HITECH and its effect on HIT

An interesting article on how HITECH has its own set of unintended consequences. In this case, the government can "screw things up" by forcing providers into acquiring HIT systems at a such a fast rate (less than 24 months), that they end up buying " certified" systems by large vendors. The result being they end up with systems that are less innovative with poor usability. This is a sure way to stiffle HIT innovation and destroy entrepreneurship. And then we wonder why HIT systems are so primitive compared with systems in other industries. Remember, Meditech introduced the ability to point-and-click by a mouse only within the last 5-7 years. This article does a great job in explaining this:

Mapping Lab terminologies

There can be anywhere from 5000 to 15,000 labs code at a given institution. The task of mapping these codes to a standard code set to another institutions codes for the purposes of use in Health Information Exchanges, EHRs for trending lab results can be daunting.

This task cannot be done by someone who understands just the bits and bytes. Considerable domain knowledge is required in order to this efficiently as well as accurately. It is common knowledge within this domain that far fewer than the 5000-15,000 codes account for the vast majority of the commonly ordered tests. And among this subset of commonly ordered, a smaller number of codes are actually important for the purposes of trending.

For example, in the in patient setting, each morning during review of patients lab during rounds, the most commonly trended lab observations are the lab elements contained within the "Comprehensive and Basic Metabolic" profiles, and the CBC. The CPK and ESR rates are trended, but usually for a limited time duration within a patients hospital stay. Test such as the Rheumatoid Factor or ANA on the other hand do not typically require a trended analysis for clinical decision making.

This paper by Daniel Vreeman et al (Regenstrief Institute, Inc. and Indiana University, Indianapolis, IN) makes the following conclusion:

"Given limited mapping resources, our findings support the strategy of focusing the effort on the small subset of observations that account for the majority of volume. Mapping the observation codes that cover 99% of the reported results would ensure that all of the results for more than 99% of patients would be mapped. Mapping even the few (49 to 68) observation codes accounting for 80% of reported results would cover all results for 91–98%
of patients."

Also see: Automated Mapping of Observation Codes Using Extensional Definitions

Hospital 30 day Re-Admission Rate now reported by CMS

The CMS website will now report on hospital's 30 day re-admission rates along with mortality data. Read more here. These measures are felt to be an indication of a hospital's quality of care. Hospitals will need to find ways to minimize repadmissions while at the same time, keeping lengths of stay low. This means, the post-hospitalization phase needs to be managed effectively, employing technologies such as telemedicine and remote monitoring.

Nursing Home Telemedcine

There has been considerable work in this field for a number of years. Lack of payer reimbursement, especially Medicare, has hindered the growth of nursing home telemedicine, preventing it from being a self-sustaining service. As a result, most applications have been grant funded. Medicare is now reimbursing this service for rural communities , and there is a bill in congress which would expand coverage to the entire country without regard to rural designation status.

I have listed below, links documenting the development of telemedicine in nursing homes:

Employing a Wireless Mobile Solution to Bring
Telemedicine to the Nursing Home Bedside

12/14/2008: Medicare will now pay for nursing home patients to be treated by telemedicine

University of Iowa Hospitals and Clinics, Family Medicine Department: Nursing home telehealth system

Dan Gunderson, Minnesota Public Radio

December 12, 2008 : Medicare will start paying for telemedicine

April 7, 2003: West Texas Rural Nursing Home Telemedicine Network Project-planned

“Direct Telemedicine in a Nursing Home Setting” Rationale – Innovation - Feasibility. Louis Lareng, Monique Savoldelli, Pierre Rumeau

Nursing Home Telemedicine- our latest presentation

See www.clinicore.com

Massachusetts Healthcare/IT related Bills

Massachusetts Healthcare/IT related Bills:


An Act to Promote a Statewide System for Chronic Care Management to Improve Health Care Quality and Contain Costs

Documents & Status: Text of Senate 1279 | Status

If Massachusetts is to contain costs of Medicaid and of the new Health Care Access Reform law without sacrificing quality of care, improved management of individuals with chronic health conditions is essential. The best management of chronic care relies on linkage with technology systems. This bill would establish a statewide strategy for chronic care management. Such a strategy would use the eHealth initiative to develop a chronic care infrastructure, prevention of chronic conditions, and chronic care management program. It would also establish the Chronic Care Management Program in the Executive office of Health and Human Services to promote collaborative strategies for managing chronic diseases among health care professionals and insurers.

See text of the Bill.

Telemedicine Studies

Telemedicine via video conferencing is comparable to face-to-face doctor-patient encounters:

Study finds virtual doctor visits satisfactory for both patients and clinicians, May 2009 issue of the Journal of Telemedicine and Telecare
"There is growing evidence that the use of videoconferencing in the medical environment is useful for a variety of acute and chronic issues," says Ronald F. Dixon, MD, an internist at Massachusetts General Hospital
"Videoconferencing between a provider and patients allows for the evaluation of many issues that may not require an office visit and can be achieved in a shorter time."