It has been a long time.

I've been very busy doing a lot of things. My newest job is to serve on a task force by the National Governors Association regarding sharing of medical information across state lines.   Sounds exciting?  I think it means more to you than you think.

In his latest post, Flea talks about the phenomenon of Retail-Based Clinics (RBC) that are reportedly sprouting up around the country. These clinics are located in retail stores, such as Wal-Mart and Walgreens(I don’t think it is limited to stores beginning with “Wal,” however), and are staffed by Nurse Practitioners. The promise is that for a fair price (in the $50 range), you can be seen quickly (within 20 minutes) and have your problem taken care of. This gives the added bonus for those stores that the patients will be walking around the store while they wait to be seen as well as being far more likely to use their pharmacy after the visit.

Those conspirators...err...people at CCHIT have approved of more EMRs.

The Certification Commission for Healthcare Information Technology approved 11
of the 17 ambulatory electronic health record products submitted in the latest
round of testing, Health IT Strategist reports. A total of 33
products now have received certification.

To be certified, ambulatory
EHR products must meet all of the more than 200 criteria for functionality,
security and interoperability. Vendors also must pay a $28,000 application fee.

The following new products received CCHIT certification:

Here is an interesting article/broadcast from ABC News (emphasis mine):

SALT LAKE CITY, Oct. 17, 2006 — To understand the lack of quality in our health care system, it helps to compare hospitals to airplanes. Air travel is remarkably safe because every pilot, mechanic and controller follows a specific checklist before takeoff. But while pilots rely on rules, protocol and universal wisdom, doctors do not.

ABC News and USA Today offer solutions to the health care problems in America during our weeklong series "Prescription for Change." Watch for special reports all week on "Good Morning America," "World News" and "Nightline."

I have written in the past that the current market is much like the automobile industry was in the early 1900’s. There were many different designs, looks, and ideas where the future of the automobile was. Some cars ran on gasoline, some on organic materials, some on steam. Some cars had steering wheels and others had levers. Eventually a dominant solution emerged and all cars became basically the same in design. This will eventually happen with EMR systems, but has not yet. As of now, you are to some extent hedging your bets when you by an EMR. You may end up with a Stanley Steamer (or Betamax, if you want a more current example). So, making the right decision on EMR can greatly affect your future.

I have been a strong advocate of EMR for a long time (having been on it for the past 10+ years).  Through this process, I have learned a good deal (more by error than by trial) about getting an EMR up and successful in a small practice.  The following are my thoughts for any physician thinking about getting up on an EMR.  How do you know if you are ready? 

Expectations are everything.  As you approach the task of changing
over an office from paper to electronic, it is very important to know
what you are getting into.  It is often the case that doctors hear that
it is a good idea to go to EMR, so they say “just do it” to their
office manager, not knowing exactly what that means.  It is crucial for there to be clear understanding on all levels of what this task will entail and what the benefits will be.  Not doing this will lead to frustration, finger pointing, and division.  So how do you set expectations properly?

What is the deal with physicians consistently attacking P4P?  Are they nuts?

In multiple posts on his blog, Kevin, MD, attacks P4P.  In general it seems there is more posts opposing P4P than in its defense, even among the primary care physicians.  This really surprises me.

The attack on P4P can be summarized as follows:

1. It will be a "break even" proposition, as they will lower the overall reimbursement and you will have to do P4P to keep your salary level.
2. Quality cannot be accurately or reliably measured.
3. It may increase cost of healthcare in general.
4. It has never been proven.

Now, I cannot debate the fact that these have to be concerns raised.  I repeat, I think they are legitimate concerns and should be addressed as P4P is pushed forward.  However, they do not negate the fact that our current system is not working (as costs are rising and quality remains low).  Attacks on P4P are not accompanied with any alternatives.

Recent Article: 

Legal issue arises over electronic patient files

South Florida Business Journal - September 8, 2006

by Brian Bandell

There's a federal push to digitize health care records, but experts are worried over allegations that a Boca Raton company cut some doctors' access to electronic patient files after they failed to pay fees.

It turns out there is no current law that would stop a software vendor from doing so, federal and state agency officials say. The laws that cover patient privacy and access to records apply to health care workers, not third-party vendors.

In a recent article in the NEJM entintled Primary care — Will it Survive?, the Thomas Bodenheimer discussed the various challenages facing primary care:

The American College of Physicians recently warned that “primary care, the backbone of the nation’s health care system, is at grave risk of collapse.”¹ And indeed, primary care is facing a confluence of factors that could spell disaster. Patients are increasingly dissatisfied with their care and with the difficulty of gaining timely access to a primary care physician; many primary care physicians, in turn, are unhappy with their jobs, as they face a seemingly insurmountable task; the quality of care is uneven; reimbursement is inadequate; and fewer and fewer U.S. medical students are choosing to enter the field.

From an article in Healthcare IT News:

SAN DIEGO – Thomas Mosher, MD, one of the 336 physicians who are part of the San Diego-based Sharp Rees-Stealy Medical Group is convinced that an electronic medical record system is essential for providing top care today.

 And, it’s the electronic record that has helped make Sharp Blue Cross’ top performing physician group for its scorecard achievements in 2005.

 Under the Blue Cross’ Quality Scorecard, program 178 participating physician groups throughout the state were paid an incentive amount totaling over $65 million for 2005.