Apple to make a push into healthcare

It seems inevitable, given the success of the iPhone in healthcare, but I'm hearing that Apple is getting ready to make a full-scale push into healthcare. I understand that the company invited several vendors to a meeting at an Apple office in Chicago this week. I have no further details on what was said or who was present, but I know that there are a couple of EMR vendors out there who have tailored their products for Macintosh, even if it's just optimizing the view over the Internet for the Safari browser.

There is this little matter of the billions of dollars in federal money being funneled into health IT over the next eight years, and Steve Jobs would be an idiot if he didn't go after some of the cash. Steve Jobs is no idiot.

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I knew it: 'The Hill' blew it

As I write today in FierceEMR, consummate Washington insider publication The Hill made a rather glaring mistake in reporting earlier this week that the $1.2 billion in federal grant funding for health information exchange and regional health IT extension centers can't be awarded until HHS finalizes its definition of "meaningful use."

In fact, the Office of the National Coordinator for Health Information Technology is going ahead with establishing the extension centers. The reporter confused the two health IT parts of the stimulus. Oops.

I grew up in the Washington area. I spent my first year after college in D.C. working for an "insider" publication, starting with a whopping $18,000 salary in the summer of 1992, but I had my very own U.S. Senate press pass. Real special, right? At the time, all it took was $6 and a letter from your boss vouching for your affiliation to get one. The "we work on Capitol Hill so we're smarter than you" mentality of some colleagues got to me. I hightailed it to Chicago and never looked back.

Sometimes you need to step back from the supposed center of the action to understand what's really going on. This is one of those times.

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A first from ONC

Perhaps it's part of the Obama administration's new PR offensive on health reform, or perhaps he just wants to update the health IT community, but National Health IT Coordinator Dr. David Blumenthal has sent out an open letter to everyone on the Office of the National Coordinator for Health Information Technology's mailing list.

Here's what he says:

In my role as National Coordinator for Health IT, I have the privilege to be part of a transformative change in health care that will help to extend the benefits of health information technology (HIT) to all Americans. With the passage earlier this year of the Health Information Technology for Economic and Clinical Health (HITECH) Act, we have the tools to begin a major transformation in American health care made possible through the creation of a secure, interoperable nationwide health information network.

Of course, this system is not an end in itself. Rather, it will enable countless other improvements in the quality and efficiency of health care that will make Americans healthier and their economy stronger.

My personal belief in this transformation is not based on theory or conjecture. As a primary care physician for over 30 years, I spent the first twenty shuffling papers in search of missing studies and frequently hoping, during middle-of-the-night emergencies, that I knew enough about patients’ medical histories to make good decisions. All that changed when I began to have access to patients’ electronic medical records. It made me a much better doctor. I would never go back, and neither would the vast majority of American physicians who have made the leap into the electronic age.

In fact, it would be hard for any health professional today to escape the conclusion that the antiquated, paper-dominated system we now have in place isn’t working well for patients, creates added costs and inefficiencies, and isn’t sustainable. As we look at our nation’s annual health care expenditures of approximately $2.5 trillion, there are many ways our current system fails both patients and providers. It is clear that change is necessary.

But how and why is nationwide electronic health information exchange so critical to achieving such change? Most importantly, because it provides the best opportunity for each patient to receive optimal care. The technology will make patients’ complete medical information securely and reliably available to health care providers where and when it is needed – when clinician and patient are together facing medical decisions that can make a lasting difference.

Better, faster, more reliable and efficient care also ultimately reduces system-wide costs by delivering results that help to avoid expensive or prolonged hospitalization from delayed or ineffective treatment, avert costly and sometimes fatal adverse events and unnecessary procedures, and can help to eliminate the onset of disease by better informed management of each patient’s health.

The goal of assuring an electronic health record for every American is daunting. We at the Office of the National Coordinator for Health Information Technology (ONC) do not pretend otherwise. We know this will be hard for some clinicians and hospitals, and we stand ready to help with resources provided by the Congress and the Administration.

We also recognize that we cannot achieve the benefits of a nationwide health information system unless we can assure all Americans that their personal health information will remain private and secure when this system exists. Putting into place safeguards for the privacy and security of this information, when it is in electronic form, will be an ongoing priority that influences and guides all of our efforts.

In the days, weeks, and months ahead, we will be rolling out a number of pivotal initiatives called for under the HITECH Act. I urge you to join and support us as we lay the foundation for every American to benefit from an electronic health record, as part of a modernized, interconnected, and vastly improved system of care delivery. We at ONC will be making every effort to keep you updated and fully engaged in all the steps of this national journey.

Sincerely,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

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IT staffing issues

The newly published July issue of Hospitals & Health Networks includes a story I wrote about the worsening staffing crunch in health IT.

Between the rush to install EMRs by January 2011, tighter HIPAA privacy and security requirements and the transition to ICD-10 coding and ANSI X12 5010 transactions, it could be a tough next few years for IT departments. But you probably already knew that.

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AMA and EMRs, continued

Last month, I wrote a rather scathing piece on the BNET Healthcare blog about the American Medical Association's annual House of Delegates meeting. I wrote another one for FierceEMR. Admittedly, I focused on a handful of fringe ideas, though one of the more audacious ones actually wound up in a resolution that the House of Delegates adopted as AMA policy. For BNET, I wrote:

[A]nother resolution directs the AMA to tell the federal government that the EMR incentive program "should be made compliant with AMA principles by removing penalties for non-compliance and by providing inflation-adjusted funds to cover all costs of implementation and maintenance of EMR systems."

It's one thing to ask for more money to cover ongoing expenses. It’s another thing altogether to conclude that the government is not in compliance with the principles of a private organization. Talk about the tail wagging the dog.

In FierceEMR, I wrote:

Delegates also took issue with the Medicare e-prescribing bonus program that passed during the Bush administration and began this year. They said the requirement that physicians write 50 percent of their Medicare Part D prescriptions electronically was too onerous, and recommended that the threshold be lowered to 25 percent.

Not surprisingly, the posts drew several comments and e-mails.

AMA Board Chairman Joseph Heyman, M.D., someone who actually does understand—and use in his own practice—EMRs and information technology, left a detailed response on the BNET post, attempting to clarify the organization's position on health IT. He's right in saying that the AMA did come out in strong support of the stimulus. My criticism was about a few delegates who spoke out rather loudly about the stimulus.

Heyman also discusses the AMA's online tools for physicians to learn about health IT, something I admittedly didn't mention in my post, though it wasn't completely relevant to my argument. I did interview Heyman at the meeting, and included some of his comments in a story I did in the July Physician Office Technology Report of Part B News. I'd like to extend an invitation to Heyman to do a podcast with me at some point in the future so we can discuss all of these issues, as well as his own practice's successful experience with an EMR.

Another, anonymous, commenter suggested that other organizations, like the American Academy of Family Physicians has an agenda that "more closely aligns with the big winners of the last election cycle, and helped buy them a seat at the table." Yeah, that would explain why some of the more conservative members of the AMA House of Delegates feel shunned. This person also says that "HIT providers"—vendors and consultants—are the real winners from the stimulus. That's certainly a risk of the massive program.

The comments on the FierceEMR piece were more supportive of my argument. "Smart Doc" said: "To call this organization an anachronistic dinosaur would not give proper credence to how out of touch it is, not only with the public, but with physicians themselves. Like others of their ilk, they're against government intervention except when it directly subsidizes them."

I'm not sure if I'd go that far, but I'm certainly on record as saying the AMA really does not represent the interests of all physicians, as the organization claims to.

My favorite exchange, though, came from Jack Smyth, the very pragmatic president and CEO of ambulatory EMR vendor Spring Medical Systems. After the FierceEMR commentary appeared, he e-mailed me to clarify the rules for the Medicare e-prescribing bonus program that took effect this year:

You commented about the 50% rule for getting the eRx bonuses this year and next. In your statement you mentioned that unless a physician prescribes controlled substances, they should be able to qualify.

The way I understand it, if a doctor enters the prescription in the eRx system, it counts. Even if they have to print it out and sign it, because it's a controlled substance, or even if the pharmacy doesn't accept eRx and it has to be faxed to the pharmacy. There are several "G" codes that can be added to an office visit or prescription refill that allow the various scenarios to qualify for addition to the numerator of the equation.

I'm very proud of my subsequent response:

Thanks again for writing. I think you're right about getting credit for entering it into an eRx system, regardless of whether it's controlled or if the patient simply wants a printout. In that case, I have no idea why the AMA thinks 50% is too high. You're either entering scripts electronically or you're not, unless perhaps you're Dr. House and you've stolen Wilson's prescription pad.

I also asked Smyth for permission to post our exchange. He then responded: "I love your "Wilson's prescription pad" comment! Yes you can use my email in your blog. I don't have time to post responses on websites and I don't like all of the banter (most of it useless) that a comment like this would create. I'll let you do that."

Consider it done.

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