Comments on: Monday Morning Update 11/23/09

By: HIS Junkie

HIS Junkie — Mon, 23 Nov 2009 16:08:54 +0000

Harvards got it right…EMRs by themselves will NOT save money…
see: http://www.kelzongroup.com/info_workflow_diff.html

By: Noah Praetor, MD

Noah Praetor, MD — Mon, 23 Nov 2009 14:58:53 +0000

!!!!They not only didn’t find any, but even the Most Wired hospitals showed no clear advantage. There are lots of limitations in their method (using Medicare cost data, using the limited quality measures in Dartmouth to extrapolate overall quality, and having incomplete data for some of the years). Do their conclusions hold water? Maybe in aggregate.!!!!!

Himmelstein et al are to be commended and not depreciated for their research. The HIT kool aiders on this site will do all to attack the person and the work. The numbers do not lie.

Those who have been forced to use the care disrupting equipment are not at all surprised.

Efficacy proven NOT and safety NOT proven.

Lawyers, are you getting it?

By: Dr. No

Dr. No — Mon, 23 Nov 2009 14:06:45 +0000

11th Way:
There is never a good reason to emerge from the secluded privacy and comfort of your office suite for useless mingling with the rank and file. Ever.

By: Ex-Kaiser

Ex-Kaiser — Mon, 23 Nov 2009 13:34:32 +0000

As a former Kaiser employee, (Northern California, Epic Ambulatory) I had Kaiser coverage. While I had some serious problems with the massive amount of irresponsible spending I saw as an employee and the strange pick of terrible, terrible managers (alongside some really great ones) I must say that the health coverage I had as a Kaiser member was the best I have ever had. I now work for a different health organization and the benefits dont hold a candle to what I had at Kaiser in terms of affordability and coverage. Also Kaiser’s integration of Epic with their legacy systems was incredible. The information was always at my doctors fingertips. Kudos to Kaiser for a great Epic implementation!

By: Jeff Eyestone

Jeff Eyestone — Mon, 23 Nov 2009 09:42:26 +0000

EMR vs. IDN EMR or Integrated Care Team EMR – and what the gov’t and institutions should be demanding from their HCIT and HIE

Obvious as this is, we should evaluate the efficacy and value of an EMR (most HCIT) by it’s use case in different care settings:

> An EMR that is one of many disparate systems across distributed and complex networks (e.g. one that enables a single patient’s caregiver network) – the typical use case for most EMR implementations

versus

> An EMR in an integrated delivery network or an integrated care team – Kaiser, the VA, the national healthcare system of Sweden, etc.

Halvorsen’s comments point to real gains being shown for KP’s multi-billion dollar Epic investment as the core tool of their IDN. (I’m a KP member – not Medicare just yet – but I agree with his assessment about time warps and primitive worlds of un-integrated healthcare settings). A comparable level ($Bs) invested in EMRs across dozens even hundreds of “un-integrated” institutions capable of caring for a population like KP’s (8MM people?) will not yield the same results. Not even close. You’d have a billion dollars in application integration professional services and I still wouldn’t know my medication history – and I don’t have any age-related dementia yet.

But this level of investment is happening. $X00MM here, $Y00MM there – I read it every other day on this site and others. And for what: operational efficiency INSIDE of these orgs?

Furthermore, government spending that perpetuates the HCIT status quo (investment in disparate systems across distributed networks with odd secret hand-shakes and misleading membership tattoos) will not make our healthcare system better or cheaper. Government should be looking to disrupt the status quo in this case.

Institutions should be demanding EMRs, HCIT and HIE that is truly interoperable and clears the path to better care and better outcomes via better data: rational methods for publishing and consuming external data and information services; enabling mash-ups and mass collaboration; and, leveraging web services, SOA, SaaS, IaaS, PaaS, etc. If our patients, payers, providers and government aren’t integrated, at least our systems might be. They are or will be in the “government option” of most other nations that are making better technology investments in care and costs.