Tuesday, June 30, 2009

Order your Edsel



The past two weeks seems to further elaborate on the issues creaging a  tightening of the Gordian Knot of Health care which


threatens to overwhelm and bring our healthcare system and even our economy to a grinding halt.

Physicians are rightly frustrated and outraged at the incursion of well meaning pundits, experts, health policy gurus and others, who have meddled with the patient doctor relationship. It may never be restored. 

The new wave of HIT and EMR adoption foists upon not only providers but misguieded taxpayers who are being sold a bill of goods akin to the "Edsel" of the 1960s.

Rick Weinhaus MD  writes in The Health Care Blog about the folly of today's unproven CCHIT certified EMRs. Here are some excerpts from his letter to David Blumenthal, ONCHT .

am writing to you on the need for user-friendly electronic health record (EHR) software programs. As a practicing physician with first-hand experience with hard-to-use CCHIT-certified EHR software, I would like to share with you a solution to this vital issue.

The CCHIT model for EHR software certification is fatally flawed because it mandates hundreds of required features and functions, which take precedence over good software design.  This flawed CCHIT model takes valuable physician time and effort away from patient care and leads to increased potential for errors, omissions, and mistakes.

As a clinician, I have had first-hand experience with a top-tier CCHIT-certified EHR.  Despite being computer literate and being highly motivated, after a year and a half of concerted effort, I still cannot effectively use this CCHIT-certified program.  The poorly designed software constantly intrudes on my clinical thought process and interferes with my ability to focus on the needs of my patients.

Just this year the National Research Council report on health care IT came to a similar conclusion. The report found that currently implemented health care IT programs often

provide little support for the cognitive tasks of the clinicians or the workflow of the people who must actually use the system.  Moreover, these applications do not take advantage of human-computer interaction [HCI] principles, leading to poor designs that can increase the chance of error, add to rather than reduce work, and compound the frustrations of executing required tasks

It is astounding that physicians would be willing to accept inferior technical tools for administration and record keeping when we insist upon medical diagnostic and therapeutic equipment that must pass muster and require regulation by the FDA, and other healthcare regulatory organizations.

We absolutely need standards for data, data transmission, interoperability, and privacy. There is no need, however, to specify the internal workings of EHR software. To do so will stifle innovative software designs that could improve our health care system. If CCHIT is allowed to mandate the meaning of the term “certified-EHR,” the $17 billion allocated for EHR adoption and use will largely be wasted.

HL 7 guy explains our current conundrum:

There are real and tangible reasons why Information Technology as it exists is of very little help to many clinicians.

Gathering the information to feed into the systems is obtrusive and disruptive to the clinicians workflow.

For an hour of clinician and patient interaction there is approximately an hour of data input as most EMR applications are currently built. This is extremely inefficient.

Clinicians aren't secretaries or clerks that can be typing away all day. They have to cure and save the lives of their patients.

Frustrations imposed by improperly built software have created an apathetic attitude from most clinicians towards technology.

Until technologists understand this and start building solutions based on use cases and that fit seamlessly into the clinicians workflows, adoptions will be scarce and the failure rate will be high.


Thursday, June 25, 2009

The Final Frontier---where no man has gone before



For those of you in the know, this week is a critical time in health care reform. The Sentate’s Health, Education, Labor, and Pension committee, chaired by Senator Ted Kennedy is analyzing and weighing the various bills being proposed in Washington, this week. NPR is carrying a good portion of the proceedings. There is a lot at stake. Not only will proposed changes make immediate impacts, but in the future these changes will have unintended consequences. This happened with Medicare, the HMO act of 1971, Congressional budget regulations regarding sustainability (SGR) adjustments each year, and others. The federal government is slow to act, and slower to re-act. Legislation cut in stone is often in the end counterproductive.

Some of the proposals lead to well intended false hopes and promises. A major flaw regarding a public health program is that it would stimulate competition in the private market. That is highly doubtful, based on common sense. It’s like the 800 pound gorilla competing with a 150 pound chimpanzee. The federal government has many built in advantages, such as contracting, freedom to set rates arbitrarily, sheer overwhelming market presence, and force. Will government competition include predatory premiums way below market values? Will payments be locked in, and will it be prohibited by providers to charge less than the public health program? These are serious questions, considering how CMS has acted in the past. Are we going to see more credentialing restrictions for providers? Will this open a door to a ‘federalized medical license’? (maybe that is a good thing)

Even though this appears to be a critical year in terms of interest and action hasty actions can and will lead to unintended consequences and disaster.

These are the members of the committee:


Democrats by Rank

Edward Kennedy (MA)
Christopher Dodd (CT)
Tom Harkin (IA)
Barbara A. Mikulski (MD)
Jeff Bingaman (NM)
Patty Murray (WA)
Jack Reed (RI)
Bernard Sanders (I) (VT)
Sherrod Brown (OH)
Robert P. Casey, Jr. (PA)
Kay Hagan (NC)
Jeff Merkley (OR)

Republicans by Rank

Michael B. Enzi (WY)
Judd Gregg (NH)
Lamar Alexander (TN)
Richard Burr (NC)
Johnny Isakson (GA)
John McCain (AZ)
Orrin G. Hatch (UT)
Lisa Murkowski (AK)
Tom Coburn, M.D. (OK)
Pat Roberts (KS)

There is one MD on the committee, Dr Tom Coburn of Oklahoma. Of note are also several ‘powerful deal makers on the committee, including Ted Kennedy (Chairman) Chris Dodd, Barbara Mikulski, Orin Hatch. There are also several ‘young senators’.

Will the ‘old wise men’ make the right decisions for the younger generation of Americans?

Now is the time to put in your two cents. Despite the overwhelming feeling amongst physicians of futility and despondence it is vital you make your voice(s) heard NOW. Without physician input and support any systemic changes will be hampered and doomed just as they have in the past 25 years.

During these committee hearings, NPR points out that looking around the room behind the cameras are the 268 seats filled with special interest lobbyists.

Tuesday, June 9, 2009

A Political Message and Agenda

The final key to HIT adoption may lie with the beleagured physician (provider) as he attempts to deliver the best (healthcare), science based medicine to his patient (consumer).  The names and titles may change, but the challenges remain the same.

The simultaneous arrival of financial crisis, healthcare crisis, ARRA, and Health Information Technology adoption seems to be the 'perfect storm' for political meddling with medical care.

This statement appears at the introduction of the 'HIT Certification Course" sponsored by an unamed group using the term HIT Certification and a web site   'healthitcertification.com '

The web site does have a contact us link.  There appear to be many pundits or 'experts' on healthcare policy', a few physicians, and lots of titles listed as: faculty and advisors.

In it's opening statements, I quote:

"While some would have approached the current recession in a different manner, President Obama reflects upon the activities that helped spur growth after the Great Depression of the 1930s with spending for jobs that will modernize aging infrastructure and hopefully restore the middle class way of life in the U.S."

Accompanying this statement is the following illustration


I don't quite get the association between FDR and HIT. Is there a not so hidden agenda with this connection?  How can anyone cast negative aspersions on a program associated with FDR, the defeat of Nazi Germany, The Japanese Empire, The New Deal, Social Security, and all while sitting in a wheel chair and smoking cigarettes with a cigarette holder?? I am not certain however he would authorize his likeness in support of Obama's opportunism in regard to health care.  Create chaos and dysfunction and jump into unravel the mess.

I took some of my valuable patient time to read through some of the certification courses (offered free as a bait for the 'real course' which participants pay mightly to register.

It struck me as peculiar that a federal program would require 'consultants' physicians, and others to take a course which they must pay  for to obtain information regarding federal funding.  Why would the government even allow this, when they are funding billions of dollars to develop the training and infrastructure. (This is all nicely outlined in ARRA and HITECH)

So, all of you who have money to burn....go ahead, and throw some at me.

I'd rather be seeing patients. (especially without an EMR).But then again, I am rapidly becoming obsolete (and fossilized).

Friday, June 5, 2009

Is Help on The Way?


Readers may turn their attention to the Federal Register, outlining the plan as part of the ARRA stimulus package to develop Regional Extension Centers for assisting in developing Health Information Exchanges and assist in the build out of EMRs, and interoperability amongst providers. This 'small tome' of the register is largely unreadable and unintelligble.  The facts are in there somewhere if you are not prone to migraine and/or presbyopia.  The goals and mandates are in there, whether they will truly be funded, and/or  pursued is up to doubt.

Certainly the Obama Administration talks the talk, and may walk the walk.  It remains to be seen whether regional differences and serious reservations which remain will impede the flow chart.