Tag Archives: health IT

Physicians

Health IT Problems Again and Again

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Various law blogs are reporting that the stimulus bill contained another reason for providers to avoid electronic medical records: Breaches of more than 500 patients trigger requirements to report to HHS, advertise on Web sites, notify individual patients, and report to the local media. It takes work to violate 500 paper records. Violating 500 electronic records might take no more than a couple of keystrokes.

The stimulus bill contains HIPAA extension provisions that will probably add significant regulatory costs to an already overburdened system. It creates more jobs for bureaucratic overseers and makes service providers like Google Health subject to HIPAA restrictions. link, and PointofLaw, February 23.]

Physicians

More on Health IT

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Here is in-depth analysis by the law firm McDermott, Will & Emery (MWE) of the Health Information Technology section of the new stimulus package. The lesson – if you would like to participate in the Brave New World of federally-prescribed Health IT, the first thing to do is hire a lawyer.

The provisions of the bill are nearly incomprehensible. And the time frames are completely unrealistic. Standards are supposed to be set by December 31, 2009 – that's ten months from now, folks. And "each person in the United States" is supposed to be using an Electronic Health Record (EHR) by 2014. There are committees galore and grants to the states and "qualified not-for-profit entities." There is money available to providers to "purchase certified EHR technology," and "incentives" under Medicare and Medicaid to become a "meaningful EHR user." For physicians, the incentive is a bonus of up to $18,000 for 2011 and 2012, and decreasing after that.

Physicians

Taking Another Look at Health Information Technology

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As part of the federal government's economic stimulus package, Congress has authorized spending about $20 billion on health information technology (health IT) and another $1 billion on comparative effectiveness research. These provisions achieved wide bipartisan support in Congress and in the health care industry, based on the hope that the investment will help improve efficiency, cut costs, and result in better care. The reality is likely to be far different.

Proponents of this spending rely heavily on a RAND Corporation analysis from 2005 that predicted $77 billion in annual savings and improved outcomes. RAND estimated "implementation would cost around $8 billion per year, assuming adoption by 90 percent of hospitals and doctors offices over 15 years." It said, "The benefits can include dramatic efficiency savings, greatly increased safety, and health benefits."

Unfortunately, RAND assumed an error-free system that is quickly and enthusiastically adopted by virtually the entire health care system. That might happen, but it is an absolute best-case scenario. Even then, instead of "dramatic savings," the $77 billion hoped-for savings amounts to a mere 4.5 percent of total costs, placed at $1.7 trillion by RAND. Continue reading Taking Another Look at Health Information Technology →

Interesting Links

Hits & Misses #2 – 2009/2/26

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New York CityOne-third of New York Medicaid patients don't bother to re-enroll. Paperwork is one problem.

Health IT in the UK. They text message STD test results to teenage patients.

Anger kills. But only in people who already have a heart problem.

Wyoming creates HSA pilot program. It's an alternative to Medicaid.

For-profit company creates products for the uninsured. $85 physician visits and 20% off on tests.

Hospitals

Health IT: What Can Go Wrong

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In December 2008, a PC used to check digital images rebooted in an operating theatre in mid-surgery at the Sheffield Teaching Hospitals Trust in England. After managers decided to disable automatic security updates to solve the problem, hospital computers were promptly infected with the Conficker worm. [link, link, and link]

The hospital system tried to keep the problem secret, warning staff not to make details of the outbreak public. When that failed, the trust said that the worm infection had not cost the public any money, "just time and effort by the IT teams." Clean-up continues. Continue reading Health IT: What Can Go Wrong →

Physicians

Just How Well Do EMRs Work?

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To visit the Marshfield Clinic, a longtime innovator in health information technology, is to glimpse medicine's digital future.

A computerized patient record is a continuously updated document that includes the patient's health history, medications, lab tests, treatment guidelines and doctors' and nurses' notes.  However, there is no crisp, conclusive cost-benefit arithmetic. Marshfield can point to various measurable savings, but has scant proof they outweigh the millions spent in the past and the $50 million-a-year technology budget. [link]

New Health Care Law

Mark Pauly on the Candidates’ Health Plans

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Writing in Health Affairs, Mark Pauly of the Wharton School of Business at the University of Pennsylvania makes a case for a hybrid plan between what Obama and McCain have proposed in their campaigns. He seems to like McCain's tax credit:

(A uniform tax credit) would not inappropriately push people into or away from group insurance, or bias choices for or against high-deductible insurance. Rather, it would push choices toward insurance that the consumer judges to be worth its true (unsubsidized) cost. This neutrality is important because group insurance is usually less administratively costly than individual purchase, and sometimes managed care is better than high cost sharing to limit overuse. However, individual insurance can give different individuals the coverage they want, and managed care makes some people angrier than high deductibles. Neutrality allows these trade-offs to be made properly. Continue reading Mark Pauly on the Candidates’ Health Plans →