Below are two links to substantive accounts of the latest MU evolution. The first, released yesterday, is an explication by HHS National HIT Coordinator Dr. D. Blumenthal & CMS deputy administrator M. Tavenner. Given tables summarize new Core and Menu Set objectives.

The second link takes you to HISTalk’s Inga, who had by early morning today, compiled a straight-forward contrast, sort of a “then-and-now,” as regards MU after yesterday’s announcement by HHS.

You’ve probably spent the last 24 hours squinting at as many websites & sources as we have. Trying to keep you up-to-date while avoiding information overload & repetition, the blogmasters extend what we’d like to call a representative sample of our latest research done for you by our agents in the field.

Meaningful Use Regulation for EHR

Inga's Comparison

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.

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

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

Will tonight’s State of the Union recharge the fight to reform healthcare?

“Congressional leaders are taking healthcare legislation off the fast track as rank-and-file Democrats, wary of unhappy midterm election voters, look to President Barack Obama for guidance in his State of the Union address.

House and Senate leaders said Tuesday they need time to determine the best way forward on healthcare in the wake of last week's special election loss in Massachusetts, which cost Democrats their filibuster-proof Senate majority”…read more on ModernHealthcare.com.

Will lawmakers come together to finally finish the job?