CPOE will be necessary in any definition of meaningful use of EHR. But a recent survey by Leapfrog has concluded that only 7 percent of hospitals meet Leapfrog medication error prevention standards, which rely on CPOE. "According to our data," said Leah Binder, CEO of Leapfrog, a healthcare watchdog organization, "a majority of hospitals have significant safety and efficiency deficits."
Also the recent KLAS CPOE Digest 2009: Meaningful Use and Physician Adoption shows concern about the adoption rate. The report also suggests that the level of CPOE adoption could signify which vendor will have the best chance of stimulating physician EMR adoption and achieving meaningful use. "Though EMR technology has yet to be deployed at many community hospitals and most physician practices, the vast majority of hospitals with more than 200 beds have already chosen a strategy and a solution for electronic medical records," said Jason Hess, general manager of clinical research for KLAS and author of the new CPOE study. "For those larger facilities, the goal now becomes one of proving that their EMR solutions will actually be used by physicians, replacing paper-based orders and instructions with computerized physician order entry."
HIMSS has released definitions for meaningful use of certified electronic health records technology. They recommend in the first phase an EHR infrastructure that includes clinical data display and CPOE with "independent licensed practitioners" entering the order. "The vast majority of orders emanating from an ambulatory practice are medications, laboratory testing or consultative requests," according to the recommendations. "For electronic prescribing, CPOE must be operational within the EHR." Without CPOE it is doubtful that meaningful use will be determined ror an EHR.
Saturday, May 30, 2009
Tuesday, May 26, 2009
A world class rural Cancer Center
One thing that is unique about MCMC is the Celilo Cancer Center. That we have this incredible resource in our community is truly amazing. Celilo offers integrated therapies to all patients and their families such as acupuncture, massage therapy, and chinese medicine. Celilo believes in the integration of mind and spirit in healing the body.
The Dalles, Oregon has been blessed to have a world class cancer treatment center at Celilo with our Medical Director, Keith Stelzer, MD, PhD. Keith was Associate Professor in the Radiation Oncology and Neurological Surgery departments at the University of Washington and he continues as a Clinical Associate Professor of Radiation Oncology at UW Medical Center. Keith is a leading expert in the application of “intensity modulated radiation therapy” (IMRT), a technology that allows doctors to control the precise shape and direction of radiation beams aimed at cancerous tissue; this precise treatment improves treatment effectiveness and drastically reduces toxic effects on healthy tissues.
On the medical oncology side we have Samuel Taylor IV, MD, Steve Fu, MD, PhD, and Nina van Es, N.P. They use about 50 anti-cancer drugs used in chemotherapy, sometimes alone and sometimes in combination with each other. The effective treatment provided at Celilo uses the best technology and the brightest minds in healthcare available. It is absolutely amazing that we are able to provide these services in our community.
Thursday, May 21, 2009
Blumenthal at Brookings
The important part of supporting the nation’s healthcare IT initiatives is to back healthcare reform, said David Blumenthal, MD, the national coordinator for health information technology and the Obama administration’s top health information appointee. “We will not succeed in our agenda unless reform succeeds,” Blumenthal said Wednesday during a healthcare forum at the Engelberg Center for Health Care Reform of the Brookings Institution in Washington, D.C. He also noted that there’s considerable skepticism about the $20 billion in the stimulus package to further adoption of health IT that it will deliver on promises to improve quality and lower costs. But he said it can play a “critical” role in a reformed health system because of the need for information technology in health care decision making.
Blumenthal also talked about stimulus money for healthcare IT and the "meaningful use” of information technology in healthcare. He said the use of electronic health records in his own practice had made him a better doctor, and he envisioned a day when IT would be as common as a stethoscope in a physician’s practice and IT skills would become part of the licensing process. “It’s going to be ultimately incorporated in the culture,” he said. Blumenthal said that his own office has moved into sharp focus since the stimulus passed because his budget has grown from $60 million to $2 billion, including grant programs it will handle for programs such as building up a health IT workforce, establishing resources to help providers adopt the technology and aiding the creation of broad health care information networks. He said his priorities include providing a definition for "meaningful use" of healthcare IT, as required by ARRA. "There is obviously an enormous amount of expectation about that,” he said. He said the definition would “focus us on the outcome of adoption rather than on the process of adoption.” He claimed they will seek much public input in developing a regulation governing incentive Medicare and Medicaid payments to doctors who make “meaningful use” of the technology. Blumenthal said the definition won’t appear “fully formed” from the federal government without “enormous” public input. The term “meaningful use” is focusing policy makers on payment for the outcomes of the use of the technology rather than on the processes involved in the technology. “We’re going to have to talk about what we will measure to decide whether meaningful use is occurring; an enormous challenge in itself,” he noted. He seems to realise that there is need to understand things from the provider’s perspective. “We are very sensitive to the need for hands-on technological support at the point of adoption,” he said. “We understand that that is a critical ingredient to success.” He also touched on health information exchanges during his keynote address. The stimulus package includes least $3 million to promote HIE at regional and sub regional level. The ONC will provide an outline for a program this spring or early summer. He also briefly mentioned privacy and security. “Privacy and security is very much on our minds,” he said. “If there is not trust in this system, it will not be acceptable to the American people.”
Blumenthal also talked about stimulus money for healthcare IT and the "meaningful use” of information technology in healthcare. He said the use of electronic health records in his own practice had made him a better doctor, and he envisioned a day when IT would be as common as a stethoscope in a physician’s practice and IT skills would become part of the licensing process. “It’s going to be ultimately incorporated in the culture,” he said. Blumenthal said that his own office has moved into sharp focus since the stimulus passed because his budget has grown from $60 million to $2 billion, including grant programs it will handle for programs such as building up a health IT workforce, establishing resources to help providers adopt the technology and aiding the creation of broad health care information networks. He said his priorities include providing a definition for "meaningful use" of healthcare IT, as required by ARRA. "There is obviously an enormous amount of expectation about that,” he said. He said the definition would “focus us on the outcome of adoption rather than on the process of adoption.” He claimed they will seek much public input in developing a regulation governing incentive Medicare and Medicaid payments to doctors who make “meaningful use” of the technology. Blumenthal said the definition won’t appear “fully formed” from the federal government without “enormous” public input. The term “meaningful use” is focusing policy makers on payment for the outcomes of the use of the technology rather than on the processes involved in the technology. “We’re going to have to talk about what we will measure to decide whether meaningful use is occurring; an enormous challenge in itself,” he noted. He seems to realise that there is need to understand things from the provider’s perspective. “We are very sensitive to the need for hands-on technological support at the point of adoption,” he said. “We understand that that is a critical ingredient to success.” He also touched on health information exchanges during his keynote address. The stimulus package includes least $3 million to promote HIE at regional and sub regional level. The ONC will provide an outline for a program this spring or early summer. He also briefly mentioned privacy and security. “Privacy and security is very much on our minds,” he said. “If there is not trust in this system, it will not be acceptable to the American people.”
Wednesday, May 20, 2009
Natural Beauty and Wonder
I am departing for today from my usual focus on health IT to write about the absolutely stunning beauty of the region that I am blessed to call home. I love the City of The Dalles and am so grateful to live in this gorgeous part of the country.
The Dalles with Mount Hood looming over
The Columbia River Gorge has so much to offer it is truly incredible. Whether you like hiking, wind surfing, rock climbing, skiing or just sitting watching the wildfowers bloom this place has everything.
View up the Columbia River Gorge
The Dalles with Mount Hood looming overThe Columbia River Gorge has so much to offer it is truly incredible. Whether you like hiking, wind surfing, rock climbing, skiing or just sitting watching the wildfowers bloom this place has everything.
View up the Columbia River GorgeIt is easy to find meaningful use for the amazing creation spread out all around. My wife and I love to go on adventures and never run out of things to do. I really do love it here and if you ever get a chance to visit you will find an amazing place and some really wonderful people.
Tuesday, May 19, 2009
Federal government is beginning to tax our patients
The Senate Finance Committee (SFC) released an options paper available here to explore ways to fund healthcare reform. It includes a wide variety of changes in the Medicare and Medicaid programs, from reducing payment updates to different health care sectors to reducing geographic variations in spending. The panel is taking the approach that just about everybody is going to have to take a hit to fund expansion of coverage.
The committee will conduct a “walk-through” of the options at a closed-door meeting Wednesday, May 20, 2009. The panel is also looking at new taxes on everything from employer’s healthcare benefits and nonprofit hospitals to alcohol and sweetened beverages, among many approaches to funding a package that could cost well over $1 trillion over 10 years.
The American Hospital Association (AHA) has been protesting some of the proposed changes in Medicare payments to hospitals. The hospital association said that implementation of the committee’s provisions on value-based purchasing, payment “bundling” and readmissions “would result in payment cuts to an already underfunded Medicare payment system.” While the AHA is certainly looking out for the interests of its members, there is a lot ot their argument.
The SFC will consider changes in Medicare out-of-pocket spending requirements to protect beneficiaries against catastrophic expense while at the same time require some minimal level of cost-sharing so that supplemental “Medigap” policies do not block beneficiaries from some sensitivity to the costs of using multiple services.
The options paper says that market basket adjustments for certain fee-for-service providers may be required to be adjusted “by some or all of the expected productivity gains as a way to improve the accuracy of Medicare payments.”
Cuts in Medicare payments for imaging are also on the table. The current method assumes that imaging machines are operated 50 percent of the time — but assuming a higher use rate would lower payments for advanced imaging technology while raising payments for other types of physician services. Another option would be to establish an expert panel to help the Centers for Medicare and Medicaid Services adjust payments “for potentially misvalued physician services,” the options paper states.
The paper also contemplates changes in funding for graduate medical education and “DSH” payments, meant to compensate hospitals that treat a disproportionate share of poor people. In fiscal 2009, Medicare DSH spending will total $10.1 billion and $9.1 billion in Medicaid, the paper notes.
The SFC report also suggests limiting the amount that workers can contribute to flexible spending accounts -- tax-free accounts workers use to pay for prescriptions and other medical expenses -- or possibly eliminating them altogether. Nonprofit hospitals that don't provide enough charitable care or meet other requirements would pay new taxes.
One thing that is important to remember in all of the options on funding is that hospitals and healthcare plans don’t pay taxes – people do. Any tax is ultimately paid by real living, breathing humans. So a tax on hospitals and healthcare providers is really a tax on patients. And the politicians already are beginning to tax our patience…
The committee will conduct a “walk-through” of the options at a closed-door meeting Wednesday, May 20, 2009. The panel is also looking at new taxes on everything from employer’s healthcare benefits and nonprofit hospitals to alcohol and sweetened beverages, among many approaches to funding a package that could cost well over $1 trillion over 10 years.
The American Hospital Association (AHA) has been protesting some of the proposed changes in Medicare payments to hospitals. The hospital association said that implementation of the committee’s provisions on value-based purchasing, payment “bundling” and readmissions “would result in payment cuts to an already underfunded Medicare payment system.” While the AHA is certainly looking out for the interests of its members, there is a lot ot their argument.
The SFC will consider changes in Medicare out-of-pocket spending requirements to protect beneficiaries against catastrophic expense while at the same time require some minimal level of cost-sharing so that supplemental “Medigap” policies do not block beneficiaries from some sensitivity to the costs of using multiple services.
The options paper says that market basket adjustments for certain fee-for-service providers may be required to be adjusted “by some or all of the expected productivity gains as a way to improve the accuracy of Medicare payments.”
Cuts in Medicare payments for imaging are also on the table. The current method assumes that imaging machines are operated 50 percent of the time — but assuming a higher use rate would lower payments for advanced imaging technology while raising payments for other types of physician services. Another option would be to establish an expert panel to help the Centers for Medicare and Medicaid Services adjust payments “for potentially misvalued physician services,” the options paper states.
The paper also contemplates changes in funding for graduate medical education and “DSH” payments, meant to compensate hospitals that treat a disproportionate share of poor people. In fiscal 2009, Medicare DSH spending will total $10.1 billion and $9.1 billion in Medicaid, the paper notes.
The SFC report also suggests limiting the amount that workers can contribute to flexible spending accounts -- tax-free accounts workers use to pay for prescriptions and other medical expenses -- or possibly eliminating them altogether. Nonprofit hospitals that don't provide enough charitable care or meet other requirements would pay new taxes.
One thing that is important to remember in all of the options on funding is that hospitals and healthcare plans don’t pay taxes – people do. Any tax is ultimately paid by real living, breathing humans. So a tax on hospitals and healthcare providers is really a tax on patients. And the politicians already are beginning to tax our patience…
Monday, May 18, 2009
Bacteria Communication
Did you know that bacteria can actually communicate with each other? Bonnie Bassler, a microbiologist at Princeton, has discovered how bacteria communicate with each other and describes how they use chemical molecules and enzymes to communicate. Her research focused on the molecular mechanisms that bacteria use for intercellular communication.
She found a gene these bacteria use to sense whether they are part of a dense or sparse population of bacteria -- for example, whether they are living in the human body, as opposed to a puddle of water. And she discovered that more common and more dangerous bacteria have the same gene.
The gene could become a valuable tool to drug developers looking for new ways to attack bacteria that are becoming increasingly resistant to current treatments. In some cases, bacteria only start emitting the toxins that cause disease after they multiply and develop into a dense population.
Bassler found this molecular signal after years of studying certain luminescent bacteria that are widespread in oceans but are harmless to people. Her work focuses on figuring out how and why two species, called Vibrio harveyi and Vibrio fischeri, emit a blue glow.
In a petri dish, the arrow contains a mutant form of V. harveyi. On the left is a patch of E. coli that causes intestinal infections; on the right is Salmonella; in the middle, above and below the stem of the arrow, is a lab strain of E. coli that has lost its ability to harm people. In the dark (bottom photo), V. harveyi glows in the presence of the two pathogenic bacteria but not the harmless one.
She explains her work on her website here and in the video below:
She found a gene these bacteria use to sense whether they are part of a dense or sparse population of bacteria -- for example, whether they are living in the human body, as opposed to a puddle of water. And she discovered that more common and more dangerous bacteria have the same gene.
The gene could become a valuable tool to drug developers looking for new ways to attack bacteria that are becoming increasingly resistant to current treatments. In some cases, bacteria only start emitting the toxins that cause disease after they multiply and develop into a dense population.
Bassler found this molecular signal after years of studying certain luminescent bacteria that are widespread in oceans but are harmless to people. Her work focuses on figuring out how and why two species, called Vibrio harveyi and Vibrio fischeri, emit a blue glow.
In a petri dish, the arrow contains a mutant form of V. harveyi. On the left is a patch of E. coli that causes intestinal infections; on the right is Salmonella; in the middle, above and below the stem of the arrow, is a lab strain of E. coli that has lost its ability to harm people. In the dark (bottom photo), V. harveyi glows in the presence of the two pathogenic bacteria but not the harmless one.She explains her work on her website here and in the video below:
Friday, May 15, 2009
HIT Standards Committee Meeting
The HIT Standards Committee meeting met this morning. I have the transcript posted here on Wordpress you can also see the Twitter stream and particpate in the discussion. Please feel free to comment on the meeting here on this blog as well. I am enjoying seeing the reaction to the beginning of this important work through blog postings, Twitter, email and other conversations.
Thursday, May 14, 2009
Join the conversation...
Earlier this year I read a post from John Halamka's Blog that got me very interested in social networking for business purposes. I already had a Facebook account, an old out of date LinkedIn and Plaxo accounts, but I was intrigued at the possibilities to use this platform as a way to rapidly connect with others interested in healthcare information technology and healthcare reform. Up to that point I had mostly used Facebook as a personal space to connect with close friends and family (I still reserve it for mainly that purpose - my wife and I share the same page) I started exploring the features of LinkedIn and Plaxo and have recently opened a Twitter account.
LinkedIn and Plaxo are great ways to network with other professionals in your field. I know people who have found both jobs and excellent employees using these social media sites. There groups that you can join which will help you connect with like-minded people. All 500 corporations of the Fortune 500 are represented on LinkedIn. You might be amazed at the connections you can make. Check out the LinkedIn Blog to learn more about these powerful tools.
I have found Twitter to be a very powerful tool for real-time communication and an amazing way to connect with people, events and information from all over the world. I have kept my focus completely on health IT. I don't think there are many people wanting to know my adventures in dog walking or my recent struggle with pizza addiction ;-) You can see my latest posts on the left of this page and follow me on Twitter. If you open a new Twitter account a good primer is found on the Wall Street Journal web site. There is also a great article on Healthcare Informatics web site.
The Obama administration has been using Twitter and Facebook. Now almost every federal government agency has an account. The recent HIT Policy Committee had interesting coverage on Twitter from the #HITpol hashtag. There will be more coverage for the Standards committee on Friday at this site. As the flow of information intensifies over 'meaningful use' of an EHR, and the dollars start to flow from ARRA, Twitter can be a great tool to keep in touch with developments, make contacts, and join in the discussion. Together, we can do this thing...
Wednesday, May 13, 2009
Being open and sharing
I think the talk below by Tim Berners-Lee has philosophical ramifications for healthcare. One of the greatest problems with 'meaningful use' of EHRs is interoperability. We need to consider how we can best securely share data and develop open standards that work.
20 years ago, Tim Berners-Lee invented the World Wide Web. For his next project, he's building a web for open, linked data that could do for numbers what the Web did for words, pictures, video: unlock our data and reframe the way we use it together.
In the 1980s, scientists at CERN were asking themselves how massive, complex, collaborative projects could be orchestrated and tracked. Tim Berners-Lee, then a contractor, answered by inventing the World Wide Web. This global system of hypertext documents, linked through the Internet, brought about a massive cultural shift ushered in by the new tech and content.
Berners-Lee is now director of the World Wide Web Consortium (W3C), which maintains standards for the Web and continues to refine its design. Recently he has envisioned a "Semantic Web" -- an evolved version of the same system that recognizes the meaning of the information it carries. He is also a senior researcher at MIT's Computer Science and AI Lab.
Data is relationships!
Hugging data leads to closed data silos. Of course, privacy requires tight controls, but standards need to be as open as possible so that when data needs to be shared there is a common framework to link data. Without open standards there could be no World Wide Web. Try to imagine life without an Internet...
Tuesday, May 12, 2009
Medicare and Social Security Going Broke
As we see the developments in Social Security and Medicare Trust Funds a few thoughts come to mind...
What Are the Trust Funds?
Congress established the trust funds in the U.S. Treasury to account for all program income and disbursements. Social Security and Medicare taxes, premiums, and other income are credited to the funds.
How big are Social Security and Medicare?
Social Security is currently 4.4% of GDP. Medicare is currently 3.2% of GDP.
When do these entitlements start paying out more than they bring in?
In the case of Social Security, 2016. In the case of Medicare, today. Medicare is already losing money.
There are actually four separate trust funds. For Social Security, the Old-Age and Survivors Insurance (OASI) Trust Fund pays retirement and survivors benefits, and the Disability Insurance (DI) Trust Fund pays disability benefits. (The two trust funds are often considered on a combined basis designated OASDI.) For Medicare, the Hospital Insurance (HI) Trust Fund pays for inpatient hospital and related care. The Supplementary Medical Insurance (SMI) Trust Fund comprises two separate accounts: Part B, which pays for physician and outpatient services, and Part D, which covers the prescription drug benefit.
What Are the Trust Funds?
Congress established the trust funds in the U.S. Treasury to account for all program income and disbursements. Social Security and Medicare taxes, premiums, and other income are credited to the funds.
How big are Social Security and Medicare?
Social Security is currently 4.4% of GDP. Medicare is currently 3.2% of GDP.
When do these entitlements start paying out more than they bring in?
In the case of Social Security, 2016. In the case of Medicare, today. Medicare is already losing money.
There are actually four separate trust funds. For Social Security, the Old-Age and Survivors Insurance (OASI) Trust Fund pays retirement and survivors benefits, and the Disability Insurance (DI) Trust Fund pays disability benefits. (The two trust funds are often considered on a combined basis designated OASDI.) For Medicare, the Hospital Insurance (HI) Trust Fund pays for inpatient hospital and related care. The Supplementary Medical Insurance (SMI) Trust Fund comprises two separate accounts: Part B, which pays for physician and outpatient services, and Part D, which covers the prescription drug benefit.
Medicare Cost and Non-Interest Income by Source as a Percent of GDP
Concern about the long-range financial outlook for Medicare and Social Security often focuses on the exhaustion dates for the HI and OASDI Trust Funds—the time when projected finances under current law would be insufficient to pay the full amount of scheduled benefits. A more immediate issue is the growing burden that the programs will place on the Federal budget well before the trust funds are exhausted.
The Medicare Modernization Act (2003) requires that the Board of Trustees determine each year whether the annual difference between program outlays and dedicated revenues (the bottom four layers of the chart above) exceeds 45 percent of total Medicare outlays within the first 7 years of the 75-year projection period. In effect, the law sets a threshold condition that signals that a trust fund's dedicated financing is inadequate and/or that general revenue financing of Medicare is becoming excessive.
Projected OASDI and HI Tax Income Shortfall plus the 75-Percent General Fund Revenue Contribution to SMI
(Percentage of GDP)
The combined difference grows each year, so that by 2016, net revenue flows from the general fund would total $369 billion (1.8 percent of GDP). The positive amounts that begin in 2016 for OASDI, and started in 2008 for HI, initially represent payments the Treasury must make to the trust funds when assets are depleted to help pay benefits in years prior to exhaustion of the funds. Neither the redemption of trust fund bonds, nor interest paid on those bonds, provides any new net income to the Treasury, which must finance redemptions and interest payments through some combination of increased taxation, reductions in other government spending, or additional borrowing from the public.
The chart above shows that the difference between outgo and dedicated payroll tax and premium income will grow rapidly in the 2010-30 period as the baby-boom generation reaches retirement age. These Trust Funds are not to be trusted... This is the greatest Ponzi scheme ever!
Monday, May 11, 2009
New methods of certification... and forming groups
I got the impression from the HIT Policy Committee meeting this morning, and the comments from David Blumenthal, M.D. National Coordinator for Health Information Technology that the certification process for Electronic Health Records (EHRs) will be changing. Blumenthal did not specify if the Certification Commission for Healthcare IT (CCHIT) which was established under the previous administration and currently certifies EHR systems now available on the market, will retain any functions along with the two new advisory committees. "The certification process is under review," Blumenthal said, adding, "There was a complicated committee structure in the past"
It seems that CCHIT will either be relaced by a new organization or be substantially changed by the HIT Policy Committee and the Office of the Nation Coordinator for Health Information Technology (ONCHIT). I hope that the thousands of hours already expended in developing certification standards for EHRs will not be wasted.
The commitee is large and somewhat unwieldy. I was glad to see that they plan to split the work between different categories and even left open the possibility that nonmembers of the committee could assist in work groups.
Much of the meeting was devoted to the formation of work groups to do the heavy lifting for the HIT Policy committee. After initally listing at least six possible groups, three were eventually decided upon. One was a work group to come up with an initial set of criteria for the “meaningful use." This group would also develop ways for the government to assist in the adoption of health IT systems. The second work group would focus on requirements of IT system certification. And the third group would address workforce development needs.
I expected them to assign a group that would give direction to the HIT Standards Committee, but not much direction was forthcoming. We will have to wait and see...
It seems that CCHIT will either be relaced by a new organization or be substantially changed by the HIT Policy Committee and the Office of the Nation Coordinator for Health Information Technology (ONCHIT). I hope that the thousands of hours already expended in developing certification standards for EHRs will not be wasted.
The commitee is large and somewhat unwieldy. I was glad to see that they plan to split the work between different categories and even left open the possibility that nonmembers of the committee could assist in work groups.
Much of the meeting was devoted to the formation of work groups to do the heavy lifting for the HIT Policy committee. After initally listing at least six possible groups, three were eventually decided upon. One was a work group to come up with an initial set of criteria for the “meaningful use." This group would also develop ways for the government to assist in the adoption of health IT systems. The second work group would focus on requirements of IT system certification. And the third group would address workforce development needs.
I expected them to assign a group that would give direction to the HIT Standards Committee, but not much direction was forthcoming. We will have to wait and see...
Saturday, May 9, 2009
Improving EMRs
- Lyle Berkowitz, MD, FHIMSS
Improving EMRs 2009
View more presentations from Lyle Berkowitz, md.
Friday, May 8, 2009
Skipping Vista
I beta tested Windows 7 for the last couple months and I have been testing Windows 7 Release Candidate (RC) and am very please so far. If you want to try out Windows 7 you can get the Windows 7 RC download here and the license is good until June 1, 2010. You can use the PC World tool to see if your PC is ready for Windows 7. There is even an Adobe Reader for Windows 7 already.
I am running Windows 7 RC1 on a virtual machine that I have assigned 32 GB of hard rive and 1 GB of RAM. All of our clinical applications (Meditech, APTA Connect, PtCT, etc.) seem to work fine. I have had some trouble with NextGen, but using terminal services (which is how we publish this application generally) works great. For applications that will not run in Windows 7 you can use Windows 7 XP Mode, a virtualized version of Windows XP that runs on Windows 7. My experience has been that Windows 7 XP Mode is better than running XP virtualized on a Vista system.
I will be trying Windows 7 on a spare hard drive on an Optiplex desktop later this month to see if I run into any driver compatibility issues. I plan to thoroughly investigate the use of this OS on our Active Directory domain with standard hardware configurations before next year when the final version is released.
We are a Dell shop and run Windows XP on almost all of our over 500 workstations. Licenses for both Vista Business and Ultimate allow users to downgrade to XP so we have only deployed Vista on a few Information Systems (IS) machines and our CEO. We have had some difficulty with log in times and driver compatibility trying to use Vista thoughout the enterprise. Microsoft will continue to allow Dell downgrading Vista systems to XP so we will continue to purchase them. A memo leaked from Microsoft does suggest that Dell should be clear with customers about future XP support:
"It’s important to remind customers that Microsoft are still planning to retire XP Pro Mainstream support on April 14, 2009 and will only provide OS security updates beyond that date unless the customer has an Extended Hotfix Support contract. MS Extended Support for XP Pro ends on April 8th, 2014."
Obviously the Microsoft roadmap is going to push us along past XP at some point. So far I have found Windows 7 to be our best next step. I will continue testing Windows 7 and deploying XP desktops, notebooks and tablets, while watching carefully to ensure that as we build out interoperability with our EHR and develop a Health Information Exchange, we are using the most appropriate OS. I have a strong feeling we will be skipping Vista...
I am running Windows 7 RC1 on a virtual machine that I have assigned 32 GB of hard rive and 1 GB of RAM. All of our clinical applications (Meditech, APTA Connect, PtCT, etc.) seem to work fine. I have had some trouble with NextGen, but using terminal services (which is how we publish this application generally) works great. For applications that will not run in Windows 7 you can use Windows 7 XP Mode, a virtualized version of Windows XP that runs on Windows 7. My experience has been that Windows 7 XP Mode is better than running XP virtualized on a Vista system.
I will be trying Windows 7 on a spare hard drive on an Optiplex desktop later this month to see if I run into any driver compatibility issues. I plan to thoroughly investigate the use of this OS on our Active Directory domain with standard hardware configurations before next year when the final version is released.
We are a Dell shop and run Windows XP on almost all of our over 500 workstations. Licenses for both Vista Business and Ultimate allow users to downgrade to XP so we have only deployed Vista on a few Information Systems (IS) machines and our CEO. We have had some difficulty with log in times and driver compatibility trying to use Vista thoughout the enterprise. Microsoft will continue to allow Dell downgrading Vista systems to XP so we will continue to purchase them. A memo leaked from Microsoft does suggest that Dell should be clear with customers about future XP support:
"It’s important to remind customers that Microsoft are still planning to retire XP Pro Mainstream support on April 14, 2009 and will only provide OS security updates beyond that date unless the customer has an Extended Hotfix Support contract. MS Extended Support for XP Pro ends on April 8th, 2014."
Obviously the Microsoft roadmap is going to push us along past XP at some point. So far I have found Windows 7 to be our best next step. I will continue testing Windows 7 and deploying XP desktops, notebooks and tablets, while watching carefully to ensure that as we build out interoperability with our EHR and develop a Health Information Exchange, we are using the most appropriate OS. I have a strong feeling we will be skipping Vista...
Thursday, May 7, 2009
HIT Standards and Policy Committees
I participated in a conference call this morning with David Blumenthal, M.D. National Coordinator for Health Information Technology where he dicussed of the HIT Standards and Policy Committees and named the members of these important groups. I even was able to ask Dr. Blumenthal a question regarding the work of the HIT Standards Committee and how much influence the previous work of groups like NeHAC and HITSP would have on thei efforts. He indicated that they were not interested in reinventing the wheel and the committee included a broad range of stakeholders, including providers, ancillary healthcare workers, consumers, purchasers, health plans, technology vendors, researchers, relevant Federal agencies, and individuals with technical expertise on health care quality, privacy and security, and on the electronic exchange and use of health information. I was thrilled to learn that John Halamka, M.D. Chief Information Officer and Dean for Technology at Harvard Medical School was named Vice Chairperson to this important committee. The 20 HIT Policy Committee members, established under the American Recovery and Reinvestment Act, are as follows:I look forward to seeing these excellent groups progress and I am extremely hopeful that we will see incredible results from their efforts.
HHS Budget Plan Released
The fiscal 2010 budget proposal released by the Obama administration recaps the Medicare cuts it proposed earlier this year to pay for a health overhaul, but offers new details on efforts to fight fraud and how it might reduce the cost of legislation erasing deep scheduled Medicare cuts in payments to doctors. According to the HHS Press Release this budget would help control the skyrocketing cost of healthcare.
President Obama proposed Thursday to largely hold flat budgets for agencies under the Department of Health and Human Services in fiscal 2010, as they continue to spend billions of dollars in extra money they received under the economic stimulus law passed in February. He also has proposed some spending cuts and legislative changes for the department that could prove controversial, including the elimination of abstinence-only sex education programs.
Mr. Obama is requesting a total of $828 billion for HHS, including $78.3 billion in discretionary spending, according to the department. The discretionary amount would be slightly less than the $78.5 billion the department received in fiscal 2009. HHS Budget Request (PDF)
The economic stimulus law, however, provides the department an extra $22.4 billion in discretionary funds for fiscal 2009 and fiscal 2010, and $109 billion in total, obviating the budget reduction.
The Food and Drug Administration, which did not receive stimulus money, would get a $367 million increase in its fiscal 2010 budget. Obama also proposes that Congress allow the FDA to begin approving generic competitors to complex biotech drugs, and that it allow the agency to assess a fee for the approval of generic drugs. Obama proposes $141 million in new user fees for the agency, which together with increases in existing fees would provide the agency a $511 million spending increase over fiscal 2009 enacted.
The budget would add $125 million in funding next year to the nearly $1.5 billion now spent on the “HCFAC” program, established under 1996 legislation creating a joint effort by HHS and the Justice Department to crack down on health care fraud. A total of $311 million next year in discretionary funding for the Health Care and Fraud and Abuse Control Program would be allocated as follows: $220 million for Medicare; $31 million for Medicaid; $30 million for the Department of Justice; and $30 million for the HHS Office of the Inspector General.
Part of the Medicare money would be used to go after fraud in the private plan side of Medicare, the Medicare Advantage side offering private health plans and the Medicare Part D side offering coverage through private prescription drug plans.
The HHS Budget in Brief (PDF) (12.6MB) provides an overview of the HHS budget and how the budget supports the major initiatives of the Department. The HHS “Budget in Brief” document notes that “as part of health care reform, the administration would support comprehensive, but fiscally responsible, reforms to this payment formula. Consistent with this goal, the administration will explore the breadth of options available under current authority to facilitate such reforms including an assessment, both substantively and legally, of whether physician administered drugs should be covered under the payment formula.” According to a Centers for Medicare and Medicaid Services (CMS) estimate, not including the cost of those drugs in assessing adherence to physician spending targets would lower the 10-year legislative cost of a freeze from $311 billion to $181.5 billion. But the $129.6 billion reduction in how much the legislation would cost Congress would increase the federal deficit by that amount.
The HHS Performance Highlights (PDF) (1.31MB) summarizes key past performance and financial information and planned performance.
This list of Fiscal Year (FY) 2007 Performance Measures by HHS Strategic Goal and Strategic Objective (PDF) (775KB) provides more detailed information on HHS agencies’ performance measures.
Wednesday, May 6, 2009
HIT Policy Standards Committees to Meet
The HIT Policy Committee will hold its first meeting May 11 in Washington D.C. The HIT Standards Committee will hold its inaugural meeting on May 15, also in Washington D.C. More information on both meetings is available in notices published May 6 in the Federal Register, at:
Instructions on how to access the meetings and participate in person or on the web are below.
The policy committee will advise David Blumenthal, M.D. on issues involving implementation of a National Health Information Network (NHIN) and Electronic Health Records (EHRs). The standards committee will advise on standards, implementation specifications and certification criteria for the electronic exchange and use of health information. Sixteen appointments to the policy committee have been announced. Membership in the standards committee has not been announced. According to the published notices of both committees, members will be introduced at the May meetings. "Because of initial delays in processing members' nominations, the 15-day deadline for notification was not met."
My hope is that NeHC will evolve to become a part of the HIT Standards Committee. U.S. Government Accountability Office (GAO), announced the appointment of 13 members to the Health Information Technology Policy Committee. The Secretary of Health and Human Services will appoint three members of the HIT Policy Committee. President Obama can appoint additional members to represent federal agencies. Senate Majority Leader Mitch McConnell (R-Ky.) has not yet announced his appointment. The additional three members that have been named are:
- House Speaker Nancy Pelosi (D-Calif.) has appointed Paul Egerman, chair and CEO at eScription Inc., Needham, Mass.
- House Minority Leader John Boehner (R-Ohio) has appointed Gayle Harrell of Stuart, Fla., a former member of the Florida House of Representatives.
- Senate Majority Leader Harry Reid (D-Nev.) has appointed Frank Nemec, M.D., a Las Vegas-based gastroenterologist.
(PDF) GAO Announces Appointments to Health Information Technology
The first meeting of the HIT Standards Committee is:
Friday, May 15, 2009, 9:00 a.m. to 12:00 noon (Eastern) at the
Department of Health and Human Services
Mary C. Switzer Building
Suite 1200, Conference Room 1114330 C Street SW
Washington, DC 20201
Seating is limited and given on a first-come, first-served basis.
Health IT Standards Comittee Meetings: How to Participate Webconference:
At least 10 minutes prior to the meeting start time, please go to:
http://altarum.na3.acrobat.com/HITstandards
(If for any reason the link does not work, simply copy and paste the URL into your browser's address bar) Select "enter as a guest" Type your first and last name into the field Click “enter room”
Test Your System: You will need to have an up-to-date version of Flash Player to view the webconference. Please test your system prior to the meeting by visiting
http://altarum.na3.acrobat.com/common/help/en/support/meeting_test.htm
NOTE: when running this system test, you do not need to install the Adobe Connect Add-in (step 4 of the test), as that is not relevant to this meeting.
Audio: You may listen in via computer or telephone.
US toll free: 1-877-705-6006
International Direct: 1-201-689-8557
Confirmation Code: HIT Committee Meeting
The first meeting of the HIT Policy Committee is:
Monday, May 11, 2009 - 8:30 to 11:30 a.m. (Eastern) at the
Department of Health and Human Services,
Hubert H. Humphrey BuildingRoom 505A 200 Independence Avenue SW
Washington, DC 20201
Health IT Policy Comittee Meetings: How to Participate Webconference:
At least 10 minutes prior to the meeting start time, please go to: http://altarum.na3.acrobat.com/HITpolicy
(If for any reason the link does not work, simply copy and paste the URL into your browser's address bar) Select "enter as a guest" Type your first and last name into the field Click “enter room”
Test Your System: You will need to have an up-to-date version of Flash Player to view the webconference. Please test your system prior to the meeting by visiting
http://altarum.na3.acrobat.com/common/help/en/support/meeting_test.htm
NOTE: when running this system test, you do not need to install the Adobe Connect Add-in (step 4 of the test), as that is not relevant to this meeting.
Audio: You may listen in via computer or telephone.
US toll free: 1-877-705-6006
International Direct: 1-201-689-8557
Confirmation Code: HIT Committee Meeting
If you have any technical questions, please send an email to webmeeting@altarum.org
Friday, May 1, 2009
Record Locator Service / Community Electronic Health Record
As we look to the future to develop a National Health Information Network (NHIN), I think that the first piece needs to be accomplished locally. Using a community based Electronic Health Record (EHR), with possibly a Record Locator Service (RLS) to aggregate the data from disparate systems. I envision the beginnings of a regional Health Information Exchange (HIE) as a sort of virtual EHR. A key infrastructure component, after deployment of an Electronic Medical Record (EMR) system, would be a RLS that presents a unified view to clinicians at the point of care.
RLS code and message schemas are made available below courtesy of Connecting for Health.
I think it will be very important that we include all stakeholders and care providers in the discussions. Long-term care, public health, hospitals, clinics and physician practices will need to cooperate to create a meaningful system that will allow the data to be approriately and securely shared, with the result of better care and lower costs.
Once true EHRs are connected through an HIE a robust NHIN can develop, possibly including a web based Personal Health Record (PHR). A PHR has the ability to transcend local networks, but I do not think we should wait for these products to mature before developing EHRs connected via HIE at the local level.
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