Thursday, March 19, 2009

You Gotta Spend Money to Spend Money

"HHS is establishing a new Office of Recovery Act Coordination within the Office of the Secretary to ensure successful implementation of the American Recovery and Reinvestment Act (ARRA) throughout HHS. This Office will be led by a new Deputy Assistant Secretary for Recovery Act Coordination."

Starting on Tuesday March 3rd, and on each Tuesday thereafter through May 12th, agencies receiving Recovery Act funds will be submitting weekly cumulative reports detailing their latest recovery activities. These reports give regular updates to government officials, Congress, and the public on how much is being spent and on what, and list out the agency's major actions.

Spending data covers appropriations, obligations, and expenditures, by Treasury account, as recorded in the agency's financial system. Using the Treasury account code allows us to track the money by the specific program on which it is spent. For now, only appropriations and obligations are required, and expenditure data reporting is optional. After April 6th, all three types of data will be required.Full story...

All Quiet on the Western Front?

You'd think with all the hubbub around transparency and EMRs that I'd be writing like a man possessed these days. While it's true that I've rarely been busier, I'm mostly sitting, watching, waiting. Something big is about to happen, that's for sure.

Stimulus money is already being spent, agencies are fervently plannign on where best to put the money once it starts flowing. I've been part of some very interesting discussions, and I've gotten to hear about som every interesting plans. I've also been part of some very odd discussions, with the requisite odder plans.

Myself, I'm working on several health care transparency projects right now, plus a P4P project which is extremely interesting, so I'm keeping busy for sure, but I am on tenterhooks, drooling with the thought of all the data that might start becoming available if any of this health reform movement actually gets it's steam up.

The problem is, you can't really mix health reform, which by definition means trying to attain lower costs, with stimulus spending, which by definition means spending like there's no tomorrow.

With the proposition that moeny will fall from the sky for physicians to buy EMR software, lots of companies are gearing up to offer their product to a much wider market. has updated it's advice on EMR selection with a timely article update on "Should CCHIT Influence Your EHR Selection?"

Anyone thinking about buying an EMR package should read this. It succinctly explains what CCHIT is, and why you need to care what it is. For the uninitiated, CCHIT is the Certification Commission for Healthcare Information Technology, which simply means they say what an EMR has to do to pass muster.

If only it were that simple...

However, if you go on to read the related article on stimulus monies being used to reward adoption of EMR software, the larger picture starts coming in to focus. Roughly twenty billion dollars is sitting in a pot waiting to be given to physicians who become "meaningful users" of "qualified EHR" software.

"Meaningful" and "qualified" are where the rubber hits the road, and these two articles will help you sort through the NewSpeak.


On a related note, I was forwarded this WP piece this morning: Bad Bet on Medical Records. Long story short, health care professionals (Stephen B. Soumerai and Sumit R. Majumdar) posit there's no clinical evidence that electronicization is a good thing.

"there is little evidence that currently available computerized systems will improve care."

Those of us in the common sense portion of the universe may want to point out that very, very few physicians use EMR, therefore there is, by definition, very little evidence.

Oh, wait.

"The latest national survey, published in the New England Journal of Medicine, shows that only 4 percent of doctors have fully functional electronic records that can provide any kind of clinical recommendations."

They did it for me.

How is this not the bleeding obvious? More worryingly, how is dragging the only industry on the planet currently NOT participating in the Information Age not a bleedingly obvious good thing to do?

Do we *really* need clinical evidence to prove that these new-fangled com-poo-ters are good tools?

As the authors suggest:

"Before moving ahead, the administration should first consider conducting well-controlled research on the cost-effectiveness of health IT in office practices, which are the bulk of the U.S. medical system."

I agree totally.


I wonder how people so bent on evidence-based judgment for everything park their cars in the morning. I see no clinical evidence on the efficacy of E-mail. In fact, I see plenty of anecdotal and research-based evidence that E-mail can be harmful to efficient work processes. I hope the authors took that into account before sending in their article.

What else? Oh yeh, the system is corrupt.

"Moreover, personal financial ties have been found between some researchers and the companies that produce these systems, and as far back as 2005 studies have shown that health IT developers are about three times more likely to report "success" than evaluators who had no part in system development."

However, physicians who don't use said software and have their Medicare payments reduced but rail against the use of such software, that's not self-serving at all? Getting rid of these requirements directly impacts every physicians income.

And if you look to your IT developer for success stories, you probably believe everything your car dealer tells you, and I have a bridge I'd like to sell you.

To rephrase the above sentence, we could say that "studies have shown that people who make stuff are three times more likely to say the stuff they make is awesome."

Well, duh.

Let's take a closer look at self-serving protectionism. The authors clearly state that one way they can affirm a positive impact is in single payer systems. This article tells me that for true improvement, we need not only EMR but less players in the market. Do the authors examine the feasibility of a single payer in the US? Of course not, it's business as usual. We have too many players and payers, EMR will never work.


But of course, you can't just stand up and complain, you have to think of the children.

"For many chronically ill and vulnerable patients, it does not matter much whether their health records are digital or their prescriptions typed. Without patient access to clinicians and adequate health insurance that includes affordable drug coverage, a $50 billion investment in health information technology won't do much for many Americans. These funds are needed elsewhere."

That old whine. Money is needed elsewhere, so it instantly becomes an either/or argument. This is a logical fallacy at best. Money is needed in LOTS of places. HIT is one of them.

NO-one who wants to spend money on HIT thinks it's the only problem.

It is 2009. We use computers now. We have begged the industry to figure it out, but they can't or won't.

Need clinical evidence that computers are a good thing?


I propose that the physician population start submitting hand-written bills to the insurance companies they work with. And insurance companies should start hand-writing checks to doctors. It'll slow things down a bit, but at least we'll be able to gauge the average physician's love or lack thereof of interconnected data systems.

YES to computerized billing systems so I get paid faster!

NO to electronically storing my patient's data!

Full story...

Tuesday, March 3, 2009

Medical Data Privacy: Consumers v Hackers

I just left the following as a comment over at THCB, but after I got done ranting it seemed like a mouthful so I'm reposting it here.

I enjoy the position of being involved in HIT, clinical and claims data, *and* being one of the afore-mentioned hackers. Please distinguish hacker from malicious hacker or "cracker". The term "hacker" has no negative connotation in the community.

That said, I'd like to promise you all this:

When we're done, your health information will be as private and secure as your credit card information.

It will flow across secured networks using portions of the public Internet. It will be covered by copious security policies, all well-intentioned, and few implemented fully.

It will be accessible to you, the patient, electronically. A vague audit trail will also be available.

People who have access to this data - doctors, nurses, covered entities, HMOs, government workers, will store it on their laptops. Their thumb drives. Some will have identifiable data. Some will have deidentified. Some will have patient-level data, some will have aggregated.

Some of them will have their laptop stolen, forget it at the airport, lose their thumb drive. Some will just take it because they can sell it to some guy in Romania.

Third parties will make decisions about you based on your unique profile. Some of these decision will help you, such as reminding you to go get that mammogram. Some will hurt you, because you, like me, have not yet fully quit smoking.

All the above is going to happen. You have no say in it. It's begun, it's overdue, and it will be as imperfect a system as the current one, but with more detailed history of its imperfections.

It will surface new ways to practice medicine, and many of them will be for the collective good. It will surface new ways to lower cost, and many of them will be for the collective good.

You will be as secure in the safety of your medical data as you currently are with your credit data. You all punch your PIN in to the supermarket checkout machine while 15 people watch you. Right?

The government does not have your credit history any more than I have your credit history. The government may have your health score, the same way it can access your credit score. Or your landlord, or your employer, or your private detective.

You will have no more and no less security than with any other confidential information you currently manage, such as your Web site password for your online broker or your online checking account, the credit card bill you throw away unshredded, your mother's maiden name.

I don't hear any of you cutting up your credit cards.

I am not a doctor, a health provider, nor a policy maker. I am merely a tech-savvy consumer who happens to build health report cards using what little data is available to me. If nothing else, I look forward to the day I can actively score the use of evidence based medicine using clinical data delivered deidentified. That and I'd like to know what my last test result were, even if they were a couple years ago.

This is a non-conversation, and allowing the world and their mother to have a say in the indisputably inevitable is merely costing more money and wasting more time. HIPAA already covers who can see what when; properly implemented using standards-based EHR software is already happening, and will continue to happen.

The sooner we build it, the sooner we can start making it better day by day.
Full story...

Disclosures and Disclaimers


My employer is compensated through funding to provide analytical research, technology solutions, and Web-based public and private health care performance reports by the State of New York, the State of Illinois, the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, the Commonwealth Fund and Bridges to Excellence. I am not being compensated by any of these organisations to create articles for or make edits to this Web site or any other medium; and all posts authored by me are as an individual and do not represent my employer or the agencies I work for.