Not one Republican voted for it, neither did 34 Democrats. But, with 219 “Yea’s” the rest of the sitting Democrats in the House passed a revolutionary Healthcare Bill that President Obama signed into law on Tuesday.

The primary goal of this bill is to extend healthcare coverage to the 32 million Americans who are currently uninsured, but what’s next? We’ve been hearing about “healthcare reform” since July…wait since Clinton, Carter, Nixon, Johnson…Roosevelt** (Teddy) was in office! Well, according to Politico, Congress needs to sell their actions to Americans and that process is already in motion. In the coming weeks we should start seeing advertisements lauding the good that this bill will accomplish, and (as I’m sure you all know) spots that will decry the horrors soon to befall us.

So, now that it’s signed all Americans are insured, right?? Well, not yet. There were TWO bills that passed simultaneously in the House. HR 3590: the original Patient Protection and Affordable Care Act and HR 4872: the Reconciliation Act of 2010. The reconciliation bill swings back into Senate and they must pass a package that resolves the differences in the House and Senate bills. (In the Senate, Republicans have warned that they will use every means necessary to stall and block the passage of this bill, but their gusto is fading (read about it on The Hill).) Once it is passed in the Senate HR 4872 bill will go in front of the President, and there is little doubt he will sign it into law. As for the original and much lauded HR 3590, President Obama signed it into law stating, “After a century of striving, after a year of debate, after a historic vote, health-care reform is no longer an unmet promise. It is the law of the land.”

Let’s back up a moment… reconciliation—what? I thought BOTH Houses passed “healthcare reform” last year? They did, but here’s the deal.

HR 3590 generally referred to as “Healthcare Reform” was passed by the House on 10/08/09 and the Senate on 12/24/09, they passed two different versions of the same bill though. So, on 03/17/10 HR 4872 was introduced to reconcile the two healthcare bills and yesterday it was passed with the original sending the reconciliation back to the Senate for a final vote and the original to the President’s desk.

It’s still a bit convoluted to me, so if you have additional insights let me know. Please comment with your thoughts!

More Reading:

WSJ’s “Obama Signs Landmark Health Bill”

LexisNexis “How a Bill becomes a Law” (interactive)

PolitiFacts “Top 5 Lies about Healthcare”

Tracking HR 3590 & 4872

*Updated with further and corrected information.

**Not a comprehensive list of all of our Presidents who have called for healthcare reform.

We’ve mention on this blog before how much money could be saved if doctors didn’t have to practice defensive medicine and on the trials of medical malpractice. But, beyond cost saving and healthcare reform there is a human face associated with medical errors. The price of a mistake made by a doctor or nurse goes deeper than a million dollar settlement, not only for the patient and their family, but for the person who made the mistake as well. Today’s Wall Street Journal has an excellent article about adapting a hospital’s culture to not only prevent errors, but to treat clinicians fairly when something does go wrong.

Hospitals are taking what might seem like a surprising approach to confronting [medical errors]: Not only are they trying to improve safety and reduce malpractice           claims, they’re also coming up with procedures for handling-and even consoling-staffers who make inadvertent mistake…”We know punishing human error does not improve safety,” says St. Mary’s Dr. Byrne. “But we have to separate unavoidable error from reckless behavior and unjustifiable risk.”                                                     “The Informed Patient: New Focus on Averting Errors: Hospital Culture”

The article focuses on David Marx who founded a community, Just Culture, which promotes the development of “open, fair, and just cultures that are supportive of system safety by facilitating open communication within the organization, while working within a system of accountability that supports safe behavioral choices among staff.”

While the world is focusing on healthcare reform for a variety of reasons including providing healthcare to those who can’t afford it, we shouldn’t lose sight of the other encompassing problems in the system. When patient safety isn’t a priority it affects more than just the patient.

Another popular discussion point at HIMSS2010 is the intrinsic need for workflow change when practices move to an EMR. Simply installing a new solution will not necessarily fix process issues and inefficiency. As our brand new EVP of Sales stated “EMR is, and should be, more than just a pretty screen.”

You are introducing a new element that must change the way you work. For instance the process of a nurse putting a folder on an exam room door, to notify the doctor that a patient is ready (sometimes accompanied by a little green flag on the door frame), will be unnecessary and redundant. The number of these processes and workflows that need to be reviewed, and adjusted accordingly, will greatly depend on each practice’s current state of documentation, but everything should be evaluated.

This massive evaluation isn’t in vain, every change should be an improvement and every improvement, great or small, will have a ripple effect that at the end of the day will improve patient care and patient safety. Ultimately, that is the overriding goal. (Oh, and cost savings…but that’s understood, right?)

More Reading:

www.emrandhipaa.com (don’t miss the comments here)

"Workflow of the Workflow"

Dr. Greiver: Workflow is King

By: Bill W. Childs

I had the honor of meeting with David Blumenthal at HIMSS last week along with selected CIO’s, physicians, and vendor representatives. Our discussions centered on the costs and benefits of the ARRA and Meaningful Use criteria.

My Concerns:

1. Time lines for ARRA, Meaningful Use, HIPAA 5010, and ICD-10 are too tight. Some providers (with anywhere from one to ten facilities)who have been working on these efforts for years, can easily reach meaningful use criteria. However, there are many large and small providers who will not be able to meet the time lines as established.  “Too many guidelines; too little time”.
2. The cost of these efforts is beyond the ability for 80% of providers. It will take a great deal to implement and prove the needed requirements to reach meaningful use and history shows that it will cost much more than most people expect.
3. There is not enough industry experienced talent to get these projects implemented. As an industry observer for more than 30 years, I can already see providers hiring bodies that are not talented enough to get the job done. Implementing these systems is a very difficult task, and many of the most talented are already on the assignment.

My Peers' Concerns (in addition to those listed above):

1. The board and “C” suite lack of understanding the full impact of the effort (time, cost, talent, change, security, and interactions with entities not under their control).
2. The cost of sustaining these Herculean efforts.
3. The cost and effort to report to all of the new agencies and on all of the new data requirements.

My session with Blumenthal was enlightening. Not only were some of my concerns confirmed, but I was also made aware of other aspects to be apprehensive about.  Here is one silver lining though: The effort and direction is a good thing. HIT, if built properly, implemented properly, and maintained the right way with updates as necessary, is the only technology introduced to healthcare delivery systems that has the potential to reduce costs and eliminate errors, thus improving quality.

What are your major concerns? What efforts and ideas would you like to applaud? 

HIMSS wrapped up today and as a recap I thought I’d post some interesting conversation topics. First up is a conversation with some good folks at Henry Mayo Newhall Memorial Hospital (HMNMH).

How important is it to have a Physician Champion for your EMR projects? According to the two doctors and the Physician Project Manager from HMNMH, there was no doubt that it’s essential. I gleaned from that conversation that one of the overriding concerns of doctors, who have yet to adopt a certified EMR, is that many don’t want to change a system they are already comfortable with. Those doctors need a colleague who have seen the benefits of an EMR; an expert who can optimize the project, provide education, champion the project, mentor staff, and generally be a guide who garners support.  A role that was once defined simply as a “subject matter expert” has evolved into a position of critical importance integral to the success of ERM adoption.

This is no longer a one-way street with the IT department handing down process changes and the Champion promoting them, a good Physician Champion is involved in the entire redesign of processes and workflows, ensuring that changes align with how a clinician thinks and works. (Digitized Medicine).  The goal is to use the Physician Champion’s expertise to structure the project and optimize the way the EMR is used. From structured document templates to order sets and support tools, the Champion is a key player in strategic decision making. Selecting and installing an EMR is just one half of the battle. Participating doctors need to be on board and ready to use their newly adopted systems. A Physician Champion can rally the support needed to bring the whole thing full circle on the Information Superhighway (you know that speedway we were warned about?).

Projects that do not commence with a Physician Champion can experience problems on a variety of levels resulting from a lack of insight and general usage. A Champion is the person who can make a new EMR implementation a win-win for doctors, patients, and IT administrators (maybe a win-win-win?).

Stay tuned for more conversations from HIMSS.

More Reading:

The Healthcare Blog

EMR Selection: The Physician Champion

Are Physician IT Champions Necessary?