Daffy Duck for President

In the heated election season I thought it would be a nice break to remind ourselves of our constitutional form of government via a humorous civics lesson from Bugs Bunny.



Daffy Duck for President is a children's book, published by Warner Bros. and the United States Postal Service in 1997 to coincide with the release of the first Bugs Bunny U.S. postage stamp. The book was written and illustrated by Chuck Jones, edited by Charles Carney, and art directed by Allen Helbig. It was Jones' last published book before his death in 2002.

In 2004, Warner Bros. released a four-minute animated short of the same name based on the book. The film was produced by Tony Cervone, Spike Brandt, and Linda M. Steiner. It was considered for a 2005 Academy Award for Best Animated Short.

Doctors Using Electronic Health Records Provide Higher Quality Healthcare

The use of electronic health records is linked to significantly higher quality care, according to a new study¹ by Lisa Kern and her team, from the Health Information Technology Evaluation Collaborative in the US. Their work appears online in the Journal of General Internal Medicine, published by Springer.

Electronic health records (EHRs) have become a priority in the US, with federal incentives for 'meaningful' use of EHRs. Meaningful use entails tracking and improving specific patient outcomes, as well as gathering and storing information.

Kern and colleagues examined the effect of EHRs on ambulatory care quality in a community-based setting, by comparing the performance of physicians using either EHRs or paper records. They assessed performance on nine specific quality measures for a total of 466 primary care physicians with 74,618 patients, from private practices in the Hudson Valley region of New York.

The quality measures included: eye exams, hemoglobin testing, cholesterol testing, renal function testing for patients with diabetes, colorectal cancer screening, chlamydia screening, breast cancer screening, testing for children with sore throat, and treatment for children with upper respiratory infections.

Approximately half of the physicians studied used EHRs, while the others used paper records. Overall, physicians using EHRs provided higher rates of needed care than physicians using paper, and for four measures in particular: hemoglobin testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening.

The specific quality measures included in this study are highly relevant to national discussions. Of the seven quality measures expected to be affected by EHRs, all seven are included as clinical quality measures in the federal meaningful use program. There has been little evidence previously that using EHRs actually improves quality for these measures.

This study took place in a community with multiple payers. This is in contrast to integrated delivery systems, such as Kaiser Permanente, Geisinger, and the Veterans Administration, all of which have seen quality improvements with the implementation of health information technology. Most health care is delivered in “open” rather than integrated systems, thus increasing the potential generalizability of this study.

The authors conclude: "We found that EHR use is associated with higher quality ambulatory care in a multi-payer community with concerted efforts to support EHR implementation. In contrast to several recent national and statewide studies, which found no effect of EHR use, this study's finding is consistent with national efforts to promote meaningful use of EHRs."

1: Kern LM et al (2012). Electronic health records and ambulatory quality of care. Journal of General Internal Medicine; DOI 10.1007/s11606-012-2237-8

Study: Exercise as a Vital Sign Improves Patient Care

Exercise is now a “vital sign” for all Kaiser Permanente members. While they have their weight, height and blood pressure measured before a doctor visit, patients are asked how often they exercise so that doctors can follow up.

A Kaiser Permanente study 'Initial Validation of an Exercise “Vital Sign” in Electronic Medical Records' published in the journal Medicine & Science in Sports & Exercise examined the electronic health records of 1,793,385 Kaiser Permanente Southern California patients ages 18 and older from April 2010 to March 2011 and found that 86 percent of all eligible patients had an exercise vital sign in their record. Of those patients who had an exercise record, one third were meeting national guidelines for physical activity, and two thirds were not meeting guidelines. Of those not meeting guidelines, one third were not exercising at all.

“There is no better indicator of a person’s health and longevity than the minutes per week of activity a patient engages in,” said Robert E. Sallis, M.D., one of the authors. Kaiser Permanente began using the exercise vital sign in October 2009. Patients at Kaiser are routinely asked questions about their usual daily levels of activity and are assigned a minutes-per-week value based on their answer. Using a regression model, this study demonstrated that a greater disease burden increased the likelihood of physical inactivity among the sample patient population. As expected, researchers also found lower activity levels among patients who were older, obese or members of ethnic minorities.

"Embedding questions about physical activity in the electronic medical record provides an opportunity to counsel millions of patients during routine medical care regarding the importance of physical activity for health," said study lead author Karen J. Coleman, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. "In addition, the Exercise Vital Sign has the potential to provide information about the relationship between exercise and health care utilization, cost and chronic disease that has not been previously available."

Check out the video below featuring Dr. Jed Weissberg, Senior Vice President for Hospitals, Quality, and Care Delivery.

"…The medical assistant asks the patient, ‘How many days a week do you exercise, and on those days, how many minutes do you exercise? So that is adding exercise to the set of vital signs, just like we added cigarette smoking as a vital sign so that it could be right up there at the top of the medical information for the doctor to engage in a discussion with the patient."

Living by Numbers: Wired Health Conference

I am now at the WIRED Health Conference, which is being simulcast in a free live-feed at www.wiredhealthconference.com. The WIRED Health Conference will be an exploration of the challenges and opportunities of data-driven medicine. This is going to be a great launching point for me to head to San Francisco for Strata Rx (more on that in a later post ;-)

I'd encourage you to watch the live feed, follow along on the Twitter hashtag #WIREDhealth and check out the Living By Numbers: A Wired E-Book. This is just the start of what promises to be an awesome event!

The agenda includes:

KEYNOTE SPEAKER ASHTON EATON
Gold Medalist, Olympic Decathlon World Record Holder, Decathlon and Heptathlon

KEYNOTE SPEAKER MICHAEL GRAVES
Founding Partner, Michael Graves & Associates/Michael Graves Design Group

KEYNOTE SPEAKER CRAIG VENTER
Founder, Chairman & President, J. Craig Venter Institute; CEO & President, Synthetic Genomics

KEYNOTE SPEAKER STEPHEN WOLFRAM
President & CEO, Wolfram Research

YOU CAN NOW WATCH THE ARCHIVE OF THE EVENT HERE

Digital Health Conference

I'll be starting this week at the NY eHealth Collaborative’s (NYeHC) Digital Health Conference. This conference brings together a diverse group of healthcare professionals to hear insights, ideas, and analysis from leaders in the health IT community. With keynote speakers like David J. Brailer, MD, Ph.D., the Chairman of Health Evolution Partners and Stephen J. Dubner, the bestselling author, Freakonomics and Superfreakonomics, it is sure to be an excellent event. I'll be on a panel "Taking a Healthy Risk: Best Practices and Creative Use of Social Media in Healthcare" with Twitter superstars John Lynn, Amy Dixon RN, and Wen Dombrowski MD. We'll explore best practices, discuss risks and benefits, and share ideas for creative uses of online tools and platforms for providers, administrators, patients, and healthcare organizations. There are going to be some interesting tweets at the hashtag #DHC12 throughout the event.

One thing that will be very cool is the inaugural class of the NY Digital Health Accelerator (NYDHA) to be announced at the conference. The 8 selected companies will be announced by NY State DOH Commissioner Dr. Nirav Shah on Day 1. In addition, they'll be demonstrating their products and solutions in our exhibit hall and during a dedicated conference session on Day 2. The NYDHA is $4.2 million program run by the New York eHealth Collaborative & the New York City Investment Fund for early- and growth-stage digital health companies that are developing cutting edge technology products for some of the largest healthcare providers in NY state.

“The Accelerator provides much-needed, valuable tools for providers in support of New York State's Medicaid Redesign initiative," New York State Health Commissioner Nirav R. Shah, M.D., M.P.H. said. "The initiative, which promotes a shift from the costly fee-for-service model to a more effective and efficient managed care approach, is resulting in better care - at lower cost - for patients across the continuum of care. The Accelerator is an essential first step to stimulate the market and nurture innovation within the entrepreneurial community.”




The NYDHA is a program run by the NYeHC and the Partnership for New York City Fund for early- and growth-stage digital health companies that are developing cutting edge technology products in care coordination, patient engagement, analytics and message alerts for healthcare providers.

The 9 month program will provide up to $300,000 of funding per company from a syndicate of leading venture capital and strategic investors, along with direct mentorship and feedback from senior-level executives at a broad network of provider organizations in New York State.

“We are creating the next generation of healthcare applications that will transform the healthcare delivery system,” said NYeC Executive Director David Whitlinger. “These companies are the first software development vendors to have direct access to the SHIN-NY, a secure platform that embodies all of the federal and state policies for usage of patient data by the community.”

The 8 companies announced include:

AdhereTx: KnowMyMeds web-based, interoperable software supports team-based medication management and reconciliation for high-risk patients at the point of care. KnowMyMeds enables healthcare practitioners to perform clinically validated, cost-effective medication review for high-risk patients, including “dual eligibles” and the chronically ill, to reduce their drug-related hospitalizations and readmissions. (www.adhertx.com)

Aidin: Aidin is a web-based referral platform for hospitals discharging patients to post-acute care.  Aidin collects hard data about how well post-acute providers perform and makes it easy for hospital staff to present that information to patients when they are choosing their post-acute provider - helping patients choose better providers for better outcomes. (www.myaidin.com)

Avado: Avado allows clinicians and patients to securely communicate, track, and manage health information. They centralize data from many EHR’s and make it usable for all stakeholders.  Providers can take comfort knowing that Avado exceeds Meaningful Use requirements for patient engagement while also addressing requirements for medical homes and accountable models. (www.avado.com)

CipherHealth: CipherHealth helps hospitals avoid government penalties by reducing preventable readmissions, improving outcomes, better coordinating care, and creating a positive patient experience.  CipherHealth reaches out over the phone, through tablets, via email, text, or the web, better engaging patients in their care and building stronger relationships between patients and providers. (www.cipherhealth.com)

Cureatr: Cureatr will improve how healthcare providers communicate and coordinate patient care. Their lightweight, user-friendly HIPAA-secure group messaging system integrates with existing directory, scheduling and paging systems, making it easy to use while coordinating care within or between organizations. (www.cureatr.com)

MedCPU: MedCPU delivers accurate real-time clinical care advice through its revolutionary Advisor Button technology. It uniquely captures the complete clinical picture from clinicians’ free-text notes, dictations and structured documentation entered into any EMR, and analyzes it against a growing library of best-practice content, generating real-time precise prompts for best care consideration. (www.medcpu.com

Remedy Systems: Remedy Systems leverages the power of mobile to lower the cost and improve the quality of healthcare via its flexible care coordination platform that enables physicians and nurses to concentrate on delivering the highest quality of care possible while fostering engagement from patients and family/friends. (www.remedysystems.com)

SpectraMD: SpectraMD maximizes the value of data across the continuum of care with business intelligence solutions. Their FOCUS™ Actionable Analytics platform enables stakeholders in hospitals and ambulatory care settings to improve outcomes, increase revenues, succeed in quality-based initiatives including Reducing Preventable Readmissions and leverage analytics for the Health Home initiative. (www.spectramd.com)

Twenty highly influential healthcare provider organizations will participate in the program, including New York Presbyterian, NYU Medical Center, Albany Medical Center, and the New York City Health and Hospitals Corporation.

With an initial investment of $4.2 million, the NYDHA will create approximately 1,500 jobs over five years. In addition, it is expected that the companies will attract upwards of $150-200 million in investment from the venture capital community post-program. The NYDHA will stimulate a new marketplace, creating the next generation of healthcare tools while positioning New York a hub for the health IT entrepreneurial sector.

Announcement of eHealth Exchange Compliance Test Body

On October 11, 2012 the EHR|HIE Interoperability Workgroup,  a New York eHealth Collaborative (NYeC) led consortium of states and vendors; and Healtheway, the newly formed public-private partnership of the eHealth Exchange (formerly referred to as the Nationwide Health Information Network (NwHIN) Exchange) made a joint announcement on the selection of the Compliance Test Body (the CTB). The Exchange Coordinating Committee, in conjunction with the EHR-HIE Interoperability Workgroup (IWG), issued a joint request for proposals to select a CTB. The CTB will facilitate testing for both the Exchange and support testing for participating state HIE programs. They selected the Certification Commission for Health Information Technology (CCHIT) to carry out the testing. As the CTB, CCHIT will certify that the interfaces between the HIT and HIEs are consistent across multiple states and systems. CCHIT is also an Office of the National Coordinator (ONC) authorized certification body and is an accredited testing laboratory for EHRs.

"Today's announcement brings together several activities supported by ONC over the past years: a core set of national standards, an Accredited Certification Body, the Public-private partnership that has emerged from the Nationwide Health Information Network Exchange, and the convening power of New York and other State Health Information Exchange grantees," said Dr. Farzad Mostashari, the National Coordinator for Health Information Technology. "We look forward to working with this consortium to continue progress on interoperability and secure health information exchange, and to reflect what is learned in national standards as necessary."

To expand nationwide HIE, Healtheway and NYeC formed a strategic partnership to enable technology systems, public and private providers and health information organizations (HIOs) to have access to more efficient testing. The coalition harmonized a set of functional, technical and test specifications that enable true plug and play connectivity to simplify EHR and HIE development.

"The collaboration between the states and vendors to address a shared marketplace gap and work toward a mutual vision has been one of the remarkable aspects of this effort," said David Whitlinger, Executive Director of NYeC. "And momentum is building within both communities as states grow their HIE networks by working with the EHR and HIE vendors to provide seamless integration and clinical workflow, taking the market to a new level for the benefit of patients."

Vendors have agreed to bring their products for testing according to these specifications and participating states have agreed to promote the value of EHR and HIE products certified in the program. The program will ensure that providers' EHR software has the capability to connect to their local HIE and enable communities and states to share patient health information.

"The testing program Healtheway has developed with NYeC is the key to realizing secure and interoperable exchange of health information across organizational and geographic boundaries," said Michael Matthews, Healtheway President and Board Chair. "The launch of a compliance testing program will enable the eHealth Exchange to more than double participation and connectivity over the next nine to 12 months."

There will be an announcment with more details this afternoon. For more information see hiehitnews.org

Politics and Health Reform

On October 4, 2012, Politico hosted a conversation about the role and future of accountable care organizations and their effect on providers and patients. Guests included former CMS Administrator Don Berwick, America's Health Insurance Plans (AHIP) President and CEO Karen Ignagni, Bruce Fried of SNR Denton, Premier VP Joseph Damore, and Robert Laszewski of Health Policy and Strategy Associates (see video below).

"It’s a great law, complex and complicated... but there is a continuing job to communicate how it works," Don Berwick said. He went on to state his views on health reform and some of the political implications.

"The Affordable Care Act is a great step in America towards making health care a human right in our country where if you’re an American you can get healthcare, which isn’t true now, lots of people are left out of the system, people have to worry they’re going to lose their insurance if they get sick, or if they have a preexisting condition, they can’t find insurance," said Berwick.

"The Affordable Care Act overcomes that: it says, ‘No, if you’re an American you can have health care. We’ll find one way or another,’ in partnership with the private sector to make sure that you get the health care that you need,” he said. "That’s a very important step."

Berwick claimed, and other experts on the panel agreed, that the accountable care organizations (ACOs) being promoted by the health law would continue regardless of who wins the presidential election. "Both sides endorse ACOs because it’s a good policy," Berwick said.

Health plans and large employers have tried for some time to direct patients to preferred providers as a way to control costs. This has become even more important as mounting evidence shows that high costs do not necessarily signal high quality. HMOs directed patients to particular providers by using closed networks in the mid-1990s. Robert Laszewski, who is also a former insurance executive, said there is bipartisan support for ACOs because they don’t limit patient choice of doctors like the HMOs of the 90s did. But he warned that ACOs may not save fast enough to adequately control the rising costs of Medicare. "We don’t have lots of time," he said.

Karen Ignagni, president of AHIP, also dismissed the political implications of ACOs. "I don’t think it has anything to do with the political dynamic," Ignagni said. “It has everything to do with what employers are telling health plans and their providers. They can’t afford it."



Even before the federal government launched its accountable care organization programs, ACO-style payment arrangements already had been adopted by private payers. Value-based provider networks are an attempt to help consumers make informed decisions about their care, while still maintaining their ability to choose a provider. I believe that the efforts in moving to a system that pays for value rather than volume underway in the private market will continue whatever happens politically.