Today I came across what someone called a new Health and Human Services (HHS) health information technology (HIT) website. Unfortunately, they didn’t get the same graphic designer and web developer that have been doing such a fine job with the various websites that Obama has been putting up.

I find the first page interesting since it has HHS asserting the following:
Health information technology (Health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of health IT will:

I wish that each of these bullet points had links to all of the research that shows these are indeed the outcomes of HIT. This should include the research that argues against HIT being able to solve these problems. That would turn the list into an invaluable resource on the benefits and challenges of HIT.

I’m going to need to take some time to look at the rest of the site. However, the link that said “Standards and Certifications” certainly caught my eye and is guaranteed to be a future blog post.

Many people know that I’m quite fascinated by Twitter. I love it and I love connecting with people on Twitter. However, today I came across a clearly fake twitter account. At least to me it was easy to see it was fake. It was a twitter account supposedly for Dr. David Blumenthal. Yes, the name might be familiar to many people here. How did I know it was fake? It linked to some awful news site. Plus, the tweets were just odd and so you could tell it wasn’t really Blumenthal at all.

What scares me is that many people in IT and healthcare won’t know that it’s not him. In fact, that’s why I’m not going to add a link to the fake account. I guess there’s no harm in someone following a fake account. Some of the fake accounts on twitter are really funny. In this case it was someone just promoting their waste of a website. That’s not something I like.

I’ve posted my personal twitter account on here before, but I recently just started a general EMR, EHR and HIT twitter account. It’s currently aggregating some of my favorite HIT and EMR bloggers. We’ll see how it evolves over time. I know I’ve used it to keep track of a bunch of great content that’s being created.

Also, thanks for those who have signed up for the EMR and HIPAA email subscription. It’s been growing like crazy. Nice to think that people enjoy the content I’ve created.

I recently read a nice article comparing EHR interoperability to the Transcontinental Railroad. They hit the key point when they said, “Just as standardizing the railroad gauge created a uniform distance between tracks so that track the came from the East and West would fit together, health care IT standards will create a seamless and interoperable IT infrastructure that will benefit the entire nation.”

I find the comparison incredibly intriguing and thought provoking.

The only problem I have with the comparison is that the transcontinental railroad was merging essentially 2 standards (east and west) and standardizing the gauge was the only standard needed. In health care IT we have far more stakeholders in the game and far more standards that need to be established (allergies, labs, RX, diagnosis, just to start).

This doesn’t diminish the value of the comparison since it’s often valuable to see a complicated challenge in a simplified way. I’m just saying that creating a standard in HIT is going to be much more difficult.

I’ve been really amazed at the number of people I’ve heard talking about the HITECH Act bringing in a “new age of EHR” and other similar phrases. Then, I usually consider who’s been saying it and I realize that their pocketbooks are going to be lined with money from the HITECH Act and EHR adoption. So, I take it with a grain of salt.

Instead, I like to look at examples to help me better understand what might happen with the $18 billion Obama’s planning to spend on EHR adoption. The best example I know of comes from the British National Health System. It’s certainly not a perfect match, but should open our eyes on government funded EHR systems.

The Examiner (San Francisco) provided an interesting editorial on Britain’s National Health Service’s HIT systems implementation:

Britain’s NHS, who have been trying to get their HIT system to work properly for the past 5 years. The cost of NHS’ HIT has escalated to 6 times the original estimate — the U.S. equivalent of $18.4 billion — to serve just 30,000 physicians in 300 state-run hospitals, a fraction of the health care providers in the USA.

HIT is such a mess that Leigh recommended funding alternative systems if matters don’t improve within the next 6 months.

A large 2003-04 study of 1.8 billion ambulatory patients discovered that the use of electronic health records provided no difference in 14 of 17 quality-care indicators, produced significantly better care in just two and worse care in one.

And, a summary of 33 studies done in Europe between 1985 and 2009 found that HIT actually causes a significant number of medical errors.

Definitely cause for concern since Britain has spent $18.4 billion on a MUCH smaller health care system. Looks like Obama should have applied his “down payment” principle to HITECH Act’s $18 billion towards EHR too.

I was browsing through a document on the House Ways and Means website and I was really interested in what I found listed for what I believe is the basic assumptions and plans Congress and the House used to pass the HITECH act through congress.

Health Information Technology for Economic and Clinical Health Act
or
HITECH Act

Health information technology helps save lives and lower costs. This bill accomplishes four major goals that advance the use of health information technology (Health IT), such as electronic health records by:

• Requiring the government to take a leadership role to develop standards by 2010 that allow for the
• nationwide electronic exchange and use of health information to improve quality and coordination of care.
• Investing $20 billion in health information technology infrastructure and Medicare and Medicaid
• incentives to encourage doctors and hospitals to use HIT to electronically exchange patients’ health
• information.
• Saving the government $10 billion, and generating additional savings throughout the health sector,
• through improvements in quality of care and care coordination, and reductions in medical errors and duplicative care.
• Strengthening Federal privacy and security law to protect identifiable health information from misuse as the health care sector increases use of Health IT.

As a result of this legislation, the Congressional Budget Office estimates that approximately 90 percent of doctors and 70 percent of hospitals will be using comprehensive electronic health records within the next decade.

The opening line underscores what I believe is their basic assumption “Health information technology helps save lives and lower costs.” The main problem with this assumption is that it’s not complete. A more complete assumption would be “Well implemented and designed health information technology helps save lives and lower costs.” Unfortunately, you can take a look through this long list of cases to see that poorly implemented EHR can do just the opposite. My strongest hope is that doctors will understand this and choose an EHR wisely instead of focusing on the potential stimulus money.

We could discuss many of the other points in more detail, but the one that stood out to me was the purported $10 billion in government savings from the HITECH Act. At least all of the other bullet points had a section in the document which at least at a high level described how it would be done. Somehow the description of how the HITECH Act would achieve $10 billion of government savings was missing from the document.

Can we seriously believe that the $10 billion in government savings from the HITECH act is anything but conjecture? I can’t remember the last time I looked at my savings and it ended on a nice round number like this. Maybe this calculation was done in the math class I never took in college.

I’m not saying that HIT can’t save the government money. I’m a huge proponent of leveraging technology to save money and improve quality. I just wish the HITECH act would tell me how they think this is going to happen.

I mentioned previously that I was working on an article about EHR consultants. I wanted to sincerely thank all those people who commented on EHR consultants and sent me feedback on things I should include in my article.

As you’ll see, I used a lot of the feedback that you gave me to form the article. That’s really the power of the internet to bring a bunch of bright people together to create something of far greater value than I could have created on my own. Thank you for your feedback.

I’m told the Magazine has been sent to the presses and those of you who get MDNG magazine will see my article soon (hopefully someone will get one to me). The cool thing is that my article is the cover story for the February issue of MDNG.

For those that don’t want to wait for the magazine or don’t get the magazine, my article on EHR consultants has already been posted online. It’s called: Does Your EHR Consultant Have Your Best Interests in Mind?

Let me know what you think about it.

The HITECH Act gives Health and Human Services (HHS) 90 days to develop a plan to allocate $2 Billion of discretionary funds. Talk about a nice infusion of funding for HHS. HHS does have a set of core areas of focus for the money (per an Allscripts presentation on HITECH).

The area of focus that interests me most is the “Regional Health IT Resource Centers.” Seriously, what is a regional health IT resource center? Can any of you imagine a doctor visiting a health IT resource center? I don’t understand how this will work at all.

I have a better idea. Why not take a cool million and give it to me? I’ll create a killer online platform for sharing of health care IT resources where people can share information nationally or within their region. Could be a killer application for sharing information quickly and could be available to every state in the country (and for that matter the world). Unless you think that training health care IT staff is better done without using IT.

Here’s a look at the full list of core areas of focus:

• Standards requirements due before the end of this year
• HIE Infastructure, National Health Information Network (NHIN)
• Regional Health IT Resource Centers
• Federal grants through AHRQ, HRSA, CMS
• Grants to the states in 2010
• Promote advanced EHR

I just wanted to say thank you for all the new visitors to EMR and HIPAA. The site had been doing really well lately and the Obama HIT Stimulus package (now called HITECH) has just blown this site out of the water with traffic.

I’ll be putting out a lot of content in the next few days. Just wanted to warn you so you weren’t surprised when I opened up the fire hose of information. There’s just so much out there with the EHR stimulus package.

If you like the EHR, EMR and HIPAA content I’m creating, please subscribe to my RSS Feed or subscribe to a daily EHR email of what’s been posted to EMR and HIPAA. I’m amazed and humbled at the quality of the people that have subscribed to the email list. Thanks and hopefully I’m providing some valuable insights on the EHR industry and implementing an EHR.

I love to interact with my readers so feel free to post a comment on any of my posts or contact me directly in private on my EMR and HIPAA contact page.

The Health Information Technology for Economic and Clinical Health Act’s (HITECH) major goal is to increase EHR adoption. The major questions are “Is it enough?” and “Will it work?” Let’s take a look at each of these questions.

Is it enough?
Background:
The Health Information Technology for Economic and Clinical Health Act (HITECH) provides $18 million in incentives through Medicare and Medicaid reimbursements. Starting in 2011, physicians who show that they are “meaningfully” using health IT would be eligible for $40,000 to $65,000, and hospitals would be eligible for several million dollars. The incentives would be phased out over time, with penalties in place by 2016.
Answer:
$40,000 seems like a large chunk of money for EHR. Of course, we have to remember that it’s spread out over 5 years, but $40k isn’t insignificant. Sure, many EHR out there cost $200k plus to implement. However, not all of them are this expensive. In fact, I’d say that the EHR market has shifted from mostly high priced EHR to more moderately priced EHR with unique pricing structures.

The possible problem with the HITECH legislation is that we still don’t know how HHS will interpret what a certified EHR will be. If they say it’s a CCHIT certified EHR, then $40k might not be enough reimbursement. If they create a better standard for certification which will include specialty EHR and smaller but effective EHR software, then $40k is probably enough for many doctors to turn the corner and implement an EHR.

Will it work?
My simple answer is No.

Let me explain my reasoning. I think we all underestimate the biggest reason why most doctors don’t want to implement an EHR. Many doctors just don’t want to change. Sometimes this is related to fear (see colleagues failures). Sometimes it’s related to retirement pending. Most significant is they just don’t see how it benefits them (the doctor). Throwing a little cash at them isn’t going to change their desire not to change. They’ll just find another excuse. They’re preferred EHR isn’t “certified” might be a good one.

We also have to remember that this isn’t cash up front to pay for the EHR. It comes in the form of Medicare and Medicaid reimbursements that you hope you’ll qualify for after having spent money, time and energy (the oft forgotten element in an EHR implementation) implementing an EHR. If this was cash up front I might have a different point of view. However, far too many doctors have been screwed over (excuse the descriptive language) by Medicare and Medicaid reimbursement. Let’s not be surprised if many doctors don’t believe that they’ll ever see any of this extra Medicare and Medicaid reimbursement. If you still think this is far fetched, just do some research on doctors’ experience getting this same type of reimbursement from the ePrescribing initiative.

Add in the increased “paperwork” otherwise known as reporting requirements to receive the reimbursement and hopefully you’ll have an idea of why I think this won’t work. Most doctors want to see patients. They don’t want to deal with extra paperwork which includes researching an EHR. This is government aid were talking about and that’s pretty much synonymous with red tape.

Conclusion
I’m not trying to be a pessimist, but I am trying to be realistic. I just don’t see this new stimulus package having the desired effect on EHR adoption. More importantly, I hope that doctors take their time in selecting an EHR properly and aren’t swayed by the dollar signs EHR vendors will certainly be waving for them. Another set of poorly selected and implemented EHR will set back EHR adoption for years to come.

Luckily, I’m optimistic that most doctors have seen enough failures around them that they’ll tread lightly and not rush into EHR implementation.

Today the following videos came across my Twitter feed and I was interested in video being used to discuss health care IT and in particular the health care IT stimulus package. Props to HealthTechnica for stepping in front of the camera and trying to share some knowledge about health care IT with the world.

The videos are a little long for me. The audio was a little soft too, but not too bad. I would have also liked a short intro of who was at the table speaking. I of course don’t agree with everything they said in these videos and would have liked a little more depth on some subjects, but I do like to point to people doing creative things online with HIT.

The Obama HIT Stimulus Package Video by Health Technica Part 1

The Obama HIT Stimulus Package Video by Health Technica Part 2

Best thing I heard in these videos. “Technology isn’t meant to fix things.” I’ve said this a hundred times when I’ve said, applying an EHR to a poorly run clinic just exposes all the weaknesses of that clinic.