Linux workstation.

Follow the link and download yourself a copy.