Physician Incentives Under HITECH Act

Fellow health care lawyer colleague, AHLA HIT member and friend, Jud DeLoss, provides an excellent overview of the Physician Incentives under the HITECH ACT.

The incentives focus on providing direct payment for the adoption, implementation and maintenance of electronic health records (EHRs) to "eligible professional" who establishes the "meaninful use" of an EHR.

Check out this post and others at Jud's Minnesota Health IT Blog.

Reengineering Health Information Technology to Wire The Medical Home

Over at The Health Care Blog Dr. Kibbee issues Part 2 of his Confessions of a Physician EMR Champion, subtitled "A Conversation with American Physicians About How to Save Medicine in the Age of Information." The Part 2 post, Empowering Health IT for the Connected Medical Home, is a must read for all interested in the world of changing world of health/technology.

Dr. Kibbe lays out 5 areas that health IT should focus on to be empowering and disruptive to the current models:

1. electronic data and information collection and access
2. communications among providers and patients
3. clinical decision support
4. population quality, performance, and cost reporting
5. consumer/patient education and self-management

He highlights the importance of stepping back and looking at the current EMR model (a bit of thinking outside the box):

There is nothing transformational or disruptive about EMRs because they have been designed to meet the functions and features of a status quo business model -- not the collaborative and participatory capabilities required of the business models of the future health system.

In this next installment of the conversation, I’d like to suggest some specific capabilities that health IT ought to empower doctors and health care teams to perform on behalf of, and in collaboration with, their patients.

I’m suggesting that we go back to the drawing board and design health IT that is truly a good fit for doctors and patients in a system that rewards quality, safety, and efficiency of care while working to keep people healthy, instead of simply adding up the charges when they’re sick.

I'm involved on a number of fronts looking at health information models for West Virginia that will improve the delivery of care and reduce the costs. Dr. Kibbee's comments and thoughts are valuable for others looking at these same issues.

Tip to Ted Eytan on the post.

The Facebooking of Medical Records

Bob Wachter on the Facebooking of medical records over at The Health Care Blog. Great thought provoking read for those in the health care world and who understand the powers of online social networking tools for communication.

Recently I just completed co-authoring with Jud DeLoss the feature article for the next AHLA Health Lawyers News on PHRs where we discuss what may be a major shift in health information gathering from provider-centric to patient-centric. Basically the rise of the PHR and what may be on the horizon for health lawyers with such change. Bob's example and analogy of the Facebook culture is a valuable one as we look at the pros/cons of such a shift. His thoughts on leveraging the value of collaborative social networking tools to reinvent the medical record system are valuable and should be considered as we look at ways to improve the bedrock of good medical care -- the patient history and record of care.

I'd take the ideas a bit further and provide another analogy. Think about the use of Twitter (or recently discussed and TC50 winner Yammer - Twitter for businesses) like solutions to allow access to a real time updates of the patient's condition in timeline fashion among those caregivers providing care to the patient. The providers would be the followers. If able, the patient could also participate in this stream of information. Sounds a bit like Dr. Wachter's synopsis program.

Just some Friday morning thoughts. Would be interested to hear from others in the comments.

Better Understanding of Key Health Information Technology Terms

On April 28, 2008, the National Alliance for Health Information Technology released its Report, "Defining Key Health Information Technology Terms," to the Office of the National Coordinator for Health Information Technology.

The report is an effort to get everyone working in health information technology to have a common understanding of and differences between EMRs, EHRs, PHRs, HIEs, HIOs and RHIOs. If you don't know what each of these are or are interested in better understanding these key health tech terms check out the report.

An article by Health Data Management indicates that the Report will be "presented on June 3 to the American Health Information Community, a Department of Health and Human Services advisory body, for final approval."

Google Health: Google Partners with Cleveland Clinic

The New York Times Technology Section reports on a pilot project between Gooogle and the Cleveland Clinic in an article, Google to Store Patients' Health Records.

The article indicates the pilot project will involve a volunteer patient group transferring their personal health records so that they are available via Google Health, a new health record product being developed by Google. The article quotes Pam Dixon of the World Privacy Forum concerning privacy issues under HIPAA (incorrectly referenced by the Times as HIPPA).

I don't necessarily agree with the scope of the comments regarding the applicability of HIPAA in this situation. Although I don't know the full details of the relationship for the proposed project but it would appear that Google in this situation might be serving as a business associate of the Cleveland Clinic for the project. As a business associate it is likely that Google would be held contractually to many of the HIPAA privacy standards.

Tip to Matthew Holt at Health 2.0 Blog for noticing the NYT article.

UPDATE (2/22/08): ZDNet's Larry Dignan at Between the Lines has more on the pilot project including the Cleveland Clinic's press release.

The comments to Dignan's post are interesting reading especially a couple with a legal perspective. The comment, two misconceptions, highlights the overall light enforcement efforts by OCR and lack of penalties, whether Google might fit the "healthcare clearinghouse" definition under the "covered entity" definition, entering into a contract with the health care provider (business associate requirement) and discusses the subpeona and marketing misconceptions.

Also, more from NYT's Steve Lohr, Google Health Begins Its Preseason at Cleveland Clinic which indicates that Google Health will be made available to the public following completion of the pilot project (appoximately 2 months). The article also has a quote from fellow health care blogger and CIO of Beth Israel Deaconess Medical Center in Boston, John Halamka, who indicates that the hospital is also interested in linking its EMR with Google Health. As a board member of the West Virginia Health Information Network I would like to explore the idea of utilizing and integrating Google Health into our statewide effort to bring about an integrated/interoperable health information system.

Jane Sarasohn-Kahn at HealthPopuli shares her thoughts and additional link commentary on the Google/Cleveland Clinic project. Jane highlights a recent report, Personal Health Records: Why Many PHRs Threaten Privacy, by the World Privacy Forum looking into privacy issues for PHRs.

Matthew Holt's follow up post taking a closer glimpse at the privacy questions, motives and opportunities both pro/con surrounding the Google Health project.

UPDATE (2/24/08): For the latest article covering the Google Health project check out Newsweek's article, Web Surfer, Health Thyself, out in the March 3 edition.

Also, MSNBC provides some additional insight on how Google Health will interact with the existing Cleveland Clinic EHR (or PHR) in Google Goes to the Doc's Office. The article describes the pilot project as follows:

. . . The Cleveland Clinic already keeps electronic records for all its patients. The system has built-in smarts, so that it will alert doctors about possible drug interactions or when it's time for, say, the next mammogram. In addition, 120,000 patients have signed up for a service called eCleveland Clinic MyChart, which lets patients access their own information on a secure Web site and electronically renew prescriptions and make appointments.

The system has dramatically cut the number of routine calls to the doctor and boosted productivity, though it has yet to effectively deal with information from an outside physician, Harris says. Those records are typically still on paper, and have to be laboriously added to the Cleveland Clinic system. It is a big problem, especially for the clinic's many patients who spend winters in Florida or Arizona, where they see other doctors.

Adding Google's technology lets patients jump from their MyChart page to a Google account. Once on Google, they'll see the relevant health plans and doctors that also keep electronic medical records. That means the patient can choose to share information between, say, the Arizona doctor and the Cleveland Clinic . . .

UPDATED 2/26/08: Scott Shreeve goes Giga over Google Health. Read his first impressions of the Google PHR after his test drive at HIMSS.

However, Dmitriy at TrustedMD makes some great points, including this quote:

Yet, even with free PHRs out there, consumers simply do not care for spending their time to learn and use them. Who would bother entering and checking their medical records if you are healthy and would rather go see a movie? And once you get sick, you do not want to enter them either. You just want your doctors and hospitals to hand your medical records to you. But you see, the providers have different priorities that a mere piece of software just cannot solve . . . PHRs' real problems are not technical, usability or even privacy. The real problem is consumer and provider motivation . . .

He ends his posts with some questions we should all be discussing. Until we see a reimbursement model that creates incentives for providers to look at more health information and consumers to care about and take an active part in their health -- I'm not sure the PHR/EHR initiatives will fully develop and mature.

Follow the latest news (blog posts) and the Techmeme reaction to the project.

The Ying and Yang of Health Privacy

Christina's Considerations posts a quote by Dr. William Yasnoff from a recent New York Times article, Warnings Over Privacy of U.S. Health Network. The quote caught my eye because it highlights what I'll refer to as the ying and yang involved in the conversion to a more comprehensive interoperable health information system and how you and I as patients may react.

The quote reads:

"Anything you do to make information more accessible for good, laudable purposes will simultaneously make it more accessible for evil nefarious purposes. People intuitively understand that, and they are worried."

Those of us working on health privacy and e-health issues should regularly consider and reassess this principal as we move forward to transform the way health information is collected, stored, used, disclosed and aggregated. Over the years to come health lawyers will play an increasingly important role in the process of addressing legal issues that arise from the concept highlighted by the quote.

Tags: privacy, EMR, health information technology, health care

Health 2.0: EMR Innovation from the ground up

How about this for EMR GMR innovation. Graham Walker, a Stanford med student, has built his own web 2.0 mock up of a better EMR interface. A great example of what web 2.0 might bring to health care in 2007 and beyond. I'll be interested to read the comments from physicians and others who have to work with EMR software on a day to day basis.

Watch the screencast demo and then test it out for yourself.

Courtesy of Matthew Holt at the The Health Care Blog.

Tags: health 2.0, web 2.0, EMR