HHS Announces Physician EHR Demo Project

Yesterday HHS announced that CMS will involve physicians in a five year demonstration project encouraging small and medium physician practices to adopt electronic health records.

Excerpt from Secretary Leavitt's announcement:

“This demonstration is designed to show that streamlining health care management with electronic health records will reduce medical errors and improve quality of care for 3.6 million Americans. By linking higher payment to use of EHRs to meet quality measures, we will encourage adoption of health information technology at the community level, where 60 percent of patients receive care,” Secretary Leavitt said. “We also anticipate that EHRs will produce significant savings for Medicare over time by improving quality of care. This is another step in our ongoing effort to become a smart purchaser of health care -- paying for better, rather than simply paying for more.”

Conducted by the Centers for Medicare & Medicaid Services (CMS), the demonstration would be open to participation by up to 1,200 physician practices beginning in the spring. Over a five-year period, the program will provide financial incentives to physician groups using certified EHRs to meet certain clinical quality measures. A bonus will be provided each year based on a physician group’s score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care.

The CMS demonstration also will help advance Secretary Leavitt’s efforts to shift health care in the U.S. toward a system based on value. The Department is working to effect change through its Value-Driven Health Care initiative, which is based on Four Cornerstones: interoperable electronic health records, public reporting of provider quality information, public reporting of cost information, and incentives for value comparison.

For more info check out the HHS Press Release.

Thanks to the Medicare Update blog for a tip on this new project.

WV Rolls Out BMI Wheel Project

West Virginia and Unicare rolls out a simple solution to fighting the obesity problem in West Virginia (WV ranks as the #3 heaviest state). The project involves giving West Virginia physicians a small body mass index (BMI) calculator wheel and training in how to use the wheel to recognize obesity earlier, especially in children.

Thanks to Jane Sarasohn-Kahn at Health Populi for the tip on the project.

Grand Stories at Grand Rounds

Don't miss this week's Grand Rounds hosted by Paul Levy of Running a Hospital. Paul's edition focuses on personal experiences by health care bloggers and how it caused them to change their behavior and beliefs.

Take some time today out of your busy schedule and read a couple of the linked stories.

While on the topic of blog carnivals - also check out the latest edition of Medicine 2.0 hosted this week at The Health Wisdom Blog.

Wild and Wonderful West Virginia

First big lions in West Virginia, now bigfoot sightings (more details) in Pennsylvania. The "big lion" sights in West Virginia certainly give new meaning to the motto of "Wild and Wonderful." Here's hoping that it wins the election.



UPDATE (10/31/07):

The votes have been tabulated and West Virginians have overwhelmingly chosen a return to our motto of "Wild, Wonderful." The Governor's Office just released the following press release:

CHARLESTON -- Tabulation of the results from the final round of voting for West Virginia’s official roadway welcome sign was completed this morning and 57.5 percent of the nearly 49,000 West Virginians who voted said they want the state to be known as “Wild, Wonderful,” the governor announced today.

“Wild, Wonderful,” which was on West Virginia’s Interstate highway welcome signs from 1975 until 1991, is the clear winner with 28,046 votes, followed by “Almost Heaven,” with 17,591 votes and “The Mountain State” with 3,120.

Residents cast 41,284 votes using the state’s online voting system, while 7,473 voted by telephone. In total, since the slogan contest was announced Sept. 5, more than 110,000 votes were cast by West Virginians.

“I’m delighted we had such a large number of West Virginians who took the opportunity to choose their favorite slogan,” Manchin said. “I truly want to thank everyone for their participation and for the creative suggestions many provided during the first round of voting. We had a lot of worthy entries, but it is clear that West Virginians love to call this state ‘Wild, Wonderful.’”

The governor now will take the results to the Legislature in January and ask that the members codify the people’s selection so that they can be assured their wishes will be consistently followed. “I look forward to working with the Legislature to make this slogan our official welcome,” he said.

Method of Voting	Wild, Wonderful	Almost Heaven	The Mountain State
Web site	23,653	15,015	2,616
Telephone	4,393	2,576	504
TOTAL VOTES	28,046	17,591	3,120
Grand Total Votes	48,757

New (Old) Physician Models: Dr. Parkinson and Doctokr

If you are interested in Dr. Parkinson's business model check out doctokr (doc-talker) based in Vienna, Virginia. For more what doctokr is and how Alan Dappen, MD. provides his unique service check out about/services.

Thanks to Dr. Val for the referral. I particularly like this quote from her post:

"The physical exam is a straw man for reimbursement. Doctors require people to appear in person at their offices so that they can bill for the time spent caring for them. But for longstanding adult patients, the physical exam rarely changes medical management of their condition. It simply allows physicians to be reimbursed for their time. Cutting the middle man (health insurance) out of the equation allows me to give patients what they need without wasting their time in unnecessary in-person visits."

An Early Look At How Iowan Voters Feel About Health Care

Jane Sarasohn-Kahn at Health Populi looks at some early statistics of how Iowans feel about the state of our health care system. The survey was sponsored by CodeBlueNow, a consumer-led health advocacy group.

I found it particularly interesting that Iowans believe "health care services should stress disease prevention over high-technology cures." I wonder if a poll in West Virginia would show a similar statistic.

Contrast this statistic with some data coming out of the Leadership West Virginia Conference saying that West Virginia's health care system is dysfunctional and in peril. Dave Campbell, CEO of Community Health Network said that "$10 billion a year is spent on health care in [West Virginia], but only 3 percent of that is spent on preventative measures." Chronic disease is a huge problem in West Virginia.

Citing respiratory disease and diabetes as two treatable problems that are causing health care rates to rise in West Virginia, Campbell goes on to say that of the "$4 billion a year spent in hospitals, we know that $1 out of every $10 is avoidable. Over $400 million would be avoidable if people had earlier access to prevention and primary care."

Guy V., this post is for you after our weekend discussion.

Hatfields & McCoys, Book Banning and The World Is Flat

Larry Messina beat me to the post. I agree - quote of the day from award winning author, Pat Conroy in a letter to the editor appearing in today's Charleston Gazette.

"Because you banned my books, every kid in that county will read them, every single one of them. Because book banners are invariably idiots, they don’t know how the world works — but writers and English teachers do."

More on the the story involving the suspension of two of his books, Beach Music and The Prince of Tides, from high school English class at Nitro High School.

The emailed letter to the editor was in response to an effort lead by Makenzie Hatfield, a George Washington High School senior who the article indicates is working to for form a coalition against censorship. Hatfield emailed the author about the situation and received the response.

Just another example of how the ease of modern communication (email, internet, blogging, etc.) can put anyone (student) in contact with anyone else (author). The world is flat.

Conroy also weaves in the Hatfields & McCoys and ends with my other favorite quote from the letter.

"I salute the English teachers of Charleston, West Virginia, and send my affection to their students. West Virginians, you’ve just done what history warned you against — you’ve riled a Hatfield."

New Health Care CIO Blog

A welcome to John Halamka, MD and CIO of CareGroup Health System and the Chief Information Officer and Dean for Technology at Harvard Medical School who has launched a new blog, Life as a Healthcare CIO. Dr. Halamka is also the Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE (the Regional Health Information Organization), Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing Emergency Physician.

His tag line says:

Every day I experience life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients. In this blog I record my experiences with infrastructure, applications, policies, management, and governance as well as muse on such topics such as reducing our carbon footprint, standardizing data in healthcare, and living life to its fullest.

Check out the great content in these recent posts, Top 10 Things a CIO Can Do to Enhance Security and the pro/cons of Flexible Work Arrangements. Looking forward to reading more of his posts. Tip to David Williams at Health Business Blog for pointing out this new health care CIO blog.

Data Missing on 200,000 West Virginia PEIA Members

WSAZ News, the State Journal and Charleston Gazette are reporting that data on approximately 200,000 past and current members of West Virginia Public Employees Insurance Agency (PEIA) is missing. According to the articles, the data was contained on a computer tape being mailed to a data analyst in Pennsylvania and was reported missing on October 18.

The data tape included names and maiden names, addresses, social security numbers, telephone numbers, and marital status of program participants and their covered dependents. The article indicates that the data tape did not contain medical or prescription claims information.

According to the article, letters will be mailed to impacted members and a hotline will be set up to answer questions about the lost data.

UPDATE: For more information check out the PEIA Data Loss Press Release and the Letter to Affected Policyholders about PEIA's Recent Data Loss.

Putting WV Mountaintop Removal In Perspective

How big are West Virginia's mountaintop removal sites? Check out the post "How Big is MTR Mining?" over at the Charlestonian Blog to better understand the scale.

AHIMA Report on State Level Health Information Exchange

The Foundation of Research and Education arm of the American Health Information Management Association (AHIMA) released a report titled "State Level Health Information Exchange: Roles in Ensuring Governance and Advancing Interoperability." The report was funded by ONCHIT.

I've just scanned the report but it appears to give a nice overview of the current status of state level initiatives to create an interoperable health information system.

Tip from iHealthBeat.

George Clooney and HIPAA Minimum Necessary Rule

An attorney I work with sent me a link to the following Fox News article, Doctors, Hospital Workers Suspended for Viewing George Clooney's Medical Records. For more news check out Google News search.

The article indicates that 40 employees at Palisades Medical Center in North Bergen, NJ were suspended for violating the hospital's HIPAA policies and procedures.

Based on the information in the article I suspect that the employees were found to have violated the minimum necessary provisions under the HIPAA Privacy Rule. This section of the rule provides:

For uses of protected health information, the covered entity’s policies and procedures must identify the persons or classes of persons within the covered entity who need access to the information to carry out their job duties, the categories or types of protected health information needed, and conditions appropriate to such access.

As more news comes out about this I suspect this might serve as a good example of application of the minimum necessary requirements under HIPAA. If the employees further disclosed the information to third parties outside the hospital (including the media) other provisions of HIPAA might also come into play.

Now Playing . . . The Digital Health Revolution

Friend and fellow health care blogger, Fard Johnmar, today officially announced the launch of The Digital Health Revolution. A project he has been working on with the folks at Scribe Media since meeting them at the fHealthcare Blogging Summit in Las Vegas.

Fard has great insight into the health care industry and I look forward to great content coming out of DHR. Check out the show here, including a very interesting interview with Susannah Fox, Associate Director with the Pew Internet and American Life Project on the topic of empowerment/revolution of the e-patient.

Enoch Choi, MD and I were lucky enough to be Fard's guinea pigs in his first (impromtu) interview for Scribe Media.

HealthVault: Adding Structure (Interoperability) to the Health Information Ecosystem

Last week (October 4) Microsoft rolled out a brand new vehicle that should help accelerate the growing consumer driven health care movement and creation of a national interoperable health information system. HealthVault is a new personal health record (PHR) platform that allows the user to gather, store and share health information online.

There has been a lot written about the roll out of HealthVault over the last week. I've read numerous articles and blog posts to try to get a better grasp of what it is (and what it is not). Over the weekend I ran across Vince Kuraitis' post at his e-CareManagement Blog which I found to have provided some good insight. Not until reading Kuraitis' post did I actually understand that HealthVault is not a PHR but a PHR platform.

In particular I like this quote by Kuraitis and his comparison of the pre-fax world:

" . . . this really isn’t about Microsoft vs. Google . . . It’s about creating a new business ecosystem based on the appropriate (honoring privacy and security) free flow of interoperable and transportable personal health information (PHI) — something that doesn’t exist today."

I'll throw out another comparison that I thought about as I read his post -- the natural gas transportation and storage industry. West Virginia is home to some large underground gas storage facilities. Basically, natural gas is pumped during off season to West Virginia from the Gulf Coast via large transmission lines or is gathered from small wells through gathering facilities and lines. The gas is then pumped and stored in previously depleted underground wells. In doing so, the natural gas can be stored safely and moved quickly to market in the northeast during the cold months.

HealthVault is setting out the same architecture, transportation and storage device for health information. The natural gas (health information) is very valuable and the system of moving it around is incredibly complex with multiple players and competitors. You have individuals and companies constantly adding natural gas (health information) to the system and end users who need natual gas (health information) at the opposite end. To date the health care industry does not have such a structured, standardized system of pipelines to protect and transport health information. We are largely still living in a paper world with systems that don't have the capability to talk to each other.

As I step back and take a look -- I see an industry in the midst of a tidal shift regarding the control of personal health information and maybe the bigger question of who wants (and can safely) control health information. Microsoft's HealthVault appears to be laying down more planks to create the platform for an interoperable system that will allow for health information to become more transportable, transparent and standardized. Ultimately, the question in my mind remains whether this will help to improve care and help each of us become better stewards of our own health?

Stay tune . . .

HealthBlawg Explores This Weeks Best Law Posts At Blawg Review #129

David Harlow of HealthBlawg takes to the keyboard like Columbus took to the seas and explores the world of law in Blawg Review #129. Don't miss this edition by one of my fellow health law bloggers.

Check out the upcoming editions at Blawg Review. If you are a new law blogger -- sign up to host or submit your favorite law related post.