The recently published PriceWaterhouseCoopers Health Research Institute report, Ready or Not: On the Road to the meaningful use of EHRs and health IT, has circulated through the blogmasters desk, and in our continuing effort to keep you informed, we’ve produced the following abstract…

After surveying 120 CIO’s and another handful of healthcare executives, the PwC report adds heft to the impact of the ARRA’s Meaningful Use (MU).

The report makes many keen assertions including:

• “Health systems will need to transform the way they deliver care, so they can sustain performance and grow revenue in the future.”
• Successfully achieving meaningful use “hinges on closer integration with key constituents” (physicians, health insurers, patients).
• Health systems that already have connected with physicians, patients, and health insurers around MU are “more likely to be applying for government incentives” than those that haven’t. But only half of respondents expected to apply for incentives in 2011. (By 2014, 90% expect to be applying).
• Health systems that have included patients in the planning are “more confident about meeting MU standards.”
• “Implementing MU can enhance hospital-physician alignment.”
• Most health systems are failing to connect with health insurers around MU.
• 80% of CIO’s are more than concerned about meeting MU requirements by deadlines. (An American Hospital Association survey reports that 55% of hospitals expect to incur penalties.)
• “The benefits of achieving MU outweigh the challenges.” Those benefits include improve healthcare quality, disease management, coordination of care, improved alignment with physicians, increased productivity, market advantage, and improved alignment with payers.

But PwC identified four barriers to attaining MU: Lack of MU standards clarity, shortage of skilled IT staff, vendor readiness, limited capacity of existing infrastructure . . .

and proffered five benchmarks to achieve compliance: Establish governance, balance compliance against competing priorities, forge new public-private ventures, make the patient the purpose, collaborate with physicians and health insurers.

This isn’t anything new, but David Blumenthal recently said: “Certification is a critical piece to providing meaningful use for hospitals and physician practices to be eligible for Medicare and Medicaid incentives under ARRA.”

The new final rule for the temporary certification (you know this is all very technical) should be posted on June 24^th conveniently coinciding with the day that organizations can apply to become an Authorized Testing and Certification Body (ATCB). The ONC’s goal is to have the first EHRs certified by the fall therefore, the certifying entities must be operational by the fall…are you still with me? You can read more details on HealthData Management. In summary:

• ONC is not going to move back “year one” to 2012
• One organization can do both the lab testing and certification or two organizations can partner (and apply for ATCB) in that scenario one would test, the other certify
• ATCB’s must update the list of tested/certified products weekly. The list will be available via the ONC’s website
• Potential ATCB’s applications will be decided on within 30 days
• Of the projected five applicants CCHIT has confirmed that they will apply to be an ATCB

More Reading:

Newly Certified EHRs Expected this Fall

Federal Register

Kick in the Pants?

The winners of Premier Health Alliance’s quality award for excellence in patient care and operational efficiency were announced today and VCS would like to congratulate all 21 winners, but most especially our current and former clients including:

• Albert Einstein Medical Center of Philadelphia
• Beebe Medical Center of Lewes,  Del.
• Bon Secours Maryview Medical Center of Portsmouth, Va.
• Mercy Fitzgerald Hospital of Darby, Pa.
• Paoli Hospital, Main Line Health System of Paoli, Pa.
• SSM St. Mary's Health Center of St. Louis

Congratulations!

VCS representatives are headed to the Lone Star state for this year’s International MUSE Conference in Dallas. We’ll be in booth 719 all week handing out cowboy hats and taking pictures with one of America’s favorite country music stars (sorry…we could only get the cardboard version).

Look out for some wild pictures on our Facebook page soon!

Interested in what happens now with healthcare reform? All the fervor has died down and we’re on to the next top issue (Arizona anyone?), but when will we start see the effect... Well, on July 1^st of this year people who have been unable to get health insurance because of preexisting conditions will be able to purchase subsidized coverage via a national high risk pool. On September 23^rd insurers will be banned from dropping people if they develop an illness, the dependent coverage age will extend to 26, no child will be denied because of a preexisting condition, and there will be no annual or lifetime limits. For more details read this, but in 2014 the entire law should be phased in.

That’s a brief synopsis of what’s going to happen in the coming months as a directive straight from the Patient Care and Affordability Act, but what else is going to be indirectly affected? One thing I keep reading is about the number of physicians practicing medicine. It was hard enough to practice with CMS issues, malpractice concerns, and hospital struggles…will the new law make it better for physicians to practice medicine in this country? What about the HITECH push, how is that effecting doctors?

What do you think?

More Reading:

Glamour Answers Pressing Questions

An Employer's Guide to Healthcare Reform

I Have to Buy...or else.

That didn’t take long.

Legislation has been introduced to Congress that would repeal “Patient Protection and Affordable Care Act” sponsored by Rep. Michele Bachmann [R-MN6]. This is in addition to the 12 states suing over the reform bill and 18 states refusing to cover people now uninsured. Even CNN is posting an editorial mentioning that we shouldn’t drink the kool-aid.

How far do you think the repeal will get? When will “Main Street” (to borrow a term) start seeing the changes?

More Reading:

Voters support reform in CA

...so does Schwarzenegger.

Across the Pond: Healthcare & Politics in the UK

All of the economic talk that is so prevalent now and has been for the past two years has intersected with the healthcare reform debates in various ways, but one increasingly concerning event should be focused on. Hospitals are closing. The Wall Street Journal highlighted St. Vincent’s Hospital in NYC closing earlier this month. St. Vincent’s was the last Catholic acute-care center in New York City:

Patients and residents of the Greenwhich Village neighborhood said the closing…meant they would have to travel dozens of blocks on New York City’s congested streets to the nearest emergency room…Staff at other city hospitals, many already inundated with uninsured patients coming into their emergency rooms, were bracing for more people…Patient volume at Bellevue Hospital, a city trauma and acute care center, has jumped 13% in the past 30 days. (WSJ: Hospital Closing Stirs Fear)

The result of one hospital closing means increased ambulance ride times, increased demand for government funding for the remaining hospitals, increased hours for the staff.

What do you think it means for patient safety?

More Reading

NY Times: St. Vincent's

Google “Hospitals Closing”

EP Monthly

There is an implicit and global challenge facing HIE and impeding its success: patient identification. Hospital and ambulatory systems need a standard but unique way of identifying a patient outside of name/DOB/etc. or account number. The ability to accurately identify one patient among thousands, perhaps millions, many of whom share similar identifying data is a complex problem. Beyond existing similarities there exists human error. Juxtaposing numbers in a birth date, misspelling a name, nicknames, and a lack of standard entry procedures can all create massive problems when trying to find just one person in a huge system. And this is within one health system, its hospitals and ambulatory centers.

The key is a universally accepted Enterprise Master Person Index (EMPI). An EMPI is patient information and linking system designed to accurately identify individuals using common data elements such as health card number, medical record number, date of birth and other demographic information. (Lorraine Fernandes). The EMPI application identifies people in an integrated delivery network across disparate registration, scheduling, financial, and clinical systems. (AHIMA). This identifying system is the solution to the patient identification problem and essential to healthcare information exchange. In addition to allowing a smooth transition, EMPI also promotes and enhances patient safety. By utilizing this identification method healthcare providers can cut down on errors, duplications, missing information, and more.

In the most recent data we can find 40.65% of all hospitals are utilizing an EMPI and the percentages increase for academic hospitals, urban hospitals, and multi-hospital systems.

Is your EMPI working to solve the HIE dilemma?

More Reading:

Healthcare Technology: Partners EMPI

White Paper: EMPI Provides a Critical Foundation for Improving Access to Care

Patient Identification a Crucial Aspect of Patient Safety

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.