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I don’t know about you, but I was thrilled to hear about today’s launch of MEDS-ED Link, a project of the Northern Virginia Regional Health Information Organization (NoVaRHIO) in conjunction with Inova Health System and GE Healthcare.
In a move that caught many by surprise, the recently-installed coalition government of Britain has proposed a radical reorganization of the National Health Service (NHS). The goals of the reorganization are to decentralize the control of the NHS budget, dismantle layers of bureaucracy, empower patients, and realize some £20 billion in savings through increased efficiency. All of this is set against a backdrop that calls for doing more with less – improving outcomes, ensuring high quality care and patient safety and giving providers and hospitals more autonomy while requiring more accountability. The UK, like much of Europe, is looking at ways to restructure budgets and social programs, in an attempt to reduce deficit spending and overall debt. And while the original goals of healthcare reform in the US included cost control, we on this side of the Atlantic did not take the courageous steps necessary to “bend the curve” on health care costs.
As an insider in healthcare for more than 20 years, today is an exciting day for me. Picis, the company I co-founded with Liz Popovich and helped grow into an international software company with 700 employees, is being acquired by Ingenix, a leading HIT, consulting and services company with nearly 6,000 hospital clients around the world.
This is a classic “win-win-win” situation that will benefit us, Ingenix, and all our customers and prospects. With all that is going on in healthcare industry today, I can tell you from the heart that the timing was perfect for this transaction, and this is truly the best possible home for Picis in which to grow and prosper.
Health care leaders and policy makers should be commended for making several smart moves in this week’s delivery of the final rule for the meaningful use (MU) criteria, but one of the most critical is the committee’s decision to include the emergency department (ED) as a viable place of service.
For the past several months, several of my colleagues and I have been part of the ongoing effort, working directly with legislators and other industry leaders to ensure that the ED “gets its due” in the MU final rule. One of the most cost and care intensive areas of every health system, but neglected in the initial rounds of MU criteria, the ED is where the flow of patient care most often begins and consistently feeds patients throughout the rest of the hospital – and I’m thrilled that policy makers have now shown that they agree.
Meaningful use was a major focus of many presentations at the recent Picis Exchange User Conference in Miami, but it was the representation from hospitals in Europe (including World Cup finalists Spain and the Netherlands!) and the UK, that sparked some of the most interesting discussions. It made me realize that European hospitals have been working to achieve many of the same “meaningful use” criteria that have become such a huge focus here in the U.S. – but that they have been doing it for much longer than ARRA HITECH has been around. From coordination of care to improving quality measures, Europeans have been in the “meaningful mindset” for a long time.
You may have heard the news yesterday that Allscripts has acquired Eclipsys. I weighed in on this move in an article that ran on HISTalk. You can find the article here, but I also wanted to share my thoughts here on the blog:
There is an increasing trend for general practitioners to be employed by hospitals, but an opposing trend that specialist areas like emergency and anesthesia are outsourcing physician services. So net/net, though on the surface it makes sense to combine the two areas, there is no real market force pushing for an end-to-end hospital-to-physician EHR. To the contrary, the one thing that really is taking off with lightning speed from ARRA is interoperability within and outside the hospital enterprise.
I can cite 10-15 real examples of systems already pushing CCDs among disparate EHRs, for example. Hospitals just aren’t in a position for wholesales swapouts of their IT systems across the board — it’s too disruptive and expensive. The new interoperability mandates will allow more modular approaches to building out EHRs.
I’m very torn about healthcare reform. As a business owner smack dab at the epicenter of the effects of healthcare reform, it’s a very timely boon to our business. As a taxpayer, although I think a lot of the reforms are necessary, I’m very skeptical about how we go about implementing and paying for it. And in many ways, I think so much more could have been done.
Good for business, but good for patients?
For Picis, healthcare reform and its companion legislation, the ARRA HITECH stimulus money, are going to spur tremendous growth opportunities. Today, the 32 million people that will soon be insured will end up going to the hospital emergency room for care under the EMTALA law (where hospitals aren’t allowed to turn away ER patients). The only problem is the hospital ends up footing the bill, putting pressure on their margins and reducing their ability to invest capital in IT and other systems. After covering 4 million more lives here in Massachusetts, we actually saw ER visits go up by 7 percent. Why? We didn’t add any more primary care doctors, and these newly insured patients swelled the offices of the existing general practitioner population to the point where 56 percent are no longer taking new patients. So where do these patient go? You guessed it – back to the ER, but for an entirely different reason. They’re not going to the hospital to get the only free care they can get – they’ve now got insurance – they’re going because they can’t find a doctor to see them in the ambulatory setting.
While the meaningful use debate rages on, the Centers for Medicare & Medicaid Services (CMS) have opened the proposed rule on the EHR incentive programs – which includes the definition of meaningful use and other requirements for qualifying for incentive payments – for public comments. The deadline for comments is Monday, March 15th, and we’re encouraging folks to weigh in on the good, the bad and the ugly. The more industry can shape how this rule should be shaped, the closer we come to putting the real “meaning” behind meaningful use.
For more information and to submit a comment on the proposed rule, visit the Regulations.gov website. For additional information on the proposed rule, visit http://www.cms.hhs.gov/Recovery/11_HealthIT.asp.
- Mark Crockett, M.D.
Standing in the Interoperability Showcase at HIMSS10 is frankly amazing. We are participating in the Emergency Department interoperability scenarios, passing clinical documentation to and from other systems, using IHE standards for information exchange. I was standing with a friend and CMIO who is a practicing physician, and when he saw how easy it was to get information regardless of source, his comment was, ”This is how it is supposed to work, how it was always supposed to work.” I agree. And more vendors than ever are participating.
Talking with the HIMSS folks that orchestrated the impressive setup, I come to find that the numbers of folks “interoperating” in this display have more than doubled in the past two years, now demoing nearly 60 use cases and 28 clinical scenarios. Similar to the IHE show in January, the interest in interoperability and move to embrace standards at HIMSS is palpable. And it’s not just on the show floor – I have been talking to vendors all over that are now delivering or planning to deliver shortly to their customers this type of technology.
HIMSS is always a great conference, but I have to admit – on my flight down to Atlanta, I was slightly dreading four days of endless hypotheses around meaningful use. The understandable theme of this year’s show, meaningful use, has quickly escalated from an exciting and game-changing initiative to one that has even the most optimistic healthcare enthusiasts scratching their heads and drowning in buzzwords, overpromising and under-delivering. It was only at last year’s HIMSS that one of the largest HIT vendors claimed they had meaningful use nailed down (only weeks after the announcement of the initiative) but when tested, couldn’t give a straight answer on what it meant or how it would deliver value to patients.
This year, however, I’m already noticing a reality running through HIMSS that I was pleased to find. This year’s sessions have revealed that a lot of attendees are more comfortable admitting the reality of the situation; that they are just now really understanding the challenges that this will bring. I overheard an IT executive from one of the most prestigious and well-regarded health centers in the world claim, “If we’re not sure that we are going to be ready by 2011, I can only imagine what others are facing.”
