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Monday Morning Update 12/13/10

December 12, 2010 News 11 Comments

12-12-2010 1-04-31 PM

Half of readers from hospitals say their CIO reports directly to the CEO, with a fairly even split of the remainder reporting to the CFO and COO. New poll to your right, for providers: if an HIE’s technology platform is owned by an insurance company (as in Axolotl and Medicity), would your organization be less likely, more likely, or equally likely to participate in that HIE? Click the Comments link on the poll to add yours.

The president of the Australian Medical Association says the government’s EHR efforts should focus on making information available to doctors in real time: labs, rads, meds, and discharge summaries.

Trustees of Campbell County Memorial Hospital (WY) vote to buy themselves iPads and 3G accounts, claiming their $15,000 hospital cost will save time and copying expense. Otherwise, it’s an all-paper hospital, with CPOE and ED order entry “in the mill.” That jibes with my personal experience: electronic executive toys (and the IT support to keep them running) are always of highest priority, with no justification required except, “These are cool … we want them.”

12-12-2010 1-35-48 PM

A CDC survey finds that around half of physician practices uses EMRs, but only 25% of practices use a system that meets “basic system” functionality, with just 10% using a “fully functional” EMR that includes medical history, drug interaction checking, e-prescribing, electronic ordering of lab and radiology tests, and viewing electronic images. Still, the use “fully functional” EMRs has gone from 3.1% to 10% since 2006. Laggard states include Kentucky, Louisiana, and Florida, in which more than 60% of physicians in practice do not use any form of EMR. Leading the pack is Utah, with 51.5% of office-based doctors having access to a basic EMR.

ONC announces December 10 approval of two more certification bodies: ICSA Labs and SLI Global Solutions. They join CCHIT, Drummond Group, and InfoGard Laboratories.

Children’s Dayton chooses Medicity’s Novo Grid for exchanging information with its physicians and partners.

An EMT who took a crime scene photo of a dead woman and posted it on his Facebook avoids jail time, but is sentenced to 200 hours of community service and the permanent loss of his EMT license. His attorney blamed the man’s “raw sense of humor.” Social networking may also have been involved in the woman’s death: her parents say she was killed after an enemy spread false rumors on MySpace that she was romantically involved with the man who was eventually convicted of killing her over the incident.

The Army is testing the AHLTA EMR on mobile devices that include the iPad, iPod Touch, iPhone, Sprint HTC EVO, and Samsung Epic.

An ortho tech at Memorial Medical Center (CA) is arrested and charged with stealing 23 computers from the hospital.

An interesting WikiLeaks disclosure: drug company Pfizer hired investigators to check out Nigeria’s attorney general, hoping to uncover evidence of corruption that would force him to resign. A Nigerian state had sued the company for $2 billion, claiming its testing of meningitis drug Trovan there had killed 11 children (it was later heavily restricted in the US and banned in Europe). Pfizer settled for $75 million in July, but the AG had already been removed after corruption articles were run in local newspapers.

Above is a good interview with Stuart Rosenberg, MD of Beth Israel Deaconess Physician Organization, which just signed an “Alternative Quality Contract” with Blue Cross that pays the group a fixed amount for its HMO patients. He was paid over $700K in the organization’s most recent tax return, which despite being an ample income, doesn’t seem all that excessive considering what non-clinical hospital executives make.

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Currently there are "11 comments" on this Article:

  1. I find it interesting when official statements leave open huge mysteries that can be illustrated by simple questions (some would call them ‘zingers’):

    Re: Australian Medical Association

    “The Government should concentrate all its efforts on getting pathology results, diagnostic imaging results, hospital discharge summaries, and medications dispensed information onto an electronic medical record,” Dr Pesce said.

    This leaves me wondering what the Government wasconcentrating on besides the above “Medical Informatics 101” priorities.

    Perhaps these things?

  2. I’m glad there’s competition, but I’m beginning to wonder: just how many of these ATCBs will the market support? Here’s a scenario to consider: what happens if one of them certifies an EHR now but doesn’t make it to the permanent certification process? That EHR would have to be certified under a different accredited body, which I can only imagine would be stressful and potentially disruptive to both the vendor and its clients.

  3. Re: CDC survey

    I don’t see documentation of the source of an EHR for the outpatient physicians. To me, it’s noticeable that the highest rates of EHR use are in the west and upper midwest, where employed physicians are common and IDNs are strong. The lowest rates are in the northeast and southeast, where there are still high rates of community hospitals with independent, affiliated physicians. It would be interesting to know how many of those physicians have a hospital/employer-provided EHR (i.e., forced to use it) as compared to those in independent practices (i.e., choose to use it). Those numbers might provide some insight as to the true embrace and adoption of EHRs among physicians.

  4. Re: if one of them certifies an EHR now but doesn’t make it to the permanent certification process?

    The certification is good…until you issue a new release, or you hit Stage 2. Every new release will have to undergo ‘re-certification’. That could be as simple as getting a letter from the ATCB saying it’s OK, or having to start from ground zero if you change anything that impacts MU criteria from the initial certified release. It works just likethe FDA, change your software (device) and you must ‘see the man’.

  5. The National Institute of Standards & Technology (NIST) has just published a guide entitled:

    “NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records”

    It is available at this link (PDF): http://www.nist.gov/itl/hit/upload/Guide_Final_Publication_Version.pdf

    While I am happy to see this report, my comment is that it looks like something I’d use in undergraduate computer science classes.

    That HHS needed ONC to commission NIST to issue such as report to the Health IT industry reflects not so well on the latter.

  6. RE: CDC report

    Minnesota is #2, just slightly behind Utah. Guess that’s because we’ve had HMOs for 30 years. Oh, yeah… and 75% of the population is covered by Epic.

  7. @Frank Poggio: “The certification is good…until you issue a new release, or you hit Stage 2.” That’s actually what I was referring to: the recertification everyone will have to go through to qualify for Stage 2 (and 3). Ideally, there should be no difference if you were certified originally by one or the other. In practice, I wonder if some products will have to “shape up” in ways currently unforseen if the certification body scene changes between now and then.

  8. I read the NIST guide to usability. There is a companion document entitled, “Customized Common Industry Format Template for Electronic Health Record Usability Testing”. It is unclear how they came up with this so fast after the July conference on usability at NIST. Each presenter at that conference pointed out how unusable and thus, dangerous these devices are. How can these hastily written advisories cover and cobble for the years of flawed and defective designs?

    Thus, what is the evidence that what NIST presents is valid, true, accurate, or will have any impact on redcuing the workflow disruption caused by these medical devices? Did they perform comparative effectiveness research?

    These documents have been out since November 15. Thank you to MIMD for bringing this to my attention, and to the attention of the readers of this blog.

  9. Re: In practice, I wonder if some products will have to “shape up” in ways currently unforseen if the certification body scene changes between now and then.

    What I am being told is: For stage 2 you will not have to retest Stage1 criteria (unless you do a new release that impacts one or more S1 criteria). Also you do not have to stick with the same ATCB from stage to stage. As far as products shaping up in ways unforseen- most likely YES – here’s a quote from the regs (translation – there’s is ALOT ‘unforseen’ comming, in fact we will not stop at Stage 3..there will be more)!

    NFR 7/13/2010: Please note that nothing in this discussion restricts us from requiring additional stages of meaningful use (beyond stage 3) through future rulemaking. In addition, as we expect to engage in rulemaking to adopt the criteria that will accompany Stages 2 and 3 of meaningful use, stakeholders should wait for those rulemakings to determine what will be required for those Stages and should not view the discussions in this preamble or final rule as binding the agency to any specific definition for those future stages.

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