Sunday, February 24, 2008


Readers of my last commentary will be pleased to hear of the very quick response I received from CMS regarding the exclusion of California from the new Electronic Health Record Grant announcement.


Thank you for your inquiry about CMS' new EHR demonstration.

This demonstration is being conducted by Medicare’s Office of Research, Development & Information. The EHR demonstration is one of many demonstrations across the country that the Demonstrations Program Group is conducting to examine ways to improve how care is provided to Medicare beneficiaries. Such initiatives are conducted to inform policy decisions about the Medicare program.  Because these are research projects, it is often important not to have multiple demonstrations being conducted in the same area if one project could affect the results of another. In addition, as part of this research, areas where demonstrations are being conducted are often compared to similar areas where there are no special projects going on.  When planning new demonstrations, we try to stay away from areas where there are similar existing projects or areas serving as comparison regions for these projects so as not to confound the results of those demonstrations and influence the integrity of the evaluation of these initiatives. Therefore, the list of states and counties excluded from applying to participate as community partners for the EHR demonstration reflect areas where Medicare already has similar projects and evaluations underway.

California is excluded from the EHR demonstration because primary care physicians in that state are already participating in another, similar demonstration: the Medicare Care Management Performance (MCMP) demonstration. This 3-year demonstration began last July and over 200 small to medium-sized primary care practices in the state are participating. Therefore, the decision was made not to implement this new demonstration in California or any of the other states where this or similar demonstrations are being conducted.

If  we can answer any other questions for you regarding this demonstration, please do not hesitate to contact us.

Jody Blatt

Debbie Van Hoven

Project Officers, EHR Demonstration

Medicare Demonstrations Program Group  "

Saturday, February 23, 2008


Inland Empire Regional Health Information Organization

Gary M. Levin MD, Coordinator

20032 Sweetbay Road

Riverside, Ca.


Tel: 951-746-9145

Press Release: A Letter to CMS regarding Electronic Health Records

CMS Demonstration Project: Electronic Health Records Demonstration 2008

Dear sirs;

For the past four years I have been involved with promoting and developing a regional health information exchange for the Riverside and San Bernardino County region of Southern California. This is a rather large geographic area east of Los Angeles and includes some rural and remote desert communities as well as urban and suburban areas.

I also publish a weblog devoted to information technology as a resource for area physicians and interested parties regarding RHIO progress in our area, which I might add has had dismal response. .

Despite the encouragement of the California Regional Health Information Organization and their “framework” for developing such entities there has yet to be made any significant progress, with multiple failures as we have seen in other RHIO efforts.

In my search for funding I was very encouraged to see the projected CMS Electronic Health Record Demonstration Project that was announced several weeks ago. However your recent email update surprised me and discouraged me greatly. The entire state of California is excluded from applicants and eligibility for these grant(s).

I am curious as to how and why this decision was made by policy makers? California represents a spectrum of health providers and has a large population as well as regional diversity. There is also a significant taxpayer base here, as well as CMS recipients. While there are several large health care entities who are adopting electronic heatlh records here, the adoption of EMR in smaller practices is very low. There also remains no connectivity between these groups and individual providers as well as academic medical centers.

California in the past has been on the forefront of developments in healthcare. Our state is certainly stressed in regard to healthcare for all its’s citizens. It’s hospital system has been decimated by reduced reimbursement as well as caring for uninsured as well as undocumented aliens. Our chaotic health insurance underwriting is chaotic and discriminatory for those who lose employment or have pre-existing conditions. The secondary economic toll is staggering and saps our potential wasting many lives.

The impact of granting CMS grants to our region would be great. The funds would do the greatest good for the most people. Most CMS grants seem to go to rural, underserved, or disadvanated counties or subsets of health issues. There has been a definite bias against the vast majority of insured and seemingly independent citizens who are imagined to be able to produce a system for Health Information Exchange.

The recent increased interest has produced a “feeding frenzy” amongst IT vendors whose main interest is “great profit” from medical providers . Numerous health care interests, insurance providers, CMS, have projected enormous savings and improved quality of care from health IT. Yet, some studies have failed to demonstrate this as true.

The adoption of EMR and HIE is much more than installing systems. It requires “change management” and few smaller practices have these resources available. Estimates for cost effectiveness fail to include training expenses, nor maintenance of systems which can amount to 15 or 20 percent/annum of the initial investment.

I and all the other health care providers will be interested in your important response to my question

Very truly yours,

Gary M. Levin MD

Saturday, February 16, 2008


Can physicians make the changes necessary to continue to provide quality care, while at the same time beseiged by increasing demands on the part of insurers, CMS, patients,etc.


There is no doubt there are many others willing to "steer" the boat, and relatively few physicians participate in organized medical associations. We are divided, fractured and all but trampled upon.  Chaos reigns supreme....mostly because we are not pro-active. 

Our political leaders are all chanting "CHANGE"  !!

The initial phases of information technology and how it applies to the medical industry has just begun.  Although it has not yet reached critical mass the "growth curve" indicates a steady incremental increase in the number of users of health information systems, of which  EMR is only a part.

The Annual HIMSS meeting which is taking place this week has progressively increasing attendance, a reflection of the market potential of this technology.

Many "hospital systems", large groups have or in the rollout phases of their EMRs. 

There can be no doubt that once a "critical mass" is obtained, those providers who do not utilize this tool will be at significant risk of economic and referral disadvantage.  As true of most decision-making it is much better to be proactive and be on the leading edge rather than the trailing adopter.

Adopting EMR is far more than purchasing a system. It requires "change management" of how your support system flows.

For those using EMR, despite the transitional challenge, most say they would  "never go back ".

So, who are the We's?? In my opinion it is YOU and I.

Monday, February 4, 2008

A Word of Caution


I have read that some physicians are acting proactively in installing EMR to preclude the possibility of having their reimbursement reduced by payors and CMS for not having electronic health records.

Payor and CMS requirements have not defined what they consider as electronic health records. They do not define how inclusive or what data needs to be in the EMR.  Does a document manager of scanned files fulfill their requirments??

I maintain that providers need to do what is best for THEIR PRACTICE, and not jump off an expensive cliff to satisfy some " entity", which wants data for their  own ends. 

If EMR grows and takes hold it must be led and driven by providers.