8 responses

  1. BA
    October 16, 2015

    John you really blew it on this post.

    Guess Jeb doesn’t realize that HITECH was drafted under his daddy’s administration? That is also who stood up ONC? Anyhow

    Poor fact checking.. Everyone who actually works in industry vs just writes about it knows that interoperability was baked into MU from stage 1 forward.. https://www.healthit.gov/public-course/interoperability-basics-training/HITRC_lsn1069/010301—-.htm#

    Also CMS not ONC makes the rules (vs policy) and it has spent about 30 billion so far.. It is the largest corporate welfare program we have seen in ages.. What other industry do you have to pay to adopt computers?


  2. John Lynn
    October 16, 2015

    I’m sure Jeb knew the relationship to his daddy and brother. Nothing wrong with him having a different view.

    It wasn’t poor fact checking on interoperability. The key difference is our definition of “interoperability baked into MU.” Certainly we all know that meaningful use has included overtures related to interoperability since the start. However, as you know, it has done almost nothing to move the needle when it comes to interoperability. It’s in name only. My suggestion is to move the incentives from talking about interoperability to actually paying organizations for being interoperable.

    It’s a good point about CMS. They have responsibility for the final rule, but they do it with lots of support from ONC.

  3. John Lynn
    October 16, 2015

    As for the $30 billion, I was referencing the $20 billion for Medicare: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/August2015_MedicareEHRIncentivePayments.pdf I should have added the other $10 billion for Medicaid: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/August2015_MedicaidEHRIncentivePayments.pdf I’ll update the post. The principle is still the same.

    We’ll see how the $15 billion projection I made plays out.

  4. karl walter keirstead
    October 17, 2015

    I like your “. . . blow up MU and focus on interoperability” but patients can make this happen.

    Jeb’s plan goes off the rails at “. . .lead private sector collaboration”.

    Since when do we get good results when the “leading” is done by people who collectively know virtually nothing about the domain?

    I don’t like “. . .establish national standards for electronic health record features and data interoperability” for much the same reason.

    The “standards” will end up being defined by lobbyists. Same old, same old.

    Why not reimburse on performance?

    Patients stay in system too long/relapse too often, the reimbursement goes down. Bad players either shape up or go out of business.

    When clinics unnecessarily duplicate tests, reimbursement goes down.

    For any business it’s a bad idea to have bureaucrats dictate how the owners/stakeholders should manage their operations.

    Clinics/hospitals spend years developing competitive advantage, they want to run their workflows, use their forms.

    When the focus if on “features” your only choice is to use them.

  5. karl walter keirstead
    October 17, 2015

    The other problem with ‘features” as opposed to “functions” is unsuspecting buyers can easily end up with a “hollywood stage” where you have a “nice” look/feel that links back to 1960 database technology.

    I won’t name any vendors. They know who they are.

  6. BrendonHolt
    October 17, 2015

    The future, based on the past. All this bailout will run out. 90% of the then only 120 or so vendors were Clearly GOING OUT OF BUSINESS, then Came MU and even more and more VC’s. That said, there are a lot of VNC’s out there that are not very happy, they have 20-50 Million Dollars invested in EHR’s that have less then 2000 end users. These companies blew through money, and now the MU Stimulus is all but ended, MU Stage II Money is minimal, and many Providers (Over 40% are taking the stick). So my prediction:

    We will be back down to under 200 vendors by the end of 2019. Frustrated Users will have picked different EHR’s and Venture Capital Companies will shut down the EHR’s.

    Why do I say this. Facts, and the fact is, 75% or more of the EHR’s that were developed to get certified have terrible UI (User Interfaces) and moreover Physicians Hate them. They will stop being used at some point. This is my prediction, I am sticking with it, and I have been in this business way too long.

  7. meltoots
    October 18, 2015

    15 Billion is about the amount the department of defense wants for its IT program. So we need to multiply that by 100 to really estimate the cost to implement across all patients in US. So lets think 1.5 trillion. 15 billion is nothing. Truly. And all of it is going to EHR vendors in an artificial market. Epic and Cerner have headquarters that are like amusement parks with lavish conference rooms, meals, massage stations, etc. Its disgusting.

    And I am speaking as a front line provider. Our group gave up on MU. We are taking penalties as its too inefficient, unsafe, ridiculous data entry, all under threat of audit, for peanuts from CMS. And only CMS. You could see the artificial market explode after MU was announced. Most providers took the stage 1 money as it was click boxes (we did not). Stage 2 failed and keeps failing Stage 3 as proposed is an absolute joke. As providers, we really do NOT have time for all this BS. Anyone that used EHRs prior to MU can tell you, that the EHRs that focused on the provider usability and efficiency and safety were awesome. MU destroyed that. The market would HAVE worked maybe not as fast, but it would have been better. ONC and CMS should have JUST focused on how we can interoperate, skip all the other niggling EHR details to the ones using the EHR, the vendor and provider.

    Lets look at Stage 3 as proposed:

    1. Renaming measures, objectives and then piling on multiple measures under each objective does NOT simplify NOR improve the program.
    2. Requiring 365 days of reporting will never happen. EVER.
    3. Increasing patient engagement threshold to 10 percent, including APIs, are you serious? Will NEVER happen, unless forced upon our poor patients to send us a “hi” message from the waiting room. As for APIs, sounds great to IT folks but we are PROVIDERS!! Do you understand we provide care, not APIs.
    3. TOC threshold will never happen
    4. Bidirectional exchange with immunizations and public health registries, 6 measures no less, will NOT happen.
    5. SOC and Patient education must be electronic, are you NUTS? Our patients want printouts. The do NOT want us to electronically send them anything. Stupid.
    6. CQMs electronically submitted won’t happen.
    7. Include patient generated data? Are they simply out of their minds or is this a joke?

    There is not a SINGLE vendor that will have this ready by 2018. No way. Again, I am a front line provider in a group that has ALREADY given up on MU. I thought maybe Stage 3 would bring me back in, but its a deceitful lie that its less measures, and the thresholds and counting numerators and denominators and attesting and all this clicking will NEVER happen. All under the threat of audits.

    Any database programmer would tell you that they already failed at step 1 of making an interoperable database. You need a unique ID. Without that foundation, its a mess. OCN, with these somewhat barely practicing clinicians are out of their minds if they think Stage 3 will be successful as proposed. They need to actually talk to front line providers, not sycophant informantic providers that click all day. They need to get in a room and get honest. And stop this madness. If you walk into a clinic or hospital, look around. Look at how much patient care is happening vs providers and staff at the computer monitor. Its scary. Interns and residents literally sit at computers all day, 95% of the day. The exact opposite of when I trained. I would argue we did better care back then too. The time is now that we are starting to scream, that enough is enough. There is nothing about medicine that gets better with providers that are angry, burned out, disgusted with the current state of medicine. And there are many at that level already.

  8. John Lynn
    October 19, 2015

    “Anyone that used EHRs prior to MU can tell you, that the EHRs that focused on the provider usability and efficiency and safety were awesome. MU destroyed that. The market would HAVE worked maybe not as fast, but it would have been better.”

    I agree. It’s unfortunate how drastically that’s changed.

    I don’t agree with you when it comes to APIs. I don’t think the government should be the ones mandating them and it’s true that doctors won’t ask for an API. However, doctors will ask for this new genomic medicine program they want to use be integrated into their EHR. An EHR API will facilitate that and hundreds of other similar innovations that come.

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