e-CareManagement blog

by Vince Kuraitis JD, MBA and David C. Kibbe MD, MBA

The last article in this series — Time for EHRs to Become Plug-and-Play — used words to describe a major industry shift underway in health IT.

Sometimes pictures help to make a point. Here are several diagrams that you can also download as PowerPoint slides.

 Computer Industry 1983 to 2002

  Source: Venkatraman, N. Winning in a Network Centric Era, 2006

Blueprint for Health IT Shift

From EMR 1.0 — 2008…

…to Clinical Groupware/EHR 2.0 — 2012 Continue reading “Blueprint for Change: From EMR 1.0 to Clinical Groupware (EHR 2.0)”

by Scott Shreeve, MD

We are entering an unprecedented season of change for the United States health care system. Americans are united by their desire to fundamentally reform our current system into one that delivers on the promise of freedom, equity, and best outcomes for best value. In this season of reform, we will see all kinds of ideas presented from all across the political spectrum. Many of these ideas will be prescriptive, and don’t harness the power of innovation to create the dramatic breakthroughs required to create a next generation health system.

We believe there is a better way.

This belief is founded in the idea that aligned incentives can be a powerful way to spur innovation and seek breakthrough ideas from the most unlikely sources. Many of the reform ideas being put forward may not include some of the best thinking, the collective experience, and the most meaningful ways to truly implement change. To address this issue, the X PRIZE Foundation, along with WellPoint Inc and WellPoint Foundation as sponsor, has introduced a $10MM prize for health care innovators to implement a new model of health. The focus of the prize is to increase health care value by 50% in a 10,000 person community over a three year period.

The Healthcare X PRIZE team has released an Initial Prize Design and is actively seeking public comment. We are hoping, and encouraging everyone at every opportunity, to engage in this effort to help design a system of care that can produce dramatic breakthroughs at both an individual vitality and community health level.

Here is your opportunity to contribute: Continue reading “Incentive to Innovate: Giving Health Reform a Rocket Boost”

by David C. Kibbe MD, MBA

The remarkable report, “Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home,” published in the May/June issue of Annals of Family Medicine, the Nutting Report, makes this point about the state of primary care IT offerings:

Technology needed in a PCMH is not “plug and play.” The hodge-podge of information technology marketed to primary care practices resembles more a pile of jigsaw pieces than components of an integrated and interoperable system.

Surprise!  Well, actually, no surprise.  We all recognize that health IT implementation in family practices, even under the best conditions and with the best of planning, is difficult and can be an ongoing challenge.   

What is surprising to us, however, is that Dr. Nutting and co-authors make this comment in their recommendations section:

…[I]t is possible and sometimes preferable to implement e-prescribing, local hospital system connections, evidence at the point of care, disease registries, and interactive patient Web portals without an EMR. Continue reading “Time for EHRs to Become Plug-and-Play”

by Tom Doerr, MD and Randy Bak, MD, JD

What if the health care payer were re-imagined as a service to the primary care doctor – supplying the tools, information and funding primary care physicians needed to meet the call to reform health delivery?

The structure of physician payment is considered one of the most problematic aspects of our health care system.  Driven by volume instead of coordinated, proactive care and favoring procedures over cognitive work, the payment system has driven primary care into decline and stifled improvements in quality and efficiency.  Indeed, primary care physicians are overstressed and demoralized by demands, coming from every direction, that drive them only to see more patients, as quickly as possible.   In this state, primary care cannot attract new physicians at a time when an expansion of the primary care workforce is desperately needed.  Without new primary care doctors, how will medicine meet the future volume demands of the aging “baby boomers”, much less deliver the kind of comprehensive approach to patient health needed to correct the defects in today’s care?  Despite these growing concerns, little in the way of innovation is arising from payers.

So, what if the payer model was re-imagined?  What would such a payer look like?  At ESSENCE Healthcare, we have developed the Collaborative Payer Model (CPM), which takes the first steps at answering these questions. 

The CPM brings a new approach to address what is missing in much of health care reform, including: Continue reading “Hope for Primary Care … from a Payer? A White Paper on the Collaborative Payer Model”

What’s stunning about this deal is who its NOT with.  The AMA chose NOT to partner with any of the incumbent electronic medical record (EMR) companies, e.g., Allscripts, GE, Epic, NextGen, or many others.

For those of you who have not seen earlier posts in this series, please understand that the reference to “goes to the dogs” is a great compliment.

In a joint press release, the American Medical Association and Covisint unveiled an agreement yesterday:

Compuware Corporation (NASDAQ: CPWR) announced today that its Covisint subsidiary signed an agreement with the American Medical Association (AMA) to deploy an innovative health information exchange solution delivering value to its 240,000 member physicians and the physician population at large….

Covisint will enable AMA physicians to have access to a variety of health information technologies via an AMA-branded, web-based solution.  The AMA said it will use the Covisint platform to deliver to physicians a variety of products, services and resources aimed at increasing medical practice efficiency and facilitating the adoption of health information technology (HIT), including help with implementing electronic health records (EHRs). Current product categories that the AMA is exploring include: practice management tools, resources for professional development and clinical management services. The new platform will provide personalized content, search capabilities and learning and networking opportunities, among other valuable offerings

The features of Covisint’s offering are described on its website.

This deal is a  slap in the face to incumbent EMR vendors who have been attempting to develop the electronic plumbing in physicians’ offices for the past decade. You could interpret it as a vote of no-confidence in EMR vendor abilities to develop these web-based collaboration and care coordination tools.  It’s at least a strong expression of “we’re not going to wait around to see whether you can extend your existing EMRs with these types of capabilities”.

…and it’s a strong validation for the technologies and business models of emerging, innovative companies enabling EHR 2.0 capabilities, e.g., RMD Networks, Shared Health.

What are some other possible implications?

Continue reading “Stunning Announcement: AMA Goes to the Dogs in Deal With Physician Web Portal Company”

#2 in a series — Modifications to HIPAA Privacy Laws: Impact on Microsoft HealthVault, Google Health, and other PHRs. 

by Deven McGraw JD, MPH, Center for Democracy & Technology

Introduction

There has been considerable discussion lately about whether or not the stimulus legislation (ARRA) extends HIPAA coverage to commercial vendors of personal health records (PHRs) any time they contract with entities already covered by HIPAA like hospitals, health plans or physicians groups.  (For those of you who don’t know, HIPAA is the Health Insurance Portability and Accountability Act of 1996.  The HIPAA privacy and security regulations form our national health privacy and security rules.)

The provision in question (Section 13408) states that “each vendor that contracts with a covered entity to allow that covered entity to offer a personal health record to patients as part of its electronic health record” is required to enter into a business associate agreement with the covered entity.   Under ARRA, business associates must comply with key provisions of the HIPAA privacy and security regulations. 

In this post, I argue that PHR vendors should be covered under HIPAA only under certain circumstances.  PHRs should be governed by a comprehensive framework of privacy and security protections, but HIPAA would provide inadequate privacy protection for people using these tools (at least as the HIPAA rules are currently structured).  As a result, I argue that this provision in ARRA should not be read to require the automatic application of HIPAA to PHR vendors any time they contract with covered entities to offer a PHR.   Instead, I suggest that HIPAA should cover a PHR vendor’s activities when the nature of the relationship between the vendor and the covered entity (hospital, health plan, physician office) primarily concerns the vendor performing a service for the covered entity. 

However, where the contractual relationship is primarily about improving the value of the PHR to the consumer, HIPAA should not apply.  (I know, not an easy line to draw – but I do suggest some factors that should influence the decision.) 

Finally, I urge the prompt adoption of separate, targeted privacy provisions to protect consumers using PHRs so that the choice is not HIPAA or limited protections under other federal laws. 

Why Not HIPAA – Isn’t it Better Than Nothing? Continue reading “Privacy Law Showdown? Legal and Policy Analysis.”